Female Reproductive System
Physical Exam
I. History: sexually transmitted disease, menstrual history, obstetrical history, contraception
Are
the periods in which a woman experiences pain in the lower abdominal
cramping, severe pain and intermittent or possibly back pain.
Although some pain during menstruation is normal, excessive pain is not. The medical term for excessively painful periods is dysmenorrhea.
Considerations
Many women have painful periods. Sometimes the pain makes the performance of academic, normal household, job for a few days during each menstrual cycle. Painful menstruation is the leading cause for women from their teenage years and 20 years old to waste time at school and work.
Causes
Painful periods are classified into two groups, depending on the cause:
Primary Dysmenorrhea
Secondary dysmenorrhea
Primary dysmenorrhea refers to menstrual pain that occurs more or less around the time when menstrual periods are just beginning in otherwise healthy women. This type of pain usually is not related to specific problems in the uterus or other pelvic organs. It is thought that the increase in prostaglandin hormone activity, which occurs in the uterus, plays a role in this condition.
Secondary dysmenorrhea is menstrual pain that develops later in women who have had normal periods and often is related to problems with the uterus or other pelvic organs, such as:
Endometriosis
Fibroids
Intrauterine device (IUD) made of copper
Pelvic inflammatory disease
Premenstrual syndrome (PMS)
STI
Stress and anxiety
Home Care
The following steps may allow you to avoid using drugs that require a prescription:
Apply a heating pad on the lower abdomen below the navel, but never fall asleep with a heating pad on.
Do light circular massage with the fingertips around your lower abdomen.
Drink hot liquids.
Eat little but often.
Eating a diet rich in complex carbohydrates such as whole grains, fruits and vegetables but low in salt, sugar, alcohol and caffeine.
Keep your legs elevated while lying down or lying on your side with knees bent.
Practicing relaxation techniques like meditation or yoga.
Try over-the-counter anti-inflammatory drugs like ibuprofen. Start taking it the day before when he is expected to start the period and continue taking it regularly during the first days of that period.
Try supplements of vitamin B6, calcium and magnesium, especially if the pain is from PMS.
Take warm showers or baths.
Walk or exercise regularly, including pelvic rocking exercises.
Lose weight if overweight. Regular aerobic exercise.
If these self care measures do not work, your doctor may prescribe medications such as:
Antibiotics
Antidepressants
Birth Control Pills
Prescription anti-inflammatory
Prescription analgesics (including narcotics for short periods)
When to Contact a Medical Professional
Call your doctor immediately if you have:
Vaginal discharge is increased or odor.
Fever and pelvic pain.
Sudden or severe pain, especially if your period is late by more than a week and has been sexually active.
Each month, a woman's ovaries produce hormones that tell the cells lining the uterus (womb) become swollen and thicker. The body eliminates these extra cells of the uterine lining (endometrium) when you gets her period.
If these cells, called endometrial cells, implant and grow outside the uterus, endometriosis results. The tumors are called endometrial tissue implants. Women with endometriosis tissue implants typically have in the ovaries, bowel, rectum, bladder and the lining of the pelvic area. May also occur in other body areas.
Unlike endometrial cells found in the uterus, implants of tissue outside the uterus remain in place when it has the period. They sometimes bleed a little and grow back when you have the next period. This ongoing process leads to pain and other symptoms of endometriosis.
The cause of endometriosis is unknown. One theory is that endometrial cells that are shed during menstruation returned through the fallopian tubes into the pelvis, where they implant and multiply. This is called retrograde menstruation. This retrograde menstrual flow occurs in many women, but researchers think the immune system may be different in women with endometriosis.
Endometriosis is common and sometimes can be hereditary. Although endometriosis is typically diagnosed between 25 and 35, the condition probably begins about the time of onset of regular menstruation.
A woman who has a mother or sister with endometriosis are more likely to develop this disease than other women. You are more likely to have endometriosis if:
Menstruation began at an early age.
Never had children.
Has frequent menstrual periods or last 7 days or more.
Has a closed hymen, which blocks blood flow during the menstrual period.
Symptoms
Pain is the main symptom of endometriosis. A woman with this disease may have:
Painful periods.
Lower abdominal pain before and during menstruation.
Cramps a week or two before and during menstruation (cramps may be permanent and may be dull or quite severe).
Pain during or after intercourse.
Painful bowel movements.
Pelvic or back pain that can occur at any time during the menstrual cycle.
Note: You may not manifest any symptoms. Some women with a large number of tissue implants in the pelvis do not feel absolutely no pain, while some with mild disease have severe pain.Exams and Tests
The doctor will perform a physical examination including a pelvic exam. The tests done to help diagnose endometriosis include:
Pelvic exam
Transvaginal ultrasound
Pelvic laparoscopy
Treatment
Treatment depends on the following factors:
Age.
Severity of symptoms.
Severity of the disease.
If we want children in the future.
If you have mild symptoms and never want to have children, you can simply choose to have regular exams every 6 to 12 months so the doctor can see that the disease is getting worse. You can manage the symptoms by:
Exercise and relaxation techniques.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), naproxen (Aleve), acetaminophen (Tylenol) or prescription pain medicines to relieve cramping and pain.
For other women, treatment options include:
Medications to control pain.
Hormonal medications to prevent the worsening of endometriosis.
Surgery to remove areas of endometriosis or the entire uterus and ovaries.
Treatment to stop the worsening of endometriosis often involves the use of birth control pills continuously for 6 to 9 months to prevent you from having your period and create a state similar to pregnancy, called pseudopregnancy. This therapy uses oral contraceptives containing estrogen and progesterone. This type of therapy relieves most of the symptoms of endometriosis, but does not prevent scarring neutralized nor any physical change that has already occurred as a result of disease
Uterine fibroids are common. One in 5 women may have fibroids during their childbearing years (the time after starting menstruation for the first time and before menopause). Half of women have fibroids at age 50.
Fibroids are rare in women under 20 years and are more common in black women than white women.
The cause of fibroids in the uterus. However, the growth of uterine fibroids has been linked to the hormone estrogen. As a woman with fibroids is menstruating, they are likely to grow, usually slowly.
Fibroids can be so tiny that you need a microscope to see them. However, they can grow very large, may fill the entire uterus and weigh several pounds. Although it is possible that only one fibroid to develop, usually more than one.
Fibroids are often described by their location in the uterus:
Myometrial: in the muscular wall of the uterus.
Submucosal: just below the surface of the uterine lining.
Subserosal: just under the outer covering of the uterus.
Pedicle: presented in a stem or stalk along on the outside of the uterus or within the uterine cavity.
Symptoms
The most common symptoms of uterine fibroids include:
Bleeding between periods.
Heavy menstrual bleeding (menorrhagia), sometimes with the passage of blood clots.
Menstrual periods that last longer than usual.
Need to urinate more frequently.
Pelvic cramping or pain with periods.
Feeling of fullness or pressure in lower abdomen.
Pain during intercourse.
Note: Often there are no symptoms. The doctor can find during a physical examination or other examination. Fibroids often shrink and cause no symptoms in women past menopause.
II. Inspection
- External genitalia: Normal findings
- hair distribution: variable; usually inverted triangle starting at symphysis pubis
- skin of perineum smooth, clean, slightly darker than other skin
- labia majora - may be closed or gaping
- clitoris - about 2 cm in length and 0.5 cm in width
- urethral orifice - intact, pink without irritation
- vaginal orifice - ranges from thin, vertical slit to larger orifice with moist tissue
- anus - moist and hairless - skin more darkly pigmented
- Internal genitalia:
- Cervix - normal findings: pink; midline; usually about 2 to 3 cm in diameter; smooth, firm, rounded or oval; odorless, creamy or clear secretions
- papanicolau (Pap) smear
- vagina - pink throughout; clear or cloudy, odorless secretions; about 10 to 15 cm in length
III. Palpation
- Ovaries may or may not be palpable; firm, slightly tender, oval, mobile; about 4 cm in diameter
- Uterus - mobile; rounded; palpable at level of pelvis
- Skene's glands and Bartholin's gland - normal findings: nontender, no discharge
IV. Geriatric Alterations
- Labial folds flatten
- Skin paler, shiny
- Meatus usually more posterior
- Cervix decreases in size; may appear paler
- Scanty cervical discharge
- Vagina shortens with age
- Decreased vaginal secretions
- Uterus diminishes in size; may not be palpable
- Ovaries atrophy with age
dysmenorrhea
Are
the periods in which a woman experiences pain in the lower abdominal
cramping, severe pain and intermittent or possibly back pain.Although some pain during menstruation is normal, excessive pain is not. The medical term for excessively painful periods is dysmenorrhea.
Considerations
Many women have painful periods. Sometimes the pain makes the performance of academic, normal household, job for a few days during each menstrual cycle. Painful menstruation is the leading cause for women from their teenage years and 20 years old to waste time at school and work.
Causes
Painful periods are classified into two groups, depending on the cause:
Primary Dysmenorrhea
Secondary dysmenorrhea
Primary dysmenorrhea refers to menstrual pain that occurs more or less around the time when menstrual periods are just beginning in otherwise healthy women. This type of pain usually is not related to specific problems in the uterus or other pelvic organs. It is thought that the increase in prostaglandin hormone activity, which occurs in the uterus, plays a role in this condition.
Secondary dysmenorrhea is menstrual pain that develops later in women who have had normal periods and often is related to problems with the uterus or other pelvic organs, such as:
Endometriosis
Fibroids
Intrauterine device (IUD) made of copper
Pelvic inflammatory disease
Premenstrual syndrome (PMS)
STI
Stress and anxiety
Home Care
The following steps may allow you to avoid using drugs that require a prescription:
Apply a heating pad on the lower abdomen below the navel, but never fall asleep with a heating pad on.
Do light circular massage with the fingertips around your lower abdomen.
Drink hot liquids.
Eat little but often.
Eating a diet rich in complex carbohydrates such as whole grains, fruits and vegetables but low in salt, sugar, alcohol and caffeine.
Keep your legs elevated while lying down or lying on your side with knees bent.
Practicing relaxation techniques like meditation or yoga.
Try over-the-counter anti-inflammatory drugs like ibuprofen. Start taking it the day before when he is expected to start the period and continue taking it regularly during the first days of that period.
Try supplements of vitamin B6, calcium and magnesium, especially if the pain is from PMS.
Take warm showers or baths.
Walk or exercise regularly, including pelvic rocking exercises.
Lose weight if overweight. Regular aerobic exercise.
If these self care measures do not work, your doctor may prescribe medications such as:
Antibiotics
Antidepressants
Birth Control Pills
Prescription anti-inflammatory
Prescription analgesics (including narcotics for short periods)
When to Contact a Medical Professional
Call your doctor immediately if you have:
Vaginal discharge is increased or odor.
Fever and pelvic pain.
Sudden or severe pain, especially if your period is late by more than a week and has been sexually active.
Amenorrhea
occurs when a woman has her monthly menstrual cycle or period.
Absence of menstruation
Primary amenorrhea
Causes, incidence, and risk factors
It is considered that women who are pregnant, breastfeeding or menopause have secondary amenorrhea.
Women who are taking birth control pills or receiving injections of hormones such as Depo-Provera may have no monthly bleeding. When they stop taking these hormones, your periods may not return for more than 6 months.
You are more likely to have amenorrhea if:
Are obese
Do you exercise excessively and for long periods of time
Has less than 15 to 17% body fat
Have severe anxiety or emotional distress
Excessive weight loss suddenly (for example, with a strict diet or gastric bypass surgery)
Other causes include:
Brain tumors (pituitary)
Polycystic ovary syndrome
Premature ovarian failure
Thyroid dysfunction
The following drugs may also cause missed periods:
Busulfan
Cancer chemotherapeutic drugs
Chlorambucil
Cyclophosphamide
Phenothiazines
Also, procedures such as dilation and curettage (D & C) can lead to the formation of scar tissue that can cause a woman to stop menstruating. This is called Asherman syndrome. Healing can also be caused by some severe pelvic infections.Symptoms
No menstrual period for six months or more
Previously had one or more periods that began spontaneously
Other symptoms that may occur with secondary amenorrhea include:
Changes in breast size
Weight gain or significant weight loss
Breast discharge (galactorrhea)
Headache
Increased hair growth in a "male" pattern (hirsutism) and acne
Vaginal dryness
Voice changes
If amenorrhea is caused by a pituitary tumor, there may be other symptoms related to the tumor, such as loss of vision.Signs and tests
They should do a pelvic exam and a physical examination to rule out pregnancy. Likewise, it is a pregnancy test.
They can do blood tests to check hormone levels, including:
Estradiol levels
Follicle stimulating hormone (FSH level)
Luteinizing hormone (LH level)
Prolactin level
Serum hormone levels such as testosterone levels
Thyroid stimulating hormone (TSH)
Other tests that may be done include:
CT scan of the head
Endometrial biopsy
Genetic Testing
MRI of the head
Pelvic ultrasound or sonohysterography
Treatment
Treatment depends on the cause of amenorrhea. Normal monthly periods usually return after treatment of the condition.
Absence of menstruation
Primary amenorrhea
Causes, incidence, and risk factors
It is considered that women who are pregnant, breastfeeding or menopause have secondary amenorrhea.
Women who are taking birth control pills or receiving injections of hormones such as Depo-Provera may have no monthly bleeding. When they stop taking these hormones, your periods may not return for more than 6 months.
You are more likely to have amenorrhea if:
Are obese
Do you exercise excessively and for long periods of time
Has less than 15 to 17% body fat
Have severe anxiety or emotional distress
Excessive weight loss suddenly (for example, with a strict diet or gastric bypass surgery)
Other causes include:
Brain tumors (pituitary)
Polycystic ovary syndrome
Premature ovarian failure
Thyroid dysfunction
The following drugs may also cause missed periods:
Busulfan
Cancer chemotherapeutic drugs
Chlorambucil
Cyclophosphamide
Phenothiazines
Also, procedures such as dilation and curettage (D & C) can lead to the formation of scar tissue that can cause a woman to stop menstruating. This is called Asherman syndrome. Healing can also be caused by some severe pelvic infections.Symptoms
No menstrual period for six months or more
Previously had one or more periods that began spontaneously
Other symptoms that may occur with secondary amenorrhea include:
Changes in breast size
Weight gain or significant weight loss
Breast discharge (galactorrhea)
Headache
Increased hair growth in a "male" pattern (hirsutism) and acne
Vaginal dryness
Voice changes
If amenorrhea is caused by a pituitary tumor, there may be other symptoms related to the tumor, such as loss of vision.Signs and tests
They should do a pelvic exam and a physical examination to rule out pregnancy. Likewise, it is a pregnancy test.
They can do blood tests to check hormone levels, including:
Estradiol levels
Follicle stimulating hormone (FSH level)
Luteinizing hormone (LH level)
Prolactin level
Serum hormone levels such as testosterone levels
Thyroid stimulating hormone (TSH)
Other tests that may be done include:
CT scan of the head
Endometrial biopsy
Genetic Testing
MRI of the head
Pelvic ultrasound or sonohysterography
Treatment
Treatment depends on the cause of amenorrhea. Normal monthly periods usually return after treatment of the condition.
Endometriosis
Is a disorder in the health of women that occurs when cells in the lining of the uterus (womb) grows in other areas of the body. This can lead to this pain, irregular bleeding and problems getting pregnant (infertility).CausesEach month, a woman's ovaries produce hormones that tell the cells lining the uterus (womb) become swollen and thicker. The body eliminates these extra cells of the uterine lining (endometrium) when you gets her period.
If these cells, called endometrial cells, implant and grow outside the uterus, endometriosis results. The tumors are called endometrial tissue implants. Women with endometriosis tissue implants typically have in the ovaries, bowel, rectum, bladder and the lining of the pelvic area. May also occur in other body areas.
Unlike endometrial cells found in the uterus, implants of tissue outside the uterus remain in place when it has the period. They sometimes bleed a little and grow back when you have the next period. This ongoing process leads to pain and other symptoms of endometriosis.
The cause of endometriosis is unknown. One theory is that endometrial cells that are shed during menstruation returned through the fallopian tubes into the pelvis, where they implant and multiply. This is called retrograde menstruation. This retrograde menstrual flow occurs in many women, but researchers think the immune system may be different in women with endometriosis.
Endometriosis is common and sometimes can be hereditary. Although endometriosis is typically diagnosed between 25 and 35, the condition probably begins about the time of onset of regular menstruation.
A woman who has a mother or sister with endometriosis are more likely to develop this disease than other women. You are more likely to have endometriosis if:
Menstruation began at an early age.
Never had children.
Has frequent menstrual periods or last 7 days or more.
Has a closed hymen, which blocks blood flow during the menstrual period.
Symptoms
Pain is the main symptom of endometriosis. A woman with this disease may have:
Painful periods.
Lower abdominal pain before and during menstruation.
Cramps a week or two before and during menstruation (cramps may be permanent and may be dull or quite severe).
Pain during or after intercourse.
Painful bowel movements.
Pelvic or back pain that can occur at any time during the menstrual cycle.
Note: You may not manifest any symptoms. Some women with a large number of tissue implants in the pelvis do not feel absolutely no pain, while some with mild disease have severe pain.Exams and Tests
The doctor will perform a physical examination including a pelvic exam. The tests done to help diagnose endometriosis include:
Pelvic exam
Transvaginal ultrasound
Pelvic laparoscopy
Treatment
Treatment depends on the following factors:
Age.
Severity of symptoms.
Severity of the disease.
If we want children in the future.
If you have mild symptoms and never want to have children, you can simply choose to have regular exams every 6 to 12 months so the doctor can see that the disease is getting worse. You can manage the symptoms by:
Exercise and relaxation techniques.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), naproxen (Aleve), acetaminophen (Tylenol) or prescription pain medicines to relieve cramping and pain.
For other women, treatment options include:
Medications to control pain.
Hormonal medications to prevent the worsening of endometriosis.
Surgery to remove areas of endometriosis or the entire uterus and ovaries.
Treatment to stop the worsening of endometriosis often involves the use of birth control pills continuously for 6 to 9 months to prevent you from having your period and create a state similar to pregnancy, called pseudopregnancy. This therapy uses oral contraceptives containing estrogen and progesterone. This type of therapy relieves most of the symptoms of endometriosis, but does not prevent scarring neutralized nor any physical change that has already occurred as a result of disease
Uterine fibroids
They are noncancerous (benign) occurring in the uterus (womb), a female reproductive organ.CausesUterine fibroids are common. One in 5 women may have fibroids during their childbearing years (the time after starting menstruation for the first time and before menopause). Half of women have fibroids at age 50.
Fibroids are rare in women under 20 years and are more common in black women than white women.
The cause of fibroids in the uterus. However, the growth of uterine fibroids has been linked to the hormone estrogen. As a woman with fibroids is menstruating, they are likely to grow, usually slowly.
Fibroids can be so tiny that you need a microscope to see them. However, they can grow very large, may fill the entire uterus and weigh several pounds. Although it is possible that only one fibroid to develop, usually more than one.
Fibroids are often described by their location in the uterus:
Myometrial: in the muscular wall of the uterus.
Submucosal: just below the surface of the uterine lining.
Subserosal: just under the outer covering of the uterus.
Pedicle: presented in a stem or stalk along on the outside of the uterus or within the uterine cavity.
Symptoms
The most common symptoms of uterine fibroids include:
Bleeding between periods.
Heavy menstrual bleeding (menorrhagia), sometimes with the passage of blood clots.
Menstrual periods that last longer than usual.
Need to urinate more frequently.
Pelvic cramping or pain with periods.
Feeling of fullness or pressure in lower abdomen.
Pain during intercourse.
Note: Often there are no symptoms. The doctor can find during a physical examination or other examination. Fibroids often shrink and cause no symptoms in women past menopause.
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