SEXUAL HEALTH 1

• Primary amenorrhea

  Absence of menses by age 14 with absence of development of secondary sexual characteristics
• Secondary amenorrhea

  Absence of regular menses for 3 cycles or irregular meses for 6 months in women who have previously menstruated
• Nursing Management for amenorrhea

  • Balance energy expenditure with energy intake to maintain ideal weight range
  • Modify your diet to maintain ideal weight to avoid becoming overweight
  • Avoid excessive use of alcohol and mood-altering or sedative drugs
  • Avoid cigarette smoking to prevent cardiovascular disease and lung cancer
  • Identify areas of emotional stress and seek assistance to resolve them
  • Consume adequate fiber to promote regularity
  • Balance work, recreation, and rest to reduce anxiety and stress in life
  • Maintain a positive outlook regarding any diagnoses and prognoses
  • Protect yourself from too much sun exposure
  • Participate in ongoing care and screenings to monitor any medical conditions
  • Maintain bone density through: Calcium intake (1,200 to 1,600 mg daily), Vitamin D (600 to 1,000 IU/daily), Weight-bearing exercise (30 minutes or more daily), Hormone therapy (HT) for low-risk women
• Primary (spasmodic) dysmenorrhea

  Caused by ↑ prostaglandin production
• Secondary (congestive) dysmenorrhea

  Caused by pelvic or uterine pathology
• Nursing Assessment for dysmenorrhea

  • Past medical history
  • Sexual history
  • Menstrual history
  • Bimanual pelvic examination
  • Manifestations: pain, nausea, vomiting diarrhea, fatigue, fever, headache, dizziness; bloating, water retention, weight gain, muscle aches, food cravings, breast tenderness
  • Laboratory/Diagnostic Tests: CBC, UA, Pregnancy test (hCG level), Cervical culture to exclude STI, Erythrocyte sedimentation rate, Stool guaiac, Pelvic and/or vaginal ultrasound, Diagnostic laparoscopy
• Nursing Management for dysmenorrhea

  • Exercise to increase endorphins and suppress prostaglandin release
  • Limit salty foods to prevent fluid retention
  • Increase water consumption to serve as a natural diuretic
  • Increase fiber intake with fruits and vegetables to prevent constipation
  • Use heating pads or warm baths to increase comfort
  • Take warm showers to promote relaxation
  • Sip on warm beverages, such as decaffeinated green tea
  • Keep legs elevated while lying down or lie on your side with knees bent
  • Use stress management techniques to reduce emotional stress
  • Practice relaxation techniques to enhance ability to cope with pain
  • Stop smoking and decrease alcohol use which causes vasoconstriction
• Abnormal Uterine Bleeding (AUB)


  Painless endometrial bleeding that is prolonged, excessive, and irregular and not attributed to any underlying structural or systemic disease
• PALM-COEIN acronym for causes of AUB

  • Polyp
  • Adenomyosis
  • Leiomyosis
  • Malignancy
  • Coagulopathy
  • Ovulatory dysfunction
  • Endometrial
  • Iatrogenic
  • Not yet classified
• Premenstrual Dysphoric Disorder (PMDD)


  A more severe variant of PMS affecting 5% to 8% of premenopausal women
• Risk Factors for PMDD

  • Between 25 and 35 years
  • Psychiatric history
  • Family history of PMDD
  • Unhealthy living habits
  • Stressful life events
• Symptoms of PMDD

  • Physical and psychiatric symptoms that impact women significantly during the luteal phase of her menses
• Symptoms of PMS

  • Anxiety: difficulty sleeping, tenseness, mood swings, and clumsiness
  • Craving: cravings for sweets, salty foods, chocolate
  • Depression: feelings of low self-esteem, anger, dysphoria
  • Hydration: weight gain, abdominal bloating, breast tenderness, ankle swelling
  • Other: hot flashes or cold sweats, nausea, change in bowel habits, aches or pains, dysmenorrhea, acne breakout
• Symptoms of PMDD

  • Affective lability: sadness, tearfulness, irritability
  • Anxiety and tension
  • Persistent or marked anger or irritability
  • Depressed mood, feelings of hopelessness
  • Difficulty concentrating
  • Sleep difficulties
  • Increased or decreased appetite
  • Increased or decreased sexual desire
  • Chronic fatigue
  • Headache
  • Constipation or diarrhea
  • Breast swelling and tenderness
• Endometriosis


  tissue similar to the endometrium implants outside of the uterus and can be found anywhere throughout the body most commonly the abdominal cavity
• Causes and Risk Factors for Endometriosis

  • The aging process
  • Lean body size
  • Smoking or exposure to second-hand smoke
  • Family history of endometriosis in a first-degree relative
  • Short menstrual cycle (less than 28 days)
  • Long menstrual flow (more than 1 week)
  • High dietary fat consumption
  • Infertility
  • Young age of menarche (younger than 12)
  • Few (one or two) or no pregnancies
• Diagnostic Tests for Endometriosis

  • Pelvic exam
  • Pelvic or transvaginal ultrasound
  • Laparoscopy
  • Biopsy
• Nursing Management for Endometriosis

  • Education
  • Healthy lifestyle habits: diet, exercise, sleep, and stress management
  • Support groups
• Primary infertility

  Inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception
• Secondary infertility

  Inability to conceive after a previous pregnancy
• Male Risk Factors for Infertility

  • Exposure to toxic substances (lead, mercury, x-rays, chemotherapy)
  • Cigarette or marijuana smoke
  • Diabetes
  • Heavy alcohol consumption
  • Use of prescription drugs for ulcers or psoriasis
  • Exposure of the genitals to high temperatures (hot tubs or saunas)
  • Hernia repair
  • Cardiovascular disease
  • Obesity associated with decreased sperm quality
  • Cushing syndrome
  • Frequent long-distance cycling or running
  • STIs
  • Undescended testicles (cryptorchidism)
  • Mumps after puberty
• Therapeutic Management for Infertility

  • Medication or surgery
  • Laboratory and diagnostic testing: Home ovulation predictor kits, clomiphene citrate challenge test, hysterosalpingogram, laparoscopy
  • Male factor assessment: semen analysis, sexual characteristics, external and internal reproductive organ examination, digital prostate examination
  • Female factor assessment: ovarian function, pelvic organs
• Menopause

  Menses & fertility cease, 1 year without a menstrual period, Average age is 51.4
• Menopausal transition (perimenopause)

  Transition from a woman's reproductive phase of her life to her final menstrual period, Usually 2-8 years before cessation of menstruation, Decrease levels of estrogen and testosterone
• Nursing assessment for menopause

  • Screening for osteoporosis, cardiovascular disease, and cancer risk
  • Lifestyle to plan strategies to prevent chronic conditions
• Nursing management for menopause

  • Health maintenance education; risk reduction
  • Lifestyle modifications
  • Stress management
• Impact of menopause on the body

  • Brain and central nervous system: hot flashes, disturbed sleep, mood, and memory problems
  • Cardiovascular: lower levels of high-density lipoprotein (HDL) and increased risk of CVD
  • Skeletal: rapid loss of bone density that increases the risk of osteoporosis
  • Breasts: replacement of duct and glandular tissues by fat
  • Genitourinary: vaginal dryness, stress incontinence, cystitis
  • Gastrointestinal: less absorption of calcium from food, increasing the risk for fractures
  • Integumentary: dry, thin skin and decreased collagen levels
  • Body shape: more abdominal fat; waist size that swells relative to hips
• Treatments for menopause

  • Hormone therapy
  • Non-hormone therapy
• The spasms in Primary dysmenorrhea are from?

  The contraction of the uterus during the period
• Types of Contraception

  • Behavioral methods
  • Barrier methods
  • Hormonal methods
  • Sterilization
• Contraceptive Methods

  • Reversible Methods:
  • Behavioral
  • Barrier
  • Hormonal
  • Permanent Methods:
  • Tubal ligation for women
  • Vasectomy for men
• Behavioral

  • Abstinence
  • Fertility awareness–based methods (FAMs)
  • Withdrawal (coitus interruptus)
  • Lactational amenorrhea method (LAM)
• Barrier

  • Condom (male and female)
  • Diaphragm
  • Cervical cap
  • Sponge
• Hormonal


  • OC
  • Injectable contraceptive
  • Transdermal patch
  • Vaginal ring
  • Implantable contraceptive
  • Intrauterine contraceptive
  • Emergency contraceptive
• Permanent Methods

  • Tubal ligation for women
  • Vasectomy for men
• What is the therapeutic management for Endometriosis

  Pain relief, hormonal suppression, & surgery