PD Female Genitalia Flashcards
History questions
Menarche Usual cycle length Usual flow length Gravida/para Sexual history STDs Preventative care
Common complaints
Abnormal bleeding Pain Vaginal discharge Menopausal sx Infertility Sexual dysfunction Urinary complaints
Amenorrhea
Primary, secondary
Primary - never menstruated
Secondary - previous menstruation, but none in last 6 months
Oligomenorrhea
Reduction of frequency of menstruation with interval greater than 40 days and less than 6 months
Hypomenorrhea
Reduction in number of days or amount of flow
Menorrhagia
Excessive menstrual bleeding longer in duration than usia (and amount greater than 80 mL blood loss)
Metrorrhagia
Menstrual bleeding at irregular intervals, but of expected amounts
Dysfunctional uterine bleeding
Irregular bleeding, unrelated to anatomic lesion of the uterus
Dysmenorrhea
Painful menstruation
Chronic pelvic pain
Pelvic discomfort not limited to menses for greater than 6 months
Dyspareunia
Pain associated with intercourse
Patient prep
Empty bladder Exam gown Assistant/chaperone present Ensure privacy Instruments are already prepared No surprises! Constantly communicate with the patient Patient sits at edge of table Head of bed at 30 degrees, relaxes abdominal muscles and allows you to maintain eye contact Always maintain eye contact Drape across legs and abdomen Adequate lighting to shine onto perineum Glove both hands
Why keep eye contact
Helps clinician observe patient response
External genitalia
Mons pubis Labia majora Labia minora Perineum Perianal area
Tanner staging
P1 - 5
P1 pubic hair
Preadolescent
No growth of pubic hair
P2 pubic hair
Initial, scarcely pigmented straight hair, especially along medial border of labia
P3 pubic hair
Sparse, dark, visibly pigmented, curly pubic hair on labia
P4 pubic hair
Hair coarse and curly, abundant, but less than adult
P5 pubic hair
Lateral spreading, triangle shaped to medial thighs
P1 breast
Prepubertal
P2 breast
Breast and papilla are elevated as a small mound
Areolar diameter increases
P3 breast
Further enlargement of the breast bud with loss of the contour separation between breast and areola
P4 breast
Areola and papilla form a secondary mound
P5 breast
Mature areola is part of the general breast contour
Inspection/palpation
Spread labia - inspect introits and outer vain
Urethrea - inspect/milk for discharge, skene’s glands
Bartholin’s glands - rotate finger posteriorly, grasp with thumb
Skene’s glands
Parauretheral glands, minor vestibular glands
Pair of glands situated on each side of urethral meatus
Its secretions help to lubricate the external genitalia during coitus
Types of speculum
Pederson and Graves
Pederson speculum
Flat, narrow blades with little curvature
For most nulliparous and postmenopausal women
Graves speculum
Wide, higher blades with curved sides
For most parous women
Speculum exam prep
Examine speculum
Clean, proper working order
Moisten and warm with warm water
Avoid lubricants, may interfere with cytologic and microbiologic specimens
Speculum insertion
Dominant hand
Blades completely closed
First 2 fingers on opposite hand placed lateral and just below the introits
Apply downward and inward pressure, introits open slowly
Insert speculum at 45 degree angle, usually as far as it will go
Rotate speculum down
Open speculum smoothly and deliberately
Visualize cervix and manipulate angle if necessary
Tighten screw
Speculum exam
Inspect cervix
Deep vaginal vault
Lateral walls of vagina
Samples to be taken
Pap smear
Wet prep
Cultures
Risk factors for cervical cancer
Increases in late teens to 30s Average age of newly diagnosed is 50-55 Personal hx of cervical cancer Personal hx of infection with HPV or HSV2 Early age at first sexual intercourse Multiple lifetime partners HIV Smoking Long term use of OCP (under investigation)
Rectocele
Fascia separating rectum from vagina becomes weakened allowing the front wall of the rectum to bulge into the vagina
Usually after menopause
Usually not painful
Large rectoceles may protrude the vaginal opening
Cystocele
Causes
Wall between bladder and vagina weakens, allow bladder to prolapse into the vagina
May occur from excessive straining (childbirth), chronic constipation, heavy lifting
Uterine prolapse
Uterus descends from its normal position in the pelvis into the vagina
Occurs when pelvic floor muscles/ligaments stretch and weaken
Bimanual exam
Use both hands to entrap pelvic organs for palpation
Vaginal hand and abdominal hand
Palpate uterus
Size Shape Consistency Mobility Masses Tenderness Position
Palpate cervix
Circumferential exam Size Shape Position Mobility Masses Tenderness
Palpate adnexae
Ovaries (1/2 are palpable in young women)
Tubes
Support structures
Rectovaginal exam
Not always done routinely Evaluates posterior pelvic structures Allows better palpation of ovaries Change glove of vaginal hand Use lubricant Middle finger inserted into rectum Index finger into vagina until reaches posterior fornix Palpate uterosacral ligamants Evaluate rectal canal Remove fingers steadily and rapidly
Uterosacral ligaments
Should be smooth, symmetric, nontender
Rectal canal
Masses
Sphincter tone
Stool guiac test for blood
Ovarian cancer risk factors
Age between 40-60 Taking fertility drugs Early menarche (before 12) Late menopause (after 50) Infertility, nulliparity, or first child after 30 Hx of breast CA or inherited gene mutations (BRCA1 or 2) FHx of breast or ovarian CA Hormone replacement therapy Exposure to talc or asbestos
Bacterial vaginosis
Wet mount
Most common vaginal infection of childbearing age
Normal vaginal flora disrupted and overgrowth of certain bacteria occurs
May be accompanied by odor, pain, discharge, itching, burning
Wet mount shows clue cells
Candida vaginitis
Yeast infection
Cottage cheese like discharge
Common while on antibiotics, steroids
Trichomonas vaginitis
Tx
Caused by protozoal parasite Trichomonas vaginalis
Most curable STD in young women
Sx occur 5-28 days after exposure
Frothy, yellow green vaginal discharge with strong odor
Usually treated with a single dose of metronidazole
Syphilis incubation
10-60 days
Genital warts term
Condyloma accuminata
Secondary syphilis term
Condyloma lata
Tissues that are estrogen dependent
Vaginal mucosa, cervix, endometrium, and myometrium are estrogen dependent tissues
Atrophic vaginitis
Sx
When estrogen production decreases, these tissues atrophy Dryness Itching Burning Dyspareunia Urinary symptoms
