This week, as you continue exploring common gynecologic conditions, you consider diagnosis, treatment, and management strategies for patients. You also explore ways to educate patients on these conditions.

Learning Objectives – NURS 6551: Week 5: Case Study: Dysmenorrhea and Painful Intercourse

By the end of this week, students will:

• Assess patients with common gynecologic conditions
• Evaluate differential diagnoses for common gynecologic conditions
• Analyze treatment and management plans for patients with common gynecologic conditions
• Analyze strategies for educating patients on the treatment and management of common gynecologic conditions
• Understand and apply key terms, principles, and concepts related to common gynecologic conditions
• Evaluate common gynecologic conditions in patients
• Analyze treatment modalities for common gynecologic conditions

Learning Resources 

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.

• • Chapter 24, “Normal and Abnormal Uterine Bleeding” (pp. 575-599)

This chapter differentiates normal uterine bleeding from abnormal and dysfunctional uterine bleeding. It also examines causes of abnormal bleeding and identifies assessment strategies for diagnosing and managing these conditions.

• • Chapter 25, “Hyperandrogenic Disorders” (pp. 603-618)

This chapter explores the etiology, clinical presentation, and impact of hyperandrogenic disorders. It also provides strategies for assessing, diagnosing, and managing patients with these conditions, including adolescents and pregnant women.

• • Chapter 26, “Benign Gynecologic Conditions” (pp. 621-652)

This chapter explains the incidence, presentation, assessment, and management of common benign gynecologic conditions. It also explores differential diagnoses for these conditions and types of treatment options.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

• • Chapter 7, “Care of the Woman with Reproductive Health Conditions”

• • • “Care of the Woman with Amenorrhea” (pp. 372-376)

This section differentiates between primary and secondary amenorrhea and describes treatment options for managing patients with this condition.

• • • “Care of the Woman with Abnormal Uterine Bleeding” (pp. 368-372)

This section explains the causes of dysfunctional uterine bleeding and recommends treatment options for managing this condition.

• • • “Care of the Woman with Endometriosis” (pp. 395-398)

This section identifies the prevalence of endometriosis in women. It also provides strategies for diagnosing, treating, and managing patients with this condition.

• • • “Care of the Woman with Fibroids” (pp. 398-401)

This section describes the classification of fibroids and their prevalence in women of childbearing age. It also presents methods for identifying, diagnosing, and treating this common benign tumor.

• • • “Care of the Woman with Polycystic Ovarian Syndrome” (pp. 433-437)

This section identifies the criteria for a polycystic ovarian syndrome diagnosis. It also presents treatment options for this disorder, including therapeutic options and alternative measures.

Optional Resources – NURS 6551: Week 5: Case Study: Dysmenorrhea and Painful Intercourse

Centers for Disease Control and Prevention. (2012b). Women’s health. Retrieved from http://www.cdc.gov/women/

National Institutes of Health. (2012). Office of Research on Women’s Health (ORWH). Retrieved from http://orwh.od.nih.gov/

U.S. Department of Health and Human Services. (2012a). Womenshealth.gov. Retrieved from http://www.womenshealth.gov/

Discussion: Diagnosing and Managing Gynecologic Conditions

Gynecologic conditions can be difficult to diagnose for a variety of reasons, including overlapping symptoms, lack of patient knowledge, or even patient fear or embarrassment about sharing information. Your role provides you the opportunity to develop a relationship of trust and understanding with these patients so that you can gather the appropriate details related to medical history and current symptoms. When caring for this patient population, it is important to make these women an integral part of the process and work collaboratively with them to diagnose and develop treatment and management plans that will meet their individual needs. For this Discussion, consider diagnosis, treatment, and management strategies for the patients in the following four case studies:

Case Study 1:

A 32-year-old African American female is concerned about increasing dysmenorrhea over the past three years. In the past year, this was associated with painful intercourse. She has been in a monogamous relationship with one male partner for the past five years. They tried to have children without success. Menarche was at age 10; menstrual cycles are 21 days apart and last for 6–7 days. The first day of her last menstrual period was 10 days ago and was normal. She denies vaginal itching or discharge. On gynecologic exam there was no swelling, external lesions, or erythema, urethral swelling, or vaginal discharge. Cervix is pink without lesions or discharge. Uterus was small, retroverted, and non-tender. Adnexa were small and non-tender. Nodules are noted along the cul de sac.

Case Study 2:

A 42-year-old African American female is in the clinic for a routine gynecologic exam. When asked, she admits to noticing bleeding in between her menstrual periods for the past several months. She has been pregnant three times and has three children. She is sexually active with one male sex partner in a monogamous relationship. During her bimanual exam, you note an irregular intrauterine non-tender mass about 4 cm in diameter. The mass is palpable abdominally. The remainder of her gynecologic exam was normal.

Case Study 3:

A 48-year-old Caucasian female is in the clinic concerned about prolonged menstrual bleeding for three weeks now. Her prior menstrual periods have been irregular for the past eight months, lasting no more than three days each. There have been one to two months when she had no menstrual cycles at all. She reports occasional hot flushes and mood swings.

Case Study 4:

A 16-year-old Caucasian female comes to the clinic concerned because she has not had a menstrual period for three months. She’s a junior in high school and active in sports. She has lost about 10 lbs. in the past two months. She is currently 5 ft. 4 in. and weighs 100 lbs.

To prepare:

• Review Chapter 26 of the Schuiling and Likis text and Chapter 7 of the Tharpe et al. text.
• Review and select one of the four provided case studies. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
• Consider strategies for educating patients on the treatment and management of the sexually transmitted infection you identified as your primary diagnosis.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Provide a minimum of three possible diagnoses and list them from highest priority to lowest priority. Explain which is the most likely diagnosis for the patient and why. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients on the disorder.

Read a selection of your colleagues’ responses.

By Day 6 Case Study: Dysmenorrhea and Painful Intercourse

Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to colleagues who selected different case studies than you did.

• Explain how missing information from the patient history might change the diagnoses for the patients in the case studies your colleagues selected.
• Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or contrasting perspectives.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6551: Week 5: Case Study: Dysmenorrhea and Painful Intercourse.

ADDITIONAL INFORMATION;

Dysmenorrhea and Painful Intercourse

Introduction

Dysmenorrhea is a menstrual condition that affects one billion women worldwide. It’s characterized by painful periods, cramps and other symptoms such as nausea and vomiting. Dysmenorrhea can also be accompanied by lower abdominal pain (pelvic inflammatory disease) and depression.

Dysmenorrhea is pain before, during or after your period.

Dysmenorrhea is pain before, during or after your period. It can be mild to severe and happen on one side or both sides of your abdomen.

Pain may be accompanied by:

• Irritation in the vaginal area (burning)

• Soreness or swelling around the vagina, vulva, anus and rectum

Dysmenorrhea usually lasts between two days and three weeks but it can last longer if you have a severe case.

What causes dysmenorrhea? -The cause of dysmenorrhea is not known but it’s thought to be due to uterine contractions and inflammation of the uterus. It may also be caused by prostaglandins, chemicals produced in the body that can cause cramping and pain.

There are two types of dysmenorrhea.

There are two types of dysmenorrhea. Primary dysmenorrhea is the most common form, occurring in younger women and usually lasting for a few weeks before resolving on its own without treatment. Secondary dysmenorrhea occurs less often and lasts longer (up to three months), but has similar symptoms: painful menstrual periods with abdominal cramping, lower back pain and headaches.

In both cases, there may be associated urinary tract infections (UTIs) or pelvic inflammatory disease (PID).

Most women with dysmenorrhea have mild pain that can be managed with over-the-counter medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve). If your symptoms are severe, your doctor may prescribe a stronger medication. In some cases, the pain is so debilitating that doctors prescribe hormonal contraceptives to help ease menstrual cramps.

Painful intercourse, on the other hand, involves pain that occurs during sex.

Painful intercourse, on the other hand, involves pain that occurs during sex. This can be caused by a variety of reasons. For example, endometriosis and PID are both conditions in which tissue grows outside of the uterus, causing pain during sexual intercourse.

The exact cause of painful intercourse is difficult to determine because it’s not always clear if there’s a physical issue or if something else is going on with your body that’s causing your discomfort. If you’re experiencing painful intercourse and have been diagnosed with an STI (sexually transmitted infection), it’s important to speak with your doctor about treatment options for both yourself and partners who may have been exposed to these infections through unprotected sexual contact

Painful intercourse can be caused by endometriosis

Painful intercourse can be caused by endometriosis, a common condition that involves the growth of endometrial tissue outside the uterus. The endometrial tissue usually develops during your period and grows slowly in different parts of your body (such as ovaries, fallopian tubes and other pelvic structures).

The severity of painful intercourse varies from person to person depending on where it starts and how severe it is.

Painful intercourse can also be caused by pelvic inflammatory disease (PID)

Painful intercourse can also be caused by pelvic inflammatory disease (PID), which is an infection of the uterus, fallopian tubes and/or ovaries. PID is linked to a sexually transmitted disease (STD). It’s estimated that 1-2% of women who have had sex will get PID at some point in their lives.

If you have high-risk HPV infection, you are more likely to develop PID and painful intercourse during pregnancy or after childbirth. High-risk HPV can be passed through skin-to-skin contact with an infected partner during sex without any symptoms at all!

Other causes of painful intercourse include uterine fibroids, ovarian cysts and adenomyosis among others.

Other causes of painful intercourse include uterine fibroids, ovarian cysts and adenomyosis among others.

Uterine fibroid tumors are noncancerous growths that can cause severe pelvic pain during sexual activity. They are usually referred to as leiomyomas or leiomyomata and occur in the uterus (womb). This condition is more common in women who have had children than those who haven’t. Symptoms include severe menstrual cramps that continue for several days after menstruation has stopped, heavy bleeding between periods or regular spotting without any known reason for it; pelvic pressure or burning sensation that occurs during intercourse; pelvic pain radiating into the back; lower abdominal swelling from pressure on nerves from the uterus pressing against your bladder wall causing bladder irritation/pain especially while urinating

Learn the difference between dysmenorrhea and painful intercourse

Dysmenorrhea is a term used to describe pain before, during or after your period. It can be caused by endometriosis.

Painful intercourse is a term used to describe pain during sex. Painful intercourse is more common in men and less common in women than dysmenorrhea

. Painful intercourse can be caused by an infection, inflammation or trauma.

Conclusion

Dysmenorrhea and painful intercourse are two different conditions. Dysmenorrhea is a common complaint in women of all ages, but it is more prevalent during menstrual cycles. Painful intercourse on the other hand can happen at any time during menopause or after menopause. It’s important to know that there are many causes for pain during sex so that you can treat your condition appropriately with treatment options such as pelvic floor exercises or medications like birth control pills or hormone replacement therapy (HRT).