female gu exam 3 Flashcards
what is included in the vulva?
mons pubis, labia majora, labia minora, clitoris, vestibule, skenes glands, bartholins glands, urethral meatus, vaginal introitus
fourchette
formed by inferior union of labia minora at posterior commissure
perineum
located between fourchette and anus
hymen
circular fold of tissue that may partially or completely occlude vaginal introitus
labia majora
rounded folds of adipose and connective tissue
extends from the mons to just pass the posterior commissures
labia minora
thinner, medial, pink red flods that extend anteriorly to form prepuce and clitoris
prepuce
female foreskin
innervation of the clitoris
dorsal nerve branches off the pudendal nerve to innervate
average length and width of clitoris and adult female
width= ~1 cm
length= 1.5-2 cm
what does the vestibule contain?
the urethral meatus and opening to the skene’s glands bilaterally
vaginal introitus
opening to the vagina, contains the hymen
site of episiotomy or tears during childbirth
perineum
if skenes glands are edematous or tender you should consider
infection- chlamydia or ghonorrhea
bartholins gland function
secrete watery fluid that serves as lubricant during intercours
cystocele
when the wall between the bladder and the vagina weakens
bladder falls through vaginal introitus
retrocele
wall between rectum and vagina weakens
rectum falls through vaginal introitus
uterine prolapse
Prolapse of the uterus results from weakness of the supporting structures of the pelvic floor and is often associated with a cystocele and rectocele. In progressive stages, the uterus becomes retroverted and descends down the vaginal canal to the outsid
vulva nerve innervation
pudendal nerve
-innervates majority of vulva
-responsible for proper functioning and control of urination defecation and orgasm
ilioinguinal and genitofemoral nerve
-innervate anterior to urethra
blood supply of vulva
predominately from internal pudendal arteries
where does the cervix turn into the uterus?
at the isthmus
what is the lining of the uterus called?
endometrium
*endometrial lining 2-10 cm thick depending on stage of menstrual cycle
length of vagina
~7-10 cm
length of cervix
~3 cm
muscle layers of the vagina
-inner circular muscle layer
-outer logitudinal smooth muscle layer
vaginal cells responsible for resistance to infection
superficial cells of vagina that contain glycogen which produce lactic acid with normal vaginal flora
what tissue lines the vagina?
stratified squamous epithelium
describe the fornices of the vagina
anterior fornix
-shallow
-posterior to bladder
posterior fornix
-deep
-anterior to pouch of douglas
lateral fornices
-contain broad ligaments
-may palpate fallopian tubes and ovaries here
corpus/ fundus= upper portion of uterus
-interlacing smooth msucle fibers
-freely mobile
-peritoneum covers fundus anteriorly
what is the fundus of the uterus supported by?
-broad ligament
-uterosacral ligaments
-pelvic floor
skin/tissue cells of the cervix
exocervix= squamous epithelium
endocervix=simple columnar epithelium
come together at squamocolumnar junction/transition zone
adnexa
region that houses the female reproductive organs while lie close to the uterus
*ovaries, fallopian tubes, ligaments that hold uterus in place
primary function of fallopian tubes
provide a conduit for and convey egg from ovary to uterus
what is the most common site of ectopic pregnancies?
ampulla of fallopian tubes
function of fimbriae
direct egg into fallopian tube
primary funcitons of ovaries
-oogenesis
-hormone production
innervation of the pelvic floor
-pelvic diaphragm= sacral nerve root s3-s5
-perineal membrane= pudendal nerve
menarche
onset of menses
menopause
absence of menses for 12 consecutive months usually occuring between 48 and 55 years
amenorrhea
absence of menses; most common cause is pregnancy
dysmenorrhea
pain with menses, often when bearing down, aching, or cramping sensation in the lower abdomen or pelvis
premenstrual syndrome (PMS)
atleast one symptom associated with “economic or social dysfunction” that occurs during the 5 days before the onset of menses and is present atleast 3 consecutive menstrual cycles
premenstrual dysphoric disorder (PMDD)
primary vs secondary dysmenorrhea
Primary dysmenorrhea results from increased prostaglandin production during the luteal phase of the menstrual cycle, when estrogen and progesterone levels decline.
Causes of secondary dysmenorrhea include endometriosis, adenomyosis (endometriosis in the muscular layers of the uterus), pelvic inflammatory disease (PID), and endometrial polyps
patterns of abnormal bleeding
-Polymenorrhea, or less than 21-day intervals between menses
-Oligomenorrhea, or infrequent bleeding
-Menorrhagia, or excessive flow
-Metrorrhagia, or intermenstrual bleeding
-Postcoital bleeding- CANCER UNTIL PROVEN OTHERWISE
premature ovarian failure
“early menopause” before 40 years old
Chronic pelvic pain is a red flag for
hx of sexual abuse
gynecological history
-date of last pelvic exam
-last pap smear and results
-hx of an abnormal PAP
-stis
-gyn procedures
-personal or fam hx of diabetes of cancer of the reproductive organs
GTPAL
G= # of pregnancies
T=term births
P=preterm births
A=abortions
L=living children
contraceptive hx
current method (type, length of time used, compliance, side effects, satisfaction)
previous methods and why discontinued
patient education about barrier methods
sexual hx
-number sexual partners
-gender of partners
-sexual preferences
-high risk behavior
-prior stds
genitourinary ros
urinary urgency
urinary incontinence
hematuria
painful urination
night time urination
genital ros
vaginal odor, vaginal discomfort, vaginal discharge, itching, postcoital bleeding, painful intercourse
components of female gu exam
-inspection external genitalia
-palpation external genatlia
-examination with speculum
*bimanual palpation
-rectovaginal palpation
-rectal exam
list speculums largest to smallest
graves, peterson, huffman
position of patient during pelvic exam
dorsal lithotomy
steps of internal exam
speculum insertion
inspection of cervix
inspection of cervical os
culture collection
pap smear collection
internal exam of vaginal mucosa
choose speculum size based on
patients:
age
sexual experience
introital size
nabothian cysts
cysts on cervix
the wet prep
-vaginal discharge samples collected
-normal saline on one slide
-KOH on another slide
-take a whiff a fishy odor indicative of bv
what is a normal vaginal ph
4-4.5
what does a vaginal Ph of over 4.5 suggest in premenopausal women?
suggests infections such as bv or trichomoniasis
helps to exclude candida vulvovaginitis
what do you have to do to feel a retroverted uterus?
you need to do a rectovaginal exam
what HPV subtypes are associated with genital warts?
subtypes 6 and 11
what are the 14 high risk types of HPV?
16,18,31,33,35,39,45,51,52,56,58,59,66,68
health promotion and counseling
Cervical cancer
Menopause and hormone replacement therapy
Ovarian cancer
The ACIP recommends routine vaccination for females and males beginning at age 11 or 12 years, though vaccinations can be first given at age 9
For persons first being vaccinated at ages 15 through 26 and immunocompromised persons ages 9 through 26, the recommendation is for three doses of HPV vaccine
which age to end cervical cancer screening
Age >65 yrs, assuming three consecutive negative results on cytology or two consecutive negative results on cytology plus HPV testing within 10 yrs before cessation of screening, with the most recent test performed within 5 yrs
