Dyspareunia Case Study
Individual Case Study #1
Individual Case Study #1
Assigned Scenerio
A 47 year old woman presents to the clinic. She has been menopausal but can 't deal with the hot flashes anymore. Recently she started to have pain during intercourse. She is Caucasian, 5 '6", and weighs 152 pounds. She is a gravida 2, para 2, NSVD x 2, no complications. You learn in her history that she had breast cancer and had a successful lumpectomy 7 years ago. Her vitals today are 148/82, 76, 22, 97.9
Potential Working Diagnosis: 2 points
This patient is previously known to be experiencing menopause per the description. The differential diagnoses will focus on her new onset symptom of dyspareunia. Although dyspareunia is common in relation to vaginal dryness …show more content…
Erythema would be present for atopic vaginitis and possibly Candidiasis. Supportive findings for vaginal include dryness, thin vaginal tissue, loss of labial fat pads, narrowed vaginal opening, or less distinct labia minora (Dynamed, 2013). Upon insertion of index and third fingers into vagina to assess vaginal wall, Vaginismus would present with intolerance to penetration and possible contractions. Tolerance to penetration with lubricated insertion contraindicates Vaginismus. Absence of vaginal discharge would help rule out Bacterial Vaginosis, Candidiasis, and Trichomoniasis (Schuiling & Likis, …show more content…
Medroxyprogesterone Acetate, a progesterone, can be effective when 500 mg is administered IM on days 1, 14 and 28 (Loibl, et al., 2011). Due to the unknown safety of progestins in breast cancer survivors, non-hormonal options should be considered for this patient due to her medical history (Schuiling & Likis, 2013). Hormonal treatment for the breast cancer survivor should only be considered if benefits are believed to outweigh the risk and non-hormonal treatments have been unsuccessful. In this situation, treatment should be closely monitored and implemented in collaboration with her oncologist (Loibl, et al., 2011). The patient should return within six to eight weeks for follow-up to evauluate relief of symptoms. Side effects that the patient may experience with hormone therapy include headache, bloating, mood changes, nausea, fluid retention, and breast tenderness (Schuiling & Likis,
Individual Case Study #1
Assigned Scenerio
A 47 year old woman presents to the clinic. She has been menopausal but can 't deal with the hot flashes anymore. Recently she started to have pain during intercourse. She is Caucasian, 5 '6", and weighs 152 pounds. She is a gravida 2, para 2, NSVD x 2, no complications. You learn in her history that she had breast cancer and had a successful lumpectomy 7 years ago. Her vitals today are 148/82, 76, 22, 97.9
Potential Working Diagnosis: 2 points
This patient is previously known to be experiencing menopause per the description. The differential diagnoses will focus on her new onset symptom of dyspareunia. Although dyspareunia is common in relation to vaginal dryness …show more content…
Erythema would be present for atopic vaginitis and possibly Candidiasis. Supportive findings for vaginal include dryness, thin vaginal tissue, loss of labial fat pads, narrowed vaginal opening, or less distinct labia minora (Dynamed, 2013). Upon insertion of index and third fingers into vagina to assess vaginal wall, Vaginismus would present with intolerance to penetration and possible contractions. Tolerance to penetration with lubricated insertion contraindicates Vaginismus. Absence of vaginal discharge would help rule out Bacterial Vaginosis, Candidiasis, and Trichomoniasis (Schuiling & Likis, …show more content…
Medroxyprogesterone Acetate, a progesterone, can be effective when 500 mg is administered IM on days 1, 14 and 28 (Loibl, et al., 2011). Due to the unknown safety of progestins in breast cancer survivors, non-hormonal options should be considered for this patient due to her medical history (Schuiling & Likis, 2013). Hormonal treatment for the breast cancer survivor should only be considered if benefits are believed to outweigh the risk and non-hormonal treatments have been unsuccessful. In this situation, treatment should be closely monitored and implemented in collaboration with her oncologist (Loibl, et al., 2011). The patient should return within six to eight weeks for follow-up to evauluate relief of symptoms. Side effects that the patient may experience with hormone therapy include headache, bloating, mood changes, nausea, fluid retention, and breast tenderness (Schuiling & Likis,