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GY32 Gynecology
Sexual Abuse
Toronto Notes 2019
Toxic Shock Syndrome
Multiple organ system failure due to S. aureus exotoxin (rare condition)
Toxic Shock Syndrome
• seeInfectiousDiseases,ID23
Risk Factors
• tamponuse
• diaphragm,cervicalcap,orspongeuse(prolongeduse,i.e.>24h)
• woundinfections
• post-partuminfections
• earlyrecognitionandtreatmentofsyndromeisimperativeasincorrectdiagnosiscanbefatal
Clinical Presentation
• suddenhighfever
• sorethroat,headache,diarrhea
• erythroderma
• signsofmultisystemorganfailure
• refractoryhypotension
• exfoliationofpalmarandplantarsurfacesofthehandsandfeet1-2wkafteronsetofillness
Treatment
• removepotentialsourcesofinfection(foreignobjectsandwounddebris) • debridenecrotictissues
• adequatehydration
• penicillinase-resistantantibiotics,e.g.cloxacillin
• steroidusecontroversialbutifstartedwithin72h,mayreduceseverityofsymptomsanddurationoffever
Surgical Infections
Post-Operative Infections in Gynecological Surgery
• pelviccellulitis
■ common post hysterectomy, affects vaginal vault
■ erythema, induration, tenderness, discharge involving vaginal cuff
■ treat if fever and leukocytosis with broad spectrum antibiotics, i.e. clindamycin and gentamicin ■ drain if excessive purulence or large mass
■ can result in intra-abdominal and pelvic abscess
• seeGeneralSurgery,Post-OperativeFever,GS7 Sexual Abuse
• seeFamilyMedicine,FM26,EmergencyMedicine,ER27
Sexuality and Sexual Dysfunction
SEXUAL RESPONSE
1. desire: energy that allows an individual to initiate or respond to sexual stimulation
2. arousal: physical and emotional stimulation leading to breast and genital vasodilation and clitoral
engorgement
3. orgasm: physical and emotional stimulation is maximized, allowing the individual to relinquish their
sense of control
4. resolution: most of the congestion and tension resolves within seconds, complete resolution may take
upto60min
SEXUAL DYSFUNCTION
Etiology
• psychologicaloremotional:depression,abuse • hormonal: menopause
• neurologicdysfunction:spinalcordinjury
• vascularinsufficiency:DM
• drugsideeffects:β-blockers • trauma: episiotomy
Classification
• lackofdesire(60-70%ofwomen) • lackofarousal
• anorgasmia(5-10%)
■ primary anorgasmia: never before achieved orgasm under any circumstances ■ secondary anorgasmia: was able to achieve orgasms before but now unable to
Kegel Exercises
Regular contraction and relaxation to strengthenpelvicfloormuscles
Reverse Kegel Exercises
1 s contraction then 5 s of relaxation