Term
| Just before menarche, there is a physiologic increase in vaginal secretions—a normal change that sometimes worries a girl or her mother. As menses become established, increased secretions called ________________ coincide with ovulation. They also accompany sexual arousal. These normal kinds of discharges must be differentiated from those of infectious processes |
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Definition
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Term
1-Lymph from the vulva and lower vagina drains into the
2-Lymph from the internal genitalia, including the upper vagina, flows into the |
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Definition
1-Lymph from the vulva and lower vagina drains into the inguinal nodes.
2-Lymph from the internal genitalia, including the upper vagina, flows into the pelvic and abdominal lymph nodes, which are not palpable. |
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Term
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Definition
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Menarche—age at onset of menses
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Menopause—absence of menses for 12 consecutive months, usually occurring between 48 and 55 years
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Postmenopausal bleeding—bleeding occurring 6 months or more after cessation of menses
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Amenorrhea—absence of menses
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Dysmenorrhea—pain with menses, often with bearing down, aching, or cramping sensation in the lower abdomen or pelvis
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Premenstrual syndrome (PMS)—a cluster of emotional, behavioral, and physical symptoms occurring 5 days before menses for three consecutive cycles
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Abnormal uterine bleeding—bleeding between menses; includes infrequent, excessive, prolonged, or postmenopausal bleeding
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Term
| Unlike the normal dark red menstrual discharge, excessive flow tends to be bright red and may include “clots” (not true fibrin clots). |
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Definition
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Term
1-Primary dysmenorrhea results from
2-Causes of secondary dysmenorrhea include |
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Definition
1-Primary dysmenorrhea results from increased prostaglandin production during the luteal phase of the menstrual cycle, when estrogen and progesterone levels decline
2-Causes of secondary dysmenorrhea include endometriosis, adenomyosis (endometriosis in the muscular layers of the uterus), pelvic inflammatory disease, and endometrial polyps |
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Term
1-primary amenorrhea-
2-secondary amenorrhea-
-physiologic forms of the secondary type-
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Definition
1-primary amenorrhea- Failure of periods to initiate is called
2-secondary amenorrhea-the cessation of periods after they have been established
physiologic forms of the secondary type-Pregnancy, lactation, and menopause
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Term
| Postcoital bleeding suggests _____________ or ___________, or in an older woman, _______________________. |
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Definition
| Postcoital bleeding suggests cervical polyps or cancer, or in an older woman, atrophic vaginitis. |
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Term
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Polymenorrhea-
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Oligomenorrhea-
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Menorrhagia-
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Metorrhagia-
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Postcoital bleeding-
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Definition
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Polymenorrhea, or fewer than 21-day intervals between menses
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Oligomenorrhea, or infrequent bleeding
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Menorrhagia, or excessive flow
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Metorrhagia, or intermenstrual bleeding
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Postcoital bleeding
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Term
Menopause usually occurs between 48 and 55 years,
If your patient is perimenopausal, with onset of variable cycle length, ask about such vasomotor symptoms as hot flashes, flushing, and sweating. Sleep disturbances are also common. After menopause, there may be vaginal dryness and dyspareunia, or painful intercourse, hair loss, and mild hirsutism as the androgen-toestrogen ratio increases. Urinary symptoms may also occur in the absence of infection because of atrophy of the urethra and urinary trigone. |
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Definition
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Term
| Postmenopausal bleeding suggests |
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Definition
| endometrial cancer, hormone replacement therapy, uterine and cervical polyps |
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Term
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Definition
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G = gravida, or total number of pregnancies
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P = para, or outcomes of pregnancies. After P, you will often see the notations F (full-term), P (premature), A (abortion), and L (living child).
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Term
| Amenorrhea followed by heavy bleeding suggests |
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Definition
| a threatened abortion or dysfunctional uterine bleeding related to lack of ovulation |
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Term
1-Dyspareunia-
2- Vaginismus refers to |
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Definition
1-Dyspareunia- pain during sex
2- Vaginismus- refers to an involuntary spasm of the muscles surrounding the vaginal orifice that makes penetration during intercourse painful or impossible. |
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Term
dyspareunia (Superficial pain) suggests-
dyspareunia (deeper pain) may be from
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Definition
dyspareunia (Superficial pain) suggests- local inflammation, atrophic vaginitis, or inadequate lubrication;
dyspareunia (deeper pain) may be from pelvic disorders or pressure on a normal ovary.
The cause of vaginismus may be physical or psychological |
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Term
Excoriations or itchy, small, red maculopapules suggest |
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Definition
| pediculosis pubis (lice or “crabs”). Look for nits or lice at the bases of the pubic hairs. |
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Term
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Definition
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Term
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Definition
| prolapse of the urethral mucosa |
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Term
| A Bartholin's gland may become acutely or chronically infected and then produce a swelling |
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Definition
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Term
With the labia separated by your middle and index fingers, ask the patient to bear down. Note any bulging of the vaginal walls. Bulging suggests a |
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Definition
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Term
An imperforate hymen occasionally delays menarche. Be sure to check for this possibility when menarche seems unduly late in relation to the development of a girl's breasts and pubic hair. |
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Definition
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Term
1-A yellowish discharge on the endocervical swab suggests-
2-Raised, friable, or lobed wartlike lesions in- |
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Definition
1-A yellowish discharge on the endocervical swab suggests- mucopurulent cervicitis, commonly caused by Chlamydia trachomatis, Neisseria gonorrhoeae, or herpes simplex.
2-Raised, friable, or lobed wartlike lesions in- condylomata or cervical cancer. |
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Term
| Chlamydial infection is may lead to |
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Definition
urethritis, cervicitis, pelvic inflammatory disease, ectopic pregnancy, infertility, and chronic pelvic pain.
Risk factors include age younger than 25, multiple partners, and prior history of STDs |
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Term
| Pain on movement of the cervix by examinor, together with adnexal tenderness, suggest |
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Definition
| pelvic inflammatory disease |
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Term
| Uterine enlargement suggests |
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Definition
| pregnancy, uterine myomas (fibroids), or malignancy |
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Term
| Nodules on the uterine surfaces suggest |
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Definition
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Term
| Three to five years after menopause, ovaries are atrophic and usually nonpalpable. In postmenopausal women, investigate a palpable ovary for possible |
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Definition
ovarian cyst or ovarian cancer.
Pelvic pain, bloating, increased abdominal size, and urinary tract symptoms are more common in women with ovarian cancer |
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Term
| Adnexal masses can also arise from |
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Definition
| tubo-ovarian abscess, salpingitis or inflammation of the fallopian tubes from PID, or ectopic pregnancy |
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Term
Impaired strength of pelvic muscles may be because of |
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Definition
| age, vaginal deliveries, or neurologic deficits. Weakness may be associated with urinary stress incontinence. |
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Term
| Urethritis may arise from |
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Definition
| infection with Chlamydia trachomatis or Neisseria gonorrhoeae |
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Term
“No inguinal adenopathy. External genitalia without erythema, lesions, or masses. Vaginal mucosa pink. Cervix parous, pink, and without discharge. Uterus anterior, midline, smooth, and not enlarged. No adnexal tenderness. Pap smear obtained. Rectovaginal wall intact. Rectal vault without masses. Stool brown and hemoccult negative.
OR
“Bilateral shotty inguinal adenopathy. External genitalia without erythema or lesions. Vaginal mucosa and cervix coated with thin white homogeneous discharge with mild fishy odor. After swabbing cervix, no discharge visible in cervical os. Uterus midline; no adnexal masses. Rectal vault without masses. Stool brown and hemoccult negative.”
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Definition
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Term
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Definition
| A small, firm, round cystic nodule in the labia suggests an epidermoid cyst. These are yellowish in color. Look for the dark punctum marking the blocked opening of the gland. |
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Term
| Venereal Wart (Condyloma Acuminatum) |
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Definition
| Warty lesions on the labia and within the vestibule suggest condyloma acuminatum. They result from infection with human papillomavirus. |
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Term
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Definition
| A firm, painless ulcer suggests the chancre of primary syphilis. Because most chancres in women develop internally, they often go undetected. |
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Term
| Secondary Syphilis (Condyloma Latum) |
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Definition
| Slightly raised, round or oval, flat-topped papules covered by a gray exudate suggest condylomata lata. These constitute one manifestation of secondary syphilis and are contagious. |
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Term
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Definition
| Shallow, small, painful ulcers on red bases suggest a herpes infection. Initial infection may be extensive, as shown. Recurrent infections usually are confined to a small local patch. |
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Term
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Definition
| An ulcerated or raised red vulvar lesion in an elderly woman may indicate vulvar carcinoma. |
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Term
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Definition
| A 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. |
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Term
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Definition
| When the entire anterior vaginal wall, together with the bladder and urethra, is involved in the bulge, a cystourethrocele is present. A groove sometimes defines the border between urethrocele and cystocele, but is not always present. |
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Term
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Definition
| A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus. It occurs chiefly in postmenopausal women and usually causes no symptoms. Occasionally, a carcinoma of the urethra is mistaken for a caruncle. To check, palpate the urethra through the vagina for thickening, nodularity, or tenderness, and feel for inguinal lymphadenopathy. |
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Term
| Prolapse of the Urethral Mucosa |
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Definition
| Prolapsed urethral mucosa forms a swollen red ring around the urethral meatus. It usually occurs before menarche or after menopause. Identify the urethral meatus at the center of the swelling to make this diagnosis. |
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Term
| Bartholin's Gland Infection |
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Definition
| Causes of a Bartholin's gland infection include trauma, gonococci anaerobes like bacteroides and peptostreptococci, and Chlamydia trachomatis. Acutely, it appears as a tense, hot, very tender abscess. Look for pus coming out of the duct or erythema around the duct opening. Chronically, a nontender cyst is felt. It may be large or small. |
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Term
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Definition
| A rectocele is a herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the endopelvic fascia. |
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Term
| Two kinds of epithelia cover the cervix: (1) shiny pink squamous epithelium, which resembles the vaginal epithelium, and (2) deep red, plushy columnar epithelium, which is continuous with the endocervical lining. These meet at the squamocolumnar junction. When this junction is at or inside the cervical os, only squamous epithelium is seen. A ring of columnar epithelium is often visible to a varying extent around the os—the result of a normal process that accompanies fetal development, menarche, and the first pregnancy |
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Definition
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Term
| With increasing estrogen stimulation during adolescence, all or part of this columnar epithelium is transformed into squamous epithelium by a process termed metaplasia. This change may block the secretions of columnar epithelium and cause retention cysts, also called nabothian cysts. These appear as translucent nodules on the cervical surface and have no pathologic significance. |
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Definition
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Term
| A cervical polyp usually arises from the endocervical canal, becoming visible when it protrudes through the cervical os. It is bright red, soft, and rather fragile. When only the tip is seen, it cannot be differentiated clinically from a polyp originating in the endometrium. Polyps are benign but may bleed. |
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Definition
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Term
1-Normal Shapes of the Cervical Os-
2-Types of Lacerations from Delivery- |
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Definition
1-Normal Shapes of the Cervical Os- oval or slitlike
2-Types of Lacerations from Delivery- Bilateral transverse, Unilateral transverse, Stellate |
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Term
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Definition
| Mucopurulent cervicitis produces purulent yellow drainage from the cervical os, usually as a result of infection from Chlamydia trachomatis, Neisseria gonorrhoeae, or herpes. These infections are sexually transmitted and may occur without symptoms or signs. |
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Term
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Definition
| Carcinoma of the cervix begins in an area of metaplasia. In its earliest stages, it cannot be distinguished from a normal cervix. In a late stage, an extensive, irregular, cauliflower-like growth may develop. Early frequent intercourse, multiple partners, smoking, and infection with human papillomavirus increase the risk for cervical cancer. |
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Term
| Fetal Exposure to Diethylstilbestrol (DES) |
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Definition
| Daughters of women who took DES during pregnancy are at greatly increased risk for several abnormalities, including (1) columnar epithelium that covers most or all of the cervix, (2) vaginal adenosis, i.e., extension of this epithelium to the vaginal wall, and (3) a circular collar or ridge of tissue, of varying shapes, between the cervix and vagina. Much less common is an otherwise rare carcinoma of the upper vagina. |
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Term
Trichomonal Vaginitis Candidal Vaginitis Bacterial Vaginosis
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Definition
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Cause
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Trichomonal Vaginitis
Trichomonas vaginalis, a protozoan; often but not always acquired sexually
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Candidal Vaginitis
Candida albicans, a yeast (normal overgrowth of vaginal flora); many factors predispose, including antibiotic therapy
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Bacterial Vaginosis
Bacterial overgrowth probably from anaerobic bacteria; may be transmitted sexually
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Discharge
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Yellowish green or gray, possibly frothy; often profuse and pooled in the vaginal fornix; may be malodorous
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White and curdy; may be thin but typically thick; not as profuse as in trichomonal infection; not malodorous
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Gray or white, thin, homogeneous, malodorous; coats the vaginal walls; usually not profuse, may be minimal
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Other Symptoms
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Pruritus (though not usually as severe as with Candida infection); pain on urination (from skin inflammation or possibly urethritis); dyspareunia
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Pruritus; vaginal soreness; pain on urination (from skin inflammation); dyspareunia
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Unpleasant fishy or musty genital odor
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Vulva and Vaginal Mucosa
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Vestibule and labia minora may be reddened. Vaginal mucosa may be diffusively reddened, with small red granular spots or petechiae in the posterior fornix. In mild cases, the mucosa looks normal.
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The vulva and even the surrounding skin are often inflamed and sometimes swollen to a variable extent. Vaginal mucosa often reddened, with white, often tenacious patches of discharge. The mucosa may bleed when these patches are scraped off. In mild cases, the mucosa looks normal.
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Vulva usually normal. Vaginal mucosa usually normal
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Laboratory Evaluation
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Scan saline wet mount for trichomonads
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Scan potassium hydroxide (KOH) preparation for branching hyphae of Candida.
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Term
| Retroversion of the Uterus |
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Definition
| Retroversion of the uterus refers to a tilting backward of the entire uterus, including both body and cervix. It is a common variant occurring in approximately 20% of women. Early clues on pelvic examination are a cervix that faces forward and a uterine body that cannot be felt by the abdominal hand. In moderate retroversion, the body may not be palpable with either hand. In marked retroversion, the body can be felt posteriorly, either through the posterior fornix or through the rectum. A retroverted uterus is usually both mobile and asymptomatic. Occasionally, such a uterus is fixed and immobile, held in place by conditions such as endometriosis or pelvic inflammatory disease. |
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Term
| Retroflexion of the Uterus |
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Definition
| Retroflexion of the uterus refers to a backward angulation of the body of the uterus in relation to the cervix. The cervix maintains its usual position. The body of the uterus is often palpable through the posterior fornix or through the rectum. |
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Term
| Myomas of the Uterus (Fibroids) |
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Definition
Myomas are very common benign uterine tumors. They may be single or multiple and vary greatly in size, occasionally reaching massive proportions. They feel like firm, irregular nodules in continuity with the uterine surface. Occasionally, a myoma projecting laterally can be confused with an ovarian mass; a nodule projecting posteriorly can be mistaken for a retroflexed uterus. Submucous myomas project toward the endometrial cavity and are not themselves palpable, although they may be suspected because of an enlarged uterus. |
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Term
Prolapse of the Uterus
In first-degree prolapse-
In second-degree prolapse-
In third-degree prolapse (procidentia)- |
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Definition
Prolapse of the Uterus
Prolapse of the uterus results from weakness of the supporting structures of the pelvic floor and is often associated with a cystocele and rectocele. In progressive stages, the uterus becomes retroverted and descends down the vaginal canal to the outside:
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In first-degree prolapse, the cervix is still well within the vagina.
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In second-degree prolapse, it is at the introitus.
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In third-degree prolapse (procidentia), the cervix and vagina are outside the introitus
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Term
| Adnexal masses most commonly result from |
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Definition
| disorders of the fallopian tubes or ovaries. Three examples—often hard to differentiate—are described. In addition, inflammatory disease of the bowel (such as diverticulitis), carcinoma of the colon, and a pedunculated myoma of the uterus may simulate an adnexal mass. |
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Term
Ovarian Cysts and Ovarian Cancer
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Definition
| Ovarian cysts and tumors may be detected as adnexal masses on one or both sides. Later, they may extend out of the pelvis. Cysts tend to be smooth and compressible, tumors more solid and often nodular. Uncomplicated cysts are not usually tender |
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Term
Ruptured Tubal Pregnancy
. |
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Definition
| A ruptured tubal pregnancy spills blood into the peritoneal cavity, causing severe abdominal pain and tenderness. Guarding and rebound tenderness are sometimes associated. A unilateral adnexal mass may be palpable, but tenderness often prevents its detection. Faintness, syncope, nausea, vomiting, tachycardia, and shock may be present, reflecting the hemorrhage. There may be a prior history of amenorrhea or other symptoms of a pregnancy |
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Term
| Pelvic Inflammatory Disease |
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Definition
| Pelvic inflammatory disease (PID) is most often a result of sexually transmitted infection of the fallopian tubes (salpingitis) or of the tubes and ovaries (salpingo-oophoritis). It is caused by Neisseria gonorrhoeae, Chlamydia trachomatis, and other organisms. Acute disease is associated with very tender, bilateral adnexal masses, although pain and muscle spasm usually make it impossible to delineate them. Movement of the cervix produces pain. If not treated, a tubo-ovarian abscess or infertility may ensue. |
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