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Gynecology

Learn about female anatomy, menstrual cycle, pelvic inflammatory disease, dysfunctional uterine bleeding, endometriosis, and ruptured ovarian cysts. Explore symptoms, causes, management, and more.

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Gynecology

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  1. Gynecology

  2. External Genitalia

  3. External Genitalia (Vulva) • Mons Pubis • Labia • majora • minora • Perineum • Prepuce • Clitoris • Uretheral opening (meatus) • Vestibule • Skene’s glands • Bartholin’s glands • Vaginal entrance (Introitus) • Anus

  4. Female Reproductive System

  5. Internal Reproductive Organs • Vagina • Cervix • Uterus • Corpus • Fundus • Fallopian Tubes • Ovary

  6. Female Reproductive System

  7. Female Reproductive Organs • Endometrium • Mucosal • Myometrium • Circulation • Smooth Muscles • Perimetrium • Serous • Fundus & 1/2 Corpus

  8. Menstrual Cycle • Menarche • usually between 9 and 13 • initially irregular • Normal • usually 28 day • Hormones • FSH • LH • Estrogen • Progesterone • Menopause • 45 - 55 years old

  9. Menstrual Cycle • Pituitary produces follicle stimulation hormone (FSH) • FSH stimulates ovarian follicle maturation • Follicles mature, release estrogen • Estrogen stimulates thickening of endometrium • Estrogen acts on pituitary to decrease FSH release • FSH levels begin to fall, LH levels rise

  10. Menstrual Cycle • After ovulation, luteinizing hormone (LH) acts on remains of follicle • Promotes corpus luteum formation • Corpus luteum produces progesterone • Progesterone stabilizes, maintains uterine lining

  11. Menstrual Cycle • If ovum is not fertilized • Corpus luteum dies • Progesterone levels drop • Endometrium deteriorates, sloughs • Menstrual period occurs

  12. Menstrual Cycle • If ovum is fertilized • Zygote implants in endometrium • Human chorionic gonadotropin (HCG) released • HCG sustains corpus luteum • Corpus luteum produces progesterone • Endometrium remains stable • Pregnancy continues

  13. Menstrual Cycle

  14. Pelvic Inflammatory Disease • Pathophysiology • Acute or chronic infection involving female reproductive tract, associated structures: • Cervix (cervicitis) • Uterus (endometritis) • Fallopian tubes (salpingitis) • Ovaries (oophoritis) • Pelvic peritoneum

  15. PID • Pathophysiology • Causative organisms include: • Gonorrhea • Chlamydia • E. coli, other gram negative bacilli • Gram positive cocci • Mycoplasma • Viruses

  16. PID • Most cases sexually transmitted • Risk factors include: • Previous infection • Multiple partners • Adolescence • Presence of IUD

  17. PID • History • Moderate to severe diffuse lower abdominal pain • May localize to one quadrant or radiate to shoulders • Gradual onset over 2-3 days beginning 1 -2 weeks after last period

  18. PID • History • Pain worsened by intercourse (Dyspareunia) • Associated symptoms • Fever • Chills • Nausea, vomiting • Vaginal discharge • Erratic periods

  19. PID • Physical Exam • Patient appears ill • Fever usually present • Tender abdomen • Rebound tenderness • Walks bent forward holding abdomen

  20. PID • Management • Position of comfort • General supportive care (oxygen, IV) • Transport • May be at risk for rupture of pyosalpinx or tubo-ovarian abscess

  21. Dysfunctional Uterine Bleeding • Pathophysiology • Usually younger women • Ovum not released from ovary regularly • Without ovum release/corpus luteum formation, menstrual cycle is not completed

  22. Dysfunctional Uterine Bleeding • Pathophysiology • Endometrium continues to thicken • Outgrows blood supply, breaks down • Massive vaginal bleeding results

  23. Dysfunctional Uterine Bleeding • History • History of “missed”, irregular periods • Continuous, profuse vaginal bleeding possibly persisting > 8 days

  24. Dysfunctional Uterine Bleeding • Physical Exam • Signs/symptoms of hypovolemic shock • Positive tilt test • Passage of tissue with vaginal bleeding

  25. Dysfunctional Uterine Bleeding • Management • Do not pack vagina to stop bleeding • High concentration oxygen • IV LR • MAST if indicated

  26. Endometriosis • Presence of normal endometrium at ectopic locations • Signs, symptoms • Pelvic pain • Dysmenorrhea • Pain on intercourse • Lower abdominal tenderness

  27. Endometriosis • History • Painful intercourse • Painful menstruation • Painful bowel movements

  28. Endometriosis • Rupture of endometrial masses may cause severe pain, internal hemorrhage • May require surgery • Long term management is gynecologic issue

  29. Ruptured Ovarian Cyst • Ovarian cyst = Sac on ovary • Causes include • Growth of endometrial tissue in ovary • Hemorrhaging into mature corpus luteum • Over-distension of ovarian follicle

  30. Ruptured Ovarian Cyst • Cysts rupture into peritoneal cavity • Peritonitis • Hemorrhage, shock

  31. Ruptured Ovarian Cyst • Signs, symptoms • History of menstrual irregularities, chronic pelvic pain • Unilateral abdominal pain • Unilateral tenderness • Pallor, tachycardia, diaphoresis, hypotension

  32. Ruptured Ovarian Cyst • Management • High concentration oxygen • IV LR • MAST if indicated • Rapid transport

  33. Cystitis • Inflammation of the bladder • Usually bacterial • Occurs frequently • May lead to pyelonephritis

  34. Cystitis • Assessment • Suprapubic tenderness • Frequent urination • Dysuria • Blood in urine

  35. Cystitis • Management • Supportive care

  36. Mittelschmertz • Pain at menstrual cycle midpoint • Caused by ovulation • Occurs on day 14 to 16 • Unilateral, mild to moderate • Lasts a day or less • Possible light vaginal spotting

  37. Mittelschmertz • Management • Rule out more serious causes of pain • Analgesia may be required • Self-limiting problem • Can be confirmed by keeping calendar

  38. Sexual Assault • Any sexual contact without consent • Legal rather than medical diagnosis • Seldom creates medical emergency • If medical emergency exists, usually is from trauma secondary to assault

  39. Sexual Assault • History • Do not question patient regarding details of event. • Do not question patient about sexual history or practices • Avoid taking lengthy histories • Do not ask questions which may lead to guilt feelings • Anticipate reactions such as anxiety, withdrawal, denial, anger, fear

  40. Sexual Assault • Physical Exam • Examine genitalia only if severe injury present • Avoid touching without permission • Explain procedures before proceeding • Maintain the patient’s modesty

  41. Sexual Assault • Management • Priority to immediate life threats • Psychological support is important • Limit intervention to that needed for immediate problems • Protect patient’s privacy

  42. Sexual Assault • Crime Scene • Handle evidence as little as possible • Ask patient not to change, bathe, or douche • Do not allow patient to drink or brush their teeth • Do not clean wounds unless absolutely necessary

  43. Sexual Assault • Management • May be preferable for female paramedic to attend patient • Honor patient’s wishes • Do not abandon patient at scene • Complete trip report carefully

  44. Gynecological Assessment Abdominal Pain Bleeding

  45. Gynecological PA Abdominal Pain + Female Gender = Gynecologic Problem Until Proven Otherwise

  46. Gynecological PA • Abdominal pain • When was last period? • Was it normal? • Bleeding between periods? • Regularity?

  47. Gynecological PA • Abdominal pain • Pregnant? • Missed period? • Urinary frequency? • Breast enlargement or tenderness? • N/V? • Contraception? What kind? • Vaginal discharge? • Color, amount, odor

  48. Gynecological PA • Abdominal Pain • Aggravation/Alleviation • OPQRST • Tenderness/masses at pain’s location? • Tilt test

  49. Gynecological PA • Vaginal bleeding • More, less heavy than normal period? • Possibility of pregnancy? • Associated pain/tenderness? • Perform tilt test

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