Womens Health 8

Chapter Eight Examining Gynecological Issues

External and Internal Genitalia
Mons Pubis
Labia Majora
Labia Minora
Clitoris
Urethral Opening
Vaginal Opening
Perineum
Vagina
Cervix
Uterus
Fallopian Tubes
Ovaries

Female Reproductive System

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

Preventive Measures See Figure 8.2

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

Luteal Secretion

Phases of the Menstrual Cycle
Follicular (proliferatative) phase lasts 10-14 days and is considered the most variable part of the cycle
Ovulatory phase is when the largest follicle bursts, releasing a mature egg into the fallopian tubes
Luteal phase causes the secretion of progesterone, preparing for implantation of the fertilized egg
Menstruation phase occurs when estrogen and progesterone levels drop, allowing sloughing off of the endometrium

Menstrual Cycle Breakdown of the endometrial lining and discharge of tissue (menses)

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

Pelvic Exam

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

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

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 severe Form of PMS that can occur one week prior to menses

Other Medical Concerns
Female Athlete Triad
Uterine Fibroids
Hysterectomy
Toxic Shock Syndrome (TSS)

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.

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

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

External Genitals and Sexual Response

Vaginal and Uterus Response

Breast Response

Where is the “G-Spot”?

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

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

Chapter Eight Examining Gynecological Issues

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Womens Health 8

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