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235 Cards in this Set

  • Front
  • Back
The symphysis pubis is covered by a pad of adipose tissue called the ___ or ____
mons pubis or mons veneris
Extending downward and backward from the mons pubis are the ____, two folds of adipose tissue covered by skin
labia majora
Lying inside and usually hidden by the labia majora are the ____, two hairless, flat, reddish folds
labia minora
Posteriorly, the labia minora meet as two ridges that fuse to form the ___
Tucked between the frenulum and the prepuce is the ___, a small bud of erectile tissue, the homolog of the penis and a primary center of sexual excitement.
_____ drain a group of urethral glands and open onto the vestibule on each side of the urethra.
Skene ducts
____, located posteriorly on each side of the vaginal orifice, open onto the sides of the vestibule in the groove between the labia minora and the hymen
Bartholin glands
During sexual excitement, ____ secrete mucus into the introitus for lubrication.
Bartholin glands
The vagina inclines posteriorly at an angle of approximately ___degrees with the vertical plane of the body
45 degrees
The anterior wall of the vagina is separated from the bladder and urethra by connective tissue called the ____
vesicovaginal septum
The posterior vaginal wall is separated from the rectum by the _____
rectovaginal septum
The __________ is a deep recess formed by the peritoneum as it covers the lower posterior wall of the uterus and upper portion of the vagina, separating it from the rectum
rectouterine cul-de-sac (pouch of Douglas)
In nulliparous women the uterus size is approximately ___cm long, ___cm wide, and ___ cm thick
5.5 to 8 cm, 3.5 to 4 cm, 2 to 2.5 cm
The nonpregnant uterus weighs approximately ___ g
60 to 90
The ____ of the uterus comprise the fallopian tubes and ovaries.
Each fallopian tube ranges from___ cm long and is supported by a fold of the broad ligament called the ____
8 to 14cm, mesosalpinx
The ovaries are approximately ___ long, ___wide, ___thick in the adult woman during the reproductive years
3 cm long, 2 cm wide, and 1 cm thick
The internal genitalia are supported by four pairs of ligaments:___, ___, ___, ___
the cardinal, uterosacral, round, and broad ligament
Protrusion of the abdomen as the uterus grows causes the pelvis to tilt ___, placing additional strain on the back and sacroiliac joints.
The shallow upper section is considered the ___ pelvis, which consists mainly of the flared-out iliac bones
The ___ pelvis is the lower curved bony canal, including the inlet, cavity, and outlet; through these the fetus must pass during birth
The upper border of the pelvis outlet is at the level of the___, which project into the pelvic cavity and serve as important landmarks during labor.
ischial spines
The lower border of the pelvis outlet is bounded by the___ and ___
pubic arch and the ischial tuberosities
In infants/children, The uterus is approximately ___ long, with the cervix constituting about two thirds of the entire length of the organ.
35 mm
During childhood, the genitalia, except for the ___, grow incrementally at varying rates. Anatomic and functional development accelerates with the onset of puberty and the accompanying hormonal changes.
In adolescents, If the hymen is intact, the vaginal opening is about ___
1 cm
onset of menstruation (menarche), which on the average, occurs between ____ years of age in the United States
11 and 14
The high levels of _______that are necessary to support pregnancy are responsible for uterine enlargement during the first trimester.
estrogen and progesterone
After the third month, uterine enlargement is primarily the result of __________
mechanical pressure of the growing fetus
During pregnancy, when does the uterus enter the abdominal cavity?
12 weeks of gestation
Hormonal activity (___ and ___) is responsible for the softening of the pelvic cartilage and strengthening of the pelvic ligaments.
relaxin and progesterone
Pregnancy, The symphysis pubis relaxes and increases in width, and there is marked mobility of the pelvis at term with resolution of changes occurring within _______ postpartum
3 to 5 months
During pregnancy, an increase in ___ and ___ causes pelvic congestion and edema
uterine blood flow and lymph
During pregnan y, The glands near the external os proliferate with eversion of the _____, which tend to be friable.
columnar endocervical glands
The softness and compressibility of the isthmus result in exaggerated uterine ____ during the first 3 months of pregnancy, causing the fundus to press on the urinary bladder.
During pregnancy, The vaginal changes are similar to the cervical changes and result in the characteristic ___ color
During pregnancy, The papillae of the mucosa have a ___ appearance
During pregnancy, The vaginal secretions increase and have an acidic pH due to an increase in ___ production by the vaginal epithelium.
lactic acid
___ is conventionally defined as 1 year with no menses.
avergae age of Menopause
between 40 and 55 year
After menopause, The vagina narrows, shortens, and loses its rugation; and the mucosa becomes thin, pale, and dry, which may result in ___
Menopause has systemic effects, which include an increase in___ and ___.
body fat and intraabdominal deposition of body fat (tendency toward male pattern of body fat distribution)
After Menopause, Levels of total and low-density lipoprotein cholesterol ___
After menopause, women experience an increased risk of ___ disease
shortened interval between periods
less than 19 to 21 days
lengthened interval between periods
more than 37 days
High risk HPV
HPV 16, 18, 31, 33, 45
sexual intercourse before ___ of age is a risk factor for cervical cancer
16 years
Cervical cancer Cigarette smoking: ___ the risk; tobacco by-products have been found in the cervical mucus of women who smoke.
women whose mothers took _____ during pregnancy are at risk for cervical cancer
diethylstilbestrol (DES)
Race: invasive cervical cancer rates are higher in ___, ___, ___.
blacks, Hispanics, and Native Americans/American Indians
Some evidence indicates that long-term use (___) of OC may slightly increase the risk of cervical cancer
more than 5 years
Most ovarian cancers develop after menopause; half are found in women older than ___ of age.
63 years
Reproductive history risk factor for Ovian cancer; early menarche (before ___), infertility, nulliparity, or first child after ___, menopause after ___
early menarche (before age 12), or first child after age 30, menopause after age 50
Which Inherited genetic mutation is a risk factor for Ovarian cancer
BRCA1 or BRCA2 gene.
Ovarian cancer occurs 50% more frequently in __ women than __ women.
white > black
use of cosmetic __ in feminine hygiene sprays or in sanitary napkins has been suggested as a risk factor for ovarian caner
talc (Talcum powder)
What about reproductive years are a increase risk factor for endometrial cancer
Early menarche: before 12 years of age; Late menopause: after 50 years of age; increases the number of years during which the endometrium is exposed to estrogen.
Women with increased bleeding during perimenopause have an increased risk (___greater) of endometrial cancer
4 times
Having many pregnancies __ endometrial cancer risk, and women who have not been pregnant have a___.
reduces, higher risk
Obesity increases a woman's risk of endometrial cancer by ___.
2 to 5 times
What antiestrogen drug is a risk factor for Endometrial Cancer
endometrial cancer more common in women with what endocrine disease.
both type I and type II diabetes
What genetic mutation is a risk factor for endometrial cancer
Position used to for Female GU examination
Labial swelling, redness, or tenderness, particularly if unilateral, may be indicative of a _____
Bartholin gland abscess
Labia minora, Look for inflammation, irritation, excoriation, or caking of discharge in the tissue folds, which suggests __ or ___
vaginal infection or poor hygiene
Labia minora, Discoloration or tenderness may be the result of ___
traumatic bruising
Labia minora, Ulcers or vesicles may be signs of a___
sexually transmitted infection
Generally the clitoris is about __ cm or less in length and __ cm in diameter.
2cm, 0.5cm
Clitoris Enlargement may be a sign of a __ condition
Urethral orifice, Signs of irritation, inflammation, or dilation suggest repeated ___ or ___
urinary tract infections or insertion of foreign objects
hymenal remnants (___)
myrtiform caruncles
Discharge from the Skene glands or urethra usually indicates an infection, most commonly, but not necessarily, ___
Swelling that is painful, hot to the touch, and fluctuant is indicative of an __ of the Bartholin gland
The abscess of Bartholin gland is usually ___ or ___ in origin and is pus filled.
gonococcal or staphylococcal
A nontender mass on the Bartholin gland is indicative of a ___, which is the result of chronic inflammation of the gland.
Bartholin cyst
Bulging of the anterior wall and urinary incontinence indicate the presence of a ___
Bulging of the posterior wall indicates a ____
___ is marked by protrusion of the cervix or uterus on straining.
Uterine prolapse
The perineal surface should be smooth; ___ scarring may be evident in women who have borne children
A bluish color cervix indicates _________.
increased vascularity, which may be a sign of pregnancy
Symmetric, circumscribed erythema around the os is an ___ that indicates exposed columnar epithelium from the cervical canal.
expected finding
A pale cervix is associated with ___
cervix that is pointing anteriorly indicates a ___ uterus; one pointing posteriorly indicates an ___ uterus.
retroverted, anteverted
A cervix in the horizontal position indicates a uterus in ___
Cervix Deviation to the right or left may indicate a___, __, __.
pelvic mass, uterine adhesions, or pregnancy
Cervix Projection greater than 3 cm may indicate a ____.
pelvic or uterine mass
The cervix of a woman of childbearing age is usually 2 to 3 cm in diameter. An enlarged cervix is generally indicative of a ____.
cervical infection
____ may be observed as small, white or yellow, raised, round areas on the cervix
Nabothian cysts
An ____ becomes swollen with fluid and distorts the shape of the cervix, giving it an irregular appearance.
infected nabothian cyst
Look for friable tissue, red patchy areas, granular areas, and white patches that could indicate ____, ___, ___.
cervicitis, infection, or carcinoma
The os of a ___ woman is usually a horizontal slit or may be irregular and stellate.
In pap swear, The cylindric-type brush collects___ cells only.
The ____ device is used for collecting both ectocervical and endocervical cells at the same time
DNA Probe for Chlamydia and Gonorrhea, Use a ___ (with plastic or wire shaft) when collecting your specimen, because wooden cotton-tipped applicators may interfere with the test results
Dacron swab
In a woman with vaginal discharge, these microscope examinations can demonstrate the presence of Trichomonas vaginalis, bacterial vaginosis, or candidiasis.
Wet Mount and Potassium Hydroxide (KOH) Procedures
The presence of trichomonads indicates ___.
T. vaginalis
The presence of bacteria-filled epithelial cells (clue cells) indicates ____
bacterial vaginosis (Gardnerella vaginalis)
he presence of fishy odor (the "whiff test") suggests___.
bacterial vaginosis
The KOH dissolves epithelial cells and debris and facilitates visualization of the ____
mycelia of a fungus
Cervix, Reddened patches, lesions, or pallor indicates a __ or __
local or systemic pathologic condition
Painful cervical movement suggests a pelvic inflammatory process such as ___ or ___.
acute pelvic inflammatory disease or a ruptured tubal pregnancy
uterus Deviation to the right or left is indicative of ___, ___, ___.
possible adhesions, pelvic masses, or pregnancy
____ lower abdominal pain associated with ovulation, may be accompanied by a degree of tenderness on the side in which ovulation took place that month and even by similarly unilateral and usually quite mild adnexal tenderness
Uterus should be pear shaped and ___cm long
5.5 to 8cm
A fixed uterus indicates __
Uterus Tenderness on movement suggests a ____ or ___.
pelvic inflammatory process or ruptured tubal pregnancy
The ovaries, if palpable, should feel firm, smooth, ovoid, and approximately __ by__ by__ cm in size.
3 by 2 by 1 cm
An extremely tight anal sphincter may be the result of anxiety about the examination; may be caused by scarring; or may indicate spasticity caused by __, __, __.
fissures, lesions, or inflammation
A lax anal sphincter suggests ____, whereas an absent sphincter may result from improper repair of ___ after childbirth or trauma.
neurologic deficit, third-degree perineal laceration
For infants, Examination is conducted with the infant's legs held in a ___
frog position
enlarged clitoris must always suggest ____ when seen in the newborn.
adrenal hyperplasia
In infants, An imperforate hymen is rare but can cause difficulty later, including __ in the child and ___ in the adolescent.
hydrocolpos, hematocolpos
If the baby was a ___ delivery, her genitalia may be swollen and bruised for many days after delivery.
A mucoid, whitish vaginal discharge is commonly seen during the newborn period and sometimes as late as ___after birth.
4 weeks , expected finding
Vaginal discharges in infants and young children may occur as the result of irritation from the __ or __. These discharges are usually mucoid.
diaper or powder
___ vaginitis is common in young girls and does not require an internal examination.
Bubble bath
A previously obscured hymenal opening almost always becomes visible with this technique, as does the interior of the vagina, nearly to the cervix. Most foreign bodies are visible with this method.
anterior labial traction
In teens, Bartholin and Skene glands are usually not palpable; if they are, enlargement exists. This indicates infection, which is most often (but not always) ___.
Ask the girl to cough and as she does so, observe the hymen. An imperforate hymen will __
A foul odor is more likely indicative of a ___ (particularly in preschool children)
foreign body
Vaginal discharge may also result from__, __, __ infection
trichomonal, gonococcal, or monilial
Swelling of vulvar tissues, particularly if accompanied by bruising or foul-smelling discharge, should alert you to the possibility of ___
sexual abuse
The injuries resulting from sexual molestation are generally more __- and ___ grossly.
posterior and may involve the perineum
Young women who are not sexually active should have their first examination by age ____.
21 years
In the ___ month of pregnancy the cervix, vagina, and vulva acquire their bluish color from increased vascularity.
Races have a similar percentage of the gynecoid type, but ___ women more often have the android type, and ___ women more often have the anthropoid type.
white, black
What sign and what weeks gestation: Softening of the cervix
Goodell, 4 to 6
What sign and what weeks gestation:Softening of the uterine isthmus
Hegar, 6-8 weeks
What sign and what weeks gestation:Fundus flexes easily on the cervix
McDonald, 7-8 weeks
What sign and what weeks gestation:Fullness and softening of the fundus near the site of implantation
Braun von Fernwald, 7-8 weeks
What sign and what weeks gestation:Palpable lateral bulge or soft prominence of one uterine cornu
Piskacek, 7-8 weeks
What sign and what weeks gestation:Bluish color of the cervix, vagina, and vulva
Chadwick, 8-12 weeks
Round shape pelvis
Gynecoid (50% of Women)
Heart shape pelvis
Android (23% of Women)
Oval shape pelvis
Anthropoid (24% of Women)
Flat shape pelvis
Platypelloid (3% of Women)
Which pelvis type has Usual mode of delivery C-section?
Android (23% of Women)
the most important clinical measurement for estimating the AP diameter of the pelvic inlet
Diagonal conjugate
The AP diameter of the pelvic inlet obtained only by x-ray techniques or estimated from the diagonal conjugate (there may be a discrepancy)
Obstetric conjugate
provides information on the adequacy of the pelvic outlet; two techniques can be used
Biischial diameter, intertuberous diameter, or transverse diameter of the outlet
Which way of measuring the pelvis can only be estimated
Transverse diameter or interspinous diameter:
From the symphysis pubis (inferior border) to the sacral promontory
Diagonal conjugate
From the symphysis pubis (posterior border) to the sacral promontory
Obstetric conjugate
The narrowest transverse diameter in the midplane between the interspinous processes
Transverse diameter or interspinous diameter
From the interior border of one ischial tuberosity to the other
Biischial diameter, intertuberous diameter, or transverse diameter of outlet
___ refers to the thinning of the cervix that results when myometrial activity pulls the cervix upward, allowing the cervix to become part of the lower uterine segment during prelabor or early labor.
Shortening of the cervix (<29 mm) noted on vaginal ultrasound in midpregnancy indicates risk for ____
preterm delivery
___ is the relationship of the presenting part to the ischial spines of the mother's pelvis.
The uterus may become more ___ during the first 3 months from softening of the isthmus.
Early uterine enlargement may not be symmetric, and you may feel deviation of the uterus to one side and an irregularity in its contour at the site of implantation. This uterine irregularity occurs around week 8 to 10 ___sign.
Piskacek sign
In the ___, the woman lies on her side with both knees bent, with her top leg brought closer to her chest
knee-chest position
In the___ position the woman lies on her back with her knees bent so that both legs are spread flat and her heels meet at the foot of the table
In the ____ position the woman lies on her back near the foot of the table with her legs supported under the knee by obstetric stirrups
obstetric stirrups
In the ___ position the woman lies on her back, knees bent and apart, feet resting on the examination table close to her buttocks. entire body supported by the table
In the ___ position the woman lies on her back with her straightened legs spread out wide to either side of the table. If a woman is able to put one foot in the stirrup, a variation of this position would allow the woman to hold one leg out straight and keep one foot in a stirrup.
A woman with visual or hearing impairment will probably want to assume a____ position for the pelvic examination
______ usually begins in a woman's late 20s and increases in incidence and severity as menopause approaches. It is characterized by edema, headache, weight gain, and behavioral disturbances such as irritability, nervousness, dysphoria, and lack of coordination. Symptoms occur 5 to 7 days before menses and subside with onset of menses.
Premenstrual syndrome (PMS)
____ can be caused by insufficient, nonmotile, or immature sperm, ductal obstruction of sperm, and transport-related factors
Male infertility
inability to conceive over a period of 1 year of unprotected regular intercourse has many causes, including both male and female conditions.
The presence and growth of endometrial tissue outside the uterus causes pelvic pain, dysmenorrhea, and heavy or prolonged menstrual flow. On bimanual examination, tender nodules may be palpable along the uterosacral ligaments. Diagnosis is confirmed by laparoscopy
How do Adolescents present with Endometriosis?
pelvic pain that is cyclic and noncyclic
How do older women present with Endometriosis?
The pain in older women is most often cyclic
Warty lesions on the labia, within the vestibule, or in the perianal region are the result of human papillomavirus (HPV) infection. Venereal warts are sexually transmitted. They are generally flesh-colored, whitish pink to reddish brown, discrete, soft growths. They may occur singly or in clusters and may enlarge to form cauliflower-like masses
Caused by a poxvirus
The lesions are white or flesh-colored, dome-shaped papules that are round or oval. The surface has a characteristic central umbilication from which a thick creamy core can be expressed. The lesions may last from several months to several years. Diagnosis is usually based on the clinical appearance of the lesions.
Lesions of secondary syphilis appear about 6 to 12 weeks after infection. They are flat, round, or oval papules covered by a gray exudate
A _____ is a firm, painless ulcer. Most chancres in women develop internally and often go undetected
_____ is a sexually transmitted infection that produces small red vesicles. The lesions may itch and are usually painful. Initial infection is often extensive, whereas recurrent infection is usually confined to a small localized patch on the vulva, perineum, vagina, or cervix
Genital herpes
_____ are commonly, but not always, caused by gonococcal infection. It may be acute or chronic. Acute inflammation produces a hot, red, tender, fluctuant swelling that may drain pus. Chronic inflammation results in a nontender cyst on the labium
Inflamed Bartholin glands
A ___ is a hernial protrusion of the urinary bladder through the anterior wall of the vagina, sometimes even exiting the introitus. The bulging can be seen and felt as the woman bears down. More severe degrees are accompanied by urinary stress incontinence
Hernial protrusion of part of the rectum through the posterior wall of the vagina is called _______. Bulging can be observed and felt as the woman bears down
rectocele or proctocele
____ in young women may be related to in utero DES exposure. Findings include vaginal discharge, lesions, and masses; and there may be a history of spotting, pain, and change in urinary habits. Cancer of the vulva appears as an ulcerated or raised red lesion on the vulva
Vaginal cancer
A bright red polypoid growth that protrudes from the urethral meatus, most ___ cause no symptoms
urethral caruncles
(+)KOH "whiff" test; wet mount: + clue cells
Bacterial vaginosis (Gardnerella vaginalis)
Pruritic discharge; itching of labia; itching may extend to thighs
Candida vulvovaginitis (Candida albicans)
White, curdy discharge; pH 4.0 to 5.0; cervix may be red; may have erythema of perineum and thighs
Candida vulvovaginitis (Candida albicans)
KOH prep: mycelia, budding, branching yeast, pseudohypha
Candida vulvovaginitis (Candida albicans)
Watery discharge; foul odor; dysuria and dyspareunia with severe infection
Trichomoniasis (Trichomonas vaginalis)
Profuse, frothy, greenish discharge; pH 5.0 to 6.6; red friable cervix with petechiae ("strawberry" cervix)
Trichomoniasis (Trichomonas vaginalis)
Wet mount: round or pear-shaped protozoa; motile "gyrating" flagella
Trichomoniasis (Trichomonas vaginalis)
Purulent discharge from cervix; Skene/Bartholin inflammation; cervix and vulva may be inflamed. Culture/Gram Strain
Gonorrhea (Neisseria gonorrhoeae)
Partner with nongonococcal urethritis; often asymptomatic; may complain of spotting after intercourse or urethritis ± purulent discharge; cervix may or may not be red or friable DNA probe
Chlamydia (Chlamydia trachomatis)
Dyspareunia; vaginal dryness; perimenopausal or post-menopausal Pale, thin vaginal mucosa; pH < 4.5 Wet mount: folded, clumped epithelial cells
Atrophic vaginitis
New bubble bath, soap, douche, or other hygiene products Foul smell; erythema; pH < 4.5 Wet mount:WBCs
Allergic vaginitis
Red and swollen vulva; vaginal discharge; history of use of tampon, condom, or diaphragm Bloody or foul-smelling discharge Wet mount:WBCs
Foreign body
Enlarged fluid-filled retention cysts often distort the shape of the cervix. ____ vary in size and may occur singly or in multiples.
Infected nabothian cysts
___ are bright red, soft, and fragile. They usually arise from the endocervical canal
Cervical polyps
____ produces a hard granular surface at or near the cervical os. The lesion can evolve to form an extensive irregular cauliflower growth that bleeds easily. Early lesions are indistinguishable from ectropion
Cervical cancer
Columnar epithelium from the cervical canal appears as shiny red tissue around the os that may bleed easily. ___ is not an abnormality, but because it is indistinguishable from early cervical carcinoma, further diagnostic studies (e.g., Pap smear, biopsy) must be performed for differential diagnosis.
The ____ as the result of weakening of the supporting structures of the pelvic floor, often occurring concurrently with a cystocele and rectocele. The uterus becomes progressively retroverted and descends into the vaginal canal
uterus prolapses
In ___ uterine prolapse, the cervix remains within the vagina
In ___ uterine prolapse, the cervix is at the introitus;
in ___ uterine prolapse, the cervix and vagina drop outside the introitus
Types of Uterine Bleeding and Associated Causes: Midcycle estradiol fluctuation associated with ovulation
Midcycle spotting
Types of Uterine Bleeding and Associated Causes: Anovulation or threatened abortion with excessive bleeding
Delayed menstruation
Types of Uterine Bleeding and Associated Causes: Chronic PID, endometriosis, DUB, anovulation
Frequent bleeding
Types of Uterine Bleeding and Associated Causes: Endometrial polyps, DUB, adenomyosis, submucous bleeding leiomyomas, IUD
Profuse menstrual
Types of Uterine Bleeding and Associated Causes: Endometrial polyps, DUB, uterine or cervical cancer, oral contraceptives
Intermenstrual or irregular bleeding
Types of Uterine Bleeding and Associated Causes: Endometrial hyperplasia, estrogen therapy, endometrial cancer
Postmenopausal bleeding
___ are common, benign, uterine tumors that appear as firm, irregular nodules in the contour of the uterus. They may occur singly or in multiples and vary greatly in size. The uterus may become enlarged
____ occurs most often in postmenopausal women. Nearly all ___ are of the glandular cells found in the lining of the uterus. Most known risk factors linked to the balance between estrogen and progesterone in the body. Women taking Tamoxifen are at increased risk. Postmenopausal vaginal bleeding is a red flag
Endometrial cancer
Cysts tend to be smooth and sometimes compressible, whereas tumors feel more solid and nodular; neither is usually tender
woman older than 40 years of age with persistent and unexplained vague gastrointestinal symptoms such as generalized abdominal discomfort and/or pain, gas, indigestion, pressure, swelling, bloating, cramps or feeling of fullness even after a light meal.
A ____ causes marked pelvic tenderness, with tenderness and rigidity of the lower abdomen. Motion of the cervix produces pain. A tender, unilateral adnexal mass may indicate the site of the pregnancy. Tachycardia and shock reflect the hemorrhage into the peritoneal cavity and cardiovascular collapse. This is a surgical emergency
ruptured tubal pregnancy
A sudden, dramatic change from mild, even vague abdominal pain that is there but not particularly distressing to a sudden onset of severe abdominal tenderness in the hypogastric area, particularly on the involved side.
Ectopic Pregnancy
___ produces very tender, bilateral adnexal areas; the patient guards and usually cannot tolerate bimanual examination
Acute PID
The symptoms of ___ are bilateral, tender, irregular, and fairly fixed adnexal areas
chronic PID
Inflammation or infection of the fallopian tube is often associated with PID. ___ causes lower quadrant pain with tenderness on bimanual examination
AMBIGUOUS GENITALIA , partially fused labia suggest the presence of a ___
AMBIGUOUS GENITALIA , urinary meatus that is not located behind the clitoris may indicate the presence of a ___
Vaginal secretions can collect behind an imperforate hymen. ___ may be manifested by a small midline lower abdominal mass or a small cystic mass between the labia. The condition may resolve spontaneously or may require surgical intervention.
Vaginal discharge that is accompanied by warm, erythematous, and swollen vulvar tissues is termed ____. Possible causes include sexual abuse; trichomonal, monilial, or gonococcal infection; secondary infection from a foreign body; and nonspecific infection from bubble baths, diaper irritation, urethritis, and injury
The cause of PROM is not known; however, certain conditions such as __ and ___ have been implicated
infection and hydramnios
Some health care professionals also consider the rupture of membranes before the onset of labor in a term pregnancy to be premature rupture if labor does not begin in ___
12 hours
Amniotic fluid placed on a slide and air-dried will have a ___ pattern.
Amniotic fluid has a pH of 7.15 and will turn Nitrazine paper ___.
When the presenting part of the fetus does not fill the pelvic inlet, a loop of cord may advance with the presenting part
Predisposing factors are premature labor, a fetus in breech presentation or transverse position, hydramnios, a high or floating presenting part (not engaged), and multiple pregnancy.
The presence of variable decelerations in fetal heart rate is also associated with ___
cord compression
In early pregnancy, bleeding may be due to unknown causes of little consequence or to a potentially life-threatening condition such as an ___
ectopic pregnancy
Late in pregnancy, causes of bleeding may range from benign conditions such as cervical changes to a potentially life-threatening ___
abruptio placentae
However, women who are bleeding in labor or who have a suspected ___ should not be examined without preparation for emergency cesarean section.
placenta previa
____ occur commonly during pregnancy. The varicosities may involve both the vulva and the rectal area. Pressure from the pregnant uterus and possibly hereditary factors contribute to the formation of the varicosities.
Vulvar varicosities
___ is caused by lack of estrogen. The vaginal mucosa is dry and pale, although it may become reddened and develop petechiae and superficial erosions. The accompanying vaginal discharge may be white, gray, yellow, green, or blood-tinged. It can be thick or watery, and although it varies in amount, the discharge is rarely profuse
Estrogen levels begin to rise, preparing follicle and egg for next cycle
Progesterone stimulates endometrial prostaglandins that cause vasoconstriction; upper layers of endometrium shed
Cellular activity in the alveoli decreases; breast ducts shrink
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels decrease
Menstrual bleeding may vary, depending on hormones and prostaglandins
Ovary and maturing follicle produce estrogen; follicular phase-egg develops within follicle
Proliferative phase-uterine lining thickens
Parenchymal and proliferation (increased cellular activity) of breast ducts occurs
FSH stimulates ovarian follicular growth
Egg is expelled from follicle into abdominal cavity and drawn into the uterine (fallopian) tube by fimbriae and cilia; follicle closes and begins to form corpus luteum; fertilization of egg may occur in outer one third of tube if sperm are unimpeded
End of proliferative phase; progesterone causes further thickening of the uterine wall
LH and estrogen levels increase rapidly; LH surge stimulates release of egg
Mittelschmerz may occur with ovulation; cervical mucus is increased and is stringy and elastic (spinnbarkeit)
Egg (ovum) is moved by cilia into the uterus
After the egg is released, the follicle becomes a corpus luteum; secretion of progesterone increases and predominates
LH and FSH decrease
If implantation does not occur, the corpus luteum degenerates; progesterone production decreases, and estrogen production drops and then begins to rise as a new follicle develops
Menstruation starts around day 28, which begins day 1 of the menstrual cycle
Alveolar breast cells differentiate into secretory cells
Increased levels of gonadotropin-releasing hormone (GnRH) cause increased secretion of FSH
Vascular engorgement and water retention may occur
* Evidence of general physical abuse or neglect
* Evidence of trauma and/or scarring in genital, anal, and perianal areas
* Unusual changes in skin color or pigmentation in genital or anal area
* Presence of sexually transmitted infection (oral, anal, genital)
* Anorectal problems such as itching, bleeding, pain, fecal incontinence, poor anal sphincter tone, bowel habit dysfunction
* Genitourinary problems such as rash or sores in genital area, vaginal odor, pain (including abdominal pain), itching, bleeding, discharge, dysuria, hematuria, urinary tract infections, enuresis
Medical complaints and findings:
For sexual abuse
* Problems with school
* Dramatic weight changes or eating disturbances
* Depression
* Sleep problems or nightmares
* Sudden change in personality or behavior
* Aggression or destructiveness
* Sudden avoidance of certain people or places
Examples of nonspecific behavioral manifestations:
for sexual abuse
* Use of sexually provocative mannerisms
* Excessive masturbation or sexual behavior that cannot be redirected
* Age-inappropriate sexual knowledge or experience
* Repeated object insertion into vagina and/or anus
* Child asking to be touched/kissed in genital area
* Sex play between children with 4 years or more age difference
* Sex play that involves the use of force, threats, or bribes
Examples of sexual behaviors that are concerning: Sexual abuse
No foul odor, itching or edema
Foul-smelling discharge; complains of "fishy odor"
Bacterial vaginosis (Gardnerella vaginalis)