Learning Objectives
By the end of this section, you will be able to:
- Discuss the pathophysiology, risk factors, and clinical manifestations of disorders of the female reproductive tract
- Describe the diagnostics of and laboratory values seen in disorders of the female reproductive tract
- Apply nursing concepts and plan associated nursing care of patients with disorders of the female reproductive tract
- Evaluate the efficacy of nursing care of the patient with disorders of the female reproductive tract
- Describe the medical therapies that apply to the care of disorders of the female reproductive tract
Common disorders of the female reproductive system discussed in this section include pelvic inflammatory disease, endometriosis, and uterine fibroids. These conditions may be highly personal to the patient because they often result in issues relating to sexuality and fertility. Care of the patient with disorders of the female reproductive system should be provided in a gentle, empathetic manner. These patients often require not only physical interventions and medical care but also psychosocial support.
Pathophysiology of Common Disorders of the Female Reproductive Tract
One of the most common disorders of the female reproductive system is pelvic inflammatory disease (PID), which affects nearly one million women annually (Pennsylvania Department of Health, 2023). This condition results from an infection within the reproductive tract that causes permanent scarring in the tissues. The infection is typically caused by a bacterium but can also be due to a virus, fungus, or parasite. Often, the infectious disease that results in PID is either gonorrhea or chlamydia, both of which are transmitted through sexual contact. This is significant because this condition often results in infertility and an increased risk of ectopic pregnancy (pregnancy occurring outside of the uterus, most often in the fallopian tube) which can be life-threatening.
Another common condition of the female reproductive tract is endometriosis, which affects approximately 10 percent of female individuals, or 190 million, annually (World Health Organization, 2023). The underlying pathophysiologic mechanism of this disorder is growth of uterine tissue in areas located outside of the uterus (Figure 20.12), which results in severe pain and possible infertility. The cause of this abnormal tissue growth is unknown and there is no cure, but there are treatments available for its associated symptoms.
The most common type of benign tumor affecting women is the uterine leiomyoma, more commonly called a uterine fibroid. More than half of all women will experience a uterine fibroid by the time they turn 50 years old (Mayo Clinic, 2022c). The exact cause of these slow-growing, noncancerous tumors is unknown, but they result from an inappropriate growth pattern of the smooth muscle located within the uterus.
Assessment and Diagnostics
One of the first steps in caring for a patient with a female reproductive system disorder is obtaining a thorough health history and performing a physical examination. It is important to remember many patients are uncomfortable discussing sexual function and details about menstrual cycles; therefore, the nurse should promote a warm, safe environment to facilitate an open dialogue with the patient.
Recognizing and Analyzing Cues
Clinical manifestations associated with disorders of the female reproductive tract vary depending on the specific condition. Common clinical manifestations associated with PID, endometriosis, and uterine fibroids are listed in Table 20.8.
| Disorder | Clinical Manifestations |
|---|---|
| Pelvic inflammatory disease |
|
| Endometriosis |
|
| Uterine fibroids |
|
Diagnostics
Pelvic inflammatory disease is typically diagnosed on the basis of symptoms alone, but, if necessary, diagnostic tests or procedures such as sonograms or biopsies can be used to confirm the diagnosis. Endometriosis is also diagnosed mostly on the basis of symptoms; occasionally, the provider can confirm the diagnosis by palpation of pelvic nodules. If pelvic nodules are felt, the provider is likely to order a laparoscopic exploratory procedure and collect a biopsy specimen to confirm the diagnosis and determine its severity. If uterine fibroids are suspected, they can be confirmed and diagnosed with use of a transvaginal ultrasound to assist the provider in visualizing the tumors. There are no specific laboratory tests for any of the disorders of the female reproductive system, often making them difficult to accurately diagnose and treat. A full laboratory workup of female hormones is often completed because female reproductive system disorders are often affected by the normal menstrual cycle hormones. Additionally, if a patient has a heavy menstrual cycle, a complete blood cell count often is ordered to determine if the patient has anemia as a result.
Medical Therapies and Related Care
Most female reproductive disorders can be treated with medications or surgical procedures. Treatment options for female reproductive system disorders are described in Table 20.9. Additionally, because these disorders may result in infertility, it is common for women with these disorders to seek fertility treatments when they reach reproductive age and decide that they would like to try to get pregnant.
| Disorder | Treatments |
|---|---|
| Pelvic inflammatory disease |
|
| Endometriosis |
|
| Uterine fibroids |
|
Nursing Care of the Patient with Disorders of the Female Reproductive Tract
Complex care is often needed for a patient with a disorder of the female reproductive tract, and can include physical interventions, psychological screening, and patient education. The nurse needs to address these areas with the patient while also creating a welcoming environment for the patient, and focusing on proper diagnosis, intervention, and initiation of effective treatment options
Recognizing and Analyzing Cues
During the health history and physical examination process, it is important that the nurse assess for symptoms that may indicate a female reproductive disorder. Specifically, the nurse should ask about any changes or irregularities of the patient’s menstrual cycle. Symptoms such as a heavier menstrual flow or increased abdominal cramps may be the first indicators of a female reproductive disorder.
Prioritizing Hypotheses, Generating Solutions, and Taking Action
Because of the sensitive nature of female reproductive system disorders, it is important for nurses to provide gentle and supportive care to promote a comfortable environment for the patient. Psychosocial needs of the patient with a female reproductive disorder will vary, but in all cases, the nurse should remain sensitive to the patient’s feelings and let them fully express their concerns. In some cases, the nurse may need to initiate referrals to social work or counseling to better help the patient navigate their condition and develop adequate coping skills.
One of the main nursing interventions when caring for patients with female reproductive system disorders is related to patient education. First, nurses must educate the female patient about expected physical symptoms associated with each disorder and when to seek help. The nurse will let the patient know that certain symptoms indicate a possible emergency and should be reported to the provider immediately. For example, bleeding between periods is an expected symptom of many female reproductive disorders, and the patient needs to report significantly heavier menstrual bleeding immediately because this may indicate a sign of more severe disease and could become life-threatening if left untreated. Typically, saturating one tampon or pad per hour is indicative of a heavy flow and should be reported to the provider for follow-up and intervention. Another important aspect of patient education as it relates to female reproductive disorders is their potential effects on future fertility. It is important that the nurse obtain appropriate referrals for these patients for counseling and fertility treatments as needed or as requested by the patient.
Evaluation of Nursing Care of the Patient with Disorders of the Female Reproductive Tract
To ensure proper patient care, the nurse must evaluate interventions and treatment options. This includes the patient’s psychological and educational needs, as well as any immediate or future physical needs.
Evaluating Outcomes
The main purpose of evaluating outcomes after a patient has been treated for a female reproductive system disorder is to determine whether the treatment was effective and if the patient requires further care or education. The nurse should perform a physical assessment and collect subjective data from the patient to determine whether symptoms such as heavy menstrual bleeding have improved. Ideally, symptoms will be gone or will at least be tolerable, but if not, the nurse should relay the information to the provider so a new treatment plan can be established. During the follow-up and evaluation period after receiving treatment, the nurse should also conduct a psychosocial assessment. As mentioned, these disorders can have negative impacts on fertility, which can significantly affect the female patient’s mental health. If, during the assessment, the nurse feels the patient is having difficulty coping with the diagnosis, the nurse can provide the patient additional resources, such as names of counselors or support groups.
Link to Learning
Check out the US Department of Health and Human Services, Office on Women’s Health for further information on women’s health and associated disorders.