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Reproductive System Diseases and Disorders 367
Speculum
Vagina Bladder
Swab or spatula
Rectum
Fallopian
tube
Ovary
Uterus
Vertebra
Cervix
of uterus
Figure 17-3 Use of a speculum and obtaining a Pap smear.
piece of cervical tissue including the cervical os and
endocervical lining. The diagnosis of endometrial
cancer is best discovered by obtaining tissue for biopsy
during a dilatation and curettage (D&C) (KYOU-reh-
TAHZH). This procedure involves a light surgical sed
ative, dilation of the cervix (dilatation), and scraping
(curettage) of the uterine endometrial tissue. D&C is
also commonly performed for abnormal uterine bleed
ing and following a spontaneous abortion.
A laparoscopy (LAP-ah-ROS-ko-pee; laparo =
abdomen, scopy = scope procedure), or looking inside
the abdominal cavity with a lighted scope (Figure 17-4),
is commonly used to view the female organs for abnor
malities, diagnose endometriosis, and perform a tubal
ligation. To determine the size, position, and patency of
the uterus and fallopian tubes, a hysterosalpingogram
(hystero = uterus, salpingo = fallopian tubes, gram =
picture), or X-ray, of these organs can be obtained.
During a hysterosalpingogram, a small tube is passed
through the cervix and a radiopaque dye is injected. As
the dye fills the uterus and fallopian tubes and spills into
the abdominal cavity, X-rays are taken to show patency,
or openness, of the tubes. This procedure is commonly
done as part of infertility testing.
Laboratory tests to determine reproductive dis
eases include microscopic examination and culture
Viewer
Laparoscope
pubis
Anal opening
Figure 17-4 Laparoscopy.
Uterus
Sacrum
Rectum
and sensitivity of secretions or drainage from the
vagina and genital lesions to determine the pres
ence of infection. A rapid DNA probe test may
also be used. This test is sensitive to the DNA of
specific microorganisms. Blood tests to measure
368 Chapter 17
hormone levels, including estrogen and progester
one, are also common. Other blood testing includes
the fluorescent treponemal antibody absorption
(FTA-ABS) test and rapid plasma reagin (RPR) test,
and the Venereal Disease Research Laboratory (VDRL)
test for syphilis. The VDRL is the oldest of the tests for
syphilis, but is still used in some cases.
Mammography (mam-MOG-rah-fee; mammo =
breast, ography = procedure to take a picture) is an X-ray
or radiologic examination of breast tissue (Figure 17-5)
to determine the presence of cysts or tumors. Digital
mammography is a newer technique that takes an elec
tronic image of the breast and stores it in a computer for
the radiologist to view. If an abnormal mass is discovered
during mammography, further diagnostic techniques
include fine-needle aspiration and incisional biopsy.
Ultrasound can be performed on the pelvis to
determine the presence of tumors and pregnancy and
to visualize pelvic organ position and size. Benign
breast cysts can be differentiated from solid tumors by
ultrasonography.
Genetic testing may be done if the individual has a
personal or family history of cancer. Genetic tests are
available for some types of cancer (discussed in this
chapter) such as breast cancer, ovarian cancer, and
prostate cancer.
Physical examination of the male reproductive sys
tem includes visual examination of the external geni
talia for tumors, lesions, or penile drainage. The testes
are palpated to determine the presence of tumors. A
digital rectal examination allows the physician to feel
the prostate (Figure 17-6) for abnormal enlargement
(hypertrophy or hyperplasia) and tumors.
A cystoscopy (sis-TOS-koh-pee; cyst = blad
der, oscopy = scope procedure) is performed to view
the urethra and bladder with a lighted scope to evaluate
the size of the prostate and the degree of obstruction the
gland is placing on the urethra.
Biopsy of the male reproductive organs commonly
involves the prostate and the testicle. Both procedures
are performed to determine malignancy. To obtain a
prostatic biopsy, a fine needle is guided through the rec
tum and into the prostate. A testicular biopsy involves
the use of local anesthetic and a fine needle to with
draw a small piece of tissue. Testicular biopsy also can
be used to evaluate sperm production.
Laboratory tests used in the determination of dis
eases of the male reproductive system include cultures
and sensitivities of penile drainage, lesions, and urine
to determine the presence of infection. DNA probe test
may also be used. Urine estrogen levels can assist in the
diagnosis of testicular cancers.
Figure 17-5 Mammography, needle aspiration, and incisional biopsy.
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Reproductive System Diseases and Disorders 369
Rectum
Seminal vesicle
Ejaculatory duct
Epididymis
Testis
Vas deferens
Urinary bladder
Prostate gland
Urethra
Glans penis
Prepuce (foreskin)
Scrotum
Figure 17-6 Digital rectal examination.
A blood test called a prostate-specific antigen
(PSA) is helpful in the detection of prostate cancer.
PSA levels also assist in determining effectiveness of
prostate cancer treatment. There are several types of
PSA tests now available such as the percent-free PSA,
complexed PSA, PSA density, prostate health index
(phi), and 4Kscore test. Since PSA levels are often
higher in older men, age-specific ranges for the PSA
test are no longer recommended to be used. PSA test
ing has some negative factors since the results may or
may not be diagnostic of prostate cancer. Other con
ditions in addition can raise the PSA level and some
medications can lower it. Further examination and
evaluation is needed after the results of the PSA are
obtained. The PSA is only one factor used to determine
the presence of prostate cancer.
Specific laboratory tests used for infertility testing
include microscopic examination of semen to perform
a sperm count, to check sperm viability or ability to
survive, and to look for abnormally shaped sperm.
Blood tests for the hormones testosterone and LH are
also used.
Common Diseases of
the Reproductive System
Common diseases of the reproductive system involve
those affecting both sexes, including the pregnant
female. These diseases are divided into female reproduc
tive system diseases, diseases of the breast, disorders of
pregnancy, male reproductive system diseases, sexually
transmitted diseases (STDs), and sexual dysfunction.
Female Reproductive System Diseases
The female reproductive system is affected by numerous
diseases and disorders caused by inflammation, infection,
tumors, cysts, and hormonal imbalances. Diseases can
range from mild to life-threatening. Common symptoms
include pain and abnormalities in the menstrual cycle.
Menstrual Abnormalities
■ Description. Menstrual abnormalities are a common
problem in the ovulating female.
370 Chapter 17
Pharmacology
Common Drugs for Female Reproductive Disorders
■ ■ ■ Bill ^^1 f
Highlight
Category Examples of Medications
Antibiotics
Drugs used to prevent or stop bacterial
infections
Ampicillin, amoxicillin, cefpodoxime,
ciprofloxacin, doxycycline, erythromycin,
penicillin, or tetracycline
Hormones
Drugs to reduce the symptoms of
menopause or as a treatment for breast
cancer, osteoporosis, and menopause
Estrogen or selective estrogen receptor
modulators (SERMs) such as anordrin,
bazedoxifene, cyclofenil, raloxifene,
tamoxifen, or tormifene
Antineoplastics
**•]
* " ***' *-* _
Drugs used to treat cancer
Alkylating agents
Antimetabolites
Antitumor antibiotics
Hormones/antihormones
Other substances
Chlorambucil, cyclophosphamide,
or lomustine
5-Flourauracil, mercaptopurine,
or methotrexate
Mitomycin or streptozocin
Estrogens, androgens, or flutamide
Asparaginase, bevacizumab, cabozantinib,
carboplatin, cisplatin, etoposide,
gemcitabine, l-paclitaxel, or vincristine
Antipyretics/Analgesics
•W’ i ’*
Drugs used to reduce fever and pain Acetaminophen, aspirin, ibuprofen, or
naproxen
Fertility drugs
Drugs used to stimulate ovulation Bromocriptine, clomiphene citrate,
gonadotropions, letrozole, or metformin
■ Etiology. Causes of menstrual abnormalities vary,
as does treatment. Common abnormalities include
premenstrual syndrome, amenorrhea, dysmenorrhea,
menorrhagia, and metrorrhagia. A short description of
these disorders follows.
Premenstrual Syndrome
■ Description. Premenstrual syndrome, commonly
called PMS, is a group of symptoms occurring prior to
the onset of menses.
■ Etiology. The cause of PMS is uncertain, but research
has shown an increase in PMS with rapid hormonal
changes in estrogen levels that occur during the menstrual
cycle. Other causes might be related to vitamin deficien
cies and psychological disturbances. In the past, PMS was
thought to be entirely due to emotional factors and stress,
but it is now known to have a true physical cause.
■ Symptoms. Symptoms of PMS usually begin
mid-cycle with ovulation and increase in severity until
a few hours after the onset of menses. PMS symptoms
can affect virtually every system of the body and include
headache, nausea, and back and joint pain. An increase
in water retention can cause edema, bloating, weight
gain, and breast tenderness and engorgement. Psycho
logical symptoms can include irritability, mood swings,
depression, and sleep disturbances. Symptoms of PMS
vary significantly from one individual to another. It
is unknown why some females have severe, disabling
PMS, whereas others are virtually unaffected.
■ Diagnosis. Diagnosis is difficult because the cause of
this disorder is not clearly understood. A thorough his
tory and physical examination might help determine the
correlation of the onset of symptoms in relation to the
menstrual cycle. Thyroid testing and tests for dysmen
orrhea and endometriosis aid in ruling out other causes.
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Reproductive System Diseases and Disorders 371
Pharmacology
Highlight
Common Drugs for Male Reproductive Disorders
Category Examples of Medications
Antibiotics
Drugs used to prevent or stop bacterial
infections
Ampicillin, amoxicillin, ciprofloxacin,
doxycycline, erythromycin, penicillin, or
tetracycline
Antineoplastics
Drugs used to treat cancer
Alkylating agents
Antimetabolites
Antitumor antibiotics
Hormones/antihormones
Other substances
Chlorambucil, cyclophosphamide, or
lomustine
5-Flourauracil, mercaptopurine, or
methotrexate
Mitomycin or streptozocin
Estrogens or androgens
Asparaginase, bevacizumab, bicalutamide,
carboplatin, cisplatin, etoposide, ibrutinib,
leuprolide, l-paclitaxel, or vincristine
Antipyretics/Analgesics
Drugs used to reduce fever and pain Acetaminophen, aspirin, ibuprofen, or
naproxen
Hormones
Drugs used to treat prostate cancer or
other male reproductive disorders
Estrogen or testosterone
Phosphodiesterase inhibitors
Drugs for erectile dysfunction Sildenafil, tadalafil, vanafil, or vardenafil
Because depression is common, some women might
undergo psychological testing to rule out psychiatric dis
orders and confirm that the depression is related to PMS.
■ Treatment. Due to the variation in symptoms, treatment
must be individualized because affected individuals have
differing symptoms and respond differently to treatment.
Dietary changes might be helpful and include avoidance
of caffeine, chocolate, nicotine, sugar, salt, and alcohol.
Developing a regular exercise program of brisk walking or
swimming can be beneficial. Medications might be helpful
and include diuretics, analgesics, and progesterone.
■ Prevention. PMS cannot be prevented, but certain
activities can reduce the symptoms. These activities
include quitting smoking, limiting caffeine, taking daily
calcium (1,200 mg) and vitamin B
6
(50 mg), exercising,
eating a balanced diet, and reducing stress.
Amenorrhea
■ Description. Amenorrhea (ah-MEN-oh-REE-ah; a =
without, menorrhea = menstruation) is the absence of
menstrual periods. Primary amenorrhea is defined as
not having menses by age 18. This can be caused by
hormonal disorders, malformation or absence of female
organs, pregnancy, or anorexia. Secondary amenorrhea
is the absence of menses for six months or more in a
female who has had regular cycles.
■ Etiology. Causes include hormonal imbalance, emo
tional upset, depression, malnutrition, excessive fitness
training, ovarian tumor, and pregnancy.
■ Diagnosis. Diagnosis is made on the basis of a physi
cal examination and hormonal blood and urine studies.
■ Treatment. Treatment depends on cause. If no abnor
malities are present, hormone administration will usu
ally begin the menstrual cycle in primary amenorrhea.
■ Prevention. Preventive measures include adequate
nutrition, exercise, and stress reduction.
Dysmenorrhea
■ Description. Dysmenorrhea (DIS-men-oh-REE-ah;
dys = difficult, menorrhea = menses) is painful or difficult
menses, one of the most common gynecologic disorders.
372 Chapter 17
The Chaste
Tree Berry
Benefits
Complementary and Alternative Therapy
C
haste tree berries have been used for centuries to treat such problems as premen
strual syndrome, breast disease, infertility, and prostate cancer. It is believed the
berry influences hormone levels in a complex manner ultimately causing an increase in
progesterone which is important in regulating the menstrual cycle. It is most frequently
used to reduce premenstrual symptoms but has also been found to affect polycystic
ovary syndrome. Studies has shown that the chaste berry also reduces hot flashes which
is one of the most common complaints of individuals in menopause. Some research has
demonstrated that the chaste berry can improve fertility. The herb is fairly free of side
effects but can cause problems if used in high doses. It comes in liquid and extract form.
It is not safe for use in pregnancy.
Source: Khalsa, K.P.S. (2020)
■ Etiology. Causes of dysmenorrhea include pelvic
infections, cervical stenosis, endometriosis, and unkn
own causes.
■ Symptoms. Symptoms include dull to severe cramp
ing pain in the pelvic area and low back pain. Pain also
might radiate into the upper back, thighs, and genitalia.
Pain associated with cervical stenosis and endometri
osis often occurs in females prior to childbearing and
is often relieved after the birth of a child. Prognosis is
good if the cause can be found and treated.
■ Treatment. Oral contraceptives can be effective in
reducing dysmenorrhea because they regulate and
decrease menstrual flow. Nonsteroidal anti-inflamma
tory medications are helpful in reducing inflammation
and pain. Application of a heating pad to the pelvic area
also might be helpful.
Menorrhagia
■ Description. Menorrhagia (MEN-oh-RAY-jee-ah;
meno = menses, orrhagia = bursting forth, abnormal,
excessive) is excessive or prolonged menstrual flow.
■ Etiology. Cause can be due to uterine tumors, pelvic
inflammatory disease (PID), and hormone imbalances.
■ Treatment. Treatment is related to cause and can
include surgery to remove tumors, antibiotics to treat
PID, and hormone therapy for hormone imbalances.
Metrorrhagia
■ Description. Metrorrhagia (MET-roh-RAY-jee-ah;
metro = uterus, orrhagia = bursting forth, abnormal,
excessive) is abnormal bleeding between menstrual
periods.
■ Etiology. The cause is commonly due to hormonal
imbalance, leading to an abnormal thickening and
shedding of the endometrial tissue.
■ Treatment. Treatment can be a D&C, returning the
endometrium to normal and ending metrorrhagia.
Menopause
■ Description. Menopause is the natural halting of
menstruation.
■ Etiology. Menopause is not a disease—it is a nor
mal physical change related to aging—but many
women consider menopause a disorder because they
commonly have physical and psychological symp
toms. Menopause usually takes place between the
ages of 40 and 50 years. As a woman ages, the ovaries
produce less estrogen, causing cessation of ovula
tion and menstruation. This process can be surgi
cally induced by removal of both ovaries (bilateral
oophorectomy).
■ Symptoms. Common physical symptoms of meno
pause include hot flashes, night sweats, and vaginal
dryness. Some women also experience psycholog
ical symptoms of depression, sleep disorders, and
decreased libido (sex drive). Hormonal changes
brought about by menopause increase a woman’s risk
of cardiac disease and osteoporosis.
■ Diagnosis. The blood testing for presence of FSH aids
in diagnosis of menopause.
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Reproductive System Diseases and Disorders 373
■ Treatment. Menopausal hormone therapy (MHT) has
been the treatment of choice for more than 60 years for
prevention of hot flashes and vaginal dryness in meno
pausal women. In the mid-1980s, estrogen also was
approved as preventive treatment of heart disease and
osteoporosis.
In 2002, a federally funded Women’s Health Ini
tiative (WHI) prematurely halted a hormone study,
finding that hormone therapy not only did not protect
against heart disease but actually led to a slight increase
in risk of heart attacks, breast cancer, strokes, and blood
clots. The results of this study led to a drastic and imme
diate decline in the use of MHT.
More current research has found that women who are
less than 60 years old do not appear to be at an increased
risk for heart disease. This research also found that the
benefits of MHT do outweigh the risk in most cases, espe
cially for the relief of symptoms related to low estrogen
levels. Other studies have shown that lower doses of estro
gen than were given in the WHI research not only reduce
symptoms but also assist in maintaining bone density.
Since 2002, there has been much confusion about
the safety of MHT. While many questions remain unan
swered, there are several treatment considerations that
most clinicians do agree upon.
First, decisions about MHT should be made, like
most treatments, on an individual basis by the individ
ual and her physician. Treatment options, the individ
ual’s medical and family history, and the potential risk
should all be discussed and carefully considered.
The dosage and delivery method should also be indi
vidualized to meet the individual’s particular needs. Also,
that MHT should be given for the shortest time and in
the lowest dose needed to control menopausal symptoms.
Some literature recommends botanical treatment
with estrogen-like materials such as soy, herbs, and
black cohosh. To date, the Food and Drug Administra
tion (FDA) has not determined if these natural prod
ucts are helpful and safe.
FDA current recommendations include lifestyle
changes including avoiding spicy foods, caffeine, and
alcohol; getting enough sleep; dressing to avoid becom
ing too warm; and remaining physically active.
■ Prevention. There are no preventive measures.
Vaginitis
■ Description. Vaginitis (VAJ-ih-NIGH-tis) is inflam
mation of the vagina.
■ Etiology. Vaginitis is a very common disease caused
by a variety of microorganisms including bacteria and
yeast. It is not dangerous but is irritating and uncom
fortable and often leads to a bladder infection.
■ Symptoms. Symptoms of vaginitis are burning, itch
ing, and swelling of the vagina and external genitalia. A
white cottage cheese-appearing discharge is common
with Candida vaginitis.
■ Diagnosis. Basic diagnosis is made by review of
symptoms, testing the pH level of vaginal fluid, and
microscopic (wet prep) examination. More sensitive
testing includes culture, antigen detection, and DNA
probe test.
■ Treatment. The key to proper treatment of vaginitis
is to determine the correct cause of the infection. Yeast
infections that occur more often than four times a year
need physician treatment. Abstaining from sexual inter
course until the condition has healed is recommended
primarily to decrease the risk of reinfection.
■ Prevention. Preventive activities include keeping the
vaginal area clean and dry; wearing cotton underwear to
help absorb moisture; always wiping genital area front
to back; avoiding excessive douching; avoiding deodor
ized tampons; eating yogurt, especially if taking anti
biotics; removing and replacing tampons as directed;
and decreasing intake of sweets and alcohol. The most
common types of vaginitis include the following.
Candida Vaginitis
■ Description. Candida vaginitis is a type of fungus or
yeast vaginitis that normally cohabits with Lactobacil
lus bacteria in the vagina, maintaining vaginal normal
flora. (See Chapter 4, “Inflammation and Infection,” for
more details on normal flora.)
■ Etiology. If the balance between the Candida and
the Lactobacillus is disturbed, the affected individ
ual develops a Candida vaginitis, the most common
type of vaginitis, commonly called a yeast infection
(Figure 17-7). To maintain normal healthy vaginal
flora, sufficient estrogen must be produced to enhance
the growth of lactobacilli, a beneficial, normal flora
bacterium. Lactobacilli aid in the production of lactic
acid, causing a lower vaginal pH of 4 or 4.5. This acid
environment is also a deterrent to the growth of harmful
microorganisms.
Use of tampons, diaphragms, condoms, spermi
cides, vaginal douche, and deodorant sprays can easily
upset the normal flora of the vagina and lead to vagini
tis. Antibiotic use commonly kills lactobacilli and can
lead to severe vaginitis. Candida infection is usually not
spread by sexual transmission except in severe cases.
374 Chapter 17
Figure 17-7 Candida vaginitis: view through sp
eculum.
■ Treatment. Home remedies include douching with
one teaspoon of vinegar in one gallon of water and
eating yogurt or adding the yogurt in the douche to
restore the normal flora. Over-the-counter, vaginal
antifungal ointments and tablets such as clotrimazole
(Gyne-Lotrimin®, Femcare®) and miconazole are ben
eficial in most cases. Oral antifungal medications such
as fluconazole (Diflucan®) might be needed for more
severe cases.
Trichomonas Vaginitis
■ Etiology. Trichomonas (TRICK-oh-MOH-nas) vag
initis is caused by the protozoan parasite Trichomonas
vaginalis. This parasite is commonly transmitted during
sexual intercourse (Figure 17-8).
■ Treatment. Both sexual partners must be treated
with an oral antiparasitic medication to eradicate the
infection.
Figure 17-8 Trichomonas vaginalis protozoan.
Atrophic Vaginitis
■ Etiology. Atrophic vaginitis commonly occurs after
menopause and is caused by a decrease in secretion of
estrogen, which is needed to maintain the vaginal lin
ing. Without an adequate supply, the lining becomes
more susceptible to infection.
■ Diagnosis. Diagnosis is usually confirmed by micro
scopic examination of vaginal secretions, revealing the
presence of the infecting organism.
■ Treatment. Treatment often includes estrogen ther
apy and the use of adequate lubrication during sexual
intercourse to prevent injury to the vaginal lining.
Other Female Reproductive
System Diseases and Disorders
Endometriosis
■ Description. Endometriosis (EN-doh-ME-tree-OH-
sis; endo = inside, metri = uterus, osis = condition of)
is the abnormal growth of endometrial tissue outside the
uterus. Endometrial tissue might flow retrograde during
menses and escape into the abdominopelvic cavity
through the fallopian tubes or, even worse, escape into
the blood supply and be carried to sites all over the body
(see Figure 17-9A).
■ Etiology. The cause of retrograde flow is unknown,
but use of tampons might be a causative factor. For this
reason, the use of tampons is discouraged. Common
sites of endometrial implantation include the ovaries,
fallopian tubes, abdominal wall, and intestine. Other
sites of implantation include the urinary bladder, the
diaphragm, nerves and ligaments of the back, and the
vulva, to name only a few.
This endometrial tissue continues to act under the
influence of hormones, thickening and bleeding with
menstrual cycles, causing irritation and inflammation
of normal tissue surrounding the implanted endome
trial tissue, and thus causing the development of a spe
cial blood-filled cyst (chocolate cyst), scar tissue, and
adhesions (Figure 17-9B).
■ Symptoms. This bleeding of endometrial tissue in the
abdominopelvic cavity and other ectopic (eck-TOP-ick,
out of normal place) areas causes dysmenorrhea (DIS-
men-oh-REE-ah; dys = painful, menorrhea = menses),
beginning a few days before menses and extending sev
eral days into the menstrual cycle. There might be a con
stant cramping pain in the low back, pelvis, and vagina.
Affected individuals, usually females of childbearing age,
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Figure 17-9 (A) Endometriosis—common sites of endo
metrial implants. (B) Chocolate cysts of endometriosis—
internal abdominal wall implant.
also might experience heavy menses and dyspareunia
(DIS-pah-ROO-nee-ah; painful sexual intercourse).
The primary complication of endometriosis is
infertility. Other complications include ectopic preg
nancy and spontaneous abortion.
■ Diagnosis. Diagnosis is made on the basis of history
and pelvic examination. A laparoscopy will confirm the
diagnosis and allow visualization of the extent of the
condition.
■ Treatment. Treatment depends on the affected indi
vidual’s age and desire to have children. Young females
wishing to have children should not delay childbearing.
Treatment with various hormonal medications might
be helpful in younger individuals. Pregnancy, nursing,
and menopause will not cure the condition but do cause
a remission in symptoms because the abnormal tissue
shrinks when menstrual hormones are halted. In severe
cases, a total hysterectomy, or panhysterectomy (removal
of ovaries, fallopian tubes, and uterus), might be indicated.
■ Prevention. Endometriosis cannot be prevented,
primarily because the etiology is not well understood.
Long-term birth control hormones might prevent the
condition from worsening.
Pelvic Inflammatory Disease
■ Description. PID is an inflammation of some or all of
the pelvic reproductive organs. It can be mild to severe
and might involve the cervix (cervicitis), the inner
lining of the uterus (endometritis), fallopian tubes
(salpingitis), and ovaries (oophoritis) (Figure 17-10).
■ Etiology. This inflammation is commonly due to
infection by bacteria that ascend from the vagina and
travel upward to the pelvic cavity. Bacteria can be
introduced into the female reproductive system during
childbirth, miscarriage, abortion, or other gynecologic
procedures. The most common cause of PID is STD,
including gonorrhea and chlamydia infection. Young,
sexually active females and those who use intrauterine
devices (IUDs) are most at risk of developing PID.
■ Symptoms. Symptoms are typical of an infection
and include fever, chills, pain in the pelvic area, and
leukorrhea (LOO-koh-REE-ah; leuk = white, orrhea =
flow or discharge), a white, usually foul-smelling vagi
nal discharge.
■ Diagnosis. Diagnosis is made on the basis of a pel
vic examination including a positive culture of vaginal
discharge.
■ Treatment. Treatment includes antibiotic therapy,
analgesics, and bed rest. Without proper treatment, the
infection can lead to septicemia (SEP-tih-SEE-me-ah;
septic = dirty or contaminated, emia = blood), or
blood-borne, and life-threatening. Inflammation of the
reproductive organs can lead to the development of scar
tissue and adhesions that can cause the complications of
infertility and ectopic pregnancy.
■ Prevention. PID can usually be prevented by prac
ticing safe sex with proper use of condoms. This will
reduce but not eliminate risk of contracting STDs, the
primary cause of the disease. Monogamous sexual rela
tionships and abstinence also help prevent STDs.
Figure 17-10 Pelvic inflammatory disease.
rumruay/Shutterstock.com
Ovarian Cyst
■ Description. Ovarian cysts are commonly benign,
fluid-filled sacs on or near the ovary (Figure 17-11).
■ Etiology. There are two types of cysts: physiologic—
those caused by a normally functioning ovary—and
neoplastic, an abnormal type not related to the function
of the ovary. Physiologic cysts are the most common
and can become very large (grapefruit size) before pro
ducing symptoms.
■ Symptoms. Symptoms include low back pain, pelvic
pain, and dyspareunia. Acute, extreme pain, nausea, and
vomiting can occur if the ovary becomes twisted from
the weight of the cyst.
■ Diagnosis. Diagnosis is made on the basis of history,
pelvic examination, and ultrasound.
■ Treatment. Treatment depends on the type and size
of the cyst. Small physiologic cysts usually do not need
treatment and often resolve spontaneously. Oral con-
tra-ceptive medication can be given for several months
to help resolve physiologic tumors of various sizes. Large
cysts or those of questionable type are often viewed by
laparoscopy, during which the cyst can be removed or
drained. Determination should be made of the type of
cyst because cancerous cysts need immediate treatment.
■ Prevention. Anything that prevents ovulation, such as
birth control hormones, breast-feeding, pregnancy, and
menopause, reduces the risk of ovarian cysts.
Fibroid Tumor
■ Description. Leiomyomas, commonly called fibroid
tumors, are benign tumors of the smooth muscle of
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