Learning Objectives
By the end of this section, you will be able to:
- Appraise the incidence, signs and symptoms, diagnostic procedures and treatment, and nursing care for benign uterine growths
- Differentiate the incidence, risk factors, signs and symptoms, diagnostic procedures and treatment, and nursing care for benign cervical growths
- Categorize the incidence, risk factors, signs and symptoms, diagnostic procedures and treatment, and nursing care for benign ovarian growths
- Examine the incidence, risk factors, signs and symptoms, diagnostic procedures and treatment, and nursing care for benign vulvar and vaginal growths
This module focuses on the range of conditions related to benign growths in the female reproductive system. Though benign (not cancerous), these conditions can interfere in the lives of patients. The nurse, as a health-care professional, should have a good foundation of knowledge in the cause, clinical manifestations, diagnostic approaches, and management strategies related to benign growths in the female reproductive organs to provide care and education to patients living with these conditions.
Benign Uterine Growths
Benign uterine growths consist of fibroids and polyps. These growths can cause minor complications but are not concerning for neoplasms. If these growths are not causing discomfort or complications, they do not need to be removed.
Fibroids
A fibroid, or a leiomyoma, is a benign solid tumor that develops from the smooth muscle tissue of the uterus. Fibroids can be identified via sonography and can occur in the uterus as shown in Figure 4.13. Although not fully understood, fibroid growth appears to be encouraged by the hormones estrogen and progesterone. Approximately 50 percent of people with uterine fibroids have no symptoms; the other 50 percent have symptoms, which can include heavy menstrual bleeding, pain in the pelvis, and in some cases, urinary frequency (Ward, 2023, pp. 644-645). If a tumor grows very large, it can cause pelvic heaviness and rectal pressure and can interfere with sexual activity (ACOG, 2020).
In those patients with fibroids who do not have any symptoms, the condition is often discovered during a routine examination. Fibroids are slow-growing and usually regress during menopause because of the decrease in hormones (Schuiling & Likis, 2020). If symptomatic, the most reported symptoms are heavy menstrual periods, with or without pain (ACOG, 2023c). Assessment reveals that the uterus with fibroids is nontender and may feel lumpy on palpation. The uterus can be enlarged and shaped irregularly. Diagnostic imaging, such as ultrasound or MRI, is used to confirm the presence of fibroids (ACOG, 2023c)
Treatment for fibroids includes pharmacotherapy, such as a levonorgestrel-releasing intrauterine device (IUD) or antifibrinolytic medication such as tranexamic acid (Lysteda). Other medications that produce anovulation can be used to shrink the fibroid. These methods have varying levels of success and come with their side effects (ACOG, 2023c). If surgery is recommended, a myomectomy can be performed to preserve fertility, or a complete removal of the uterus (hysterectomy) may be performed (ACOG, 2023c)
Pharmacology Connections
Tranexamic Acid
Tranexamic acid is a synthetic form of lysine. Lysine is an amino acid used to build proteins.
Tranexamic acid prevents the breakdown of blood clots. This medication is used for the treatment of heavy menstrual bleeding.
- Generic Name: tranexamic acid
- Trade Name: Lysteda, Cyklokapron
- Class/Action: miscellaneous coagulation modifiers
- Route/Dosage: Medication is started on the first day of the menstrual cycle. Oral medication, 650 mg, is prescribed three times per day for up to 5 days in a row, not to exceed more than 6 doses in 24 hours or for more than 5 days in a row. Swallow tablets whole; do not crush or chew.
- Indications: An antifibrinolytic is indicated for the treatment of heavy menstrual bleeding in persons assigned female at birth.
- Warnings and Precautions: Thromboembolic risk. Venous and arterial thromboses have been reported.
- Mechanism of Action: “Tranexamic acid is thought to lower endometrial tPA activity, resulting in decreased blood loss. It blocks lysine binding sites on plasminogen molecules, preventing plasmin formation and menstrual fluid fibrinolysis” (“Tranexamic acid (Lysteda) for treatment of menorrhagia,” 2010, p. 1210).
- Contraindications: Tranexamic acid is contraindicated in patients with increased thromboembolic risk, including those using combined hormonal contraceptive methods and those with a history of thrombosis or hypercoagulopathy.
- Adverse Reactions/Side Effects: The most common adverse effects of tranexamic acid are headache, sinus and nasal symptoms, back pain, abdominal pain, musculoskeletal pain, joint pain, muscle cramps, migraine, anemia, and fatigue.
- Nursing Implications: The nurse needs to educate the patient about this drug, especially about the signs and symptoms of thrombosis, and the expected side effects. The nurse should provide information on the appropriate time of the month to take the medication (on the first day of the period) and include instructions on when to stop taking the medication (on the last day of the period or for no more than 5 days).
(Thornton, 2023)
Polyps
A uterine polyp, also known as an endometrial polyp, is a growth that derives from the inner lining of the uterus (endometrium), shown in Figure 6.8. These growths are usually benign and do not require specific treatment unless they grow so large as to protrude through the cervix and cause discomfort to the premenopausal patient (Schuiling & Likis, 2020, p 554). Though usually benign, polyps that develop in perimenopause or menopause should be investigated with a biopsy (Tanos et al., 2017). Irregular or heavy menstrual periods can be caused by uterine polyps, and any postmenopausal bleeding requires further investigation (Tanos et al., 2017).
The diagnosis of a uterine polyp is usually made with a transvaginal ultrasound or other imaging (Schuiling & Likis, 2020). Treatment of polyps is similar to that for fibroids and includes hormones that cause anovulation to reduce estrogen and progesterone or surgical removal of the polyp. The nurse’s responsibility is to provide education on what to expect during the transvaginal ultrasound and to accompany the patient during the procedure.
Benign Ovarian Growths
An ovarian cyst, shown in Figure 6.9, is a blood- or fluid-filled sac found on or near the ovary. These cysts are derived from the different tissues that make up the ovary (Ward, 2023). Many cysts are discovered as incidental findings during regular examination. Most cysts are benign and asymptomatic but require follow-up based on the guidelines from the Society of Radiologists in Ultrasound. These guidelines consider a person’s menstrual history, family history, and whether the person is pre-, peri-, or postmenopausal (Andreotti et al., 2020). Occasionally, ovarian cysts can burst and cause pain in the abdomen. If the cyst is bleeding or causes the ovary to twist (referred to as ovarian torsion), surgical removal may be necessary (Ward, 2023).
Benign Cervical Growths
Growths on the cervix are typically benign and are usually an incidental finding during a routine examination. Patients with cervical growths may experience increased post-sex bleeding. Nurses can provide education to patients that any abnormal bleeding (bleeding following sex or midcycle bleeding) can be a sign of infection and may warrant an examination from a health-care provider (Schuiling & Likis, 2020).
Growths on the cervix are usually one of the following: mucous cysts, polyps, or warts (Ward, 2023). Mucous cysts, also called Nabothian cysts, are formed from mucus-producing tissue, are benign, and typically do not need treatment unless they become very large (Barrigón et al., 2018). Figure 6.10 shows an example of Nabothian cysts on the cervix. A cervical polyp is a fleshy, red-colored growth protruding from the cervix. They are usually benign and do not need treatment unless they become a nuisance to the patient (Ward, 2023). Condylomata acuminata (warts) are caused by the human papillomavirus (HPV) and can manifest as a cauliflower-type growth on the cervix. These growths can also be found in the vagina, on the vulva, or in the perianal area (CDC, 2021). The current HPV vaccine prevents more than 90 percent of the virus strains that cause warts in addition to the strains that lead to cancer (CDC, 2022a). Treatment for condylomata is limited to the application of an acidic solution or, in severe cases, surgical removal (CDC, 2021).
Benign Vulvar and Vaginal Growths
The Bartholin’s glands (see Figure 3.4) are located inside the vaginal opening and provide moisture and lubrication to the vagina. Obstruction of one of these glands can cause a fluid-filled cyst, a Bartholin’s cyst, or an abscess to form (Schuiling & Likis, 2020) The patient may be unaware of the cyst, and it may drain on its own. However, the cyst may become enlarged and cause pain and discomfort to the patient. Conservative treatment is warm compresses or a sitz bath to allow the cyst to resolve on its own. Antibiotics may be prescribed if the cyst appears to be large, inflamed, or infected. Occasionally, the cyst may become so inflamed that it may be necessary for the provider to drain it. Common bacteria involved in an abscess are Escherichia coli (E. coli), methicillin-resistant Staphylococcus aureus (MRSA), and those causing gonorrhea and chlamydia (Chen, 2022).
Life-Stage Context
Genital Piercing
The practice of genital piercing has become more popular in recent years, and the nurse will undoubtedly encounter this in the patients they care for. Piercing is done with several motivations. It can be a
- form of self-expression,
- test of physical endurance,
- statement of resistance to society, or a
- direct sexual statement (Van Hoover et al., 2017).
In some circumstances, genital piercing can be done as a means of overcoming past traumatic experiences (Van der Meer et al., 2008).
Genital piercing can cause infection, scarring, infertility due to infection, and tissue damage to the organ pierced or surrounding structures (Van Hoover et al., 2017).
Nurses need to be informed and prepared to assist with the removal of genital piercing in the following circumstances:
- childbirth
- breast-feeding (if the piercing is in the nipple)
- electrocautery used during procedures
- radiologic procedures
- presence of infection (Young & Armstrong, 2008)