HLTH 2501: female reproduction Flashcards
name for intercourse
coitus
what consists of the vulva?
mons pubis, labia, clitoris, and the vaginal orifice
vagina anatomy
lined with a mucous membrane and stratified squamous epithelium, and deep to this is muscle
mucosa after menopause
is thin and fragile due to decline in estrogen secretions
bartholin glands
aka greater vestibular glands; these secrete mucus in response to sexual stimulation; are located on either side on the vaginal orifice
skene glands
located by the external urethral meatus and secrete mucus
name for vaginal discharge
leukorrhea
what is leukorrhea produced by?
the skene glands and the bartholin glands
leukorrhea pH
during reproductive years it is more acidic and more puberty and after menopause it is more alkaline
what makes leukorrhea more acidic?
increased population of lactobacillus
endocervical canal
is the passageway between the internal os of the cervix and the external os at the vaginal end
function of the external os
to act as a barrier to vaginal flora attempting to ascend into the uterus due to thick mucus
epithelial of upper female tract
is columnar epithelial cells
point of change between epitheliums in the female reproductive tract
is known as the transformation zone or squamous columnar zone; this is a common site for cervical dysplasia and cancer
another name for the body of the uterus
the corpus
name for the end of the oviducts
fimbriae
name for onset of female reproductive years
menarche
what develops in the breasts due to estrogen?
mammary tissue
breasts
consist of 15 to 20 lobes supported by ligaments; also contain muscle, fatty tissue, acini, and ducts
acini
are the basic functional units of the breast tissue, consisting of epithelial cells that secrete milk and contracting cells that move the milk into ducts
areola
is the pigmented tissue surrounding the nipple and contains sebaceous glands
function of higher hormone levels in the breast
high estrogen and progesterone increase the vascularity of the breasts and the proliferation and dilation of the ducts, leading to fullness and tenderness
what structures secrete hormones in the female reproductive system?
the hypothalamus, the anterior pituitary, and the ovary
typical position of the uterus
anteverted (tipped forward) and anteflexed (bent forward over the bladder)
what factors may change the position of the uterus?
minor congenital alternation, childbirth, or a pathologic condition like a tumor of scar tissue
retroverted uterus meaning
is is tipped backward
symptoms of displaced position of the uterus
usually is painless and asymptomatic, but if the cervix is not positioned correctly, infertility may occur; marked retroversion may also cause pain, dysmenorrhea, and dyspareunia (painful intercourse)
dysmenorrhea
painful menstruation
dyspareunia
meaning intercourse
pelvic relaxation
can occur with aging or excessive stretching or trauma, causing the ligaments, fascia, muscles, uterus, bladder, and rectum to become weaker, causing these organs to shift out of their normal position
factors predisposing pelvic relaxation
prolonged labor, multiple births, births of large babies, repeated pregnancies with short intervals, and genetics; this usually becomes apparent during menopause
uterine displacement
is the descent of the cervix or uterus into the vagina
first-degree uterine displacement
the cervix drops into the vagina
second-degree uterine displacement
the cervix lies at the opening of the vagina, and the body of the uterus is in the vagina
third-degree uterine displacement other name
procidentia
third-degree uterine displacement
if the uterus and cervix protrude through the vaginal orifice
uterine prolapse symptoms
if advanced, discomfort, heaviness in the vagina, and infection may occur
pessary
support device to support the uterine during prolapse
cystocele
is a protrusion of the urinary bladder into the anterior wall of the vagina; this cause the bladder to not empty completely
common infection with cystocele
cystitis
rectocele
is the protrusion of the rectum into the posterior wall of the vagina; this interferes with defecation and creates pressure
absence of menstruation name
amenorrhea
amenorrhea
is the absence of menstruation and can be primary or secondary
primary amenorrhea
occurs when menarche has never occured and can result from turner syndrome, congenital defects affecting the hypothalamus, CNS, or pituitary gland, or congenital absence of the uterus
secondary amenorrhea
is the cessation of menstruation in an individual who previously experienced this; results from an impediment in the hypothalamic-pituitary axis when it is suppressed by conditions such as tumors, stress, weight loss, eating disorders, sports, anemia, or chemo
primary dysmenorrhea
has no organic foundation and develops when ovulation commences; can include cramping, nausea, vomiting, headache, and dizziness
what causing cramping?
the release of prostaglandins during endometrial shedding, causing strong uterine muscle contractions and ischemia
relief for dysmenorrhea
heating pad, exercise, or medication like ibuprofen, NSAIDs, midal, or oral contraceptives
why do oral contraceptives help with menstrual pain?
because they lead to anovulatory cycles that are not painful
secondary dysmenorrhea
results from pelvic disorders such as endometriosis, uterine polyps, tumors, or pelvic inflammatory disease
examples of abnormal menstrual bleeding
menorrhagia, metrorrhagia, polymenorrhea, and oligomenorrhea
menorrhagia
increased amount and duration of flow
metorrhagia
bleeding between cycles
polymenorrhea
short cycles of <3 weeks
oligomenorrhea
long cycles of >6 weeks
cause of altered bleeding patterns
a lack of ovulation or hormonal disorders such as thyroid abnormalities or tumors
premenstrual syndrome
begins a week or so before menstruation and includes symptoms like breast tenderness, weight gain, bloating, irritability, emotional lability, sleep disturbances, headache, and fatigue
most severe form of PMS
premenstrual dysphoric syndrome
endometriosis
is the presence of endometrial tissue outside the uterus on structures such as the ovaries, ligaments, or colon; the tissue responds to cyclic hormone variations and will degenerate, shed, and bleed, irritating the surrounding tissues
complications of endometriosis
fibrous tissue cause adhesions and obstructions of the involved structures and infertility can occur
endometriosis on the ovary
can cause a chocolate cyst to develop which is a fibrous sac containing old brown blood
signs of endometriosis
progressively worsening dysmenorrhea and dyspareunia
causes of endometriosis
migration of endometrial tissue up the fallopian tubes into the peritoneal cavity, developmental from embryonic tissue, spread of endometrial tissue through the blood or lymph, or transplantation of tissue during surgery
treatment for endometriosis
hormonal suppression or surgical removal of the ectopic endometrial tissue
vaginitis
in the inflammation of the vagina and can be the result of infection, imbalance in the natural flora, yeast infections, protozoal infections, allergic reactions, or atrophy due to menopause
protozoal infection of the vagina
trichomonas vaginalis
cervicitis
inflammation of the cervix caused by an STD, imbalance of the normal vaginal flora, or allergic reaction to a contraceptive or feminine hygiene products
salpingitis
inflammation of the oviduct
oophoritis
inflammation of the ovaries
mastitis
inflammation of the mammary gland and is caused by S aureus
organism responsible for non-STI infections of the female reproductive tract
S aureus
what is toxic shock syndrome caused by?
S aureus
candidiasis
is a form of vaginitis that is not sexually transmitted and is a yeast infection infecting the mucous membranes and skin
causative organism of candidiasis
c albicans
why may candidiasis develop?
can follow antibiotics (creates alkaline environment), decreased immune resistance, or increased glycogen or glucose levels in the secretions (with pregnancy, oral contraceptives, or diabetes)
signs of candidiasis
red and swollen puriritic mucous membranes with thick, white, curd like discharge; dysuria and dyspareunia may also be present
treatment for candidiasis
‘azole’ medications like butoconazole, clotrimazole, miconazole, and terconazole
pelvic inflammatory disease
is an infection of the reproductive tract, particular of the tubes and ovaries and includes cervicitis, endometritis, salpingitis, and oophoritis
complications of pelvic inflammatory disease
peritonitis, pelvic abscess, infertility, ectopic pregnancy, and the development of scar tissue
most common cause of death in women with pelvic inflammatory disease
septic shock
how does pelvic inflammatory disease develop
usually begins in the vagina or cervix, and spreads; is caused by multiple causative bacteria; the infection first affects the mucosa, causing edema and purulent exudate that may spread to the peritoneal membrane
causative agents of pelvic inflammatory disease
majority arise from STDs like gonorrhea and chlamydiosis but can also be bacteroides, group B streptococci, E coli, etc.
risk factors for developing pelvic inflammatory disease
a prior infection, after menstruation, IUDs or other instruments, abortion, childbirth, and spread from other infections like appendicitis
signs of pelvic inflammatory disease
lower abdominal pain, tenderness, purulent discharge at the cervical os, dysuria, and sometimes fever
signs of peritonitis
increasing abdominal distention and rigidity
treatment for pelvic inflammatory disease
aggressive antimicrobials such as cefoxitin and doxycycline
leiomyoma
is a benign tumor of the myometrium (can be in the uterine wall, beneath the endometrium, or under the serosa
who is a leiomyoma common in?
those in their reproductive years and Asian and African American women
what does leiomyoma appear as?
multiple well-defined but unencapsulated masses that vary in size; they may cysts and undergo necrosis
hormones and leiomyoma
they tumors are hormone dependent thus grow during pregnancy and decrease after menopause
signs of leiomyomas
often are asymptomatic but may cause abnormal bleeding like menorrhagia, urinary frequency, or constipation; they may also fertility
treatment for leiomyomas
surgery or hormonal therapy
another name for leiomyomas
fibroids
ovarian cysts
are usually multiple small, fluid-filled sacs located under the serosa covering the ovaries and last about 8-12 weeks
signs of ovarian cysts
if large, they can cause discomfort, urinary retention, menstrual irregularities, and bleedings
complications of ovarian cysts
if rupture occurs, serious inflammation of the peritoneal cavity can occur and there is also risk of torsion of the ovary
polycystic ovarian syndrome other name
stein-leventhal syndrome
polycystic ovarian syndrome
occurs when large ovaries contain cysts and are covered with a thick capsule due to hormonal abnormalities
hormone levels in polycystic ovarian syndrome
elevated androgen, estrogen, and LH and decreased FSH; fluctuations in FSH and LH are missing and ovulation does not occur
cause of polycystic ovarian syndrome
dysfunction in the hypothalamic-pituitary control system
signs of polycystic ovarian syndrome
hirsutism (abnormal hairiness), amenorrhea, and infertility
hirsutism
abnormal hairiness
treatment for polycystic ovarian syndrome
clomiphene, an antiestrogen agent, surgical wedge resections of the ovaries, oral contraceptives, and antihyperglycemic drugs in those with insulin resistance
fibrocystic breast disease other names
benign breast cancer or fibrocystic change
fibrocystic breast disease
includes a broad range of breast lesions and the presence of nodules or masses in the breast tissue that change during the menstrual cycle in response to fluctuating hormone levels, particularly estrogen
how do the breasts change during fibrocystic breast disease?
the CT of the breast is gradually replaced by dense fibrous tissue and cysts develop during the secretory phase of the menstrual cycle and vary in size; breasts also become heavy, painful, and tender before menstruation
3 categories of fibrocystic breast disease
are based on the risk of development of breast cancer and are nonproliferative lesions, proliferative lesions, and proliferative lesions with atypical cells
nonproliferative lesions for fibrocystic breast disease
includes microcysts and fibroadenomas and are not considered precancerous
proliferative lesions for fibrocystic breast disease
includes these lesions with epithelial hyperplasia in the ducts in which there are no atypical cells; there is a risk of developing breast cancer if there is family history
proliferative lesions with atypical cells for fibrocystic breast disease
is a small group and requires monitoring as there is a risk of breast cancer
treatment for fibrocystic breast disease
dietary changes such as reducing caffeine and fat intake, aspirating fluid from cysts, removing cysts, or the drug androgen danazol
carcinoma of the breast
malignant tumors that often develop in the upper, outer quadrant of the breasts and most arise from the cells of the ductal epithelium
fixed breast tumor
occurs when the tumor adheres to the muscle or fascia of the chest wall
metastasis of breast carcinoma
will first spread to nearby lymph nodes (often axillary ones), followed by spread to the lungs, brain, bone, and liver
grading of breast tumors
depends on the degree of differentiation or anaplasia, as well as the size, the involvement of lymph nodes, and the presence of metastases
how is breast cancer diagnosed?
based on the presence of estrogen or progesterone receptors on the tumor cells
causes of breast cancer
strong genetic factors, high estrogen levels (long period of regular menstrual cycles, nulliparity (no children), and delay of the first pregnancy), possibly oral contraceptives, fibrocystic disease with atypical hyperplasia, radiation,lack of exercise, smoking, and a high-fat diet
specific genes for breast cancer
BRCA1 and BRCA 2
signs of breast cancer
a single small, painless nodule that is freely moveable in the early stages, dimpling of the skin, retraction of or discharge from the nipple, and a change in breast contour
treatment for breast cancer
surgery (can be a lumpectomy or a mastectomy, and even lymph node removal), combined with chemo, radiation and hormone therapy; ovaries may also be removed
chemo and radiation for breast cancer
are useful for eradicating any undetected micrometastases in a high-risk cancer
diagnosis for breast cancer
self-examination, mammograms, MRI, ultrasound, and fine needle ductal biopsy
carcinoma of the cervix testing
usually by a pap smear
carcinoma of the cervix
occurs when the cervical epithelial tissue consist of dysplasia that usually occurs at the junction of columnar cells with the squamous cells
steps of the development of carcinoma of the cervix
normal, mild dysplasia, severe dysplasia, malignant neoplasm, carcinoma in situ, and invasive carcinoma
grading of cervical intraepithelial neoplasia
graded from I to III based on the amount of dysplasia and the degree of cell differentiation
grade III cervical intraepithelial neoplasia
consists of carcinoma in situ in which many disorganized, undifferentiated, abnormal cells are present
how long can carcinoma in situ last for cervical cancer?
10 years
stage 0 of cervical carcinoma
is cancer in situ
how does cervical carcinoma appear?
as a nodular mass or ulceration infiltrating the walls, and this spreads in all directions to adjacent tissues
where does cervical carcinoma metastasis to?
the lymph nodes
causes of cervical cancer
linked to STDs like herpes simplex type 2 and HPV strains 16, 18, 31, 34, or 45
vaccines for cervical carcinoma
gardasil protects against HPV-6, 11, 16, and 18
high-risk factors for cervical carcinoma
multiple sexual partners, promiscuous partners, sex during early teen years and history of STD, smoking also
signs of cervical carcinoma
the invasive stage will show signs of bleeding, spotting, or a slight watery discharge, as well as anemia or weight loss
treatment for cervical cancer
surgery combined with radiation
carcinoma of the uterus
is derived from CT or muscle or the glandular epithelium and are termed leiomyosarcomas; prognosis is poor and occurs in women over 40
where does uterine cancer metastasize to?
the lungs
changes in the uterus during uterine cancer
the endometrial will hyperplasia and the cells become atypical over tim; the uterine wall may thicken or project into the cavity, eventually filling this in
what cause hyperplasia in uterine cancer?
excessive estrogen stimulation
first indicator of uterine cancer
vaginal bleeding and this is obvious because it occurs mainly in women after menopause
stage I uterine cancer
tumors are confined to the body of the uterus
stage II uterine cancer
cancer is limited to the uterus and the cervix
stage III uterine cancer
the cancer has spread outside the uterus but remains within the true pelvis
stage IV uterine cancer
the tumor has spread to the lymph nodes and distant organs
causes of uterine cancer
increased estrogen levels, infertility, oral contraceptives, and those who are obese, have diabetes, and/or hypertension
treatment for uterus cancer
surgery and radiation and chemo in the later stages
chemo drugs used for uterine cancer
gemcitabine and cisplatin
ovarian cancer
is considered a silent tumor and there are types serous, mucinous, and endometrioid
causes of ovarian cancer
genetic factors, talc as a feminine hygiene product, and asbestos
most common type of ovarian cancer
serous tumors
signs of ovarian cancer
feeling of bloating and fullness, indigestion, frequent urination, backache, and pain with intercourse
diagnostic testing for ovarian cancer
large mass during a pelvic exam, ultrasound, CT, MRI, and CA123 (a protein whose high levels indicate ovarian cancer)
when is a couple considered to be infertile?
after a year of unprotected intercourse fails to produce a pregnancy
male infertility problems
change in sperm, hormonal abnormalities, obstruction of the sperm pathway, and the presence of sperm antibodies
decreased fertility causes
hormonal imbalances resulting from the hypothalamus, anterior pituitary, and ovaries/tests, oral contraceptives, stress, increasing age, structural abnormalities (ex. uterine fibroids), obstructions, infections may burn out sperm producing cells, chemo, workplace toxins, vaingla pH, and smoking
testing for infertility
first the women’s general health is investigated, then basal body temp, times of intercourse, and menstruation are recorded, followed by examination of physical abnormalities
examination of physical abnormalities for infertility
pelvic examination, ultrasound, CT scans, or laproscopy
