Day: April 26, 2024

Bartholin’s abscess This is an abscess which forms on the Bartholin’s glands which line the vagina. – It arises when one of the ducts carrying fluid from the gland gets blocked, giving a fluid filled lump (cyst) – The cysts can then become infected by bacteria leading to the formation of a Bartholin’s abscess. Symptoms: – Vaginal pain and redness – Unilateral swelling near the vaginal introitus   Diagnosis: Clinical Diagnosis   Management: – 1st line is antibiotics. – If abscess does not respond/is painful, cyst drainage is performed (using word catheter or marsupialization)   Vulval Carcinoma This describes a

Urinary Incontinence This is a very important gynaecological condition which has a huge impact of patients’ lives. – There are two main types of incontinence in females, each of which have different pathologies and treatments. – It affects about 4-5% of the population, being more common in elderly females   i) Urge Incontinence This is the involuntary leakage preceded/accompanied by a sudden desire to pass urine – It occurs due to an overactive bladder due to increase detrusor muscle overactivity   Causes: Mostly idiopathic but can be associated with neurological conditions (e.g. MS, PD) – Can be made worse by

Urinary Incontinence This is a very important gynaecological condition which has a huge impact of patients’ lives. – There are two main types of incontinence in females, each of which have different pathologies and treatments. – It affects about 4-5% of the population, being more common in elderly females   i) Urge Incontinence This is the involuntary leakage preceded/accompanied by a sudden desire to pass urine – It occurs due to an overactive bladder due to increase detrusor muscle overactivity   Causes: Mostly idiopathic but can be associated with neurological conditions (e.g. MS, PD) – Can be made worse by

Ovarian Torsion This is when the ovary twists on its supporting ligaments. It is a gynaecological emergency as it can cut of the blood supply to the ovary, resulting in ischaemia   Risk factors: – Ovarian cysts (especially dermoid cyst/PCOS) – Ovulation induction Symptoms: Sudden onset of sharp, colicky, unilateral lower quadrant abdominal pain – Nausea and Vomiting – May also be a low-grade pyrexia and sinus tachycardia   Tests: Pelvic ultrasound is used –> unilateral ovarian enlargement, oedema, ‘whirlpool’ sign – Laparoscopy is diagnostic   Treatment: Emergency laparoscopy to uncoil twisted ovary + fixation   Polycystic Ovary Syndrome (PCOS)

It is not uncommon to develop cystic masses on the ovaries. – In premenopausal women, most ovarian masses are benign. – The incidence of ovarian cancer increases with age, so postmenopausal women are at a higher risk of malignancy – There are both non-neoplastic and neoplastic types of cysts which can occur naturally or be pathological: a) Non-Neoplastic Cysts: Physiological: These cysts develop as part of the menstrual cycle. They are considered physiological and usually self-resolve over 2-3 menstrual cycles. They include: –> Follicular cysts: These occur when the dominant follicle does not rupture releasing the egg cell   –> Corpus

Menopause refers to the natural halting of the menstrual cycle due to depletion of ovarian follicles. – It is defined as amenorrhoea for 2 years below the age of 50 or 12 months over the age of 50. – The average age of menopause in the UK is 51. – Perimenopause refers to the period before the menopause in which the woman begins to experience symptoms of the approaching menopause  Pathophysiology of Menopause Symptoms: – Menstrual changes -> change in length, frequency and amount of blood loss – Hot flushes and night sweats – Joint and muscle aches – Atrophic

Mastitis This is a condition that refers to inflammation of the breast – It is associated with breastfeeding: milk stasis can cause an inflammatory response -> may then get secondary infection, most commonly with staphylococcus aureus Symptoms: Erythematous, tender, swollen area of breast – Systemic upset with fevers, chills and fatigue   Management: – 1st line is to advise continue breastfeeding, ensuring the breast is fully emptied – If symptoms do not improve after 24 hours of milk removal –> Flucloxacillin 10-14 days   Breast Abscess This can occur if mastitis is left untreated Symptoms: Gives a tender, red fluctuant

Endometrial Cancer A uterine cancer usually seen in post-menopausal women, in 2 types: i) Uterine sarcoma: A malignant proliferation of muscles of the uterus ii) Adenocarcinoma: A malignant proliferation of the endometrial glands It is the most common invasive carcinoma of the female genital tract which is further divided into two subtypes: Type 1: – This is called an endometroid carcinoma where the tumours look like normal endometrial glands – Associated with high oestrogen levels and often preceded by endometrial hyperplasia   Type 2: – This has multiple subtypes, is a rarer and not linked to oestrogen exposure   Full adenocarcinoma

Endometrial Cancer A uterine cancer usually seen in post-menopausal women, in 2 types: i) Uterine sarcoma: A malignant proliferation of muscles of the uterus ii) Adenocarcinoma: A malignant proliferation of the endometrial glands It is the most common invasive carcinoma of the female genital tract which is further divided into two subtypes: Type 1: – This is called an endometroid carcinoma where the tumours look like normal endometrial glands – Associated with high oestrogen levels and often preceded by endometrial hyperplasia   Type 2: – This has multiple subtypes, is a rarer and not linked to oestrogen exposure   Full adenocarcinoma

Endometrial Cancer A uterine cancer usually seen in post-menopausal women, in 2 types: i) Uterine sarcoma: A malignant proliferation of muscles of the uterus ii) Adenocarcinoma: A malignant proliferation of the endometrial glands It is the most common invasive carcinoma of the female genital tract which is further divided into two subtypes: Type 1: – This is called an endometroid carcinoma where the tumours look like normal endometrial glands – Associated with high oestrogen levels and often preceded by endometrial hyperplasia   Type 2: – This has multiple subtypes, is a rarer and not linked to oestrogen exposure   Full adenocarcinoma

Premenstrual syndrome (PMS) This describes the distressing physical, psychological and behavioural symptoms in the absence of organic disease that regularly occur during the luteal phase of the menstrual cycle – This occurs in most women and encompasses a whole spectrum of severity from minor to debilitating. – Cause unknown but associated with change in levels of oestrogen + 5-HT levels at the beginning of cycle   Symptoms: – Psychological –> depression, anxiety, irritability – Physical –> fatigue, bloating, mastalgia, acne   Management: – If mild, then reduce salt, caffeine and stress – 1st line is Combined oral contraceptive pill –

Cervical Ectropion A condition in which simple columnar epithelium (lining the endocervix) is present on the ectocervix. – This type of epithelium is more fragile than the stratified squamous epithelium that usually lines the ectocervix and may bleed after sexual intercourse – Ectropion can also lead to increased vaginal discharge as simple columnar cells are mucus-producing – It is diagnosed clinically after ruling out other more sinister pathologies like cervical cancer. Causes: – Raised oestrogen levels (e.g. pregnancy, COCP) Symptoms: Mostly asymptomatic but may cause: – Post-coital bleeding – An increase in vaginal discharge – Pain/bleeding during cervical screening –

Cervical Ectropion A condition in which simple columnar epithelium (lining the endocervix) is present on the ectocervix. – This type of epithelium is more fragile than the stratified squamous epithelium that usually lines the ectocervix and may bleed after sexual intercourse – Ectropion can also lead to increased vaginal discharge as simple columnar cells are mucus-producing – It is diagnosed clinically after ruling out other more sinister pathologies like cervical cancer. Causes: – Raised oestrogen levels (e.g. pregnancy, COCP) Symptoms: Mostly asymptomatic but may cause: – Post-coital bleeding – An increase in vaginal discharge – Pain/bleeding during cervical screening –

Many breast conditions can present with a lump, which can be malignant or benign. When this happens, the standard procedure is to conduct a triple assessment, which involves three types of tests: i) Clinical examination – should involve a chaperone (not a family member) ii) Radiology – Ultrasound for <35years; mammography and ultrasound for >35 years old iii) Histology – Fine needle aspiration (FNA) or core biopsy for new lumps NICE Referral Guidelines   Risk Factors The risk factors are related to oestrogen exposure as well as to specific genes: – Age (most breast cancers occur in women >50yrs) –

Premenstrual syndrome (PMS) This describes the distressing physical, psychological and behavioural symptoms in the absence of organic disease that regularly occur during the luteal phase of the menstrual cycle – This occurs in most women and encompasses a whole spectrum of severity from minor to debilitating. – Cause unknown but associated with change in levels of oestrogen + 5-HT levels at the beginning of cycle   Symptoms: – Psychological –> depression, anxiety, irritability – Physical –> fatigue, bloating, mastalgia, acne   Management: – If mild, then reduce salt, caffeine and stress – 1st line is Combined oral contraceptive pill –

Urinary Incontinence This is a very important gynaecological condition which has a huge impact of patients’ lives. – There are two main types of incontinence in females, each of which have different pathologies and treatments. – It affects about 4-5% of the population, being more common in elderly females   i) Urge Incontinence This is the involuntary leakage preceded/accompanied by a sudden desire to pass urine – It occurs due to an overactive bladder due to increase detrusor muscle overactivity   Causes: Mostly idiopathic but can be associated with neurological conditions (e.g. MS, PD) – Can be made worse by

Menopause refers to the natural halting of the menstrual cycle due to depletion of ovarian follicles. – It is defined as amenorrhoea for 2 years below the age of 50 or 12 months over the age of 50. – The average age of menopause in the UK is 51. – Perimenopause refers to the period before the menopause in which the woman begins to experience symptoms of the approaching menopause  Pathophysiology of Menopause Symptoms: – Menstrual changes -> change in length, frequency and amount of blood loss – Hot flushes and night sweats – Joint and muscle aches – Atrophic

Premenstrual syndrome (PMS) This describes the distressing physical, psychological and behavioural symptoms in the absence of organic disease that regularly occur during the luteal phase of the menstrual cycle – This occurs in most women and encompasses a whole spectrum of severity from minor to debilitating. – Cause unknown but associated with change in levels of oestrogen + 5-HT levels at the beginning of cycle   Symptoms: – Psychological –> depression, anxiety, irritability – Physical –> fatigue, bloating, mastalgia, acne   Management: – If mild, then reduce salt, caffeine and stress – 1st line is Combined oral contraceptive pill –

Bartholin’s abscess This is an abscess which forms on the Bartholin’s glands which line the vagina. – It arises when one of the ducts carrying fluid from the gland gets blocked, giving a fluid filled lump (cyst) – The cysts can then become infected by bacteria leading to the formation of a Bartholin’s abscess. Symptoms: – Vaginal pain and redness – Unilateral swelling near the vaginal introitus   Diagnosis: Clinical Diagnosis   Management: – 1st line is antibiotics. – If abscess does not respond/is painful, cyst drainage is performed (using word catheter or marsupialization)   Vulval Carcinoma This describes a

Cervical Ectropion A condition in which simple columnar epithelium (lining the endocervix) is present on the ectocervix. – This type of epithelium is more fragile than the stratified squamous epithelium that usually lines the ectocervix and may bleed after sexual intercourse – Ectropion can also lead to increased vaginal discharge as simple columnar cells are mucus-producing – It is diagnosed clinically after ruling out other more sinister pathologies like cervical cancer. Causes: – Raised oestrogen levels (e.g. pregnancy, COCP) Symptoms: Mostly asymptomatic but may cause: – Post-coital bleeding – An increase in vaginal discharge – Pain/bleeding during cervical screening –

Endometrial Cancer A uterine cancer usually seen in post-menopausal women, in 2 types: i) Uterine sarcoma: A malignant proliferation of muscles of the uterus ii) Adenocarcinoma: A malignant proliferation of the endometrial glands It is the most common invasive carcinoma of the female genital tract which is further divided into two subtypes: Type 1: – This is called an endometroid carcinoma where the tumours look like normal endometrial glands – Associated with high oestrogen levels and often preceded by endometrial hyperplasia   Type 2: – This has multiple subtypes, is a rarer and not linked to oestrogen exposure   Full adenocarcinoma

It is not uncommon to develop cystic masses on the ovaries. – In premenopausal women, most ovarian masses are benign. – The incidence of ovarian cancer increases with age, so postmenopausal women are at a higher risk of malignancy – There are both non-neoplastic and neoplastic types of cysts which can occur naturally or be pathological: a) Non-Neoplastic Cysts: Physiological: These cysts develop as part of the menstrual cycle. They are considered physiological and usually self-resolve over 2-3 menstrual cycles. They include: –> Follicular cysts: These occur when the dominant follicle does not rupture releasing the egg cell   –> Corpus

Ovarian Torsion This is when the ovary twists on its supporting ligaments. It is a gynaecological emergency as it can cut of the blood supply to the ovary, resulting in ischaemia   Risk factors: – Ovarian cysts (especially dermoid cyst/PCOS) – Ovulation induction Symptoms: Sudden onset of sharp, colicky, unilateral lower quadrant abdominal pain – Nausea and Vomiting – May also be a low-grade pyrexia and sinus tachycardia   Tests: Pelvic ultrasound is used –> unilateral ovarian enlargement, oedema, ‘whirlpool’ sign – Laparoscopy is diagnostic   Treatment: Emergency laparoscopy to uncoil twisted ovary + fixation   Polycystic Ovary Syndrome (PCOS)

Many breast conditions can present with a lump, which can be malignant or benign. When this happens, the standard procedure is to conduct a triple assessment, which involves three types of tests: i) Clinical examination – should involve a chaperone (not a family member) ii) Radiology – Ultrasound for <35years; mammography and ultrasound for >35 years old iii) Histology – Fine needle aspiration (FNA) or core biopsy for new lumps NICE Referral Guidelines   Risk Factors The risk factors are related to oestrogen exposure as well as to specific genes: – Age (most breast cancers occur in women >50yrs) –

Mastitis This is a condition that refers to inflammation of the breast – It is associated with breastfeeding: milk stasis can cause an inflammatory response -> may then get secondary infection, most commonly with staphylococcus aureus Symptoms: Erythematous, tender, swollen area of breast – Systemic upset with fevers, chills and fatigue   Management: – 1st line is to advise continue breastfeeding, ensuring the breast is fully emptied – If symptoms do not improve after 24 hours of milk removal –> Flucloxacillin 10-14 days   Breast Abscess This can occur if mastitis is left untreated Symptoms: Gives a tender, red fluctuant

This describes the 28-day cycle which occurs in women around the ages of 14 to 51, which controls the synthesis and release of egg cells and the associated hormonal changes that go along with this. – The cycle starts on the first day of the period (menstruation) and ovulation usually occurs on day 14.   The changes that occur in the female reproductive system are coordinated by the hypothalamic-pituitary-ovarian axis: – The hypothalamus produces gonadotrophin releasing hormone (GnRH) – This stimulates the anterior pituitary to secrete follicular stimulating hormone (FSH) + luteinising hormone (LH) – These hormones act on follicles

The female reproductive system lies posterior to the bladder and anterior to the rectum. – It includes the uterus, ovaries, cervix, fallopian tubes and the vagina. Ovaries The ovaries are the main female reproductive organs, as they produce egg cells and sex hormones oestrogen and progesterone. – They lie lateral to the uterus close to the pelvic wall – The right lies close to caecum/appendix and left near sigmoid   Blood supply: – Ovarian artery (direct from abdominal aorta)   Venous drainage: – Ovarian vein –> IVC on right/renal vein on left   Nerve supply: – Sympathetics from T10 –>