GYNAECOLOGICAL

NURSING
UNIT I
CONCEPTS AND PRINCIPLES
GYNAECOLOGICAL NURSING
Definition;

Gynaecological nursing is a specialization in

women's health, managing diseases and health issues
specific to women.

A Gynaecology Nurse typically works within a

multidisciplinary team to deliver personalised care to
women of all ages and backgrounds
• Health of women is a vital aspect to cater. Women

face a lot of issues that can turn from bad to worse

early on if adequate medical attention is not

sought.

• From puberty, menarche, breast development,

pregnancy to menopause, significant diseases affect

women.
• significant diseases affect women. Each of such
diseases are managed by a health professional known
as a Gynaecologist and gynaecological nurses.

• Starting from maturity when the reproductive organs

mature, women are advised to have an annual or at
least 3 yearly health check with a gynaecologist.

• Awareness of basic bodily functions and maintaining

good physical and mental wellbeing are all vital aspects
of managing women health.
 Concepts of gynaecological nursing
The major aspects includes gynaecological nursing
are
– Preventive care
– Birth control
– Clinical breast examination
– Pelvic examination
– Vaccination
– Sexual health
– Conception
– Mental health
Preventive care

Every women needs to be counselled regarding

healthy lifestyle practices to maintain good health
during puberty, pregnancy and old age to prevent
various diseases and cancers affecting each age
group.
Birth control

Sexually active females need to be advised

about birth control and the need to prevent various
diseases such as herpes, HIV, gonorrhoea, syphilis etc,
and unwanted pregnancies.
Clinical breast examination

monthly self-examination of breasts are

advised, a regular check-up from a trained
professional can help identify what is unknown.
Pelvic examination
Having a health care professional identify red flags of
any disease
Most women panic on abnormal discharges such as
blood during non-menstrual days, white discharges,
curdy discharges lumps and swellings in their private
areas etc.
hence regular clinical pelvic examinations are very
essential.
Vaccination

• Annually, a visit to the health professional is

recommended for getting the vaccination shots.

• HPV vaccinations reduce the risk of certain cancers

such as cervical, vulvar, oral, vaginal and anal
cancers.

• And other regular vaccinations such as flu-shots

prevent influenza viral illnesses.
Sexual health

• Perhaps a gynaecologist/ gynaecological nurse is

the only professional a female can freely discuss the
issues pertaining to her sexual life and well-being.

• Hence periodic follow-up will help establish a

rapport to discuss the vital aspects of sexual health
and seek immediate remedy.
Conception
• genetic diseases are high in delayed age at pregnancy, a
woman is prone to many illnesses and conceiving could
turn out a bad outcome for the baby.
• Hence a premarital counselling and preconception
counselling is extremely important to plan a child and
create a healthy family. Necessary supplements such as
vitamins, minerals and other nutrients are essential for
a healthy growth of a baby which are prescribed
individually to each women
• Mental health
• Most women suffer from regular hormonal
imbalances leading to chaotic personal life and
mental suffering. These moments are at an all-time
high during monthly menstruation, post-pregnancy,
menopause and for unknown reasons.

• During these events, the woman to have someone

to speak to comfortably and sort the issues
medically to gain proper control in life.
 Ethical Principles in gynaecological
Nursing
The ethical principles provide a foundation
for nursing as well as the gynaecological nursing
practice. Principles are defined as basis for
nurse’s decisions on consideration of
consequences and of universal moral principles
when making clinical judgments.
All ethical principles are important in gynaecological
aspect they are
• Autonomy
• Non-maleficence
• Beneficence
• Justice
• Veracity
• Confidentiality
• Fidelity
• Accountability
Autonomy
• agreement to respect another's right to self-
determine a course of action;

• support of independent decision making. Informed

consent is a method that promotes and respects a
person’s autonomy.

• For a client to make an autonomous decision and

action, he or she must be offered enough
information
Non-maleficence (no harm)

avoidance of harm or hurt; core of medical oath

and nursing ethics. Often in modern times, non-
maleficence extends to making sure you are doing no
harm in the beneficent act of using technology to
extend life or in using experimental treatments that
have not been well tested.
Nursing Interventions For Non Maleficence

–Avoiding deliberate harm, risk of harm that

occurs during the performance of nursing
actions.
–Considering the degree of risk permissible.
–Determining whether the use of
technological advances provides benefits
that outweigh risks.
Beneficence (doing good)

compassion; taking positive action to help

others; desire to do good; core principle of our
patient advocacy. Beneficence is doing or active
promotion of good. This is done by:

• Providing health benefits to the clients.

• Balancing the benefits and risks of harm.

• Considering how a client can be best helped.

Justice

Justice refers to an equal and fair distribution of

resources, based on analysis of benefits and burdens
of decision. Justice implies that all woman have an
equal right to the goods distributed, regardless of
what they have contributed or who they are.
Veracity (honesty)
the principle of truth telling, and it is grounded in respect for
persons and the concept of autonomy.
In order for a person to make fully rational choices, he or she
must have the information relevant to his or her decision.
Moreover, this information must be as clear and understandable
as possible.
Truth telling is violated in at least two ways. The first is by the
act of lying, or the deliberate exchange of erroneous
information.
Confidentiality: (secrecy) –

respect privileged information; information about

the client must be maintained client privacy.

Documentation regarding vital information about the

state of health of clients can only be read for the

purposes of treatment and health improvement of

clients. Discussion on clients outside the service area

should be avoided
Fidelity (keeping promises)

this principle requires loyalty, fairness,

truthfulness, advocacy, and dedication to our
patients. It involves an agreement to keep our
promises. Fidelity refers to the concept of
keeping a commitment and is based upon the
virtue of caring.
Accountability

definite standard that measures a

professional can be assessed in a situation
that is unclear or signs exception.
CONGENITAL ABNORMALITIES OF
FEMALE REPRODUCTIVE SYSTEM
 Congenital anomalies comprise a wide range of

abnormalities of body structure or function that are

present at birth and are of prenatal origin.

Congenital abnormality
Congenital disorders can be defined as
structural or functional anomalies that occur during
intrauterine life. Also called birth defects, congenital
anomalies or congenital malformations, these
conditions develop prenatally and may be identified
before or at birth, or later in life.

(WHO)
The female reproductive system again
subdivided in to
– External genitalia

– Internal genitalia

– Accessory reproductive organ

External genitalia/ valva refers to those parts that are outwardly
visible

Includes

– mons pubis
– Labia majora
– Labia minora
– Clitoris
– Urethral opening
– Vaginal opening
– perinum
 DEVELOPMENTAL ANOMALIES OF THE EXTERNAL

GENITALIA

• PERINEAL OR VESTIBULAR ANUS

• ECTOPIC URETER
PERINEAL OR VESTIBULAR ANUS
The entity is detected at birth. The usual anal
opening site is evidenced by anal pit.

The anal opening is situated either

– close to the posterior end of the vestibule or

– in the vestibule.

– Rarely, it is situated in the vagina (congenital

rectovaginal fistula).
• The opening is usually sufficiently big and
continence is present.

• no problem in reproduction.

• The delivery conducted by cesarean section

• If there are features of obstruction or the opening is

situated high in the vagina, pull through operation
is to be done bringing the anal end to the anal pit
with prior colostomy.
ECTOPIC URETER
• The additional ureteric opening is usually in the
vestibule close to the urethra or in the vagina.

• The main symptom is uncontrollable wetness.

• Partial nephrectomy and ureterectomy may be

indicated or implantation of the ectopic ureter into
the bladder done for the management
VAGINAL ABNORMALITIES
–Narrow introitus

–Hymen abnormality

–Septum

–Agenesis

–Associated abnormalities
NARROW INTROITUS
• The existence is revealed after marriage.

• Dyspareunia may be the first complaint, or it may

be detected during investigation of infertility.

• Treatment is effective by manual stretching under

general anesthesia or by surgical enlargement
(Perineoplasty/Fenton’s operation)
HYMEN ABNORMALITY
• Gross hymenal abnormality of significance is imperforate
hymen.

• It is due to failure of disintegration of the central cells of the

Müllerian eminence that projects into the urogenital sinus

• The existence is almost always unnoticed until the girl attains

the age of 14–16 years. As the uterus is functioning normally,
the menstrual blood is pent up inside the vagina behind the
hymen (cryptomenorrhea).
• Depending upon the amount of blood so
accumulated, it first distends the vagina
(hematocolpos). The uterus is next involved and the
cavity is dilated (hematometra). In the late and
neglected cases, the tubes may also be distended
after the fimbrial ends are closed by adhesions
(Hematosalpinx)
Clinical features
• The girl is aged about 14–16 years.
– periodic lower abdominal pain, which may be
continuous,

– primary amenorrhea

– urinary symptoms, such as frequency, dysuria or even

retention of urine.
• Abdominal examination; suprapubic swelling, which
may be uterine or full bladder
• Vulval inspection; tense bulging membrane of bluish
coloration
• Rectal examination; bulged vagina.
• Ultrasonography; diagnosis of hematometra and
hematocolpos
• In newborn (usually within one week of birth),
accumulated mucus behind the imperforate membrane
gives the clinical entity of mucocolpos.
Treatment
• incision is made in the hymen. The quadrants of the
hymen are partially excised not too close to the
vaginal mucosa. Spontaneous escape of dark tarry
colored blood is allowed. Pressure from above
should not be given. Internal examination should
not be done.

• The patient is put to bed with the head end raised.

• Antibiotic should be given.

VAGINAL MALDEVELOPMENTS
• Common variations of vaginal
maldevelopments are,

• Agenesis of vagina

• Failure of vertical fusion

• Failure of lateral fusion

• Etiological factors
– not clearly understood/ unknown causes.

– probable causes are: polygenic, multifactorial,

teratogens, or environmental.

• Pathology of Müllerian malformation

– due to failure of formation of the vaginal plate or due to
its failure of cavitation.
Vertical fusion defects

result in failure of fusion of the Müllerian system

with urogenital sinus. It may also be due to

incomplete or segmental canalization of the vagina

Disorders of lateral fusion

due to failure of the two Müllerian ducts to

unite. This results in double uterovaginal canals. Such

malformation may be obstructive or nonobstructive.

Transverse vaginal septa are due to faulty fusion or

canalization of the urogenital sinus and the Müllerian

ducts. About 45% occur in the upper vagina, 40% in

mid vagina and 15% in the lower vagina.

• Septum located in the lower vagina is often complete
and the signs and symptoms are similar to that of
imperforate hymen.
• Ultrasonography is a useful investigation to detect
hematometra, hematocolpos, and also urinary tract
malformations.
• The principles of surgical treatment are the same.
Septum in the upper vagina is often perforated. Incision
of a complete (imperforate) septum becomes easy
when the upper vagina is distended.
• Longitudinal septum of the vagina may be present
when the distal parts of the Müllerian ducts fail to
fuse (fusion failure).

• It may associated with double uterus and double

cervix. It may be asymptomatic and needs no
treatment.

• it may cause dyspareunia or may obstruct delivery.

PARTIAL AGENESIS OF UPPER VAGINA

• segment of vagina may be atretic in the upper-third. It is

often associated with hypoplasia or even absence of cervix.

• Uterus may be normal and functioning or malformed.

• Primary amenorrhoea (cryptomenorrhea), hematometra,

hematocolpos, cyclic lower abdominal pain and presence of

lower abdominal mass (as felt per abdomen or per rectum)

point to the diagnosis.

Treatment
hysterectomy. Currently, abdominovaginal
approach is made to establish communication
between the uterovaginal canal above and the newly
created vagina below.

Prosthesis is used to prevent restenosis.

Assisted reproductive technology would be the

option, when desired, using a surrogate uterus.
COMPLETE AGENESIS
• Complete agenesis of the vagina is almost always
associated with absence of uterus.

• however, presence of healthy gonads and fallopian

tubes. The patient is phenotypically female, with
normal female karyotype pattern.

• The patient usually seeks advice for primary

amenorrhea and dyspareunia.
Treatment
needs psychological counseling. Often they are
depressed concerning their sexual and reproductive
life.

Treatment options are

– Nonsurgical

– Surgical.
Nonsurgical method
Repeated use of graduated vaginal dilators for a period
of 6–12 months. Presence of a vaginal dimple (1 cm) is often
seen. This method (Frank, 1938) is a simple and effective.
Surgical methods various procedures of vaginal
reconstruction (vaginoplasty) are done.

• McIndoe-Reed procedure; A space is created digitally

between the bladder and the rectum. Split thickness
skin graft is used over a mould. This mould is kept in
this neovaginal space.

• Williams Vulvovaginoplasty; A vaginal pouch is created

from skin flaps of labia majora in the midline.

• Vaginoplasty with amnion graft

Complications of vaginoplasty

– infection and bleeding

– Dyspareunia,

– restenosis
ASSOCIATED ABNORMALITIES

• Vesicovaginal fistula is formed when the Müllerian

eminence ruptures into the vesicourethral part of the
cloaca instead of the pelvic part of the urogenital sinus

• Rectovaginal fistula when the Müllerian eminence opens in

the dorsal segment of the endodermal cloaca.

• Persistent urogenital sinus with various irregularities of

urethral and vaginal orifices in the sinus
UTERINE ANOMALIES
• American Fertility Society ( AFS) classification-
– Class I: Mullerian agenesis/ Hypoplasia

– Class II: Unicornuate uterus with or without

rudimentory horn.

– Class III: Uterus didelphys

– Class IV: Bicornuate uterus

– Class V: Septate uterus

– Class VI: Arcuate uterus

– Class VII: Diethylstilbesterol (DES) related anomalies

Incidence
varies in 3-4% women affect with uterine anomalies
in general population
• Mullerian agenesis failure of development of one
or both Mullerian ducts:

• Absence of both ducts leads to absence of uterus

including oviduct and absence vagina as well.

• Primary amenorrhoea is cheif complaint.

• Absence of one duct leads to unicornuate uterus

with single oviduct.
• Arcuate uterus (18%) Fundus looks concave with
heart shaped cavity outline.

• This looks more like a normal uterus, except it has a

deep or slight indentation at the top.

• It is a common abnormality, affecting 1:25 in

general population

• It doesn’t usually make conceiving difficulty

• Uterus didelphys Complete lack of fusion of the
Mullerian ducts with a double uterus and double
vagina.
• Uterus has two inner cavities, each cavity may leads
to own cervix and vagina, so there are two cervix
and two vaginas.
• It is uncommon affecting 1:350 women.
• It is possible to concieve and have a straight
forward pregnancy
• Uterus bicornis are varying degrees of fusion of
muscle walls of two ducts.
• Uterus bicornis bicollis: There are two uterine
cavities with double cervix with or without vaginal
septum.
• Uterus bicornis unicollis: There are two uterine
cavities with one cervix. Horns may be equal or one
horn may be rudimentary and have no
communication with developed horn.
• Septate uterus Two Mullerian ducts fused together
but there is persistence of septum in between two
either partially or completely
Unicornuate utrus Failure of development of one
Mullerian duct
DES related abnormalities
It is due to DES exposure during intra uterine life,
variety of mal formations are included
• Vagina: Adenosis, adenocarcinoma

• Cervix : Cockscomb cervix, cervical collar.

• Uterus : Hypoplasia, T-shaped cavity, uterine

synechiae.

• Fallopian tube: Cornual budding, abnormal

fimbriae.
ABNORMALITIES OF THE FALLOPIAN TUBE

• Elongated tubes

• accessory ostia or diverticula.

• Absent of tube on one side.

These conditions may lower the fertility or favor

ectopic pregnancy.
• LABIA MINORA: Labial fusion due to developmental

defect

• LABIA MAJORA: Hyperplastic or hypoplastic labia,

Abnormal fusion in adrenogenital syndrome

• CLITORIS: Clitorial hypertrophy—often associated

with various intersex problems

Trends and issues in nursing
 Gynaecological nursing is a specialized

field that focuses on women's health,

specifically the female reproductive system.

Some current trends and issues in

gynaecological nursing include:

Advancements in Technology

Improved technology in diagnostic tools and

treatment options have revolutionized the field of
gynaecological nursing.

For example, the use of robotic surgery for

gynaecological procedures can lead to quicker
recovery times and improved outcomes.
Focus on Preventative Care

There is a growing emphasis on

preventative care in gynaecological
nursing, including education on screening
tests such as Pap smears and HPV
vaccinations to prevent cervical cancer.
Addressing Health Disparities

Gynaecological nurses are increasingly

focusing on addressing health disparities
among women, particularly in marginalized
communities. This includes advocating for
improved access to healthcare services and
resources.
Promoting Women's Health Across the
Lifespan
Gynaecological nurses play a crucial role
in promoting women's health at all stages of
life, from adolescence to menopause and
beyond. This includes providing education on
reproductive health, family planning, and
menopausal care.
Mental Health Support

Gynaecological nurses are recognizing the

importance of mental health support for
women dealing with gynaecological issues such
as infertility, pregnancy loss, and gynaecological
cancers. Providing emotional support and
resources is a key aspect of their role.
 Patient- Centered Care

There is a shift towards more patient-

centered care in gynaecological nursing, which

involves actively involving patients in decision-

making regarding their care and treatment

options.
Research and Evidence-Based Practice
Gynaecological nurses are increasingly
involved in research to improve patient
outcomes and enhance evidence-based
practice in the field. Staying current with
the latest research findings is important for
providing high-quality care.
 These are just a few of the trends and issues
shaping the field of gynaecological nursing today. It's
an exciting and dynamic field that continues to evolve
to meet the healthcare needs of women.
 SEXUALITY AND
REPRODUCTIVE HEALTH
 SEXUALITY
Sexuality is the state of having sex. The collective

characteristics that mark the difference between the

male and female". Or "the constitution of an

individual in relation to sexual attitude and behaviour.

CHARACTERISTICS OF DEVELOPMENT SEXUALITY
• Adolescence starts with quick alterations in the body and
experiences with sexuality.

• changes create inner alterations exhibited in the adolescence

behaviour.

• A sense of identity is the developmental crisis of adolescent.

• Development of the identity is the major need of intimate

relationship to other especially with opposite sex.

• Adolescence perceive themselves as unique and distinct.

• The adolescents experience unfamiliar feeling and seek
peer approval because of rapid physical growth and
maturational changes.

• During adolescence period try to achieve autonomy

from the family.

• Adolescence are become egocentric, lack the ability to

differentiate their own opinions from that of others.

• During early adolescence, they have concrete thinking.

• Adolescents do not like parental restraints

• afraid to be independent when they think of the

responsibilities along with independence.

• Adolescents wish to enjoy freedom

• develop social relationship.

• need acceptance from friends, close friends and

supportive family
• Adolescents, tends to be critical, argumentative and
reject parental control.
• spend more time outside the family with the peer
group.
• behaviour fluctuates according to the mood. In early
adolescence,
• peer group begin to provide information regarding
sexual relationship and expects development of such
relationship. These expectations vary from culture to
culture.
Sexual ethics
• Societal restriction for some sexual activities
are considered as inappropriate
• Sex is degraded when performed outside the
marriage
• Sex should involve partners completely both
physically and psychologically
• Types

– Sexual function with in the marriage

– Sex out side the marriage

• Sexual function with in the marriage

– Fulfills the bond between couples

– Provide emotional and psychological satisfaction

– Reinforces exclusive relationship

– Resolve conflict

– Reduces anxiety
Sex out side the marriage

• just for a sake of recreation and not for love

• Only provide materialistic value

• Medical issues in sexual activity

– Sexual dysfunction

– Sexually transmitted disease

– Rape ( abusive sexuality)

– Sexual harassment
 REPRODUCTIVE HEALTH
Puberty is a term used to describe a period in
which there are tremendous and rapid changes in the
child's body that dramatically transform children's
lives, exposing them to new dangers and new
opportunities. Puberty marks the gradual progression
from a non-fertile child to a sexually developed adult.
 Pubertal changes occur under the influence of
hormones that stimulate the growth and change of
many different parts of the body.

The lack of adequate information, acceptance

and support creates on an experience of anxiety and
isolation.
 Puberty is the process of physical changes
by which a child's body matures into an adult
body capable of sexual reproduction to enable
fertilization. It is initiated by hormonal signals
from the brain to the gonads;( the ovaries in
girls)
• Physical growth-height and weight-accelerates in

the first half of puberty and is completed when the

child has developed an adult body. Until the

maturation of their reproductive capabilities,

• the pre-pubertal, physical differences between boys

and girls are the genitalia, the penis and the vagina.
Definition of Puberty

"It is a period of rapid physical change and personality

growth when individual achieve their adult bodily
structure". Or "Puberty is the period in the
developmental span when the child changes from an
asexual to a sexual being".
Age of Puberty

The age of puberty varies among girls. In girls, it

usually occurs at the age of 10 years to 14 years
Physical Sex Characteristics of Girls

The development of primary sex characteristics and

the secondary sex characteristics.

Primary Sex Characteristics
• Increase in the weight of the uterus.
• Maturation of reproductive mechanism.
• First menstrual flow.
• The girls menstrual periods generally occur at irregular
intervals and vary markedly in length for the first year
or so. This period is known as stage of adolescent
sterility.
• Rapid growth in length in the uterus and in the weight
of the ovaries.
Secondary Sex Characteristics
The physical features which distinguish males
from females and which makes member of sex
appealing to members of the other sex.

Characteristics Includes enlargement of hip

bone, breast, hair growth, muscles and voice changes
occur.
Effects of Puberty Changes

The physical changes of puberty affect every

area of the body, both internally and externally

• last to bring about a change in habitual pattern of
behavior attitude and personality.
• Effect on physically well being
• Effect on attitude and behavior
• Desire for isolation
• Boredom
• Incoordination
• Excessive modesty, the child become excessive
modest for fear that other will notice these changes
comment on them unfavorably.
• Loss of self confidence
MENSTRUAL HYGIENE
internal organ reaches its maturity, is called
menarche.

the visible manifestation of cyclic physiologic uterine

bleeding occur due to shedding of endometrium.

During menstruation girls feel physically and

behaviorly more uncomfortable they feel some kind
of symptoms like: cramps, headache, backache,
vomiting, change in behavior.
• to discuss, explain and counsel a girl experiencing
pubertal changes.
– Take warm bath

– Avoid to take tea and coffee

– Take rest

– Use comfortable pads during menstruation if girls are

atheletes
 teaching Girls how to Manage Menstruation
Young girls need to learn how to cope with the
periods, i.e. use hygienic pads which serve their
purpose by absorbing and containing the menstrual
flow.
– Cloth should be properly protected from stains.

– Proper use of pads so that they remain free to pursue

their activities without being continually reminded.

– Discard the pad frequently.