FHP: Sexuality and Reproductive

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FHP Sexuality and Reproductive

• Carole J. Howe, PhD
• Spring 2007

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Vocabulary

• Coopers ligaments
• peau dorange
• tail of Spence
• retraction/dimpling
• supernumerary nipples
• axillary nodes (central. pectoral, subscapular,
  lateral)
• Contralateral/ipsilateral

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Human Sexuality

• Emotionality and body image
• PLISSIT Model

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Objectives

• PLISST Model
• Human Sexuality
• Breast Cancer statistics
• BSE
• TSE
• Conducting a health history
• Axillary nodes
• Level 1
• by RN
• health hx
• screen for sexual function
• limited sex education

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Facilitating Communication

• Self-knowledge understanding
• Normalizing questions
• Open-ended questions
• Terminology

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History FHP

• Gender role and identification
• Lifestyle protective practices
• Sexual satisfaction abuse
• STDs
• Family risk factors of cancer of breast, ovaries,
  testicular cancer
• Reproductive Hx

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Reproductive Hx

• Obstetric/Number of children
• Endocrine disorders (e.g., diabetes)
• Contraceptive
• Health Prevention Traid of Care
• BSE, TSE (monthly)
• Clinical exam (annual)
• Mammogram TSA Pap Smear

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History ROS

• Do you have or have you ever had a problem with
  your breasts or reproductive organs such as
  vaginal discharge, cervical, vaginal, uterine
  infections, surgery (hysterectomy, tubal
  liagation) scrotal pain or swelling, sexually
  transmitted diseases?

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Cont.

• urinary frequency, urgency, hesitancy,
  hematuria, change in libido, dyspareunia, penile
  or urethral discharge?
• History of menarche, menses, menopause

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History Specific Questions

• Describe your current sexual activity
• How satisfied are you with your sexual relations?
• Do you have any concerns about your sexual
  performance?
• Has anything changed that interferes with your
  sexual performance
• How do you feel your illness has effected your
  sexual performance?

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History ROS Breast

• Pain
• Lump
• Discharge (color, incidents)
• Rash
• Swelling
• Trauma

• History of breast disease
• Surgery
• Self-care behaviors
• Rash, lump, swelling of axillae

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Breast Cancer

• 2nd leading cause of cancer death in women in the
  US
• leading cause of cancer death among Black women
  in the US
• 1 in 8 women will acquire breast cancer
• 5-year survival is 97

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Risks

• Female gender
• age 50 years
• atypical hyperplasia
• first degree relative with breast cancer
• mother, sister, daughter)

• Nulliparity
• First child after 30 yrs
• Menstruation before age 12
• Menopause after age 55
• Alcohol intake of 1-2 drinks a day
• High fat diet

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Testicular Cancer

• Cancer of young men
• Most common cancer in men 15-34
• Undescended testicle
• Curable if diagnosed early

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TSE

• After shower when hands/scrotum warm
• Monthly
• Gentle palpation between thumb and index middle
  fingers

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Breast Exam Inspection

• General Appearance
• symmetry of size shape
• Skin
• redness, bulging, dimpling, edema
• Lymphatic Drainage
• bulging, discoloration, edema
• Nipple (scaling, inversion, ulceration,
  discharge)
• Retraction

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Inspection

• Arms down by the sides
• Arms over the head
• Push hands into hips
• Lean forward
• Lift arm to inspect axillae

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Palpation

• Sitting
• Use bimanual palpation for pendulous breasts
• Palpate Axillae
• Palpate central along chest wall
• Palpate inner aspect of upper inner arm
• Palpate anterior border of axilla
• Palpate along the posterior border

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Palpation

• Supine
• arm over head
• pillow under examined side
• pads of 3 fingers
• rotary movement
• circular or spoke pattern
• nipple

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Breast Health and Augmentation

• Mammogram same schedule
• More complex studies
• Augmentation is NOT a risk factor for cancer

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Male Examination

• Inspect palpate chest wall
• Palpate nipple area for lump or enlargement
• Monthly BSE
• Annual clinical exam

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Significant Findings

• Unilateral changes
• Nipple drainage, retraction
• Mass in upper outer quadrant
• Cancer
• Solitary, unilateral nontender mass
• Solid, hard, fixed

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Documentation

• No nodes palpable (axillary, infraclavicular, or
  supraclavicular)
• No masses, tenderness or retractions
• Nipples symmetrically positioned
• Small amount sanguinous discharge from lt nipple
  upon palpation