24 Questions
What is a bulge caused by the bladder protruding into the submucosa of the anterior vaginal wall?
Cystocele
What is a bulge caused by the rectal cavity protrusion?
Rectocele
What can result in incompetency of the musculature?
Trauma to anterior vaginal wall
What is a condition in which the cervix and uterus descend under pressure through the vaginal canal?
Uterine prolapse
What may cause a laceration, usually transverse, giving the cervical os a “fishmouth” appearance?
Multiparity
What is a sign of early pregnancy?
Bluish coloration of the cervix
What is the result of a weakening of the vaginal walls in pelvic organ prolapse?
The pelvic organs descend and protrude into the vaginal canal
What is the primary cause of a cystocele?
Injury or strain during childbirth
What is the characteristic of a rectocele?
An upward pouching of the rectum
What is the risk factor for developing a cystocele?
Multiparity
What is the primary goal of medical management for fistulas of the vagina?
To eliminate fistula and treat infection
What is the characteristic of a vesicovaginal fistula?
Urine escapes into the vagina
What is the treatment for a rectovaginal fistula?
Low-residue diet and drainage
What is the purpose of methylene blue dye instillation in the diagnosis of fistulas of the vagina?
To check for staining in the vagina
What is the condition where the intestinal wall protrudes into the vagina?
Enterocele
Which type of prolapse causes the anterior vaginal wall to bulge downward?
Cystocele
What is the surgical procedure that repairs perineal lacerations?
Perineorrhaphy
What is the condition where the uterus descends into the vaginal canal?
Uterine Prolapse
Which symptom is commonly associated with Uterine Prolapse?
Urinary incontinence
What is the purpose of a pessary device?
To support the uterus, bladder, or intestines
What is the goal of postoperative nursing care for a rectocele repair?
To prevent infection and pressure on the suture line
What is the condition where the rectal wall bulges into the vagina?
Rectocele
What is the surgical procedure that repairs a cystocele?
Anterior colporrhaphy
What is the consequence of delayed treatment for perineal lacerations?
All of the above
Study Notes
Physical Exam
- Supine lithotomy position is commonly used
- Inspection:
- Nulliparous: labia minora come together at the opening of the vagina
- Multiparous: labia minora may gape and vaginal tissue may protrude
- Cervix:
- Nulliparous: usually 2-3 cm wide and smooth
- Multiparous: may have a laceration, usually transverse, giving the cervical os a "fishmouth" appearance
- Uterine prolapse: cervix and uterus descend under pressure through the vaginal canal
- Cystocele: bladder protrudes into the submucosa of the anterior vaginal wall
- Rectocele: rectal cavity protrudes into the posterior vaginal wall
Fistulas of the Vagina
- A fistula is an abnormal opening between two internal hollow organs or between an internal hollow organ and the exterior of the body
- Examples:
- Vesicovaginal fistula: opening between the bladder and vagina
- Rectovaginal fistula: opening between the rectum and vagina
- Clinical manifestations:
- Vesicovaginal: urine escapes into vagina
- Rectovaginal: fecal incontinence; flatus discharged into vagina
- Assessments and diagnostics:
- Methylene blue dye instilled into bladder, then vaginal packing is added to check for staining
- Cystourethroscopy; IV cystourethroscopy to determine exact location
- Medical management:
- Goal: eliminate fistula/treat infection
- Proper nutrition; cleansing douches; enemas; rest; admin of intestinal antibiotics
Structural Disorders
Pelvic Organ Prolapse
- Weakening of the vaginal walls allows the pelvic organs to descend and protrude into the vaginal canal
- Risk factors: age; parity; menopause; hx pelvic surgery; genetic predisposition
- Types:
- Cystocele: downward displacement of the bladder toward the vaginal orifice
- Rectocele: upward pouching of the rectum that pushes the posterior wall of the vagina forward
- Enterocele: protrusion of the intestinal wall into the vagina
- Clinical manifestations:
- Cystocele: pelvic pressure and urinary problems
- Rectocele: rectal pressure instead of urinary symptoms
- Prolapse: feelings of pressure and ulcerations and bleeding; dyspareunia
- Medical management:
- Kegel exercises; pessary device; surgical repairs (anterior colporrhaphy, posterior colporrhaphy, perineorrhaphy)
Uterine Prolapse
- Structures that support the uterus weaken (typically from childbirth), the uterus may work its way down the vaginal canal and even appear outside the vaginal orifice (procidentia)
- Symptoms:
- Pressure and urinary problems (incontinence or retention)
- Symptoms aggravated when a woman coughs, lifts a heavy object, or stands for a long time
- Medical management:
- Surgery: uterus is sutured back into place
- Postmenopausal: hysterectomy or repair via colpopexy
- Conservative treatments and mechanical options, including lifestyle changes, pessaries, and pelvic floor muscle training
Benign Disorders
Vulvitis and Vulvodynia
- Vulvitis: inflammation of the vulva, may occur with other disorders or poor hygiene
- Vulvodynia: chronic vulvar pain syndrome
This quiz covers the physical exam and assessment techniques used in gynecology, including positioning, inspection, and trauma evaluation.
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