female genitalia Flashcards
1
Q
name for external genitalia
A
vulva
2
Q
where does the vulva extend
A
from the superior portion of the prepuce to perineum
3
Q
hair covered fat pad overlying the symphysis pubis
A
mons pubis
4
Q
the opening to the vagina
posterior portion of the vestibule
may be hidden by the hymen
A
introitus
5
Q
thinner pinkish red hairless folds extending from the peruse at the clitoris
A
labia minora
6
Q
boat shaped fossa between the labia minora
A
vestibule
7
Q
the area between the inferior portion of the vulva and the anus
A
perineum
8
Q
in the superior vestibule between the clitoris and introitus
A
urethra meatus
9
Q
adjacent to the urethetral meatus
A
skene glands (paraurethral glands)
10
Q
located posteriorly on either side of the vaginal opening. not usually visible. situated deep
A
bartholins glands
11
Q
musculomembranous tube extending upward and posterior. between the bladder/urethra and rectum.
A
vagina
12
Q
how does the upper third of the vagina lie
A
horizontal plane
13
Q
where does the vagina terminate
A
fornix
14
Q
what do the walls of the vagina have
A
transverse rugae
15
Q
cup shaped area of the vagina that surrounds the cervix (anterior, posterior, and lateral)
A
fornix (fornices)
16
Q
transition area between the cervix and the corpus (body of the uterus)
A
isthmus
17
Q
vaginal surface of the cervix. covered by stratified columnar epithelium (SCE)
A
ectocervix
18
Q
the external opening of the cervix
A
external cervical os
19
Q
- thick walled fibromuscular organ
- almost lies at a right angle to the vaginal canal
A
uterus
20
Q
three layers of uterine wall
A
perimetrium
myometrium
endometrium
21
Q
before puberty the cervix is covered with ______________
A
“plushy red” columnar epithelium
22
Q
during puberty the broad band of SCE that surrounds the os (ectropion) is slowly replaced by _____________
A
stratified squamous epithelium (SSE)
23
Q
what creates the transformation zone (TZ)
A
the squamocolumnar junction (SCJ) migrating towards the os
24
Q
why do we perform Pap smears
A
the TZ is the area at risk for dysplasia
25
palpable on pelvic exam in roughly half of women during the reproductive years
fallopian tube
26
what is adnexa
ovaries, tubes, and supporting tissues
27
what are the two primary functions of ovaries
1. production of ova
2. secretion of hormones: estrogen, progesterone and testosterone
28
where does the parietal peritoneum extend
behind the uterus into the rectoutuerine pouch (pouch of Douglas)
29
how are the pelvic organs supported inferiorly
sling of tissue consisting of muscle, ligaments and fascia
30
what two basins compose the pelvis
1. broad major basin (false pelvis)
2. minor basin (true pelvis)
31
bladder prolapse
cystocele
32
small bowel prolapse
enterocele
33
rectum prolapse
rectocele
34
what muscles form the pelvic diaphragm
levator ani and coccygeus
35
what passes through the pelvic diaphragm
- urethra
- vagina
- anorectum
36
below the pelvic diaphragm is the second supporting structure
urogenital diaphragm
37
what is the urogenital diaphragm composed of
ischiocavernosus and bulbocavernosus muscles
38
how to asses maturity in girls
Tanner scale
38
what makes up the pelvic floor
pelvic diaphragm and urogenital diaphragm
39
what do tanner's stages consider
pubic hair and breast development
40
just before menarche there is an increase in _______ and as memes is established it will coincide with ovulation
vaginal secretions (leukorrhea)
41
where does lymph from vulva and lower vagina drain
inguinal nodes
42
where does lymph from internal genitalia, including the upper vagina flow into
pelvic and abdominal lymph nodes (not palpable)
43
- no breast tissue
- no pubic hair
stage 1
44
- breast buds
- sparse, long pigmented hair along the labia majora
stage 2
45
- enlargement of breast and areola without separation
- darkening, coarsening, curling of hair which extends up and laterally
stage 3
46
- areola and nipple form a mound atop breast tissue
- hair of adult consistency limited to the mons
stage 4
47
- adult configuration with areola and breast having smooth contour
- hair spreads to the medial aspect of the thighs
stage 5
48
age at onset of menses
menarche
49
absence of menses for *12 consecutive months*, usually occurring between 48-55 years
menopause
50
bleeding occurring 6 months or more after cessation of menses
postmenopausal bleeding
51
absence of menses
amenorrhea
52
pain with menses, often with bearing down, aching or cramping sensation in the lower abdomen or pelvis
dysmenorrhea
53
a cluster of emotional, behavioral and physical symptoms occurring 5 days before menses for three consecutive cycles
premenstrual syndrome (PMS)
54
what questions to ask about menstrual history?
- age at menarche
- LMP and one prior if possible
- how often does she have periods
- regular or irregular
- how long do they last
- how heavy is flow (# of pads/tampons used daily)
- what color
- any bleeding between periods
- any bleeding after intercourse
- pain with menses?
55
bleeding between menses; includes infrequent, excessive, prolonged or post menopausal bleeding
abnormal uterine bleeding
56
what questions to ask about dysmenorrhea menstrual history
- what does it feel like
- how long does it last
- does it interfere with ADLs
- any associated symptoms
57
primary dysmenorrhea caused by...
increased prostaglandin production during luteal phase of menstrual cycle, when estrogen and progesterone levels decline
58
secondary dysmenorrhea caused by
endometriosis, adenomyosis, PID, endometrial polyps
59
what are some PMS symptoms
depression, anger, irritability, anxiety, confusion, crying, sleep disturbance, poor concentration, social withdrawal
60
what to inquire about for someone with PMS
- bloating
- weight gain
- swelling of hands and feet
- aches and pains
61
what is critical for a PMS diagnosis
1. symptoms and signs in the 5 days prior to menses for at least 3 consecutive cycles
2. cessation of symptoms and signs within 4 days after onset of menses
3. interference with ADLs
62
absence of periods including menarche
primary amenorrhea
63
absence of periods after menarche
secondary amenorrhea
64
physiologic forms of secondary amenorrhea
- pregnancy lactation
- menopause
- low body weight
- hypothalamic pituitary ovarian axis dysfunction
65
less than 21 days between menses
polymenorrhea
66
infrequent bleeding
oligomenorrhea
67
excessive flow
menorrhagia
68
intermenstrual bleeding
metrorrhagia
69
what does post intercourse bleeding suggest
cervical polyps or cancer in older women or atrophic vaginitis
70
what does postmenopausal bleeding cause
- endometrial cancer
- HRT
- uterine and cervical polyps
71
how to interview the adolescent about menstrual history
- explore pt concerns and attitude about body
- ask how did you first learn about monthly periods
- how did you feel when they started?
72
how to ask about menopause
- ask if they have stopped menstruating and if so, when?
- were there any accompanying symptoms during her transition to menopause
- any bleeding since that time
73
what age does menopause occur
48-55
median age 51
74
cessation of menses for 12 months, progressing through several stages of erratic cyclical bleeding
perimenopause
75
menopause symptoms
- vary in cycle length
- hot flashes
- flushing
- diaphoresis (esp. at night)
- accelerated bone loss
- increase in total and LDL
- vulvovaginal atrophy
- vaginal drying, dysuria and sometimes dyspareunia
76
how to interview the gravid patient (pregnant)
- have you ever been pregnant
- how many times have you been pregnant
- how many living children do you have
- have you ever miscarried
- how many miscarriages have you had
- have you ever had any difficulties with your pregnancies
- ask about timing (what stage of pregnancy) and circumstances of miscarriages
- ask if they have ever had an induced abortion
- inquire about how they felt about loss
77
how to write out gravida, para, abortus
G3P2A1
78
number of times pregnant
twin pregnancy counted as 1
gravida
79
- an abbreviation for parity
- number of pregnancies reaching a viable gestational age (live and stillbirths)
- twins count as 1
para
80
- number of pregnancies lost for any reason
- stillbirths are not counted
abortus
81
a woman who has never been pregnant (gravida 0)
nulligravida
82
a woman who is pregnant for the first time or has been pregnant one time (gravida 1)
primagravida
83
a woman who has been pregnant more than one time
multigravida or secundigravida
84
another way to write term/premature/abortions/living (TPAL)
T1, P1, A1, L3 or 1-1-1-3
85
- after 37 weeks
- twins count as one birth but each twin is counted separately in the living children category (L)
term births
86
number of miscarriages (not ectopic) and induced abortions. if a fetus is aborted after 20 weeks then it is counted as a premature birth
abortions
87
number of living children
living children
88
vulvovaginal symptoms
- vaginal discharge
- local itching
- color, consistency, odor, local sores, lumps
89
how to ask about sexual orientation
- what is your relationship status
- tell me about your sexual preference: men, women, both
- ascertain if any uncertainness and any concerns in realm of medicine
- be informed and no personal attitudes towards patients sexual practices -- within reason
90
how to ask about sexual response
- ask do you have any concerns regarding your sex life
- are you satisfied with your sex life as it is
- any significant changes over last few years that are concerning
- if there is concern then ask more direct questions: libido, orgasm, lubrication, etc
91
what to consider when evaluating sexual response
- dyspareunia should be evaluated with respect to localization, timing during intercourse as well as the other characteristics of pain
- must consider lack of estrogen, medical illness and psych conditions
- vaginismus
92
involuntary spasm of the muscles surrounding the vaginal orifice, making penetration during intercourse painful or impossible. may be physical or psychological
vaginismus
93
some causes of sexual dysfunction
- general health
- medications and drugs
- alcohol
- partners knowledge of sexual practices, techniques
- her attitudes, values, fears
- communication
- settings
94
why does acute pelvic pain in menstruating girls and women warrant immediate attention
some things on differential are life threatening:
- ectopic pregnancy
- ovarian torsion
- appendicitis
95
what do you have to consider when a woman has acute pelvic pain
- recent instrumentation
- IUD placement
- STDs
-GI
- urinary sources
96
what to do for woman with acute pelvic pain
careful pelvic exam and pregnancy testing
97
pain that lasts more than 6 months and does not respond to treatment
chronic pelvic pain
- ask pt to keep a pain journal
98
- chronic pelvic pain
- occurs due to retrograde menstrual flow and extension of the uterine lining outside the uterus
- 50-60% of women and girls with pelvic pain
endometriosis
99
- chronic pelvic pain
- from tumors in the uterine wall, submucosal or subserosal surfaces
adenosis and fibroids
100
chronic pelvic floor other considerations
- red flag for history of sexual abuse
- consider pelvic floor spasm
101
how to ask about STIs
- ask about the normal attributes of pain
- inquire about sexual orientation
- inquire about sexual contacts and number of prior partners over the prior months
- ask about birth control
- ask if they have concerns about contracting HIV, desire HIV testing or has current or past partners at risk
- ask about oral and anal sex. any symptoms involving the mouth, throat, anus, rectum
102
how to educate pt about safe sex
- abstain: surest way
- get tested for HIV and other STIs
- use latex or polyurethane condome correctly every time. male or female not both at same time
- talk with partenr
- monogamy
- limit # of sex partners
- use protection for all kinds of sexual contact
- know other types of bc won't protect from HIV
- get screened for STIs: herpes esp
- don't use douche
- don't use alc/drugs
103
what is the most important risk for cervical cancer
persistent infection with high risk HPV subtypes 16 or 18
104
what is HPV 6 and 11 associated with
genital infection with genital warts (low risk subtype)
105
two notable risk factors for cervical cancer
- failure to undergo screening (true for half those diagnosed)
- multiple sex partners
106
cervical cancer average risk women defined as:
- no history of high grade, precancerous cervical lesion or cervical cancer
- not immunocompromised
- no in utero exposure to DES
107
recommended age to screen for cervical cancer
21 years
108
recommended cervical cancer screening method and intervals
- ages 21-65 yrs: cytology q3y
OR
- ages 21-29: cytology q3y
- ages 30-65: cytology plus HPV testing
109
recommended age at which to end cervical cancer screening
- age > 65 yrs
- assuming 3 consecutive negative results on cytology
- or 2 consecutive negative results on cytology plus HPV testing within 10 yrs before sensation of screening
- with most recent test performed within 5 yrs
110
is cervical cancer screening after hysterectomy with removal of cervix recommended
no
111
3 steps of classification of Pap smear cytology: Bethesda system
1. negative for intraepithelial lesion or malignancy
2. epithelial cell abnormalities: squamous cells (undetermined significance: ASC-US) and glandular cells (atypical endocervical cells specified, not otherwise specified (NOS), or favor neoplasia
3. other malignant neoplasms, such as sarcomas or lymphomas are rare
112
what is the HPV vaccine recommendations
- routine vaccination for girls ages 11 and 12
- 3 dose vaccination series over 6 months with either the quadrivalent or bivalent vaccine for girls and boys at ages 11 or 12, before their first sexual encounter. the series can be as early as age 9
113
what is the catch up vaccination for HPV
recommended for females age 13-26 who have not had prior vaccination or completed the 3 dose series
114
3 important symptoms of ovarian cancer
- abdominal distention
- abdominal bloating
- urinary frequency
115
risk factors for ovarian cancer
- history of breast cancer 1 (BRCA 1 or BRCA2 gene mutation
- first degree relative with breast cancer or ovarian cancer
116
what testing should not be used for ovarian cancer
CA-125. not sensitive or specific.
117
what reduces risk of ovarian cancer
- oral contraceptives
- pregnancy
- history of breast feeding
118
most commonly reported STI is US and most common in women
chlamydia trachomatis
119
chlamydia trachomatis without treatment
40% will progress to PID, 20% become infertile
120
chlamydia risk factors
- new or multiple partners
- inconsistent use of condoms
- occupational sex work
121
what is the recommended screening for chlamydia and gonorrhea
annually for sexually active women ages 25 years old or older with risk factors
122
- periodic abstinence
- withdrawal
- lactation
- highest failure rate: 18%
natural contraception
123
- condom (18%)
- diaphragm (6-12%)
- cervical cap
barrier contraception
124
- IUD
- subdermal implant
- lowest failure rate: 0.8%)
implantable contraception
125
- spermicide
- bc pill
- injections
- patches
- vaginal rings
- 6-12%
pharmacologic/hormonal contraception
126
- tubal ligation
- transcervical sterilization
- vasectomy
surgical/ permanent contraception
127
techniques of female genital exam
- avoid intercourse, douching, or use of vaginal suppositories for 24-48 hours before exam
- empty bladder
- lie supine with head and shoulders elevated
- hands down at her side or across chest
- obtain consent
- select chaperones
- drapes from mid abdomen to knee
- avoid sudden movement (ALWAYS ANNOUNCE WHAT YOU ARE GOING TO DO BEFORE YOU DO IT)
- choose correct size speculum
- warm speculum and lubricant
- watch pt face for discomfort
- GENTLE
128
three different steps of female genital exam
1. external inspeciton
2. bimanual exam (rectovaginal exam if indicated)
3. cervical evaluation with Pap smear
129
what equipment do you need for female exam
- movable light source
- vaginal speculum of appropriate size
- water soluble lubricant
- drapes
- Pap smear equipment, cultures, DNA probes, OUT AND READY
130
what do you check on external exam
- asses sexual maturity (pubic hair distribution according to Tanner stages)
- WARN PT BEFORE YOU TOUCH:
labia minora
clitoris
urethral meatus
introitus
131
when to examine and palpate bartholins glands
swelling or inflammation
132
how to do internal cervical exam with speculum
- warm and moisten speculum with water
- let pt know you are about to insert it
- with one finger APPLY DOWNWARD PRESSURE at introitus to slightly enlarge the vaginal opening
- with other hand insert speculum while CLOSED, past your fingers in a DOWNWARD slope
- keep speculum closed until you are ready to ready to evaluate the cervix
- once inserted, remove finger
- rotate speculum horizontally
- insert to full length
- ONLY OPEN WHEN INSERTED TO FULL LENGHTH
133
what to note on cervical exam
color
position
surface characterisitics
ulcerations
nodules
masses
bleeding
discharge
134
3 tests for obtaining specimens for cervical cytology
1. one specimen from endocervix
2. one specimen from ectocervix
3. for sexually active women age 26 or younger, and other asymptomatic women at increased risk of infection, plan to culture the cervix routinely for chlamydia
135
what can be used for all three tests
cervical broom (but use two brooms)
136
4 indications for rectovaginal exam
1. palpate a retroverted uterus
2. palpate the uterosacral ligament, cul-de-sac, and adnexa
3. screen for colonrectal cancer in women 50 years old or older
4. asses for pelvic pathology
