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Chapter Eight

Examining Gynecological Issues

© 2008 McGraw-Hill Higher Education. All rights reserved.

External and Internal Genitalia

• Mons Pubis• Labia Majora• Labia Minora• Clitoris• Urethral Opening• Vaginal Opening

• Perineum• Vagina• Cervix• Uterus• Fallopian Tubes• Ovaries

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Female Reproductive System

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Breast Tissue

• The function of breasts are as follows:• Contain mammary glands for new-born nourishment• Sex organ for arousal

• Each breast contains 15-25 clusters called lobes which connect to the nipple

• The nipple (erectile tissue) are effected by temperature, sexual stimulation, and lactation

• Breast size is determined by the following:• Genetics• Amount of fat and glandular tissue

• Nearly 70% of women experience benign breast changes during the menstrual cycle, 85-90% of lumps are benign

See Figure 8.1

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Preventive Measures

See Figure 8.2See Figure 8.2

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Menstruation

• Menarche is the first menstrual cycle for young girls• The average age of onset are 12.8 years• Genetics, socioeconomic conditions, nutritional status,

obesity, and exercise can affect menarche• 6 primary hormones are involved in regulating the

reproductive system:• Gonadotropin-releasing hormone (GnRH)• Follicle-stimulating hormone (FSH)• Luteinizing hormones (LH)• Estrogen• Progesterone• Testosterone

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Luteal Secretion

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Phases of the Menstrual Cycle

1. Follicular (proliferatative) phase lasts 10-14 days and is considered the most variable part of the cycle

2. Ovulatory phase is when the largest follicle bursts, releasing a mature egg into the fallopian tubes

3. Luteal phase causes the secretion of progesterone, preparing for implantation of the fertilized egg

4. Menstruation phase occurs when estrogen and progesterone levels drop, allowing sloughing off of the endometrium

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Menstrual Cycle

Breakdown of the

endometrial lining

and discharge of

tissue (menses)

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Pelvic Examinations

• Pelvic exams include a visual screening to ensure that the reproductive organs look normal in size, shape, and location

• Exams should be conducted annually for 3 consecutive years until your health provider decides otherwise

• A speculum is inserted into the vagina to observe for internal organ normalcy

• A pap test and bimanual exam (physical check of the ovaries and uterus), followed by a rectal exam is common procedure for pelvic exams

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Pelvic Exam

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Pap test

• A pap test consists of taking a sample of cells from the cervical area (squamous epithelium)

• The primary purpose is to prevent invasive squamous cell carcinoma from occurring

• The area is where 90% of all cervical cancers begin

• A brush or thin-prep is used to scrape cells from the cervix and smeared onto a slide

• Another sample is taken from the endocervical canal

• Both slides are taken to the lab for analysis

© 2008 McGraw-Hill Higher Education. All rights reserved.

Menstrual Disorders

• Endometriosis occurs when the lining of the endometrium fragments and lodges in other parts of the body

• Dysmenorrhea describes painful menstrual cramps, believed to be a normal response to uterine contractions resulting from increased prostaglandin production

• Amenorrhea is the absence of a menstrual cycle• Primary amenorrhea: significant physical disorder affecting

young girls• Secondary amenorrhea: due to pregnancy or the onset of

menopause• Polycystic Ovarian Syndrome occurs when the ovaries

produce excessive amounts of male hormones and small cysts develop

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Premenstrual Syndrome

• PMS is a disorder with an array of physical and psychological symptoms associated with the luteal phase of menstruation

• Most symptoms taper off with menstruation, although some women continue to experience symptoms throughout their period

• Researchers believe that the cyclical trigger are due to normal ovarian function

• The best approach to dealing with PMS is to alleviate them through non-invasive strategies such as:

• Biofeedback• Exercise• Nutritional changes• Vitamin/mineral supplementation• Relaxation techniques• Reducing salt, caffeine, and refined sugars

Premenstrual Dysphoric Disorder (PMDD) is a severeForm of PMS that can occur one week prior to menses

© 2008 McGraw-Hill Higher Education. All rights reserved.

Other Medical Concerns

• Female Athlete Triad

• Uterine Fibroids

• Hysterectomy

• Toxic Shock Syndrome (TSS)

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Menopause

• American women (1.25 million annually) experience the normal cessation of their menstrual cycle

• Occurs normally between the ages of 40-58 years and most women experience this by age 50

• The 4 stages of menopause are:• Premenopause: periods are beginning to become irregular• Perimenopause: period of time (3-7 yrs.) before and after the last

menstrual period during which the cycle becomes erratic and hot flashes begin

• Menopause: results from normal aging of the ovaries, when estrogen levels fall and menstruation has ceased for 1 yr.

• Postmenopause: Menstruation has ceased for over 1 yr.

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Hormone Replacement Therapy (HRT)

• The risks of using combined estrogen and progestin have been surprising based upon the findings of the National Heart, Lung and Blood Institute

• Study findings show that the increases in the following:• 41% increase in strokes• 29% increase in CHD events• 100% increase in blood clots• 26% increase in breast cancer

• Given the recent findings, women are exploring more natural strategies such as:

• Exercise• Nutritional products• Reducing stress• Wearing comfortable clothing

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Human Sexual Response Cycle

• Masters and Johnson determined that the Human Sexual Response Cycle includes 4 predictable phases:

• Excitement• Plateau• Orgasm• Resolution

See Figure 8.4

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External Genitals and Sexual Response

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Vaginal and Uterus Response

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Breast Response

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Where is the “G-Spot”?

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Orgasm

• Rhythmic contractions (3-15) of uterine walls, the first 3-6 are most intense

• Most anorgasmic experiences have psychological and sociological roots or can be caused by a lack of proper technique

• Most women need continuous clitoral stimulation to experience an orgasm

• Orgasm can be achieved with adequate stimulation, whether through masturbation or intercourse

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Aging and Sexual Response

• Physiologically, the excitement phase takes longer for the vagina to lubricate

• The orgasmic phase is shorter in duration and contractions may be less intense

• The resolution phase has been found to take longer

• While sexual desires continue throughout the lifespan, a woman’s perceptions of relationship qualities provide a strong indicator of the level of sexual desire she attains during the aging process

© 2008 McGraw-Hill Higher Education. All rights reserved.

Chapter Eight

Examining Gynecological Issues