At the beginning of the work, it is pivotal to take a complete medical history from the patient to exclude problems with other systems of the body. When interviewing the patient, special attention must be paid to potential pregnancy, sexual history, past gynecological diseases, changes in general health condition, the characteristics of vaginal discharge, and menstruation history. The following details should be clarified about menstruation: whether periods are regular, the first day of the LMP, the length of the cycle, period heaviness, the presence of pain, the characteristics (color, odor, etc.) of the menstruum, and the presence of metrorrhagia. Also, the questions concerning abnormal bleeding between periods/after sex and the age of menarche should be asked.
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Questions related to sexual history and contraception should also be included in the interview to understand the nature of the condition. In particular, the patient should be asked about the recent sexual activity, types of sexual contacts (heterosexual/homosexual; oral/anal/vaginal) practiced the total number of partners, the cases of unprotected sex/accidental contacts/rape, partners’ STD history, personal hygiene before/after contacts, preferred methods of contraception. Also, it is pivotal to include questions about the presence of dyspareunia, genital traumas, STD history, and pregnancy symptoms.
The patient reports having abnormal vaginal discharge, and she needs to be interviewed about its characteristics. Among them are its color (white, clear, yellow, green, etc.), smell, frequency, volume, and the circumstances in which it appears (after coitus, periods, at the beginning/end of the monthly flux) (Hasan & Ocviyanti, 2016). Also, given that having discharge is the chief complaint, the girl should be asked about any abnormal symptoms that she or her partner’s notice (eruptions, itchiness, pain), her smear history, pregnancies, miscarriages, and abortions. The information concerning general health condition (the history of substance/alcohol abuse, abnormal weight changes, breast lumps/discharge, and dermatological issues should also be taken into account.
Before performing a physical examination, it is critical to explain the purpose of the procedure to the patient and obtain her written permission. Importantly, to maintain dignity, the patient should be allowed to use a panel screen when undressing. First, the patient’s general physical condition should be analyzed to identify skin color changes, abnormal weight, or fever. Then, a vaginal examination should be performed to ensure that there are no skin damages, lumps, or eruptions. During an intravaginal examination, special equipment such as bivalve speculum needs to be used to evaluate the patient’s vaginal walls, the cervix, and check the presence of lumps or other abnormal signs (Dabson, Magin, Heading, & Pond, 2014). The symptoms that the patient reports can often be caused by retained foreign bodies such as tampons or condoms, and their presence should also be checked (Zuckerman & Romano, 2016). If there is any discharge, a cervical smear should be taken with the help of clean cervical brushes.
The Plan of Care
The patient’s chief complaints (abnormal discharge and a foul odor) can be related to a range of gynecological diseases, and the plan of care should be constructed about all potential diagnoses. The symptoms the patient reports are manifested in women with bacterial vaginosis, candidal vaginitis, pelvic inflammatory disease, or STDs such as trichomoniasis and chlamydiosis (Hasan & Ocviyanti, 2016).
An important component of the care plan is excluding pregnancy with the help of pregnancy tests (urine, blood) and analyzing hCG levels. Considering the key symptoms, the sexual history of the patient, and the characteristics of discharge, STD diagnostic tests are necessary (cervical specimens are to be collected). Trichomonas vaginalis or other parasites can be detected with the help of traditional wet preparation microscopy tests (Van Der Pol, 2015). In certain cases, abnormal discharge indicates cancer; consequently, if some lumps are detected during the examination, cancer screening can also be included in the plan of care.
The use of treatments would depend on the final diagnosis and the patient’s pregnancy status. With that in mind, treatments that can be used in the case under analysis vary from various medications such as antibiotics to surgical operations. Disregard of the diagnosis, the patient should be provided with recommendations concerning self-hygiene and sexual life. To begin with, sexual contacts (especially vaginal) are to be avoided during treatment to prevent further exacerbation of symptoms. Also, the development of proper hygiene habits is extremely important to avoid irritation and itching. Consideration should also be given to the choice of self-hygiene products that would not dry the patient’s skin and impair pH balance.
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Common Infections in Sexually Active Women
Sexual activity is associated with increased risks of urinary and vaginal infections in adult women. Nowadays, the most common urinary infections in the specified population group are urethritis and cystitis, the conditions that are often caused by sexually transmitted infections (John, Mboto, & Agbo, 2016). Vaginal infections that are common in the population under analysis are trichomoniasis and bacterial vaginosis (Hasan & Ocviyanti, 2016). The prevalence of the diseases may vary depending on race – it is usually higher for racial minorities due to economic constraints and the lack of STD prevention knowledge.
Dabson, A. M., Magin, P. J., Heading, G., & Pond, D. (2014). Medical students’ experiences learning intimate physical examination skills: A qualitative study. BMC Medical Education, 14(1), 39. Web.
Hasan, F. D., & Ocviyanti, D. (2016). Identifying causes of vaginal discharge: The role of gynecologic symptoms and signs. Indonesian Journal of Obstetrics and Gynecology (INAJOG), 3(1), 3-10.
John, A. S., Mboto, C. I., & Agbo, B. (2016). A review on the prevalence and predisposing factors responsible for urinary tract infection among adults. European Journal of Experimental Biology, 6(4), 7-11.
Van Der Pol, B. (2015). Clinical and laboratory testing for Trichomonas vaginalis infection. Journal of Clinical Microbiology, 54(1), 7-12.
Zuckerman, A., & Romano, M. (2016). Clinical recommendation: Vulvovaginitis. Journal of Pediatric and Adolescent Gynecology, 29(6), 673-679.