Congenital and Benign Vulva, Vagina and Uterus -Gambone

Question 1

What is female pseudohermaphroditism? What can cause this?

Answer 1

genetic female who appears to be male

-masculinization in utero causing an enlarged clitoris (congenital adrenal hyperplasia, ingestion of exogenous hormones by mother, androgen-producing tumors)

Question 2

What is a true hermaphrodite?

Answer 2

both testicular and ovarian tissues

Question 3

What are the complications related to a transverse vaginal septum? What can this be confused with?

Answer 3

the septum doesn’t allow blood/mucous to escape the vagina –> primary amenorrhea and cyclic pain

large hematocolpos==> may be confused with imperforate hymen

Question 4

What type of tissue is the vagina?

Answer 4

epithelium!

not mucosa —> he said this a lot

Question 5

What is a Gartner’s Duct Cyst?

Answer 5

arise from the remnant of the wolffian duct

thick walled cyst of the vagina –> asymptomatic

Question 6

What type of vaginal cyst is generally very painful and found growing into the vulva?

Answer 6

Bartholin’s cyst –> needs drained

Question 7

What can endometriosis of the vagina present as?

Answer 7

painful, cyclic

cystic steel gray or black lesions in the upper 1/3 of the vagina

Question 8

What embryologic tissue do the upper vagina, cervix, uterine corpus and fallopian tubes arise from?

Answer 8

paramesonephric (Mullerian) ducts

Question 9

What are cervical abnormalities normally due to? What can cause this?

Answer 9

malfusion of the mullerian ducts with varying degrees of separation

can be due to Diethylstilbesterol (DES) exposure (T shaped uterus and cervical collar deformity)

Question 10

What is cervical incompetence? What can this lead to?

Answer 10

ervix loses the ability to maintain closure

predisposes to premature delivery and 2nd trimester abortion

Question 11

What is a uterine leiomyoma? What are some risk factors?

Answer 11

benign neoplasm derived from the smooth mm cells of the myometrium
(estrogen stimulates the proliferation)
-causes irregular enlargement of the uterus
-low malignant potential

Risks:

• increasing with age up to 50
• african american have 2-3x risk
• nulliparity
• family history
• higher BMI

Question 12

What is associated with a decreased risk for uterine leiomyomas?

Answer 12

Oral contraceptives

mostly produce progesterone

Question 13

What kind of uterine leiomyoma can cause infertility?

Answer 13

submucosal growing into the uterine cavity

can prolapse = “delivering myoma”–> severe pain and hysterectomy is often performed because of the bleeding

Question 14

Why do many patients with leiomyomas experience symptoms during pregnancy?

Answer 14

high estrogen state –> induce growth

Question 15

What are some medical treatment options for leiomyoma?

Answer 15

hormonal treatment (protestins or estrogen and progesterone combinations)

GnRH agonist is time limited –> reduce size prior to surgery

Question 16

What are the surgical treatments for uterine fibroids? How does this affect women who have additional pregnancies after the procedure?

Answer 16

Myomectomy (removal of a single or multiple fibroids) is the preferred surgical procedure for women with a small number of tumors who desire uterine preservation

1/4 require second operation

*cesarian delivery should be performed for subsequent pregnancies due to the tendency of the defect to rupture

Question 17

What is rapid growth of uterine leiomyomas thought to be associated with?

Answer 17

leiomyosarcoma

Question 18

What is the likely cause of a symmetrically enlarged uterus?

Answer 18

adenomyosis (can be confused with fibroids which have an irregular enlargement)