Female Flashcards
The external genitalia are called the ______, or pudendum.
vulva
The ____ ______ is a round, firm pad of adipose tissue covering the symphysis pubis. After puberty, hair covers in an inverted triangle.
mons pubis
The _____ ______ 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
Surrounding the urethral meatus are the tiny, multiple paraurethral (______) glands. There ducts are not visible but open posterior to the urethra at the 5 and 7 o’clock positions.
skene’s
On the other side and posterior to the vaginal orifice are two vestibular (________) glands, which secrete a mucus during intercourse.
bartholin’s
What is the subjective data?
Menstrual, obstetric, and past history Menopause Self-care behaviors Urinary symptoms vaginal discharge sexual history contraceptive use STI contact STI risk reduction
_______ history is usually nonthreatening; thus it is a good place to start assessment.
Menstrual
________-mean age at onset at 12 to 13 years; delayed onset suggests _______ or underweight problems
Menarche
endocrine
A cycle is normal every ___ to ____ days
18-45
Absent menses
amenorrhea
What is the duration of a cycle?
3-7 days
Heavy menses
Menorrhagia
Clotting indicates _____ flow or vaginal pooling.
heavy
Any pain or cramps?
Dysmenorrhea
number of pregnancies
gravida
number of births
para
Abortions are interrupted pregnancies, which include _______ abortions and _________ miscarriages
elective
spontaneous
Cessation of menstruation-_________
menopause
Perimenopausal period from 40-55 years has ______ shifts, resulting in vasomotor instability.
hormone
Side of effects of HRT (hormone replacement therapy include _____ retention, breast pain, vaginal bleeding, and ____ _____ risk.
fluid
breast cancer
Begin cervical cancer screening within __ years after first vaginal intercourse or age 21, and continue _____ until age 30. After age 30, if you have three consecutive normal ___ tests, women may be screened every 2 to 3 years.
3
annually
pap
Under self care behaviors, has your mother ever mentioned taking hormones while pregnant with you?…What does this cause?
Maternal ingestion of diethylstilbestrol (DES) causes cervical and vaginal abnormalities in female offspring requiring frequent follow-up
Any burning or pain on urination?
Dysuria
Awaken during the night to urinate?
nocturia
Blood in the urine?
hematuria
Is your urine dark, cloudy, foul smelling?
Bile in urine or UTI
Involuntary urine loss from overactive detrusor muscle in bladder. It contracts causing urgent need to void.
Urge incontinence
Involuntary urine loss with physical strain, sneezing, or coughing.
Stress incontinence
______ discharge is small, clear or cloudy, and always nonirritating.
normal
If character of vaginal discharge is white, yellow-green, curd-like, foul smelling, it suggests a vaginal ________
infection
________ (painful intercourse) occurs with vaginitis of any cause.
Dyspareunia
What factors increase to risk for vaginitis?
- Oral contraceptives increase glycogen content of vaginal epithelium providing fertile medium for some organisms
- Broad-spectrum antibiotics alter balance of normal flora
- Diabetes increases glycogen content
- Menses, postpartum, menopause have a more alkaline vaginal pH.
- Frequent douching alters pH.
- Spray has risk for contact dermatitis
- Local irritation
When you ask about any past surgery on the uterus, ovaries, vagina, make sure to assess _______. Some fear loss of sexual response after hysterectomy, which may cause problems in intimate relationships
feelings
When asking about sexual activity, begin with _____-ended question to assess individual needs. Include appropriate questions as a routine: this communicates that you _____ individual’s sexual activity and believe it is important, your comfort with discussion prompts pt interest and possible _____ that the topic has been introduced, and provides opportunity to screen ______ problems.
open
accept
relief
sexual
infertility is considered after __ year of engaging in unprotected sexual intercourse without receiving.
1
In the aging adult:
- Post menopausal ______ warrants further work up and referral
- Vaginal itching, discharge, pain with intercourse is associated with ______ ______, and pressure in the genital area, loss of urine with cough/sneeze, back pain, or constipation occurs with a weakened pelvis musculature and uterine _______.
bleeding
atrophic vaginitis
prolapse
What is a Pederson speculum (narrow blades) useful for?
young or postmenopausal women with narrowed introitus
While positioning the pt, initially the woman should be sitting up. An equal status position is important to establish ______ and rapport before the vaginal exam
trust
Help the pt into a ______ position, with the body supine, feet in stirrups, and knees apart, and buttocks at edge of exam table
lithotomy
On inspection of external genitalia, skin color is ____, labia minora are a darker pink. Note any pigmented nevus or _______ that the woman cannot see. refer any suspicious ones for biopsy.
even
lesions
While inspecting the hair, should be inverted triangle, consider ______puberty if no pubic hair or breast development has occurred by age 13 years. Also look for nits or lice at the base of pubic hair.
delayed
Continued inspection:
Labia majora normally symmetric, plump, and well formed. In the nulliparous woman, labia meet in the _______; after vaginal delivery, the labia are gaping and slightly _______.
*no lesions should be present, except for occasional _______cysts. These are yellowish, 1-cm nodules that are firm, non-tender, and often multiple.
midline
shriveled
sebaceous
Abnormal: swelling
Inspection continues by separating the labia majora to inspect:
- Clitoris- look for excoriation, nodules, rash, or lesions
- Labia minor are dark pink and _____, usually symmetric.
- Urethral opening appears stellate or slit-like and is midline.
- Vaginal opening, or _______, may appear as a narrow vertical slit or as a larger opening.
- Perineum is ______. A well-healed episiotomy scar, midline or mediolateral, may be present after vaginal birth.
- Anus has coarse skin of _______ pigmentation.
moist
introitus
smooth
increased
Assess the support of pelvic musculature by using these maneuvers:
- ) palpate the perineum, normally, it feels thick, smooth, and muscular in the nulliparous woman and thin and rigid in the multiparous woman. Abnormal findings?
- ) Ask the woman to squeeze the vaginal opening around your fingers; it should feel tight in the nulliparous woman and have less tone in the multiparous woman. Abnormal findings?
- ) Using your index and middle fingers, separate the vaginal orifice and ask the woman to strain down. normally, no bulging of vaginal walls or urinary incontinence occurs. Abnormal findings?
- ) tenderness, paper-thin perineum
- ) absent or decreased tone may diminish sexual satisfaction
- ) bulging of the vaginal wall indicates cystocele, rectocele, or uterine prolapse. urinary incontinence
S: Severe perineal itching.
O: Excoriations and erythematous areas. May see little dark spots (lice are small), nits (eggs) adherent to pubic hair near roots. Usually localized in pubic hair, occasionally in eyebrows or eyelashes.
Pediculosis Pubis (crab lice)
S: Episodes of local pain, dysuria, fever
O: Clusters of small, shallow vesicles with surrounding erythema; erupt on genital areas and inner thigh. Also, inguinal adenopathy, edema. Vesicles on labia rupture in 1 to 3 days, leaving painful ulcers. Initial infection lasts 7 to 10 days. the virus remains dormant indefinitely. recurrent infection last 3 to 10 days with milder symptoms.
Herpes Simplex Virus-Type 2 (Herpes Genitalis)
O: Begins as a small, solitary silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge. Palpation-nontender indurated base; can be lifted like a button between thumb and finger. nontender inguinal lymphadenopathy.
Syphilitic Chancre
S: history of skin contact with allergenic substance in environment, intense pruritus.
O: Primary lesion-red, swollen vesicles. Then may have weeping of lesions, crusts, scales, thickening of skin, excoriations from scratching. May result form reaction to feminine hygiene spray or synthetic underclothing
Red Rash- Contact Dermatitis
S: painless warty growths, may be unnoticed by woman.
O: pink or flesh-colored, soft, pointed, moist, warty papules. Single or multiple in a cauliflower-like patch. occur around vulva, introitus, anus, vagina, cervix
Human papillomavirus (HPV) Genital Warts
- *Common among sexually active woman, esp adolescents, regardless of ethnicity or SES.
- *Risk factors include early age at menarche and multiple sexual partners.
- *The long incubation period (6 weeks to 8 months) makes it difficult to establish history of exposure
S: local pain, can be severe
O: overlying skin red, shiny, and hot. Posterior part of labia swollen; palpable fluctuant mass and tenderness. Mucosa shows red spot at site of duct opening. Requires incision and drainage, antibiotic therapy.
Abscess of Bartholin’s Gland
S: Dysuria, burning sensation
O: palpation of anterior vaginal wall shows erythema, tenderness, induration along urethra, purulent discharge from meatus. Cause by Neisseria gonorrhoeae, chlamydia, or staphylococcus infection.
Urethritis
S: tender, painful with urination, urinary frequency, hematuria, dyspareunia, or asymptomatic.
O: Small, deep red mass protruding from meatus; usually secondary to urethritis or skenitis; lesion may bleed on contact.
urethral caruncle
S: feeling of pressure in vagina, stress incontinence
O: with straining, note introitus widening and the presence of a soft, round anterior bulge. The bladder, covered by vaginal mucosa, prolapses into vagina.
Cystocele
S: feeling of pressure in vagina, possible constipation
O: With straining, not introitus widening and the presence of a soft, round bulge from posterior. Here, part of the rectum, covered by vaginal mucosa, prolapses into vagina.
Rectocele
O: with straining or standing, uterus protrudes into vagina. Nontender, non-fluctuant, smooth hemisphere; may cause a broad based gait.
Uterine Prolapse
- 1st degree: cervix appears at introitus with straining
- 2nd degree: cervix bulges outside introitus with straining
- 3rd degree: whole uterus protrudes even without straining-essentially, uterus is inside out.
O: bluish discoloration of the mucosa around the cervix, occurs normally in pregnancy (chadwick sign at 6-8 weeks gestation) and with any other condition causing hypoxia or venous congestion (e.g heart failure, pelvic tumor)
Bluish Cervix-Cyanosis
O: cervical lips inflamed and eroded. Reddened granular surface is superficial inflammation, with no ulceration (loss of tissue). Usually secondary to purulent or muco-purulent cervical discharge. Biopsy needed to distinguish erosion from carcinoma; cannot rely on inspection.
Erosion
O: Virus can appear in various forms when affecting cervical epithelium. Here, warty growth appears as abnormal thicken white epithelium. Visibility of lesion is enhanced by acetic acid (vinegar) wash, which dissolves mucus and temporarily causes intracellular dehydration and coagulation of protein.
Human papillomavirus (HPV, Condylomata)
S: may have mucoid discharge or bleeding
O: bright red, soft, pedunculated growth emerges from os. It is a benign lesion, but this must be determined by biopsy. May be lined with squamous or columnar epithelium
Polyp
S: prenatal exposure to this causes cervical and vaginal abnormalities not apparent until adolescence.
O: Red, granular patches of columnar epithelium extend beyond normal squamocolumnar junction onto cervix and into fornices (vaginal adenosis). Also cervical abnormalities: Circular groove, transvere ridge, protuberant anterior lip, “cockscomb” formation.
cosa with abraded areas that bl
Diethylstilbestrol (DES) Syndrome
*structural abnormalities cause infertility, ectopic pregnancy, spontaneous abortion, and preterm labor.
S: bleeding between menstrual periods or after menopause, unusual vaginal discharge.
O: Chronic ulcer and induration are early signs of carcinoma, although the lesion may or may not show on the exocervix.
Carcinoma
- Diagnosed by Pap smear and biopsy. Risk factors for cervical cancer are early age at first intercourse, multiple sex partners, cigs, certain sexually transmitted infections.
S: postmenopausal vaginal itching, dryness, burning sensation, dyspareunia, mucoid discharge (may be fleked with blood)
O: pale mucosa with abraded areas that bleed easily; may have bloody discharge.
Atrophic vaginitis
*an opportunistic infection related to chronic estrogen deficiency
S: pruritus, watery and often malodorous vaginal discharge, urinary frequency, terminal dysuria, itching. Symptoms are worse during menstruation when the pH becomes optimal for the organism’s growth.
O: Vulva may be erythematous. Vagina diffusely red, granular, occasionally with red, raised papules and petchiae (“strawberry” appearance). Frothy, yellow green, foul smelling discharge. Microscopic exam of saline wet mount specimen shows characteristic flagellated cells.
Trichomoniasis
S: Intense pruritus, thick whitish discharge.
O: vulva and vagina are erythematous and edematous. Discharge is usually thick, white, curdy, like “cottage cheese” diagnose by microscopic exam of discharge on potassium hydroxide wet mount
Candidiasis (monillasis)
**Predisposing causes– use of oral contraceptives or antibiotics, more alkaline vaginal pH (as with menstrual periods, postpartum, menopause), also pregnancy from increased glycogen and diabetes.
S: profuse discharge, “constant wetness” with “foul, fish, rotten” odor.
O: Thin, creamy, gray-white, malodorous discharge. No inflammation on vaginal wall or cervix b/c this is a surface parasite. Vaginal pH >4.5. Microscopic view of saline wet mount specimen shows typical “clue cells” (epithelial cells with stippled borders). Sniff for fishy odor after adding KOH to slide (“whiff test”)
Bacterial Vaginosis (Garnerella, haemophilus, or nonspecific)
S: minimal or no symptoms. May have urinary frequency, dysuria, or vaginal discharge, postcoital bleeding.
O: may have yellow or green mucopurulent discharge, friable cervix, cervical motion tenderness.
Chlamydia
- signs are subtle, easily mistaken for gonorrhea. Important to distinguish b/c antibiotic treatment is different.
- If the wrong drug is given or untreated, can ascend to cause pelvic inflame disease (PID) and result in infertility.
- Most common STI, highest prevalence is young adolescent girls
- Now, urine chlamydia testing using nucleic acid amplification tests (NAAT) is a noninvasive method to screen. Use a single urine specimen to detect both pregnancy and chlamydia.
S: variable: vaginal discharge, dysuria, abnormal uterine bleeding, abscess in Bartholin’s or Skene’s glands; the majority of cases are asymptomatic.
O: often no signs are apparent. May have purulent vaginal discharge. Diagnose by positive culture of organism. If the condition is untreated, it may progress to acute salpingitis, PID
Gonorrhea
