Round ligament – allows anteversion of the uterus

  Broad ligament – contains uterine vessels

  Infundibular ligament – contains ovarian artery, nerve, and vein

  Cardinal ligament – holds cervix and vagina

ULTRASOUND

  Very good at diagnosing disorders of the female genital tract

PREGNANCY

  Can see most pregnancies on ultrasound at 6 weeks

  Gestational sac is seen with beta-HCG of 1,500

  Fetal pole usually is seen with beta-HCG of 6,000

ABORTIONS

  Missed – 1st-trimester bleeding, closed os, positive sac on ultrasound, and no heartbeat

  Threatened – 1st-trimester bleeding, positive heartbeat

  Incomplete – tissue protrudes through os

  Ectopic pregnancy (life threatening) – acute abdominal pain; positive beta-HCG, negative ultrasound for sac; can also have missed period, vaginal bleeding, hypotension

•  Risk factors for ectopic pregnancy: previous tubal manipulation, PID, previous ectopic pregnancy

•  Significant shock and hemorrhage can occur from an ectopic pregnancy

ENDOMETRIOSIS

  Symptoms: dysmenorrhea, infertility, dyspareunia

  Can involve the rectum and cause bleeding during menses → endoscopy shows blue mass

  Ovaries – most common site

  Tx: OCPs

PELVIC INFLAMMATORY DISEASE

  Has ↑ risk of infertility and ectopic pregnancy

  Symptoms: pain, nausea, vomiting, fever, vaginal discharge

•  Most commonly occurs in the first ½ of the menstrual cycle

  Risk factors: multiple sexual partners

  Dx: cervical motion tenderness, cervical cultures, positive Gram stain

  Tx: ceftriaxone, doxycycline

  Complications: persistent pain, infertility, ectopic pregnancy

  HSV – vesicles; HPV – condylomata

  Syphilis – positive dark-field microscopy, chancre

  Gonococcus – diplococci

MITTELSCHMERZ

  Rupture of graafian follicle

  Causes pain that can be confused with appendicitis

  Occurs 14 days after the 1st day of menses

VAGINAL CANCER

  #1 primary – squamous cell CA

  DES (diethylstilbestrol) – can cause clear cell CA of vagina

  Botryoides – rhabdosarcoma that occurs in young girls

  XRT – used for most cancers of vagina

VULVAR CANCER

  Elderly, nulliparous, obese; usually unilateral

  Tx: < 2 cm (stage I) – WLE and ipsilateral inguinal node dissection

•  > 2 cm (stage II or greater) – radical vulvectomy (bilateral labia) with bilateral inguinal dissection, postop XRT if close margins (< 1 cm)

•  Paget’s VIN III or higher – premalignant

•  VIN – vulvar intra-epithelial neoplasia

OVARIAN CANCER

  Leading cause of gynecologic death

  Abdominal or pelvic pain; change in stool or urinary habits; vaginal bleeding

  ↓ risk – OCPs, bilateral tubal ligation

  ↑ risk – nulliparity, late menopause, early menarche

  Types – teratoma, granulosa-theca (estrogen secreting, precocious puberty); Sertoli–Leydig (androgens, masculinization); struma ovarii (thyroid tissues); choriocarcinoma (beta-HCG); mucinous; serous; and papillary

  Clear cell type – worst prognosis

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