The Vagina - Women's Health Packet 2

external genitalia

clitoris, labia minora, labia majora, vagina, urethra, perineum, anus, mons pubis

clitoris

at top of vaginal orifice

labia majora and minora

folds of tissue

introitus

entrance to the vagina

urethra

External opening to the urinary system

perineum

area between vagina and anus

anus

external opening of GI system

internal pelvic structures

uterus, cervix, fallopian tubes, ovaries

cervix

bottom part of uterus

ovarian ligament

suspend ovaries

cervical os

opening of the cervix to the uterus

fimbria

finger-like projection at the free end of the fallopian tube

hormones

biochemical substances produced in one area of the body and carried via the blood to send signals that trigger responses in another part of the body

GnRH

gonadotropin releasing hormone

FSH

follicle-stimulating hormone

are women born with all the follicles they will ever have?

yes

endometrium

uterine lining

LH

luteinizing hormone

ovulation

release of the ovum from the ovary

HcG

human chorionic gonadotropin

what is the menstrual cycle driven by?

hormones

what is the first step of the menstrual cycle?

hypothalamus produces GnRH which stimulates the anterior pituitary to produce FSH

what produces GnRH?

hypothalamus

what produces FSH? what stimulates this?

anterior pituitary produces

GnRH stimulates

what does FSH stimulate? what step of the cycle is this?

step 2

stimulates the development of follicles in the ovary, one of which becomes dominant

what do developing follicles produce?

estrogen

what effect does estrogen have in the menstrual cycle?

causes the uterine lining to thicken in preparation for the potential implantation of an egg

what does the dominant follicle produce? when does this happen?

a sharp rise in estrogen

peaks 1-2 days before ovulation

what does the estrogen surge signal? where is this released from?

the release of LH from the anterior pituitary

how does LH travel to the ovary?

via blood

when LH arrives in the ovary, what happens? what is the name of this event?

an enzyme release that makes a hole in the dominant follicle, releasing an egg

ovulation

what happens to estrogen levels after ovulation?

they drop dramatically

what does the dominant follicle become after ovulation (where it was transformed by LH)?

it becomes the corpus luteum and continues to produce some estrogen and progesterone

what is progesterone needed for?

to develop the endometrium so a potentially fertilized egg can implant

what happens if fertilization occurs?

the corpus luteum's life is extended by the presence of HcG and it continues to produce progesterone and some estrogen

what takes over hormone production as pregnancy progresses?

the placenta

what happens if no pregnancy occurs?

the CL dies, progesterone levels fall, and a new cycle begins with the onset of menses (where endometrium is expelled)

what signals day 1 of a menstrual cycle

day 1 of period

what is the average length of a cycle?

28 days, with ovulation the 14th day

what happens if a cycle is longer than average?

ovulation is later

pelvic examination

inspect first for abnormalities

pt lays in lithotomy position

lithotomy position

Speculum Examination

use an intravaginal instrument (speculum) to see cervix and vagina

3 kinds of speculums, from biggest to smallest

Graves, Pedersen, Virginal

what hormone is dominant in the first half of the cycle?

estrogen

what is the first half of the cycle referred to?

follicular phase

what hormone is dominant in the second half of the cycle?

progesterone

what is the second half of the cycle referred to?

luteal phase

biannual pelvic examination

hands on exam

palpate internal pelvic organs (uterus, cervix, ovaries)

adnexa

area where fallopian tube and ovary are on each side

pap smear procedure

put broom in cervical os and turn at least 3 times to collect cells, tissues, mucus

put in preservative and send to lab

if post-hysterectomy, use spatula and swab vaginal cuff

pap smear

screening test for cervical cancer

gravida

number of times pregnant

first thing to do when approaching a patient

take patient history

patient history (9)

determine if routine or problem visit

7 factors

onset of problem, duration, and relation to cycle

any previous pelvis problems?

obstetrical hx

birth control

family hx

LMP

sexual history

4 parts of obstetrical hx

gravida, terms, abortions, live births

LMP

last menstrual period

4 parts of PE

1) visual inspection of external genitalia

2) speculum exam

3) bimanual pelvic exam

4) rectal exam, possibly

4 normal pathophysiology of vagina

1) clear/white vaginal fluid

2) normal flora is lactobacillus, staph epidermidis, and beta hemolytic strep

3) pH 3.8-2.5

4) under microscope, see long rods, epithelial cells, and a few WBCs

common vaginal symptoms (5)

discharge (with color, foamy, or curd like)

edema

erythema

pruritus

odor

pH assessment

apply drop of vaginal discharge to pH paper and determine if basic or acidic based on color change

change of pH with yeast infection

decreases

change of pH with trichomonas

increases

change of pH with bacterial vaginosis

increases

amine test/whiff test

small amount of discharge on slide with 10% KOH

release of aromatic amines indicates presence of anaerobes

KOH

potassium hydroxide

anaerobes

Bacteria that grow in the absence of oxygen and are destroyed by oxygen

what does a positive whiff test smell like? what is this associated with?

fishy, bacterial vaginosis

wet-mount microscopic exam

sample of discharge on slide with a drop of saline

may see bacteria, yeast cells, trichomonads, WBCs, and clue cells

clue cells are indicative of what?

bacterial vaginosis