Female GU Flashcards
Mons Pubis
This is the rounded area in front of the pubic bones at the lower part of the abdomen.
It becomes covered with hair at puberty.
Female Vestibule
The vulva vestibule contains the opening to the urethra and the vaginal opening. The borders of the vulva vestibule are formed from the edge of the labia minora.
Contains the bartholin’s glands
Labia Minora
Two inner folds of skin that surround the opening of thevagina.
Thelabia minoraare part of the external femalegenitals, or genitals present in individuals assigned females at birth, which also includes themons pubis, labia majora,vaginalopening, hymen, andclitoris.
Labia Majora
prominent pair of cutaneous skin folds that will form the lateral longitudinal borders of the vulval clefts.
The labia majora forms the folds that cover the labia minora, clitoris, vulva vestibule, vestibular bulbs, Bartholin’s glands, Skene’s glands, urethra, and the vaginal opening.
Labia majora function
protect vagina from mechanical irritation, dryness and infection.
Forchette
Labia unite here posteriorly. A thin fork-shaped fold of skin designed to stretch at the bottom of the entrance to thevagina.
Vaginal Introitis
The entrance to the vagina, encompassing the anterior and posterior vestibules and the perineum.
Vaginal Anatomy specifics
Musculomembranous tube between the urethra and rectum
Vagina mucosa lies in transverse folds called rugae.
Protrusion of cervix into the vagina divides into 4 fornixes:
Anterior
Posterior: Deep and ant to rectovaginal cul-de-sac (pouch ) of douglas
TWO lateral: broad ligaments, Ovaries and fallopian tubes are palpable here
Arterial Supply of the vagina + ovaries
- Internal Iliacs
- Uterine Artery
and - Ovarian artery
Vagina Lymphatics
- lower 2/3 vagina - inguinal lymph nodes
- upper 1/3 vagina hypogastric and sacral nodes/ abdominal and pelvic nodes
Uterine cavity
Triangular 6-7cm
Normal=Anteverted
Can be retroverted or anteflexed
Lies at almost right angle of vagina
Fundus: Convex upper surface of the body
Cervix: Lower part protrudes into vagina
Blood supply: Uterine and Ovarian Arteries
Lymphatics: to lumbar nodes
TAH and TVH
- Total abdominal hysterectomy
- Total Vaginal hysterectomy
The adnexa are
made up of the fallopian tubes and ovaries. Cysts are fluid-filled structures that can develop in the adnexa.
Ovary anatomy specifics
Almond shape
Palpable on pelvic exam 50% time
Two primary functions:
Production of ova
Secretions of hormones
Estrogen/Progesterone/Testosterone
HPA hormone secretion
Hypothalamic pituitary axis - Releases factors from hypothalamus: controls secretion of hormones from anterior pituitary: FSH/ LH
Ovarian Graafian follicles
secretes estrogen in response to FSH / LH
Corpus Luteum
Ovarian follicle after ovulation
Secretes estrogen and progesterone
Pituitary gland influence on menses
pituitary secretes FSH and LH,a process which actually begins before the onset of your menses.
These hormones in turn stimulate the growth of several ovarian follicles, each containing one egg.
The number of follicles in the monthly “cohort” of developing follicles is unique to each individual
FSH, LH, and Estrogen integration for ovulation
Positive feedback triggers the anterior pituitary to release more FSH and LH.
More FSH and LH cause the ovary to produce more estrogen. The ensuing LH surge is responsible for ovulation.
Estrogen Birth control action
prevents pituitary gland from releasing LH, with no LH, egg does not mature and ovulation does not occur.
Polymenorrhea
less than 21 day intervals between menses
Oligomenorrhea
Infrequent bleeding
Menorrhagia
excessive flow
Metrorrhagia
intermenstrual bleeding
Postcoital bleeding
bleeding after sexual relations
GPFPAL
G=Gravida=>total # of pregnancies
P=Para=>outcomes of pregnancies
F=Full term
P=Premature
A=Abortion or Miscarriage
L=Living child/children
Female GU relavent Hx questions
Family history
Menarche (first menses-ovulation begins after 1-2 years)
Menstruation
Menopause (last uterine bleeding induced by ovulation
Postmenopausal bleeding (after 608 months of amenorrhea)
Pregnancy
Vulvovaginal symptoms: m/c sxs=discharge and vaginal itch, Lesions/rashes
Sexual activity: Dyspareunia, vaginismus, Hx STI’s
Vaginal Inspection
Discharge
Inflammation
Edema
Ulceration
Lesions
Prolapse
Stress Incontinence
Phases of the Pelvic exam
Inspection/Palpation ext genitalia
Examination with a speculum
Bimanual Examination
Rectovaginal Palpation
External genitalia inspection
External genitalia
Masses, lesions, discharge, infection, Bartholin’s cyst, rashes, moles, ulcers, warts, scarring, trauma
Lichen Sclerosis: uniformed reddened, smooth , shinny appearance
Cervix inspection
Cervix:
Nullipara vs Multipara
Color, erythema, lesions, masses, discharge, erosion
Vaginal mucosa - Inspection
Color, inflammation, discharge, ulcers, masses, atrophy
Pap smear screening elements
Two primary types of cervical cancer
Squamous cell 80-90%
Adenocarcinoma 10-20%
Risk Factors for cervical cancer
Behavioral
Sexual activity at a young age, Failure to do proper screening
Multiple partners, h/o STIs
Viral
HPV (oncogenic strains 16,18)
Present in 95-100% squamous cell cancers in the cervix
Pap Screening Guidelines
Start at age 21, regardless of sexual activity
Screen every 3 years in 20’s, unless more often when indicated
Pap smear: cells are scraped from the cervix and checked for diseases or other problems under a microscope
PE palpation
Cervix: Soft, firm, nodule, friable, pain with motion
Uterine body/Bimanual exam: Position, size, shape, mobility, consistency, tenderness
Adnexa: Ovaries, masses, tenderness
Posterior fornix: Pouch of Douglas
Rectovaginal exam
PE write up
BUS: Bartholin, Urethral, Skene’s glands normal
Vagina: Atrophy, lesions, color, moisture, discharge, bleeding
Cervix: Appearance, lesions, erythema, petechiae, discharge, strawberry cervix, laceration, nulliparity vs multiparity, cervical motion tenderness (Chandelier sign with PID)
Uterus: size, shape, anteverted, retroverted, mobility, tenderness
Adnexa: masses, tenderness (?ovaries palpated)
Rectum: confirms retroversion, posterior fibroid, endometriosis, size, rectal masses
Protrusion of cervix into the vagina divides into 4 fornixes:
Anterior
Posterior: Deep and ant to rectovaginal cul-de-sac (pouch ) of douglas
Lichen Sclerosis
uniformed reddened, smooth , shinny appearance
Usually in girls before period onset
and post menopausal women.
Two primary types of cervical cancer
Squamous cell 80-90%
Adenocarcinoma 10-20%
