·
Meiosis I is arrested in prOphase for years until Ovulation.
Meiosis II is arrested in METaphase until fertilization. An egg MET
a sperm.
·
Relaxin is the only
hormone produced both by the ovary and uterus.
Renin
is the only hormone produced by both the theca and kidney.
Inhibin
is produced in the granulosa, theca, and corpus luteum.
Inhibin-A under the influence of LH
suppresses FSH during the luteal phase of the cycle.
Inhibin-B directly suppresses pituitary FSH
secretion in the follicular phase of the cycle.
Activin
is produced in the granulosa.
Follistatin
is produced in follicles.
Enkephalin
is produced by the ovary.
Epidermal growth factor-like is produced in granulosa and theca.
Transforming growth factor-beta
is produced in theca, ovarian interstitial tissue, and granulose.
Müllerian-inhibiting
substance is produced in the granulosa.
Angiotensin II
is produced in the follicular fluid.
from
the granulosa: Müllerian-inhibiting
substance, activin, inhibin,
follicle regulatory protein, insulin-like growth factor-1, epidermal growth
factor-like, platelet-derived growth factor, proopiomelanocortin,
and gonadotropin surge-inhibiting factor,plasminogen
activator
from the
theca: transforming growth factor, renin,
inhibin, and relaxin; and
from the
corpus luteum: basic fibroblast growth
factor,inhibin,relaxin
from
follicular fluid: angiotensin II,
luteinizing inhibitor and luteinizing stimulator, oocyte
meiosis inhibitor, follicle regulatory protein, and renin.
·
Bacterial vaginosis is a condition is which
there is an overgrowth of anaerobic bacteria in the vagina that replaces the normal lactobacillus.
Women with this type of vaginitis complain of an
unpleasant vaginal odor that is described as musty or fishy and a thin,
gray-white vaginal discharge that is adherent to the vaginal walls. Vulvar irritation and pruritus
are rarely present. To confirm the diagnosis of bacterial vaginosis,
a wet smear is done. To perform a wet smear, saline is mixed with the vaginal
discharge and clumps of bacteria and clue cells are identified. Clue cells are vaginal epithelial cells with
clusters of bacteria adherent to their surfaces. In addition, a whiff test can be performed by mixing
potassium hydroxide with the vaginal discharge. In cases of bacterial vaginosis, an amine-like odor will be detected. The
treatment of choice for bacterial vaginosis is metronidazole (Flagyl) 500
mg given twice daily for 7 days.
·
In cases of candidiasis, patients commonly complain
of vulvar burning, pain, pruritus,
and erythema. The vaginal discharge tends to be
white, highly viscous, granular, and adherent to the vaginal walls. A wet
smear with potassium hydroxide can confirm the diagnosis by the identification
of hyphae.
Treatment of candidiasis can achieved with the
administration of topical imidazoles or triazoles or the oral medication Diflucan.
·
Trichomonas vaginitis is the
most common nonviral, nonchlamydial
sexually transmitted disease of women. It is caused by the anaerobic,
flagellated protozoan T. vaginalis. Women with Trichomonas vaginitis commonly complain
of a copious vaginal discharge that may be white, yellow, green, or gray and
that has an unpleasant odor. Some women complain of vulvar
pruritus, which is primarily confined to the
vestibule and labia minora. On physical exam, the
vulva and vagina frequently appear red and swollen. Only a small percentage of
women possess the classically described strawberry
cervix. Diagnosis of trichomoniasis is
confirmed with a wet saline smear. Under the microscope, the Trichomonas organisms can be visualized under high power;
these organisms are unicellular protozoans that are
spherical in shape with three to five flagella extending from one end. The
recommended treatment for trichomoniasis is a one-time
dose of 2 g metronidazole.
·
Chlamydia trachomatis is an intracellular parasite that
can cause an infection that may be manifested as cervicitis,
urethritis, or salpingitis.
Patients with mild cases may be asymptomatic. On physical exam, women with chlamydial infections may demonstrate a mucopurulent
cervicitis. The diagnosis of chlamydia
is suspected on clinical exam and confirmed with cervical cultures. Treatment
for a chlamydial cervicitis
is with oral azithromycin, 1 g, or doxycycline 100 mg twice daily for 7 days.
·
Treatment of Bartholin's
cysts with marsupialization has the best success
rate.
Although rare, adenocarcinoma of the Bartholin’s gland
must be excluded in women over 40
years of age who present with a cystic or solid mass in this area. The
appropriate treatment in these cases is surgical
excision of the Bartholin’s gland to allow
for a careful pathologic examination. In cases of abscess formation, both marsupialization of the sac and incision with drainage as
well as appropriate antibiotics are accepted modes of therapy. In the case of
the asymptomatic Bartholin’s cyst, no treatment is
necessary.
·
The classic physical exam finding of PID is the "chandelier
sign," which describes the patient's response to severe pain
caused by movement of the cervix.
·
In the female, the order of puberty is thelarche (breast bud), pubarche
(pubic hair), maximum growth velocity, and menarche.
·
The two syndromes that are characterized by
breast development and absence of a uterus, androgen insensitivity and müllerian agenesis, can be distinguished by a karyotype.
·
Ferriman and Gallwey Scoring
system for scoring hirsutism depending on
body site. Less than 8 is normal; greater than 15 is
severe.
·
The two main types of specula commonly used to
perform Pap smears are the Pederson and Graves specula. The Pederson speculum works best for nulliparous women and menopausal women with atrophic vaginas;
the blades are flat and narrow and barely curve on the sides. The blades of the
Graves speculum are wider, higher,
and curved on the sides; they work better for parous women
with looser vaginal walls. A child’s vagina can best be examined using an
instrument called a vaginoscope
or some type of endoscope such as a hysteroscope. The
Graves and Pederson speculums come in pediatric sizes to be used in virginal
adults or young children.
·
Vulvar vestibulitis is
syndrome of unknown etiology. To make the diagnosis of this disorder, the
following three findings must be present: (1) severe
pain on vestibular touch or attempted vaginal entry, (2) tenderness to pressure localized within the vulvar vestibule, and (3) visible findings confined to vulvar erythema of various
degrees. To treat vulvar vestibulitis,
the first step is to avoid tight clothing, tampons, hot tubs, and soaps, which
can all act as vulvar irritants.
Topical treatments include lidocaine,
estrogen, and steroids. Tricyclic antidepressants
and intralesional interferon injections have also
been used. For women refractory to medical therapy, surgical excision of the
vestibular mucosa may be helpful.
·
The Centers for Disease Control’s recommendation
for inpatient management of PID
includes the following:
- Cefoxitin 2 g IV every 6 h or cefotetan 2 g IV every 12 h plus doxycycline 100 mg PO or IV twice daily or
- Clindamycin 900 mg IV every 8 h plus gentamicin loading dose IV or IM (2 mg/kg) followed by maintenance dose (1.5 mg/kg) every 8 h
The Centers for Disease Control’s
recommendation for the outpatient management of
PID includes the following:
- Cefoxitin 2 g IM plus probenecid 1 g PO in a single dose concurrently or ceftriaxone 250 mg IM plus doxycycline 100 mg PO twice daily for 14 days or
- Ofloxacin 400 mg PO two times a day for 14 days plus either clindamycin 450 mg PO four times a day or metronidazole 500 mg PO two times a day for 14 days.
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