Women's Health Flashcards
S3Q2 (22 cards)
WOMEN: Anatomy
pelvis table - names/other name, shape, transverse x AP size, subpubic angle, pelvic side wall, ischial spine prominence, type of delivery
GYNECOID (female)
- shape: transverse
- pubic side wall: straight & parallel
- subpubic angle: 90 (more round)
- type of delivery: normal
ANDROID (male)
- shape: heart
- pubic side wall: convergent
- subpubic angle: <90 (more acute)
- ischial spine: only prominent
- type of delivery: difficult via instruments
ANTHROPOID/APE
- shape: AP oval
- sizing: only AP>transverse
- pubic side wall: narrow
- type of delivery: face to pubes
PLATYPOID
- pubic side wall: divergent
- type of delivery: asynticism + NVD, if ugly head = CS
WOMEN: Anatomy
female - tilt, true pelvis (1.2)
male - tilt, for, true pelvis (2)
acetabulum
bone thickness
force closure - what, for (2)
form closure - (3=1)
female pelvis
- more ant tilt
- true pelvis (birth canal): broad, shallow
- acetabulum: smaller, more space
- bone thickness: smoother, lighter, thinner
male pelvis
- true pelvis: narrow, deep; for building
- acetabulum: larger, less space
force closure
- interlocking ridges & grooves of joint surface of pelvis
- keep wedge-shaped sacrum between ilia, upward force stabilize pelvis on pelvic floor
form closure
- compressive force of muscle, ligament, fascia = passive SIJ stability
WOMEN: Anatomy - Pelvic Muscles
part of, organs (8), contribute to (3), superficial (2)
IAS (2), EAS (2)
organ: urethra
- part of core musculature
- organs: bladder, urethra, prostate, vagina, uterus, rectum, anus, intraabdominal contents
- contribute to: incontinence, arousal, orgasm
- superficial: perineal, EAS
- IAS: extension of circular layer of rectum
- EAS: extension of longitudinal layer of rectum, thickened PFM, part of levator ani
WOMEN: Anatomy - Pelvic Muscles
MOINA - puborectalis pubococcygeus iliococcygeus coccygeus piriformis obturator internus
puborectalis
- O/I: pubic symphysis
- N: S3-S5
- A: elevate pelvic floor
pubococcygeus
- O/I: pos pubic bone & arcus tendinae | coccyx & anococcygeal ligament
- A: maintain upright position of floor
ilio
- O/I: arcus tendinae & ischial spine | coccyx & anococcygeal raphe
- A: voluntary urination
coccy
- O/I: ischial spine | lower sacrum upper coccyx
- A: support fetal head
piriformis
- O/I: ant sacrum | pos GT
- N: S1-S2
- A: ER, ABD, retroversion
obturator internus
- O/I: pelvic surface of lium & ischium | pos GT
- N: L5-S2
- A: ER
WOMEN: Anatomy
pelvic diaphragm - forms, has a what of what (2), from to (2)
urogenital diaphragm - has (2), where (3)
pelvic diaphragm
- form inf border of abdominopelvic cavity
- has thin funnel shaped sling of fascia & muscle
- from symphysis pubis to coccyx, one sidewall to another
urogenital diaphragm
- has triangular lig, strong muscle membrane
- external & inf to pelvic diaphragm, space between symphysis pubis & ischial tuberosity, across triangular ant surface of outlet
WOMEN: Anatomy - Ligaments
pelvic ligaments - what, has (3), subserous fascia other name + what + purpose
broad ligaments - what of what, from to
cardinal - other name, from to
uterosacral - from to
pelvic ligaments
- fake; thickened retroperitoneal fascia
- has vessels, nerve, CT
- subserous/endopelvic fascia: continuation of transversalis fascia; support abdomen
broad ligaments
- thin mesenteric-like reflection of peritoneum
- from lat sidewall to uterus
cardinal/mackenrodt’s ligaments
- from lat aspect of upper cervix & vagina to pelvic wall
uterosacral ligaments
- from upper cervix to S3
WOMEN: Pelvic Dysfunction
2=trend
lead to (8)
boat in dry dock theory
soda can theory - (1=1=2=2), diaphragm purpose
lead: incontinence, emptying
- prolapse & incontinence = biggest & unaddressed women problem
lead to
- urinary, fecal incontinence
- diff emptying urinary tract, defecation dysfunction
- sexual, chronic pain syndrome, sensory
- prolapse
boat in dock theory
- PFM relaxed/damaged = only ligaments & fascia will support organs
soda can theory
- diaphragm: pressure stabilizer
- close can/glottis = same pressure = keep structure & form = balance & posture
WOMEN: Pelvic Dysfunction
factors - predisposing (1), inciting (2), promoting (4), decompensating (5)
PFM is not responsible for what but what, subject to what esp when (2), dysfunction how seen
decompensating: aging
- predisposing: normal (gender, environment, race)
- inciting: surgery, damage
- promoting: meds, obese, menopause, activities
- decompensating: aging, dementia, environment, disease, meds
extra shit
- PFM not for gross but help trunk muscles
- subject to strain during pregnancy & birth
- dysfunction = seen during motion = restrictive
WOMEN: PE
include (3), exam (5)
c/c (6)
4 from pelvic dysfunction lead to
- include: lumbar, girdle, lower limbs
- exam: EMG, MRI, US for descent, vaginal squeeze, PFM dynamometry
c/o
- incontinence, emptying, sexual, pain
- leakage of urine/feces
- feel or see bulge from vagina or anus
WOMEN: Types of PFD - Urinary Incontinence
what, risk (8), who
overflow incontinence - cause (2), sx (2), tx
atonic bladder - cause (2), sx (1), tx
functional
mixed
risk: inc BMI, chronic disease
- leakage of urine
- who: high level female athlete
- risk: inc BMI/obese, smoking, inc parity, chronic disease, constipation, hormone, FMHx, race
overflow incontinece
- cause: fecal impaction, BPH
- sx: can’t empty
- tx: alpha adrenergic
atonic bladder
- cause: stroke, DM
- sx: no conytol
- tx: intermittent catheter
functional
- can’t go to bathroom
mixed
- stress + urge
WOMEN: Types of PFD - Urinary Incontinence
stress - other name, d/t (4=1), etiology (8), tx (1)
urge - other name, (1=1=1), etiology (6.1.1), tx
stress eti: aging, NVD; urge eti: stroke
STRESS INCONTINENCE/OUTLET INCOMPETENCE
- cough laugh sneeze exertion = intraabdominal pressure
- eti: aging, neuro, active, NVD, pregnancy, pelvic surgery, prolapse, urologic
- tx: topical estrogen
URGE INCONTINENCE/DETRUSOR OVERACTIVITY
- loss of bladder viscoelasticity = detrusor contract = overpower sphincter
- eti: neuro (stroke PD MS alzheimer’s stenosis SCI), non-neuro (radiation), idiopathic
- tx: anticholinergics
WOMEN: Types of PFD - Pelvic Floor Myofascial Pain
sx (1=1=1)
etiology (3), risk (2)
lead to (2)
tx - mainstay, pharma (2)
eti: weak, risk: trauma
- sx: taut band = trigger point = pain c referred pressure
- eti: weak PFM, overuse, dysfunctional posture
- risk: birth trauma, sexual abuse
- lead to: dyspareunia, chronic pain
tx
- mainstay: PT
- pharma: NSAIDS, antidepressants
WOMEN: Types of PFD - Pregnancy & Postpartum
changes during pregnancy (3.5)
pain from (4)
risk (3)
tx - PT (2), pharma when
pelvic girdle pain - trend (2), where, etiology (5), subgroup
relaxin - from, purpose (3=1)
change: body mass, risk: overuse, girdle eti: mechanical
changes during pregnancy
- inc body mass, lengthened abdominal muscle, inc laxity of joints
- inc hip ABD EXT, PF, lordosis, ant pelvic tilt
pain from: lumbar, girdle, hip, PFM
risk: workload, trauma, LBP
tx: PT realign & stabilize, NSAIDS post-pregnancy
pelvic girdle pain
- most common cause of back & pelvic pain
- iliac crest to gluteal folds
- eti: mechanical, hormonal, neural, inflammatory, collagen
- subgroup: all 3 joints
relaxin
- from corpus luteum
- relax uterine muscle, ligaments, joints = allow pelvic expansion
WOMEN: Types of PFD - Pelvic Nerve
nerves (3) - where (2.1)
nerve #4 - sx (2), d/t (3)
tx - pharma (2), (3)
d/t: anal, tx: cortico, radiofrequency
ilioinguinal, iliohypogastric, genitofemoral
- ilio: pfannenstiel, low transverse incision
- genito: during gyne surgery
pudendal nerve
- sx: urinary, sexual
- d/t: anal intercourse, pelvic trauma during NVD, cycle
tx
- corticosteroids, cream c ketamine
- radiofrequency ablation, pulsed radiofrequency, neuromodulation in sacral plexus or spine
WOMEN: Types of PFD - Diastasis Recti Abdominis
epidemiology - who (1=1)
where + size
lead to what disease, (3=more prone to 2), (1)
prognosis - recovery (1->1)
tx (1)
- 3rd trimester > after delivery
- separated at linea alba = >2.7cm at umbilicus
lead to
- inter rectus disease: seen congenital but develop later
- trunk mechanics + pelvic stability + changed posture = lumbar & pelvic injury
- herniation
prognosis
- natural & best at 1d-8w p delivery -> plateau
tx
- bracing
WOMEN: Tx
check for compensation of (3)
position - easiest & hardest, SH, exercise (2)
hypertonic - sx (4), tx (3)
hypotonic - sx (4), tx (1)
hyper sx: pasok labas, hypo sx: c/c
- compensation of abdominals, hip, glutes
- supine -> standing, 2-3SH
hypertonic
- sx: painful vaginal penetration, difficulty initiating or maintaining urine, constipation, pelvic pressure
- tx: DDBE, relaxation, happy baby pose (stretch floor)
hypotonic
- sx: leakage, diff empty, frequent urge, dec sensation in vaginal canal
- tx: kegel’s
WOMEN: Tx - Female Athletic Triad
menstrual
normal vs. abnormal term, primary vs. secondary
HPG axis - purpose (2), hypothalamus purpose (2), etiology (3), (1=1.2=condition)
infertile term (2)
MENSTRUAL DYSFUNCTION
- eunorrhea -> amenorrhea
- primary amenorrhea: no mens at 15y
- secondary amenorrhea: no period for 3m/90d
- persistent amenorrhea/luteal deficiency = infertile
- eti: stress, heavy exercise, disordered eating
- dec caloric intake = inc cortisol (stress hormone) & dec estrogen and progesterone (female reproductive hormone) = functional hypothalamic amenorrhea
hypothalamic-pituitary-gonadal axis
- hypothalamus: master gland, endocrinologic functions
- HPA: regulate reproductive, ovarian hormone release
WOMEN: Tx - Female Athletic Triad
energy deficiency - other name, d/t (2) (2)
impaired bone health - condition patho (3) + who (2), factors (4)
tx - durations (3), inc what hormone
ENERGY DEFICIENCY / LOW ENERGY AVAILABILITY
- d/t disorered eating, eating disorder, low BMD, mens condition
IMPAIRED BONE HEALTH / OSTEOPOROSIS
- bone fragile, deterioration of tissue, low bone density
- older, post-menopause
- factor: aging, estrogen, vitamin D, calcium
tx
- days/weeks, months, years
- inc anabolic hormone (IGF-1)
WOMEN: PCOS
what/structure, pathology, associated (7), lead to (2)
sx (10)
tx - sx (3), (1), meds + side effects (4)
sx: sex drive, acne, hair, meds: insomnia
- endocrine; altered hormone
- associated: insulin resistance, Htn, cardio, anxiety, depression, obesity, hyperlipidemia
- lead to: ovarian cyst, endometrial cancer
sx
- low sex drive, missed period, fatigue, high testosterone, difficulty conceiving/infertility
- acne, difficult losing weight, mood
- dec head hair, inc body hair
tx
- sx: lower back/sacral pain, lower quadrant/abdominal pain, low energy
- exercise, weight loss
- clomiphene citrate = insomnia, blurred vision, vomit, frequent urge
WOMEN: PCOS
insulin resistance - lead to what condition, inc/dec (1=1=1), affects (2)
criteria - how many, 1st (2) + define, 2nd values (3) + via + sx (3), 3rd (2G)
insulin resistance
- lead to DM
- inc androgen secretions = inhibit hepatic production of sex hormone binding globulin = inc testosterone
- affects ovulation & infertility
rotterdam criteria (>2)
1. oligo (skipped period), anovulation (no period)
2. inc androgen
- total: >70ng/dl, androstenedione >245ng/dl, DHEA-S >248ug/dl
- sx: acne, hirusitism, acanthosis nigricans (dark neck d/t insulin resistance)
- via blood test
3. polycystic ovaries
- >12 follicles (2-9mm diameter) in each ovary, >10cc volume
WOMEN: Dysmenorrhea
other name, where, etiology (2)
tx - pharma (1), modality (2), (4)
- menstrual cramps
- lower abdomen
- eti: inc vasopressin & prostaglandin
tx
- NSAIDS
- TENS, HMP
- aerobics (jogging), yoga, stretching, kegel
WOMEN: Gender Affirming Surgery
transgender female vs. male
can lead to (1)
PT’s role + eval (4)
inc PFD d/t (4)
- vaginoplasty, phalloplasty
- lead to weakness
- PT: neovaginal dilation; MMT palpation PA gait
- inc PFD d/t tucking, not use outside restroom, hormonal replacement surgery, sexual assault
