Normal vaginal discharge
Clear to white
Most common cause of vaginitis
Bacterial 50%, trichomonas 25%, yeast 25%
Curdy discharge pH < 4.5, hyphae w/itching/burning
Green-yellow discharge w/irritation
Gray-white odorous discharge w/ pH > 4.5
A woman presents with pain and pressure like she is sitting on something. She has difficulty voiding (has to put her fingers in the vagina), urinary incontinence and sexual difficulties. How do you treat her?
She has symptoms of pelvic relaxation. You can treat with pessary and surgery.
What causes urge incontinence?
What causes stress incontinence?
Anatomic loss of support from increased abdominal pressure
What causes overflow incontinence?
Obstruction or loss of neurological control results in a constantly full bladder that dribbles
What drugs can be used to treat urge incontinence?
Anticholinergics, muscarinic receptor antagonists and TCAs (paralyze detrusor)
What drugs can be used to treat stress incontinence?
Anticholinergics, estrogen therapy, TCAs, pessary and surgery.
What drugs can be used to treat overflow incontinence?
Muscarinic agonists, surgery and behavior modification
Gynecologic differential for acute pelvic pain
Ruptured adnexal cysts, hemorrhagic adnexal cysts, ectopic pregnancy and infection
Non-gynecologic differential for acute pelvic pain
Appendicitis, diverticulitis, ischemic bowel, bowel obstruction, UTI and kidney stones
Differential for chronic pelvic pain
GYN: Endometriosis, pelvic congestion syndrome, degenerating fibroids, adenomyosis, dysmenorrhea and adhesions. Non-GYU: UTI, neurologic, psychiatric and abdominal wall conditions.
A 20-30 year old woman presents with dysmenorrhea, dyspareunia, infertility and chronic pelvic pain. Her mother had a similar condition. What is your diagnosis?
Progestins, GnRH agonists, surgery
Test for GC/Chlamydia, treatment for GC/chlamydia PID?
NAAT. Treat for both conditions (ceftriaxone, azithromycin (1x) or doxycycline (7 days)
A patient comes in with pelvic pain, fever, mucopurulent discharge, elevated ESR, elevated CRP. She has a history of GC/chlamydia cervicitis. Laparoscopy is shown below What is your diagnosis?
Note Fitz-Hugh-Curtis adhesions over the liver, typical of PID.
Functional components of the normal menstrual cycle
Hypothalamic-pituitary unit, ovaries and endometrium.
Most common cause of abnormal uterine bleeding?
Anovulation. Bleeding disorders in young patients, fibroids, atrophy and pregnancy complications are also common.
Bleeding through super tampon with a pad longer than 7 days at normal intervals.
Menorrhagia > 80 mL
Irregular menstrual intervals
Bleeding at intervals < 21 days
Bleeding at intervals > 40 days
Treatment of acute dysfunctional uterine bleeding
High-dose estrogen followed by progestins.
Treatment for chronic dysfunctional uterine bleeding
Progestins, OCPs, ablation and hysterectomy