Other causes include inflammatory necrosis, neoplasms, and granuloma.
TREATMENT—Refer the patient for definitive evaluation.
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 ship’s personnel have expanded to include those of the Navy’s women.
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 examination, 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 Department (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.
MENSTRUAL HISTORY
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 Onset—An unusually late or early menarche (beginning of menstrual function) may be indicative of various endocrinopathies. l Interval—Although 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 pathologic conditions.
Duration—As 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 days.
Quantity—A marked reduction in the flow may indicate certain endocrinopathies, while a marked excess may indicate a dysfunctional disorder or other problems.
Character of Menstrual Flow—Normal appearance of menstrual blood is dark venous and unclotted. Bright red, clotted blood is the type of flow seen in excessive menstruation.
Menstrual Pain—Painful 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 requires further investigation.
Intermenstrual Bleeding—Intermenstrual bleeding is a serious symptom. Even light bleeding frequently can indicate organic causes, such as polyps, erosion of the cervix, and occasionally cervical malignancy. 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. 2-33
