nsg 211 chapter 26

round firm pad of adipose tissue covering the symphysis pubis.

after puberty it is covered with hair in the pattern of an inverted triangle

two rounded folds of adipose tissue extending from the mons pubis down around to the perineum.

hair covers outer surfaces of labia

inner folds are smooth and moist and contain sebaceous follicles

located inside the labia majora

two, smaller, darker, folds of skin

a transverse fold of skin joining the labia minora posteriorly

a small pea shaped erectile body

homologous to the the male penis and highly sensititive to tactile simulation

appears as a dimple 2.5 cm posterior to the clitoris

surrounding the ureathral meatus are tiny,multiple paraurethral (skene glands)

ducts are not visible

open posterior to urethra at the 5 and 7 o'clock positions

posterior to the urethral meatus

appears either as a thin slit or as a large opening with irregular edges, depending on the presentation of the membraneous hymen.

thin, circular,cresecent shape fold that may over the vaginal orifice or may be absent completely

located on either side and posterior to the vaginal orifice

secrete a clear lubricating mucus during intercourse

ducts not visible but open in the groove between the groove between the labia minora and the hymen.

-a flattened tubular canal extending from the orifice up and backward into the pelvis.

9 cm long

-sits between the rectum posteriorly and the bladder and urethra anteriorly.

-walls are in thick transvers walls or rugae, enableing the vagina to dilate widely dyruing childbirth.

-located at the end of the vaginal canal projecting into the vagina

-appears as a smooth shaped doghnut-shaped area with a small circular hole or os

-vagina and cervix are covered in smooth pink stratified squamos epithelium

-the endocervical canal is lined with columnar epithelium that looks red and rough

the point where these two tissues meet is the squamocolumnar junction.

continuous recess present around cervix in front and back

pear shaped

thick walled

muscular organ

flattened anteroposteriorly

-5.5 to 8 cm long by 3.5 to 4 cm wide and 2 to 2.5 cm thick

freely moveable, not fixed

usually tilts fwd and superior to the bladder

-"a position labeled as anteverted and anteflexed"

two pliable, trumpet shaped, tubes

10 cm in length

-extend from uterinefundus laterally to the brim of the pelvis where they curve posteriorly

their fimbriated ends located near ovaries

one on each side of uterus

at level of anterior superior iliac spine

oval shaped

3 cm long by 2 cm thick

serves to develop ova (eggs) and female hormones

severe perineal itching

excoriations and erythematous areas

may see little dark spots

adherent to pubic hair

occasionally in eyebrows or eyelashes

episodes of local pain, dysuria, fever

-clusters of small, shallow vesicles with surrounding erythema

erupt on genital areas and inner thigh

inguinal adenopathy edema

vesicles on labia rupturein 1-3 days

leaves painful ulcers

initial infection lasts 7-10 days

virus remains dormant indefinately

recurrent infections last 3-10 days with milder symptoms

history of skin contact with allergic substances in environment

intense pruritus

primary lesion: red, swollen vesicles

may have weeping of lesions, crusts, scales, thickening of skin, excoriations from scratching

-may result from reaction to feminine hygiene spray or synthetic underclothing

-begins as small, solitary silvery papule that erodesto a red, round or oval, superficial ulcer with a yellowish serous discharge

-palpation-nontender indurated base, can be lifted like a buttonbetween thumb and finger

nontender inguinal lymphadenpathy

painless warty growths

pink or flesh colored

soft

pointed

moist

warty papules

local pain

can be severe

overlying red skin

palpable fluctuant mass and tenderness

mucosa shows red spot at site of duct opening

requires incision and drainage

antibiotic therapy

feeling of preote intoitus widening and the presence of a sft round anterior buldge in vagina

stress incontinence

note introitus widening and presence of a soft round anterior bulge

bladder covered by vaginal mucosa, prolapses into vagina

feeling of pressure in vagina

possibly constipation

note intoitus widening and the presence of a soft round bulge from posterior

part of the rectum covered by vaginal mucosa

prolapses into vagina

uterus protrudes into vagina

nontender

smooth hemisphere

may cause broad gate

1st degree: cervix appears at introitus with straining

-2nd degree: cervix bulges outside introitus with straining

-3rd degree: whole uterus protrudes even without straining essentially uterus turns inside out

-virus may appear in various forms when effecting cervical epithelium

-warty growths here appear as abnormal thickened white epithelium

-visibilty of lesion is enhanced by acetic acid which dissolves mucus and temporarily causes intracellular dehydration and coagulation of protein

may have mucoid discharge or bleeding

bright, red, soft, peduculated growth emerges from os

benign lesion (must be determined from byopsy)

may be lined with squamos or columnar epithelium

bleeding between menstrual periods or after menopause

unusual vaginal discharge

-chronic ulcer and induration are early signs of carcinoma although the lesion may or may not show on the exocervix (here the lesion is mostly around theexternal os)

diagnosed by pap smear and biopsy

risk factors:

first in intercourse

multiple sex partners

cigarette smoking

certain sexually transmitted infections

post menopausal vaginal itching

dryness

burning sensation

dyspareunia

mucoid discharge (may be flecked with blood)

pale mucosa with abraded areas that bleed easily

may have bloody discharge

opportunist infection related to chronic estrogen deficiency

intense prurititis

thick whitish discharge

vulva and vagina are erythematous

discharge usually thick, white, curdy "cottage cheese"

-diagnose by microscope examination with microscope of discharge on hydroxide wet mount

caused by;

oral contrceptives or antibiotics

-more alkaline vaginal ph (as with menstrual periods,postpartum,menopause)

pregnancy from increased glycogen and diabetes

pruritis

watery and often malodorous vaginal discharge

urinary frequency

terminal dysuria

itching

-symptoms worse during menstration when PH becomes optimal for organisms growth

vulva may be erythematous

vagina may be diffusely red

granular

-occasionally with red raised papules and petechiae (stawberry apperance)

frothy yellow green foul smelling discharge

-microscopic examination of saline wet mount specimen shows characteristic flagellated cells

profuse discharge

constant wetness

foul fishy smell or rotten odor

thin creamy gray white malodorous discharge

no inflammation because its a surface parasite

vaginal PH >4.5

microscopic view of saline wet mount specimen shows typical "clue cells", (epithelial cells with stippled borders)

sniff for fishy odor after adding KOH to slide "whiff test"

minimal or no symptoms

may have urinary infrequency

dysuria

vaginal discharge

postcoital bleeding

may have greenish/yellow mucopurulent discharge

friable cervix

cervical motion tenderness

-signs are subtle and easily mistaken for gonorrhea (important to distinguish between the two because different antibiotics used for each)

-chlamydia can ascend to cause pelvic inflammatory disease (PID) and result in infertility

most common STD

highest prevalence in sexually active adolescent girls

-urine chlamydia testing using nucleic acid amplification tests (NAAT), noninvasive method to screen

single urine specimen to detect both pregnancy and chlamydia

-variable discharge, dysuria, abnormal uterine bleeding, abscess in Bartholin's or Skene's glands

majority of cases asymptomatic

may have purulent vaginal discharge

diagnose by positive culture of organism

may progress to acute salpingitis (PID)

-amenorrhea, fatigue, breast engorgement,nausea, change in food tolerance, weight gain

-early signs: cyanosis of vaginal mucosa and cervix (chadwick sign)

palpation:

soft consistency of cervix

-enlarging uterus with compressible fundus and isthmus (hegar sign at 10-12 weeks)

varies depending on size and location

often no symptoms

syptoms consist of:

vague discomfort

bloating

heaviness

pelvic pressure

dyspareunia

urinary frequency

backache

hypermenorrhea if myoma disturbs endometrium

-uterus irregulary enlarged, firm, mobile, and nodule in the uterine wall

heavy bleeding produces anemia

usually benign

-highest incidence occurs between ages 30-45 in blacks

estrogen dependent

after menopause usually regress but do not disappear

surgery may be indicated

-abnormal and intermenstrual bleeding before menopause

-postmenopausal bleeding or mucosanguineous discharge

pain and weight loss occur late in disease

uterus may be enlarged

-pap smear rarely effective in detecting endometrial cancer

-abnormal vaginal bleeding or at high risk women should have endometrial tissue sample taken

risk factors include are early menarche, late menopause, history of infertility, failure to ovulate, tamoxifen, uopposed estrogen therapy (which continually stimulatest the endometrium, causing hyperplasia), obesity (causes excess endogenous estrogen)

-cyclic or chronic pelvic pain, occurring as dysmenorrhea. or dyspareunia, low back ache

may have irregular uterine bleeding or hypermenorrhea

may be asymptomatic

uterus fixed, tender to movement

-small firm nodular masses tender to palpation on posterior aspect of fundus, uterosacral ligaments, ovaries, sigmoid colon.


ovaries often enlarged

-masses are aberrant growths of endometrial tissue scattered throughout pelvis, probably as a result of transplantation of tissue by retrograde menstruation.

-ectopic tissue responds to hormone stimulation, builds up during menstruation

-ectopic tissue responds to hormone stimulation, builds up between periods, sloughs during menstration

may cause infertilityfrom pelivic adhesions from pelvic adhesions , tubal obstruction, decreased ovarian function