Module 1 Study Guide

Question 1

What is the vulva?

Answer 1

blanket term for all external female genitals.

Question 2

Where is the mons pubis and what is its purpose?

Answer 2

Lies directly in front of the pubic bone. This is where pubic hair grows. It helps cushion the area during sex and houses the sebaceous glands that secrete the hormones for sexual attraction.

Question 3

Where is the labia majora and what is its purpose?

Answer 3

“larger lips” these are folds of connective and adipose tissue that extend inferiorly from the mons and merge posteriorly into the perineal body. Before vaginal birth, both labia help keep the vaginal introitus closed and protect the urethral opening.

Question 4

Where is the labia minora and what is its purpose?

Answer 4

“smaller lips”these are two thin folds of connective tissue. Before vaginal birth, both labia help keep the vaginal introitus closed and protect the urethral opening. In a multip, the labia minora may protect beyond the labia majora.

Question 5

Where is the clitoris and what is its purpose?

Answer 5

a highly innervated, erectile organ located in the superior portion of the vestibule where the labia minora fuse. Its function is purely erogenous. It includes internal and external parts.

Question 6

Where is the urethral orifice and what is its purpose?

Answer 6

the external opening (or meatus) of the urethra, located just below the clitoris. This is where urine exits the body

Question 7

What is the vaginal introitus?

Answer 7

the entrance to the vagina, encompassing the anterior and posterior vestibules and the perineum.

Question 8

Where are the Skene’s glands, and what is their purpose?

Answer 8

Usually open onto the vestibule on either side of the urethra but sometimes open on the posterior wall of the urethra. They secrete mucus during sexual stimulation/arousal.

Question 9

Where are the Bartholin’s glands, and what is their purpose?

Answer 9

located beneath the fascia of the vestibule on either side of the vaginal opening at 4 o’clock and 8 o’clock positions. They secrete mucus during sexual arousal.

Question 10

Where are ovaries, and what is their purpose?

Answer 10

the organs of gamete production in the female. They also produce estrogen and progesterone. They are located in the upper part of the pelvic cavity and are attached by ligaments.

Question 11

Where are fallopian tubes, and what is their purpose?

Answer 11

two long, narrow, muscular tubes that extend from the uterine horns. They transport the ovum from the ovary to the uterus. Fertilization normally takes place in them.

Question 12

Where is the uterus and what is its purpose?

Answer 12

A pear-shaped muscular organ that, in a non-pregnant state, is situated in the pelvic cavity superior to the bladder. It functions to receive a fertilized ovum and provide an environment for an embryo/fetus. It also helps in the expulsion of the fetus and placenta.

Question 13

Where is the cervix and what is its purpose?

Answer 13

The narrow passage forming the lower end of the uterus. It allows fluids to flow in and out of the uterus to the vagina and, during pregnancy, acts as a gatekeeper to protect the pregnancy.

Question 14

What is the vagina?

Answer 14

a muscular structure extending from the vulva to the cervix.

Question 15

Describe the breast and pubic hair development for Tanner stage 1 and when it occurs.

Answer 15

No Hair, Elevation of the nipple only

A girls ovaries will enlarge internally and female hormone production will begin, but external development is not yet visible.

Age 8-11y/o

Question 16

Describe the breast and pubic hair development for Tanner stage 2 and when it occurs.

Answer 16

Downy Hair (straight or only slight curl).

Breast buds and enlargement of the areola diameter

8-14y/o

Question 17

Describe the breast and pubic hair development for Tanner stage 3 and when it occurs.

Answer 17

Dark, coarser and curled hair spread sparsely

Further enlargement of breast and areola without separation of contours

9-15y/o

Question 18

Describe the breast and pubic hair development for Tanner stage 4 and when it occurs.

Answer 18

Terminal hair that fills the entire triangle overlying the pubic region.

Projection of the areola and papilla to form a secondary mound above the level of the breast.

10-16 y/o, Menarche typically occurs here 1-3 years after thelarche

Question 19

Describe the breast and pubic hair development for Tanner stage 5 and when it occurs.

Answer 19

Terminal hair that extends beyond the inguinal crease onto the thigh.

Projection of the nipple only.

12-19 y/o

Question 20

We usually think of menstrual cycles as being regular, but they often aren’t for young teens. Why aren’t they, and when is regularity expected to develop?

Answer 20

They typically begin as irregular anovulatory cycles with heavy bleeding (due to an immature HPO axis). If puberty is not reached by 13 or there is an absence of menarche by 15, they should be evaluated. . After about a year, we would expect more regularity of cycles, although some variance in cycle length can be normal.

The luteal phase is started with ovulation and continues until the start of a new cycle, which generally lasts 14 days (Periods 101 video). It is my understanding that the luteal phase is generally not the phase of the ovarian cycle (and therefore the menstrual cycle) that attributes to the variability in cycle length from person to person and cycle to cycle. This 14 days is fairly reliable among almost all people (periods 101 video). So if young teens aren’t necessarily experiencing ovulation, the regular timing of their cycles should not be expected.

Question 21

What are the sources, roles/actions, patterns of secretion, and feedback systems that control the secretion of the following hormone: GnRH

Answer 21

Source: Hypothalamus
Role: Stimulates the release of FSH and LH
Pattern of secretion: Pulsatile
Feedback System: Release of GnRH stimulates the pituitary to produce FSH and LH

Question 22

What are the sources, roles/actions, patterns of secretion, and feedback systems that control the secretion of the following hormone: FSH

Answer 22

Source: Anterior Pituitary
Role: Targets the ovaries to stimulate the growth and development of the primary follicles (results in production of estrogen and progesterone)
Feedback System: Governed by a negative feedback mechanism

Question 23

What are the sources, roles/actions, patterns of secretion, and feedback systems that control the secretion of the following hormone: LH

Answer 23

Source: Anterior Pituitary
Role: Targets the developing follicle in the ovary and is responsible for ovulation, corpus luteum formation, and hormone production in the ovaries.

Question 24

What are the sources, roles/actions, patterns of secretion, and feedback systems that control the secretion of the following hormone: Estrogen

Answer 24

Source: Ovaries
Role: Proliferates the endometrium to prepare it for pregnancy
Feedback System: Stimulated by FSH and LH

Question 25

What are the sources, roles/actions, patterns of secretion, and feedback systems that control the secretion of the following hormone: Progesterone

Answer 25

Source: Corpus Luteum
Role: Suppresses the growth of new follicles, increases basal body temp. & Maintains the endometrium to prepare it for pregnancy
Feedback System: Stimulated by FSH and LH

Question 26

What are the ovarian phases of the menstrual cycle, and what changes occur in the other reproductive organs during this time?

Answer 26

Follicular Phase: chacterized by the development of ovarian follicles and lasts day 1 (of menses) to day 14 of ovarian cycle. This is where the follicles are recruited and developed to prepare for fertilization.The dominant follicle then moves to the surface of the ovary.

Ovulatory Phase: When the mature ovum is released from the dominant follicle. This occurs 10-12 hours after the LD peak.

Luteal Phase: The remaining follicle’s granulosa cells that are left in the ruptured follicle become enlarged, undergo luteinization and form the corpus luteum which functions for 8 days post ovulation. It secretes progesterone and estrogen to prevent further ovulation. Without a fertilized ovum, it regresses to the corpus albians. All which causes the initiation of the next menstrual cycle.

Question 27

What are the endometrial phases of the menstrual cycle, and what changes occur in the other reproductive organs during this time?

Answer 27

Proliferative: Entails regrowth of the endometrium after the menstrual bleed. Starts on day 4-5 of the cycle and ends with the release of the ovum.

Secretory: Begins at ovulation and does not take place without ovulation. The endometrium becomes thick, cushiony, and nutritive in preparation of implantation. In absence of implantation, the corpus luteum shrinks and progesterone and estrogen levels decline. The endometrium regresses toward the end of this phase.

Mentrual: Begins with the initiation of menses and lasts 3-5 days. It is due to enzymatic autodigestion of the functional layer of the endometrium. Degradation of the endometrium causes interstitial hemorrhage and blood escapes into the endometrial cavity.

Question 28

What happens to the basal body temperature at different times in a menstrual cycle? Why does the basal body temperature change throughout the cycle?

Answer 28

BBT changes due to the increased levels of progesterone, which cause body temperature to rise.

BBT is the temp taken in the morning before getting up. Like progesterone, it will increase post-ovulation and remain elevated with pregnancy. If Pregnancy does not occur, the BBT will lower to pre-ovulation levels.

Question 29

What changes in the body might a person notice throughout the menstrual cycle?

Answer 29

Changes in vaginal discharge. There is usually none right after menstruation and prior to ovulation, discharge is stretchy and sticky. After ovulation, the discharge becomes thick.

There may be changes in breast size or tenderness, mood swings, libido changes.

Question 30

What are the major components of gynecologic history-taking and physical exams?

Answer 30

History taking: obtaining detailed information on symptoms and past medical and gynecologic history

Physical Exam: Breast and pelvic exam

Question 31

What are the guidelines for who needs gynecologic care and exams, and how often? Is there controversy about this? What is it based on?

Answer 31

The American College of Obstetricians and Gynecologists recommends that pelvic and breast examinations be performed when indicated by medical history or symptoms. Patients should be seen annually but don’t necessarily need the pelvic exam unless symptomatic, pregnancy, or history/condition warrants the exam.

There are conflicting guidelines due to the lack of evidence

There are few studies about the benefits of routine exams. Data from these studies are inadequate to support a recommendation for or against performing a routine screening pelvic examination among asymptomatic, nonpregnant women who are not at increased risk of any specific gynecologic condition. Data on its effectiveness for screening for other gynecologic conditions are lacking.

Shared decision making should be included when debating a pelvic exam.

Question 32

What are the major indications for performing a pelvic exam?

Answer 32

When indicated by medical history of symptoms
Before prescribing/placing an IUD
Screening for STIs
Screening test like a PAP

Question 33

What causes primary dysmenorrhea? Describe its presentation.

Answer 33

Primary: no evident pathology; diagnosis of exclusion

Caused by myometrial contractions and is associated with ovulatory cycles. Theorized to be caused by imbalance of prostanoids and high levels of prostaglandins. Onset within 1-2 years of menarche.

Symptoms: pain starts around the onset of bleeding and resolves within a 8-72 hours. May also report nausea, vomiting, diarrhea, diaphoresis, fatigue, headache, and sleep disorders.

Question 34

What causes secondary dysmenorrhea? Describe its presentation.

Answer 34

Secondary: underlying pathology that causes pain with menses (i.e. endometriosis, IUD, infection, scaring from surgery, or uterine fibroids)

Onset usually 2 or more years after menarche.

Symptoms are the same, but dysmenorrhea not improved by typical treatments and accompanied by other symptoms such as dyspareunia, heavy bleeding, postcoital bleeding, infertility indicate secondary cause.

Question 35

How will you determine what type of dysmenorrhea a patient has?

Answer 35

Thorough history, physical and possibly pelvic imaging.

Symptom diary?

Question 36

Why does primary dysmenorrhea happen? What hormones or processes are involved?

Answer 36

Dysmenorrhea is associated with ovulatory cycles because prostaglandins are a major contributor; they are released from the endometrium, and without ovulation, there is no endometrium.

Prostaglandins are released from the endometrium, which causes uterine contractions, decreased uterine blood flow, and uterine hypoxia resulting in pain.

Question 37

What are the standard treatments for primary dysmenorrhea? How do they work?

Answer 37

**First line: NSAIDs 2-3 days before the period starts. 400-600 mg q4-6h (NSAIDs interrupt prostaglandin cascade)
**Combined hormonal contraceptives or progestin only (good for endometriosis), DMPA

Secondary: treat cause
NonPharm: biofeedback, acupuncture, herbal therapy, heat therapy, lifestyle changes (stop smoking, decrease stress, aerobic exercise), dietary changes (limit sugary food and drink

Question 38

Know the difference between PMS and PMDD.

Answer 38

PMS: symptoms with specific timing (right or soon after ovulation, with an escalation in the luteal phase) that are distressing to the woman
PMDD: a small subset of women with severe PMS that cause impairment

Question 39

Describe the assessment (history, physical examination, and diagnostic testing) and management options for patients with dysmenorrhea, PMS, and PMDD.

Answer 39

Assessment: Focus on ruling out pathology, accuratlly assessing time and severity of symptoms.

PMS Management:
-Exercise (increase aerobic exercise), reduce caffeine/Na/ETOH, stress reduction. *Key-involve the patient
-Complementary:
Ca, VB complex, curcumin, acupuncture, cognitive-behavioral therapy.
CHC(progesterone only do not help, estrogen only increase cancer risk), NSAIDs.
SSRIs: Prozac, Zoloft. Take at the luteal phase OR beginning with symptoms and then stop when period starts. Paroxetine should only be used continuously

Question 40

Differentiate PMS from dysmenorrhea. They are not the same thing!

Answer 40

Premenstrual syndrome (PMS) has a wide variety of signs and symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression.
Menstrual cramps (dysmenorrhea) are throbbing or cramping pains in the lower abdomen.

Question 41

Progesterone and prostaglandin are both hormones beginning with P, but they are very different! What is each one’s role in the menstrual cycle and in the symptoms related to the menstrual cycle?

Answer 41

Progesterone: Maintains the endometrium for the potential of pregnancy after ovulation
Prostaglandins: are responsible for uterine contractions during menstruation