CH 27 jarvis female geniturinea Flashcards
external genitalia are called the
- clitoris
- labia majora
- labia minora
vulva, or pudendum
is a round, firm pad of adipose tissue covering the symphysis pubis.
mons pubis (cover symphysis pubis)
are two rounded folds of adipose tissue extending from the mons pubis down and around to the perineum
labia majora
Inside the labia majora are two smaller, darker folds of skin, the
labia minora.
labia minora are joined posteriorly by a transverse fold, the
frenulum, or fourchette.
is a small, pea-shaped erectile body, homologous with the male penis and highly sensitive to tactile stimulation.
clitoris
labial structures encircle a boat-shaped space, or cleft, termed the
- urethral meatus and vaginal orifice are visible
- ducts of the paraurethral (Skene) glands and the vestibular (Bartholin) glands are present but not visible.
vestibule.
appears as a dimple 2.5 cm posterior to the clitoris.
urethral meatus
Surrounding the urethral meatus are the tiny, multiple
-Their ducts are not visible but open posterior to the urethra at the 5 and 7 o’clock positions.
paraurethral (Skene) glands
is posterior to the urethral meatus. It appears either as a thin median slit or a large opening with irregular edges, depending on the presentation of the membranous hymen
vaginal orifice
is a thin, circular or crescent-shaped fold that may cover part of the vaginal orifice or may be absent completely
hymen
posterior to the vaginal orifice are which secrete a clear lubricating mucus during intercourse. Their ducts are not visible but open in the groove between the labia minora and the hymen.
two vestibular (Bartholin) glands,
, a flattened, tubular canal extending from the orifice up and backward into the pelvis
- 9 cm long and sits between the rectum posteriorly and the bladder and urethra anteriorly.
vagina (internal genitalia)
nulliparous (never given birth) female the cervix appears as a smooth doughnut shape with a small circular hole, or
-After childbirth the os is slightly enlarged and irregular.
os
vagina & cervis (stratified squamous) + OS (columnar) meet
squamocolumnar junction (not visible)
Behind the posterior fornix another deep recess is formed by the peritoneum. It dips down between the rectum and cervix to form the
rectouterine pouch, or cul-de-sac of Douglas
is a pear-shaped, thick-walled, muscular organ. It is flattened anteroposteriorly,
- freely movable, not fixed, and usually tilts forward and superior to the bladder (a position labeled as anteverted and anteflexed,
uterus
are two pliable, trumpet-shaped tubes, 10 cm in length, extending from the uterine fundus laterally to the brim of the pelvis.
fallopian tubes
are located one on each side of the uterus at the level of the anterior superior iliac spine.
-develop ova (eggs) and the female hormones.
two ovaries
-At birth the external genitalia are engorged because of the
presence of maternal estrogen. (infant)
ovaries are located in the abdomen during childhood. The uterus is small with a straight axis and no anteflexion
infant genital development
stimulate the growth of cells in the reproductive tract and the development of secondary sex characteristics.
puberty estrogens
are breast development (thelarche) and pubic hair development, beginning between the ages of 8 to 10 years (mean = 11.6 years).
first signs of puberty
because of the occasional failure to ovulate
-With menarche the uterine body flexes on the cervix. The ovaries now are in the pelvic cavity.
Irregularity of the menstrual cycle is common during adolescence
is helpful in teaching girls the expected sequence of sexual development
Tanner’s table on the 5 stages of pubic hair development (sexual maturity rating [SMR])
signs of the growing fetus
- changes in the cervix on internal examination.
first missed menstrual period the genitalia show
becomes globular in shape and is too large to stay in the pelvis.
By 10 to 12 weeks’ gestation, the uterus
has an oval shape. It rises almost to the liver, displacing the intestines superiorly and laterally.
20 to 24 weeks, the uterus
and are thick, white, and more acidic because of Lactobacillus acidophilus, which changes glycogen into lactic acid. The acidic pH keeps pathogenic bacteria from multiplying in the vagina, but the increase in glycogen increases the risk for candidiasis (commonly called a yeast infection) during pregnancy.
Cervical and vaginal secretions increase during pregnancy & PH impact
of human papillomavirus (HPV)
cervical cancers result as a long-term consequence
cervical cancer screening by a ? every 3 years from ages 21 to 65 years
Papanicolaou test
is cessation of the menses
-Ovaries stop producing progesterone and estrogen
Menopause
of decreased myometrium (decreased smooth muscle tissue of uterus)
uterus shrinks in size because
not palpable after menopause
ovaries
- Ovulation still may occur sporadically after menopause.
- sacral ligaments relax, and the pelvic musculature weakens; thus the uterus droops. The cervix shrinks and looks paler with a thick, glistening epithelium.
changes to genital after menopause
vagina becomes shorter, narrower, and less elastic. Without sexual activity the vagina atrophies to one-half its former length and width
vagina alterations
Decreased vaginal secretions leave the vagina dry and at risk for irritation and pain with intercourse
(dyspareunia)
alkaline, and glycogen content decreases from the decreased estrogen. These factors also increase the risk for vaginitis because they create a suitable medium for pathogens.
vaginal pH becomes more
test from cervix for cervical cancer
-21 & up
Pap test screening
is an invasive, coercive surgical procedure performed on girls before puberty.
-removal, partial or total, of the clitoris
Female genital mutilation, or “cutting,”
—Normally every 28 days; varies from 18 to 45 days
-Duration—Average 3 to 7 days
Cycle
—Absent menses
Amenorrhea
—Heavy menses.
Menorrhagia
responds to ibuprofen because it works on uterine smooth muscle.
Dysmenorrhea (menstrual cramps)
—Number of pregnancies.
Gravida
—Number of births.
Para
—Interrupted pregnancies, including elective abortions and spontaneous miscarriages.
Abortions
period from ages 40 to 55 years has hormone shifts, resulting in vasomotor instability.(hot flashes)
Perimenopausal
include fluid retention, breast pain, vaginal bleeding, and cardiovascular and breast cancer risk.
Side effects of HRT (hormone replacement therapy)
-this by testing first-catch urine.
yearly screening for chlamydial infection in all sexualy active women under 25
urinary tract infection (UTI) and kidney disease.
Hematuria occurs with
—overactive detrusor muscle in bladder.
Urge incontinence
—Involuntary urine loss with physical strain, sneezing, or coughing.
Stress incontinence
is small, clear or cloudy, and always nonirritating
Normal discharge
vaginitis of any cause.
Dyspareunia occurs with
is result of irritation from discharge
Rash
increase glycogen content of vaginal epithelium, providing fertile medium for some organisms.
Oral contraceptives (birth control)
increases glycogen content.
Diabetes
Menses, postpartum, menopause
have a more alkaline vaginal pH.
is considered after 1 year of unprotected sexual intercourse without conceiving.
Infertility
such as gonorrhea, herpes, HIV/AIDS, chlamydial infection, venereal warts, syphilis
STI
in the United States.
-The 2-dose series of Gardasil 9 is recommended for girls and boys 9–14 years, doses separated by 6–12 months.9
HPV is the most common STI
Vaginal dryness, decreased lubrication are common with decreased estrogen
aging alterations female vagina
These are yellowish, 1-cm nodules that are firm, nontender, and often multiple.
-normal
occasional sebaceous cysts. in vagina
cystocele, rectocele, or uterine prolapse
Bulging of the vaginal wall indicates
is pink and even
- . During the 2nd month of pregnancy it looks blue (Chadwick sign), and
- after menopause it is pale.
Normally the cervical mucosa (color)
—Bright red growth protruding from the os
Cervical polyp
are benign growths that commonly appear on the cervix after childbirth.
-They are small, smooth, yellow nodules that may be single or multiple. Less than 1 cm, they are retention cysts caused by obstruction of cervical glands.
Nabothian cysts (common after childbirth)
- Vaginal Pool
- Cervical Scrape
- Endocervical Specimen (safe during pregnancy)
collect the cellular specimens from the following 3 locations. (cervical cultures)
Female vaginal swab specimens are the best specimen type
screen for STIs
It softens and feels velvety at 5 to 6 weeks of pregnancy
(Goodell sign).
there may be endometriosis or PID adhering it.
If the retroverted uterus is fixed and immobile,
Pulsation or palpable fallopian tube suggests
ectopic pregnancy
should feel smooth, thin, firm, and pliable
Rectovaginal septum
feel firm and smooth.
• Uterine wall and fundus feel
(1) the structures are intact,
(2) the vagina is present,
(3) the hymen is patent
childhood a routine screening is limited
labia majora are swollen, the labia minora are prominent and protrude beyond the labia majora, the clitoris looks relatively large, and the hymen appears thick. Because of transient engorgement, the vaginal opening is more difficult to see now than it will be later. Place your thumbs on the labia majora. Push laterally while pushing the perineum down and try to note the vaginal opening above the hymenal ring
-Do not palpate the clitoris because it is very sensitive.
newborns genitalia
are rare but are suggested by a markedly enlarged clitoris, fusion of the labia
Ambiguous genitalia
(mucoid discharge) is normal during the first few weeks because of the maternal estrogen effect. (This also may cause transient breast engorgement and secretion.)
sanguineous vaginal discharge or leukorrhea (infant)
labia majora are flat, the labia minora are thin, the clitoris is relatively small, and the hymen is tissue-paper thin. Normally no irritation or foul-smelling discharge is present.
Between the ages of 2 months and 7 years, the labia
, the mons pubis thickens, the labia majora thicken, and the labia minora become slightly rounded. Pubic hair appears beginning around age 11 years, although sparse pubic hair may occur as early as age 8 years. Normally the hymen is perforate. Menarche closely follows the adolescent growth spurt, accompanied by normal body odor and acne.
the young school-age girl (7 to 10 years)
indicates delayed puberty.
Absence of pubic hair by 13 years
because of the estrogen effect.
physiologic leukorrhea is normal (adolescent)
the history suggests abnormal vaginal discharge, missed periods, and a positive pregnancy test, or at 21 years of age
Perform a pelvic examination when
in the adolescent.
adnexa are not palpable
show hyperemia of the perineum and vulva because of increased vascularity. Internally the walls of the vagina appear violet or blue (Chadwick sign) because of hyperemia
external genitalia (pregnant woman)
isthmus of the uterus feels softer and is more easily compressed between your two hands.
Hegar sign (pregnant woman)
between your two hands; it feels connected to, but distinct from, the cervix because the isthmus is so soft.
The fundus balloons(pregnant woman)
Natural lubrication is decreased
-Pedersen speculum (rather than the Graves) because its narrower, flatter blades are more comfortable in women with vaginal stenosis or dryness.
Aging Adult
Pubic hair gradually decreases, becoming thin and sparse in later years. The skin is thinner, and fat deposits decrease, leaving the mons pubis smaller and the labia flatter with a hanging appearance. Clitoris size also decreases after age 60 years.
Aging Adult
increases the risk for infection and trauma.
Vaginal atrophy (Aging Adult)
- rugae of the vaginal walls decrease, and the walls look pale pink because of the thinned epithelium.
- cervix shrinks and looks pale and glistening. It may retract, appearing to be flush with the vaginal wall
aging adult
cervical cancer screening if they have ≥3 consecutive negative Pap tests or ≥2 consecutive negative HPV and Pap tests within the last 10 years. Also, women with a total hysterectomy for benign findings may stop cervical cancer screening.3
Women ages 65+ years may choose to stop screenings if
hot flashes, night sweats, numbness and tingling, headache, palpitations (fast heart beat), drenching sweats, mood swings, vaginal dryness, and itching.
associated symptoms of menopause
hot flashes, night sweats, numbness and tingling, headache, palpitations (strong, irregular heart beat), drenching sweats, mood swings, vaginal dryness, and itching.
associated symptoms of menopause
normal flora, which may lead to the development of vaginitis
Broad-spectrum antibiotics alter the balance of
