structural abnormalities of vagina Flashcards
a 45-year-old female complaining of pressure in the pelvis and vagina along with discomfort when straining. She also feels that her bladder hasn’t fully emptied after urinating. What does this women have?
Cystocele
Describe a cystocele?
anterior vaginal prolapse of the posterior bladder wall into the vagina
What types of symptoms would you suspect in someone with a cystocele
- feeling of incomplete voiding
- feeling of pressure
- discomfort when straining
How can you Diagnose a cystocele?
with a POP-Q: pelvic organ prolapse quantification): quantifies the extent and location of defects
Can also do ultrasound or MRI
Can you use a VCUG test for evaluating a cystocele?
yeah
What is the Tx for cystocele?
flexible pessary ring
Can also do kegels to prevent it
What kind of therapy after menopause helps keep vaginal tone?
estrogen
a 50-year-old female with pelvic pressure reports and a sensation of a mass present in the vagina. She reports chronic constipation and a sensation that the rectum is not completely emptied following a bowel movement. Occasionally, she experiences episodes of fecal incontinence. What does this patient likely have?
a rectocele
What is a rectocele?
herniation of the rectum into posterior portion of the vaginal wall
What kinds of symptoms would you suspect in a patient with a rectocele?
pelvic pressure + bowel symptoms
Symptoms include a soft bulge of tissue in the vagina that may or may not protrude through the vaginal opening
How can you diagnose a rectocele?
POP-Q (pelvic organ prolapse quantification): quantifies the extent and location of defects
What test should someone with a rectocele get?
a colonoscopy to rule out cancer
Tx for rectocele?
Kegel exercises, pelvic floor retraining, behavioral changes, bowel regimen, pessary, surgical repair or repair with mesh augmentation
How would you expect a patient with ovarian torsion to present?
sudden onset of sharp and usually unilateral lower abdominal pain, in 70% of cases accompanied by nausea and vomiting
What is the diagnostic test of choice for ovarian torsion?
ultrasound with doppler flow
What is the gold standard diagnostic test for ovarian torsion?
laparoscopy
What is the Tx for ovarian torsion?
laparoscopic surgery to uncoil the ovary
What is uterine prolapse?
This is when uterus descends towards or into the vagina
Why does a uterine prolapse happen?
This occurs because the pelvic floor muscles and ligaments get weak and can no longer support the uterus
Symptoms of uterine prolapse?
Vaginal fullness, abdominal pain worse late in the day, after prolonged standing. Relieved by lying down.
Describe the different grades of uterine prolapse?
0 degree: No descent
1st degree: To the upper vagina/descent between normal and ischial spine
2nd degree: To the introitus/between ischial spines and hymen
3rd degree: Cervix is outside the introitus/within hymen
4th degree (sometimes referred to as procidentia): Uterus and cervix entirely outside the introitus/through the hymen
How do you diagnose a uterine prolapse?
Diagnosis is confirmed by a speculum or bimanual pelvic examination
Tx for symptomatic patient with uterine prolapse?
treated with a pessary if the perineum can structurally support a pessary
Severe or persistent symptoms and 3rd - or 4th-degree prolapse require surgery
