Bates female genitalia

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Bates female genitalia
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2013-05-30 22:34:51
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Bates female genitalia ch 14
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  1. external female genitalia
    vulva
  2. a hair-covered fat pad overlying the symphysis pubis
    Mons pubis
  3. rounded folds of adipose
    labia majora
  4. thinner pinkish-red folds that extend anteriorly to form the prepuce and clitoris
    labia majora
  5. the boat-shaped fossa btwn the labia minora
    vestibule
  6. Distal cervix protrudes into the vagina, dividing upper vagina into 3 recesses:
    • Anterior fornice
    • Posterior fornice
    • Lateral fornice
  7. 2 parts of the uterus:
    the body (or corpus) and the cervix
  8. marks the opening into the endocervical canal
    external os of the cervix
  9. what are the cellular types of the ectocervix?
    • plushy, red columnar epithelium surrounding the os, which resembles the lining of the endocervical canal
    • the squamous columnar junction (forms the boundary)
    • a shiny pink squamous epithelium continuous with the vaginal lining
  10. what is the ectropion
    • the broad band of columnar epithelium encircling the os before puberty
    • during puberty, the ectropion is replaced with columnar epithelium
  11. what area is sampled for pap smear?
    • the Transformation zone
    • it is created by the squamocolumnar junction migrating towards the os
    • This area is at risk for later dysplasia
  12. what are the ovaries shaped like?
    average size?
    are they palpable?
    • Almond-shaped structures
    • Varies in side, averages 3.5 x 2 x 1.5 cm from adulthood thru menopause
    • Are palpable on pelvic exam in ab ½ women during reproductive years
  13. 2 primary function of the ovaries:
    • production of the ova
    • secretion of hormones (estrogen, progesterone, & testosterone)
  14. what is leucorrhea?
    • physiological increased secretions (usually just before menarche)
    • Normal change
    • Can worry girls and their mothers
    • Coincides with ovulation
    • Accompanies sexual arousal
    • Normal discharge must be differentiated from
    • infectious processes
  15. Tanner assessment of sexual maturity in girls depends on:
    • internal exam
    • growth of pubic hair
    • dev of breasts
  16. Lymph from vulva and lower vagina drain into:
    inguinal nodes
  17. lymph from internal genitalia (including upper vagina) flows into:
    • pelvic & abd lymph nodes
    • not palpable
  18. what are the common concerns?
    • Menarche, menstruation, menopause, postmenopausal bleeding
    • Pregnancy
    • Vulvovaginal symptoms
    • Sexual preference and sexual response
  19. menarche of girls in the US usually begins:
    9-16 y
  20. menopause is usually btwn:
    48-55 yrs
  21. interval betwn periods range from:
    24-32 days
  22. period flow lasts from:
    3-7 days
  23. age of menarche depends on:
    • genetics
    • socioeconomic status
    • nutrition
  24. Primary dysmenorrhea:
    results from:
    • s/ an organic cause
    • Results from ↑ prostaglandin production during the luteal phase of the menstrual cycle, when estrogen and progesterone levels ↓
  25. Secondary dysmenorrhea:
    causes include:
    • c/ an organic cause
    • Causes include endometriosis, adenomyosis, pelvic inflammatory disease, and endometrial polyps
  26. Criteria for dx of PMS:
    • S & S in the 5 days prior to menses for at least 3 consec cycles
    • Cessations of S & S c/in 4 days after onset of menses
    • Interference c/ daily activities
  27. primary amenorrhea:
    failure of periods to initiate
  28. secondary amenorrhea:
    cessation of periods after they have been established
  29. causes of amenorrhea
    • Preg, lactation, & menopause
    • Other causes include: low body wt (from any cause- stress, malnutrition, anorexia nervosa, chronic illness) hypothalamic- pituitary- ovarian dysfunction
  30. causes of abnormal uterine bleeding
    Causes vary by age and include: preg, cervical or vag infection or CA, cervical or endometrial polyps or hyperplasia, fibroids, bleeding disorders, & hormonal contraception or replacement therapy
  31. polymenorrhea
    fewer than 21-d intervals btwn menses
  32. oligomenorrhea
    infreq bleeding
  33. menorrhagia
    • excessive flow
    • "its raining men"
  34. metorrhagia:
    • intermenstrual bleeding
    • -bleeding btwn expected periods
  35. postcoidal bleeding suggests:
    • Suggests cervical polyps or CA
    • In older adults, atrophic vaginitis
  36. menopause follows a period of:
    of fluctuation in pituitary secretion of FSH and LH and ovarian function
  37. what drugs can help with menopause?
    • Estrogen replacements relieves symptoms, but ↑ risk of thrombosis
    • Antidepressants and alpha-blockers can be helpful
  38. what are the vasomotor symptoms?
    • hot flashes
    • flushing
    • sweating or night sweats
  39. symptoms of menopause?
    • Vaginal dryness
    • Dyspareunia (painful intercourse)
    • Hair loss, mild hirsutism as the androgen-to-estrogen ratio ↑
    • Urinary symptoms may occur s/ infection bc of atrophy of urethra and urinary trigone
  40. what is the GP notation?
    • Gravida: total # of pregnancies
    • Para: outcomes of pregnancies
    • F (fullterm, 37 wks)
    • P (premature, 20-37 wks)
    • A (abortions, <20 wks)
    • L (living children)
    • Abortions= spontaneous & elective
  41. symptoms of pregnancy
    • Tenderness, tingling, increased size of breasts, urinary freq, N/V, easy fatigability
    • 20 wks: Feelings that baby is moving
  42. what are the MC vulvovaginal symptoms?
    • Vaginal discharge (Note: amt, color, consistency, & odor)  Ask ab local sores or lumps in vulvar area… painful?
    • Local itching
  43. vaginismus
    involuntary spasm of the muscles surrounding the vaginal orifice that makes penetration painful or impossible
  44. causes of vaginismus
    Superficial pain?
    deeper pain?
    • physical or psychological
    • Superficial pain: suggests local inflammation, atrophic vaginitis, or inadequate lubrication
    • Deeper pain: suggests pelvic disorders or pressure on a normal ovary
  45. probs with sex?
    Lack desire, failure to become aroused, failure to obtain adequate lubrication, failure to reach orgasm.
    causes??
    Causes include: lack of estrogen, medical illness, & psychiatric conditions. MCly related to situational or psychosocial factors
  46. 2 primary types of cervical CA:
    • 80-90% are squamous cell carcinomas
    • 10-20% are adenocarcinomas in glandular cells
  47. MC STD in the US
    HPV infection
  48. 70% of cervical CA are caused by:
    HPV 16 & 18
  49. 90% of genital warts are caused by?
    HPV 6 & 11
  50. Pap guidelines:
    1st screen:
    • 3 y after 1st sex           OR
    • by 21 y; whichever is 1st
  51. pap guidelines:
    up to age 30:
    • Screen annually c/ regular test          OR
    • q 2 y c/ liquid-based cytology test
  52. pap guidelines
    30 & older:
    • Q 2-3 y if 3 consec annual cytology results are negative       OR
    • If combined cytology testing & high-risk HPV testing results are negative
    • Screen more freq if (+) pap      OR
    • (+) high-risk HPV test results, HIV infection, immunosuppressed, DES exposure in utero, prior Hx of cervical CA
  53. epithelial cell abnorms:
    • Squamous cells
    • Glandular cells (Atypical endocervical cells or atypical endometrial cells)
    • Other malignant neoplasms (Sarcomas or lymphomas)
  54. HVP vac is recommended for?
    what does it target?
    reduces risk for?
    what does it prevent?
    • girls 11-26 yo
    • targets 6, 11, 16, 18
    • reduce risk of cervical CA & anogenital dz
    • Almost 100% effective preventing 16 & 18-related cervical intraepithelial neoplasia grade 2 or 3 and adenocarcimona in situ in those c/ no prior exposure to those types
  55. strongest RF of ovarian CA
    • FH of breast or ovarian CA
    • BRCA1 and BRCA2 mutations
  56. MC reported STD in the US and MC STD in XX
    Chlamydia trachomatis
  57. indications for pelvic exam:
    Menstrual abnormalities, unexplained abd pain, vaginal discharge, Rx of contraceptives, sexually active, pts desire for assessment
  58. delayed puberty causes:
    • Often familial or related to chronic illness
    • Abnoms in hypothalamus, ant pituitary gland, or ovaries
  59. Excoriations (itchy, small,red maculopapules) can be from=
    pediculosis pubis
  60. cystocele:
    • is a bulge of the upper two thirds of the anterior vaginal wall, together with the bladder above it
    • it results from weakened supporting tissues
  61. rectocele
    herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the endopelvic fascia
  62. yellowish d/c on endocervical swab suggests mucopurulent cervicitis, commonly caused by:
    Chlamydia trachomatis, Neisseria gonorrhea, or herpes simplex
  63. what should pts be advised before exam?
    pt should avoid intercourse, use of douches, tampons, contraceptive foams or creams, vaginal suppositories for 48 h before exam. And should not be menstruating
  64. options for obtaining pap:
    • cervical scrape
    • endocervical brush
    • cervical broom
  65. Chlamydia infection is linked to:
    • urethritis, cervicitis, pelvic inflammatory dz, ectopic preg, infertility, & chronic pelvic pain
    • Rf: age <25, multiple partners, prior hx of STDs
  66. pain on movement of the cervix, together c/ adnexal tenderness
    PID
  67. uterine enlargement can be from:
    preg, uterine myomas, or malignancy
  68. nodules on the uterine surface=
    myomas
  69. Adnexal masses can arise from:
    tubo-ovarian abscess, salpingitis or inflammation of the fallopian tubes from PID, or ectopic preg
  70. Pelvic pain, bloating, ↑ abd size, and urinary tract symptoms are more common in:
    ovarian CA
  71. 3-5 yrs after menopause ovaries are:
    • atrophic and usually nonpalpable.
    • In postmenopausal XX, investigate a palpable ovary for ovarian cyst or ovarian CA
  72. impaired strength of pelvic muscles can be from:
    from age, vaginal deliveries, or neurological deficits, or from urinary stress incontinence
  73. 3 purposes for rectovaginal exam:
    • To palpate retroverted uterus, uterosacral ligaments, cul-de-sac, and adnexao  
    • To screen for colorectal CA in XX 50 yrs or oldero  
    • To assess pelvic pathology
  74. MC hernia that occurs in the XX groin
    Indirect inguinal hernia
  75. Urethritis may arise from:
    Infection c/ Chlamydia trachomatis or Neisseria gonorrhea
  76. small, red benign tumor visible at the posterior part of the urethral meatus
    menopausal women
    no symptoms
    urethral caruncle
  77. slightly raised, round, or oval, flat-topped papules covered by a gray exudate
    secondar syphilis (condyloma latum)
  78. types of cervical lacerations from delivery
    • bilateral transverse
    • stellate
    • unilateral transverse

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