Female Genitalia Flashcards
what are risk factors of pelvic floor weakness
- aging
- Prior surgery or trauma
- childbirth
- obesity, DM, MS, parkinsons
- meds
- chronically increased abdominal exam
what are the fornix’
the corners of the cervix
what can weakness of the pelvic floor muscles cause?
- pain
- urinary or fecal incontinence
- Prolapse of the pelvic organs
what are important questions to ask in history?
- contraception type
- cervical cytology
- history of gynecological findings
- history of gynecological/abdominal procedures
- screening for intimate partner violence
what is the average age of menarche
9-16 yo in the US
LMP
last menstual period
PMP
prior menstrual period
How to calculate cycle
first day of period to first day of period
what is pain with menses
Dysmenorrhea
what f/u questions should be asked if experiencing dysmenorrhea
- pain
- length
- does it impact ADL
- associated symptoms
what causes primary dysmenorrhea
- no specific organic cause
what hormone increase can attribute to Primary dysmenorrhea
increased prostoglandin production
what causes secondary dysmenorrhea
ORGANIC cause
* endometriosis
* adenmyosis
* PID
* Endometrial polyps
what is emotional and behavioral symptoms such as sleep disturbances, poor concentration, social withdrawl etc in menstruating women?
in regards to period
Premenstrual syndrome (PMS)
what are the 3 criterias for diagnosis of PMS
- occur in the 5 days before menses for 3 cycles
- resolves within 4 days after menses onsest
- interferes with daily activities
what is amenorrhea
absense of periods
what is polymenorrhea
less than 21 days between menses
oligomenorrhea
infrequent bleeding
menorrhagia
excessive flow
metrorrhagia
intermenstrual bleeding
postcoital bleeding
post sex bleeding
PALM COEIN
structural: Polyp, Adenomyosis, Leiomyoma, Malignancy
Non-Structural: Coagulopathy, Ovulatory, Endometrial, Iatrogenic, Not classified
causes of abornmal bleeding
cessation of menses for ___ months is
menopause
what age does menopause occur
between 48-55
hot flashes, flushing sweating, are what type of symptoms of menopause
vasomotor symptoms
what is erratic cyclical bleeding and vasomotor symptoms before menses cease
perimenopause
what is bleeding post menopause concerning for
early sign of cancer
full term delivery is after what week
37 weeks
preterm labor is between what weeks
20-36 weeks and 6 days
what is an abortion classified as
loss of pregnancy before 20 weeks
what color is healthy discharge
white
what can pink vaginal discharge be from
- cervical bleeding
- vaginal irritation
- implantation
*
what can cause gray vaginal discharge
bacterial vaginosis or trichomoniasis
what causes yellow/green discharge
sexually transmitted infection (gonorrhea, chlamydia, trichomoniasis)
what caues red vaginal discharge
- menstruation
- cervical infection
- cervical polp
- endometrial or cervical cancer
what is the most common type of acute pain?
Pelvic inflammatory disease
History of STIs and recent IUD insertion are red flags for what?
PID
what are the three most common causes of acute pelvic pain
- PID
- ruptured ovarian cyst
- appendicitis
what is a mild, one sided pelvic pain that lasts longer than a few hours midcycle (from ovulation)
Mittelshmerz
what differential diagnoses should always be included for acute pelvic pain
- ectopic pregnancy
- ovarian torsion
- appendicitis
what should ALWAYS be ruled out in pts of reproductive age with abdominal pain?
ectopic pregnancy; use HcG levels or TVUS
what is pelvic pain that lasts longer than 6 months and doesn’t respond to treatment
Chronic pelvic pain
what are the DDx of chronic pelvic pain>
- endometriosis
- adenomyosis
- myomas (fibroids)
what are some cervical cancer risk factors?
- HPV infection
- failure to screen
- smoking
- multiple partners
- immunosuppression
- long term contraception use
- chlamydia trachomatis coinfection
- parity
- prior cervical cancer
when do you start screening and what is the interval
21 years
cyctology q3 years or
21-29yo: cytology q3 years and 30-64 yo: cytology + HPV q5 years
when do you stop screening for cervical cancer
age 65 + 3 consecutive negative cytology
pap smear stands for
papanicolaou test
what is a procecure where a brush is used to remove cells from the cervix to be check for atypia
pap smear
what is a procedure that takes a samples of cervical cells to check for HPV 16 and 18
hrHPV
what is the 5th leading cause of cancer death in women?
ovarian cancer
what cancer has no effective screen tests
ovarian cancer
what can CA-125 indicated
it can be elevated in women with ovarian cancer but also breast cancer (prostate ect)
what 3 symptoms indicate concern for ovarian cancer in women >50
- abdominal distention
- abdominal bloating
- urinary frequency
what are the risk factors of ovarian cancer
- family history of breast or ovarian
- BRCA1 or BRCA 2
- obesity
- nulliparity
- post menopausal hormone replacement therapy
what is the most common reported STI in the us right now
chlamydia trachomatis
what is the mc way to test for STI
dirty urine sample (doesn’t test for gonorrhea)
what population should have screening of chlamydia, syphilis, hep b, and HIV
pregnant women (add gonorrhea for at risk women)
for chlamydia, gonorrhea,
when should you test for STIs in women
sexually active <25 yo and retest 3 months post treatment
when should you screen for syphilis
asymptomatic adults at increased risk (incarceration or transactional work)
when should you screen for trichomonas
women receiving care in high prevelance setting (STI clinics, correctional facility)
what are the screening recs for HIV?
all women 13-64 at least 1x
what are the recommendations for screening for HPV and cervical cancer?
women 21-29yo q3 years
women 3-65 yo q3 years or q5 year combo with cytology and HPV testing
what are the screening recommendations for HepB
women at increased risk (more than 2 partners in 6 months)
what are the screening guildelines for Hep C
all adults over 18 yo
what are the two most common hernias in females
- indirect
- direct
- femoral
what is tanner stage 1
prepubertal, no pubic hair
tanner stage 2
sparse hair growth with minimally pigmented hair, mainly on the labia
what is tanner stage 3
considerably darker and coarser hair spreading over the mons pubis
what is tanner stage 4
thick adult-type hair that does not spread to the medial surface of the thighs
what is tanner stage 5
adult type hair that is distributed on classical inverse triangle
what is the lithotomy position
- heels in footrest
- but exrtending slightly beyond the table
- thighs flexed, abducted, externally rotated at the hips
- head supported by a pillow
- hands on the side or folded on her chest
2 shapes of a speculum
- graves (wider-vaginal prolapse)
- Pedersen (for everything else)
what angle should the speculum be at?
30-45 degree
what should flagellated, motile trichomonads
Trichomonas on a wet prep
what shows clue cells?
bacterial vaginosis
what is the name of the vaginal pH testing paper
litmus paper
what is the normal vaginal pH
<4.5
what does a pH greater than 4.5 indicated?
bacterial vaginosis, trichomonas
what method of herpes culture sample is more likely to be a false positive
swabbing the residual erosions
chandelier sign is a hallmark of
PID (cervical motion tenderness)
what may cause the uterus to not be palpable
retroversion or retroflexion of the uterus
what is the average size of a ovary
3.5cm x 2cm x 1.5cm
when are ovaries not palpable
within 3-5 years of menopause onset
what can cause adnexal masses?
- tubo ovarian abscess
- salpingitis
- ectopic pregnancy
- PID
- malignancy
what are the indicates for rectovaginal examination
- to palpate a retroverted uterus, uterosacral ligament, cul-de-sac
- colorectal cancer >45
- pelvic pathology
what is a small, firm, round, cystic nodule in the labia
epidermoid cyst (benign)
what color discharge is associated with epidermoid cyst
white or yellowish
what is cauliflower-shaped or verrucous lesions
condyloma acuminatum
what is hyperpigmented, smooth, broad based, flat topped papules?
condyloma latum
a manifestation of secondary syphilis
what is a firm PAINLESS ulcer
syphilitic chancre from treponema pallidum
what is localized vesicles followed by PAINFUL ulcer on an erythematous base?
genital herpes
what is the most common cause of genital herpes
HSV-1 and HSV-2
what is an ulcerated or raise red vulvar lesion
carcinoma of the vulva
what is the most common type of carcinoma of the vulva
squamous cell carcinoma
what is a bulge of the upper 2/3 of the anterior vaginal wall? what causes it?
cystocele
caused by: bladder prolapse/shifting
what is a bulge of the entire anterior vaginal wall? waht causes it?
cystourethrocele
bladder and urethra
what is a herniation of the rectum into the posterior wall of the vagina?
rectocele
what is a small, red, benign tumor at posterior urethral meatus?
urethral caruncle
mostly in post menopausal women & aysmptomatic
what is a tense, hot, tender gland that has purulent drainage from the ducts?
acute bartholin gland infection
what is a red swollen RING around the urethral meatus
prolapse of the urethral mucosa
pre-menarche or post menopausal
what is a nontender, cystic nodule at the edge of the labia
chronic bartholin gland infection
what is the characteristics of trichomonal vaginitis?
- yellow/green/gray and malodorus discharge
- straberry cervix
- wet mount prep
- pH >4.5
what are characteristics of candidal Vaginitis
- white, curdy, thick discsharge
- reddened vaginal mucosa with white patches of discharge
- branching hyphae on KOH prep
- pH <4.5
what are characteristics of bacterial vaginosis
- gray or white, thin discharge
- malodorous discharge (fishy)
- normal appearance on exam
- saline wet mount for clue cells
- positive whiff test
- pH >4.5
what is a nulliparous os look like
oval
what does a parous os look like
slit-like
what is a nabothian cyst
“retention cyst”
* translucent nodules with no pathologic significance
what are charcteristics of cervical polyps
benign but may bleed
arises from the endocervical canal
characterstics of mucopurulent cervicitis
- purulent yellow discharge
- from c. trachomatis, n. gonorrhoeae, herpes infections
what can later stages of carcinoma of the cervix look like?
irregular cauliflower-like growth that may develop
what are characteristics of fetal exposure of DES
- columnar epithelium covere most or all of the cervix
- there is a circular collar or ridge of tissue between the cervix and vagina
what is the tilting backwards of the entire uterus so the cervix faces forward
retroversion of the uterus
* uterine body can not be felt with abdominal hand
what is the backward angulation of the body of the uterus in relation to the cervix, and the cervix remains in its usual position>
retroflexion of the uterus and the uterine body can not be felt with abdominal hand
what is first degree uterine prolapse
cervix falls into the upper part of the vagina
what is 2nd degree uterine prolapse
cervix is at the vaginal introitus
what is 3rd degree uterine prolapse
cervix and part of the uterus is outside of the vaginal introitus
what is 4th degree uterine prolapse (procidentia)
the cervix and all of the uterus falls out of vagina
what type of mass on the ovary is benign, smooth, and compressible
ovarian cyst
what is a mass that is firm, and more nodular on the ovary?
ovarian cancer
experience symptoms of pelvic pain, bloating, abdominal size and uti symptoms
what has a palpable adenexal mass in more the 1/2 of cases
ectopic pregnancy
what are clinical features of ectopic pregnancy
- abdominal pain
- adnexal tenderness
- abnormal uterine bleeding
what may PID develop into
tubo-ovarian abscess
