Ch. 45 Disorders of the Female Reproductive System-1

What are the Bartholin glands?

A pair of mucus-secreting glands located in the lower right and left portions of the vaginal introitus (opening).

Note: Tiny glands that make slippery stuff so the vagina doesn’t get dry.

What is the function of the Bartholin glands?

Vaginal lubrication.

Note: They’re like natural lotion for the vagina.

What is a Bartholin gland cyst?

A benign blockage of the Bartholin gland, usually unilateral and asymptomatic.

Note: Sometimes the gland gets clogged and makes a little bump, usually harmless.

What is the management for a spontaneously draining Bartholin gland cyst?

Sitz baths and analgesics.

Note: Warm baths and pain medicine help it feel better if it pops on its own.

What is Lichen Simplex Chronicus?

A common form of chronic neurodermatitis.

Note: A skin problem that keeps coming back.

How does Lichen Simplex Chronicus present?

Dry, patchy areas of skin that are scaly and thick.

Note: Skin looks rough, thick, and flaky.

What causes Lichen Simplex Chronicus?

Habitual scratching or rubbing.

Note: Your skin gets irritated from scratching too much.

What is Lichen Sclerosus?

A chronic skin condition that affects the vulva and anus.

Note: Skin problem on private parts that sticks around.

What symptoms occur with Lichen Sclerosus?

Itching and pain.

Note: Makes your private area really itchy and sore.

How does Lichen Sclerosus appear?

White areas of skin that are often shiny or wrinkled.

Note: Skin looks pale, shiny, and crinkly.

What is a complication of untreated LS?

Painful scarring and skin cancer.

Note: If not treated, it can hurt a lot and sometimes turn into cancer.

What is the first-line treatment for LS?

High-potency topical corticosteroid ointment.

Note: Strong cream that calms the skin but doesn’t cure it.

What is vulvodynia?

A chronic vulvar discomfort/pain condition of unknown etiology.

Note: Your private area hurts for no clear reason.

How is vulvodynia diagnosed?

Careful medical history and pelvic exam with cotton-swab test.

Note: Doctors check history and gently poke to see where it hurts.

What is vulvar cancer?

An uncommon malignancy primarily affecting postmenopausal women.

Note: A rare cancer in older women’s private parts.

What is the most common subtype of vulvar cancer?

Squamous cell carcinoma.

Note: Most vulvar cancers start in the skin cells.

What is vaginitis?

The most common gynecologic diagnosis characterized by inflammation of the vagina.

Note: Your vagina gets red, swollen, and uncomfortable.

What is the most common cause of vaginitis?

Bacterial vaginosis.

Note: Germs called bacteria upset the vagina the most.

What is the most common vaginitis in postmenopausal women?

Atrophic vaginitis.

Note: Vaginas in older women can get thin, dry, and irritated.

What is vaginal cancer associated with?

Human Papillomavirus (HPV) and maternal exposure to Diethylstilbestrol (DES).

Note: A virus or medicine your mom took can sometimes cause this rare cancer.

What is cervicitis?

Inflammation of the uterine endocervix.

Note: The cervix (the opening to the uterus) gets red and swollen.

What is a complication of cervicitis?

Pelvic inflammatory disease (PID).

Note: If it spreads, it can hurt the whole uterus and tubes.

What are infectious causes of cervicitis?

Gonorrhea, chlamydia, herpes simplex virus (HSV), trichomonas vaginalis, and mycoplasma genitalium.

Note: Different germs and viruses can cause cervix swelling.

What are cervical polyps?

Benign growths protruding from the surface of the cervical canal.

Note: Small harmless bumps sticking out inside the cervix.

What causes cervical cancer?

HPV infection.

Note: A virus called HPV can make the cervix cells turn cancerous.

How is cervical cancer prevented?

Early detection with Papanicolaou (Pap) testing and HPV vaccination.

Note: Pap smears and shots help catch it early or stop it from happening.

What is endometritis?

Infectious inflammation of the endometrium.

Note: The inside of the uterus gets infected and swollen.

What is the most common postpartum infection?

Postpartum endometritis.

Note: After having a baby, the uterus can get infected.

What is acute endometritis (unrelated to pregnancy) classified as?

Pelvic Inflammatory Disease (PID).

Note: A non-baby-related uterus infection is part of PID.

What is endometriosis?

Presence of endometrial tissue outside the uterus.

Note: Uterus lining grows where it shouldn’t, like in other spots, and it hurts.

What is adenomyosis?

Benign invasion of endometrial glands into the myometrium.

Note: The inside lining of the uterus sneaks into the muscle layer, making the uterus bigger.

What is the treatment for adenomyosis?

Hysterectomy.

Note: The only sure way to fix it is removing the uterus.

What is the most common cancer of the female reproductive organs in the U.S.?

Endometrial cancer.

Note: Cancer that usually happens in the uterus lining, most often in older women.

What characterizes Type I endometrial cancer?

Estrogen-sensitive carcinoma arising in the presence of endometrial hyperplasia.

Note: Cancer grows when there’s too much estrogen, usually after the lining gets thick.

What is the most common risk factor for Type I endometrial cancer?

Obesity.

Note: Extra body fat makes more estrogen, which can lead to this cancer.

What characterizes Type II endometrial cancer?

Not associated with hyperplasia; develops in the presence of atrophy.

Note: This cancer happens when the lining is thin and small, usually more serious.

What are leiomyomas?

The most common benign tumor affecting women.

Note: Non-cancerous muscle lumps in the uterus.

What do leiomyomas depend on for growth?

Estrogen and progesterone levels.

Note: They grow bigger when hormones are high.

What is the leading indication for hysterectomy?

Leiomyoma.

Note: Many women get their uterus removed because of fibroids.

What are the locations of leiomyomas?

Subserosal, intramural, and submucosal.

Note: They can grow on the outside, inside muscle, or inside the uterus cavity.

What causes PID most commonly?

Chlamydia and Gonorrhea.

Note: Germs from sex can infect the uterus, tubes, and ovaries.

What are complications of untreated PID?

Chronic pelvic pain, infertility, and ectopic pregnancy.

Note: If not treated, it can make you hurt all the time, stop you from having babies, or cause a dangerous pregnancy outside the uterus.

What is an ectopic pregnancy?

The embryo implants somewhere outside of the uterus.

Note: A baby starts growing in the wrong place, usually a tube, which can be dangerous.

What are ovarian cysts?

Benign, fluid-filled structures.

Note: Little water balloons on your ovaries that are usually harmless.

What are complications of ovarian cysts?

Rupture, hemorrhage, and torsion.

Note: Sometimes they pop, bleed, or twist, which hurts a lot and needs a doctor fast.

What is Polycystic Ovary Syndrome (PCOS)?

The most common reproductive endocrine disorder in women of reproductive age.

Note: Ovaries make too many eggs or hormones, causing problems with periods and babies.

What criteria diagnose PCOS?

Hyperandrogenism, ovulatory dysfunction, and polycystic ovaries.

Note: Signs include too much male hormone, messed-up periods, and many small ovary bumps.

What is the most common cause of anovulation/ovulatory infertility?

PCOS.

Note: PCOS is the main reason some women don’t ovulate and have trouble getting pregnant.

What is an Adult Granulosa Cell Tumor associated with?

Estrogen hypersecretion.

Note: Rare tumor that makes extra estrogen, causing changes like early periods or bleeding.

What characterizes a Sertoli-Leydig Cell Tumor?

Androgen secretion causing virilization and de-feminization.

Note: Very rare tumor makes male hormones, so women may get more hair or changes in their body.

What is the gynecologic cancer with the highest mortality rate?

Ovarian cancer.

Note: Most deadly female reproductive cancer because it hides until late.

What are the strongest risk factors for ovarian cancer?

Advancing age and family history including BRCA1 and BRCA2 gene mutations.

Note: Older age or family genes make this cancer more likely.

What is a cystocele?

Protrusion of the bladder when it descends into the vagina.

Note: Bladder sags into the vagina like a little balloon.

What is a rectocele?

Rectal tissue herniation into the vaginal lumen.

Note: The back wall of the vagina bulges because of rectum tissue.

What provides a definitive diagnosis for rectocele/enterocele?

Defecography.

Note: Special X-ray to see the poop tube and how it bulges.

What is the normal uterine position?

Flexed about $45$ degrees anteriorly with the cervix in the anteverted position.

Note: Uterus usually tilts slightly forward like a little hill.

What is primary amenorrhea?

Menarche has not occurred by $15$ years of age.

Note: A girl hasn’t started periods by 15.

What is secondary amenorrhea?

Cessation of previously regular menses for $6$ months.

Note: Someone who used to have periods stops for a long time.

What is primary dysmenorrhea?

Painful menstruation not associated with other pathology.

Note: Period cramps without any other problem.

What is secondary dysmenorrhea?

Painful menstruation associated with underlying pathology.

Note: Period pain caused by another problem, like fibroids.

What are Premenstrual Disorders (PMD)?

Psychiatric or somatic symptoms developing within the luteal phase.

Note: Mood swings or body changes right before your period.

What triggers PMD symptoms?

Cyclical changes in estrogen and progesterone levels.

Note: Hormone ups and downs before periods cause these problems.

What is galactorrhea?

Milk production from the breast unrelated to pregnancy or lactation.

Note: Breasts make milk even if you’re not pregnant or breastfeeding.

What causes lactational mastitis?

Inadequate drainage of milk and bacterial infection.

Note: Milk gets stuck and germs make the breast sore and red.

What is a fibroadenoma?

A painless, benign, solid breast tumor.

Note: A lump in the breast that isn’t cancer and doesn’t hurt.

What are fibrocystic changes?

The most common benign breast condition.

Note: Breasts feel lumpy or tender, but it’s not cancer.

What is the second most common cancer diagnosed in women in the U.S.?

Breast cancer.

Note: Lots of women get this, mostly in the milk ducts.

What is effective screening for breast cancer?

Mammography.

Note: X-ray pictures of breasts to check for lumps early.

What is Mammary Paget's disease associated with?

An underlying in situ or invasive cancer.

Note: A nipple problem usually means there’s breast cancer underneath.

What accounts for $30$% of infertility cases?

Male infertility.

Note: Sometimes the man has problems with sperm.

When is female infertility evaluation indicated?

Unsuccessful pregnancy after $12$ months of unprotected regular intercourse or $6$ months if over $35$.

Note: If a couple can’t get pregnant after a year (or 6 months if older), doctors check the woman.

What infectious process carries the greatest risk of infertility with PID?

Chlamydia.

Note: This germ can block tubes and make it hard to get pregnant.

What are uterine causes of infertility?

Space-occupying lesions like submucosal or intracavitary leiomyomas or reduced endometrial receptivity.

Note: Lumps in the uterus or a lining that won’t let a baby stick can cause infertility.

What is the most common and effective ART?

In Vitro Fertilization (IVF).

Note: Babies are made in a lab dish and then put in the uterus.