PHYSICAL EXAMINATION OF THE FEMALE GENITALIA Flashcards
What is known as an absent menstrual cycle?
amenorrhea
What includes the following?
- mons pubis
- labia majora
- labia minora
- clitoris
- vestibular glands
- vaginal vestibule
- vaginal orifice
- urethral opening
Vulva or external female genital organs
The symphisis pubis is covered by adipose tissue called the what?
mons pubis or mons veneris
Under the labia majora are the hairless labia minora that divide into what?
two lamellae
The lower pair of lamellae form the frenulum of the clitoris but the upper pair form the what?
Prepuce
The labia minora fuse to form the what?
fourchette
What is a small bud of erectile tissue and is the primary center of sexual excitement?
clitoris
In the labia minora is a vestibule containing what?
- urethra
- vagina
- skene glands
- Bartholin glands
What glands are located posteriorly on each side of the vaginal orifice, open onto the sides of the vestibule in the grooves between the labia minora and the hymen and during sexual excitement secrete mucus into the introitus for lubrication?
Bartholin glands
What is a musculomembranous tube that is transversely rugated during the reproductive phase of life and inclines posteriorly?
vagina
The anterior wall of the vagina is separated from the bladder and urethral by that?
vesicovaginal septum
The posterior wall of the vagina is separated from the rectum by the what?
rectovaginal septum
What is located at the upper end of the vagina?
uterine cervix
What is known at the lining of the uterus?
endometrium
Pelvic organs may be palpated through pockets around the cervix called what?
fornices
How much does the nonpregnant uterus normally weigh?
60-90 g
The uterus is divided anatomically into what ?
corpus and cervix
The uterine corpus consists of what?
- fundus (convex upper portion)
- body (main portion)
- isthmus (constricted lower portion adjacent to cervix)
The adnexa of the uterus are composed of what?
fallopian tubes and ovaries
What are a pair of oval organs resting in a slight depression on the lateral pelvic wall at the anterosuperior iliac spine?
ovaries
The internal genitalia are supported by what ligaments?
- cardinal
- uterosacral
- round
- broad
What do these four bones form?
- two innominate (ilium, ischium and pubis)
- sacrum
- coccyx
pelvis
What are the four pelvic joints?
- symphisis pubis
- sacrococcygeal
- two sacroiliac joints
During pregnancy, increased levels of what circulating hormones contribute to the strengthening and elasticity of pelvic ligaments and softening of the cartilage?
- estrogen
2. relaxin
True or False
Later on in pregnancy the pubic symphysis separates
True
What is considered the false pelvis?
shallow upper section
What is the true pelvis?
lower curved bony canal, including the inlet, cavity and outlet
What is the average age for the onset of menstruation (menarche) in the united states?
11-14 years old
During pregnancy, muscular walls become more elastic, and the uterus rises out of the pelvis into the abdominal cavity by what week of gestation?
12 weeks
Uterine weight at term, excluding the fetus and placenta, is about how heavy?
1000g
Pelvic congestion and edema during pregnancy occurs from what?
increases in blood volume
True or False
During pregnancy uterine pressure obstructs lymph and blood flow
True
True or False
The cervix becomes bluish, and vaginal secretions increase during pregnancy
True
What during pregnancy results in a “waddle gait” ?
the pelvic joints separating slightly
Ovarian function diminishes around what age?
40 y/o
Menopause typically occurs between what ages?
40-55 y/o
Ovulation ceases about how many years before menopause?
1-2 years
Menopause is defined as how many years with no menses?
1 year
True or False
After menopause woman experience an increased risk of cardiovascular disease
True
What is usually prescribed to women to help reduce the impact of menopausal symptoms and sequelae?
postemenopausal hormone replacement (estrogen with or with out progestin)
Is marked anxiety before the examination a sign in a patient that something is not quite right?
yes
What examination position is where the patient lies on her back with her knees bent so that both legs are spread flat and her heels meet at the foot of the table?
Diamond-shaped position
What female genital exam position is this?
Woman lies on her back, knees bent and apart, feet resting on the exam table close to her buttocks. This position does not require the use of stirrups.
M-shaped position
What female genital exam position is this?
Woman lies on her back with her straightened legs spread out wide to either side of the table. A variation of this position would allow the woman to hold one leg straight out and keep one foot in a stirrup.
V-shaped position
Upon exam, generally how long is the clitoris?
2cm or less
Abscesses of the Bartholin are usually from what bacteria?
- gonococcal
2. staphylococcal
When assessing for muscle tone during a female genital exam, bulging of the anterior wall and urinary incontinence indicates the presence of what?
cystocele
When assessing muscle tone during the female genital exam, bulging of the posterior wall indicates a what?
Rectocele
What is marked by the protrusion of the cervix or uterus on straining?
Uterine prolapse
When visualizing the cervix, a bluish color indicates increased vascularity, which may be a sign of what?
pregnancy
A cervix that is pointed anteriorly indicates a what?
retroverted uterus
A cervix that is pointing posteriorly indicates what?
anteverted uterus
When visualizing the cervix a deviation to the right or left may indicate what?
- pelvic mass
- uterine adhesions
- pregnancy
Hymenal tags may be visible after what?
after the hymen has torn
True or False
Perineum is thinner and more rigid in multiparous women (women who’ve given birth) and may be more thick and smooth in nulliparous women (not given birth)
True
A pale cervix suggests what ?
Anemia
True or False
Os (cervical opening) of nulliparous women may be small, round, or oval; while os of multiparous women may be more horizontal, irregular, or stellate
True
In newborns, labia majora are separate and clitoris is prominent up to what week of gestation?
36 weeks
Enlarged clitoris in newborns suggests what?
Adrenal hyperplasia
Young women who are not sexually active should have their first examination by what age?
21
Vaginal discharge (yellow, green, or gray) with odor suggests what?
infection
Pregnant women
Softening if the isthmus is known as what?
Regar sign
Pregnant women
A bluish cervix is known as what?
Chadwick sign
Pregnant women
Cervical softening is what sign?
Goodell sign
What is Piskacek sign?
the uterus deviates at 8-10 weeks of gestation
What common disorder usually begins in a woman’s late twenties and increases in incidence and severity as menopause approaches?
Premenstrual syndrome (PMS)
What is characterized during or right before menses by edema, headache, weight gain, and behavioral disturbances such as irritability, nervousness, dysphoria, and lack of coordination?
PMS
symptoms occur 5-7 days
What is the inability to conceive over a period of 1 year of unprotected regular intercourse?
infertility
What is the presence and growth of endometrial tissue outside of the uterus and causes pelvic pain, dysmenorrhea, and heavy prolonged menstrual flow?
Endometriosis
What are warty lesions on the labia, within the vestibule or in the perianal region as a result of HPV infection?
Condyloma acuminatum (genital warts)
What are sexually transmitted and flesh-colored, whitish pink to reddish brown, discrete, soft growths and may form cauliflower like masses?
Veneral warts
What is a benign skin infection caused by a poxvirus, may be transmitted by sexual contact, with an incubation period from 2-7 weeks?
Molluscum Contagiosum
What are lesions of secondary syphilis that appear about 6-12 weeks after infection, Flat, round, or oval papules covered by gray exudates?
Condyloma latum
What can be seen as a firm, painless ulcer and may develop internally in women?
Syphilitic chancre (primary syphilis)
What is an STI that produces small red vesicles; the lesions may itch and are painful and usually confined to a small localized patch on the vulva, perineum, vagina, or cervix?
Herpes lesions
What is usually caused by a gonococcal infection, acute inflammation produces a hot, red tender, fluctuant swelling that may drain puss?
Inflammation of the Bartholin glands
What is a hernial protrusion of the urinary bladder through the anterior wall of the vagina, bulging can be seen as the woman bears?
Cystocele
What is a hernial protrusion of part of the rectum through the posterior wall of the vagina?
Rectocele
What is a bright red polypoid growth that protrudes from the urethral meatus?
Urethral carbuncle
What kind of vaginal infection shows watery discharge; usually not foul smelling; dysuria, profuse frothy, greenish discharge?
Trichomoniasis
What kind of vaginal infection shows purulent discharge from the cervix; skene/Bartholin inflammation?
Gonorrhea
What kind of vaginal infection shows a homogenous thin, white or gray discharge; positive KOH with clue cells?
Bacterial vaginosis
What are enlarged fluid-filled retention cysts that vary in size?
Infected Nabothian cysts
What are bright red, soft and fragile arise from the endocervical canal?
cervical polyps
What results of weakening of the supporting structures of the pelvic floor, often occurring with a cystocele or rectocele?
Uterine prolapse
In a second-degree prolapse, the cervix is where?
at the introitus
True or False
In a third-degree prolapse, the cervix and vagina drop outside the introitus
True
What are common, benign, uterine tumors that appear as firm, irregular nodules in the contour of the uterus?
Myomas
What causes marked pelvic tenderness, with tenderness and rigidity of the lower abdomen and is a surgical emergency?
Ruptured tubal pregnancy
What is often caused by a gonococcal and chlamydial infection that may be acute or chronic; produces very tender bilateral adnexal areas and fixed adnexal areas?
Pelvic inflammatory disease (PID)
What is inflammation or infection of the fallopian tube and associated with PID?
Salpingitis
What is known as vaginal secretions that collect behind an imperforate hymen and manifested by a small midline lower abdominal mass or small cyst between the labia?
Hydrocolpos
What is vaginal discharge accompanied by warm, erythematous, and swollen vulvar tissue?
Vulvovaginitis
What is caused by a lack of estrogen, vaginal mucosa is dry and pale, accompanying vaginal discharge may be white, gray, yellow, or green or blood-tinged?
Atrophic vaginitis
