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154 Cards in this Set
- Front
- Back
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External Anatomy |
aka Vulva/Pudendum Mons Pubis Labia majora Labia minora Prepuce Clitoris Vestibule Perineum |
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Mons Pubis |
Pad of adipose tissue covering the symphysis pubis Covered by coarse terminal hair |
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Labia majora |
Outside fold of adipose tissue Outer surface covered with hair |
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Labia minora |
Smaller, hairless fold of skin inside the labia majora Joined anteriorly at the clitoris and posteriorly at the fourchette |
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Prepuce |
Hood of skin over clitoris |
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Clitoris |
Erectile tissue |
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Vestibule |
Contains openings to several structures and glands Urethral meatus Paraurethral glands Vaginal orifice Bartholin's glands |
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Perineum |
Tissue between fourchette and anus |
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Urethral meatus |
Anterior position within vestibule Sometimes within the vagina: increases risk of UTIs |
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Paraurethral glands |
Skene's glands Urethral ducts on each side of urethra that secrete fluid and drain into urethra Commonly infected by gonorrhea: purulent drainage |
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Vaginal orifices |
Introitus Posterior to urethral meatus Contains Hymen |
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Hymen |
Fold of tissue at vaginal opening Ruptures spontaneously or at time of sexual intercourse, tampon use Can leave remnants of tissue/skin tags |
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Bartholin's glands |
Ductal openings not usually visible Secrete clear lubricating mucous during sexual excitement phase Located at 4 and 8 o'clock posterior to vaginal opening |
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Bartholin's cyst |
Obstruction of ductal opening |
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Bartholin's abcess |
Infection usually caused by gonoccocal infection |
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Internal anatomy |
Vagina Cervix Uterus Adenexa |
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Vagina |
Between bladder (anterior) and rectum (posterior) Lined with Rugae |
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Rugae |
Folds along the walls during reproductive years Smooth after menopause |
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Cervix |
Neck of uterus Protrudes 1-3 cm into vagina Fornix Two types of cells: squamous, columnar Squamo-columnar junction Transformation zone |
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Prolapsed cervix |
Protruding > 3 cm into vagina |
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Fornix |
Circular pocket around cervix Anterior, posterior, lateral fornices |
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Cervical cells |
Squamous cells Columnar cells: glandular endocervical cells - Secrete mucous, darker tissue |
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Squamo-columnar junction |
Area where columnar cells meet squamous cells |
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Transformation zone |
Common cervical cancer site |
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Uterus |
Muscle Lined with endometrium |
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Endometrium |
Lines uterus Shed with menstration Not shed if a fertilized ovum attaches and becomes an embryo |
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Adenexa |
Ovaries and fallopian tubes, right and left Ovum released from ovaries and travels through fallopian tubes |
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Developmental changes: Puberty |
Estrogen stimulates growth and development of secondary sex characteristics Begins between 8-13, lasts approx 3 yrs Irregular menstration cycle in adolescence: failure to ovulate each month |
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Puberty |
First sign: breast and pubic hair development Menarche: ages 10-14 yrs |
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Precocious puberty |
Development of secondary sex characteristics before age 8 |
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Developmental changes: Older adult |
Menopause Ovarian function changes Pubic hair thins and grays Atrophy of labia, clitoris, vagina, ovaries, uterus Ligaments relax, uterus may slightly prolapse Vaginal changes: atrophic vaginitis, increased vaginal pH |
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Menopause |
One yr without menses 48-55 yrs, average age 51 yrs Some incidence of premature menopause |
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Older adult ovarian changes |
Cycles become irregular and further apart r/t irregular ovulation Ovaries stop producing estrogen and progesterone |
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Prolapsed uterus |
May cause stress incontinence r/t increased pressure of the uterus on the bladder |
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Atrophic vaginitis |
Decreased elasticity, dryness May cause dyspareunia May treat with estrogen vaginal cream |
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Dyspareunia |
Pain with intercourse |
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Increased vaginal pH |
Alkalinity More prone to infections in postmenopausalwomen |
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Subjective History: Menstral history |
Age of menarche: early menarche results in longer lifetime exposure to estrogen and increased risk of certain cancers (breast) LMP LNMP |
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LMP |
Last menstral period First day of last period |
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LNMP |
Last normal menstral period |
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Subjective Data: characteristics of cycle and menses |
Regularity, frequency, duration, character of flow, associated symptoms Premenstral symptoms: HA, weight gain, edema, breast tenderness, irritability, mood, physical and emotional changes Dysmenorrhea |
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Dysmenorrhea |
Painful menstration |
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Amenorrhea |
Absences of menses |
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Primary Amenorrhea |
Failure to start menses |
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Secondary amenorrhea |
Cessation of menses after starting Pregnancy, lactation, menopause, decreased body fat |
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Uterine bleeding |
Excessive bleeding may result in anemia |
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Hypomenorrhea |
Light menstral bleeding or spotting |
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Menorrhagia |
Heavy bleeding during periods Associated with dysmenorrhea Fibroids |
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Metrorrhagia |
Bleeding at irregular intervals Hormonal imbalance Uterine Cancer |
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Post-coital bleeding |
Rough Sex Cervical inflammation: STDs Cervical polyps |
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DUB |
Dysfunctional uterine bleeding Abnormal uterine bleeding Diagnosis can only be made after ruling out tumo, inflammation, pregnancy, trauma, hormonal imbalance |
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Postmenopausal bleeding |
Menstral bleeding 6 months after menopause May indicate endometrial cancer |
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Menopause Symptoms |
Hot flashes Mood changes Insomnia Vaginal dryness |
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Surgical menopause: hysterectomy |
Hysterectomy with bilateral salpingo-oophorectomy (SBO) Immediate menopause Endometrial cancer vs fibroids |
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Myoma |
Fibroids |
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Surgical menopause: Total hysterectomy |
Removal of uterus and cervix only Will not have periods Will still have menopause |
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Hormone replacement |
Indicated for menopausal symptoms Not recommended No more than 5 yrs |
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Estrogen + Progesterone |
Premarin + Provera Progesterone prevents uterine cancer |
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Estrogen only |
S/P hysterectomy Increases risk of endometrial cancer |
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Estrogen replacement |
Breast cancer Decreases osteoporosis |
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Menopausal birth control |
At high risk for pregnancy during perimenopausal period |
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Subjective data: Urinary symptoms |
Dysuria Urgency Frequency Nocturia suprapubic heaviness/discomfort |
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Subjective data: obstetric history |
Gravida: number of pregnancies Para: number of births Problems: gestational diabetes Abortions |
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Abortions |
SAB: spontaneous TAB: therapeutic |
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Subjective: Para |
Number of births Vaginal vs C-Section Preterm vs term |
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Papanicolaou Smear |
PAP smear Done to assess for abnormal cervical cells, cervical cancer |
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Risk of abnormal PAP |
Risk increased for cervical cancer Multiple sex partners Partners with multiple partners Early sexual activity (before 18): increased total lifetime partners Oral contraceptives: less likely to use condoms STIs: HPV Smoking: increases risk for cervical cancer |
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Recommendation for PAP smears: < 21 yrs |
No screening |
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Recommendations for PAP smears: 21-29 yrs |
Cytology every 3 yrs |
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Recommendations for PAP smears: 30-65 yrs |
Cytology + HPV co testing every 5 yrs or Cytology every 3 yrs |
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Recommendations for PAP smears: > 65 yrs |
No screening if prior screening negative
- 3 consecutive negative cytologies or 2 negative co-test results within 10 yrs, most recent test within 5 yrs - No history of cervical cancer, CIN grade 2 or higher, adenocarcinoma in situ |
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Abnormal PAPs |
Colposcopy: biopsy of cervix Acetic acid applied to cervix, lesions turn white and biopsy can be taken |
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Cervical Dysplasia |
Can lead to cervical cancer Decreased ability to have children |
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Procedures to destroy abnormal cells |
Cervical dysplasia LEEP procedure Cryosugery Follow up PAP q 3 months |
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LEEP |
Loop electrocautery excision procedure Burns abnormal tissue Normal cells replace abnormal |
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Cryosurgery |
Freezes abnormal tissue |
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STI |
Sexually transmitted infections Gonorrhea, chlamydia, PID, trichomonous, syphilis, herpes, HPV, HIV, Hep B |
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Immunizations: Hep B |
3 dose series Give at month 0, 1, 6 |
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HPV vaccines: Gardisil |
Can be given to males and females Protects against subtypes 16 & 18 (70% of cervical cancer) Protects against subtypes 6 & 11 (90% of genital warts) Protects against precancers of vulva and vagina Given at month 0, 2, 6 |
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Gardisil ages |
Girls: 11-12 yrs, as early as 9 yrs old - Catch up vaccine 13-26 yrs if not previously given Boys: 9-26 yrs |
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HPV vaccines: cervarix |
Protects only against subtypes 16 & 18 Protects only against cervical cancer Given at month 0, 1, 6 Not recommended for boys/men: doesn't protect against condyloma |
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Condyloma |
Genital warts |
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Non-Sexually transmitted infections |
Candidiasis (yeast) Bacterial vaginosis (BV) |
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Candidiasis and DM |
Elevated blood glucose levels are prone to frequent yeast infections Undiagnosed or poorly controlled diabetics |
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Bacterial vaginosis |
Avoid douching: changes vaginal pH Avoid tight clothing: jeans, thongs |
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Reproductive surgeries |
Tubal ligation Hysterectomy Oopherectomy |
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Birth control method |
Satisfaction, knowledge, commitment, problems |
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Estrogen-related complications |
ACHES Abdominal pain: liver, toxicity Chest pain/SOB: PE Headache: stroke Eye/vision changes: stroke Severe leg pain: DVT |
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Emergency contraception |
After UPIC Plan B - One step |
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Plan B- One step |
Progestin only pill All women of child bearing age may get without prescription Take within 72 hrs of UPIC, best within 24 hrs May be effective up to 5 days |
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UPIC |
Unprotected intercourse |
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Condoms |
Use for risk of pregnancy and STI Encourage use even while women is taking other contraceptives |
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Sexual history |
Number of partners Time with current partner Mutually monogamous relationship Use of barrier protection Difficulties, concerns, problems, satisfaction, sexual preference |
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Family history |
Gynecologic or breast cancer Diethylstilbestrol exposure Multiple pregnancies |
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DES |
Diethystilbestrol (DES) exposure in utero 1938-1971 drug to decrease risk of miscarriage Increased risk of vaginal and cervical cancers |
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Pelvic exam |
Pt to empty bladder prior to exam Check light source, have supplies within reach Lithotomy position (supine, feet in foot rest) Protect modesty (drape) Ensure privacy |
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Anxiety toward pelvic exam |
Excessive anxiety should not be ignored Address your observations with the pt Underlying issues: sexual abuse, molestation, fear of finding abnormalities |
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Inspect external genitilia |
Hair distribution Skin Parasites Lesions Discharge |
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Palpate external structures |
Inguinal lymph nodes Labia majora: lesions, tenderness Paraurethral glands Bartholin's glands |
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Palpate inguinal lymph nodes |
Enlarged, tender: drain external genitilia Do not drain uterus or ovaries |
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Palpate paraurethral glands |
Place finger in vagina and stroke upward along urethra Observe for urethral meatus May indicate urethritis r/t STI |
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Batholin's glands |
Palpate with thumb and index finger Swelling, discharge, tenderness If there is swelling: warm compress, Sitz bath, can lead to abcess |
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Assess pelvic musculature |
Insert index and middle finger into vagina Ask pt to contract muscles Muscle laxity: neurologic problem, MS Ask pt to bear down: check for prolapse |
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Cytocele |
Prolapsed bladder through vaginal wall Anterior pouching |
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Rectocele |
Prolapsed rectum through vaginal wall Posterior pouching |
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Uterine prolapse |
Cervix protrudes > 3-5 cm into vagina Severe prolapse needs surgical correction |
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Internal exam |
Use speculum, lubricated with tap water only as not to alter results of PAP and cultures Clear or metal |
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Pederson Speculum |
Small, narrow blade May use for nulliparous and post menopausal women |
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Graves speculum |
Larger, wider blade Use for multiparous women |
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Vaginal walls |
Assess for color or lesions, abnormal secretions Rugation |
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Menopausal rugation |
smooths out |
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Vaginal discharge: clear without odor |
Normal finding |
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Vaginal discharge: white, curd-like |
Yeast |
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Vaginal discharge: yellow, foamy |
Trichomonous |
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Vaginal discharge: gray, malodorous |
Bacterial vaginosis |
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Cervical exam |
Poor technique if not fully visualized Color Position |
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Cervical color: postmenopausal |
Dark pink |
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Cervical color: menopausal |
Pale |
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Cervical color: pregnancy |
Bluish-purple Chadwick's sign |
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Anteverted uterus |
Posterior cervix |
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Retroverted uterus |
Anterior cervix position |
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Midposition uterus |
Horizontal cervix |
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Anteflexed uterus |
Bent uterus Horizontal cervix |
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Retroflexed uterus |
Bent uterus Horizontal cervix |
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Right or left deviation of cervix |
Pelvic mass Uterine adhesions Pregnancy |
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Cervical protrusion |
> 3 cm into vagina Pelvic mass Uterine mass Uterine prolapse |
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Cervical surface characteristics |
Smooth Squamocolumnar epithelium may be visible |
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Nabothian cyst |
Small white or yellow papule on cervix Common Occurs when squamous tissue grows over mucous secreted by columnar tissue Benign, documented but not treated |
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Cervicitis |
Indicates STI Endocervical contact bleeding with cotton swab Friable cervix Presence of mucopurulent endocervical exudate from cervical os |
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Strawberry cervix |
Seen with trichomonas |
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Cervical shape |
Round: before childbirh Horizontal slit: after vaginal delivery Laceration |
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PAP smear |
Specimen collection: be sure to sample transformation zone Spatula and brush Broom |
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Spatula and brush |
Ectocervix: squamous cell, spatula Endocervical: columnar cells, brush |
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Broom |
Collects cells from ectocervix and endocervix |
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Slide method |
Use fixative immediately Cells die within seconds |
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Thin Prep collection |
Twirl spatula/broom and brush 10x in solution Don't leave spatula, brush, broom in the solution because cells may adhere and prevent analysis |
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Blood and PAP results |
Collect PAP when not on menstrual period Collect PAP before wet mount or cultures |
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PAP report |
No transition zone: not a good specimen Needs to be repeated |
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Wet mount |
Microscopic eval of vaginal discharge to assess for infection |
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Wet Mount: KOH |
Potassium hydroxide: candida under microscope have branchlike Hify and buds |
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Wet mount: Positive amine |
Whiff test: fishy BV and trichomonous |
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Wet mount: NS |
Microscopic view to look for BV or trichomonous BV: Clue cells Trichomonous: tail, mobile, STI |
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pH of vaginal secretions |
Vulvovaginal candidiasis < 4.5 BV > 4.5 Trichomonous > 5 |
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Vaginal cultures |
Chlamydia and Gonorrhea Insert swab into cervix, rotate and leave for 20-30 seconds |
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Bimanual abdominal exam |
Index and middle finger in vagina/hand on abd Intravaginal fingers in anterior fornix/press on abd Palpate uterus: anteverted, anteflexed |
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Uterine position: Anteverted/Anteflexed |
Most common |
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Uterine position: Retroverted and retroflexed |
Difficult to get fingers into posterior fornix under cervix: slide off |
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Uterine size and contour |
Smooth Non pregnant: 5.5 - 8 cm x 4 cm Enlarged: pregnancy or mass, myoma |
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Palpate adnexa |
Ovaries Fallopian tubes |
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Ovaries |
Palpated intravaginally Smooth, firm, moderate TTP Premenopausal 3 x 2 x 1 cm Post menopausal 1-2 cm - Should not be palpated, definitely not 5 yrs post menopause. - Enlargement may be r/t ovarian cancer |
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Fallopian tubes |
Should not be palpable Could be adnexal mass |
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Assess CMT |
Cervical motion tenderness "Chandalier sign" Sign of PID, pain with motion Inflammation from uterus to sterile peritoneum |
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Bimanual recto-vaginal exam |
Necessary for evaluation of retroverted and retroflexed uterus Vagina and middle finger in rectum, abd wall Place index finger in posterior fornix and pt bear down: moves cervix and uterus down, press down on the abd wall Palpate posterior cervix and uterus |
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Seen on bimanual assessment |
Ovarian cyst Ectopic pregnancy Myoma Endometrial cancer Endometriosis |
