Female Genitalia Flashcards
What can dates of previous periods signal?
Possible pregnancy or menstrual irregularities
Primary dysmenorrhea
Results from increased prostaglandin production during the luteal phase of the menstrual cycle, when estrogen and progesterone levels decline
What are the causes of secondary dysmenorrhea?
endometriosis, adenomyiosis (endometriosis in muscular layers of uterus), pelvic inflammatory disease, endometrial polyps, low body weight from any causes including malnutrition, and anorexia nervosa, stress, chronic illness, hypothalamic-pituitary-ovarian dysfunction
What are the causes of abnormal uterine bleeding?
Vary by age group; includes pregnancy, cervical or vaginal infection or cancer, cervical or endometrial polyps or hyperplasia, fibroids, bleeding disorders, and hormonal contraception or replacement therapy
What is suggestive of postcoital bleeding?
cervical polyps or cancer; atrophic vaginitis in an older women
What are causes of postmenopausal bleeding?
endometrial cancer, hormone replacement therapy, uterine polyps, and cervical polyps
What is suggestive of amenorrhea followed by heavy bleeding?
Suggests a threatened abortion or dysfunctional uterine bleeding related to lack of ovulation
What are the signs and causes of female sexual dysfunction?
A woman may lack desire, fail to become aroused an attain adequate vaginal lubrication, or despite adequate arousal, may be unable to reach orgasm. Causes include lack of estrogen, medical illness and psychiatric conditions
What is suggestive of superficial pain?
May suggest local inflammation, atrophic vaginitis, or inadequate lubrication
What is suggestive of deeper pain?
May suggest pelvic disorders or pressure on a normal ovary
What is the most common cause of acute pelvic pain?
Pelvic inflammatory disease (PID), followd by ruptured ovarian cyst, and appendicitis. STIs and recent IUD insertion are red flags for PID.
What must always be ruled out first when doing a serum or urine test?
Ectopic pregnancy
What can you consider if a patient presents with pelvic pain?
Mittelschmerz (pain from ovulation at midcycle), ruptured ovarian cyst and a tubo-ovarian abscess
Endometriosis
Caused from retrogade menstrual flow and extension of the uterine lining outside the uterus. It affects 50% to 60% of women and gerils with pelvic pain
What are other causes of endometriosis?
Adenosis and fibroids, from tumors in the uterine wall or submucosal or subserosal surfaces arising from the smooth muscle cells of myometrium.
Red flag for chronic pelvic pain
sexual abuse
Conventional pap smears
Have a 30% to 87% sensitivity and 86% to 100% specificity for detecting cervical cancer
Liquid-based cytology
Have a 61% to 95% sensitivity and 78% to 82% specificity. Blood cells can be filtered out during this test
Delayed puberty
Often familial or related to chronic illness. May also arise from abnormal function of the hypothalamus, anterior pituitary gland or ovaries
What is suggestive of pediculosis pubis (lice or “crabs”)?
Excoriations or itchy, small, red maculopapules. Look for nits or lice at the bases of the pubic hairs
What conditions are indicated by enlarged clitoris?
masculinized conditions
What should you look for when examining the urethral meatus?
Observe for urethral caruncle, prolapse of the urethral mucosa and tenderness in interstitial cystitis
What can occur to Bartholin’s gland?
May become acutely or chronically infected and then produce a swelling
Imperforate hymen
This condition occasionally delays menarche. Be sure to check for this possibility when menarche seems unduly late in relation to the development of a girl’s breasts and pubic hair
What should you look for in an endometriosis involving the uterosacral ligament?
look for lateral displacement of the cervix
What does a yellowish discharge on endocervical swab suggests?
Suggests a mucopurulent cervicitis, commonly caused by Chlamydia trachomatis, Neisseria gonorrheae, or herpes simplex
What occurs in condylomata or cervical cancer?
lesions that are raised, friable, or lobed wartlike
What is chlamydial infection linked to?
It is linked to urethritis, cervicitis, pelvic inflammatory disease, ectopic pregnancy, infertility, and chronic pelvic pain.
What are risk factors for chlamydial infection?
Age younger than 26, multiple partners, and prior history of STI’s
What can be used to test for Chlamydia and gonorrhea?
cervical broom and liquid-based cytology
What causes vaginitis with discharge?
Candida, Trichomonas vaginalis, and bacterial vaginosis
What does the diagnosis of vaginitis depend on?
Depends on laboratory tests because sensitivity and specificity of discharge characteristic is low. Vaginal cancer is rare int his condition.
What are risk factors for vagintis?
diethylstilbestrol (DES) exposure in utero and HPV infection
What distinction can a rectovaginal examination make?
It can distinct the difference between a rectovaginal mass (simulated by stool in rectum & dented by digital pressure) and malignant mass.
What does cervical motion tenderness and/or adnexal tenderness suggest?
They can suggest pelvic inflammatory disease, ectopic pregnancy, and appendicitis
What can a uterine enlargement suggest?
It can suggest pregnancy, uterine myomas (fibroids), or malignancy
What does nodules on uterine surfaces suggest?
Myomas
Palpation of ovaries
Ovaries are often non-palpable and atrophic 3 to 5 years after menopause. In postmenopausal women, investigate a palpable ovary for possible ovarian cyst or ovarian cancer
What are common some signs of ovarian cancer?
pelvic pain, bloating, increased abdominal size, and urinary tract symptoms
What are some causes of adnexal masses?
Can arise from tubo-ovarian abscess, salpingitis or inflammation of fallopian tubes form PID or ectopic pregnancy. Should distinguish from uterine myoma.
What are some causes of pelvic floor muscle weakness?
Due to aging, vaginal deliveries, neurological conditions. Associated with stress incontinence
What causes overrecruitment with tightening, vaginal wall tenderness, and refered pain found in pelvic pain?
Pelvic floor spasm, interstitial cystitis, vulvodynia, and urethral spasms
Trigger point tenderness in pelvic floor muscles can be seen in what condition?
Pelvic floor spasm
What occurs in endometriosis?
nodularity and thickening of uterosacral ligaments, and pain with uterine movement
What is the most common type of hernia found in women?
An indirect inguinal hernia is the most common followed by femoral hernia.
What can cause urethritis?
Can arise from infection with Chlamydia trachomatis or Neisseria gonnorrhea
Syphilitic chancre lesion
firm, painless ulcer
Variations in cervical surfaces
squamous epithelium, columnar and squamous epithelium, retention/nabothian cysts, cervical polyps
Retroversion of uterus
tilting backward of entire uterus, including both body and cervix; can be due to endometriosis or pelvic inflammatory disease; cervix faces forward and uterine body cannot be felt by abdominal hand
Retroflexion uterus
backward angulation of uterus in relation to cervix; cervix maintains normal position; body of uterus palpable through rectum or posterior fornix
Myomas (fibroids)
Common benign uterine tumors that feel like firm, irregular nodules in continuity with uterine surface
Prolapse of uterus
results from weakness of supporting structures of pelvic floor and is often associated with rectocele and cystocele.
1st degree prolapse:
cervix is still within vagina
2nd degree prolapse:
cervix at introitus
3rd degree prolapse (procidentia):
cervix and vagina are outside introitus
