Chapter 57: Management of Patients with Female Reproductive Disorders

A public health nurse is participating in a campaign aimed at preventing cervical cancer. What strategies should the nurse include is this campaign? Select all that apply. A) Promotion of HPV immunization B) Encouraging young women to delay first intercourse C) Smoking cessation D) Vitamin D and calcium supplementation E) Using safer sex practices

A, B, C, E. Preventive measures relevant to cervical cancer include regular pelvic examinations and Pap tests for all women, especially older women past childbearing age. Preventive counseling should encourage delaying first intercourse, avoiding HPV infection, participating in safer sex only, smoking cessation, and receiving HPV immunization. Calcium and vitamin D supplementation are not relevant.

Following a recent history of dyspareunia and lower abdominal pain, a patient has received a diagnosis of pelvic inflammatory disease (PID). When providing health education related to self-care, the nurse should address which of the following topics? Select all that apply. A) Use of condoms to prevent infecting others B) Appropriate use of antibiotics C) Taking measures to prevent pregnancy D) The need for a Pap smear every 3 months E) The importance of weight loss in preventing symptoms

A, B. Patients with PID need to take action to avoid infecting others. Antibiotics are frequently required. Pregnancy does not necessarily need to be avoided, but there is a heightened risk of ectopic pregnancy. Weight loss does not directly alleviate symptoms. Regular follow-up is necessary, but Pap smears do not need to be performed every 3 months.

The nurse is caring for a patient who has just been told that her ovarian cancer is terminal and that no curative options remain. What would be the priority nursing care for this patient at this time? A) Provide emotional support to the patient and her family. B) Implement distraction and relaxation techniques. C) Offer to inform the patients family of this diagnosis. D) Teach the patient about the importance of maintaining a positive attitude.

A. Emotional support is an integral part of nursing care at this point in the disease progression. It is not normally appropriate for the nurse to inform the family of the patient's diagnosis. It may be inappropriate and simplistic to focus on distraction, relaxation, and positive thinking.

The nurse is caring for a 63-year-old patient with ovarian cancer. The patient is to receive chemotherapy consisting of Taxol and Paraplatin. For what adverse effect of this treatment should the nurse monitor the patient? A) Leukopenia B) Metabolic acidosis C) Hyperphosphatemia D) Respiratory alkalosis

A. Feedback: Chemotherapy is usually administered IV on an outpatient basis using a combination of platinum and taxane agents. Paclitaxel (Taxol) plus carboplatin (Paraplatin) are most often used because of their excellent clinical benefits and manageable toxicity. Leukopenia, neurotoxicity, and fever may occur. Acidñbase imbalances and elevated phosphate levels are not anticipated.

A female patient with HIV has just been diagnosed with condylomata acuminata (genital warts). What information is most appropriate for the nurse to tell this patient? A) This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) test annually. B) The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. C) The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse. D) The human papillomavirus (HPV), which causes condylomata acuminata, cannot be transmitted during oral sex.

A. Feedback: HIV-positive women have a higher rate of HPV. Infections with HPV and HIV together increase the risk of malignant transformation and cervical cancer. Thus, women with HIV infection should have frequent Pap smears. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom will not protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

You are caring for a patient who has been diagnosed with genital herpes. When preparing a teaching plan for this patient, what general guidelines should be taught? A) Thorough handwashing is essential. B) Sun bathing assists in eradicating the virus. C) Lesions should be massaged with ointment. D) Self-infection cannot occur from touching lesions during a breakout.

A. Feedback: The risk of reinfection and spread of infection to others or to other structures of the body can be reduced by handwashing, use of barrier methods with sexual contact, and adherence to prescribed medication regimens. The lesions should be allowed to dry. Touching of lesions during an outbreak should be avoided; if touched, appropriate hygiene practices must be followed.

A patient comes to the free clinic complaining of a gray-white discharge that clings to her external vulva and vaginal walls. A nurse practitioner assesses the patient and diagnoses Gardnerella vaginalis. What would be the most appropriate nursing action at this time? A) Advise the patient that this is an overgrowth of normal vaginal flora. B) Discuss the effect of this diagnosis on the patients fertility. C) Document the vaginal discharge as normal. D) Administer acyclovir as ordered.

A. Gray-white discharge that clings to the external vulva and vaginal walls is indicative of an overgrowth of Gardnerella vaginalis. The patient's discharge is not a normal assessment finding. Antiviral medications are ineffective because of the bacterial etiology. This diagnosis is unlikely to have a long-term bearing on the patient's fertility.

A nurse is caring for a pregnant patient with active herpes. The teaching plan for this patient should include which of the following? A) Babies delivered vaginally may become infected with the virus. B) Recommended treatment is excision of the herpes lesions. C) Pain generally does not occur with a herpes outbreak during pregnancy. D) Pregnancy may exacerbate the mothers symptoms, but poses no risk to the infant.

A. In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. There is a risk for fetal morbidity and mortality if this occurs. Lesions are not controlled with excision. Itching and pain accompany the process as the infected area becomes red and swollen. Aspirin and other analgesics are usually effective in controlling the pain.

A female patient tells the nurse that she thinks she has a vaginal infection because she has noted inflammation of her vulva and the presence of a frothy, yellow-green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infection? A) Trichomonas vaginalis B) Candidiasis C) Gardnerella D) Gonorrhea

A. The clinical manifestations indicate T. vaginalis, which is treated with metronidazole in the form of oral tablets. Candidiasis produces a white, cheese-like discharge. Gardnerella is characterized by gray-white to yellow-white discharge clinging to external vulva and vaginal walls. Gonorrhea often produces no symptoms.

A patient with trichomoniasis comes to the walk-in clinic. In developing a care plan for this patient the nurse would know to include what as an important aspect of treating this patient? A) Both partners will be treated with metronidazole (Flagyl). B) Constipation and menstrual difficulties may occur. C) The patient should perform Kegel exercises 30 to 80 times daily. D) Care will involve hormone therapy to control the pain.

A. The most effective treatment for trichomoniasis is metronidazole (Flagyl). Both partners receive a one-time loading dose or a smaller dose three times a day for 1 week. In pelvic inflammatory disease, menstrual difficulties and constipation may occur. Kegel exercises are prescribed to help strengthen weakened muscles associated with cystocele and other structural deficits. Hormone therapy does not address the etiology of trichomoniasis.

A nurse practitioner is examining a patient who presented at the free clinic with vulvar pruritus. For which assessment finding would the practitioner look that may indicate the patient has an infection caused by Candida albicans? A) Cottage cheese-like discharge B) Yellow-green discharge C) Gray-white discharge D) Watery discharge with a fishy odor

A. The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of T. vaginalis. Gray- white discharge and a fishy odor are signs of G. vaginalis.

The nurse is caring for a patient with a diagnosis of vulvar cancer who has returned from the PACU after undergoing a wide excision of the vulva. How should this patients analgesic regimen be best managed? A) Analgesia should be withheld unless the patients pain becomes unbearable. B) Scheduled analgesia should be administered around-the-clock to prevent pain. C) All analgesics should be given on a PRN, rather than scheduled, basis. D) Opioid analgesics should be avoided and NSAIDs exclusively provided.

B. Because of the wide excision, the patient may experience severe pain and discomfort even with minimal movement. Therefore, analgesic agents are administered preventively (i.e., around the clock at designated times) to relieve pain, increase the patient's comfort level, and allow mobility. Opioids are usually required.

A patient with ovarian cancer is admitted to the hospital for surgery and the nurse is completing the patients health history. What clinical manifestation would the nurse expect to assess? A) Fish-like vaginal odor B) Increased abdominal girth C) Fever and chills D) Lower abdominal pelvic pain

B. Clinical manifestations of ovarian cancer include enlargement of the abdomen from an accumulation of fluid. Flatulence and feeling full after a light meal are significant symptoms. In bacterial vaginosis, a fish-like odor, which is noticeable after sexual intercourse or during menstruation, occurs as a result of a rise in the vaginal pH. Fever, chills, and abdominal pelvic pain are atypical.

A middle-aged female patient has been offered testing for HIV/AIDS upon admission to the hospital for an unrelated health problem. The nurse observes that the patient is visibly surprised and embarrassed by this offer. How should the nurse best respond? A) Most women with HIV dont know they have the disease. If you have it, its important we catch it early. B) This testing is offered to every adolescent and adult regardless of their lifestyle, appearance or history. C) The rationale for this testing is so that you can begin treatment as soon as testing comes back, if its positive. D) Youre being offered this testing because you are actually in the prime demographic for HIV infection.

B. Feedback: Because patients may be reluctant to discuss risk-taking behavior, routine screening should be offered to all women between the ages of 13 to 64 years in all health care settings. Assuring a woman that the offer of testing is not related to a heightened risk may alleviate her anxiety. Middle-aged women are not the prime demographic for HIV infection. The nurse should avoid causing fear by immediately discussing treatment or the fact that many patients are unaware of their diagnosis.

When teaching patients about the risk factors of cervical cancer, what would the nurse identify as the most important risk factor? A) Late childbearing B) Human papillomavirus (HPV) C) Postmenopausal bleeding D) Tobacco use

B. Feedback: HPV is the most salient risk factor for cervical cancer, exceeding the risks posed by smoking, late childbearing, and postmenopausal bleeding.

A 31-year-old patient has returned to the post-surgical unit following a hysterectomy. The patients care plan addresses the risk of hemorrhage. How should the nurse best monitor the patients postoperative blood loss? A) Have the patient void and have bowel movements using a commode rather than toilet. B) Count and inspect each perineal pad that the patient uses. C) Swab the patients perineum for the presence of blood at least once per shift. D) Leave the patients perineum open to air to facilitate inspection.

B. Feedback: To detect bleeding, the nurse counts the perineal pads used or checks the incision site, assesses the extent of saturation with blood, and monitors vital signs. The perineum is not swabbed and there is no reason to prohibit the use of the toilet. Absorbent pads are applied to the perineum; it is not open to air.

A patient is post-operative day 1 following a vaginal hysterectomy. The nurse notes an increase in the patients abdominal girth and the patient complains of bloating. What is the nurses most appropriate action? A) Provide the patient with an unsweetened, carbonated beverage. B) Apply warm compresses to the patients lower abdomen. C) Provide an ice pack to apply to the perineum and suprapubic region. D) Assist the patient into a prone position.

B. If the patient has abdominal distention or flatus, a rectal tube and application of heat to the abdomen may be prescribed. Ice and carbonated beverages are not recommended and prone positioning would be uncomfortable.

A patient has been diagnosed with endometriosis. When planning this patients care, the nurse should prioritize what nursing diagnosis? A) Anxiety related to risk of transmission B) Acute pain related to misplaced endometrial tissue C) Ineffective tissue perfusion related to hemorrhage D) Excess fluid volume related to abdominal distention

B. Symptoms of endometriosis vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or pain. Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur. Ineffective tissue perfusion is not associated with endometriosis and there is no plausible risk of fluid overload. Endometriosis is not transmittable.

A patient comes to the clinic complaining of a tender, inflamed vulva. Testing does not reveal the presence of any known causative microorganism. What aspect of this patients current health status may account for the patients symptoms of vulvitis? A) The patient is morbidly obese. B) The patient has type 1 diabetes. C) The patient has chronic kidney disease. D) The patient has numerous allergies.

B. Vulvitis, an inflammation of the vulva, may occur as a result of other disorders, such as diabetes, dermatologic problems, or poor hygiene. Obesity, kidney disease, and allergies are less likely causes than diabetes.

A 14-year-old is brought to the clinic by her mother. The mother explains to the nurse that her daughter has just started using tampons, but is not yet sexually active. The mother states I am very concerned because my daughter is having a lot of stabbing pain and burning. What might the nurse suspect is the problem with the 14-year-old? A) Vulvitis B) Vulvodynia C) V aginitis D) Bartholins cyst

B. Vulvodynia is a chronic vulvar pain syndrome. Symptoms may include burning, stinging, irritation, or stabbing pain and may follow the initial use of tampons or first sexual experience. Vulvitis is an inflammation of the vulva that is normally infectious. Bartholin's cyst results from the obstruction of a duct in one of the paired vestibular glands located in the posterior third of the vulva, near the vestibule.

A patient with a genital herpes exacerbation has a nursing diagnosis of acute pain related to the genital lesions. What nursing intervention best addresses this diagnosis? A) Cover the lesions with a topical antibiotic. B) Keep the lesions clean and dry. C) Apply a topical NSAID to the lesions. D) Remain on bed rest until the lesions resolve.

B. Feedback: To reduce pain, the lesions should be kept clean and proper hygiene practices maintained. Topical ointments are avoided and antibiotics are irrelevant due to the viral etiology. Activity should be maintained as tolerated.

A patient has returned to the post-surgical unit after vulvar surgery. What intervention should the nurse prioritize during the initial postoperative period? A) Placing the patient in high Fowlers position B) Administering sitz baths every 4 hours C) Monitoring the integrity of the surgical site D) Avoiding analgesics unless the patients pain is unbearable

C. Feedback: An important intervention for the patient who has undergone vulvar surgery is to monitor closely for signs of infection in the surgical site, such as redness, purulent drainage, and fever. The patient should be placed in low Fowler's position to reduce pain by relieving tension on the incision. Sitz baths are discouraged after of wide excision of the vulva because of the risk of infection. Analgesics should be administered preventively on a scheduled basis to relieve pain and increase the patient's comfort level.

While taking a health history on a 20-year-old female patient, the nurse ascertains that this patient is taking miconazole (Monistat). The nurse is justified in presuming that this patient has what medical condition? A) Bacterial vaginosis B) Human papillomavirus (HPV) C) Candidiasis D) Toxic shock syndrome (TSS)

C. Candidiasis is a fungal or yeast infection caused by strains of Candida. Miconazole (Monistat) is an antifungal medication used in the treatment of candidiasis. This agent is inserted into the vagina with an applicator at bedtime and may be applied to the vulvar area for pruritus. HPV, bacterial vaginosis, and TSS are not treated by Monistat.

A patient diagnosed with cervical cancer will soon begin a round of radiation therapy. When planning the patients subsequent care, the nurse should prioritize actions with what goal? A) Preventing hemorrhage B) Ensuring the patient knows the treatment is palliative, not curative C) Protecting the safety of the patient, family, and staff D) Ensuring that the patient adheres to dietary restrictions during treatment

C. Feedback: Care must be taken to protect the safety of patients, family members, and staff during radiation therapy. Hemorrhage is not a common complication of radiation therapy and the treatment can be curative. Dietary restrictions are not normally necessary during treatment.

When reviewing the electronic health record of a female patient, the nurse reads that the patient has a history of adenomyosis. The nurse should be aware that this patient experiences symptoms resulting from what pathophysiologic process? A) Loss of muscle tone in the vaginal wall B) Excessive synthesis and release of unopposed estrogen C) Invasion of the uterine wall by endometrial tissue D) Proliferation of tumors in the uterine wall

C. Feedback: In adenomyosis, the tissue that lines the endometrium invades the uterine wall. This disease is not characterized by loss of muscle tone, the presence of tumors, or excessive estrogen.

A 45-year-old woman has just undergone a radical hysterectomy for invasive cervical cancer. Prior to the surgery the physician explained to the patient that after the surgery a source of radiation would be placed near the tumor site to aid in reducing recurrence. What is the placement of the source of radiation called? A) Internal beam radiation B) Trachelectomy C) Brachytherapy D) External radiation

C. Feedback: Radiation, which is often part of the treatment to reduce recurrent disease, may be delivered by an external beam or by brachytherapy (method by which the radiation source is placed near the tumor) or both.

A patient is being discharged home after a hysterectomy. When providing discharge education for this patient, the nurse has cautioned the patient against sitting for long periods. This advice addresses the patients risk of what surgical complication? A) Pudendal nerve damage B) Fatigue C) Venous thromboembolism D) Hemorrhage

C. Feedback: The patient should resume activities gradually. This does not mean sitting for long periods, because doing so may cause blood to pool in the pelvis, increasing the risk of thromboembolism. Sitting for long periods after a hysterectomy does not cause postoperative nerve damage; it does not increase the fatigue factor after surgery or the risk of hemorrhage.

The nurse is planning health education for a patient who has experienced a vaginal infection. What guidelines should the nurse include in this program regarding prevention? A) Wear tight-fitting synthetic underwear. B) Use bubble bath to eradicate perineal bacteria. C) Avoid feminine hygiene products, such as sprays. D) Restrict daily bathing.

C. Instead of tight-fitting synthetic, nonabsorbent, heat-retaining underwear, cotton underwear is recommended to prevent vaginal infections. Douching is generally discouraged, as is the use of feminine hygiene products. Daily bathing is not restricted.

A patient has been diagnosed with polycystic ovary syndrome (PCOS). The nurse should encourage what health promotion activity to address the patients hormone imbalance and infertility? A) Kegel exercises B) Increased fluid intake C) Weight loss D) Topical antibiotics as ordered

C. Lifestyle modification is critical in the treatment of PCOS, and weight management is part of the treatment plan. As little as a weight loss of 5% of total body weight can help with hormone imbalance and infertility. Antibiotics are irrelevant, as PCOS does not have an infectious etiology. Fluid intake and Kegel exercises do not influence the course of the disease.

A 30-year-old patient has come to the clinic for her yearly examination. The patient asks the nurse about ovarian cancer. What should the nurse state when describing risk factors for ovarian cancer? A) Use of oral contraceptives increases the risk of ovarian cancer. B) Most cases of ovarian cancer are attributed to tobacco use. C) Most cases of ovarian cancer are considered to be random, with no obvious causation. D) The majority of women who get ovarian cancer have a family history of the disease.

C. Most cases of ovarian cancer are random, with only 5% to 10% of ovarian cancers having a familial connection. Contraceptives and tobacco have not been identified as major risk factors.

A student nurse is caring for a patient who has undergone a wide excision of the vulva. The student should know that what action is contraindicated in the immediate postoperative period? A) Placing patient in low Fowlers position B) Application of compression stockings C) Ambulation to a chair D) Provision of a low-residue diet

C. Sitting in a chair would not be recommended immediately in the postoperative period. This would place too much tension on the incision site. A low Fowler's position or, occasionally, a pillow placed under the knees, will reduce pain by relieving tension on the incision. Application of compression stocking would prevent a deep vein thrombosis from occurring. A low-residue diet would be ordered to prevent straining on defecation and wound contamination.

The nurse is providing preoperative education for a patient diagnosed with endometriosis. A hysterectomy has been scheduled. What education topic should the nurse be sure to include for this patient? A) Menstrual periods will continue to occur for several months, some of them heavy. B) Normal activity will be permitted within 48 hours following surgery. C) After a hysterectomy, hormone levels remain largely unaffected. D) The bladder must be emptied prior to surgery and a catheter may be placed during surgery.

D. The intestinal tract and the bladder need to be empty before the patient is taken to the OR to prevent contamination and injury to the bladder or intestinal tract. The patient is informed that her periods are now over, but she may have a slightly bloody discharge for a few days. The patient is instructed to avoid straining, lifting, or driving until her surgeon permits her to resume these activities. The patient's hormonal balance is upset, which usually occurs in reproductive system disturbances. The patient may experience depression and heightened emotional sensitivity to people and situations.

The nurse notes that a patient has a history of fibroids and is aware that this term refers to a benign tumor of the uterus. What is a more appropriate term for a fibroid? A) Bartholins cyst B) Dermoid cyst C) Hydatidiform mole D) Leiomyoma

D. A leiomyoma is a usually benign tumor of the uterus, commonly referred to as a ìfibroid.î A Bartholin's cyst is a cyst in a paired vestibular band in the vulva, whereas a dermoid cyst is a benign tumor that is thought to arise from parts of the ovum and normally disappears with maturation. A hydatidiform mole is a type of gestational neoplasm.

A 25-year-old patient diagnosed with invasive cervical cancer expresses a desire to have children. What procedure might the physician offer as treatment? A) Radical hysterectomy B) Radical culposcopy C) Radical trabeculectomy D) Radical trachelectomy

D. A procedure called a radical trachelectomy is an alternative to hysterectomy in women with invasive cervical cancer who are young and want to have children. In this procedure, the cervix is gripped with retractors and pulled down into the vagina until it is visible. The affected tissue is excised while the rest of the cervix and uterus remain intact. A drawstring suture is used to close the cervix. For a woman who wants to have children, a radical hysterectomy would not provide the option of children. A radical culposcopy and a radical trabeculectomy are simple distracters for this question.

A student nurse is doing clinical hours at an OB/GYN clinic. The student is helping to develop a plan of care for a patient with gonorrhea who has presented at the clinic. The student should include which of the following in the care plan for this patient? A) The patient may benefit from oral contraceptives. B) The patient must avoid use of tampons. C) The patient is susceptible to urinary incontinence. D) The patient should also be treated for chlamydia.

D. Because of the high incidence of coinfection with chlamydia and gonorrhea, the patient should also be treated for chlamydia. Avoiding the use of tampons is part of the self- care management of a patient with possible toxic shock syndrome (TSS). The patient is not susceptible to incontinence and there is no indication for the use of oral contraceptives.

A patient with genital herpes is having an acute exacerbation. What medication would the nurse expect to be ordered to suppress the symptoms and shorten the course of the infection? A) Clotrimazole (Gyne-Lotrimin) B) Metronidazole (Flagyl) C) Podophyllin (Podofin) D) Acyclovir (Zovirax)

D. Feedback: Acyclovir (Zovirax) is an antiviral agent that can suppress the symptoms of genital herpes and shorten the course of the infection. It is effective at reducing the duration of lesions and preventing recurrences. Clotrimazole is used in the treatment of yeast infections. Metronidazole is the most effective treatment for trichomoniasis. Posophyllin is used to treat external genital warts. Acyclovir is used in the treatment of genital herpes.

The nurse is teaching a patient preventative measures regarding vaginal infections. The nurse should include which of the following as an important risk factor? A) High estrogen levels B) Late menarche C) Nonpregnant state D) Frequent douching

D. Feedback: Risk factors associated with vulvovaginal infections include pregnancy, premenarche, low estrogen levels, and frequent douching.

A patient has herpes simplex 2 viral infection (HSV2). The nurse recognizes that which of the following should be included in teaching the patient? A) The virus causes cold sores of the lips. B) The virus may be cured with antibiotics. C) The virus, when active, may not be contracted during intercourse. D) Treatment is aimed at relieving symptoms.

D. HSV-2 causes genital herpes and is known to ascend the peripheral sensory nerves and remain inactive after infection, becoming active in times of stress. The virus is not curable, but treatment is aimed at controlling symptoms. HSVñ1 causes ìcold sores,î and varicella zoster causes shingles.

A nurse providing prenatal care to a pregnant woman is addressing measures to reduce her postpartum risk of cystocele, rectocele, and uterine prolapse. What action should the nurse recommend? A) Maintenance of good perineal hygiene B) Prevention of constipation C) Increased fluid intake for 2 weeks postpartum D) Performance of pelvic muscle exercises

D. Some disorders related to ìrelaxedî pelvic muscles (cystocele, rectocele, and uterine prolapse) may be prevented. During pregnancy, early visits to the primary provider permit early detection of problems. During the postpartum period, the woman can be taught to perform pelvic muscle exercises, commonly known as Kegel exercises, to increase muscle mass and strengthen the muscles that support the uterus and then to continue them as a preventive action. Fluid intake, prevention of constipation, and hygiene do not reduce this risk.

A 27-year-old female patient is diagnosed with invasive cervical cancer and is told she needs to have a hysterectomy. One of the nursing diagnoses for this patient is disturbed body image related to perception of femininity. What intervention would be most appropriate for this patient? A) Reassure the patient that she will still be able to have children. B) Reassure the patient that she does not have to have sex to be feminine. C) Reassure the patient that you know how she is feeling and that you feel her anxiety and pain. D) Reassure the patient that she will still be able to have intercourse with sexual satisfaction and orgasm.

D. The patient needs reassurance that she will still have a vagina and that she can experience sexual intercourse after temporary postoperative abstinence while tissues heal. Information that sexual satisfaction and orgasm arise from clitoral stimulation rather than from the uterus reassures many women. Most women note some change in sexual feelings after hysterectomy, but they vary in intensity. In some cases, the vagina is shortened by surgery, and this may affect sensitivity or comfort. It would be inappropriate to reassure the patient that she will still be able to have children; there is no reason to reassure the patient about not being able to have sex. There is no way you can know how the patient is feeling and it would be inappropriate to say so.