Question

Give a brief description how you would assess the reproductive system of a male or female patient, young adult, middle age, or older patient (choose).You may only cover one aspect of the assessment.

Discuss, in brief, one psychosocial or psychological impact of the effect of breast disorder of a patient. Choose which disorder you want to talk about.

Discuss, in brief, one gynecologic problem of a patient. Choose which disorder you want to talk about.

Answer 1

• Assessment of Female Reproductive System of Middle aged Female:

The female reproductive system consists of the breasts; uterus; fallopian tubes; cervix and introitus. The assessment of the reproductive system should be done in presence of a female attendant (if the person who is assessing is a male); with privacy and consent of the patient.

A.Inspection:

                     Breasts: 1. To inspect the position and size of the breast and if it is corresponding with the age and generalised overall condition of the breast.

                                     2. To inspect the nipple and look for any retraction ; eversion and its normal position.

                                     3. To inspect the areola and look for any fissure present or not.

                    Per Abdomen: 1. To look for any striae; any incision lines or any obvious swelling present or not

                                             2. To look at the position of umbilicus or any obvious abdominal distension present/not.

                      Introitus: 1. To look for any discharge per-introital or any redness or obvious swelling.

                                     2. To look for any protruding out of the introitus and to look for cough impulse.

                                     3. To visualize the cervix with the help of a speculum and look for any breach in the continuity, any bleeding or discharge.

B. Palpation:

                        Breasts: 1. To assess the mobility of the breasts; and any heaviness of the breasts.

                                       2. To palpate the axillary lymph nodes in that area.

                                       3. To look for any generalized increase in temperature or tenderness in any of the breast

                        Abdomen:

                                        1. To look for any increase in temperature or tenderness per abdomen.

                                        2. To palpate for any mass in the lower abdominal area or any evidence of presence of fetus pole.

                      Per Introital:

                                       1. To feel the wall of the introital mucosa is consistent and palpate for any mass/ swelling.

                                        2. To palpate the external os and find whether it is open/ closed; along with its consistency.

                                        3. To palpate the cervix and assess its size and shape.

                                        4. To assess the level of the fetus pole (if present) with the level of the iscial spine to assess the fetal descent.

C. Percussion: To look for any shifting dullness / fluid thrill to assess ascites.

D. Auscultation: To look for any IPS(Intestinal Peristaltic Sound) or FHS(Fetal Heart Sound) per abdomen present or not.

Psychological effect of breast disorder of a patient:

Patients suffering from breast disorders suffer from various psychological problems. It occur mainly due to lack of knowledge about the course of the disease; the social stigma and apprehension about the line of treatment and recovery period. Generally, the patients suffer from anxiety disorder and depression. It occurs due to the apprehension and lack of support from the relatives.Breasts are also organ of feminity and sexuality. Due to a disorder, the sexual drive of the person may decrease. The patient becomes concerned about her looks after its removal and its effect on motherhood. As a result of cumulative effect of the above scenarios, result in lack of sleep of the patient and tendency to commit suicide in the late stages.

Gynecological Problem: Let us put a discussion on painful or difficult mensuration in a patient.

The above complaint is referred to as Dysmenorrhoea in medical terms.

Classification:

It can be divided into primary and secondary dysmennorhoea.

Clinical points	Primary Dysmennorhoea	Secondary Dysmennorhoea
Age	Occurs in adolescent	Occurs after 25 years
Etiology	Occurs due to excessive prostaglandin production and anatomical abnormality	Occurs due to gynecological disorders like endometriosis;PID; fibroid etc.
Clinical Features	Onset of pain before mensturation; stays for 1-2 days	onset after mensturation and persists throughout the period
Associated Symptoms	Associated with headache, nausea, dizziness, vomiting	Associated with menorrhagia,dysmenorrhoea
USG	usually normal findings	May reveal the underlying pathology
Treatment	Analgesics, OCPs	According to the cause; generally surgery