The Female Reproductive System

Question 1

Anatomy of the Female Genital Tract

Answer 1

Consists of ovaries, uterus, fallopian tube, vagina, and vulva
* Ovaries divided into cortex and medulla
* Uterus divided into cervix, corpus, and fundus
* Cervix divided into vaginal portion and endocervix

Question 2

First half of Menstrual Cycle

Answer 2

Endometrial glands and stroma proliferate under influence of estrogen from ovarian follicle

Question 3

Midcycle

Answer 3

Ovulation occurs;
* Follicle discharges an egg, becomes a corpus luteum that produces estrogen and progesterone
* Progesterone: Endometrium undergoes secretory phase to prepare for receiving fertilized ovum

Question 4

If no pregnancy occurs (in Normal Mestrual Cycle)

Answer 4

• Corpus luteum degrades
• Estrogen and progesterone levels fall
• Secretory endometrium is shed with blood
• New cycle begins

Question 5

Female Genital Tract Infections

Answer 5

Vaginitis; Cervicitis; Salpingitis; PID; Condylomas;

Question 6

Vaginitis

Answer 6

Common; causes vaginal discharge, itching, and irritation
* Candida albicans
* Trichomonas vaginalis
* Gardnerella (Haemophilus) vaginalis in conjunction with anaerobic bacteria
(nonspecific vaginitis)

Question 7

Cervicitis

Answer 7

Mild chronic inflammation; common in women who have had children
* More severe inflammation caused by gonococci or Chlamydia
* May spread to infect tubes and adjacent tissues; pelvic inflammatory disease
(PID)

Question 8

Salpingitis

Answer 8

Tubal infection

Question 9

PID - pelvic inflammatory disease

Answer 9

Inflammation of fallopian tubes, along with ovaries at times

Question 10

Condylomas

Answer 10

Venereal warts in genital tract
* Benign tumorlike overgrowths of squamous epithelium
* Acquired and transmitted by sexual contact

Question 11

Toxic Shock Syndrome (TSS)

Answer 11

Caused by toxin produced by staphylococci
* First associated with tampon use; occurred in vagina
* Also occurs from staphylococcal infections of skin, bones, kidneys, with toxin released in the bloodstream

Question 12

Clinical Manifestations of TSS

Answer 12

• Fever, vomiting, diarrhea, muscle aches and pains
• Erythematous or sunburn-like rash followed by flaking and peeling

Question 13

Treatment of TSS

Answer 13

• General supportive measures until effects of toxin wear off
• Antibiotics to eradicate staphylococci do not shorten course of disease

Question 14

Condylomas of the Genital Tract

Answer 14

• Venereal warts
• Caused by human papillomavirus (HPV)
• Occur most often on the vulvar mucosa and around the vaginal
  opening and the anus

Question 15

Diseases of the Vulva

Answer 15

Vulvar dystrophy; Carcinoma of the vulva

Question 16

Vulvar dystrophy

Answer 16

• Irregular white patches on vulvar skin (leukoplakia)
• Intense itching
• May progress to carcinoma
• Local treatment usually effective

Question 17

Carcinoma of the vulva

Answer 17

• Found in pre- and postmenopausal women
• Usually with a preexisting vulvar dystrophy
• Treated by vulvectomy and excision of inguinal lymph nodes

Question 18

Cervical polyps

Answer 18

• Benign, arise from the cervix
• Usually small but may be quite large
• Erosion of tip may cause bleeding
• Surgical removal

Question 19

Cervical dysplasia

Answer 19

• Abnormal growth and maturation of cervical squamous epithelium

Question 20

Mild dysplasia

Answer 20

Result of cervical inflammation
* Regresses spontaneously

Question 21

Severe dysplasia

Answer 21

Does not regress
* May progress to in situ carcinoma
* May progress to invasive carcinoma

Question 22

Cervical Intraepithelial Neoplasia

Answer 22

Constitute different stages in a progressive spectrum of epithelial abnormalities classified as cervical intraepithelial neoplasia (CIN)
* Grade I: Mild dysplasia
* Grade II: Moderate dysplasia
* Grade III: Severe dysplasia
Some HPV strains that cause cervical condylomas are carcinogenic and predispose to cervical neoplasia

Question 23

Diagnosis of Cervical Intraepithelial Neoplasia

Answer 23

HPV test to supplement Pap smear when cytologic changes in Pap smear are inconclusive (atypical squamous cells of undetermined significance)
* If HPV test is negative, cytologic changes are not significant

Question 24

Irregular Uterine Bleeding

Answer 24

Occurs because follicle fails to mature and no corpus luteum is formed (anovulatory cycle)
* Disturbance of normal cyclic interaction of estrogen and progesterone on the endometrium
* Uterus is subjected to continuous estrogen stimulation and responds by shedding and bleeding in an irregular manner instead of shedding all at once as in a normal menstrual cycle (anovulatory bleeding)

Question 25

Endometrial Disorders

Answer 25

* Benign endometrial hyperplasia: Associated with irregular uterine bleeding * Benign endometrial polyps: Common; May bleed if tip is eroded * Endometrial adenocarcinoma: Related to prolonged endometrial stimulation by estrogen use; Irregular uterine bleeding or postmenopausal bleeding

Question 26

Endometriosis

Answer 26

Deposits of endometrial tissue outside normal location in endometrial cavity

Question 27

Ectopic sites

Answer 27

Uterine wall; ovary; elsewhere in pelvis; appendix; rectum * Ectopic endometrium responds to hormonal stimuli and undergoes cyclic menstrual desquamation and regeneration * Secondary scarring may obstruct fallopian tubes

Question 28

Diagnosis of Endometriosis

Answer 28

Laparoscopy - Allows visualization of ectopic deposits followed by removing or destroying these deposits surgically or with drugs or hormones

Question 29

Endometriosis Treatment

Answer 29

* Synthetic hormones with progesterone activity to completely suppress menstrual cycle * Oral contraceptives to suppress ovulation * Drugs that suppress output of gonadotropin from pituitary gland

Question 30

Primary dysmenorrhea

Answer 30

Most common type; pelvic organs are normal * Crampy lower abdominal pain that begins just before menstruation * Pain lasts for 1 to 2 days after onset of menstrual flow * Treatment with prostaglandin inhibitors, oral contraceptives

Question 31

Secondary dysmenorrhea

Answer 31

* From various diseases of the pelvic organs, such as endometriosis * Treatment is to correct underlying cause

Question 32

Ovarian cysts

Answer 32

Arise from ovarian follicles or corpora lutea that have failed to regress normally and have converted to fluid-filled cysts

Question 33

Functional cysts

Answer 33

Follicle and corpus luteum cysts from deranged maturation and involution, regress spontaneously, do not become large

Question 34

Endometrial cysts

Answer 34

Endometrial deposits in ovary filled with old blood and debris

Question 35

Benign cystic teratoma (dermoid cyst)

Answer 35

Arise from unfertilized ova that undergo neoplastic change * Contains skin, hair, teeth, bone, parts of gastrointestinal tract, thyroid, and other tissues growing in a jumbled fashion

Question 36

Malignant teratoma

Answer 36

Very rare

Question 37

Serous tumor

Answer 37

Resembles cells that line fallopian tubes

Question 38

Cystadenoma

Answer 38

Benign, cystic serous tumor

Question 39

Cystadenocarcinoma

Answer 39

Neoplastic epithelium may extend on the surface of tumor and break off, implanting in other parts (pelvis, peritoneal cavity, omentum)

Question 40

Mucinous tumor

Answer 40

Resembles mucus-secreting tumor of endocervix

Question 41

Endometrioid tumor

Answer 41

Resembles endometrial tissue

Question 42

Fibroma

Answer 42

From fibrous connective tissue cells of ovary

Question 43

Granulosa theca cell tumor

Answer 43

Ovarian tumor that produces estrogen * Arises from the granulosa cells or estrogen-producing cells that line the follicle or from theca cells located adjacent to follicle cells * Induces excessive endometrial stimulation from estrogen produced by tumor

Question 44

Male-hormone-producing ovarian tumors

Answer 44

Induces masculinization