(14) Female Genitalia Flashcards
(151 cards)
1
Q
mons pubis
A
hair covered fat pad overlying the symphysis pubis
2
Q
labia majora
A
rounded folds of adipose tissue forming the outer lips of the vagina
3
Q
labia minora
A
thinner pinkish-red folds or inner lips that extend anteriorly to form the prepuce
4
Q
vestibule
A
boat-shaped fossa between th elbaia minora
5
Q
introitus
A
vaginal opening (may be hidden by hymen in virgins)
6
Q
perineum
A
tissue between the Introits and anus
7
Q
urethral meatus
A
opens into vestibule between clitorus and vagina
8
Q
paraurethral (Skene) glands
A
lie just posterior and adjacent to the meatus on either side of the openings
9
Q
Bartholin glands
A
located posteriorly on both sides of the vaginal opening but not usually visible
10
Q
vagina
A
musculomembranous tube extending upward and posteriorly between the urinary bladder and urethra and rectum
- its upper 3rd lies at a horizontal plane and terminates in the cup-shaped fornix
- vaginal mucosa lies in transverse folds or rugae
- lies at almost right angle to uterus
11
Q
uterus
A
thick-walled fibromuscular structure shaped like an inverted pear
- convex upper surface is the uterine fundus
- body of uterus (corpus) and cylindrical cervix are joined inferiorly at the isthmus
12
Q
3 layers of uterine wall
A
perimetric - serial coating from perineum
myometrium - distensible smooth muscle
endometrium - adherent inner coating
13
Q
cervix
A
protrudes into vagina, diving the upper vagina into 3 recesses (anterior, posterior, lateral fornices)
14
Q
ectocervix
A
vaginal surface of cervix
- seen easily w/ the help of a speculum
- at its center is round, oval, or slit-like depression(the external os of the cervix) which marks the opening into the endocervical canal
- covered by plushy red columnar epithelium that surrounds the os and lines the endocervical cancel, and by shiny pink squamous epithelium continuous with the vaginal lining
15
Q
cervical puberty changes
A
- broad band of columnar epithelium encircling os (ectropion) is gradually replaced by squamous epithelium
- squamocolumnar junction migrates toward the os creating the transformation zone: this is the area at risk for dysplasia and tested by pap smear
16
Q
Fallopian tube
A
has a fanlike tip (fimbria)
- extended from ovary to each side of the uterus and conducts oocyte from the periovarian peritoneal cavity to the uterine cavity
- normally not palpable
17
Q
ovaries
A
almond shaped glands that vary considerably in size but aver approx 3.5x2x1.5cm from adulthood to menopause
-palpable on pelvic exam in 1/2 of women during reproductive years
18
Q
adnexa
A
ovaries
tubes
supporting tissues
19
Q
2 primary functions of ovaries
A
- production of oocytes
2. secretion of hormones (estrogen, progesterone, testosterone)
20
Q
increased ovarian hormonal secretion at puberty causes:
A
growth of uterus and its endometrial lining
enlargement of vagina
thickening of epithelium
development of secondary sex characteristics (breasts, pubic hair)
21
Q
parietal perineum
A
extends downward behind uterus into a cul-de-sac called rectouterine pouch (pouch of Douglas)
- can just reach on rectovaginal exam
22
Q
greater pelvis
A
- protected by bony wings of ilia
- contains lower abdominal viscera, narrows inferiorly at lesser pelvis which surrounds the pelvic cavity and perineum
23
Q
pelvic floor
A
supports pelvic organs
a long of tissue composed of muscle, ligaments, and end-pelvic fascia
helps support the pelvic organs above the outlet of the lesser pelvis
aid in sexual function (orgasm), urinary and fecal continence, stabilizing of connecting joints
consists of pelvic diaphragm and perineal membrane
24
Q
pelvis diaphragm
A
separates the pelvic cavity from the perineum
consists of elevator ani and coccygeal muscles which attach to the inner surface of the lesser pelvis
25
perineal membrane
triangular sheet of fribromuscular tissue that contains the bulbocavernosus and ischiocarvernous muscles, the superficial transverse perineal body, and the external anal sphincter
spans the anterior triangle. that anchors the urethra, vagina, and perineal body to ischiopubic rami
26
urogenital (levator) hiatus
key-like opening in the center of the pelvic diaphragm where the urethra, vagina, and anorectic pass through
27
deep urogenital diaphragm
inferior to the pelvic diaphragm
includes the external urethral sphincter, urethra, supporting deep transverse perineal muscles (which runs from inferior ischium to the midline)
28
pelvic structures of posterior triangle
external and sphincter muscles that encircles the rectum and internal sphincter
29
pelvic diaphragm is innervated by ?
sacral nerve roots S3 to S5
30
perineal membrane and urogenital diaphragm are innervated by ?
pudendal nerve
31
weakness of pelvic floor muscles may cause:
pain
urinary incontinence
fecal incontinence
prolapse of pelvic organs that can produce a cystocele, rectocele, enterocoele
32
risk factors for pelvic floor weakness
advancing age
prior pelvic surgery or trauma
parity and childbirth
clinical: obesity, diabetes, MS, parkinsons
meds: anticholinergics, alpha-adrenergic blockers
chronically increased intra-abdominal pressure from COPD
chronic constipation
33
loss of urethral support contributes to ?
stress incontinence
34
weakness of the perineal body d/t childbirth predisposes to ?
rectoceles and enteroceles
35
pubic hair
spreads downward in triangular position, pointing toward vagina
- may form an inverted triangle pointing toward umbilicus (10%)
- growth not complete until mid 20s
- growth + breast development are main components of sexual maturity assessment in girls
36
leukorrhea
vaginal secretions
- increase just before menarche
- coincide with ovulation
- accompany sexual arousal
- must differentiate from cervical/vaginal infection discharge
37
lymph from vuvla and lower vagina drains into ?
lymph from internal genitalia (upper vagina) flows into ?
inguinal nodes
pelvic and abdominal lymph nodes (not palpable)
38
female genitalia: common/concerning symptoms
- menarche, menstruation, menopause, postmenopausal bleeding
- pregnancy
- vulvovaginal symptoms
- sexual health
- pelvic pain (acute/chronic)
- STIs
39
menarche
age at onset of menses
40
dysmenorrhea
pain w/ menses, often w bearing down, aching, or cramping sensation in lower abdomen or pelvis
41
premenstrual syndrome (PMS)
cluster of emotional, behavioral, and physical symptoms occurring 5 days before menses for 3 consecutive cycles
42
amenorrhea
absence of menses
43
abnormal uterine bleeding
bleeding between menses
includes infrequent, excessive, prolonged, or postmenopausal bleeding
44
menopause
absence of menses for 12 consecutive months, usually occurring between 48-55
45
postmenopausal bleeding
bleeding occurring 6 months or more after cessation of menses
46
onset of menstruation
9-16 y/o
- takes about 1 year to settle into regular pattern
- depends on genetics, socioeconomic status, nutrition
47
normal vs excessive menstrual blood
normal: dark red
excessive: bright red w/ "clots: (not true fibrin clots)
48
primary dysmenorrhea results from ?
increased prostaglandin production during luteal phase of menstrual cycle when estrogen and progesterone levels decline
49
causes of secondary dysmenorrhea?
```
endometriosis
adenomyosis (endometriosis in muscular layers of uterus)
PID
endometrial polyps
```
50
criteria for PMS diagnosis
- signs and symptoms in the 5 days prior to menses for at least 3 consecutive cycles
- cessation of S/S within 4 days after onset of menses
- interference with daily activities
51
PMS symptoms & signs
```
emotional and behavioral symptoms:
depress
angry outbursts
irritability
anxiety
confusion
crying spells
sleep disturbance
poor concentration
social withdrawal
```
bloating
weight gain
swelling of hands/feet
generalized aches/pains
52
primary amenorrhea
absence of ever having periods
53
secondary amenorrhea
| & causes
cessation of periods after they have been established
- pregnancy
- lactation
- menopause
- low body weight (malnutrition, anorexia)
- stress
- chronic illness
- hypothalamic-pituitary-ovarian dysfunction
54
patterns of abnormal bleeding
- polymenorrhea (<21 days between menses)
- ogliomenorrhea (infrequent bleeding)
- menorrhagia (excessive flow)
- menorrhagia (intermenstrual bleeding)
- postcoital bleeding
55
postcoital bleeding suggests ?
cervical polyps of cancer
| in older women: atrophic vaginitis
56
perimenopause symptoms
vasomotor symptoms: hot flashes, flushing, sweating
57
menopause changes
- ovaries stop producing estradiol or progesterone
| - pituitary secretion of luteinizing hormonal and follicle-stimulating hormone gradually becomes markedly elevated
58
causes of postmenopausal bleeding
endometrial cancer
hormone replacement therapy
uterine/cervical polyps
59
Gravida
total number of pregnancies
60
Para
outcomes of pregnancies
61
amenorrhea followed by heavy bleeding suggests
threatened abortion
| dysfunctional uterine bleeding r/t lack of ovulation
62
most common vulvovaginal symptoms
vaginal discharge
| itching
63
sexual dysfunction
classified by the phase of sexual response
- lack desire
- fail to become aroused and attain adequate lubrication
- unable to reach orgasm
64
causes of sexual dysfunction (females)
```
lack of estrogen
clinical illness
trauma/abuse
surgery
pelvic anatomy
psych conditions
```
65
dyspareunia
pain with intercourse
66
vaginismus
involuntary spasm of the muscles surrounding the vaginal orifice that makes penetration during intercourse painful to impossible
-causes may be physical or psychological
67
superficial vaginal pain suggests ?
local inflammation
strophic vaginitis
inadequate lubrication
68
deeper vaginal pain suggests ?
pelvic disorders
| pressure on normal ovary
69
sexual problems are commonly related to ?
situational and psychosocial factors
70
Acute pelvic pain suggests ?
```
*warrants immediate attention*
ectopic pregnancy
ovarian torsion
appendicitis
PID
ruptured ovarian cyst
Mittelschmerz (mild unilateral pain last a few hours-days at mid cycle from ovulation)
tubo-ovarian abscess
```
71
red flags for PID (causes)
new IUD insertion
| STIs
72
chronic pelvic pain suggests ?
(lasts >6 months and doesn't respond to tx)
```
endometriosis (from retrograde menstrual flow and extension of uterine lining outside of uterus)
PID
adenosis
fibroids
sexual abuse
pelvic floor spasm
```
73
Female Genitalia: health promotion
```
cervical cancer screenings
ovarian cancer: risk factors and screening
STIs
options for family planning
menopause and HRT
```
74
most important risk factor for cervical cancer
persistent infection w. high risk HPV subtypes (16&18)
75
2 notable risk factors for cervical cancer
- failure to undergo screening
- multiple sexual partners
(also smoking, immunosuppression, long term OCP, chlamydia, parity, prior cervical CA)
76
3 symptoms of ovarian cancer
abdominal distention
abdominal bloating
urinary frequency
77
ovarian cancer risks
```
BRCA1/2
family hx breast/ovarian CA
obesity
nulliparity
use of postmenopausal HRT
```
78
ovarian cancer risk decreased by
OCP
multiple pregnancies
breastfeeding
tubal ligation
79
Chlamydia is cause of ?
```
urethritis
cervicitis
PID
ectopic pregnancy
infertility
chronic pelvic pain
```
80
female genitalia important areas of examination
```
external:
mons pubis
labia major and minora
urethral meatus; clitoris
vaginal introitus
perineum
```
```
internal:
vaginal, vaginal walls
cervix
uterus; ovaries
pelvic muscles
rectovaginal wall
```
81
Pap smear and menses
glass-slide technique: don't conduct during menses b/c blood can interfere w/ interpretation
liquid-based cytology: blood cells can be filtered out
82
tips for successful pelvic exam: patient
- 24-48 hrs before no sex, douching, suppositories
- empty bladder
- lie supine w/ head/shoulders elevated, arms at side or across chest to enhance eye contact and reduce tightening of abd muscles
- thighs flexed, abducted, externally rotate at hips
83
delayed puberty suggests ?
often familiar or r/t chronic illness
| - reflect disorders of hypothalamus, anterior pituitary gland, ovaries
84
external female genitalia: excoriations or itchy small red maculopapules suggest ?
```
pediculosis pubis (lice, crabs)
(often found at bases of pubic hairs)
```
85
enlarged clitoris is seen in ?
masculinizing endocrine disorders
86
speculum insertion: 2 steps
1. when inserting speculum hold at angle then
2. slide inward along posterior wall of vagina applying downward pressure to keep vaginal Introits relaxed
(then rotate into horizontal position maintaining posterior pressure to insert to full length - don't open blade early)
87
lateral displacement of cervix suggests ?
endometriosis involving the uterosacral ligaments
88
yellowish discharge on endocervical swab suggests ?
mucropurulent cervicitis from C. trachoma's, N. gonorrhoeae, herpes simplex
89
raised, friable, or lobed warlike lesion on cervix suggests ?
condylomata
| cervical cancer
90
use of lower speculum blade as retractor during bearing down help expose?
upper blade?
anterior vaginal wall defects such as cystoceles
rectoceles
91
stool vs rectovaginal mass
can dent stool w/ digital pressure
92
cervical motion tenderness and/or adnexal tenderness are hallmarks of ?
PID
ectopic pregnancy
appendicitis
93
uterine enlargement suggests ?
pregnancy
uterine myxomas (fibroids)
malignancy
94
nodules on uterine surfaces suggest
myomas or fibroids
95
how to palpate uterus
internal hand to elevate cervix and uterus + external hand on abdomen midway between umbilicus and symphysis pubis
- then slide pelvic hand fingers into anterior fornix and palpate body of uterus (pelvic hand feels anterior surface, abdominal hand feels posterior surface)
-if can't feel uterus may be posterior tipped (retrodisplaced): slide pelvic fingers into posterior fornix and feel for uterus
obese of poorly relaxed abdominal wall can prohibit palpation
96
involuntary voiding or lack of awareness suggests ?
cognitive or neurosensory deficits
97
stress incontinence arises from
decreased intraurethral pressure
98
pain from sudden bladder overdistention accompanied ?
acute urinary retention
99
bladder disorders may cause ? pain
suprapubic
100
bladder infection vs sudden over distention of bladder vs chronic bladder distention pain
infection: lower abdomen, dull and pressure like
sudden: agonizing
chronic: usually painless
101
how to palpate ovaries
abdominal hand - lower quadrant
| pelvic hand - lateral fornix
102
ovaries 3-5 years after menopause
become atrophic and nonpalpable
investigate palpable ovary for ovarian cyst or breast cancer
103
S/S ovarian cancer
pelvic pain
bloating
increased abdominal size
UTI symptoms
104
Adnexal masses can arose from ?
tubo-ovarian abscess
salpingitis
inflammation of Fallopian tubes from PID
ectopic pregnancy
*distinguish mass from uterine myoma*
105
pelvic muscle weakness arises from ?
| contributes to ?
aging
vaginal deliveries
neurologic conditions
urine leakage of stress incontinence during increased abdominal pressure
106
pelvic floor over recruitment w/ tightening, vaginal wall tenderness, and referred pain signal ?
pelvic pain from pelvic floor spasm, interstitial cystitis, vulvodynia, urethral spasm
107
trigger point tenderness in external pelvic floor muscles accompanies ?
pelvic floor spasm and pelvic floor dysfunction from trauma, interstitial cystitis, fibromyalgia
108
pelvic floor disorders include:
urinary/fecal incontinence
pelvic organ prolapse
other sensory and emptying abnormalities of lower urinary and GI tracts
109
modularity and thickening of the uterosacral ligaments occur in ?
endometriosis
| also pain w/ uterine movement
110
retrovaginal exam: 3 primary purposes
1. palpate retroverted uterus, uterosacral ligaments, cul-de-sac, adnexa
2. screen for colorectal cancer in women >50
3. assess pelvic pathology
111
how to do retrovaginal exam
index - vagina
middle - rectum
-pt strain to relax anal sphincter & app pressure between fingers
112
most common hernia in women
1. indirect inguinal
| 2. femoral
113
causes of urethritis
Gon. & Chlamydia
114
how to palpate groin hernia in females
stand up
| indirect inguinal - palpate in labia majora and upward to just lateral under pubic tubercles
115
how to assess urethritis or inflammation of paraurethral glands
index finger - vagina
| milk urethra gently outward from inside - note any discharge
116
Epidermoid Cyst
small, firm round cystic nodule in labia
- yellowish
- look for dark puncture marking the blocked opening of a gland
117
lesions of the vulva:
1. epidermoid cysts
2. venereal wart (condyloma acuminatum)
3. syphilitic chancre
4. secondary syphillis (condyloma latum)
5. genital herpes
6. carcinoma of vulva
118
Venereal Wart
(condyloma acumination)
warty lesions on labia and within vestibule
-from human papillomavirus infection
119
Syphilitic Chancre
firm, painless ulcer from primary syphilis
- forms about 21 days after exposure to Treponema palladium
- may remain hidden and undetected in the vagina and heals regardless of treatment in 3-6 weeks
120
Secondary Syphilis
(condyloma latum)
large raised, round or oval, flat-topped gray or white lesions
-contagious and long w/ rash and mucous membrane sores in the mouth, vagina, or anus are manifestations of secondary syphilis
121
Genital herpes
shallow small painful ulcers on red bases
- Herpes Simplex 1 or 2
- ulcers may take 2-4 weeks to heal
- recurrent outbreaks of localized vesicles, then ulcers are common
122
Carcinoma of the Vulva
ulcerated or raised red vulvar lesion (in elderly woman)
| -usually squamous cell carcinoma arising on labia
123
Bulges and Swelling of the Vulva, Vagina, and Urethra
```
cystocele
urethral caruncle
bartholin gland infection
cystourethrocele
prolapse of the urethral mucosa
rectocele
```
124
Cystocele
bulge of the upper 2/3 of the anterior vaginal wall, together with the bladder above it
-results from weakened anterior supporting tissues
125
Urethral Caruncle
small red benign tumor visible at the posterior urethral meatus
- occurs chiefly in postmenopausal women
- usually asymptomatic
- occasionally mistaken w/ carcinoma of the urethra
- to check, palpate the urethra through the vagina for thickening, modularity, or tenderness, and palpate for inguinal lymphadenopathy
126
Bartholin Gland Infection
- causes: trauma, gonococci, anaerobes like bactericides and peptostreptococci, and C. trachoma's
- acute: gland appears as a tense, hot, very tender abscess
- look for pus emerging from he duct or erythema around the duct opening
- chronic: contender cuts is felt that may be large or small
127
Cystourethrocele
- entire anterior vaginal wall, together w/ bladder and urethra, produces a bulge
- a groove sometimes define the border between the urethrocele and cystocele but isn't always present
128
Prolapse of the Urethral Mucosa
forms a swollen red sing around the urethral meatus
- usually occurs before menarche or after menopause
- identify the urethral meatus at the center of the swelling to make this diagnosis
129
Rectocele
herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the end-pelvic fascia
130
physiologic discharge
clear or white
may contain clumps of epithelial cells
not malodorous
131
Trichomonal Vaginitis:
```
cause
discharge
other symptoms
vulva/vaginal mucosa
lab eval
```
cause: Trichomonas vaginalis (protozoan), often but not always sexually transmitted
discharge: yellowish, green or gray; frothy; often profile and pooled in vaginal fornix; may be malodorous
other symptoms: pruritus (less severe than yeast); pain on urination; dyspareunia
vulva/vaginal mucosa: vestibule and labia minor may be erythematous; vaginal mucosa may be diffusely reddened, w/ small granular spots to petechiae in posterior fornix; in mild cases looks normal
lab eval: can saline wet mount of trichomonads
132
Candidal Vaginitis:
```
cause
discharge
other symptoms
vulva/vaginal mucosa
lab eval
```
cause: Candida albicans - yeast; Abx and other factors predispose
discharge: white and curdy; may be thin but typically thick; not as profuse as rich; not malodorous
other symptoms: pruritus; vaginal soreness; pain on urination; dyspareunia
vulva/vaginal mucosa: vulva and even surrounding skin are often inflamed and sometimes swollen to a variable extent; vaginal mucosa is often reddened w/ white patches of discharge; mucosa may bleed when these patches are scraped off; in mild cases looks normal
lab eval: scan KOH preparation for the branding hyphae of Candida
133
Bacterial Vaginosis:
```
cause
discharge
other symptoms
vulva/vaginal mucosa
lab eval
```
cause: bacterial overgrowth from anaerobic bacteria; often sexually transmitted
discharge: gray or white, thin, homogenous; malodorous; coats vaginal walls; usually not profuse, may be minimal
other symptoms: unpleasant fishy or musty genital odor; reported to occur after intercourse
vulva/vaginal mucosa: vulva and vingal mucosa usually appear normal
lab eval: scan saline wet mount of clue cells (epithelial cells q/ stippled borders); sniff for fishy odor after applying KOH (whiff test); test vaginal ph secretions for ph>4.5
134
2 kind of epithelium cover cervix:
1. shiny pink squamous epithelium which resembles the vaginal epithelium
2. deep red, plushy columnar epithelium, which is continuous with the endocervical lining
(these meet at the squamocolumnar junction - when this junction is at or inside the cervical os only squamous epithelium is seen)
- ring of columnar epithelium is often visible to a varying extent around the os: result of normal process that accompanies fetal development, menarche, and first pregnancy
135
Cervical retention cyst
(Nabothian cysts)
- appear as translucent nodules on cervical surface and have no pathologic significance
- estrogen stimulation increases during adolescence - all or part of columnar epithelium is transformed into squamous epithelium by metaplasia: this change may block secretions of columnar epithelium and cause these cysts
136
Cervical Polyp
usually arises from endoervical canal becoming visible when it protrudes through cervical os
- bright red, soft, fragile
- when only tip is seen it cannot be differentiated clinically from a polyp originating in endometrium
- polyps are benign but may bleed
137
Mucopurulent Cervicitis
produces purulent yellow drainage from cervical os usually from chlamydia, Gon., herpes
138
carcinoma of cervix
- begins in area of metaplasia
- in earliest stages cannot be distinguished from normal cervix
- later stages, extensive, irregular, cauliflower like growth may develop
- early frequent intercourse, multiple partners, smoking, HPV increase risk
139
normal position variants of uterus
retroversion
| retroflexion
140
retroversion of uterus
tilting backward of entire uterus, including both body and cervix
- cervix faces forward
- uterine body cannot be felt by abdominal hand
moderate: body may not be palpable w/ either hand
marked: body can be felt posteriorly through posterior fornix of rectum
-usually mobile and asymptomatic
141
fixed and immobile uterus suggests ?
endometriosis
| PID
142
retroflexion of uterus
backward angulation of body of uterus in relation to cervix
- cervix maintains usually position
- body of uterus often palpable through posterior fornix or through rectum
143
myomas of uterus
(fibroids)
- very common benign uterine tumors
- may be single or multiple and vary greatly in size, ocassionally reaching large proportions
- feel like firm irregular nodules that are continuous w/ uterine surface
- may be confused w/ ovarian mass or retroflexed uterus
- submucosal myomas may project towards the endometrial cavity and are not palpable although they may be suspected b/c enlarged uterus
144
prolapse of uterus
results from weakness of the supporting structures of the pelvic floor
- often associated w/ cystocele and rectocele
- progressive stages the uterus becomes retroverted and descends down into vaginal canal to the outside:
1st degree: cervix still well w/in vagina
2nd degree: cervix at introitus
3rd degree: (providentia) cervix and vagina are outside introitus
145
what may simulate an adnexal mass?
inflammatory disease of bowel (diverticulitis)
carcinoma of colon
pedunculate myoma of uterus
146
ovarian cysts
- smooth and compressible (tumors solid/nodular)
- uncomplicated are usually nontender
- small <6cm: mobile, cystic masses in young women usually benign and often disappear after next menstrual period
147
polycystic ovarian syndrome
- rests on exclusion of several endocrine disorders and 2 of 3 features: ovulatory dysfunction, androgen excess (hirsutism, acne, alopecia, elevated serum testosterone), and confirmation of polycystic ovaries on US
- obese, metabolic syndrome, diabetes/impaired glucose tolerance are risk factors
148
ovarian cancer
rare and usually persists at advanced age
- symptoms: pelvic pain, bloating, increased abdominal size, urinary tract symptoms
- often palpable ovarian mass
- no screening tests but family hx ovarian/breast cancer is risk
149
ectopic pregnancy risk factors
```
tubal damage from PID
prior ectopic pregnancy
tubal surgery
>35
IUD
sub fertility
IVF
```
150
Ectopic pregnancy
results from implantation of fertilized ovum outside endometrial cavity (Fallopian tube)
S/S: abd pain, adnexal tenderness, abnormal uterine bleeding
-palpable adnexal mass: large, fixed, ill defined w/ adherent momentum or small/large bowel
151
PID
d/t spontaneous ascension of microbes from cervix or vagina to endometrium, Fallopian tubes, adjacent structures
- usually involve STDs (GC/Chlamydia) to bacterial vaginosis affecting fallopian rubes or ovaries
hallmark: adnexal, cervical, and uterine compression tenderness
- may lead to tube-ovarian abscess, infertility
