Female Genitalia: Hx/PE/Health Maintenance

ROS female GU

menstrual regularity/frequency/duration/volume of periods; last period; bleeding between menses; dysmenorrhea; menopause/post-menopausalbleeding; vaginal discharge/pruritis; vulvar lesions/pruritis/pain; dyspareunia; bleeding after intercourse

red flags female GU

sudden incontinence, post-menopausal bleeding

sudden incontinence is concerning for

cauda equina syndrome

post-menopausal bleeding is concerning for

endometrial cancer

menarche

onset of menses

dysmenorrhea

painful menstruation

premenstrual syndrome

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

amenorrhea

absence of menstruation

abnormal uterine bleeding

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

menopause

absence of menses for 12 consecutive months bt ages 48 and 55

postmenopausal bleeding

bleeding occurring 6 mo or more after cessation of menses

primary amenorrhea

Absence of ever initiating periods

causes of primary amenorrhea

Congenital defects, genetic disorders, acquired CNS lesions

secondary amenorrhea

cessation of periods after they have been established

Causes of secondary amenorrhea

pregnancy, lactation, menopause, low body weight, malnutrion, anorexia nervosa, stress, chronic illness, hypothalmic-pituitary-ovarian dysfunction

primary dysmenorrhea

painful menstruation that begins at puberty and has no clear cause

causes of primary dysmenorrhea

excess prostaglandin production during the luteal phase when estrogen and progesterone levels decline

Secondary dysmenorrhea

painful menstruation that begins during adult life, usually as a consequence of a pelvic disorder

causes of Secondary dysmenorrhea

endometriosis, adenomyosis, pelvic inflammatory disease, endometrial polyps

criteria for premenstrual syndrome

SS in the 5 days prior to menses for at least 3 consecutive cycles, cessation of SS within 4 days after onset of menses, and interference with daily activities

polymenorrhea

less than 21-day intervals between menses

oligomenorrhea

infrequent bleeding

menorrhagia

excessive menstrual bleeding, bright red with clots

metrorrhagia

bleeding between periods or intermenstrual bleeding

menometrorrhagia

excessive uterine bleeding at both the usual time of menstrual periods and at other irregular intervals

postcoital bleeding

bleeding after intercourse which suggests cervical polyps, cancer, or atrophic vaginitis in older women

Postmenopausal bleeding

bleeding occurring 6 months or more after cessation of menses

MCC of acute pelvic pain

pelvic inflammatory disease

How should the pt be positioned for a pelvic exam?

Drape the patient, place her heels in the foot holders, and assist her into the lithotomy position with thighs flexed, abducted, and externally rotated. Ensure her buttocks extend slightly beyond the table edge and support her head with a pillow.

graves speculum description

wider, larger, curved

indications for a graves speculum

parous women with vaginal prolapse

pederson speculum description

narrower, flatter blades

indication for pederson speculum

small introitus such as a virgin or elderly women

most comfortable speculum for a sexually active woman

medium pederson

during a papsmear, cells collected from the ectocervix are

squamous epithelium

during a papsmear, cells collected from the endocervix are

columnar epithelium

cervical broom

Press, turn, scrape in full circle

cervical scrape

Press, turn, scrape in full circle

endocervical brush

Press, turn, scrape in half circle

tanner stage 1

Preadolescent—no pubic hair except for the fine body hair (vellus hair) similar to that on the abdomen

tanner stage 2

Sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled, chiefly along the labia

tanner stage 3

Darker, coarser, curlier hair, spreading sparsely over the pubic symphysis

Tanner stage 4

Coarse and curly hair as in adults; area covered greater than in stage 3 but not as great as in the adult and not yet including the thighs

tanner stage 5

Hair adult in quantity and quality, spreads on the medial surfaces of the thighs but not up over the abdomen

cystocele

a bulge of the upper two-thirds of the anterior vaginal wall with the bladder

urethral caruncle

small red benign tumor visible at the posterior urethral meatus

bartholin gland infection

Acute-tense, hot, tender abscess, pus or erythema from or near duct; chronic-nontender cyst large or small

cystourethrocele

bulging of the anterior vaginal wall, bladder, and urethra

prolapse of the urethral mucosa

swollen red ring around the urethral meatus

rectocele

herniation of the rectum into the posterior wall of the vagina

retention cysts

translucent nodules on cervical surface, no pathologic significance, occur via metaplasia and blocking secretions of columnar epithelium

cervical polyp

arises from the endocervical canal, bright red, soft, fragile; benign but may bleed

normal shape of cervical os

oval and slit-like

types of cervical lacerations from delivery

bilateral transverse, stellate, unilateral transverse

normal positions of the uterus

retroversion and retroflexion

retroversion of the uterus

tilting backward of the entire uterus

retroflexion of the uterus

backward angulation of the body of the uterus in relation to the cervix

myomas of the uterus (fibroids)

common benign uterine tumors, firm irregular nodules that are continuous with the uterine surface

prolapse of the uterus

results from weakness of the supporting structures of the pelvic floor; associated with a cystocele and rectocele

first degree prolapse

cervix is still well within the vagina

second degree prolapse

at the introitus

third degree prolapse

cervix and vagina are outside the introitus

current cervical cancer screening guidelines for average risk women

start at 21, end at >65 yo

current USPSTF guidelines regarding menopause and hormone replacement therapy

Recommends against the use of either estrogen alone for women who have had a hysterectomy or combined use of estrogen and progesterone; did not address using HRT to treat menopausal symptoms

current USPSTF guidelines regarding screening for ovarian cancer

Not recommended for asymptomatic, average risk patients; screen women with BRCA mutation with transvaginal US, pelvic exams, serum cancer antigen 125 testing

What reduces ovarian cancer in women with a BRCA mutation?

chemoprevention or prophylactic surgery