General Gyne Flashcards
What is the DSM IV Dx: Persistent or recurrent deficiency or absence or sexual fantasies and desire for sexual activity
Hypoactive Sexual desire disorder
What is the DSM IV Dx: Persistent or recurrent extreme aversion to or avoidance of all or almost all genital sexual contact with a sexual partner
Sexual aversion disorder
What is the DSM IV Dx: Persistent or recurrent delay in or absence of orgasm following sexual excitement phase
Orgasmic disorder
What is the DSM IV Dx: Persistent or recurrent genital pain associated with sexual intercourse
Dyspareunia
What is the DSM IV Dx:
Persistent or recurrent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal pentration with penis, finger, tampon or speculum is attempted
Vaginismus
First line treatment for PMDD
SSRI
What is the diagnosis? Vaginal burning and pain, vaginal pH <4.5, pseudohyphae on wet mount
Vulvovaginal Candidiasis
How do you diagnose and treat recurrent vulvovaginal candidiasis?
4 or more episodes in 12 months
Tx: Induction and maintenance treatment.
Eg. Fluconazole 150mg PO 3 doses 72 hours apart THEN 150mg PO weekly x 6 months
What is the diagnosis and treatment? malodorous frothy voluminous discharge with wet mount showing motile parasite
Dx: Trichomonas (flagellated parasitic protozoan)
Tx: Metronidazole 500mg PO BID x 7 days or 2g PO x1, treat partner (not reportable disease in Canada)
What is the diagnosis and treatment? Vaginal pH > 4.5, Clue cells on wet mount, positive whiff test (amine odour with additional of KOH
Dx: Bacterial Vaginosis (overgrowth of vaginal flora, less lactobacilli)
Tx: Metronidazole 500mg PO BID x 1 week (or vaginal 0.75% x 5days), alternate Metronidazoel 2g PO x1 or clindamycin cream or PO x 7 days
When does hysterosalpingogram require antibiotics?
When tubes are dilated, give doxycycline
Most common strain of HSV causing genital herpes
HSV2
What is the rate of transmission of genital HSV to a partner while on suppressive therapy?
1%
Genital Warts in prepubertal child requires consideration of what?
Sexual abuse, no need to biopsy
Cervical cytology screening is considered what type of prevention?
Secondary prevention (looking for pre cancerous lesions)
What kind of prevention is the HPV Vaccine?
Primary Prevention - the best form of prevention for HPV
HPV is implicated in what types of cancers?
cervical, vaginal, vulvar, anal, head and neck
HPV is associated with what percentage of vulvar cancer and vaginal cancer ? Anal cancer? Head and neck cancer?
Vu/Va: 20-50%, Ano: 80-90%, H&N: 10-20%
HPV is most common among young sexually active women, what percentage will clear the virus?
80%
What proteins doe HPV use to be oncogenic?
E6 and E7 proteins interfere with normal cell regulatory functions
When should an IUD be removed in PID?
after 72 hours if no clinical improvement
Risk of PID post IUD placement in the first 90 days?
0.5%
What are the Benefits of OCP?
- Contraception
- Regulation of menses
- Treatment of the following:
o dysmenorrhea
o PMS
o Menstrual headaches
o Acne
o Hirsutism - Long term benefits:
o Reduced rates of endometrial, ovarian and colorectal cancer
What is the risk of VTE with OCP?
Background risk 4-5/10 000 women years
(doubles)
OCP risk 8-10/10 000 women years
Pregnancy risk 29/10 000
Peripartum risk 300/10 000
Treatment for Primary Dsymenorrhea
C - Heat pads, exercise
M - NSAIDS (Tylenol), COC (IUD, DMPA, Visanne)
S - for secondary causes (endo ablation, hysterectomy EM ablation + COC)
Other: TENS, accupuncture
Adolescent Pregnancies are at higher risk for:
Maternal:
antepartum - depression, ?HTN, IPV, anaemia, substance use, etoh, STI, PPROM
intrapartum: SVD
Postpartum: unintended pregnancy, depression, low rate of breast feeding
Fetal:
antepartum - congenital anomaly, congenital infection (chlamydia), IUGR, PTL, PTN
Intrapartum - SB
Post partum - NND, children with lower education
Most common US findings for Ovarian torsion and what are other US findings?
- Ovarian enlargement
- absence of doppler flow
Others:
When would you consider oopheropexy in the management of ovarian torsion?
- repeat torsion
- congenitally long ligament
- no obvious cause of torsion
Classic findings in Turners 46 X
- Short stature
- Micrognathia
- Epicanthal folds
- High arched palate
- Hearing loss
- Webbed neck
- Shield chest
- Absent breast development
- Wide spaced areolae
- Cubitus valgus
- Short 4th metacarpal
- AI disorder
- AI thyroiditis
- Renal anomalies
- Aortic coarctation
Obstructive hemi vagina is associated with ?
ipsilateral renal agenesis (didelphys, obstructed hemivagina and ipsilateral renal anomaly = OHVIRA
What are the most common additional anomalies seen with mullerian anomalies?
Renal, Spinal
What mullerian anomaly has the best fertility outcomes?
Didelphis uterus
What are the obstetrical complications associated with mullerian anomalies?
SA, RPL, PTL, PTB, IUGR, SGA, PPROM, Malposition, Fetal malformation (septum)
Describe the phenotype for 46XY complete AIS
No uterus, testis present (intra-abdominal), no pubic or axillary hair, breasts present , short blind end vagina
Describe the phenotype for 46 XX with Complete mullerian genesis (MRKH)
No uterus, short pouch vagina, no testis, ovaries present, normal breasts, axillary and pubic hair present
What are the indications for EUA with a straddle injury?
- inability to void
- ongoing bleeding
- expanding hematoma
- suspicion of penetrating injury (need to inspect upper vagina)
- suspected anal sphincter injury
