11/6- Benign Gynecology Flashcards
Describe the normal physiology of the vagina:
- Role of hormones
- Metabolic content
- Bacterial environment
- pH
- Estrogenized
- Increased glycogen content
- Bacterial flora
- Lactobacilli predominate: produce lactic acid lowering the pH to 3.5-4.5
- Wide variety of aerobic and anaerobic bacteria occur
What are risk factors for vaginal infection?
Anything that alters normal flora of the vagina
- Antibiotics (that allow pathogenic organisms to flourish)
- Douching alters the pH
- Sexual intercourse with semen release raises the pH for 6-8 hrs
- Foreign bodies (e.g. retained tampon)
What are symptoms of vulvovaginitis?
- Vaginal discharge
- Pruritis
- Burning
- “Late” burning (not pain when they urinate, but when it touches skin)
What is on the DDx/etiologies for vulvovaginitis?
- Bacterial vaginosis*
- Candida*
- Trichomoniasis*
- Atrophic vaginitis (post-menopausal women)
- Foreign body vaginitis
- Genital ulcer disease
*most common
In what ways can a wet mount be prepared?
- Components
- Sample of vaginal discharge
- pH paper
- Normal saline
- KOH
- Microscope slide
What is bacterial vaginosis?
- What are typical causes
- Symptoms
- Risk factors
Bacterial vaginosis is the disruption of “normal” flora with characteristic bacteria
- Typical: Gardnerella vaginalis
- Profuse milky white discharge
- Alkaline pH (>4.5, typ 5-6)
- Clue cells (can see them in squamous ep cells)
Risk factors:
- New sexual partners
- Smoking
- IUD
- Douching
What is Candidiasis?
- Etiological cause
- Symptoms
- Risk factors
- Caused by Candida albicans (90% of vulvovaginal candidiasis)
Symptoms:
- Vaginal itching, burning, and irritation
- White odorless vaginal discharge
Risk factors:
- Diabetes
- High dose OCPs
- Antibiotic use
- Immunosuppression
- Pregnancy
What is Trichomoniasis?
- Etiological cause
- Symptoms
- Spread
- Caused by protozoan T. vaginalis
Symptoms:
- Vulvovaginal irritation
- Green yellow frothy vaginal discharge
- Strawberry cervix
- “Musty” odor
- Around 50% of women are asymptomatic!
It’s an STI (not contracted spontaneously… although some proof it can spread via fomites) (pic 515)
Describe how the following vulvovaginal infections are diagnosed (what is seen):
- Candidiasis
- Bacterial vaginosis (BV)
- Trichomoniasis
- Candidiasis: wet mount with pseudohyphae or budding yeast
- Bacterial vaginosis (BV)- Gardnerella:
- Wet mount with “clue cells”
- Positive whiff test
- pH > 4-5
- Trichomoniasis: motile trich on wet mount
Describe how the following vulvovaginal infections are treated:
- Candidiasis
- Bacterial vaginosis (BV)
- Trichomoniasis
- Candidiasis: Fluconazole (po) or other azole (miconazole) for (3-7d, vaginally)
- Vaginal treatment may soothe/treat faster
- Bacterial vaginosis (BV)
- Metronidazole (7d, po) OR
- Clindamycin (7d, pv)
- Trichomoniasis: Metronidazole (po)
What is pelvic organ prolapse?
Protrusion of the pelvic organs into the vaginal canal or beyond the vaginal opening
- Anterior vaginal prolapse (cystocele)
- Posterior vaginal prolapse (rectocele)
- Apical vaginal and uterine prolapse (uterine prolapse)
- Enterocele (small bowel pressing on vagina)
What is complete procedentia?
Uterine prolapse through the vaginal hymen with failure of all the vaginal supports
What causes pelvic organ prolapse (physiology/anatomy)?
- Increased risk
Weakness in the endoplevic fascia investing the vagina along with the ligamentous supports
- Increased risk with pregnancy, labor, and vaginal delivery; also
- Increased intraabdominal pressure (chronic cough, ascites, heavy lifting, habitual straining)
What are symptoms of pelvic organ prolapse?
- Vaginal fullness, vaginal pressure and vaginal bulge
- Anterior vaginal prolapse: stress urinary incontinence, urinary retention
- Posterior vaginal prolapse: straining for bowel movements, splinting
- Complete procedentia: discharge, ulceration, bleeding and rarely carcinoma of the cervix
Describe the stages of prolapse
(This system will tell you how bad/far the prolapse it is, but not what is causing it)
- Stage 1: Most distal portion of the prolapse > 1 cm above the hymen
- Stage 2: Most distal portion of the prolapse is between 1 cm above and 1 cm below the hymen
- Stage 3: Most distal portion of the prolapse is > 1 cm below the hymen
What is the treatment for pelvic organ prolapse?
- Non surgical
- Surgical
Non-surgical:
- Relieve causes of increased intra-abdominal pressure
- Estrogen
- Pelvic floor exercises
- Pessaries
- Require proper fit
- Cleaned and inserted every 6-12 weeks
Surgical (less in elderly):
- Anterior/posterior colporrhaphy
- Vaginal vault suspension
- LeFort colpocleisis (sew up vagina with channels remaining on sides)
- Complete colpocleisis
What is incontinence?
- Prevalence
- Subtypes
Involuntary loss of urine that is objectively demonstrable and is a social/hygiene problem
- 50% of women affected in their lifetime
Subtypes:
- Stress urinary incontinence
- Urge urinary incontinence (overactive bladder)
- Overflow incontinence
Define the following types of incontinence:
- Stress urinary
- Urge urinary (overactive bladder)
- Overflow
- Stress urinary: Involuntary leakage of urine in response to physical exertion, sneezing or coughing (valsalva)
- Urge urinary (overactive bladder): Involuntary leakage of urine accompanied by or immediately preceded by urgency (due to bladder spasm)
- Overflow: Involuntary leakage resulting from detrusor areflexia or a hypotonic bladder as seen with lower motor neuron disease, spinal cord injuries or autonomic neuropathy
Describe Chlamydia cervicitis:
- Etiology
- Found where (anatomically)
- Symptoms (how many asymptomatic)
- Symptoms (specifically)
- Caused by Chlamydia trachomatis
- Chlamydia is #1 bacterial STI (HPV more common)
- Found in urethra, endocervix, endometrium, fallopian tubes and rectum
- Most individuals are asymptomatic
- Symptoms include yellow discharge from a swollen, red, friable cervix and dysuria
What are some of the different classes of uterus deformities?
(Don’t memorize)
- Hypoplasia/agenesis
- Unicornate (to one side with/out horn)
- Didelphus (two uteri but one vagina)
- Bicornate (split uterus)
- Septate (full/partial divide)
- Arcuate
- DES drug related
What is endometriosis?
- Prevalence
Endometrial glands/stroma that have implanted outside the uterine cavity and walls
- 5-15% of women have some degree of this disease
What is seen here?
“Powder-burn” lesions of endometriosis
What is seen here?
“Chocolate cyst” of endometriosis (has endometrionic blood within)
