Female Genitalia - Abnormal Assessment Findings Flashcards
In a patient with pelvic pain, what are some life-threatening conditions that should be on your differential?
- ectopic pregnancy- including rupture
- ovarian torsion
- appendicitis
Symptoms, exam findings and wet mount findings for trichomonal vaginitis
- discharge - yellowish green or grey, poss. frothy, often profuse and pooled in the vaginal fornix-may be malodorous
- pruritis (itching)
- pain with urination
- dyspareunia (pain w/ intercourse)
- vestibule and labia minora may be erythematous
- vaginal mucosa may be diffusely reddened w/ small red granular spots or petechiae
- trichomonads on wet mount
Symptoms, exam findings and wet mount findings for candidial vaginitis
- discharge - white and curdy - may be thin, but typically thick - not as profuse and not malodorous
- Vulva and surrounding skin inflammed and sometimes swollen
- vaginal mucosa is often reddened w/ white tenacious patches or discharge
- mucosa may bleed when patches are scrapped off
- branching hyphae of Candida on wet mount
Symptoms, exam findings and wet mount findings for bacterial vaginosis
- discharge - grey or white, thin, homogenous, malodorous; coats the vaginal walls, not usually profuse, may be minimal
- unpleasant fishy or musty genital odor, reported to occur after intercourse
- vulva and vaginal mucosa normal
- clue cells on wet mount
What are ambiguous genitalia? What are some possible etiologies?
- masculinization of the female external genitalia - rare condition caused by endocrine disorders such as congenital adrenal hyperplasia
Physical signs of sexual abuse in the pediatric patient
Possible:
- marked and immediate dilation of anus
- hymenal notch or cleft
- condyloma acuminata in child >3yrs
- bruising, abrasions, lacerations or bite marks of labia
- herpes
- purulent or malodorous vaginal discharge
Strong: -
- lacerations, ecchymosis, newly healed scars of the hymen or posterior fourchette
- no hymenal tissue from 3 o’clock to 9 o’clock
- perianal lacerations extending to external sphincter
**A sexual abuse expert must evaluate a child with concerning physical signs for a complete history and sexual abuse examination**
What can cause vaginal discharge in the pediatric patient?
Leukorrhea
STI from consensual sexual activity or sexual abuse
Bacterial vaginosis
Foreign body
External irritants
Most common cause of pelvic pain
PID - must rule out life-threatening causes
3 major symptoms of ovarian cancer
- abdominal bloating
- abdominal distention
- urinary frequency (usually reported within 3mo of dx)
Herniation of the rectum into the posterior vaginal wall
Rectocele
Seen in the upper 2/3 of the anterior vaginal wall
Cystocele
Benign tumors (uterine fibroids)
Myomas
Your female patient presents today with a chief complaint of painful swelling “in my vagina.” On PE of the vaginal vestibule (posterior introitus), you observe an erythematous, painful, abscess with exudate (pus) expressed. You suspect:
Bartholin gland infection
Your patient presents with profuse vaginal drainage that is yellow-green, frothy, and malodorous. She also complains of pain with urination. You suspect that your patient may have:
trichomonal vaginitis
A 69 year old woman comes to the clinic with complaints of persistent vulvar itching. She has had the itching for several weeks. She has type 2 diabetes mellitus. Physical exam shows a erythematous and swollen vulva. There are pustules on the medial aspect of her thighs. A KOH preparation shows psuedohyphae and budding yeast under the microscope. What is the likely diagnosis?
Candida Vaginitis
