Gynaecology - Signs and Symptoms Flashcards
POP (pelvic organ prolapse) symptoms
- Mild genital prolapse – may be asymptomatic + an incidental finding
- Symptoms are related to the site + type of prolapse
• Vagina/general symptoms can be common to all types of prolapse
o Sensation of pressure/fullness/heaviness
o Sensation of a bulge/protrusion/”something coming down”
o Seeing or feeling a bulge/protrusion
o Difficulty retaining tampons
o Spotting (in the presence of ulceration of the prolapse)
• Urinary symptoms
o Recurrent UTI
o Incontinence
o Frequency
o Urgency
o Feeling of incomplete bladder emptying
o Weak/prolonged urinary stream
o Need to reduce prolapse manually before voiding
o Need to change position to start or complete voiding
• Bowel symptoms
o Constipation/straining
o Urgency of stool
o Incontinence of flatus or stool
o Incomplete evacuation
o Splinting – The need to apply digital pressure to the perineum or posterior vaginal wall to enable defecation
o Digital evacuation necessary in order to pass a stool
• Coital difficulty o Dyspareunia o Loss of vaginal sensation o Vaginal flatus o Loss of arousal o Change in body image
Symptoms of overactive bladder syndrome
- Urgency that is difficult to delay
- Urge incontinence
- Frequency
- Nocturia
- Abdominal discomfort
Signs and symptoms of PID (pelvic inflammatory disease)
• Asymptomatic – infertility +/- chronic pelvic pain
• Acutely
• Bilateral lower abdominal pain/tenderness
• Deep dyspareunia
• Abnormal vaginal bleeding (PCB, IMB, menorrhagia)
• Vaginal or cervical discharge is purulent
• Fever>38 (but may be apyrexial)
Signs
• Mucopurulent cervical discharge + cervicitis seen on speculum examination
• Cervical motion tenderness + adnexal tenderness on bimanual vagina examination
• N+V
• Urinary symptoms
• Proctitis
• Adnexal mass
Bartholin’s cyst signs and symptoms
Symptoms
• Woman may find it uncomfortable to walk or sit
• Superficial dyspareunia
• Vaginal discharge – esp. in women with STIs
Signs • Cysts or abscesses are usually unilateral o Unilateral labial mass o Cyst = soft, fluctuant, non-tender o Abscess = tense, hard, erythema
- Onset of abscess is rapid – days/hours
- Labial oedema before a swelling forms
• Swelling may be very painful
o Wide legged gait
o Uncomfortable for pt to sit
- Spontaneous bursting of the cyst or abscess – sudden relief of pain
- Palpable inguinal nodes, fever if infected
Endometriosis symptoms and signs
Symptoms
• Appearance or worsening of symptoms at the time of menstruation or just prior to it - ?endometriosis
• Common symptoms o Dysmenorrhoea (no menorrhagia differentiates this from fibroids) o Dyspareunia o Cyclical or chronic pelvic pain o Subfertility/Infertility
• Other symptoms
o Period-related or cyclical GI symptoms – painful bowel movements
o Period-related or cyclical urinary symptoms – haematuria, dysuria
o Cyclical pain or bleeding e.g. epistaxis, haemoptysis at extrapelvic sites
o Menstrual irregularity
o Abdominal pain, low back pain
o Painful defecation, Bloating, Constipation
o lethargy
• Less common symptoms o Cyclical rectal bleeding o Menorrhagia o Diarrhoea o Haematuria
Signs
• Examination is often normal
• There may be
o Posterior fornix or adnexal tenderness
o Palpable nodules in posterior fornix or adnexal masses – endometriosis can cause cystic lesions on the ovaries - chocolate cysts
o Bluish haemorrhagic nodules visible in the posterior fornix
- Inflammation
- Pain
- Formation of adhesions
Fibroids symptoms and signs
- Most are asymptomatic
- Lethargy
- Pallor
- Menorrhagia (larger fibroids)
- IMB (pedunculated submucosal fibroids)
- Pelvic pain
• Sx of enlarged uterus o Lower abdominal discomfort o Abdominal swelling o Heaviness o Constipation – pressure on bowel o Urinary symptoms – pressure on bladder
• During pregnancy
o Acute pain - Fibroid degeneration
o Recurrent miscarriage
o Infertility (only with submucous fibroids – their removal restores fertility to baseline rates)
Signs
• Can cause significant morbidity incl. prolonged or heavy menstrual bleeding, pelvic pressure or pain, can contribute to reproductive dysfunction
• Iron deficiency anaemia
• Palpable abdominal mass arising from the pelvis
• Bimanual palpation – Enlarged, irregular, firm, non-tender uterus
Signs and symptoms of cervical polyps
- Asymptomatic
- Small bleeding and discharge
- PCB
- Contact bleeding e.g. postcoital bleeding, postvaginal examination bleeding
- Abnormal bleeding – during intercourse, heavy menstrual periods, IMB, postmenopausal bleeding
Signs and symptoms of cervical ectropion
IMB
PCB
Increased discharge
Contact bleeding e.g. postcoital bleeding, postvaginal examination bleeding
Signs and symptoms of endometrial polyp
IMB - Usually hx of irregular spotting and bleeding between menstrual periods
?infertility
Menopause signs and sympotms
• Menstrual irregularity
o Changes in menstrual cycle which may last for up to four years
o The cycle may lengthen to many months or shorten to 2-3 weeks
o Increase in the amount of menstrual blood loss is common
o Approximately 10% of women have an abrupt cessation of periods
o Persistent amenorrhoea – often initial oligomenorrhea/irregular or shortened cycles
• Vasomotor symptoms
o Hot flushes, night sweats, palpitations, headaches
o Hallmark symptoms
o Hot flushes commonly affect the face, head, neck and chest + last a few minutes
o (caused by loss of homeostasis by the central thermoregulatory centre)
• Urogenital
o Urogenital atrophy
o Dyspareunia, vaginal discomfort and dryness, vaginal irritation
o Recurrent lower UTI, urinary incontinence, frequency, dysuria
o Urinary symptoms may not manifest until 5-10 years after menopause
o Urogenital atrophy = thinning and shrinking tissues of the vulva, vagina, urethra, bladder cause by oestrogen deficiency
• Sleep disturbance
o Most common symptom reported by women
• Psychological
o Anxiety, nervousness, irritability, lethargy, memory loss, difficulty concentrating
o These present first
• Loss of libido
o Hormonal factors – oestrogen, progesterone, testosterone have all been implicated
o Vaginal dryness, loss of self-image, psychosocial factors
• Musculoskeletal symptoms
o Joint + muscle pain
• Other changes
o Brittle nails, thinning of the skin, hair loss, generalised aches and pains
o Due to falling oestrogen levels
Symptoms and signs of atrophic vaginitis
- Vaginal dryness
- Burning or itching of the vagina/vulva
- Dyspareunia
- Vaginal discharge (usually white or yellow)
- Vaginal bleeding or postcoital bleeding
• Urinary symptoms o Increased frequency o Nocturia o Dysuria o Recurrent UTI o Stress incontinence o Urgency
• External genitalia - reduced pubic hair, reduced turgor or elasticity, arrow introitus
• Vaginal examination o Thin mucosa with diffuse erythema o Occasional petechiae or ecchymoses o Cracks or fissures o Dryness o Lack of vaginal/rugal folds
Signs and symptoms of Asherman’s syndrome
- Irregular periods
- Reduced menstrual flow
- Increased cramping + cyclical abdominal pain
• Amenorrhoea
o Either due to complete destruction of the uterine lining or by obstruction of the cervix or lower portion of the uterus due to adhesions – menses are either retained in the uterus or flow into the abdominal cavity causing endometriosis
• Some pt may have normal periods
• Amenorrhoea + pain
o Pain may indicate that menstruation is occurring but the blood cannot exit the uterus because the cervix is blocked by adhesions
o This can also cause retrograde menstruation (menstruation blood that flows backwards into the fallopian tubes instead of being expelled from the body) - retrograde menstruation proposed as a RF for endometriosis
- Recurrent miscarriage
- Infertility
Why might some women feel dizzy and have a slow HR while they are miscarrying?
• If a woman is having miscarriage + the products of conception are coming through the cervix, the cervical excitation can cause parasympathetic stimulation + a bradycardia, even if there is a blood loss
Gestational trophoblastic disease symptoms and signs
• Irregular vaginal bleeding
o Painless
o Any woman who develops persistent vaginal bleeding after a pregnancy event is at risk of having GTN
o Excessive vaginal bleeding can be associated with molar pregnancy
- Positive pregnancy test
- Supporting ultrasonographic evidence
o Excessive uterine enlargement (uterus is large for dates)
o Abdominal distension due to theca lutein cysts – uterus larger than expected for GA
o Hyperemesis (increased HCG)
o Hyperthyroidism (from high hcg mimicking TSH)
o Early-onset pre-eclampsia
o O/E – excessive uterine size for gestation
• GTN – should be considered in any woman developing acute respiratory or neurological symptoms after pregnancy
• Presentations due to metastatic disease affecting the lungs or brain
o Haemoptysis
o Seizures
• Other symptoms of malignancy
o Persistent PV bleeding, hyperemesis, lower abdominal pain
o Lung mets – haemoptysis, dyspnoea, pleuritic pain
o Bladder/bowel – haematuria, PR bleeding
PCOS signs and symptoms
• Commonest presentation
o Infertility
o Menstrual irregularities (oligomenorrhoea or amenorrhoea)
Oligomenorrhoea = <9 periods per year
Prolonged amenorrhoea = <1 period every 3 months (oligomenorrhoea >3 months)
o Hirsutism
Upper lips, lower abdomen
Male pattern hair loss – tinning of hair starting from the crown of the head (alopecia)
- Acne
- Overweight/obesity or difficulty losing weight
- Hypertension
- Acanthosis nigricans (dark velvety patches in the creases of the neck, groin, underarms) sign of severe insulin resistance
- Occasionally, clitoromegaly, increased muscle mass, deep voice
- Sleep apnoea
