6: Female Pathology Flashcards
What is endometriosis?
Estrogen dependent disorder where tissue sheds outside of the uterus and deposits in the pelvic cavity
When does endometriosis develop?
Teenage years
What are the risk factors for endometriosis?
- Maternal family history
- Delay pregnancy
- Early menarche
- Abnormal cycles
- Low birth weight
- High red meat and trans fat
What is the most common clinical presentation with endometriosis?
Dysmennorhea, dyspareunia, pain with bowel movements, infertility
What are other symptoms of endometriosis?
Low-grade fever, diarrhea, constipation, rectal bleeding, referred pain
How is endometriosis diagnosed?
Laparoscopy, MRI, ultrasound
What are treatments for endometriosis?
Hormone therapy, birth control, yoga, aromatherapy, acupuncture, naturopathic
What physical therapy interventions can be used for endometriosis?
General exercise, modalities, stress management, posture and body mechanics education, trigger point
What is BPS/IC?
Bladder pain syndrome/ Interstitial cystitis - complaint of suprapubic pain related to bladder filling that is accompanied by other symptoms in the absence of other pathology
What is the mechanism of BPS/IC?
Overactive PFM
What are the four characteristics of the clinical presentation of BPS/IC?
- Urinary urgency
- Nocturia
- Pain, stabbing sensation
- Difficulty emptying
How is BPS/IC diagnosed?
History, physical , cystoscopy, urinalysis, voiding diary, pelvic ultrasound
What are treatments for BPS/IC?
Stress management, manual therapy, trigger point, scar massage, CBT, stretching, muscle re-education
What is POP?
Pelvic organ prolapse - downward descent of female pelvic organs into or through the vagina
What is the prevalence of POP?
43-76% of women
What is cystocele?
Prolapse of bladder through urethra
What is rectocele?
Prolapse of the rectum
What is uterine prolapse?
Prolapse of uterus through the cervix
What is enterocele?
Prolapse of small intestine
What are the symptoms of vaginal POP?
- Bulging or protrusion sensation
- Seeing or feeling bulge
- Pressure
- Heaviness
What are symptoms of urinary POP?
- Incontinence
- Frequency and urgency
- Weak or prolonged urinary stream
- Hesitancy
- Feeling of incomplete voiding
- Position change to start or complete voiding
What are the symptoms of bowel POP?
- Incontinence of flatus or stool
- Feeling of incomplete emptying
- Straining during defecation
- Urgency
- Splinting to start or complete defecation
What are the risk factors for POP?
- Constipation
- Pelvic surgery
- Genetic factors
- Caucasian ethnicity
- Pregnancy with vaginal delivery
- CT disorders
- COPD
How do you examine POP?
POP-Q: performed in supine and standing, measure degree of prolapse
What is Stage 0 on the POP-Q?
No prolapse
What is Stage I on the POP-Q?
Most distal portion of the prolapse is > 1cm above hymen
What is Stage II on the POP-Q?
Most distal portion is < 1 cm proximal or distal to hymen
What is Stage III on the POP-Q?
Distal portion of prolapse is > 1cm below the plane of the hymen but protrudes no further than 2 cm less than TVL
What is Stage IV on the POP-Q?
Distal portion of the prolapse protrudes to at least 2 cm of the TVL
What are the treatments for POP?
- Pessaries
- PFMT
What are the dimensions of FSD?
Female sexual disorder - sexual identity, function, and relationship
What it the etiology of FSD?
- Biological
- Psychosexual
- Contextual
What is dyspareunia?
Pain with penetration, superficial vs deep
What are causes of dyspareunia?
CPPD, psychologic trauma, endometriosis, post-partum, vulvovaginitis
What are the two types of CPPD?
- Vaginismus
- Vulvar vestibulitis
What is vaginismus?
Involuntary contraction and spasm of perineal muscles that makes penetration difficulty, painful, or impossible
What are six clinical findings with vaginismus?
- Dehydrated tissues
- Decreased elasticity
- Pale color
- History of bleeding with penetration
- Painful/impossible penetration
- High resting tone
What is vulvar vestibulitis?
Pain in the vestibule with palpation of entry
What does vulvar vestibulitis occur?
Wearing tight clothing, use of tampons, intercourse
What are risk factors for vulvar vestibulitis?
Recurrent yeast infections, sleep dysfunction, PTSD
What are causes of vulvar vestibulitis?
Physical cause becoming psychologically based
What is the prevalence of vulvar vestibulitis?
16% of women 18-64, common pre-menopause
What symptoms are associated with vulvar vestibulitis?
- Extreme sensitivity
- Bartholin glands, Skene’s glands
- Inflamed superficial blood vessels
- Patient expresses anxiety regarding physical exam
What clinical findings are associated with vulvar vestibulitis?
- High tone
- Trigger points
- Dyspareunia
- History of yeast infection self-treatment
- Urinary frequency and urgency
- cottons swab tough test
What are treatments for FSD?
- Hormone therapy
- Analgesia
- Anti-depressant
- Counseling
- PFMT
- Botox
