Clinica Cayanga Medical Resources

Female Genitalia

• PAST HISTORY:
  • Gravida: Number of pregnancies
  • Para: Number of live deliveries
  • Number of planned and spontaneous abortions.
• ABNORMALITIES in MENSTRUATION: Normal menstrual period = about 40 mL of blood.
  • Amenorrhea: No menstruation for 3 months or more.
    • Primary Amenorrhea: Failure of menarche
      • Kallman's Syndrome: Primary GnRH deficiency
      • Turner's Syndrome: XO
      • Testicular Sensitization Syndrome: Androgen insensitivity. Genotypic male may be diagnosed with testicular feminization when he presents as a teenager with primary amenorrhea.
      • Imperforate hymen
      • Congenital malformations of GU tract: Uterine agenesis, vaginal malformations.
    • Secondary Amenorrhea: Amenorrhea occurring any time after menarche has occurred.
      • Environmental Factors:
        • Weight-reduction amenorrhea: Anorexia and related disorders, malnutrition.
        • Psychogenic amenorrhea
        • Exercise-induced amenorrhea
        • Post-pill amenorrhea
      • Pituitary Disease:
        • Prolactinoma
        • Sheehan Syndrome = post-partum hemorrhage causing pituitary infarct from lack of blood-flow and increased pituitary demand.
      • Premature ovarian failure: Menopause occurring before age 35. Can be caused oophoritis (mumps virus), or may be idiopathic.
      • Polycystic Ovary Syndrome
      • Asherman's Syndrome: Amenorrhea caused by intrauterine adhesions (synechiae) that obliterate part of the uterine cavity. This can occur subsequent to vigorous dilatation and curettage (D&C) of the endometrium.
  • Hypomenorrhea: Decrease in volume of flow or duration of periods.
  • Menorrhagia, Hypermenorrhea: Abnormally heavy volume of flow or abnormally long periods.
    • Most common causes: Uterine fibroids (leiomyomas), PID, Endometriosis, IUD
  • Metrorrhagia: Bleeding at mid-cycle. It is usually precipitated by the drop in estrogen that occurs after ovulation.
  • Dysmenorrhea: Painful menstruation. Symptoms = lower abdominal pain, nausea, vomiting, fatigue, diarrhea.
    • Primary Dysmenorrhea: Unexplained, idiopathic dysmenorrhea. Believed to be caused by high uterine levels of PGE₂.
    • Secondary Dysmenorrhea: Endometriosis, PID, imperforate hymen, uterine polyps, adhesions.
  • Dysfunctional Uterine Bleeding (DUB): Abnormal uterine bleeding in which no etiologic agent can be found after history and pelvic exam.
• OTHER THINGS RELATING TO MENSTRUATION:
  • MENOPAUSE:
  • PRE-MENSTRUAL SYNDROME:
• NON-MENSTRUAL VAGINAL BLEEDING: Bleeding not related to menstruation. When vaginal bleeding presents, we must determine whether it is menstrual or non-menstrual.
  • Post-Menopausal Bleeding: Consider uterine cancer, cervical cancer. Atrophic vaginitis if patient is not on ERT.
  • Pregnancy, either intrauterine or ectopic, may cause bleeding for a variety of reasons.
  • Birth control methods: IUD, breakthrough bleeding with pill.
• PELVIC PAIN:
  • ACUTE PELVIC PAIN:
    • Mittelschmerz: Pelvic pain occurring at mid-cycle and related to ovulation.
    • Torsion of Ovary: Cystic ovary can get large and twist on itself, cutting off its blood supply ------> acute-onset pelvic pain.
    • Ruptured tubal pregnancy.
  • CHRONIC PELVIC PAIN:
    • Endometriosis: Dysmenorrhea, dyspareunia, infertility. Often have chronic pelvic pain, associated with the location of the ectopic glandular tissue.
      • Pain of endometriosis tends to be constant, and tends to radiate to coccyx, lower back.
      • Onset of disease is usually between 25 and 40. Undifferentiated dysmenorrhea often presents younger than age 25.
• URINARY TRACT INFECTIONS:
• PREGNANCY and INFERTILITY:
  • Early Pregnancy: Common symptoms
    • Secondary amenorrhea. Patient may also see reduced flow, or slight vaginal bleeding at time of normal period.
    • Morning Sickness: Nausea and vomiting
    • Breast tenderness
    • Urinary frequency: cause may be anatomical or hormonal.
    • Constipation
    • Weight change: weight loss is common in early pregnancy, followed by weight gain later.
  • Late Pregnancy:
    • Chloasma: Characteristic darkening of skin around eyes, nose, cheeks. Darkening also occurs in areolae, skin between umbilicus and pubic ridge.
    • Striae Gravidarum: Stretch marks of pregnancy.
    • Spider angiomas may occur in skin, because of high estrogen.
  • Pelvic Changes with Pregnancy:
    • Chadwick's Sign: Blue or purple discoloration of the vagina.
    • Leukorrhea: Clear or white vaginal discharge with faint musty odor. It may occur during pregnancy or in other circumstances.
    • Goodell's Sign: Bluish discoloration and softening of the cervix.
    • Braxton Hicks Contractions: Painless uterine contractions occurring after the 28^th week.
    • Quickening: The first fetal movement of which the patient is aware. Normally occurs at 18 weeks during first pregnancy, and at 16 weeks in subsequent pregnancies.
  • Hydatidiform Mole: Signs of a molar pregnancy:
    • Uterus increases rapidly in size shortly after implantation.
    • Persistent vaginal bleeding, no fetal movement, and no fetal heart tones by 12 weeks.
    • Nausea and vomiting more intense than usual.
    • Grape like clusters of tissues may be expelled through the vagina.
• ABNORMALITIES in SEXUAL FUNCTION:
  • Vaginismus: Spasmodic, guarding contraction of vagina upon attempt of intercourse. Often occurs subsequent to rape or trauma.
• VAGINAL DISCHARGE and ITCHING
  • Physiologic Discharge: Clear or white discharge occurring at midcycle.
  • Trichomonas Vaginalis:
    • Discharge: Gray, foamy discharge having bad odor.
    • Mucosa: Red, strawberry cervix.
    • Confirm: Confirm with wet-mount (saline suspension microscopy).
  • Gonorrhea:
    • Discharge: Profuse mucoid discharge with foul odor.
    • Mucosa: Red, tender mucosa.
    • Confirm: Confirm with culture.
  • Gardnerella Vaginalis: Also called Non-specific vaginitis. Co-infection with anaerobes usually also occurs.
    • Discharge: Gray or white, fishy odor
    • Mucosa: Normal
    • Confirm: Clue cells = large epithelial cells with many coccobacilli adherent to them.
  • Chlamydia:
    • Discharge: Little, yellow, mucous and pus in cervical canal.
    • Mucosa: Cervical erosion.
    • Confirm: FA stain of smear shows elementary bodies.
  • Candida Albicans: Yeast infection.
    • Discharge: White, cottage-cheese like
    • Mucosa: White patches stuck to a red base.
    • Confirm: KOH preparation, look for pseudohypha.
  • Atrophic Vaginitis: Estrogen deficiency
    • Discharge: Little discharge, some blood
    • Mucosa: Atrophic, pale or red.
    • Confirm: history, age.
• PELVIC RELAXATION: Loss of pelvis support due to atrophy of muscular viscera,
  • Urethrocele: Urethra herniates into the vaginal canal.
  • Cystocele: Bladder herniates into the vaginal canal.
  • Rectocele: Rectum herniates into the vaginal canal.
  • Uterine Prolapse: Descent of the uterus into the vaginal canal. Graded from 1 (mild) to 3 (uterus descends past the vulva).
• HIRSUTISM