When a woman reaches puberty, she begins to ovulate and experience menstruation. Ovulation is the cycle where the ovum is released. The onset of menstruation is called menarche and usually occurs between the ages of 11 and 16 years. Menopause marks the end of menstrual activity. The process of fertilization begins in the vagina where sperm is deposited in the female reproductive tract. As the ovum moves slowly down the fallopian tube, the sperm fertilizes it. When the ovum is fertilized in the fallopian tube, the developing embryo travels into the uterus, where the lining of the walls of the uterus has become engorged with blood. The embryo attaches to the uterine wall and grows. If fertilization doesn’t occur within 14 days of ovulation, the lining of the uterus begins to separate and menstruation occurs, which lasts about a week.
Gynecologic emergencies vary from sexually transmitted diseases to trauma. Pelvic Inflammatory Disease is where disease-causing organisms enter the vagina during sexual activity and can lead to an ectopic pregnancy, which is a pregnancy that occurs outside of the uterus. It is an infection specifically of the uterus, ovaries, and fallopian tubes. It can lead to the development of a life-threatening abscess. The most common signs are lower abdominal pain, foul-smelling vaginal discharge, increased pain during sexual intercourse, fever, malaise, and nausea and vomiting.
Chlamydia is the most commonly reported sexually transmitted disease in the USA. Common signs are lower abdominal pain, low back pain, nausea, fever, pain during sexual intercourse, and bleeding between menstrual periods. If left untreated, it can spread to the rectum and eventually lead to Pelvic Inflammatory Disease.
Bacterial vaginosis is the most common vaginal infection in women aged 15 to 44. In this infection, normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms. Some signs include itching, burning, and may be accompanied by a fishy, foul-smelling discharge. Pregnant women with bacterial vaginosis can have premature babies. If left untreated, it can lead to Pelvic Inflammatory Disease.
Gonorrhea is a bacterium that multiplies rapidly in the warm, moist areas of the reproductive tract. The bacterium can also grow in the mouth, throat, eyes, and anus. Symptoms generally appear 2 to 10 days after exposure. Some symptoms include painful urination, burning or itching, yellowish or bloody vaginal discharge, usually with a foul odor, and blood associated with vaginal sexual intercourse. There is also sore throat and difficulty swallowing, swollen lymph glands, and fever. If the infection is not treated, the bacterium may enter the bloodstream and spread to other parts of the body, including the brain.
There can be many causes of vaginal bleeding, including abnormal menstruation, vaginal trauma, ectopic pregnancy, spontaneous abortion (miscarriage), cervical polyps, and cancer. Ectopic pregnancy or spontaneous abortion are two conditions that can cause vaginal bleeding. Always ask if there is pain associated with bleeding. Never try to stop it by inserting anything into the vagina, including a tampon. Ask when the last menstrual period was, about birth control, number of pads used, syncope, and lightheadedness. Assess for shock, use sanitary pads to control the amount of blood, and document the number of pads. Always call for a female provider if available.
Special considerations and precautions EMTs must observe when arriving at the scene of a suspected case of sexual assault or rape include not cross-examining and gently discouraging the patient from urinating or cleaning themselves. If they refuse transport, offer to call a local rape crisis center. If transported to the hospital, she will be seen by a Sexual Assault Nurse Examiner (SANE nurse). Compassion is the best tool you have to help the patient gain confidence and encourage her to get help.
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