NCM 109-CARE OF MOTHER AND

CHILD AT RISK OR WITH PROBLEMS

(ACUTE AND CHRONIC)

GYNECOLOGIC NURSING

JEAN N. GUILLASPER, PH.D.,RN

CON INSTRUCTOR
 ANATOMY RECALL
FEMALE REPRODUCTIVE SYSTEM:
EXTERNAL STRUCTURES ( VULVA/ PUDENDUM)
A. MONS PUBIS OR MONS VENERIS
= PAD OF FAT OVER THE SYMPHYSIS PUBIS. HAIRLESS
& SMOOTH IN CHILDHOOD, IT IS COVERED BY DARK &
CURLY HAIR CALLED ESCUTCHEON AFTER PUBERTY. HAIR
PATTERN IS TRIANGULAR WITH BASE UP.
B. LABIA MAJORA
= LENGTHWISE, TWO THICK FOLDS OF FATTY SKIN
EXTENDING FROM THE MONS TO THE PERINEUM THAT
PROTECTS THE LABIA MINORA, URINARY MEATUS AND
VAGINAL MUCOSA.
The Female Pelvic Organ
C. LABIA MINORA
= THINNER, LENGTHWISE FOLDS OF
HAIRLESS SKIN, ENCIRCLING THE CLITORIS
ANTERIORLY (PREPUCE) AND UNITE
POSTERIORLY ( FOURCHETTE) .BELOW THE
PREPUCE IS CALLED FRENULUM. HIGHLY
SENSITIVE TO MANIPULATION AND TRAUMA,
THE REASON WHY IT IS OFTEN TORN DURING
DELIVERY.
D. VESTIBULE
= TRIANGULAR SPACE LOCATED BETWEEN
THE LABIA MINORA CONTAINING VAGINAL
INTROITUS, URETHRAL MEATUS BARTHOLIN’S
& SKENE’S GLANDS
E. GLANS CLITORIS
= SMALL ERECTILE STRUCTURE; CONTAINS
NERVE ENDINGS, SENSITIVE TO
TEMPERATURE AND TOUCH. IT IS THE SEAT OF
SEXUAL AROUSAL AND EXCITEMENT IN
FEMALES. IT IS THE MOST SENSITIVE PART OF
A WOMAN’S BODY. IT IS ALSO THE
STRUCTURE THAT GUIDES THE NURSE TO THE
URINARY MEATUS.
F. URETHRAL MEATUS
= THE EXTERNAL OPENING OF THE URETHRA.
SLIGHTLY BEHIND AND TO THE SIDE ARE THE
OPENINGS OF THE SKENE’S GLANDS
(PARAURETHRAL GLANDS); THE SECRETIONS
OF WHICH HELP TO LUBRICATE THE EXTERNAL
GENITALIA. THE SHORTNESS OF THE FEMALE
URETHRA MAKES WOMEN MORE SUSCEPTIBLE
TO UTI THAN MEN.

G. HYMEN .
= A TOUGH BUT ELASTIC SEMICIRCLE OF
TISSUE THAT COVERS THE OPENING TO THE
VAGINA. THE REMNANT OF HYMEN IS CALLED
CARUNCULAE MYRTIFORMIS.
 Imperforate hymen:
 Lack of opening in the vaginal hymen
 No menstrual bleeding
 Enlarged uterus
 S/S
 Amenorrhoea
 Cryptomenorrhea -A condition where menstrual
products are prevented from exiting the body by a
partial or complete obstruction.
 Dyspareunia
 Female infertility
 Haematocolpos- An accumulation of menstrual
blood in the vagina
 Haematometra -An accumulation of blood in the
uterus
 Hydrometrocolpos -accumulation of secretions in
the vagina and uterus
 TREATMENT
 Medical therapy has no role in the
management of imperforate hymen

 SURGICAL MANAGEMENT
 Hymen incision
H. VAGINAL ORIFICE / INTROITUS
= EXTERNAL OPENING OF THE VAGINA,
COVERED BY A THIN MEMBRANE ( HYMEN) IN
VIRGINS. LOCATED LATERAL TO THE VAGINAL
OPENING ON BOTH SIDES ARE THE
BARTHOLIN’S GLANDS (VULVOVAGINAL
GLANDS). IT LUBRICATES THE EXTERNAL VULVA
DURING COITUS AND THE ALKALINE PH OF
THEIR SECRETION HELPS TO IMPROVE SPERM
SURVIVAL IN THE VAGINA. THE GRAFENBERG
OR G-SPOT IS A VERY SENSITIVE AREA
LOCATED AT THE INNER ANTERIOR ASPECT OF
THE VAGINA.
I. FOURCHETTE
= THIN FOLD OF TISSUE FORMED BY
MERGING OF THE LABIA MAJORA AND
LABIA MINORA BELOW THE VAGINAL
ORIFICE.
J. PERINEUM
= MUSCULAR SKIN COVERED AREA
BETWEEN VAGINAL OPENING AND ANUS.
 INTERNAL STRUCTURES:
A.VAGINA
HOLLOW MEMBRANOUS & MUSCULAR CANAL,
3-4 INCHES LONG,DILATABLE, CONTAINS
RUGAE (WHICH PERMITS CONSIDERABLE
STRETCHING WITHOUT TEARING).IT IS
LOCATED IN FRONT OF THE RECTUM &
BEHIND THE BLADDER.
= PASSAGEWAY OF MENSTRUATION
= PASSAGEWAY OF FETUS
= ORGAN OF COPULATION
= SEMEN DEPOSITORY
** DODERLIEN’S BACILLUS MAINTAINS THE
NORMAL FLORA OF THE VAGINA, WHICH MAKES
THE pH OF VAGINA ACIDIC, DETRIMENTAL TO
THE GROWTH OF PATHOLOGIC BACTERIA.
 VAGINA

 Functions:
 Organ of copulation
 Discharges
menstrual flow
 Birth canal

pH 4-5 : acidic
 RUGAE – TRANSVERSE FOLDS OF SKIN IN
THE VAGINAL WALL THAT IS ABSENT IN
CHILDHOOD, APPEAR AFTER PUBERTY &
DISAPPEARS AT MENOPAUSE.
 FORNIX-FORNICES= THE CERVIX PROJECTS
TO THE VAGINA FORMING FOUR RECESSES
OR DEPRESSION AROUND ITS UPPER
PORTION CALLED FORNICES: ANTERIOR
FORNIX, LATERAL FORNICES, POSTERIOR
FORNIX.
 VAGINITIS

 inflammation of the vagina characterized by

an increased vaginal discharge containing
numerous WBCs

Causes:
 Douches
 Antibiotics
 Hormones
 Contraceptives (oral and topical)
 Change in sexual partners
 VAGINITIS
Signs and Symptoms:
 Itching
 Burning
 Pain
 Erythema
 Edema
 BARTHOLIN’S CYST
 occlusion of a duct with mucus retention resulting in a
nontender mass approx. 1-4cm in size

Causes
 if the duct becomes
blocked for any reason:
infection,
injury or chronic
inflammation
 Very rarely, caused by
cancer
 Unknown (many cases)
Causative organisms: Staphylococcus aureus
(others: Strep. fecalis, E. coli, N. gonorrhea, )

Symptoms:
 Bartholyn’s Cyst (asymptomatic)
 Bartholin’s Abscess - pain or tenderness, dyspareunia

Diagnosis
 clinical

Management
 incision and drainage
 marsupialization – entire abscess is incised and sewn
open
 broad spectrum antibiotic
Nursing interventions
 Teach the importance of completing the course of
antibiotic
 Teach the importance of good hygiene
 Sitz bath – for both pain relief and to decrease
healing time
 CONGENITAL ABSENCE OF THE
VAGINA

 The usual lesion consists:

 absence of the middle and upper vagina,
 total absence or a rudiment in the location of the
uterus,
 an absence or one or both Fallopian tubes.
 The vagina may be totally absent, or
represented by a rudimentary pouch of up to
one half to three quarters of an inch deep.
Vaginal agenesis
 CONGENITAL ABSENCE OF THE
VAGINA
 is a rare anomaly, 1: 5000 birth
 Known also as aplasia or dysplasia of the
Müllerian (paramesonephric) ducts.
 Referred to as ROKITANSKY-KUSTER-
HAUSER SYNDROME
 The external genitalia and vestibule, deriving
from the urogenital sinus, are normal.
 The sex chromatin pattern is female.
 endocrine system is not affected.
 Ovarian function is normal
 CONGENITAL ABSENCE OF
THE VAGINA
 Cause :
UNKNOWN
 no known gene is linked to this condition.
 MANIFESTATION
 Primary amenorrhea and cyclic abdominal pain
 Infertility
 Inability to have intercourse
 Associated with renal malformation
 There are associated renal and vertebral anomalies (e.g.,
fused or solitary pelvic kidney, spina bifida).
 PHYSICAL FINDING
 Normal secondary female sexual characteristics are
present after puberty.
 Height is normal.
 Speculum examination of the vagina may be impossible
or difficult because of the degree of vaginal agenesis.
 The vulva, labia majora, labia minora, and clitoris are
normal.
 A palpable sling of tissue may be present at the level of
the peritoneal reflection.
 Diagnostic:
 Imaging studies
 UTZ
 MRI
 Laparoscopy provides only indirect assessment
of uterine cavitation.
 Laparoscopy is the preferred procedure when
uterine remnants or endometriosis cause cyclic
pelvic pain requiring excision.
 Pyelography: Perform intravenous pyelography
to assess renal structure.
 Radiography: Perform spinal radiography to
exclude vertebral anomalies
 Management
 Treatment : Surgical
 Vaginal reconstruction
 modified McIndoe vaginoplasty
 Prognosis:
 The patient may have normal sexual functioning
after surgical reconstruction.
 Surgical reconstruction does not establish the
ability to conceive through natural means.
Modified McIndoe Vaginoplasty
** DODERLIEN’S BACILLUS MAINTAINS THE
NORMAL FLORA OF THE VAGINA, WHICH MAKES
THE pH OF VAGINA ACIDIC, DETRIMENTAL TO
THE GROWTH OF PATHOLOGIC BACTERIA.

B. UTERUS
= HOLLOW, MUSCULAR PEAR SHAPED
ORGAN LOCATED IN THE PELVIS, WEIGHING 50-
60 g IN A NON-PREGNAT WOMAN. HELD IN
PLACE BY BROAD LIGAMENTS. ABUNDANT
BLOOD SUPPLY COMES FROM UTERINE AND
OVARIAN ARTERIES.