Other causes include inflammatory necrosis,
neoplasms, and granuloma.
TREATMENTRefer the patient for defini-
FEMALE SPECIFIC CONDITIONS
As the roles and numbers of women entering
the naval service have increased, so has the role
of the independent duty hospital corpsman
expanded. With the assignment of women to
duty aboard ships, the responsibilities for taking
care of the health care needs of the ships
personnel have expanded to include those of the
Most of the conditions and complaints that
bring women to seek medical attention will be no
different than those of their male counterparts.
However, there are some conditions that are
obviously limited to females. To effectively treat
these conditions, you must become familiarized
with the female anatomy and physiology,
techniques of physical examination, and
diagnosing and treating the more commonly
encountered female specific conditions.
With the exception of the female genitals and
the breasts, the techniques for physical examina-
tion, as discussed earlier in this chapter, will apply
to both males and females. The Navy policy as
set forth in the Manual of the Medical Depart-
ment (MANMED) establishes the requirement
that in other than emergency situations or when
totally impractical, no member of the Medical
Department will examine or treat a member of
the opposite sex without the presence of a witness.
That witness, whenever possible, must be a
member of the same sex as the patient.
Just as there are certain aspects of the physical
examination of women that differ from the
physical examination of men, there are also
different types of information to be extracted
during the medical history. The single most
important part of the history to be taken when
a woman presents with a gynecologic condition
is the menstrual history. It should be remembered
that many women are currently taking oral
contraceptive pills that may modify the menstrual
cycle. No history of the menstrual cycle is
complete without making a note of the form of
contraception employed. The following points are
important data concerning the menses.
l Age of OnsetAn unusually late or early
menarche (beginning of menstrual function) may
be indicative of various endocrinopathies.
l IntervalAlthough the typical menstrual
interval is 28 days, there are many variations even
in otherwise normal women. The normal range
is 21 to 35 days and any departure from normal
must be viewed as potentially produced by various
. DurationAs stated above, any change
from the normal must be viewed as possibly the
result of a pathologic condition. The quantity of
the flow frequently parallels the duration; a
prolonged flow will generally be excesive. The
normal duration of the flow is from 2 to 7
. QuantityA marked reduction in the flow
may indicate certain endocrinopathies, while a
marked excess may indicate a dysfunctional
disorder or other problems.
l Character of Menstrual FlowNormal
appearance of menstrual blood is dark venous and
unclotted. Bright red, clotted blood is the type of
flow seen in excessive menstruation.
. Menstrual PainPainful menstruation
(dysmenorrhea) is one of the most frequently
encountered of all gynecologic complaints. The
character of the pain or cramps, onset, and
duration should be determined. Most menstrual
pain will begin the day of onset of menses. Any
increase of severity of pain or the appearance of
pain in a previously asymptomatic woman re-
quires further investigation.
. Intermenstrual BleedingIntermenstrual
bleeding is a serious symptom. Even light bleeding
frequently can indicate organic causes, such as
polyps, erosion of the cervix, and occasionally
l First Day of the Last Menstrual Period
(LMP)Many women are unsure of the exact
date their LMP began; however, it is important
to establish it. Dates are necessary to determine
whether the cycle is irregular as well as to establish
the time of conception.