1. Medical Problems & Navigating
the Health Care System
Chapters 22 & 23
By: Lilibeth Barclay

2. Chapter 22:
Selected Medical Problems
 Breast
 Uterus & Cervix
 Ovaries
 Selected Reproductive
Tract Problems
 Vulva
 The Vagina
 The Bladder
 Other Pelvic Conditions

3. Medical Problems- Breasts:
Breast Lumps: Breast Cancer:
 Cysts: fluid filled sacs that develop
- 1 in 9 women can develop breast
from dilated lobules or ducts
(common during our 40’s-50’s) cancer
 Fibroadenomas: benign growths that - 70-80% of women whom develop it
form mostly during teens & 20’s; do not have any risk factors besides
rarely associated w/ cancer. age
 Pseudolumps: areas of dense normal - 40,000 women die per year
breast tissue, usually during
premenopausal yrs. Risk Factors- Age, personal history of
breast cancer, genetics, reproductive
- More than 80% are not cancerous but they
should be checked to put ones mind at factors, hormonal factors, also consuming
ease. alcohol, lack of exercise, history of high
dose radiation exposure to chest area.
- The physician can perform a physical
examination, a mammogram or an - It is recommended that women over
ultrasound and can refer one to a breast the age of 50’s (every year) and even in
specialist if needed. their 40’s (every 2 years) should get
- They should be operated if they cause examined.
pain or if they are big and surround the
breast tissue.

4. Diagnosing & Types of Breast Cancers
Screening for Breast Cancer:
 Mammography- used to identify malignant tumors with a low dose of radiation
 Ultrasound/Sonography- used to evaluate abnormalities that appear on
mammograms; it distinguishes between solid tumors & fluid-filled cysts.
 MRI (Magnetic Resonance Imaging)- detects invasive breast cancer yet can
falsely identify benign lesions as malignant.
 PEM (Positron Emission Mammography), BSGI (Breast-Specific Gamma
Imaging), Thermography
Types of Breast Cancers:
 LCIS (Lobular Carcinoma in situ)- low risk factor in developing cancer; 20-40%
developed cancer over 20 yrs.
 DCIS (Ductal Carcinoma in situ)- noninvasive cancer can become invasive
within time passing; 96-98% of women are alive ten yrs. after diagnosis, should
be removed to reduce local recurrence.
 Invasive/Infiltrating Breast Cancer- breast cancer cells have moved outside the
ducts or lobules and into the surrounding tissue; would require local surgery or
radiation therapy along with hormone-locking medicines &/or chemotherapy.

5. The Uterus, Cervix & Ovaries
Uterus:
 Fibroids (Leiomyomas, Myomas)- solid benign Cervix:
smooth-muscle tumors that appear, often in groups
 Cervical Cancer- most often caused by HPV
outside, inside & within the uterine wall, which can
infections; a routine pap test can screen for abnormal,
possibly change the size & shape of it.
precancerous or cancerous changes in cervical cells.
 Can cause heavy vaginal bleeding, abdominal/back Early diagnosis can increase the rate of survival;
pain, urinary problems & constipation; can make it 10,000-11,000 cases are presented a year resulting in
difficult to conceive or have a full term pregnancy. 3,000-4,000 deaths.
 Certain procedures performed to remove or alleviate  Treatments- for invasive cervical cancer a hysterectomy
they symptoms can include a is recommended to remove lymph nodes in the pelvis;
Hysterectomy, Myomectomy, Embolization of uterine if it has progressed radiation or a hysterectomy with the
arteries, focused ultrasound surgery, Lupron the most additional removal of the ovaries is performed.
recent is an IUD- Mirena
 Cervical Dysplasia- precancerous cervical problems;
 Uterine Cancer (Endometrial Cancer): 80% of dysplasia cases do not develop into cancer, cells
can return to normal.
 Most common pelvic cancer affecting 14 out of 10,000
women  Should be treated if severe an if it progresses;
types can include colposcopy, punch biopsy &
 Symptoms can include: Bleeding after cone biopsy which should be done by
menopause, increased menstrual flow & bleeding specialized practitioners with experience other
between periods. options can include cryotherapy or Loop
 Early intervention has a high success rate, methods used Electrical Excision Procedure.
are surgeries, radiation or chemotherapy.
 Cervicitis, Cervical Eversion, Cervical Erosion &
 Polyps, Hyperplasia & Abnormal Uterine Bleeding Cervical Polyps
(AUB)
Ovaries:
 Diagnosing methods- Endometrial
 Ovarian Cysts & Ovarian Cancer
Biopsy, Transvaginal Ultrasound, Sonohysterogram &
Hysteroscopy.

6. Selected Reproductive Tract Problems &
Procedures
• Pelvic Inflammatory Disease: an infection that affects the lining of the uterus, the fallopian tubes, and/or the ovaries; it
affect nearly 1 million women 300,000 of which become hospitalized.
 Primarily caused by sexually transmitted infections and can develop into peritonitis or a tuboovarian abscess.
 Symptoms can include: pain in lower abdomen, tightness/pressure in reproductive organs, occasional dull ache,
may include abnormal or foul discharge from vagina or urethra, pain/bleeding during intercourse, irregular
bleeding or spotting, increased menstrual cramps, pain during ovulation, frequent or burning urination, inability
to empty bladder, swollen abdomen, sudden high fever or low grade fever, chills, swollen lymph nodes, lack of
appetite, nausea/vomiting, pain around kidneys/liver, pain in the lower back or legs, weakness, tiredness,
depression, diminished sex drive.
 Treatment can include: taking two different types of antibiotics for 10-14 days even after symptoms are gone and
may be hospitalized; you may need a hysterectomy if damage has occurred to organs,
 Endometriosis: hormonal & immune system disease in which tissue grows outside the uterus; Estimated 6 million girls
& women in the US are affected.
 Symptoms can include pain before & during menstrual periods as well as during or after sexual activity,
infertility, fatigue, heavy bleeding, lower back pain w/ periods, intestinal upset w/ periods; these women can be at
a high risk of developing chronic autoimmune diseases like fatigue syndrome, fibromyalgia, hypothyroidism,
lupus, multiple sclerosis, rheumatoid arthritis & Sjogren’s syndrome.
 DES (Diethylstilbestrol): a powerful synthetic hormone that crosses the placenta of pregnant women which can
damage the reproductive system of the developing fetus; can affect the endocrine, immune, skeletal & neurological
systems. This was prescribed to women roughly 4.8 million women between 1938-1971 thinking to prevent
miscarriage.
 Hysterectomy: removal of the uterus; either total, total with bilateral salpingooophorectomy or supracervical .
 Oophorectomy: removal of either one or both ovaries and may also remove the fallopian tubes.

7. The Vulva, Vagina & Bladder
The Vulva:
The Bladder:
 Vulvitis: Inflammation of the vulva that may be caused by
several medical conditions, medical creams or external  Urinary Tract Infection: Can be caused by bacteria getting
irritants; into the urethra & bladder from the gastrointestinal
system; also poor diet, stress trauma from childbirth to the
 Symptoms: itching, redness, swelling, burning & pain. urethra. Pregnant women & postmenopausal women are
Treatment: antifungal creams or antibacterial treatment; more prone.
if worsens may need vulvar biopsy.
 Cystitis: Most common UTI, it’s the inflammation or
 Vulvodynia: chronic vulvar pain, with severe infection of the bladder
burning, pain, itching, stinging &/or irritation.
 Most common symptoms include: a frequent
 Vulvar Cancer: rare yet women with a history of HPV urinating feeling that burns yet nothing comes
infections are at higher risk. out; pain above the pubic bone, food allergies
The Vagina:  Urinary Incontinence: a condition where women,
involuntarily lose urine. Can appear during pregnancy,
 Vaginal Infections: can produce abnormal discharge, mild damage due to birth trauma, pelvic surgery or advanced
or severe itching, burning of the vulva, chafing of the age.
thighs & frequent urination. May be caused by lowered
resistance, douching, scented sprays, birth control
pills, etc. Can be treated by antibiotics or natural/herbal  Painful Bladder Syndrome/Interstitial Cystitis: chronic
remedies. pain syndromes that may develop for many reasons;
 Yeast Infections: caused by yeast like organism, that grow clinical diagnosed by urgency/frequency of urination (60-
profusely & cause thick white discharge with a bad odor. 80x’s) or pain in the bladder and/ or the pelvis; other
Causes burning or irritation. Treated by vaginal symptoms include, vaginal/rectal pain & pain during
suppository, cream or oral antifungal intercourse. Affects about 500,000 women mainly in their
40’s. May be misdiagnosed, tests can show negative
 Bacterial Vaginosa: disturbance of the ecology of the results. Provided treatments consist of medication, low-
vagina, with an overgrowth of certain microorganisms. dose antidepressants, diet changes, transcutaneous electric
Treated with metronidazole or clindamycin for 5-7 days. nerve stimulation; surgery may be performed yet pose
risks and positive outcomes are guaranteed.

8. Other Pelvic Conditions
 Obstetric Fistula: An injury caused during labor  Polycystic Ovarian Syndrome (PCOS):
in which the prolonged pressure caused by the Most common hormonal & reproductive
baby’s head on the vagina creates a hole between problem affecting women of childbearing
the bladder (or rectum) & the vagina. Occurs age; it’s characterized by two of either an
mostly in under developed countries, Africa & irregular menstrual cycle/ lack of ovulation
South Asia. for a prolonged time, elevated levels of
androgens in the blood and/or many small
 Female Genital Cutting: Also known as female follicles on the ovaries.
circumcision or genital mutilation cultural
practice by some countries in African, Asia or in  Symptoms: irregular/infrequent/absent
the Middle East where certain parts of a girls or menstrual periods, acne/oily skin, fertility
young women’s genitalia (the whole, parts or the problems, overweight/obesity, male-pattern
baldness, etc.
hood of the clitoris, the labia minora or the
external genitalia) are cut, narrowed or stitched to  Treatments: weight loss, oral
curb sexuality or as a rite of passage into contraceptives, cyclic progesterone, diabetes
womanhood. There can be some difficulties that medication, spironolactone.
these women can experience such as excessive
bleeding, infections & shock; also painful
intercourse, dermoid cyst, UTI’s, pelvic infection  When facing any health issue or
among other recurrent symptoms. concern, “Although most doctors have
good intentions, they tend to offer only the
 Pelvic Relaxation: When the muscles of the pelvic
floor become slack & no longer support the pelvic
treatment they know best. It’s wise to get a
organs as they should. Severe cases where the
second opinion before committing yourself
ligament tissues holding the uterus are weakened to a plan, even if you feel confident with
allowing the uterus to fall into the vagina is known your first doctor. (pg599)”
as Uterine Prolapse.

9. Chapter 23
Navigating the Health Care Making Health Care Decisions:
System “A good decision involves gathering and evaluating
information, weighing, what’s important to
you, finding the resources needed to maximize the
quality of care you receive, and dealing with the
associated costs.”
One must weigh the benefits of tests/treatment &
possible negative effects associated with treatments
one receives.
Positive-
• Gaining information about ones health and
care, achieving a pregnancy, Getting welcome
relief from symptoms, increasing chance of
living longer
Negative-
• Possible of ineffective results, unreliable
Determining When We Need Health Care: information, financial costs, effects on ability to
work, pain & discomfort, as well as emotional
“We regularly make decisions that affect our
effects.
health… these self-care decisions… can have
profound effects on our well-being and need
for medical care (pg.652).”

10.  How the new health reform law affects women’s access to health care and health
insurance: A national comprehensive healthcare reform law was enacted in
2010, making it more accessible to affordable health care & insurance.
 Help finding health insurance: By going online to healthcare.gov one can be directed
to answers about insurance plans offered & finding low-cost health care.
 Coverage of important health care services: Certain preventive care & screenings are
available to women under this new law, including mammograms, Pap tests without
co-pays, maternity care, prescription drugs & mental health care.
 Additional provisions affecting women: Women will have direct access to obstetrical
& gynecology care, pregnant women will have additional options for labor &
birth, children can remain in their parents insurance plan until age 26, the Medicare
“donut hole” will be eliminated for older women.
 Restrictions on immigrant women and women seeking abortions: Immigrant women
must wait 5 yrs. before becoming eligible for Medicaid for sliding scale insurance
subsidies, if they lack documentation on their legal status they become ineligible; for
women seeking abortions they will have to pay two separate payments one for the
abortion coverage and another for the remainder of the premium.
 Sources of health information: One has to trust their own judgment on how their
body feels, the symptoms, prior/current health problems, the partners health status &
family history.

11. Information From Health Care Providers
 Providers’ information may be influenced by financial incentives that benefit the
institution, pressure from drug companies for the use of certain
medications/drugs, particular “standards of care” that work for some may not work on
others, fear of lawsuits, lack of knowledge/negative attitudes toward cares &/or
treatments;
 It’s important for the individual to be informed, ask questions, state doubts & fears
confidently to make a knowledgeable decision that supports our beliefs and desires;
 There are support, self-care & self-help groups, one can go to seek more reliable
information, as well as discuss topics & treatments available;
 There is excess information also available online yet one has to make sure it is from a
reliable source with accurate and up to date information;
 The media can be a source of misguided material used only to draw attention to
companies and their products, so research should be done on the validity of the
advertisements being presented;
 Research literature & research studies are also obtainable with recent studies done on
various topics of interest which can help in getting the most up to date
information, especially from peer-reviewed articles; keeping in mind that results may
vary person-to-person so one can’t expect the same outcomes.

12. Our Rights to Informed Consent & Accessing Health Care
Refusal
o Choosing a health care provider: male vs.
 One has the right to decide what is done female, does your insurance cover
to their own body so communication with them, experience they have, etc.
the physician is important and a better o The imbalance of power in the
decision is made when one is informed Doctor/Patient relationship: make sure
properly and understands what will take you don’t feel intimidated by your
place. The risks & benefits of physician, that he listens to your questions
procedures, alternatives to & answers them so you understand, hears
treatments, specific health issue, success your concerns & deals with them
rates, anticipate problems & costs. accordingly, etc.
o Making the most of your health care visit:
 Refusing treatment can be done even come prepared with questions, medicines
after a procedure has been set, as long as taken, medical history, bring a person you
the person is competent and understands trust & will make sure your questions &
the information presented by their your best interests are being met, ask for
providers, even if it may lead to their test results if any were done.
deaths. o Patient Advocates: Important to bring to
an appointment a person one trusts, who
can help when deciding on treatment
options being presented.

13. Recognizing & Overcoming Barriers to Getting
Good Health Care
 Financial Barriers:
 Extending Medicaid Coverage:
 Health Care Disparities:
 Bias Against Substance Abusers:
 Language & Culture:
 Disability Issues:
 Homophobia, Transphobia & Heterosexism:
 Multiple Barriers for Incarcerated Women:
Women should be aware of these barriers that may present themselves and be
informed on how to deal with them because it can affect they type of care they receive.

14. Conclusion
My Thoughts…
 I believe that at times people give their
physicians the power to make their health
decisions and feel intimidated when stating
any concerns they have. Recurrent illness
Enforcing Our Rights or symptoms are things that should be
o Women need to enforce their rights when it taken serious and a person needs to take
comes to their health & body. We have to live the steps to acquire the information needed
with the symptoms of our illness & no about the benefits and negative effects that
physician can know better than ourselves what that could happen.
we are going through. If there are any
issues, concerns or complaints, we have a right
to be heard and the issue to be discussed to
make a knowledgeable consent or refuse if
there is some doubts.
Question ???
 Do you use any specific resources
when facing a health issue before going
to your physician? If so where do you
get your information & how do you
know it’s reliable?