Female Genitalia Flashcards
Things to avoid prior to exam
Intercourse
douching or suppositories 24 to 48 hours prior
Prep for exam
-raise head and shoulder with pillow, bed
-empty bladder
-arms down or crossed
-warn the pt!!!
lithotomy position: with buttocks beyond edge of bed and hips flexed, abduted and externally rotated
Tanner stages
1: no pubic hair
2. few dark hairs on labia (straight)
3. some pigmented hairs across pubes (curly)
4. has not spread to thighs
5. adult: spread to inner thighs
Nulliparous vs. multiparous cervix
nuliparous external os is a small circular opening, multiparous is slit shaped because of previous childbirths
Nabothian cyst location, prognosis
located on the cervix, normal variant
Papsmear screening
- within 3 years of first intercourse
- annually until 30 yo
- > 30 with 3 consecutive normal papsmear, do every 2-3 years
- continue in hysterectomy patients
What are you sampling in a papsmear?
Translocation junction or external os of cervix
What cells are located in the translocation junction? Ectocervix and endocervix
Ectocervix: simple squamous
Endocervix: columnar cells
What is the name of the system you retrieve results for PAPsmears
BETHESDA (CIN) system
What does CIN stand for?
Cervical Intraepithelial neoplasia
CIN 1
within normal limits
atypical squamous cells of undetermined significance (ASC-US)
mild dysplasia Low grade squamous intraepithelial lesion (LGSIL)
CIN2
high grade squamous intraepithelial lesion (HGSIL)
Moderate dysplasia
CIN 3
HGSIL with severe dysplasia or carcinoma in situ
In what direction do you insert the speculum
Obliquely
Which finger is placed in the anal canal for the rectovaginal exam
middle finger, feel wall for abnormal thickness in infection, fistula and malignancy
What is palpated in the bimanual exam
fallopian tubes (adnexa) pelvic side walls for nodularity of ovaries
What is the purpose of the bimanual exam?
check the uterus for: size position shape contour mobility
Where can adenocarcinoma arise from?
endocervix endometrium and extrauterine sites
AGC and treatment
atypical glandular cells
tx:colposcopy with our without biopsy
HPV
human papillomavirus
what does HPV infect
keratinocytes of skin and mucus membranes
How is HPV transmitted
genital contact
What is the leading cause of cervical cancer
HPV
Who gets the HPV vaccine
before sexual activity begins
What strains does the HPV vax cover
6, 11, 16, 18
Anteverted uterus
normal position (anteriorly)
retroverted uterus
body of the uterus and the cervix are tilted backwards
Retroflexion of uterus
backward angulation of body of uterus in respect to cervix, cervix unmoved
pH of bacterial vaginosis
> 4.5 (basic)
Cause of bacterial vaginosis
imbalance of bacterial flora, may or may not be STI
d/c of bacterial vaginosis
grey/white
Diagnosis of bacterial vaginosis
clue cells (bound to bacteria) positive whiff test
pH of trichhomonal vaginitis
> 4.5
infections with pH <4.5
Yeast
Infections with pH >4.5
Bact Vaginosis, trichomonas, gonorrhea
Cause of Trichomonal vaginitis
STI
Trichomonas vaginalis
Discharge of Trich
greenish/white
signs of trich
strawberry cervix, protozoa
pH of yeast infection
<4.5
discharge of yeast infection
thick white with itching and burning
Lab of yeast infection
hyphae in KOH
Colposcopy
illuminate cervix to take punches (biopsy)
pH of gonorrhea
> 4.5
Discharge of gonorrhea
green/yellow with pruritus
PAP smear guidelines- NEW!
65
Hysterectomy
HPV vaccinated
under 21, don't do 21-29: cytology every 3 yr 30-65: cytology every 3 years or co-testing (HPV and cytology every 5 yr) >65: don't do unless prior concerns Hysterectomy: don't do unless HGSIL HPV vax: continue to screen
