Abnormal Bleeding and Findings Flashcards
What is cervical ectropion
Occurs when the columnar epithelium of the endocervix has extended to the ectocervix
What is the finding on speculum examination of ectropion
Lining of endocervix is visible on exam which has a different appearance to the normal endocervix
What are the properties of endocervix
more fragile and prone to trauma, more likely to bleed with sexual intercourse.
Which populations is cervical ectropion more common in
Associated wit high oestrogen levels so more common in younger women, those taking COCP and pregnancy
Presentation of cervical ectopion
Asymptomatic
Increased vaginal discharge
Vaginal bleeding
Dysparenuria
Postcoital bleeding
Treatment of cervical ectopion
Asymptomatic - no treatment
Usually resolves as patient gets older, stops taking pill or is no longer pregnant.
Cauterisation using silver nitrate or cold coagulation during colposcopy
What is a nabothian cyst
Fluid filled cyst on the surface of the cervix - usually up to 1cm in size
How do nabothian cysts form
The squamous epithelium of the ectocervix slightly coverse the mucus secreting columnar epithelial cells, so the mucus becomes trapped and forms a cyst
When do nabothian cysts mainly form
After childbirth, minor trauma, or cervicitis secondary to infection
Presentation of nabothian cysts
Rarely cause symptoms and found incidentally as smooth white round lumps on the cervix typically near Os.
Management of nabothian cysts
Reassurance and no treatment, do not cause harm and often resolve spontaneously
What is a Bartholins cyst
When the ducts become blocked the swell and fill with fluid, they are located on either side of the posterior part of the vaginus introitus - usually 1-4cm
Complication of bartholins cyst
Can become infected and cause abscess which will be hot, red, tender and drain pus. This will require abx and swab of pus
Management of Bartholins cyst
Hygiene, analgesia, warm compresses
Can be treated surgically with word catheter or marsupialisation
What is FGM
Involves surgically changing the genitals of a female for non-medical reasons. Cultural practises which usually occur in girls before puberty. Form of child abuse and safeguarding issue.
Types of FGM
Removal of part of all of clitoris
Removal of part or all of clitoris and labia minora, labia majora may also be removed
Narrowing or closing of the vaginal orifice (infibulation)
All other unnecessary procedures to female genitalia
Immediate complications of FGM
Pain, bleeding, infection, swelling, urinary retention, urethral damage and incontinence
Long term complications of FGM
Vaginal infections, pelvic infections, UTIs, dysmenorrhoea, sexual dysfunction, dysparenuria, infertility, pregnancy related complications, psychological issues, reduced engagement with healthcare and screening
Management of FGM
Education
Report case if below 18 years old
De-infibulation - correcting the narrowing or closure of the vaginal orifice, improving symptoms and restoring normal function
Causes of pelvic inflammatory disease (PID)
Neisseria gonorrhoea
Chlamydia trachomitis
Mycoplasma genitalium
Gardenella vaginalis
Haemophilus influenza
E coli
Most commonly STIs
Risk factors for PID
No barrier protection
Multiple sexual partners
Younger age
Existing STI
Previous PID
IUD
Presentation of PID
Pelvic or lower abdominal pain
Abnormal vaginal discharge
Abnormal bleeding
Pain during sex
Fever
Dysuria
Examination of PID
Pelvic tenderness
Cervical motion tenderness
Inflamed cervix
Purulent discharge
fever and signs of sepsis
Investigations into PID
NAAT swabs
HIV test
Syphilis test
High vaginal swab
Microscope to look for pus cells
Pregnancy test
Inflammatory markers
