Cardiovascular disease in pediatrics patients

I need for today

Presentation :
Chronic Pelvic pain , Dysmenorrhea, Dyspareunia

Suzelle L. Costales

Advanced Primary care of family II

Florida National University

What is Chronic Pelvic Pain and what are s/s ?

Chronic pelvic pain is pain below the umbilicus mainly at and around the pelvic area of the body , pain associated with CPP is pain that lasts more than six months and is not associated with menstrual period symptoms.

Incomplete relief with OTC treatments

Significantly impaired function at work or home/ sex life

Altered family roles

Signs of depression , weight loss /gain and anxiety.

Chronic pelvic pain can be associated with other disease process and usually arises from gynecological causes

Chronic Pelvic Pain epidemiology / Pathophysiology

CPP is a common reason for office visit in the US. According statistics 1 out of 7 women in the USA visit a medical office with chief complaint of chronic pelvic pain.

Of all references to a gyn specialist 10 % are for pelvic pain and prevalence for CPP in reproductive aged women is aprox 39 %.

CPP is considered a symptom of an underlying problem that can be gynecological , gastrointestinal and neuro-muscular in origin. CPP can be very complex to treat due to the many factors that can be contributing and causing CPP. Each provider takes a personalized approach for each patient in order to find the root cause of CPP.

Risk Factors of Chronic Pelvic Pain

C- section

Endometriosis ( endometrial cells grow outside the uterus )


Longer menstrual flow

Ovarian cysts

Uterine fibroids


Pelvic inflammatory disease

Long term sexual abuse as child or adult

Adenomyosis ( endometrial tissue growing in uterine wall)


Chronic UTI

Bladder Stones

Guidelines for screening : CPP

Accurate and complete Health history: important to get chronological history of pain.

Physical examination : gynecological, urologic , gastroenterological , and psychologic examination , musculoskeletal exam

Assess pain each visit / detailed

Vaginal examination , pap smear, pelvic examination: single digit and bimanual

Labs: CBC, Urinalysis, pregnancy test , STD test,

Transvaginal ultrasound , CT scan , MRI, laparoscopy


“Menstrual cramps” or pain that is associated with the menstrual cycle each month.

Lasts 3-5 days , starts before menstruation begins can last during and after menstruation

Pain is mainly in the pelvis and lower abdomen

More than 50 % of women experience some level of dysmenorrhea each month right before

Screening for Breast Cancer, Cervical Cancer, Ovarian Cancer, and Endometrial Cancer


Karel Bell-Lloch



Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. 

That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.


Cancer in the female population

Breast cancer:

Cervical Cancer

Ovarian cancer

Endometrial cancer

Breast cancer

The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast. 

Breast cancer

A. Ducts

B. Lobules

D. Nipple

Breast Cancer epidemiology

About 1 in 8 U.S. women (about 12.4%) will develop invasive breast cancer over the course of her lifetime.

In 2018, an estimated 266,120 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 63,960 new cases of non-invasive (in situ) breast cancer.

In women under 45, breast cancer is more common in African-American women than white women

About 85% of breast cancers occur in women who have no family history of breast cancer. These occur due to genetic mutations that happen as a result of the aging process and life in general, rather than inherited mutations.

These occur due to genetic mutations that happen as a result of the aging process and life in general, rather than inherited mutations.


Breast cancer risk factors

The most significant risk factor for breast cancer are gender (being a woman) and age (growing older).

Alcohol intake, smoking and obesity

A man’s lifetime risk of breast cancer is about 1 in 1,000.


Guidelines for breast cancer screening

Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms

Women age 45 to 54 should get mammograms every year.

Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening.

Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer


During a mammogram, your breasts are compressed between two firm surfaces to spread out the breast tissue. Then an X-ray captures black-and-white images of your breasts that are displayed on a computer screen and examined by a doctor who looks for sign

Elizabeth Gonzalez
Dr. Alain Llanes Rojas
Advanced Primary Family

Reproductive Health across

the lifespan


Labor and Birth Processes

A woman and the fetus during the late pregnancy prepares for labor process. During this period the fetus is ready for extra uterine life. There are several physiologic adaptations that a woman undergoes which prepares her for birth and motherhood. The end of pregnancy is represented by the labor and birth process which ushers in a extra uterine life for the newborn and a change for the family.



Birth Process

Giving Birth In United States

Model of birth

Medical model


Site of birth


Birth center


Stages of Labor

First stage: latent, active, transition


Second stage

Pushing and birth

Third stage

Delivery of placenta


The first stage of labor is divided into three phases: latent, active, and transition.

The first, the latent phase, is the longest and least intense. During this phase, contractions become more frequent, helping your cervix to dilate so your baby can pass through the birth canal

Active phase

You may feel intense pain or pressure in your back or abdomen during each contraction.

Transition phase

During transition, the cervix fully dilates to 10 centimeters. Contractions are very strong, painful, and frequent, coming every three to four minutes and lasting from 60 to 90 seconds.


Begins when the cervix is completely opened. At this point, your doctor will give you the OK to push. Your pushing, along with the force of your contractions, will propel your baby through the birth canal. The fontanels (soft spots) on your baby’s head allow it to fit through the narrow canal.

Your baby’s head crowns when the widest part of it reaches the vaginal opening. As soon as your baby’s head comes out, your doctor will suction amniotic fluid, blood, and mucus from his or her nose and mouth


After your baby is delivered, you enter the final stage of labor. In this stage, you deliver the placenta, the organ that nourished your baby inside the womb.

Each woman and each labor is different. The amount of time spent in each stage of delivery will vary. If this is your first pregnancy, labor and delivery usual