Abnormal Findings (Chapter 26: Female Genitourinary System)

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1

External Genitalia Abnormalities

Pediculosis Pubis (Crab Lice)

S: severe perineal itching

O: excoriations and erythematous areas. May see little dark spots (lice are small), nits, adherent to public hair near roots. Usually localized in public hair, occasionally in eyebrows or eyelashes

2

External Genitalia Abnormalities

Herpes Simplex Virus - Type 2 (Herpes Genitalia)

S: episodes of local pain, dysuria, fever

O: STI often presents as clusters of small, shallow vesicles with surrounding erythema; erupts on genital areas and inner thigh. Also inguinal adenopathy, edema. Vesicles on labia rupture in 1-3 days, leaving painful ulcers. Initial infection lats 7-10 days. Virus remains dormant indefinitely; recurrent infections last 3-10 days with milder symptoms

3

External Genitalia Abnormalities

Syphilitic Chancre

O: STI begins as a small, solitary silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge. Palpation - nontender indurated base; can be lifted like a button between thumb and finger. Nontender inguinal lymphadenopathy. May go unnoticed; resolves spontaneously. But secondary syphilis follows: fever, lymphadenopathy, mucocutaneous red rash, sore throat

4

External Genitalia Abnormalities

Red Rash - Contact Dermatitis

S: Hx of skin contact with allergenic substance in environment, intense pruritus

O: primary lesion - red, swollen vesicles. Then may have weeping of lesions, crusts, scales, thickening of skin, excoriations from scratching. May result from reaction to feminine hygiene spray or synthetic underclothing

5

External Genitalia Abnormalities

HPV Warts

S: painless warty growths; may be unnoticed by woman

O: pink or flesh-colored, soft, pointed, moist, warty papules. Single or multiple in a cauliflower-like patch. Occur around vulva, introitus, anus, vagina, cervix. HPV infection is the most common STI especially in adolescents.

Risk factors: early age at menarche and multiple sex partners. Genital warts are less common than cervical lesions but must be treated with topical medication or surgical removal. Abstain from sex while warts are present

6

External Genitalia Abnormalities

Abscess of Bartholin Gland

S: local pain, can be severe

O: overlying skin red, shiny, and hot. Posterior part of labia swollen; palpable fluctuant mass and tenderness. Mucosa shows red spot at site of duct opening. Requires incision and drainage, antibiotic therapy

7

External Genitalia Abnormalities

Urethritis

S: inflammation of urethra presents as dysuria, burning sensation

O: palpation of anterior vaginal wall shows erythema, tenderness, induration along urethra, purulent discharge from meatus. Caused by Neisseria gonorrhoeae, chlamydia, or staphylococcus infection

8

External Genitalia Abnormalities

Urethral Caruncle

S: tender, pain with urination, urinary frequency, hematuria, dyspareunia, or asymptomatic

O: small, deep red, benign mass protruding from meatus; usually secondary to urethritis or skenitis; lesion may bleed on contact. More common in postmenopausal women

9

Pelvic Musculature Abnormalities

Cystocele

S: feeling pressure in vagina, stress incontinence

O: with straining, note introitus widening and the presence of a soft, round anterior bulge. The bladder, covered by vaginal mucosa, prolapses into the vagina

10

Pelvic Musculature Abnormalities

Rectocele

S: feeling of pressure in vagina, possibly constipation

O: with straining, note introitus widening and the presence of a soft, round bulge from posterior. Here, part of the rectum, covered by vaginal mucosa, prolapses into the vagina

11

Pelvic Musculature Abnormalities

Uterine Prolapse

O: with straining or standing, uterus protrudes into vagina. Nontender, non-fluctuant, smooth hemisphere; may cause a broad-based gait.

Prolapse is graded:

  • 1st degree: cervix appears at introitus with straining
  • 2nd degree: cervix bulges outside introitus with straining
  • 3rd degree: whole uterus protrudes even without straining - essentially uterus is inside out

Decreased estrogen - older women at risk

12

Pediatric Genitalia Abnormalities

Ambiguous Genitalia

Female pseudohermaphroditism is a congenital anomaly resulting from hyperplasia of the adrenal glands, which exposes the female fetus to excess amounts of androgens.

This causes masculinized external genitalia. Ambiguous means that the enlarged clitoris here may looks like a small penis with hypospadias and the fused labia look like an incompletely formed scrotum with absent testes.

Other forms of intersexual conditions occur, and the family must be referred for diagnostic evaluation

13

Pediatric Genitalia Abnormalities

Vulvovaginitis in Child

This is acute, nonspecfic

Causes in the prepubertal child include infection from a respiratory or bowel pathogen, STI, presence of a foreign body, or Candida albicans in a child with diabetes