Answer:

i.Congenital adrenal hyperplasia: hypertrophy of the clitoris due to increased secretion of androgens

ii.Double uterus: due to failure of gender differentiation in which the two Mϋllerian ducts fail to fuse properly to form the female reproductive tracts

Answer:

i.Herpes viruses: herpes simplex viruses (HSVs) lead to painful genital ulcers (non-malignant);human papilloma virus (HPV) causes development of cancers of cervix, vagina and vulva.

ii.Fungal Infections (e.g. Candida albicans): symptomatic candidiasis when microbial environment is disturbed by, e.g., diabetes, antibiotics, pregnancy

iii.Trichomonas vaginalis: sexually transmitted infection, 4 days – 4 weeks. Asymptomatic or symptoms of yellow frothy vaginal discharge, vulvovaginal discomfort, dysuria, dyspareunia

iv.Chlamydia trachomatis: sexually transmitted infection. Mainly affects cervix but can get to uterus and Fallopian tubes. Can cause pelvic inflammatory disease (PID)

Answer:

Signs and symptoms are:

·    Pelvic pain, adnexal tenderness, fever and vaginal discharge. Caused by Neisseria gonorrhoeae, Chlamydia trachomatis. Puerperal infections after delivery or abortion are important causes of PID.

Complications:

·    Acute complications: peritonitis and bacteraemia can cause suppurative arthritis, endocarditis, meningitis.

·    Chronic complications: adhesions between pelvic and bowel organs, can cause obstruction of Fallopian tubes and infertility, ectopic pregnancy, pelvic pain and intestinal obstruction.

Answer:

·    Functional endometrial tissue is found in sites outside the uterus.

·    Main symptoms are: chronic pelvic pain, dysmenorrhoea, deep pain during or after sexual intercourse, period-related or cyclic gastrointestinal symptoms, period-related or cyclic urinary symptoms, infertility with 1 or more of above.

Answer:

Benign growths from smooth muscle known as fibroids. The different types are:

·    subserosal: on outer wall of uterus

·    intramural: in the wall of the uterus

·    submucosal (including pedunculated submucosal): directly under the lining of the uterus

Answer:

i.    Cystocele: bladder support is weakened, bladder descends and anterior vagina wall bulges and bladder herniates into the vagina.

ii.   Rectocele: develops similarly but posterior vaginal wall is weakened and rectum bulges into vagina.

iii.  Uterine prolapse: main supportive ligaments for uterus stretch and uterus bulges down into vagina.

Uterine prolapse stages are:

·    Stage 0: no prolapse

·    Stage 1: furthermost part of prolapse is more than 1 cm above the introitus

·    Stage 2: furthermost part of prolapse equal or less than 1 cm above introitus

·    Stage 3: furthermost part of prolapse more than 1 cm below introitus, but protrudes no more than 2 cm less than the length of the vagina

·    Stage 4: Complete eversion of vagina, i.e. whole of uterus is outside introitus, known as procidentia

Answer:

Major characteristics are anovulation and androgen excess. The major signs and symptoms are: infertility, irregular uterine bleeding and pregnancy loss. Often occurs with obesity and signs of metabolic syndrome, including insulin resistance; e.g. diabetes, cardiovascular disease, increased risk of endometrial cancer and other chronic health conditions related.

Answer:

·    Supported by evidence: asbestos, HRT (oestrogen-only), tobacco smoking, adult-attained height, body fatness

·    Some with limited evidence include: talc-based body powder (perineal use), X-radiation, gamma radiation

Answer:

·    Fertilised ovum becomes implanted outside uterus; 90% within Fallopian tube. Blastocyst can implant in ovary, abdominal cavity or intrauterine part of Fallopian tube.

·    Usual presentations: abdominal pain (moderate to severe) and vaginal bleeding 6–8 weeks after last menstrual period. Ectopic pregnancy in Fallopian tube can cause rupture.

Answer:

·    Hypertension, oedema and proteinuria usually during last trimester of pregnancy, and commoner with first babies.

·    May develop eclampsia with serious illness and convulsions. Neurological disturbances with convulsions and, possibly, coma.

·    Headaches and visual disturbances indicate severe pre-eclampsia – delivery often initiated.

Answer:

Lasts 42 weeks or more. Risks to woman and fetus increase.

Fetal risks include:

·    Postmaturity: placenta can no longer support normal growth and development. Signs of postmaturity include:

o dry, peeling skin, overgrown nails, large amount of scalp hair, marked creases on palms and soles, lack of fat deposition, skin stained green or yellow by meconium from fetal bowel

o abnormal fetal growth, oligohydramnios, meconium-stained amniotic fluid

o fetal and neonatal death

Maternal risks include:

o abnormal or difficult labour, often long because fetus is large

o assisted delivery, e.g. vacuum extraction with perineal suturing

o postpartum haemorrhage (PPH): loss of 500+ mL of blood within 24 hours of delivery

o risks associated with surgery, i.e. Caesarean section

Answer:

Occurs due to infection in uterus following delivery, often at placental site. Symptoms are:

·    pain in lower abdomen or pelvis caused by swollen uterus

·    foul-smelling vaginal discharge

·    feelings of discomfort or illness, headache, loss of appetite

·    elevated temperature, chills

·    pale skin, can be sign of large volume blood loss

Answer:

Non-specific symptoms leading women to consult doctor about a breast disorder are:

·    pain: cyclic or non-cyclic. Most painful masses are benign but 10% of malignant breast tumours are painful.

·    palpable mass needs differentiating from normal ‘lumpiness’ of breast. Most common masses are cysts, fibroadenomas and invasive carcinomas. Only 10% in women under 40 but 60% of those in women over 50 are malignant.

·    nipple discharge less common but more likely to occur with malignancy.

Answer:

Numerous different factors increase the risk of developing breast cancer.

·    Genetic factors: family members with breast cancer, breast cancer genes

·    Life-style factors: overweight or obese after menopause, alcohol intake slightly increases risk

·    Hormonal factors: HRT, contraceptive pill, childbirth lowers risk; levels of sex hormones

·    Individual factors: commoner with age, age of starting/finishing menstruation

·    Tall height: à increased risk after menopause; ethnicity: higher incidence in white women

·    Medical history: exposure to radiation, some other conditions, previous cancer

·    previous breast disorders

Answer:

A number of treatment methods are used:

·    Surgery: depending on tumour size, position, breast size, wishes of individual:

o lumpectomy: tumour and small area of healthy tissue removed

o mastectomy: whole breast removed

o breast reconstruction: performed after mastectomy to provide similar breast; implant usually used, additional surgery to replace a nipple

o removal of lymph nodes: if malignant cells spread into nearby lymph nodes

·    Radiotherapy and chemotherapy (see Chapter 3)

·    Hormone therapy: used on cells with oestrogen receptors to prevent action of oestrogen or progesterone level or blocking effects

·    Usually used as adjuvant (or neo-adjuvant) treatment before or after surgery or chemotherapy or combined with radiotherapy

·    Targeted cancer drugs: mainly monoclonal antibodies which help to control cell

Answer:

i.    Ovulation problems: polycystic ovary syndrome

ii.   Fibroids: prevent fertilised egg attaching to uterine lining

iii.  Endometriosis: can damage Fallopian tubes and prevent passage

iv.  Pelvic inflammatory disease: infection can damage and scar Fallopian tubes

Three main approaches are:

·    Medication: mostly used to deal with problems of ovulation

·    Surgery: procedures that may help to correct female infertility

·    Assisted conception: introducing gametes or embryo into uterus:

o intrauterine insemination: sperm introduced through cervix into uterus

o in vitro fertilisation (IVF): egg production stimulated and removed from ovary, fertilised and inserted into uterus to develop

o egg and sperm donation: an egg or sperm provided by donor and IVF performed