Female GU Flashcards
Lymphatic drainage to external genitalia & perineum
Superficial and deep inguinal nodes
Blood supply to external genitalia & perineum
Internal pudendal arteries
Remnant of hymen
Carnunculae myrtiformes
2 things that result from imperforate hymens
Hematocolpos & mucocolpos
Posteriorly the labia minora meet to form the_______
Fourchette
Length of vagina
8cm
Arterial supply of the vagina
Internal iliac
Uterine artery
Middle hemorrhoidal artery
Lymphatic drainage of the vagina
Lower third: inguinal nodes (palpable)
Upper two thirds: hypo gastric and sacral
Thickness of endometrium
2-10mm
Process of the change of the structure of the cell at the scj
Squamous metaplasia
Area between squamous metaplasia
Transformation zone
When does the scj change for the second time and where does it relocate to?
In menopausal years
In the endocervical canal
Where does squamous intraepithelial neoplasia occur most?
The transformation zone
What is a precursor to cervical cancer?
Squamous intraepithelial neoplasia
What do you do if someone has an abnormal pap?
Colposcopy to look at scj
Most important supporting ligament of the uterus
Cardinal
Pain in which ligament is most clinically important
Round ligament
Which ligaments extend from the lateral pelvic walls to insert on the lateral portion of the cervix & vagina?
Cardinal ligaments
Cardinal ligaments aka as______
Mackenrodt’s ligament
Job of the round ligaments
Keep uterus antiverted or retroverted
Path of round ligaments
Anterior uterus
Pelvic side wall in fold of broad ligament
Transverse inguinal canal
End in labia majors
Contents of broad ligament
Fallopian tubes
Round ligaments
Uterine and ovarian lymph, vessels, nerves
Ureters
Broad ligament path
Lateral pelvic side wall to uterus and adnexa
Ligaments that insert to posterioinferior portion of uterus at level of isthmus
Uterosacral ligaments
Ligaments that support uterus to prevent enters ele
Uterosacral ligaments
Ligaments which pass anterior ly around bladder to posterior surface of pubic symphysis
Pubocervical ligaments
3 pelvic floor muscles
Puborectalis
Pubococcygeus
Iliococcygeus
Uterine blood supply
Uterine arteries
Ovarian arteries
Uterine lymphatics
Lumbar nodes
Length of Fallopian tubes
8-14cm
What supports the Fallopian tubes?
Mesosalpinx
Location of fertilization
Ampulla of Fallopian tube
Location of most ectopic pregnancies
Ampulla
How does PID influence Fallopian tubes
Decreases it’s ability to move
Where do the ovaries rest
Ovarian fossa
Which hormones are produced in the ovaries
Estrogen
Progesterone
Testosterone
Adnexa includes
Ovaries
Tubes
Supporting tissues
What secretes estrogen and an ovum
Ovarian Graafian follicle
What does the Graafian follicle become after ovulation?
Corpus luteum
What does the corpus luteum secrete
Estrogen and progesterone
What causes a rise in body temp and what is it a sign of?
Progesterone secretion
Ovulation
What do ovarian hormones cause a change in
Breast and uterus
What happens when pregnancy doesn’t occur
Corpus luteum regresses
Decrease ovarian hormones
(Premensrual symptoms)
5 days later the menses begin
Term for When ladies can feel ovulation
Mittleschmertz
Normal length of menstruation
3-7 days
Amount of blood from menstruation
50-150mL
Contents of menstrual “clot”
Red cells
Glycoproteins
Mucoid substances
Mean age of menarche
12.8
After menarche irregular for…
1-2 years
Age of menopause
50-55
51.5 average
Premature menopause
Before 40
Perimenopausal symptoms
3-5 years prior
Most common menopausal distress symptom
Hot flashes
Other menopausal symptoms
Night flushes
Insomnia
Tiredness
Irritability
Post menopausal vagina shrinks or expands?
Shrinks
Effects of menopause on bladder
Decrease elastic capacity
Secondary amenorrhea
Absence of menses for 6 months in previously regular woman
Who is amenorrhea common in
Runners Anorexia Low body fat Disease of hypothalamus Pituitary dz Ovary dz Uterus dz Thyroid dz Chronic dz
Fat causes estrogen to increase or decrease
Increase
Primary amenorrhea
No bleeding by 16 or no secondary sexual characteristics by 14
Excessive or prolonged menses > 7 days
Menorrhagia
Irregular bleeding
Metrorrhagia
Heavy irregular bleeding
Menometrorrhagia
Post menopausal bleeding
Uterine cancer until proven otherwise.
Painful menstruation
Dysmenorrhea
Tx for dysmenorrhea
Ocp or NSAID if not pathologic
Cause of dysmenorrhea
Prostaglandin release from uterus
Dysmenorrhea symptoms
Colicky uterine contractions
Pain in lower abdomen and back
Pain radiation to legs
NVD
Dysmenorrhea occurring in the first 6-12 months of menarche
Primary
Dysmenorrhea occurring within 2 years of menarche most likely
Secondary
Endometriosis
Descent of urethra
Urethrocele
Who does cystocele occur most in
Parous women
Stress incontinence
Urgency
Incomplete emptying
Falling out
Cystocele
Upper vaginal wall prolapse
Enterocele
Where does the pouch of Douglas herniate to in enteroceles
Between Uterosacral ligaments into rectovaginal septum
What does an enterocele contain?
Loops of small bowel maybe omentum
Where is an enterocele
Bulge above rectocele
Maybe prolapsed through vagina
What is often injured in a uterine prolapse
Endopelvic fascia
Cardinal ligaments
Uterosacral ligaments
Pelvic floor muscles
Complete uterine prolapse aka
Procidentia
What is often present in a uterine prolapse
Cystocele and rectocele
Cause of trichomonas vaginitis
Trichomonas vaginalis
Discharge in trichomonas
Gray/green/yellow Frothy Profuse Pooled in vaginal fornix Malodorous
Other symptoms of trichomonas
Pruritis Dysuria Dysparunia Erythematous vestibule Strawberry cervix
Lab eval for trichomonas
Saline wet mount
Cause of candida
Candida albicans
Aka candida
Monilia
Risk factors for candida
Pregnancy
Abx
Candida discharge
White and curdy
Not malodorous
Not profuse
Other symptoms of candida
Pruritis
Vaginal soreness
Dysuria
Dysparunia
Appearance of vulva in candida
Inflammed and swollen
Appearance of vaginal mucosa in candida
Red
Specked white discharge
Friability
Lab eval for candida
Potassium hydroxide preparation
Cause of bacterial vaginosis
Anaerobic bacteria
Sexually transmitted
Discharge of bv
Gray/white
Thin
Malodorous
Minimal
Lab eval for bv
Saline wet mount for clue cells
Only one done with saline
What is the only lab eval done with saline?
Bv
What are clue cells?
Epithelial cells with stippled borders (bv)
Cause of strophic vaginitis
Decreased estrogen after menopause
Discharge of atrophic vaginitis
Variable in color consistency and amount
+- blood tinged
Other symptoms of atrophic vaginitis
Pruritis
Soreness
Burning
Dyspareunia
Appearance of vulva in atropic vaginitis
Atrophic Dry Pale Red Bleeds easily Erosion
3 questions for itching
DM
Soap
Douching
New partner
Vaginal itching associates with
Monila Glycosuria Vulvar leukoplakia Pyschosomatic Chemical
Involuntary contractions of the vagina
Vaginismus
Hirtsuitism
Menstral irregularities
Infertility
Obesity
Polycystic ovarian disease
Causes of alopecia
Meds Chemo Crash diets Pregnancy Infections
Causes of neurological incontinence
Cerebral dysfunction
Spinal cord disease
Peripheral nerve lesion
MS
Infertility
Inability to achieve pregnancy after 1 year
Menstral history
Catamenia
Catamenia calculation
Age of menarche x length of cycle x # days they bleed
Full term how many weeks
37
Collects endocervical sample
Ayer
Collects columnar cells
Cervix brush
Elevation of bed to
30 degrees
What to tell patient when milking urethral meatus
Urge to urinate
Pediatric speculum
Pederson
Speculum that is wider and curved
Graves
Angle of speculum
45 degrees
Cysts in cervix that can get plugged
Nabothian
Uterus is evaluated for this on bi manual exam
Size Shape Consistency Mobility Masses
When is it especially important to do rectovaginal exam
Over 40
Mass
Retroverted uterus
Most common uterine position
Anteverted
Anteflexed
Posterior cervix _____ uterus
Anteflexed
Antiverted
Mid position
Anterior cervix ______ uterus
Retroverted
Which uterus position is hard to feel
Anteflexed
