Women's Health Flashcards
4 Principles of Practice
Safety of our patients
True to our professional pledge (Hippocratic Oath)
Must transform to a value-base system of health care delivery
Must focus on prevention and early mitigation of disease
Barker Hypothesis
perturbations / disturbances in the gestational environment may influence the development of adult diseases such as CV disease, obesity, diabetes, and stroke.
Appropriate Age and Interval of health screening for women
PAP age 21-29 every 3 years then may do co-testing every five years age 30 to 65.
Annual breast exam at age 40, every 1-3 years before that
Mammogram at age 40 (ACOG) or 50 (USPTF)
Colonoscopy age 50, every 4-5 years
TSH at age 50
Cholesterol/lipids at least every 5 years until 65
BP screening every 2 years at least
Height/Weight BMI every visit
Bone Mineral Density testing age 65+, or younger if risk is present
Preconception screening components and timing
Elements of the well woman physical
Obstetric History
Menstrual History (age of menarche, intervals, duration, character
Contraceptive History - type and complications
Medical History
Surgical History
Social History
System review and exam (including breast exam)
Differentiate the signs of pregnancy (presumptive, probable, positive)
Presumptive - skin and mucous membrane changes. Chadwick sign is the dark discoloration of vulva and vaginal wall. The Chloasma is the pigmentation under the eyes
Probable - Physical changes to uterus. Globular change, softening of uterus
Positive - Fetal heartbeat, fetal movements
Hegar Sign
Uterine consitenency is softer and able to palpate the connection between cervix and fundus
Fetal Heartbeat Detection
Endovaginal ultrasound - 6-7 weeks (sac identified at 5 weeks)
Doppler - 9-12 weeks
Stethoscope - 16-20 weeks
Fetal movement can be felt
7-8 weeks
Benign conditions of the vulva
epithelium of the vulva is susceptible to the same skin pathologies seen on other parts of the body. Often the appearance of those processes may be altered by the moisture and warmth of the genital tissue
White lesions , red lesions, or pigmented lesions
Licen sclerosus
commonly found in the anogenital area of midlife women. It often presents with intense pruritus, dyspareunia and burning pain, but can also be an asymptomatic finding. Anal involvement can cause constipation. The skin is white, thin, and inelastic, with a crinkled cigarette-paper appearance on gentle stretch. Widespread excoriation is common. It starts with isolated pearly white papules and plaques that coalesce over time and form scars. The result is a “figure of 8” field of scarring from the area encircling the labia, constricting down around the perineal body and ballooning out again around the perineal area into the gluteal cleft. The clitoral hood scars, burying the clitoris. Treat with potent topical steroids.
Hidradenitis suppurativa
Painful, recurrent condition of the apocrine glands; results in red papules that have chronic purulent drainage; increased risk with obesity and smoking. Treat with corticosteroid injections in lesions and antibiotics if cellulitis is also present
Seborrheic dermatitis
Affects skin folds of genital area; skin has red-glazed shiny appearance; may also find dry, greasy areas of the scalp too. Treat with topical corticosteroids
Vulvovaginal atrophy
Occurs in many postmenopausal women; underlying fat of the labia decreased with thinning of the epithelium; appears white and vaginal opening may constrict. Treat with estrogen creams or moisturizers
Aphthous ulcers
extremely painful lesions, similar to the “canker sores” found in the mouth. They can be small (<1cm) and eventually heal without scarring, or they can be larger (>2cm diameter and 1cm deep) and cause permanent scarring. Recurrence rates are as high as 35%. Symptomatic care.
Epidermal cysts
most common type of genital cyst, peaking in incidence in women in their 40s and 50s and located primarily in the labia majora, labia minora, and inguinal areas. Epidermal cysts develop when the hair follicles become obstructed; the deeper portion of the follicle swells to accommodate the desquamated cells. These cysts are generally dome-shaped, clear white to skin colored lesions rising above the surrounding epithelium. Cosmetic concern.
Urethral caruncle v. overt urethral prolapse
caruncle is a solitary red papule at the meatus less than 1cm and dome shaped. A urethral prolapse looks like a swollen red cuff surrounding the meatus and occurs at the extremes of age.
Congenital abnormalities of the vulva
The most significant of the vulvar anomalies are those that pose challenges to the assignment of gender at birth. Caution, sensitivity, complete evidence collection, and clear communication with often anxious family members are all required
Female pseudohermaphroditism
Female pseudohermaphroditism is caused by in utero masculinization due to androgens from maternal or fetal congenital adrenal hyperplasia, androgen-producing tumors of the mother’s ovary or adrenal glands, or the mother’s use of exogenous androgens. Often the infant will present with ambiguous genitalia.
Androgen insensitivity syndrome
Androgen insensitivity syndrome (a form of male pseudohermaphroditism and formerly called testicular feminization) is a genetic deficiency of androgen receptors that results in a 46,XY infant developing female external genitalia and, later in life, secondary sexual characteristics.
Iatrogenic anatomical changes of the vulva
may be the result of medical procedures such as episiotomies or cultural dependent such as female genital mutilation.
Benign conditions of the vagina
The epithelium of the vagina is also subject to chemical irritants and contact dermatitis and it is also sensitive to estrogen levels.
Vaginal ulceration
Most ulceration of the vagina is associated with acute infection due to herpes simplex or cytomegalovirus; vaginal lichen planus may present as ulcers
Bartholin cyst
Cystic mass below hymenal ring at 4 or 8 o’clock; must rule out underlying malignancy in older women. Asymptomatic - no treatment, symptomatic - drain with Word catheter
Vaginisumus
involuntary contraction of the muscles surrounding the introitus. It may have psychological and/or physical causes, but the contraction makes any vaginal penetration either extremely painful or impossible. Many women with vaginismus report prior sexual abuse, but others may deny any such trauma. It is important that the health care professional understands that vaginismus is an involuntary reaction much like the reflex to shut the eyelid when a foreign object is seen to be approaching. Voluntary control can be learned, but it takes much counseling and patience.
Congenital abnormalities of the vagina
Vaginal agenesis represents the most extreme instance of a vaginal anomaly, with total absence of the vagina except for the most distal portion.
The more common structural anomalies of the vagina include canalization defects such as imperforate hymen, transverse and longitudinal vaginal septa, partial vaginal development, and double vagina
Adenosis of the vaginal wall
Adenosis of the vaginal wall consists of islands of columnar epithelium in the normal squamous epithelium. It is often located in the upper third of the vagina. The incidence of this finding is much higher in women exposed to diethylstilbestrol in utero.
Differentiate the types of vulvar and vaginal cancer
Most tumors are squamous cell carcinomas, and they occur mainly in postmenopausal women. A history of chronic vulvar itching is common and may present with a vulvar lump
Paget disease of the vulva predominantly affects postmenopausal white women, Itching and tenderness are common and may be long-standing. The affected area is usually well demarcated and eczematoid in appearance
Malignant melanoma is a pigmented lesion
