WH Dx 3 Flashcards
dyspareunia
vulvovaginal or pelvic pain that is provoked by or exacerbated during sexual contact
vulvovaginal or pelvic pain that is provoked by or exacerbated during sexual contact
dyspareunia
dyspareunia risk factors
6
- pelvic floor muscle hypertonia
- PID
- depression
- anxiety
- hx of sexual abuse
- < 50 y.o.
dyspareunia hallmark sx
pain with genital sexual contact
dyspareunia DD
3
- STD
- PID
- endometriosis
dyspareunia education
This is pain with intercourse. This can be caused by a number of things like anatomy changes, infection, hormones, trauma, and inflammation. Some self-help options can include lubricants, relaxation techniques, and breathing exercises
dyspareunia meds
NSAIDs
dyspareunia test
no lab or imaging test; can r/o other conditions like STDs and UTI
dyspareunia f/u
Refer to pain specialist if appropriate, pelvic floor PT, and sex therapist. Come back in 3 months
dyspareunia red flags
5
- worsening symptoms
- change in menstrual period
- change in discharge
- bleeding or spotting between periods
- signs of abuse
endometriosis
endometrial tissue grows outside the uterine cavity
endometriosis - patients classically present during when with what
their reproductive years with sx of pelvic pain, infertility, ovarian mass
endometriosis peak age
25-35
endometriosis s/sx
8
- chronic abdominal pain
- pelvic pain or pressure
- severe dysmenorrhea
- dyspareunia
- heavy menstrual bleeding
- infertility
- low back pain
- chronic fatigue
endometriosis bowel and bladder
can cause bowel and bladder dysfunction -
pain
urgency
frequency
endometriosis physical exam findings
4
- focal tenderness on vaginal exam
- nodules in posterior fornix
- adnexal masses
- immobility or lateral placement of cervix or uterus
chronic abdominal pain, pelvic pain, pressure, severe dysmenorrhea
endometriosis
pelvic pain, infertility, and ovarian mass
endometriosis
tenderness on vaginal exam, immobility or lateral placement of cervix
endometriosis
endometriosis DD
3
dysmenorrhea
PID
Uterine malignancy
endometriosis education
4
- In this condition, the cells that normally grow within the uterine lining, grow outside of it.
- This leads to inflammation inside the body.
- This causes a lot of symptoms and fertility issues.
- Avoid fatty food, red meats, caffeine and alcohol.
endometriosis meds
2
- NSAID for pain
- Oral contraceptives
endometriosis test
2
A TVUS is recommended.
The only definite dx is through a laparoscopy which is a biopsy.
endometriosis f/u
4-6 weeks to determine effectiveness of treatment
endometriosis red flags
4
- worsening sx
- increased pelvic pain
- increased bleeding
- GI or GU concerns
fibroadenoma
benign breast mass
benign breast mass
fibroadenoma
fibroadenoma is most common in who
women 30-40
fibroadenoma risk factors
2
- hormone replacement therapy
- family history of breast cancer
fibroadenoma physical exam findings
benign solid mass, painless, firm, and mobile
breast mass that is painless and mobile
fibroadenoma
breast mass that is painless and immobile
possible breast cancer
fibroadenoma DD
2
breast cyst
breast carcinoma
fibroadenoma education
2
these are typically benign masses
perform a self-breast exam monthly to monitor this mass
fibroadenoma medication
none - may need surgical intervention if bothersom
fibroadenoma test
3
- < 30 breast US to determine solid from cystic masses
- > 35 then a mammogram or US can be performed
- definitive test is a breast tissue biopsy
fibroadenoma f/u
every 6 months until stable and then yearly
fibroadenoma red flags
3
- worsening of symptoms
- mass begins to proliferate
- new breast changes such as changes to your skin, nipples, discharge or more
Infertility
failure to achieve successful pregnancy after 12 months or more of regular, unprotected sex
failure to achieve successful pregnancy after 12 months or more of regular, unprotected sex
infertility
Infertility evaluation and tx should be initiated at what stage for women < 35 and >35
< 35, 12 months
>35, 6 months
Infertility DD
2
PCOS
endometriosis
Infertility education
3
- quit smoking
- reduce excessive caffeine intake and alcohol intake
- have appropriate timing and frequency of sex
Infertility meds
May involve drug therapies, surgery, and/or procedures such as IVF
Infertility tests
4
- semen analysis
- assess ovarian reserve (blood test)
- HSG test to check fallopian tube patency (x ray with contrast)
- SIS test to assess uterine cavity (saline with US)
Infertility f/u
in 4 weeks to discuss lab and imaging results, from here we can make the appropriate referrals
Infertility AG
3
- cervical cancer screening
- STD screening
- get vaccinated
Infertility red flags
4
- irregular cycle
- upper body weight gain
- growing abnormal facial hair
- increase in acne
