Vaginal Discharge Solution
Teach the patient to notify the physician of an increase in bleeding, return of painful uterine cramping, malodorous vaginal discharge, temperature greater than 100.4 F, or persistent feelings of depression. HOME CARE. Teach the patient to avoid strenuous activities for a few days. Encourage the patient to use peripads instead of tampons for light vaginal discharge to decrease the likelihood of an infection. Explain that the patient should avoid intercourse for at least 1 week and then use some method of birth control until a future pregnancy can be discussed with the physician. Follow-up is suggested. A phone call to the patient on her due date will demonstrate support and provide an outlet for her to express her grief.
In most instances, precancerous lesions are totally excised by conization and no further operation will be necessary. Accordingly, diagnostic conization serves also as a therapeutic measure. Occasionally cervical conization may be required as a means of treatment, e.g.,in patients with resistant vaginal discharge. Here, careful histological examination of the squamocolumnar junction is advisable to ensure that possible precancerous changes are not overlooked.
An assessment of quality of life showed no difference in depression scores between groups. Hot flushes were noted in 81 of the women on tamoxifen compared to 69 of the placebo group and the tamoxifen-associated hot flushes appeared to be of greater severity than those in the placebo group. Moderately bothersome or severe vaginal discharge was reported by 29 of the women in tamoxifen group and 13 in the placebo group. No differences in occurrence of irregular menses, nausea, fluid retention, skin changes, or weight gain or loss were reported.207'208
Symptoms of vaginitis include vaginal discharge, pruritus, irritation, soreness, odor, dyspareunia and dysuria. Dyspareunia is a common feature of atrophic vaginitis. Abdominal pain is suggestive of pelvic inflammatory disease and suprapubic pain is suggestive of cystitis.
A diagnosis of cervicitis, typically due to Neisseria gonorrhoeae or Chlamydia trachomatis, must always be considered in women with purulent vaginal discharge. The presence of high-risk behavior or any sexually transmitted disease requires screening for HIV, hepatitis B, and other STDs.
Diagnosis is based on history, physical examination, and laboratory testing. The patient's history alone is correct in 90 of patients. Urinary leakage or excess vaginal discharge is sometimes mistaken for PROM. B. The patient should be evaluated for the presence of chorioamnionitis fever (over 38 C), leukocytosis, maternal and fetal tachycardia, uterine tenderness, foul-smelling vaginal discharge .
Primary genital episode genital HSV is characterized by multiple painful vesicles in clusters. They may be associated with pruritus, dysuria, vaginal discharge, and tender regional adenopathy. Fever, malaise, and myalgia often occur one to two days prior to the appearance of lesions. The lesions may last four to five days prior to crusting. The skin will reepithelialize in about 10 days. Viral shedding may last for 10 to 12 days after reepithelialization.
Any pregnant woman with a vaginal discharge or inflamed vulvovaginal area should be evaluated for Candida. Candida vulvovaginitis is the second most common cause of vaginitis after bacterial vaginosis. Many women are asymptomatic, but the classic signs are a profuse, pruritic, thick, white, curdlike discharge associated with dysuria, dys-pareunia, and pruritus ani. The diagnosis of Candida vulvovaginitis is a clinical diagnosis that is confirmed by culture and microscopic detection of the yeast. A drop of the cervicovaginal fluid should be immersed in a 10 potassium hydroxide (KOH) preparation on a glass slide with a coverslip for microscopic examination. Sometimes, this
Postoperatively monitor the patient's vaginal discharge, which should be minimal, as well as the patient's pain level and response to analgesics. Sitz baths may be used for comfort. In an anterior repair, an indwelling urethral catheter is inserted and left in place for approximately 4 days. Encourage fluid intake to assure adequate urine formation. After a posterior repair, stool softeners and low-residue diets are often given to prevent strain on the incision when defecating.
In a multicenter study, including 2322 women, the Pearl Index of efficacy in compliant patients was 0.8. Irregular bleeding was uncommon (5.5 of cycles), and withdrawal bleeding occurred in 98.5 of cycles. Compliance was 86 , with 15 of women discontinuing treatment because of an adverse event, most commonly device-related discomfort, headache, or vaginal discharge vaginitis. Only 2.5 of discontinuations were device related.
Health care providers should maintain a low threshold for the diagnosis of PID, and sexually active young women with lower abdominal, adnexal, and cervical motion tenderness should receive empiric treatment. The specificity of these clinical criteria can be enhanced by the presence of fever, abnormal cervical vaginal discharge, elevated ESR and or serum C-reactive protein, and the demonstration of cervical gonorrhea or chlamydia infection.
All sexually active women presenting with lower abdominal pain should be carefully evaluated for the presence of salpingitis and or endometritis-pelvic inflammatory disease (PID). In addition, routine bimanual and abdominal examinations should be carried out on all women with a presumptive STI, since some women with PID or endometritis will not complain of lower abdominal pain. Women with endometritis may present with complaints of vaginal discharge and or bleeding and or uterine tenderness on pelvic examination. Symptoms suggestive of PID include abdominal pain, dyspareunia, vaginal discharge, menometrorrhagia, dysuria, pain associated with menses, fever, and sometimes nausea and vomiting.