Female Reproductive System and Gynecologic Emergencies

• The female reproductive system consists of the external female genitalia, uterus, vagina, Fallopian tubes, ovaries, and perineum. • The ovaries are almond-shaped bodies responsible for producing ova (eggs) and hormones estrogen and progesterone. • The Fallopian tubes extend from the uterus and terminate near the ovary, carrying ova from the ovary to the uterus and sperm from the uterus towards the ovary. • The uterus is a muscular organ where the fertilized egg implants and grows, responsible for contractions during labor and pushing the infant through the birth canal. • The vagina is the outermost cavity of the female reproductive system, forming the lower part of the birth canal and ending at the external opening of the body. • The cervical canal is the passageway from the uterus to the opening into the vagina. • The external female genitalia, known as the vulva, comprise the mons pubis, labia majora and minora, clitoris, vestibule, urethral opening, vaginal orifice, and anus. • Each month, hormone levels increase in females, stimulating the development of eggs and ovaries, and thickening the endometrium in preparation for a fertilized egg. • If an egg is fertilized and implants in the uterus, menstruation is suspended until pregnancy ends; if not, menstruation begins, characterized by the cyclic shedding of the uterine lining, which occurs approximately every 28 days and lasts 4-6 days. • The average female loses approximately 25-60 mL of blood during menstruation. • Menopause is the cessation of menstruation and ovarian function, usually occurring between 45-55 years of age. • Premenstrual syndrome (PMS) affects approximately 20-30% of premenopausal women, characterized by symptoms 7-14 days before menstruation, including stress, diet, and prescription/non-prescription drugs exacerbating symptoms. • Reactive hypoglycemia may occur in women with PMS, resulting in increased fatigue, and prehospital treatment is supportive, with possible administration of oral or IV glucose. • Mittelschmerz is abdominal pain in the two weeks before menstruation, resulting from the ovulatory process, and may start at any time during ovulation. • Amenorrhea is the absence or cessation of menstruation, commonly caused by pregnancy, exercise-induced amenorrhea, emotional problems, or extreme stress. • Disorders in the female reproductive system can lead to gynecologic emergencies, including acute or chronic infections, hemorrhage, rupture of a cyst or ectopic pregnancy, and pelvic inflammatory disease (PID). • PID is an acute or chronic infection of the upper female reproductive organs, which may expand to the Fallopian tubes and ovaries, characterized by pelvic pain and fever, and may lead to complications such as sepsis, abscess formation, infertility, and scarring. • Sexually transmitted infections (STIs) can cause PID, and treatment involves placing the patient in a position of comfort and providing supportive care. • Bacterial vaginosis is the most common vaginal infection, affecting women between 15-44 years old, caused by an overgrowth of other bacterial forms, and may lead to premature or low birth weight if left untreated during pregnancy. • A cancroid is a highly contagious and curable infection caused by bacteria, characterized by painful sores or ulcers, usually on the genitals, and may cause swollen painful lymph glands in the groin area. • Chlamydia is a bacterially caused STI, commonly reported in the United States, characterized by mild or absent symptoms, but may lead to PID if untreated. • Cytomegalovirus (CMV) is a common viral infection with no known cure, which may remain dormant in the body for years, and can cause prolonged high fever, chills, headache, malaise, extreme fatigue, and an enlarged spleen. • Genital herpes is an infection caused by herpes simplex virus type 1 or 2, characterized by tingling or sores near the area where the virus entered the body, along with fever, muscle aches, and pains, headache, vaginal discharge, and swollen glands in the groin area. • Gonorrhea affects the cervix, uterus, and Fallopian tubes in women, and can also affect the urethra in women and men, characterized by symptoms such as dysuria with associated burning or itching, yellow or bloody vaginal discharge, and bleeding between periods. • Genital warts are caused by human papillomavirus (HPV) and may not present symptoms in some infected people, while others may have multiple growths in the genital area. • Syphilis is a disease that manifests in three stages: primary (characterized by painless sores), secondary (characterized by mucous membrane lesions and a rash), and tertiary (characterized by internal damage). • Trichomoniasis is a common cause of vaginal infection, characterized by symptoms such as frothy yellow-green vaginal discharge with a strong odor, irritation, and itching, discomfort during intercourse, abdominal pain, and disuria. • Vaginal yeast infections occur when the normal acidic environment of the vagina is altered, allowing yeast to grow, characterized by symptoms such as itching, burning, and soreness, as well as a white vaginal discharge. • Ruptured ovarian cysts are painful and may need surgical removal, and internal bleeding is rare but possible. • Ectopic pregnancy is a life-threatening emergency that occurs when a pregnancy develops outside the uterus, usually in the Fallopian tube, characterized by sudden stabbing pain in the lower abdomen. • Causes affecting the normal pathway of the ovum include previous surgical adhesions, PID, tubal ligation, and intrauterine devices (IUDs). • Vaginal bleeding during the third trimester of pregnancy is a serious emergency and may indicate a spontaneous abortion or miscarriage. • Placenta previa presents with bright red bleeding and abruptio placentae presents with dark bleeding, with varying degrees of bleeding and pain. • Endometritis is the inflammation or irritation of the endometrium, commonly caused by infection, characterized by symptoms such as malaise, high or low-grade fever, constipation, and uncomfortable bowel movements, vaginal bleeding and/or discharge, abdominal distension, and lower abdominal or pelvic pain. • Endometriosis is a condition where endometrial tissue grows outside the uterus, characterized by pain localized in the lower back, pelvic, and abdominal regions, and symptoms such as painful intercourse, GI pain, disuria, and painful bowel movements during the menstrual cycle. • Postpartum eclampsia is a condition where the mother is at risk for seizures and hypertension after delivery, usually presenting within the first 24 hours after delivery but may occur as late as 4 weeks following birth. • Sexual assault victims require compassion and transport, and may have multi-system trauma requiring treatment for shock along with supportive care.