CM: Intro to Female Repro

Question 1

What does anovulatory mean and how can it be recognized?

Answer 1

pt not ovulating

irregular, dark color, painless, short or long in duration

Question 2

What routine STD screening is recommended in sexually active adolescents?

Answer 2

chlamydia and gonorrhea

Question 3

What does intermittent or colicky pain suggest?

Answer 3

muscle contraction in a hollow viscus

Question 4

What does dull or throbbing pain suggest?

Answer 4

chronic inflammatory dz or changes internal to pelvic tumor

Question 5

What is dysmenorrhea? primary and secondary?

Answer 5

painful menses
primary (30-40% of teenagers) - no pelvic pathology, usually begins w onset of menstrual cycles, starts 2-3 days prior to menses and goes away w full flow
secondary - older age of onset, begins well before menses and persists throughout flow –> pathology

Question 6

What is the pathophysiology of dysmenorrhea?

Answer 6

retention of menstrual blood –> myometrial distension

higher PGF-2alpha concentration

Question 7

How can ovulatory pain (mittelschmerz) be recognized?

Answer 7

occurs mid cycle - “day of ovulation”
lasts 2-3 days
can be treated w analgesics and OCPs

Question 8

What is the pathophysiology of endometriosis? What percentage of premenopausal women does it affect?

Answer 8

benign - endometrial glands and stroma found in extrauterine locations (ovary)
5-15%

Question 9

What are the theories proposed for the etiology of endometriosis?

Answer 9

Sampson’s theory of retrograde menstruation, tissue metaplasia, lymphatic or hematogenous spread, decreased immune response

Question 10

What is the clinical presentation of endometriosis?

Answer 10

dysmenorrhea, dyspareunia, infertility, rectal pain, premenstrual bloody staining, backache
pelvic tenderness, fixed retroflexed uterus, nodularity of uterosacral ligaments, enlarged ovaries

Question 11

How is endometriosis diagnosed?

Answer 11

laparoscopy w biopsy of lesions - hemosiderin laden macrophages

Question 12

What is the pathophysiology of PID?

Answer 12

infection of upper reproductive tract organs
usually ascending bacteria
N gonorrhoeae, C. trachomatis (asymptomatic)

Question 13

What is the presentation of PID?

Answer 13

constant pain - unilaterial progresses to bilateral
yellow discharge, fever, cervical motion tenderness, leukocytosis, elevation of ESR, cultures + or - (if above cervix already)

Question 14

What are the possible complications of PID?

Answer 14

tubo-ovarian abscess

infertility

Question 15

What are the generalities of the menstrual cycle?

Answer 15

day 1 is first day of menses
proliferative and luteal phases - both around 14 days (if 1 changes, it is proliferative)
menses w progesterone withdrawal if no pregnancy

Question 16

What are the major effects of estrogen?

Answer 16

endometrial proliferation
vaginal cornification
watery cervical mucus
positive and negative feedback

Question 17

What are the major effects of progesterone?

Answer 17

thermogenic
secretory endometrium, viscous mucus
modulates feedback
lobuloalveolar growth of breasts

Question 18

What is the effectiveness of condoms with regard to STIs?

Answer 18

no evidence of risk reduction of HPV or trichomonas vaginalis
syphilis, chlamyida, and gonorrhea all have reduced risk
still 60% relative risk of herpes
still 15% risk of HIV