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87 Cards in this Set
- Front
- Back
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What is puberty?
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- the complex process of sexual maturation
- its biological & psychological |
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When is the onset of puberty?
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- girls = 8 - 13 years
- boys = 9 - 14 years *Note: 55-90% of females are anovulatory (cannot get pregnant) their first 2 years |
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What is delayed puberty?
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- secondary sex characteristics develop at a later age ~ W = 13 years & M = 14-14.5 years
- 3% of the population has delayed puberty - more common in men than women |
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What causes delayed puberty?
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Hormonal changes:
~ hypergonadotropic hypogonadism = increase of FSH & LH ~ Hypogonadomtropic Hypogonadism = decrease LH & depressed FSH ~ Eugonadism |
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What is precocious puberty?
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- puberty occuring very early; more rare than delayed
- 75% of girls = idiopathic (no known cause/reason) - 3 different forms: 1) isosexual 2) heterosexual 3) incomplete - often reversed by meds, etc |
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Menstrual Cycle: length?
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- Cycle starts day 1 of bleeding
- lasts average of 28 days from cycle to cycle - Range of Normal = w/n 21 – 45 days |
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The menstrual cycle phases:
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- MENSES = flow lasts 3 to 6 days; blood loss average from 10 to 40ml (N < 80ml)
- FOLLICULAR PHASE = length varies; patho: FSH from Ant. Pituitary stimulates maturation of mature ovarian follicle/egg -> granulosa cells of the follicle secrete estrogen stimulating uterine endometrial proliferation - OVULATION = major change of hormones - LUTEAL PHASE is fixed @ 14 days = time from when egg is released until start of next flow/cycle; LH secretion from the Ant. pituitary initiates secretory phase of endometrium to prepare for implantation of pregnancy; no pregnancy = corpus luteum degenerates, stops secreting estrogen & endometrial lining is shed |
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What is not normal of Menstrual Cycle?
- Polymenorrhea - Oligomenorrhea - Hypermenorrhea - Menorrhea - Menorrhagia - Menometrorrhagia |
- Polymenorrhea = cycles shorter than 3 weeks
- Oligomenorrhea = cycles longer than 6-7 weeks - Hypermenorrhea = excessive flow - Menorrhea = extra duration of flow - Menorrhagia = increased amount and increased duration of flow - Menometrorrhagia = prolonged flow with intermediate bleeding b/t flow cycles |
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Dysfunctional Uterine Bleeding (DUB)
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- A disturbance of the menstrual cycle most often caused by an anovulatory cycle (egg not produced during that cycle)
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Causes of DUB
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- Progesterone is absent
- Estrogen continues to secrete - Estrogen stimulates hyperplasia of endometrial glands - endometrium reaches hypervascularity and breaks down - leading to irregular, prolonged, excessive bleeding *Note: anovulation = #1 cause of abnormal bleeding |
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What is primary amenorrhea?
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- absence of menstration by age 14 w/o development of secondary sex characteristics OR failure of menstration by age 16 regardless of presence of characteristics
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Etiologies of Primary Amenorrhea:
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- drastic weight reduction, malnutrition, extreme obesity, chronic illnesses, genital abnormalities present since birth, congenital dysgenesis, hypoglycemia, hyper/hypothyroidism, cystic fibrosis, Cushing’s Disease, hypogonadoprophic hypogonadism, hyperprolactinemia, testicular feminization, true hermaphroditism, adrenogenital syndrome, congenital heart disease, lesions of the CNS, Prader-Willi syndrome, Chromosomal abnormalities, pregnancy
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What is secondary amenorrhea?
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- NO vaginal bleeding for 6 months or more in a woman who has had PREVIOUS menstrual cycles
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What reasons for Secondary Amenorrhea?
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- lactation
- early adolescence - perimenopausal - hysterectomy - menopause - pregnancy - anovulation - dramatic weight loss - strenuous exercise - ovarian cysts - other; anemia & chemotherapy |
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What are the main causes of Secondary Amenorrhea?
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1) increased ovarian hormones
- polycystic ovarian syndrome-androgen excess - masculinizing tumors - feminizing tumors 2) decreased ovarian hormones - LOW gonadotropin levels - HIGH gonadotropin levels |
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What is primary dysmenorrhea?
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- pelvic pain associated with the onset of menses; occurs usually 1-2 days before period & 1-2 days once the period started
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What is the pathology of primary dysmenorrhea?
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1) excessive prostaglandin
2) increased myometrial contractions 3)constricts endometrial blood vessels 4)results in ischemia, endometrial bleeding and pain (pain comes from ischemia & contraction of myometrial) |
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What does secondary dysmenorrhea associated with? Lead to?
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- Secondary dysmenorrhea is diagnosed when symptoms are attributable to an underlying disease, disorder, or structural abnormality either within or outside the uterus. Primary dysmenorrhea is diagnosed when none of these are detected.
- endometriosis - pelvic adhesions - Uterine Fibroids - inflammatory disease - adenomyosis |
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What is Mittelsmirtz which can occur during the menstrual cycle?
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- it’s during mid-cycle, sharp pain, may last for several days
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What is the etiology of Mittelsmirtz?
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- development of a follicle result in ovarian enlargement; as the egg is extruded small amount of bleeding into the peritoneal cavity
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What are ovarian cysts?
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- ovarian cysts can be normal & abnormal; when we ovulate, every period we produce an ovarian cyst = is totally normal
- Abnormal ovarian cysts tend to be very LARGE; cause: discomfort, urinary retention, menstrual irregularities, bleeding if they rupture |
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What is polystic ovary syndrome (PCOS)?
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- excessive amounts of androgens (w/ conversion to estrogen) results in inhibited ovulation (aka no egg is secreted which is the #1 causes of infertility in women)
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What are the clinical manifestations of Polycystic ovary syndrome?
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- obesity
- dysfunctional bleeding - amenorrhea/oligomenorrhea - hirsuitism - acne - infertility - hormone specific – *increased insulin, increased androgens, possible decreased estrogen receptors |
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What are the etiologies of Polycystic Ovary Syndrome?
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- genetic x-linked disorder
- Cushing syndrome - genetic adrenal hyperplasia - thyroid disease - tumors *may have normal to high estrogen but low to very low progesterone with increased risk for endometrial polyps or cancer, breast cancer, metabolic syndrome, & low bone density |
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What are polycystic ovarian diseases?
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1) Stein- Leventhal syndrome
- large ovaries are covered with cysts - no ovulation - Idiopathic = inherited in some females 2) a variant of Syndrome X - hypertension - dyslipidemia - hyperinsulinemia (increased androgen) *All the above increase chances of stroke & heart attack |
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What does polycystic ovaries look like?
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- the ovaries are enlarged and have several fluid-filled sacs or cysts. These cysts may look like a string of pearls
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What is PMS/PMDD?
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- distressing physical, psychological, behavioral changes directly related to the luteal phase of the menstrual cycle
- over 200 different symptoms have been attributed to PMS – but only a discrete number have been shown well through controlled studies to constitute the syndrome |
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What is PMS?
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- abnormal responses to normal hormonal changes involving the brain, nervous, vascular, gastrointestinal & immunolgic systems
- most prominent in 30-40 years of age - etiology = unknown but evidence of somatic rather than psychic causes - distressing physical, psychological, behavioral changes directly related to the luteal phase of the menstrual cycle - The number of severity of symptoms have not been established for a definitive diagnosis - If symptoms appear through at lease 2-3 consecutive cycles, PMS is diagnosed |
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What is Leiomyoma?
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- aka fibroids
- it’s the overgrowth muscle tissue; benign tumor of the myometrium -> not considered precancerous - idiopathic - hormone dependent (grows rapidly during pg) |
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When is leiomyoma common?
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- during reproductive years & shrinks following menopause
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What type of symptoms does someone with meiomyoma have?
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- asymptomatic (no symptoms of disease or illness) until it grows too large & can be palpated
- Symptoms then are: abnormal bleeding with large tumors, pressure on adjacent structures & infertility |
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Endometriosis is?
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- characterized by the presence & proliferation of endometrial tissue in sites outside the endometrial cavity
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Endometriosis is located?
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- most frequent sites in or near the ovaries, uteroscaral ligaments & uterovesical peritoneum
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What is the etiology of endometriosis?
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- transportation via implantation or vascular dissemination
- endometrial tissue develops spontaneously outside the uterus |
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What are the clinical S/S of the endometriosis?
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- pelvic pain, dysmenorrhea, backache, abnormal uterine bleeding, dyspareunia, infertility, painful defecation or constipation
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What are the complications of endometriosis?
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- blood collects in cysts – aka chocolate cysts
- cyst ruptures leading to adhesions - bowel obstruction |
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What are pelvic relaxation disorders?
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- pelvic muscles are more relaxed therefore vagina becomes weaker & structures around vagina begin to protrude into the soft tissues of vagina
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What are these pelvic relaxation disorders?
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- cystocele: urinary bladder protrudes through the vaginal wall; due to lack of muscle control
- urethrocele: A hernia in which part of the urethra presses on or bulges through the vaginal wall - rectocele: colon protrudes through the vaginal wall - enterocele: small bowel protrudes through the vaginal wall - Uterine Prolapse: uterus begins to exit the vagina to the exterior |
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What happens during rectocele?
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- the colon is pressing against bladder posteriorly b/c lack of muscle control; colon is enlarging b/c stools collect there since muscles can not force bowel movement become constipated
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What causes pelvic relaxation?
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- Etiology: childbirth, weakness, injury, surgery, strong genetic predisposition
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What are the manifestations of pelvic relaxation?
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- discomfort, heaviness, constipation, bladder incontinence, irritation & infection of cervix
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What are common female sexual dysfunctions?
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- Vaginismus: involuntary muscle spasms of the pubococcygeal muscle in response to penetration
- Anorgasmia: inability to achieve orgasm - Dyspareunia: painful intercourse |
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What are male reproductive system problems?
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- Urethral Structure: caused by scarring resulting in narrowing of the urethra; can result in hydronephrosis (urinary retention) and renal failure
- varicocele: painful dilation of a vein w/n the spermatic cord - hydrocele: scrotal swelling caused by collection of fluid w/n the tunica vaginalis |
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What is hypospadias?
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- hole of urethra is on the posterior side of penis = abnormal
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Male Reproductive System Disorders: Cyptorchidism?
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- Cyptorchidism: failure of one or both testes to descend into scrotum
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Male Reproductive Disorders: Torsion of the Testis?
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- Torsion of the Testis: interruption of blood supply as the testis rotates & twists the arteries & veins in the spermatic cord = pain & swelling
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Male Reproductive Disorders: Phimosis?
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- Phimosis: foreskin of an uncircumcised penis cannot be retracted
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Male Reproductive Disorders: Paraphimosis?
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- Paraphimosis: foreskin of an uncircumcised penis is retracted but cannot get skin back over head of penis -> causes SEVERE PAIN
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Male Reproductive Disorders: Peyronie Disease?
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- Peyronie Disease: causes a bent penis during erection. A hard, fibrous layer of scar tissue (plaque) develops under the skin on the upper or lower side of the penis. When the penis is erect, the scar tissue pulls the affected area off at an angle, causing a curved penis. The plaque, formed by thickened layers of soft tissue in the penis is noncancerous (benign). The condition can cause pain and make sexual intercourse difficult.
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Male Reproductive Disorders: Priapism?
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- Priapism: extended erection; often painful
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Male Reproductive Disorders: Orchitis?
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- Orchitis: is the inflammation of one or both of the testicles, often caused by infection.
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Male Reproductive Disorders: BPH?
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- Benign Prostatic Hyperplasia (BPH): enlargement of the prostate; can cause urinary retention
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What is Benign Prostatic Hypertrophy?
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- prostate is pretty small when younger & then around age 30, it rapidly grows
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Male Reproductive System – EPIDIDYMITIS:
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- inflammation of the epididymis
- most common in sexually active young males |
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Etiology of Epididymitis?
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- STI
- Intestinal bacteria - UTI |
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What are the clinical manifestations of Epididymitis?
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- scrotal or inguinal pain
- pyuria, bacteriuria, urethral discharge - edematous scrotum |
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Male Reproductive System – Urethritis:
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- STI, not always but usually N. gonorrhea
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Male Reproductive System – Prostatits:
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- inflammation of the prostate
- Types: acute bacterial, chronic bacterial, nonbacterial |
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Female Reproductive – Vaginitis:
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- infection related to the vaginal pH and normal vaginal flora
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Vaginitis: Risk Factors?
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- anything that alters acidic vaginal environment aka Normal Flora
- douching - soaps - pregnancy - diabetes - antibiotic secondary infections |
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What are the causes of Vaginitis?
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1) infection of the vagina
- bacterial vaginosis - candida albicans - sexually transmitted pathogens 2) breakdown of defense mechanisms - skin integrity - vaginal pH (normal flora, cervical secretions) |
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What is Pelvic Inflammatory Disease (PID)?
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- painful acute inflammatory process involving the uterus, fallopian tubes, ovaries, or the entire peritoneal cavity
- most often associated with STI’s but not always - polymicrobial infection: gonorrhea/ chlamydia/ anaerobes/ other organisms |
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What is the pathology of PID?
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- microbes ascend > edema of tubule walls > lumen is filled with purulent exudate > obstructs tube > restricts drainage into uterus > exudate drips out of the fimbriae onto ovary & surrounding tissue -> abscesses possible
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What are the PID manifestations?
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- sudden, severe pain or dull & steady pain
- fever - salpingitis - symptoms during or after menstruation - dysuria - irregular bleeding |
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PID Sequella:
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- repeated infections are common
- infertility - ectopic pregnancy - chronic pelvic pain - adhesions - abscess - septic shock |
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Male & Female Disorders of the Breast: Fibrocystic Breast Disease =
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- Fibrocystic Breast Disease: have to have presence of nodules or masses in breast tissue aka benign breast disease
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When does fibrocystic breast disease occur?
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- changes occur during the menstrual cycle esp. with fluctuation in estrogen but not with fibroadenoma
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What happens?
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- connective tissue replaced by dense fibrous tissue
- epithelial cells in ducts proliferate with hormones - cysts enlarge over time -> causes degeneration of normal tissue |
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The 3 classifications r/t risk developing cancer
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- nonproliferative – fibroadenoma= single & movable; 15-35; increased estrogen sensitivity in localized area
- Proliferative lesion – increased risk of cancer exp. if family hx - atypical hyperplasia |
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Benign Breast disease: Mastitis
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- inflammatory condition
- staphylococcus - S/S = erythema, pain, fever, leukocytosis |
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Breast Mentionables:
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- Galactorrhea: pathophys = not breast, primarily hormonal
- Gynecomastia: overdeveloped breast tissue in men |
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Topics I should focus on
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• alterations in sexual maturity
• normal menstrual patterns • abnormal uterine bleeding • pathophys of dysmenorrhea • causes for primary & secondary amenorrhea • manifestations for & pathophysiology of PCOS • types of pelvic relaxation & contributing factors • benign prostatic hypertrophy • outcomes of types of sexually transmitted infections (STI) *contributing factors for STIs • Pelvic inflammatory disease (PID) |
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90-95% delayed puberty is due to =
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slow maturation
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disturbance menstrual cycle due to anovulation characterized by irregular/heavy bleeding, endometrial hyperplasia=
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dysfunctional uterine bleeding
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pelvic relaxation disorder, descent bladder ant anterior vaginal wall, related to childbirth =
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cystocele
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sites of implantation of endometrial tissue throughout body that responds to changes in menstrual cycle =
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endometriosis
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leading cause of infertility, female =
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PID, pelvic inflammatory disease
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common etiology true precocious puberty=
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idiopathic
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menstrual cycle, abnormal =
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luteal phase of 7 days
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common s/s with polycystic ovaries, hirutism, acne =
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increased androgens
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prolonged duration, excessive menstrual flow =
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menorrhagia
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Testicular torsion =
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involves blood flow interruption
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most common bacterial sexually transmitted infection =
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chlamydia
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painful dilation and decreased blood flow caused by incompetent valves of spermatic veins =
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varicocele
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foreskin cannot be retracted over penis =
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phimosis
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men over 50, urinary retention, difficulty starting stream, =
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BPH
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leiomyomas =
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benign tumors of myometrium
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