alterations of sexual maturation Flashcards
percocious puberty
sexual maturation before - 6-7 in girls - 9 in boys forms - isosexual - heterosexual - incomplete
delayed pubety
no secondary sex characteristics
- females: by age 13
- males: by age 14
etiology: - undernutrition
- athletics
- HPG defects
- stress
- environmental exposures
painful menstruation
associated with prostaglandin release in ovulatory cycles
- r/t duration and amount of menstrual flow.
tx: NSAIDs and COX inhibitors
dysmenorrhea
primary: usually develops 1-2 years after menarche when ovulatory cycles established
secondary: more dull pain, increases with age, associated with pelvic disorders
- endometriosis
- leiomyomoas
- pelvic adhesions
tx for dysmenorhhea
primary: focus on phenmenon of prostaglandin-induced enhanced uterine contractility
- prostaglandin inhibitors
secondary: dx therapies
- medical/surgical therapy for underlying condition
primary amenorrhea
failure of menarche and the absence of menstruation by age 14; without development of secondary sex characteristics by 16
secondary amenorrhea
absence of menstruation for a time equivalent to 3+ cycles or 6 months in women who havve previously menstruated
etiology:
- pregnancy
- dramatic wt loss
- malnutrition
- excessive exercise
- hypothyroidism
- PCOS
- perimenopause
- lactation
tx for amenorrhea
directed to correcting interuption in hormone functioning
- may include hormone supplementation
- tumor removal
abnormal uterine bleeding (AUB)
bleeding other than monthly cycle Etiology: - hormonal imbalance: menopause - pregnancy - polyp/fibroids - cervical infection - endometrial cnacer - hormone replacement therapies tx: - treat cause
dysfunctional uterine bleeding
abnormal uterine bleeding not associated with
- tumor, inflammation, pregnancy, trauma, or hormonal effects
Most common around time of menarche and menopause
- adolescents: immature functioning of pituitary and ovary
- menopause: progressive degeneration and failure of the ovary to produce estrogen.
pelvic organ prolaps
bladder, urethra, and rectum are supported by the endopelvic facia and perineal muscles
- loses tone and strength with aging
- uterine
- cystocele and rectocele
- vaginal
- urethrocele
- cystourethrocele
- enterocele
uterine prolapse
degrees
- normal
- 1st degree: uterine descent within vagina
- 2nd degree: cervix protrudes through the introitus
- 3rd degree: vagina is completely everted.
s/s of uterine prolapse
sensation of bearing down and discomfort in vagina
discomfort with walking, sitting
difficulty urinating
tx of uterine prolapse
hysterectomy
pessary: supportive device holds uterus in place
cystocele and s/s
urinary bladder into anterior vagina s/s: - pressure in vagina - dysuria - incontinence - back pain - fullness at vaginal opening
cystocele tx
surgical repair
support bladder
rectocele and s/s
rectum into posterior vagina s/s: - difficult bowel elimination - constipation: laxative and enema dependent - pressure -painful sex
rectocele tx
surgical repair
support vaginal wall
PID
acute inflammation caused by infection
may involve any organ of reproductive tract
- salpingitis: cervix, oviducts
- oophoritis: uterus, ovaries
PID etiology
nml cervical secretions provide protective barrier for reproductive organs
- prevents bacterial agents from ascending into uterus
conditions that alter or destroy cervical mucous
- insertion of IUD
- pelvic surgery
- abortion
- pregnancy
- STI
- pelvic abscess
PID s/s
- abdominal pain and tenderness
- cervix pain and tenderness
- increased temp
- increased WBC
PID Tx
antibiotics
drain abscess
vaginitis
infection of the vagina
- STI
- candida albicans
Vaginal acidic pH is protective
cervicitis
inflammation or infection of the cervix
s/s vaginitis/cervicitis
from candidiasis - thick, white discharge - red, edematous mocous membrane - white flecks adhering to vaginal wall - itchaing from other infection - purulent discharge - malodorous - irritation - inflammation - dysuria
tx of vaginitis/cervicitis
antifungal
antibiotics
cool compress
sitz bath
vulvitis
inflammation of external genitalia
etiology:
- contact with soaps, detergents, lotions, hygienic sprays, shaving, menstrual pads, or titgh-fitting clothing
- vaginal infection that spread to the labia
bartholinitis
inflammation of one or both docts that lead from the vaginal opening to bartholin glands
- narrows the distal ducts
- leads to obstruction and stasis of glandular secretions
bartholinitis s.s
abscess: bartholin cyst
- tenderness, swelling
- pus
- fever
- malaise
tx of bartholinitis
antibiotics
abscess drainage
endometrial polyps
overgrowth of endometrium
fingerlike growths variable in size that attach to the wall of the uterus
endometrial polyps etiology
tend to when there is high estrogen risk factors - obesity - tamoxifen - postmenopause - hormone replacement therapy - lynch syndrome or cowden syndrome
endometrial polyps s/s
menstrual bleeding that is not regular or predictable
bleeding between periods
bleeding from vagina after menopause
trouble getting or staying pregnant
endometrial polyps test and tx
exams ans tests:
- transvaginal ultrasound
- hysteroscopy
- endometrial biopsy
- hysterosonogram
tx: - removal due to possibility of cancer via hysteroscopy or D&C
ovarian cyst
fluid filled sac
arrise from normal monthly follicle continuation of growing
ovarian cyst s/s
dull aching pelvic pain dysparenunia irregular menstruation abnormal uterine bleeding abdominal bloating
ovarian cyst complications
cyst rupture: sharp abdominal pain, or asymptomatic
ovarian torsion: cyst >4cm yield inc. risk of torsion
- obstruction and ischemia
- infarction may result
follicular cyst
maturing follicle fails to release ovum
- continues to enlarge and produce estrogent
corpus lutem cyst
corpus luteum fails to degenerate properly
- continues to grow and produce progesterone
theca-lutein cyst
bilateral and filled with clear straw colored fluid
- associated with hydatidiform mole, choriocarcinoma, or hormone therapy.
cyst tx
recurrent: oral contraceptive
surgery if hemorrhaging
endometriosis
endometrial cells attaching to other location of body rather than uterus
transportation endometriosis
endometrial tissue backflow through oviducts during menstrual cycle
- retrograde menstruation
metaplasia endometriosis
inflammation or hormonal change triggers metaplasia
induction endometriosis
combo of transportation and metaplasia
- regurgitated endothelium chemically induces mesenchyma to form endometrial endothelium
endometriosis s/s
dysmenorrhea pain with BM menstrual flow changes - excessive bleeding - anemia and fatigue
endometriosis tx
relieve pain restore/maintain fertility NSAIDs hormonal agents surgical
leiomyomas
myomal fibroids
in muscle region of uterus
leiomyomas s/s
abdominal pain/pressure abnormal vaginal bleeding and discharge back pain constipation urinary frequency/urgency prevent pregnancy/ carrying to term difficult
leiomyoma tx
surgical removal
possible hysterectomy
cervical cancer
Viral induced cancer
-almost 100% from HPV
common site: squamocolumnar junction at exocervix
cervical cancer s/s
preinvasive no s/s
early:
- abnormal vaginal bleeding
- vaginal discharge
- pain and bleeding after sex
later:
- s/s appear
cervical cancer tx
surgery - precancerous -- cryotherapy -- excision -- laster hysterectomy chemo radiation
endometrial cancer
most common cancer of the female reproductive tract
- commonly in postmenopausal women
- early sign: involve bleeding
endometrial cancer s/s
bleeding between cycles
postmenopausal bleeding
endometrial cancer tx
radiation
hysterectomy
-possible ovaries and oviducts as well
ovarian cancer
typically has poor prognosis
-r/t later dx
woman with BRCA1 mutation have a increased risk
ovarian cancer s/s
when occur related to intra-abdominal metastasis
- increased abdominal girth
- wt loss
- abdominal pain
- dysuria
- urinary frequency
- constipation
ovarian cancer tx
chemo
radiation
surgery
vaginal cancer
squamous cell carcinoma - most common, slow pathogenesis risk factors: - 70+ years diethylstilbestrol DES: hormonal drug given to some women to prevent miscarriage between 1940-1971: multigenerational
vaginal cancer s/s
vaginal spotting or discharge
pain
groin masses
changes in urinary pattern
vaginal cancer tx
radiation
surgery
try to preserve vaginal function
- only possible in early stages
vulva cancer
rare peak: mid-60's prescence of white plaquelike or ulcerated lesions Predispose factors: - STI - chronic pruritis of vulva with swelling and dryness - obesity - HTN - DM - no pregnancy
vulva cancer s/s
masses
abnormal urination
abnormal BM
vulva cancer tx
partial excision of vulva
