Chapter 66: Concepts of Care for Patients With Gynecologic Problems

Uterine leiomyomas, commonly known as fibroids or myomas, represent benign smooth muscle tumors whose growth is frequently driven by estrogen levels, resulting in symptoms including abnormal uterine bleeding patterns, pelvic pressure sensations, and disrupted bowel and bladder function. Clinical management of leiomyomas ranges from conservative watchful waiting approaches through hormonal therapeutic interventions to definitive surgical procedures such as myomectomy for fibroid removal while preserving the uterus or hysterectomy for complete uterine removal. Endometrial cancer emerges as the most prevalent malignancy affecting the gynecologic system and requires prompt recognition and intervention. Pelvic organ prolapse occurs when weakened pelvic floor musculature and supportive ligaments allow downward displacement of pelvic structures including the uterus, bladder, or rectum, significantly impairing elimination and mobility. Surgical correction of prolapse previously employed synthetic mesh materials in transvaginal procedures; however, regulatory oversight led the FDA to discontinue these approaches in 2019 due to serious complications. Vulvovaginitis, characterized by vaginal inflammation from infectious pathogens or chemical irritants such as douches and tight synthetic clothing, requires appropriate identification and treatment with particular attention to severe presentations that can progress to toxic shock syndrome, a life threatening condition necessitating immediate infectious source removal, aggressive fluid resuscitation, and broad spectrum antimicrobial therapy. Throughout care of gynecologic conditions, nurses must establish therapeutic environments free from judgment, sensitively address concerns related to sexual function and reproductive capacity, provide evidence based cervical cancer prevention education including HPV vaccination recommendations, and recognize the profound psychosocial impact these conditions exert on patients' self image and intimate relationships.