6: Female Pathology

Question 1

What is endometriosis?

Answer 1

Estrogen dependent disorder where tissue sheds outside of the uterus and deposits in the pelvic cavity

Question 2

When does endometriosis develop?

Answer 2

Teenage years

Question 3

What are the risk factors for endometriosis?

Answer 3

• Maternal family history
• Delay pregnancy
• Early menarche
• Abnormal cycles
• Low birth weight
• High red meat and trans fat

Question 4

What is the most common clinical presentation with endometriosis?

Answer 4

Dysmennorhea, dyspareunia, pain with bowel movements, infertility

Question 5

What are other symptoms of endometriosis?

Answer 5

Low-grade fever, diarrhea, constipation, rectal bleeding, referred pain

Question 6

How is endometriosis diagnosed?

Answer 6

Laparoscopy, MRI, ultrasound

Question 7

What are treatments for endometriosis?

Answer 7

Hormone therapy, birth control, yoga, aromatherapy, acupuncture, naturopathic

Question 8

What physical therapy interventions can be used for endometriosis?

Answer 8

General exercise, modalities, stress management, posture and body mechanics education, trigger point

Question 9

What is BPS/IC?

Answer 9

Bladder pain syndrome/ Interstitial cystitis - complaint of suprapubic pain related to bladder filling that is accompanied by other symptoms in the absence of other pathology

Question 10

What is the mechanism of BPS/IC?

Answer 10

Overactive PFM

Question 11

What are the four characteristics of the clinical presentation of BPS/IC?

Answer 11

1. Urinary urgency
2. Nocturia
3. Pain, stabbing sensation
4. Difficulty emptying

Question 12

How is BPS/IC diagnosed?

Answer 12

History, physical , cystoscopy, urinalysis, voiding diary, pelvic ultrasound

Question 13

What are treatments for BPS/IC?

Answer 13

Stress management, manual therapy, trigger point, scar massage, CBT, stretching, muscle re-education

Question 14

What is POP?

Answer 14

Pelvic organ prolapse - downward descent of female pelvic organs into or through the vagina

Question 15

What is the prevalence of POP?

Answer 15

43-76% of women

Question 16

What is cystocele?

Answer 16

Prolapse of bladder through urethra

Question 17

What is rectocele?

Answer 17

Prolapse of the rectum

Question 18

What is uterine prolapse?

Answer 18

Prolapse of uterus through the cervix

Question 19

What is enterocele?

Answer 19

Prolapse of small intestine

Question 20

What are the symptoms of vaginal POP?

Answer 20

• Bulging or protrusion sensation
• Seeing or feeling bulge
• Pressure
• Heaviness

Question 21

What are symptoms of urinary POP?

Answer 21

• Incontinence
• Frequency and urgency
• Weak or prolonged urinary stream
• Hesitancy
• Feeling of incomplete voiding
• Position change to start or complete voiding

Question 22

What are the symptoms of bowel POP?

Answer 22

• Incontinence of flatus or stool
• Feeling of incomplete emptying
• Straining during defecation
• Urgency
• Splinting to start or complete defecation

Question 23

What are the risk factors for POP?

Answer 23

• Constipation
• Pelvic surgery
• Genetic factors
• Caucasian ethnicity
• Pregnancy with vaginal delivery
• CT disorders
• COPD

Question 24

How do you examine POP?

Answer 24

POP-Q: performed in supine and standing, measure degree of prolapse

Question 25

What is Stage 0 on the POP-Q?

Answer 25

No prolapse

Question 26

What is Stage I on the POP-Q?

Answer 26

Most distal portion of the prolapse is > 1cm above hymen

Question 27

What is Stage II on the POP-Q?

Answer 27

Most distal portion is < 1 cm proximal or distal to hymen

Question 28

What is Stage III on the POP-Q?

Answer 28

Distal portion of prolapse is > 1cm below the plane of the hymen but protrudes no further than 2 cm less than TVL

Question 29

What is Stage IV on the POP-Q?

Answer 29

Distal portion of the prolapse protrudes to at least 2 cm of the TVL

Question 30

What are the treatments for POP?

Answer 30

- Pessaries - PFMT

Question 31

What are the dimensions of FSD?

Answer 31

Female sexual disorder - sexual identity, function, and relationship

Question 32

What it the etiology of FSD?

Answer 32

- Biological - Psychosexual - Contextual

Question 33

What is dyspareunia?

Answer 33

Pain with penetration, superficial vs deep

Question 34

What are causes of dyspareunia?

Answer 34

CPPD, psychologic trauma, endometriosis, post-partum, vulvovaginitis

Question 35

What are the two types of CPPD?

Answer 35

- Vaginismus - Vulvar vestibulitis

Question 36

What is vaginismus?

Answer 36

Involuntary contraction and spasm of perineal muscles that makes penetration difficulty, painful, or impossible

Question 37

What are six clinical findings with vaginismus?

Answer 37

1. Dehydrated tissues 2. Decreased elasticity 3. Pale color 4. History of bleeding with penetration 5. Painful/impossible penetration 6. High resting tone

Question 38

What is vulvar vestibulitis?

Answer 38

Pain in the vestibule with palpation of entry

Question 39

What does vulvar vestibulitis occur?

Answer 39

Wearing tight clothing, use of tampons, intercourse

Question 40

What are risk factors for vulvar vestibulitis?

Answer 40

Recurrent yeast infections, sleep dysfunction, PTSD

Question 41

What are causes of vulvar vestibulitis?

Answer 41

Physical cause becoming psychologically based

Question 42

What is the prevalence of vulvar vestibulitis?

Answer 42

16% of women 18-64, common pre-menopause

Question 43

What symptoms are associated with vulvar vestibulitis?

Answer 43

- Extreme sensitivity - Bartholin glands, Skene's glands - Inflamed superficial blood vessels - Patient expresses anxiety regarding physical exam

Question 44

What clinical findings are associated with vulvar vestibulitis?

Answer 44

- High tone - Trigger points - Dyspareunia - History of yeast infection self-treatment - Urinary frequency and urgency - + cottons swab tough test

Question 45

What are treatments for FSD?

Answer 45

- Hormone therapy - Analgesia - Anti-depressant - Counseling - PFMT - Botox