FRANCISCAN UNIVERSITY CENTER TECHNICAL COURSE OF NURSING

Compiled by: Prof.. Enf ª. Marin Alessandra Santini

Anatomic features of the female genital tract
Internal Organs:

Vagina Uterus Ovaries Fallopian Tube

External Genitalia (Vulva):

Little Big Lips Lip Mount of Venus Clitoris Hymen Urethral meatus
Internal Organs:
Vagina

It is a canal lined by mucous membrane, with 80-10 cm long, elastic walls, which
connects the cervix to the external genitalia.

The entrance to the vagina is protected by a circular membrane (the hymen), whic
h partially closes the hole vulva and vagina and is almost always drilled in the
center, which may take various forms. Generally, the membrane is broken in the
first sexual intercourse. The vagina is where the penis sperm deposited during s
exual intercourse. Besides enabling the penetration

Has either side of its opening, but internally, two glands called Bartholin's gl
ands (size of a bean that secretes lubricating mucus by a small duct into the va
gina).
Uterus
It is a pear-shaped structure, located within the basin.

It has about 7.5 cm long and 5 cm wide at the top.

Its walls are about 1.25 cm

It consists of several muscle layers that allow its expansion during pregnancy a
nd its contraction during labor. It has two parts: the cervix and the bottom or
body and is covered internally by a layer called the endometrium, where the fert
ilized egg attaches and develops. Each month the endometrium prepares for a poss
ible pregnancy,
Ovaries

Two structures are oval, about 3 cm long. Produce estrogen and progesterone, fem
ale sex hormones.

At birth, the girl has thousands of ovogônias lying within structures called fol
licles or Graafian follicles.

From adolescence, under the hormonal action, ovarian follicles begin to grow and
develop. The developing follicles secrete the hormone estrogen. Monthly, only o
ne follicle usually complete the development and maturation, breaking up and rel
easing the secondary oocyte (female gamete):

After his break, the resulting cell mass becomes the corpus luteum or yellow, wh
ich is to secrete the hormones progesterone and estrogen. The female gamete rele
ased to the surface of the ovaries is collected by thin ends of the fallopian tu
be (the fimbria). At the end of embryonic development of a girl, she already has
all the cells that will

Fallopian Tube

Are cylindrical structures, with one end with a conical shape.

The tubes collect the egg released from the ovary and allowing its transfer to t
he uterus. Inside the tube, the sperm find the egg and fertilize. The fertilized
ovum (egg now called) continues its path until it reaches the uterus.

External Genitalia (Vulva):

Big Lips
Are two folds of skin intensely irrigated tissue fibro-greasy, rich in sweat and
sebaceous glands. Extend laterally from the Mount of Venus across the slit and
round the vulva. Are covered with hair.

Little Lips

They are also two small folds of skin located between the labia and entrance to
the vagina. In its upper course, merge and involve the clitoris. They are compos
ed of elastic fibers and connective. They feature lots of sweat and sebaceous gl
ands.

Mount of Venus

Also called mons pubis. It is an elevation in the uppermost portion of the vulva
, composed of fat covering the pubic bone in order to lessen the impact during i
ntercourse. It is covered with hair.

Clitoris

It is a small structure, similar to the penis and is also endowed with the abili
ty to swell due to sexual excitement. It is an organ endowed with extensive inne
rvation.

Hymen

It is a membrane that closes the entrance of the vagina. Even in virgin women pr
esents a central hole that allows the output of the menstrual flow.

At the time of first sexual intercourse, the hymen is broken and atrophies. Howe
ver, in some cases, their constitution may be so elastic that can allow the pass
age of the penis without breaking. This case is called Hymen compliant.

Urethral meatus
It is located between the labia minora, clitoris and between the vaginal orifice
. It is the external opening of the female urethra with about 3 inches long.

DISEASES OF THE FEMALE GENITAL APPARATUS

Ovarian Cyst:

It is a type of ovarian cancer can be benign or malignant. The most common cyst
is known as functional that appears during the process of ovulation (irregular h
ormone).

Types of Cysts: Functional: They are most common. Form during the process of ovu
lation when the woman produces tiny lumps that must be expelled in menstruation.
When they are not expelled, they form cysts. Tend to decline naturally. Serous:
secrete a clear fluid. This type does not regress. In contrast, tends to grow.
Teratoma: They have inside sebum, hair and even teeth. Are formed by embryonic c
ells that have multiplied in place undue. Cells are nonspecific and determine se
veral characteristics simultaneously. Endometriotic: They consist of cells of th
e endometrium (the layer formed during the monthly reproductive cycle and is exp
elled). The interior features a bloodstained fluid. Malignant: Are ovarian tumor
s and occur in about 1% of women after 50 years.

Causes: Not known; Genetic; indefinite multiplication of cells of the superficia

l layer of the ovary (epithelium). Differentiated embryonic cells appear to orig
inate in part from eggs that disappear with maturation. Size: The size varies an
d may be the size of pea is a grain, size of an orange and even a watermelon.

Symptoms:

Irregular menstruation; Heaviness; abdominal edema, progressing to ascites in ab

dominal organ compression rectum and bladder edema MSIS; acute abdominal pain or
chronic lower lumbar pain, weight loss (case of malignant cyst).
Treatment will depend on the size and type of cyst by ultrasonography.

Puncture (the fluid is taken from inside the cyst) Surgery (Oophorectomy) Hormon
al: contraceptives (treatment and prevention)
Nursing: Preoperative: pre Administer anesthetics CPM. Health and perineal s
having. Postoperative: Perform observing curative aspect. Investigate weight
loss.
Uterine fibroids:
Concept:
They are benign tumors that grow in the muscle tissue of the uterus. They may be
single or multiple.

Types of fibroids: Submucous: It is the most important type of myoma, affects th

e endometrial cavity and causes major cramping and bleeding. Intramural: When th
e fibroid is in the intramural portion of the uterus. Shows no tendency to bleed
ing. Subceroso: These are tumors on the outer surface of the uterus. Can become
very large and produce a minimal symptomatology.
Incidence:

Are very common, occurring in about 20% of white women and 4% to 50% of black wo
men. Develop slowly between ages 25-40 years and almost always reach large sizes
after this period.

Symptoms:

Sometimes they do not cause symptoms, menorrhagia, back pain, constipation, pain
due to compression of neighboring organs; often cause menorrhagia and infertili
ty.
Treatment:

As the tumor is hormone dependent, it decreases with menopause. Contraceptive us

e reduces the risk of fibroids in 17% for each 5 years of use. Surgical: depends
on size and location (hysterectomy, myomectomy).
Submucous myoma
Concept:

Cervicitis:

It is the inflammation of the mucous glands of the neck. May occur after abortio
ns, intrauterine manipulation or childbirth a condition which if untreated can s
pread to the uterus, fallopian tubes and pelvic cavity. The inflammation can cau
se erosion of the cervical tissue resulting in bleeding and stains.
Causing Agents:

Streptococcus, staphylococcus, gonococcus, Treponema.

Signs and Symptoms:

Flow genital (leukorrhea may be yellow or white), abdominal pain or sacred; Metr
orrhagia; urinary disorders.

Treatment: ATB Cautery (cases of wounds) Nursing: Advise the patient to the medi
cal and preventive treatment. Use of drugs and condoms correctly.

Definition: inflammation of the vagina is almost always the result of bacterial

infection or parasite. The vagina is protected by its acidic pH (3.5 to 4.5) and
the hormone estrogen, which induces the formation of glycogen which breaks down
into lactic acid.
Vaginitis:

Causes: Sexual intercourse with infected partner; Precarious hygiene Clothes fai
r; Diabetes. Signs and Symptoms: Vaginal discharge type milky-looking clabber by
desquamation of epithelial cells. Perineum angry with burning micturition.

Types of Vaginitis:

Nonspecific Vaginitis vaginitis by Candida albicans Vaginitis Gardnerella

Nonspecific vaginitis:

Occurs when there is an imbalance of vaginal flora. It can be caused by bacteria

or fungi that proliferate in the vagina.

Symptoms: Leucorrhoea Pruritus Erythema Edema Burns Symptoms are agg

ravated by urination and defecation.
Vaginitis by Candida albicans:
It is a fungal infection (candidiasis). Information is disseminated through towe
ls, clothes and contaminated instruments. The microorganisms grow readily in dam
p environments and with a pH above 5. It is found in patients with diabetes mell
itus or in patients who overuse of antibiotics.

Symptoms: white as curdled milk flow and formation of pseudomembranes bleeding t

o withdraw it; The rash is more vulvar and symptoms are more severe before menst
ruation. Treatment: Metronidazole and avoid sexual intercourse (condom use) Douc
he daily

Gardnerella vaginalis vaginitis:

The Gardnerella vaginalis is a bacterium that is part of the normal vaginal flor
a of 20% to 80% of sexually active women. When by an imbalance of flora, there i
s a predominance of this bacterium causes vaginitis.

Symptoms: Vaginal odor intensity (after intercourse with the presence of sperm i
n the vaginal environment usually occurs the release of odor similar to "rotten
fish") Leucorrhoea gray and white amber. In man cause urethritis, inflammation o
f the glans and foreskin) Treatment: According to medical management. The partne
r must also adhere to treatment.

Nursing:

Avoid contact with secretions from the patient, administer medication COM; Condu
ct thorough hygiene in the perineum;
Infection with Herpes Virus Type 2:
(Genital herpes, herpes simplex) Definition:

Viral infection that causes sores on the cervix, vagina and external genitalia.,
It is an STD, but can be transmitted asexually, by autotransmissão (touching th
e lesion and genital area).
Symptoms:

Itching, pain, swelling, redness, blisters, ulcers and crust; Malaise; Dysuria.

The initial infection is very painful and lasts about a week. Recurrences are us
ually less painful and produce less intense itching and burning. Symptoms may re
cur with stress, sunburn, inadequate nutrition. Treatment: There is no cure, onl
y relief of symptoms. Zovirax (acyclovir).

Nursing:

Prevent the spread of infection; Giving comfort to the patient, reduce the poten
tial health risks and initiate a program of counseling and education; Use of app
ropriate medication and route (acyclovir-topical, oral and IV).
Endometriosis:

Concept: a benign lesion of the cells lining the womb, growing at an aberrant pe
lvic cavity outside the uterus. In order of frequency attacks the ovaries, ligam
ents, fund sac, peritoneum, the outer surface of the uterus, umbilicus, bags and
herniated appendix. When the uterus goes through the process of menstruation, t
his ectopic tissue bleeds also in areas that have no outlet, causing pain and gr
ip. These lesions are small, pleated and brown or blackish blue.

Clinical Manifestations:

Depends on the location of endometrial tissue. Dysmenorrhea, Pain deep inside th

e abdomen, vagina, posterior pelvis and back one or two days before the menstrua
l period, uterine bleeding, dyspareunia.

Diagnosis: Anamnesis; Laparoscopy. Treatment depends on the nature of the sympto

m. Desire for pregnancy and disease extension, administration of hormones; Surge
ry.

Nursing:
Relief of pain, dysmenorrhea, dyspareunia and prevention of infertility; explana
tion of the various diagnostic procedures, emotional support.
Bartholinitis:

Concept: It is the blockage of the duct Bartholin's glands (lubricate the vagina
l canal) by the inflammatory process, forming an accumulation of secretion, givi
ng rise to a cyst. Symptoms: Throbbing vaginal pain, general discomfort, dyspare
unia (pain during intercourse), edema in the labia, swelling.

Causing Agents: gonococci, staphylococcus, Escherichia coli. Nursing Care: Bathi

ng accent for relieving discomfort; Home; Administer medications COM; rigorous v
ulvo-perineal hygiene.

Prolapsed Uterus:

Concept: It is the descent of the uterus into the vaginal canal may appear out o
f the vaginal orifice. Symptoms: Blood and urinary incontinence or retention by
the displacement of the bladder.

Causes:

Occurs due to weakness and laxity of the muscular structures,€more frequent in m

ultiparous women and patients with advanced age, and obstetric trauma. The probl
ems are compounded when women cough, weight lift or stand for a long time.
Classification of Degrees: a degree: the cervix is below its normal level, but
remains within the vagina; 2nd degree: the cervix is down and highlight the v
aginal opening; 3rd degree: the cervix and body of the uterus are externalized
.

Treatment: Vaginal hysterectomy combined with anterior and posterior repair (the
uterus is sutured back into place and repaired by reinforcing the muscle strip.
) Nursing Care: Guidance for perineal exercises to strengthen pelvic muscles. Ta
rgeting seek medical attention when it detects any suspicious symptoms. Use of p
essaries.
Cystocele:

Concept: It is a shift down of the bladder toward the vaginal orifice.

Causes:

Weakening of the tissues; genital atrophy with age, damage received during child
birth.
Symptoms:

Feeling of pelvic pressure, fatigue easily; Frequent symptoms like urinary incon
tinence, increased urinary frequency and urgency, pain in the back and pelvis.
Treatment: Surgical: colporrafia previous correction of the anterior wall of t
he vagina. perineal exercises are effective in the early stages. Care Nursing:
(ditto the prolapsed uterus) Orientation perineal exercises to strengthen pel
vic muscles. Targeting seek medical attention when it detects any suspicious s
ymptoms. Use of pessaries.
Enterocele:

It is the herniation of the small intestine by a defect in the peritoneum that p

uts you in direct contact with vaginal mucosa.