OBGYN: sexual diff, DUB, PMS/PMDD, sexual dsyf, fertility Flashcards
define gonads
men?
women?
primary sex organs
men=testes
women=ovaires
gonads produce?
sex cells called gametes–sperm and ova
secondary sex organs provide?
route by which sex cell unite
men: epididymis, vas def, protate, etc
women: FTs, vagina, uterus, external genitalia, etc
how many chromosomes in cell dna
22
gametes have how many chromosomes
22 + X o Y
total=23
who determines the sex of baby
father
what week of gestation will the embryo differentiate into male or female
6-7th week
what week does testosterone secretion begin
8th week
SYR gene is only present in?
males—sex determination region on the Y chromosome
SRY gene produces
testes-determining factor–which will produce male gonads
when can you determine via US the sex of fetus
15-16th week the EARLIEST
general causes of AUB
MCC?
structural issues
- polps
- adenomyosis
- leiomyoma (fibroids)
- malignancy
non-structual issues
- coagulopathy
- ovulatory
- endometrial
- iatrogenic
MCC=lack of ovulation (90%)
when AUB is caused by anovulation, it is called?
Dysfunctional uterine bleeding (DUB)
in a normal cycle, what causes the proliferation of endometrium
estrogen secreted from follicle
what acts on endometrium to limit growth and cause changes in vasculature of endmetrium–which limits bleeding during menses
proegsteorne
describe progesterones effect on proliferating endometrium
- limit growth
- cause changes in vasculature of endometrium
* *all of which limits bleeding during menses
what happens if a follicle forms but never releases the ovum?
follicle will continue to produce estrogen—->encouraging proliferation beyond normal 14 days
*****no progesterone is being produces
what happens when there is no progesterone produced bc no ovulation occured
no progesterone=inhibiting the thickened endometrium from shedding in a predictable fashion w/o excessive blood loss
what happens without ovulation (3)
- flow becomes irregular–>Metrorrhagia
- menorrhagia—>excessive bleeding
- Menometrorrhagia–>both excessive + irregular flow
define the following:
- metrorrhagia
- Menorrhagia
- Menometrorrhagia
- irregular flow
- excessive flow
- both excessive + irregular flow
causes of DUB (5)
- girls at the edges of reproductive years–prepubescent and perimenopausal
- PCOS
- obesity
- hyperthryoidism and hypothyroidism
- estrogen secreting tumors
tx for DUB
1st line
2nd line
- NSAIDS= FIRST LINE
2. hormonal contraception*****
why is NSAIDS helpful in DUB
they reduce prostaglandin syntehsis w/in the endometrial tissue–>causes vasoconstriction—>decreased menstrual blood loss
how do hormonal contraceptives help DUB
they override the HPG (hypopituitarygrowth) axis and mimic normal menstrual bleeding or suppress it early
PMS and PMDD
cyclical recurrence of distresing physical, psychologic or behavioral changes that impair interpersonal relationships or interfere with usual activites
s/s of PMS and PMDD occur when in the cycle
-how long can these s/s last
after ovulation—- after day 14
during luteal phase
can last up to 4 days into the menstrual cycle
what is most imp for establishing diagnosis of PMS or PMDD
symptom frequency and severity vs the actual symptoms
diagnostic criteria for PMDD
“Presence of at least one psychological or physical symptom that causes significant impairment and is confirmed by means of prospective ratings (i.e. at least present for 2 cycles of a symptom diary, etc.).”
most women report what around their menses
some form of distress
—90%
enough distress around their menses to interrupt their daily life and routine is called?
PMS–pre-menstrual syndrome
women report predictable symptoms that cause significant impairment around their menses is called?
PMDD— premenstrual dysphoric disorder
the s/s of PMS and PMDD are brought on by?
ovulation
NOT
menstruation
**bc the s/s are before menstruation and after ovulation
list the most distressing s/s of PMS/PMDD (4)
- emotional—depression, anger, irritability, fatigue
tx for PMS and PMDD initial tx 1st line med 2nd severe severe cases
PMS
mediated by lifestyle, social and psychological factors–>tx is mainly symptomatic tx*
Initial tx:
- validation of premenstrual experience
- education on PMS and self help techniques
1st line medical
-hormonal contraceptions—regulates womens cycle and decrs amount of circulation hormones
2nd
-SSRIs continually or during premnstrual pd
severe cases—menses can be terminated by using GnRH and suppressing the entire cycle—-very intense tx tho and we try to avoid this…
four phases of sexual response
- excitement
- plateau
- orgasm
- resolution
define sexual dysfunction
causes?
lack of satisfaction with sexual function—
causes
- pain
- deficiency in sexual desire, arousal or orgasm/climax
define dyspareunia
painful intercourse
-pain at arousal, orgasm, or any time during intercourse
causes of dyspareunia
inadequate lubrication:
- low estrogen levels can decr lubrication—lactation, menopause,
- drugs can decr lubrication—-anything that has drying effect such as antihistamines
four categories that sexual dysfunction is divided into
- disorders of desire
- disorders of arousal
- disorders or orgasm
- disordrs of pain—- dyspareunia
define infertility
inability to concieve after ONE FULL YEAR of unprotected sex with same, opposite partner
*can be reduced to 6 MO for women 35 YO+
majority of intertility is MC male or woman fault?
woman
factors contributing to intertility
- ovulatory factors
- age
- abnormalities of reproductive tract—endometriosis, adhesions, and scarring from PID
list the five female intertility tests
- ovulation is occuring normally
- endometrium is responidng normally to hormones
- reproductive tissues are free of tumors or infections
- woman has any chronic conditions interfering with fertilization or implantation
- reproductive tract is adequately patent
list the imp perineal muscles holding bladder, urethra and rectum
transverse perineal muscles
levator ani
pelvic organ prolapse (POP)
-define
descent of one or more of the following
- vaginal walls
- uterus
- vaginal apex (after a hysterectomy)
define cystocele
MCC
descent of a portion of bladder wall into vagianl canal
-caused MC trauma of childbirth
define rectocele
bulging of rectum and posterior vaginal wall into vaginal canal
causes
- childbirth
- yrs after menopause MC time it comes
- life long chronic constipation and straining
uterine prolapse
-define
descent of cervix or entire uterus through vaginal wall
severe cases— the cervix will protrude thru introitus
first line tx uterine prolapse
pessary—removable mechanical devise that holds uterus in position
-pelvic fascia may be strengthened thru KEGEL exercises or by estrogen tx in menopausal women
MC pessary?
Gellhorn
