Lecture 9: Approach to Reproductive Topics Flashcards
What is puberty?
Developmental stage characterized by transition from sexual immaturity to sexual maturity
What is gonadarche activation?
Stimulation of gonads by FSH and LH from anterior pituitary
What is adrenarche?
Increase in androgen production by adrenal cortex
What is thelarche?
Development of breast tissue due to estrogen from ovaries
What is menarche?
First menstrual cycle
What is spermarche?
First sperm production
What is pubarche?
Pubic hair development
When do females normally undergo puberty?
What is developing then?
Ages 10-14
- breast/areolar development
- menarche
When do males normally undergo puberty?
What is developing then?
Ages 11-16
- penile growth
- pubic hair development
What are the Tanner stages for the development of external genitalia in boys?
Stage 1: Prepubertal
Stage 2: Enlargement of testes and scrotum (scrotal skin reddens and changes in texture)
Stage 3: Enlargement of penis lengthwise and growth of testes
Stage 4: Increased size of penis and development of glans; testes and scrotum larger, scrotal skin darker
Stage 5: Adult genitalia
What are the Tanner stages for the development of breast development in girls?
Stage 1: Prepubertal
Stage 2: Breast bud stage w/ elevation of breast and papilla, enlargement of areola
Stage 3: Further enlargement of breast and areola - no separation of their contour
Stage 4: Areola and papilla form a secondary mound above level of breast
Stage 5: Mature stage: projection of papilla only
What are the Tanner stages for the development of pubic hair in both boys and girls?
Stage 1: Prepubertal (vellus hair)
Stage 2: Sparse growth of long, slightly pigmented hair at base of penis or labia
Stage 3: Darker, coarser, curlier hair sparesley over junction of pubes
Stage 4: Hair adult in smaller area
Stage 5: Adult hair with horizontal upper border
What should be included in a menstrual history?
Age of menarche
Duration: how many days each period lasts
Flow: heavy/light
Cycle: length of each menstrual cycle
What should be included in a gynecologic history?
Breast history Last mammogram GYN surgeries Infertility Last pap smear
What should be included in an obstetrical history regarding pregnancies?
Gravida: number of pregnancies Para: number of viable births/offsprings -T: Term deliveries (>37 weeks) -P: Preterm deliveries (20-37 weeks) -A: Abortion (<20 weeks) -L: Live delivery regardless of gestational age
What would be the obstetrical history of a patient who had 6 pregnancies: 1 spontaneous abortion at 17 weeks, 2 fetal demise at 22 and 23 weeks?
G6P3213
What would be the obstetrical history of a patient who had one pregnancy and twins born at 38 weeks?
G1P2
What is other information that should be noted in an obstetrical history?
Mode of delivery Gestational age at delivery Maternal complications Fetal complications Delivery/operative complications
What is information that should be noted in a contraceptive/sexual history?
Contraception methods Currently sexual active Number of partners New partners in last 3 months Condom use History of sexual abuse
At what age should women get pap smears?
Ages 21-65
How often should women get pap smears?
Yearly: abnormal pap smears
Every 3 years: normal pap smears
Every 5 years: normal pap smears with negative HPV testing
What is the purpose of a pap smear?
Screen for cervical cancers
-mostly caused by HPV
Where is a sample taken in a pap smear?
Ectocervix
Endocervix
Transitional Zone: between original and new SCJ
Squamocolumnar Junction (SCJ)
What is the most important area to take a sample when testing for cervical cancer?
Transitional zone
What is the difference between a pelvic exam and pap smear?
Pap smears: looks at cervix and obtains samples
Pelvic exam: inspects both external and internal genitalia
Describe a pelvic exam.
- Visual inspection
- Bimanual exam: insert index and middle finger into vagina to examine vagina, uterus, and ovary on both left and right side
- Check cervical motion
- Obtain swabs to check for STI and vaginosis
What is an ectopic pregnancy?
How does it present?
Fertilized egg implants and grows outside the main cavity of the uterus
- abdominal or pelvic pain with vaginal bleeding
- pregnancy symptoms
What is a workup for a woman presenting with ectopic pregnancy?
Double check pregnancy
Speculum exam
Surgical removal
What are some symptoms of an UTI?
Dysuria Urinary frequency Urinary urgency Suprapubic pain Hematuria
What physical exam findings can be found in a patient with an UTI?
Costovertebral angle tenderness (Lloyd’s punch)
What is a workup for a woman presenting with an UTI?
Urinalysis
-also pregnancy test
True or false?
Males should have regular prostate and testicular exams.
False
Describe a male genital exam.
- Inspect scrotum, penile shaft, glans, and inguinal region
- Palpate penile shaft and scrotum with thumb and first two fingers
- Retract foreskin if present
- Palpate inguinal region and examine for hernias
- Examine prostate by palpation on digital rectal exam
Which age group is more prone to develop testicular cancer?
Younger males
Describe an inguinal hernia.
How does it present?
Bulge in a weak spot in the abdominal muscles
-pain with increased intra-abdominal pressure
What are the 5 P’s of sexual history?
Partners Practices Prevention of Pregnancy Protection from STIs and HIV Past History of STI
What are some risk factors of STIs?
New sexual partner
Multiple sex partners
Sex with sex partners recently diagnosed w/ STI
No/Inconsistent use of condoms
Trading sex for money/drugs
Sexual contact with sex workers or anonymous partners from internet
What are some bacterial STIs?
Chlamydia
Gonorrhea
Syphils
What are some viral STIs?
Herpes simplex 2
Human papilloma virus (HPV)
Hepatitis B and C
HIV/AIDS
What are some protozoa STIs?
Trichomoniasis
How does gonorrhea present?
Men: penile discharge and dysuria (or asymptomatic)
Females: pelvic pain or mucopurulent vaginal discharge
When treating gonorrhea, what other STI is also treated with it?
Chlamydia
How does chlamydia present?
Most cases asymptomatic
Males: penile discharge, pruritus (itchiness), dysuria
Females: vaginal discharge, vaginal bleeding, or pain during intercouse
If gonorrhea and chlamydia are left untreated, what can be some complications?
Pelvic inflammatory disease
Fertility issues due to scarring of fallopian tubes
How does syphilis present?
Primary: chancre (ulcers)
Secondary: joint pains, fatigue, lymphadenopathy, mucopapular rash
Latent phase: asymptomatic
Tertiary: neurosyphilis
What are some complications of syphilis?
Neurosyphilis
-infection of the central nervous system
How does genital herpes present?
Single of clusters of vesicles on genitalia
-Burning, tingling, and pain
What are complications of genital herpes?
Meningitis
Pelvic inflammatory disease
Hepatitis
Increase risk of HIV infection
How does trichomonasis present?
Men: mostly asymptomatic but might have penile discharge
Female: foul smelling, thin, or purulent vaginal discharge, vaginal pruritis, dysuria
How does HPV present?
Genital warts
What are complications of HPV?
High risk strains can lead to cancer
-cervix, penile, or anorectal
