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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