Female Genitourinary

Menses

monthly flow of bloody fluid from uterus

Menarche

onset of menses

Menopause

absence of menses for 12 consecutive months; usually around 48-55

Perimenopause

period of years marking the transition to menopause

Postmenopausal Bleeding

bleeding occurring 6 months or more after cessation of menses

Amenorrhea

absence of menses

Dysmenorrhea

pain with menses

Premenstrual Syndrome (PMS)

cluster of emotional, behavioral, and physical symptoms occurring 5 days before menses for 3 consecutive cycles

Abnormal Uterine Bleeding

bleeding between menses or infrequent, excessive, prolonged, or postmenopausal bleeding

Frequency

from first day of menses to first day of next menses (around 24-32 days)

Duration

number of days the flow lasts (around 3-7 days)

5 Phases of Reproductive Health

Prepuberty (premenstruation)

Puberty (menarche)

Childbearing (menstruation)

Perimenopausal

Menopausal

Menopause symptoms

vaginal dryness, hot flashes, dyspareunia, mild hirsutism, hair loss, postmenopausal bleeding, dysmenorrhea

Obstetric History

pregnancy, contraception

Gravida (G)

total number of pregnancies

Para (P)

outcomes of pregnancies

F = full term

P = premature

A = abortion

L = living child

Early symptoms of pregnancy

amenorrhea, tenderness/increased size of breasts, urinary frequency, N/V, easily fatigued, sensations that baby is moving (about 20 weeks)

Contraception

methods, satisfied?, questions about options

Vulvovaginal symptoms

vaginal discharge, local itching

Pelvic Exam: Patient

avoid sex/douching/suppositories for 24-48 hrs before exam, empty bladder, lie supine, reduce tightening of abdominal muscles

Pelvic Exam: Nurse

obtain permission, chaperone, explain steps in advance, drape patient, warm speculum, monitor comfort by watching pateint's face

Exam preparation

lithotomy position, draping, enhance comfort

Inspection

skin color, hair distribution, mons pubis, labia majora, labia minora, urethral meatus, clitoris, vaginal opening, perineum, any lesions

Palpation

Skene's glands, Bartholin's glands, pelvic musculature

Pediculosis Pubis

crab lice

Epidermoid Cyst

cystic nodule in skin

Venereal Wart

HPV warts

Syphilitic Chancre

skin lesion associated with primary syphilis

Uterine Prolapse

downward displacement of the uterus into the vagina

Genital Herpes

shallow ulcers on red bases

Bartholin Gland Infection

labial swelling

Speculum Examination

performed to collect specimens and assess the cervix

Cystocele

protrusion of the bladder

Rectocele

protrusion of the rectum

Vaginal Candidiasis

vaginal yeast infection

Cervical Cancer Screening

pap smear, HPV infection

Risk factors for cervical cancer

persistent infection, HPV subtypes, failure to undergo screening, multiple sex partners, smoking, immunosuppression, long-term use of oral contraceptives, sexual activity before 17, DES exposure in utero,

Chlamydia Trachomatis

most common STI reported

Chlamydia Trachomatis risk factors

< 24, sexually active, prior infection, new/multiple sexual partners, inconsistent condom use, occupational sex worker