NSG 3180 Unit 9: Disorders of the Female Genitalia and Reproductive
Function
Structural Disorders
Alterations in uterine position and pelvic support
Pelvic organ prolapse
Caused by weakening of vaginal walls → pelvic organs descend into vaginal canal
Risk factors:
Vaginal childbirth trauma
Hormone deficiency
Age
Previous pelvic surgery
Genetics
Uterine Prolapse
When the pelvic muscles weaken, the
uterus can slide down the vaginal canal
and protrude through the vaginal
opening
Procidentia: severe prolapse where
uterus protrudes outside vaginal
orifice.
Prolapse may drag vaginal walls,
bladder (cystocele), or rectum
(rectocele).
Symptoms
Pressure
Pulling
Incontinence/retention
Activity/increases abd pressure can worsen s/s
Symptoms worsen with coughing, lifting, prolonged standing, stair climbing.
Management
Surgical vs non-surgical
• The uterus can be stitched back into place
• Hysterectomy (postmenopausal)
1
, • Colpocleisis (vaginal closure) - for women not desiring intercourse or fertility
• Lifestyle changes
• Pessaries
• Kegel exercises
• Conservative management preferred for mild prolapse, women desiring children,
or those unfit for surgery.
• Transvaginal surgical mesh is no longer considered effective treatment
Preventative measures
Early detection during pregnancy and postpartum visits.
Educate women on pelvic floor exercises to strengthen supportive muscles.
Prompt treatment prevents complications (infection, cervical ulceration, cystitis,
hemorrhoids).
Cystocele
Downward movement of the bladder
Can protrude through vaginal opening
Due to damage to pelvic floor muscles
Often results from childbirth injury/strain; may
present years later with aging and genital
atrophy.
Can also affect younger multiparous,
premenopausal women.
Rectocele
Upward pushing of rectum which pushes the vaginal wall forward
Lacerations during childbirth can increase risk
Often related to childbirth trauma, muscle tears, or perineal lacerations.
Severe cases: complete tear of anal sphincter fibers.
Infections
Infection
Vaginal Protection Against Infection Normal vaginal pH: 3.5–4.5 Maintained by:
Lactobacillus acidophilus → produces lactic acid (lowers pH) and hydrogen peroxide
(toxic to anaerobes).
2
, Estrogen → stimulates glycogen formation → glycogen breakdown → lactic acid
production.
Factors that disrupt protection:
Stress, illness, or reduced immune resistance.
Hormonal changes (↓ estrogen during lactation, peri-/postmenopause → ↓
glycogen → ↑ infection risk).
Antibiotic therapy (reduces normal flora, alters pH, allows fungal overgrowth).
Contact with infected partner.
Tight, nonabsorbent clothing (retains heat & moisture).
Menopause effects:
Atrophy of vaginal/labial tissue (thin, fragile mucosa). Increased susceptibility to
infection.
Inflammation
Clinical manifestations
Discharge
Itching
Odor
Redness
Burning
Edema
Assessment
Examine ASAP
Instruct client not to douche before assessment → removes needed discharge for
diagnosis.
Assess for: erythema, edema, excoriation, abnormal discharge.
Ask about: discharge characteristics, odor, itching, burning, dysuria.
Rule out UTI → urine culture and sensitivity.
3
Function
Structural Disorders
Alterations in uterine position and pelvic support
Pelvic organ prolapse
Caused by weakening of vaginal walls → pelvic organs descend into vaginal canal
Risk factors:
Vaginal childbirth trauma
Hormone deficiency
Age
Previous pelvic surgery
Genetics
Uterine Prolapse
When the pelvic muscles weaken, the
uterus can slide down the vaginal canal
and protrude through the vaginal
opening
Procidentia: severe prolapse where
uterus protrudes outside vaginal
orifice.
Prolapse may drag vaginal walls,
bladder (cystocele), or rectum
(rectocele).
Symptoms
Pressure
Pulling
Incontinence/retention
Activity/increases abd pressure can worsen s/s
Symptoms worsen with coughing, lifting, prolonged standing, stair climbing.
Management
Surgical vs non-surgical
• The uterus can be stitched back into place
• Hysterectomy (postmenopausal)
1
, • Colpocleisis (vaginal closure) - for women not desiring intercourse or fertility
• Lifestyle changes
• Pessaries
• Kegel exercises
• Conservative management preferred for mild prolapse, women desiring children,
or those unfit for surgery.
• Transvaginal surgical mesh is no longer considered effective treatment
Preventative measures
Early detection during pregnancy and postpartum visits.
Educate women on pelvic floor exercises to strengthen supportive muscles.
Prompt treatment prevents complications (infection, cervical ulceration, cystitis,
hemorrhoids).
Cystocele
Downward movement of the bladder
Can protrude through vaginal opening
Due to damage to pelvic floor muscles
Often results from childbirth injury/strain; may
present years later with aging and genital
atrophy.
Can also affect younger multiparous,
premenopausal women.
Rectocele
Upward pushing of rectum which pushes the vaginal wall forward
Lacerations during childbirth can increase risk
Often related to childbirth trauma, muscle tears, or perineal lacerations.
Severe cases: complete tear of anal sphincter fibers.
Infections
Infection
Vaginal Protection Against Infection Normal vaginal pH: 3.5–4.5 Maintained by:
Lactobacillus acidophilus → produces lactic acid (lowers pH) and hydrogen peroxide
(toxic to anaerobes).
2
, Estrogen → stimulates glycogen formation → glycogen breakdown → lactic acid
production.
Factors that disrupt protection:
Stress, illness, or reduced immune resistance.
Hormonal changes (↓ estrogen during lactation, peri-/postmenopause → ↓
glycogen → ↑ infection risk).
Antibiotic therapy (reduces normal flora, alters pH, allows fungal overgrowth).
Contact with infected partner.
Tight, nonabsorbent clothing (retains heat & moisture).
Menopause effects:
Atrophy of vaginal/labial tissue (thin, fragile mucosa). Increased susceptibility to
infection.
Inflammation
Clinical manifestations
Discharge
Itching
Odor
Redness
Burning
Edema
Assessment
Examine ASAP
Instruct client not to douche before assessment → removes needed discharge for
diagnosis.
Assess for: erythema, edema, excoriation, abnormal discharge.
Ask about: discharge characteristics, odor, itching, burning, dysuria.
Rule out UTI → urine culture and sensitivity.
3
