Repro wk 6 Flashcards
What is FGM?
All procedures that involve partial or total removal of external female genitalia
Or other injury to female genital organs for cultural or non-medical reasons
How many types of FGM are there?
4
What is type 1 FGM?
Clitoridectomy (partial/total removal of clitoris)
What is type 2 FGM?
Excision
Parital/total removal of clitoris and labia minor
+/- removal of labia majora
What is type 3 FGM?
Infibulation - narrowing of vaginal opening through creation of covering seal
Seal formed by cutting + re-positioning inner/outer labia
+/- removal of clitoris
What is type 4 FGM?
All other harmful procedures to female genitalia for non-medical purposes
What is de-infeibulation?
Surgical procedure to opening up the closed vagina of FGM type 3?
What are the complications fo FGM?
Severe pain/shock Infection Injury to adjacent tissues Sprains, disolcations, broken bones/injuries from being restrained Immediate fatal haemorrhaging Infection by blood bourne virus
What are the long term complications of FGM?
Urine retention Difficulties with menstration Uterine, vaginal, pelvic infections Cysts /neuromas INcreased risk of fistula On-going impact of trauma/PTSD Sexual dysfunction
What are the psychological effects of FGM?
PTSD Anxiety Depression Fear of intimacy Loss of trust Unresolved anger NIghtmares Flashbacks
What increases the risk of FGM?
Mother has FGM Siblings/cousins undergone FGM MOther/father request reinfibulation Parents express views valuing practice Girl withdrawn from teaching classes on personal/social/health education
What are the types of breast cancer?
In situ carcinoma Invasive carcinoma >Ductal >Lobular >Tubular >Cribriform >Medullary
When are women screened for breast cancer?
Aged 50-70 every 3 years
Through GP practice
What is looked for in breast screening?
Lump/thickening in breast (often painles) Discharge/bleeding from nipple Change in size/contours of breast Change in colour or appearance of areola Redness or pitting of skin
What tests are used to diagnose breast cancer?
Clinical exam
Mammography
Ultrasound
FNA cytology
What is sentinel lymph node biopsy?
Checking the first lymph nodes to recieve lymph from breast tumour
If negative then rest of the nodes in the basin will aslo be negative
How do you treat breast cancer?
Resection (mastectomy/just affected tissue)
Micromets treatment
>Hormone therapy - oestrogen if receptors present
>Chmo
>Targetted therapy (HER2 - trastuzumab)
What are the risk factors for vulva intra-epithelial neoplasia?
Smoking
Previous related malignancy
Immunosuppression
Other genital intra-epithelial neoplasia
Who gets lower genital tract intra-epithelial neoplasia?
Decreasing age of presentation
Younger women with multi-focal with HPV +
Older women unifocal with HPV -
What is the presentation of VIN?
Raised papular or plaques lesions Erosions, nodules, warty Keratotic roughened appearance Sharp border Differentiated VIN tends to be unifocal ulcer or plaque Discoloration
How do you diagnose VIN?
Punch biopsy
How do you manage VIN?
Prevent cancer Eliminate symptoms Preserve sexual function Preserve body image Surveilence Surgery Laser ablation Topical treatments
What topical treatments can be used in VIN?
Imiquimod
Photodynamic therpay
5FU, alpha-interferon, cidofivir
What are the types of vulva cancer?
Mostly SCC (caused by:)
>VIN
>Lichen sclerosus
Also BCC
What is the presentation of vulval cancer?
pain
itch
bleeding
lump/ulcer
Mostly over 60
Younger women with VIN
What is groin node dissection?
Inguinal and upper femoral nodes
Separate node incisions
Staging and remove nodal disease
Associated with significant morbidity
>Wound infection
>Lymphocysts
>Nerve damage
What are the risk factors for urinary incontinence?
Age Parity Menopause Smoking Medical problems Raised Intra abdo pressure Pelvic floor trauma Denervation Connective tissue disease Surgery
What examinations should you do with complaint of urinary incontinence?
General Abdominal Neurological Gyanae Pelvic floor
How do you manage stress urinary incontinence?
PT - pelvic floor training
Surgery (Tension-free vaginal tape )
Pharmacological - duloxetine
