Female Reproductive System Overview Biomed

Cycle is 28 days. First 14 days of cycle are the cool ovulatory phase, prominent hormones here
are estrogens/estradiol. Days 15-28 of cycle are the warmer luteal phase. Progesterone
increases to raise the basal body temperature. The first half of the cycle is preparing the body
for conception while the second half of the cycle is warming to prepare the body to maintain
pregnancy once an egg
implants.

Change in basal body

temperature during luteal
phase usually correlates with
changes in progesterone
levels. By measuring BBT you
can measure when you
ovulate

FSH is higher in the first

couple days of cycle, it
stimulates the ovarian
follicles to mature.

LH- Around day 12-14 luteal

hormone rises and initiates
ovulation- it erodes the wall
of the ovarian follicle
producing a hole through
which the ovum is released.

FSH and Estrogen are

prominent during the first
weeks of the cycle. Once FSH
rises and stimulates enough
ovarian follicles, estrogen
rises and signals FSH to
decrease.

Near midcycle LH is released to help stimulate ovulation.

Ovulation takes place on day 14, the egg bursts into the fallopian tube and is swept into the
uterus. The follicle becomes corpus luteum and produces progesterone- this creates warmth
and your body temperature rises.
Time Summary: Follicular phase is from day 1 to 13. Menstruation is from day 1 to 5. The
Ovulation phase starts at day 14 and luteal phase is day 15-28.

Female Reproductive System TCM Tests

What hormone increases after ovulation?

● Progesterone
o Produced by corpus luteum and is essential for maintaining the lining of the
uterus in to which the fertilized egg can implant and continue to grow;
progesterone levels increase after ovulation and hence make the woman more
fertile; progesterone rises in the blood following ovulation, peaks 5-9 days after
ovulation (days 19-21) and then declines.

The average blood loss during menstruation is ______ with _______ considered normal
● 35 milliliters with 10-80 considered normal
o Because of this blood loss, women are more susceptible to iron deficiency than
men are; an enzyme called plasmin inhibits clotting in the menstrual field

What hormone acts on the eggs in the ovary causing them to mature?
● FSH- follicle stimulating hormone
o Stimulates follicles (the sacs within the ovaries that contain eggs) to grow; FSH is
produced by the pituitary gland and travels into the ovaries and stimulates the
follicles to produce the female hormone estrogen and produce mature eggs

Which hormone stimulates ovulation?

● Luteinizing hormone (LH)
o LH, also known as lutropin, is a hormone produced by the anterior pituitary
gland; in females, an acute rise of LH, called the LH surge, triggers ovulation and
development of the corpus luteum.

The average ovulatory cycle in women is 28 days

● A cycle is counted from the first day of 1 period to the first day of the next period. The
average menstrual cycle is 28 days long; cycles can range anywhere from 21 to 25 days in
adults and from 21 to 45 days in young teens

The three naturally occurring estrogens in women are:

● Estrone (E1)
o Produced during menopause
● Estradiol (E2)
o Predominant form in non-pregnant females
● Estriol (E3)
o Primary estrogen of pregnancy

FSH stimulates: immature follicles in the ovaries to grow

 ● FSH stimulates the development of 15-20 follicles each month and stimulates follicular
secretion of estradiol. FSH further induces expression of FSH receptors by follicles. As
estradiol levels increase under the influence of FSH, estradiol inhibits the secretion of
FSH and FSH levels decreased; under normal circumstances, one follicle evolves into the
dominant follicle, destined for ovulation, while the remaining follicles undergo atresia; it
is currently not known how the dominant follicle is selected; yet it has been observed
that the dominant follicle always expresses abundance of FSH receptors.

Luteinizing hormone is secreted in the: anterior pituitary gland.

Which structure contains the egg?

● Follicle
o Ovarian follicles are the basic unit of female reproductive biology, each of which
is composed of roughly spherical aggregations of cells found in the ovary. They
contain a single oocyte (immature ovum or egg); these structures are periodically
initiated to grow and develop, culminating in ovulation of usually a single
competent oocyte in humans; these eggs/ova are only developed once every
menstrual cycle.

FSH is stimulated by the anterior pituitary gland

● AP glands regulatory functions are achieved through the secretion of various peptide
hormones that act on target organs including the adrenal gland, liver, bone, thyroid
gland, and gonads. The anterior pituitary itself is regulated by the hypothalamus and by
negative feedback from target organs

An acute rise of which hormone triggers ovulation?

● Luteinizing hormone (LH)
o Peaks in the blood and urine one to two days before ovulation, at the onset of
the most fertile period in the cycle; the length of the LH surge varies from
between 10 to 31 hours; research has proven that LH surge is among the best
indicators of ovulation; pregnancy tests monitor LH levels via the urine

Regular menstruation usually lasts 3 to 5 days, but anywhere from 2 to 7 is considered normal

Estrogen increases during the luteal phase and during

● Follicular growth
o Throughout the entire follicular phase, rising estrogen levels in the blood
stimulates growth of the endometrium and myometrium of the uterus

Which enzyme in the endometrium inhibits the menstrual blood from clotting?
● Plasmin
o To enable menstrual blood to flow freely from the uterus and leave the body
without clotting, the uterus produces an anti-clotting agent called plasmin;
however, when menstrual loss is heavy, the anti-clotting agent may not be
adequate for the menstrual period and the blood is likely to form clots;
 additionally, if menstrual blood accumulates faster than the ability to transfer it
out of the uterus, clots can also return

Follicle stimulating hormone (FSH) secretion is highest during all of the following EXCEPT
● Beginning of luteal phase
● At the end of the follicular stage
● During ovulation
● End of luteal stage
o The end of the luteal phase is also called the ischemic phase; it occurs on day 27
and lasts one day; the follicular phase starts on day 1 of the 28 day menstrual
cycle and usually lasts 13 days

Which hormones do the follicles secrete that tell the pituitary to stop secreting
follicle-stimulating hormone (FSH)?
● Estrogen and Progesterone
o The female reproductive hormones are regulated by the gonadotropins, ,and, in
turn, the gonadotropins are regulated via negative feedback from the estrogens;
FSH and LH stimulate estrogen and progesterone secretion, but then when the
levels of estrogen and progesterone get high enough, they inhibit FSH and LH
synthesis

Which of the following is NOT TRUE about progesterone?

● Helps to build and maintain bone
● Regulates monthly menstrual cycle
● Plays a role in sexual desire
● Helps to create lean muscle mass
o Testosterone is what helps to create lean muscle ass
● Prepares and nourishes the lining of the uterus after ovulation to sustain the fertilized
egg

The term gonads refer to the ovaries and testes

● The gonad is the organ that makes gametes; the gonads in males are the testes and the
gonads in females are the ovaries; for example, spermatozoon and egg cells are
gametes; the gonads are controlled hormonally by LH and SH secreted by the anterior
pituitary gland; this secretion is, in turn, controlled by the hypothalamus
gonadotropin-releasing hormone.

FSH induces follicular growth.

● FSH stimulates growth of follicle which then turns into corpus luteum which then
produces estrogen and progesterone

Which hormone triggers the acute release of luteinizing hormone (LH)

● Gonadotropin-releasing hormone (GnRH)
Which of the following statement is INCORRECT about estrogen?
● Refers to one hormone
● Responsible for the growth and development of female sexual characteristics
● Important for the maintenance of normal brain function and development of nerve cells
● Produced by both males and females
● Controls growth of the uterine lining during the first part of the menstrual cycle

From menarche to menopause which of the forms of estrogen has the highest concentration
level?
● Estradiol
o The most important estrogen in non-pregnant women who are between the
menarche and menopause stage of life; during pregnancy this role shifts to
estriol, and in post-menopausal women estrone becomes primary.

Follicle stimulating hormone (FSH) stimulates the production of estrogen in the ovaries. Both
estrogen and progesterone are produced following FSH and LH stimulation of the ovary.

For each individual healthy woman the length of the luteal phase remains constant rarely
changing by more than 1-2 days from cycle to cycle.
● The luteal phase length is constant, rarely changing by more than a day or two from
cycle to cycle for the same woman; the luteal phase usually lasts from 12-14 days, but
may last from 10-16 days.

Ovulation detection kits that determine fertility look for the presence of luteinizing hormone
(LH)
● Ovulation tests work by detecting LH; at the beginning of the menstrual cycle, the body
begins to produce FSH; FSH facilitates the formation of a follicle in one of the ovaries;
the follicle contains and nurtures the ovum. When a follicle has adequately matured, a
surge of LH causes the follicle to burst and release the ovum into the fallopian tube at
the moment of ovulation.

Secondary source of estrogen, which are especially important in postmenopausal women are
found in all of the following EXCEPT the,
● Pancreas
● Adrenal glands
● Liver
● Breasts
● Fat cells

The corpus luteum develops during the luteal phase

● The luteal phase is named after the corpus luteum, a structure that grows on the surface
of the ovary where a mature egg was released at ovulation; the corpus luteum produces
progesterone in preparing the body for pregnancy
Polymennorhea refers to menstrual cycle which are less than 21 days
● Polymenorrhea is a type of abnormal uterine bleeding; polymenorrhea occurs when the
menstrual cycle is less than 21 days long; it is sometimes difficult to distinguish
polymenorrhea from metrorrhagia (uterine bleeding at irregular intervals, particularly
between the expected menstrual periods); however, bleeding that occurs at regular
intervals less than 21 days apart is usually polymenorrhea; normal menstrual cycles are
from 21 to 35 days long

The corpus luteum is a structure in the ovary which forms after the egg is released at ovulation

Sperm survives inside a woman for up to 7 days.

● It can survive up to 7 days but most often it is 3-5 days; sperm ejaculated into a woman’s
vagina can live in the reproductive tract for up to five days or perhaps even longer;
fertilization is possible as long as the sperm remain alive; sperm ejaculated outside the
body may survive only minutes to a few hours.

Progesterone raises body temperature during the luteal phase.

Body temperature rises during the luteal phase of the menstrual cycle.
● In the first phase, the follicular phase, your body temperature is a little lower and
progesterone causes your temperature to rise in the second luteal phase, once ovulation
has occurred. Your body temperature is known to rise by 0.2-0.45 C due to the increase
of progesterone hormone levels during the luteal phase which occurs from day 15-28.
The ovulation phase starts at day 14. Follicular phase is from day 1 to 13. Menstrual
phase is from day 1 to 5.

There is a sustained rise in body temperature during the luteal phase of the menstrual cycle.
● Progesterone is responsible for raising basal body temperature.
● Comparing progesterone and estrogen:
o Estrogen promotes the widening of blood vessels, heat dissipation and lower
body temperatures
o Progesterone promotes the narrowing of blood vessels, heat conservation and
higher body temperatures

Menarche is the first menstrual cycle, or first menstrual bleeding; from both social and medical
perspective it is often considered the central event of female puberty, as it signals the possibility
of fertility

Amenorrhea refers to menstrual cycles which are absent for 90 days or more. Young women
who haven’t started menstruating by age 15 or 16 or within three years after their breasts
develop are also regarded as having amenorrhea.

Estrogen is produced primarily in all of the following EXCEPT

● The corpus luteum
 ● The cervix
o The cervix does not produce estrogen but responds to it; after menstruation and
directly under the influence of estrogen, the cervix undergoes a series of changes
in position and texture; during most of the menstrual cycle, the cervix remains
firm, like the tip of the nose, and is positioned low and closed; as a woman
approaches ovulation, the cervix becomes softer, more similar to the lips, and
rises and opens in response to the high levels of estrogen present at ovulation
● Follicles in the ovaries
● The placenta

A woman who wants to detect the ovulation phase depends on any of the following EXCEPT
● Basal body temperature
● Menstrual bleeding
o Fertility awareness refers to a set of practices used to determine the fertile and
infertile phases of a woman’s menstrual cycle; fertility awareness relies on
observation of changes in one or more of the primary fertility signs (basal body
temperature, mucus, and cervical position), tracking menstrual cycle length and
identifying the fertile window based on this information, or both
● Cervical fluid
● Cervical position

The corpus luteum develops from ovarian follicles

● When a follicle releases its egg, the ruptured follicle begins producing large quantities of
estrogen and progesterone in preparation for conception; this changed follicle is now
called the corpus luteum

Menstruation and menstrual cycle mean the same thing

● False: menstruation can last 3-5 days; menstruation is a phase of the menstrual cycle in
which the average cycle lasts 28 days

The luteal phase is the postovulatory phase of the menstrual cycle

● During the luteal (post-ovulatory) phase, the ovum will travel through the fallopian tubes
towards the uterus. If fertilized by a sperm, it may perform implantation there 6-12 days
later.

If a woman wants to conceive, what is the most fertile time?

● Five days before ovulation and the day of ovulation
o The fertile window which is the best time to get pregnant has been defined as
the days of the menstrual cycle during which intercourse is most likely to result in
pregnancy; this fertile window extends for 6 days starting at 5 days before
ovulation until the day of ovulation. Your fertile days are the 4-5 days before and
the day of ovulation, but the most fertile days are just the 2 days before and the
day of ovulation.

Which hormone stimulates the development of female mammary glands at puberty?

 ● Estrogen
o Breast development during puberty begins after the ovaries start to secrete
estrogen. This accumulates fat within the connective tissue of the breasts,
causing breasts to enlarge.
o Prolactin is a hormone secreted by the pituitary gland in the brain that stimulates
lactation-secretion of milk from the mammary glands of the breast.
o Oxytocin plays a role in breast development during pregnancy.
o Progesterone contributes to the development of the breast by signaling for the
formation of milk glands. Estrogen first induces enlargement of tissues within the
breast, and progesterone ensures these tissues develop proper functioning
within the breast to aid in breast development. If pregnancy occurs,
progesterone levels remain high and control the development of the milk buds to
prepare the mother for breastfeeding.

Menstrual cramps are caused by:

● Prostaglandins
o Uterine contractions are caused by prostaglandins. Prostaglandins are a natural
substance made by the body; uterine prostaglandins cause uterine contractions;
uterine contractions cause the blood supply to the uterus to temporarily shut
down, depriving the uterine muscle of oxygen and setting up the cycle of
menstrual contractions and pain

Menstrual bleeding occurs when:

● Estrogen and progesterone decrease
o The menstrual cycle begins with menstrual bleeding (menstruation), which marks
the first day of the follicular phase. Bleeding occurs when levels of estrogen and
progesterone decrease, causing the thickened lining of the uterus or
endometrium to degenerate and be shed.

The egg can be fertilized for up to how many hours after release?
● 24 hours
o The egg is released and travels into the fallopian tube where it remains until a
single sperm penetrates it during fertilization; the egg can be fertilized for about
24 hours after ovulation.

How is the menstrual cycle initiated?

● Hypothalamus > Pituitary gland > ovaries
o GnRH is secreted by the hypothalamus, the gonadotropins FSH and LH are
secreted by the anterior pituitary gland, and estrogen and progesterone are
secreted at the level of the ovary; GnRH stimulates the release of LH and FSH
from the anterior pituitary, which in turn stimulate release of estrogen and
progesterone at the level of the ovary.

What structure of the ovary’s releases progesterone?

● Corpus Luteum
 o Progesterone belongs to a group of steroid hormones called progestogens; it is
mainly secreted by the corpus luteum in the ovary during the second half of the
menstrual cycle. It plays important roles in the menstrual cycle and in
maintaining the early stages of pregnancy.

PMS is defined by symptoms that occur during the:

● Luteal phase
o PMS only occurs during the luteal phase, between ovulation and the start of
menstrual bleeding, or soon after; PMS can occur during the entire luteal phase
or can appear briefly during ovulation, in the days leading up to menstrual
bleeding, or both.
o
Mittelschmerz is: ovulation pain
● Means middle pain, a medical term for ovulation pain or mid cycle pain; about 20% of
women experience mittelschmerz, some every cycle, some intermittently.

The fertilized egg is called

● A zygote
o The product of the fusion of an egg and a sperm; it contains two copies of each
chromosome, one from each parent. Egg and sperms cells, on the other hand,
each contain only one copy of each chromosome; the zygote develops into an
embryo.

The ovulatory phase ends with

● The release of the egg
o Ovulation is the release of a single, mature egg from a follicle that developed in
the ovary; it usually occurs regularly, around day 14 of a 28-day-menstrual cycle;
once released, the egg is capable of being fertilized for 12 to 48 hours before it
begins to disintegrate

Right after the ovulation the follicle is transformed into

● The corpus luteum

What is the normal duration of pregnancy?

● 40 weeks
o Childbirth usually occurs about 38 weeks after conception; in women who have a
menstrual cycle length of four weeks, this is approximately 40 weeks from the
start of the last normal menstrual period; in the U.S the duration of pregnancy is
a week shorter than it was just over a decade ago, dropping from 40 weeks to 39
weeks, according to a new analysis from the March of Dimes.

Sperm cells do not fertilize the egg in the body of the uterus but in the:
● Distal 2/3 of the fallopian tube
 o Fertilization usually occurs in the distal portion of the tube; the fallopian tube is
vital for the survival of the fertilized egg, which moves through the fallopian tube
for up to five days before it passes into the uterus and implants on the wall of the
uterine cavity

What does it indicate if a woman in her 3rd trimester has elevated levels of nitrites and
leukocyte esterase?
● Cystitis
o Bacteria that cause a urinary tract infection make an enzyme that changes
urinary nitrates to nitrites; nitrites in urine show a UTI is present; leukocyte
esterase shows leukocytes (white blood cells) in the urine; WBCs in the urine may
mean a UTI is present

The luteinizing hormone causes the follicle that has the egg to rupture. This ruptured follicle is
called:
● The corpus luteum

During the menstrual cycle the follicle-stimulating hormone stimulates the growth of how many
follicles?
● 3 to 30
o During the natural menstrual cycle, many follicles start to develop inside each
ovary; follicles are small cysts filled with liquid that contain the ovules; when one
of these follicles reaches a bigger size, there is an inhibition in the growth of the
rest.

Prior to ovulation, the follicle only secretes estrogen. After ovulation the follicle becomes
transformed into the corpus luteum and also secretes:
● Progesterone

During what phase of the menstrual cycle is an egg (ovum) released?

● Ovulation
o Event that defines the phases of the menstrual cycle; the phase before ovulation,
when the ovarian follicles are developing, is called the follicular phase; the phase
after ovulation is called the luteal phase

Low levels of estrogen and progesterone in the blood stimulate which structure to initiate the
menstrual cycle?
● Hypothalamus releases gonadotropin releasing hormone (GnRH)
o FSH induces estrogen and progesterone secretion at the level of the ovary and
exerts negative feedback on GnRH secretion

The inside lining of the uterus is called:

● Endometrium
o The uterus has two layers of structure: the outer myometrium and the inner
endometrium; the endometrium is the innermost glandular layer and functions
 as a lining of the uterus, preventing adhesions between the opposed walls of the
myometrium; during the menstrual cycle the endometrium grows to a thick,
blood vessel-rich, glandular tissue layer which is the optimal environment for the
implantation

The first day of the follicular phase is marked by:

● Menstrual bleeding

Pregnancy Disorders TCM Tests

Sperm production is improved by avoiding: heat, as in hot baths

● Sperm tends to die off when over-heated; it is important not to overheat the testicles

Frequent urination during early pregnancy usually subsides when:

● The uterus rises into the abdominal cavity

Quickening, the initial fetal movement, is usually felt between

● 16-20 weeks
o In pregnancy, the movement of quickening refers to the initial motion of the
fetus in the uterus as it is felt by the pregnant woman; normally quickening
occurs naturally around the middle of pregnancy; a woman pregnant for the first
time typically feels fetal movements at about 18-20 weeks, whereas a woman
who has already given birth at least twice will usually feel movement around
15-17 weeks

Which of the following can relieve constipation during pregnancy?

● Exercise
o The pregnancy hormone progesterone has a realizing effect on the intestines,
and this slows the movement of the bowel causing constipation during
pregnancy; lack of exercise and poor diet also contribute to constipation.

When a woman has her monthly period, the blood flow is the result of the sloughing of the
endometrium.

Birth control pills are NOT recommended for women older than age 35 who:
● Smoke
o Oral contraceptives are not recommended for women older than 35 who smoke
because it increases the risk of cardiovascular disease.

How would you describe a baby between 8 and 12 weeks of gestation?

● A fetus that has fully developed arms and legs
o Head a t7 weeks, eyes at 8 weeks, arms and legs at 9 weeks, neck at 10 weeks,
genitals at 11 weeks, fingernails at week 12
How would you advise a woman in her third trimester who has shortness of breath during
sleep?
● Elevate the upper body when sleeping

Women who smoke during pregnancy have a greater risk of?

● Delivering prematurely

HCG( human chorionic gonadotropin) is a hormone produced by the:

● Placenta
o HCG is a hormone produced during pregnancy; it is produced by the developing
embryo after conception and later by part of the placenta; hCG promotes the
maintenance of the corpus luteum during the beginning of pregnancy; this
causes the secretion of the progesterone hormone; progesterone causes the
uterus to thicken with a lining of blood vessels and capillaries which help to
sustain the growing fetus

Which of the following lab tests is for determining pregnancy?

● HCG (human chorionic gonadotropin)

To meet the calcium requirements, a pregnant woman would need to drink

● 3-4 cups of milk daily, 1000 mg

The recommended weight gain during pregnancy for a woman of normal pre-pregnancy weight
is
● 25-35 pounds

For a woman who does not like milk, what else can she eat to get enough calcium?
● Leafy green vegetables

The sex of the baby is set

● At fertilization of the ovum in the fallopian tube

What can indicate trichomoniasis vaginitis in a woman three months pregnant?

● Foul smelling, frothy vaginal discharge
o It is the most common nonrival sexually transmitted infection; the most common
symptoms are vulvar itching and increased foul-smelling vaginal discharge, which
is yellow-green in color; trichomoniasis is associated with preterm delivery,
premature rupture of the membranes, and low birth weight.

Folic acid supplementation is important during pregnancy because it

● Prevents neural tube defects

What is the most likely cause of frequent urination late in pregnancy?

● The enlarged uterus’ descent into the pelvis
A 35 year-old female recently gave birth. She has breasts which feel heavy, warm, achy, and
tender. The skin looks like it has an orange-peel appearance and does not itch. The axillary
lymph nodes are swollen. The breast has no lumps. There is no discharge from the nipples, but
they are inverted. Her body temperature is normal. These symptoms and signs make you think
of which diagnosis?
● Inflammatory breast cancer

During pregnancy, when should sexual intercourse be avoided?

● If the membranes have ruptured
o During pregnancy, the fetus is surrounded and cushioned by a fluid-filled
membrane called the amniotic sac; intercourse should be avoided if the amniotic
membrane has ruptured or if there is a suspicion that it may be leaking.

A pregnant patient is on the third trimester of pregnancy. She has had severe headaches for the
past two days. What should she do?
● Go to her doctor for an immediate exam
o Pre-eclampsia, sometimes called toxemia of pregnancy, is a condition in which
hypertension arises in pregnancy; pre-eclampsia is diagnosed when a pregnant
woman develops high blood pressure on two separate readings taken at least six
hours apart of 140/90 or more and evidence of proteinuria

A normal 3-month-old will be

● Capable of raising the head and shoulders

Reproductive Disorders TCM Tests

Chlamydia: a bacterial infection transmitted from person to person through oral, anal, or vaginal
sexual contact; can also be transmitted from mother to child through the birth canal; it is the
most common STD in the US; most people do not show signs of symptom’s after infection;
women who are symptomatic have bleeding after sex or between periods, lower abdominal
pain, burning urination, and vaginal discharge; men have discharges from the penis, burning
urination, and pain in the testicles; infected partners need to me treated

Risk factors for breast cancer:

1) Getting older- about 77% of women diagnosed are over age 50 with almost half are 65
and older
2) Direct family history
3) Genetics- carriers of the altered genes called BRCA1 or BRCA2

The physical exam of the external vagina shows a cauliflower-like lesion across the labia. They
are not tender and the largest is 1 CM. There is no vaginal discharge and the pelvic examination
is normal. What is most likely diagnosis?
● Genital warts. HPV causes. Can appear raised or flat, small or large, and single or
clumped in a group which sometimes looks like cauliflower.
How can woman reduce the risk of toxic shock syndrome?
● Not using super absorbent tampons
o Toxic shock syndrome is a rare but life threating complication due to bacterial
infection; it has been linked to the use of super absorbent tampons and
occasionally with the use of contraceptive sponges

New guidelines by the American Cancer Society recommend starting screening at age 45,
screening every single year until age 55, where the screening changes to once every two years.

Women smokers that use oral contraceptives have serious risk consequence of developing
blood clots, heart attacks, and strokes.

A breast lump can indicate cancer if: it has an irregular shape and firmly attached
● Four types of breast lumps
1) A cyst feels smooth and squishy with some give to it, like a water balloon
2) Fibroadenomas are round breast lump which can be firm and can be moved around
during a breast-self exam
3) Pseudolumps on the breast can feel quite hard and most of the time do not change
shape during a menstrual cycle; they may or may not be movable
4) Cancerous lumps are of an irregular shape with a pebbly surface like a golf ball and
very firm, like a slice of raw carrot; cancerous breast lumps may not be movable
during a breast self-exam but may appear to be because the underlying tissue is
moving

What is one way to determine if the bleeding during a woman’s menstrual cycle is normal?
● How many sanitary pads used
o 2-8 tablespoons is normal
o Recording number of tampons or pads used helps doctor determine whether
there is excessive bleeding

How is benign prostatic hyperplasia first assessed?

● A digital rectal exam- BPH is present in many men over 40 and 90% of men over 80.
Once a DRE is done, if BPH is present, a PSA (prostate specific antigen test) is performed.

Some women with fibrocystic disease get relief from their symptoms by eliminating their intake
of:
● Caffeine- avoiding coffee, tea, chocolate, and soft drinks can significantly decrease
breast discomfort.

Cysts can be soft to firm, round, mobile, and often tender.

Breakthrough bleeding- aka spotting, refers to abnormal menstrual bleeding during times other
than at menses; the most common cause of bleeding between periods is the use of birth control
pills; fibroid tumors that form on the interior uterine walls can also be a cause of spotting
between periods

Orchitis is an inflammation of one or both of the testicles; it can be caused by an infection from
many different types of bacteria and viruses; the most common virus that causes orchitis is
mumps that occurs in boys after puberty; orchitis usually develops 4-6 days after the mumps
begin; because of childhood vaccinations, mumps is now rare in the US; some boys develop
orchitis caused by mumps will have testicular atrophy; orchitis may also cause infertility

A patient with fibroid tumors may have pelvic region pressure and heavy menstrual bleeding.
Fibroids can also put pressure on the bladder causing frequent urination; if the fibroid is very
large it can make a woman look pregnant.

Inguinal hernia occurs when tissue pushes through a weak area in the groin muscle; this causes
a bulge in the groin or scrotum; the hernia can suddenly appear after living heavy weights,
coughing, bending, straining, or laughing; the hernia may be painful, but some hernias cause a
bulge without pain.

Syphilis:
● STI- primary route through sexual contact
● Four stages
o Primary begins three weeks after infection- small painless sores called chancres
o Secondary sx begins 2 to 10 weeks after the chancre sore appears- most common
sx are rash on palms and soles
o Latent stage starts when sx of secondary end which can start form 2-30 years
after first being infected. Latent syphilis, the infection is quiet, and the risk of
infecting others is low or absent
o Tertiary syphilis there is damage to many parts of the body such as the heart, the
eyes, the brain, and nervous system, the bones, and the liver

Women with fibrocystic breasts usually experience lumps in both breasts that increase in size
and tenderness just prior to menstrual bleeding; occasionally there is the presence of nipple
discharge as well

Genital herpes are caused by HSV-2, HSV1 is what normally causes fever blisters around the
mouth; the genital herpes infection appears as small blisters or ulcers on the genitals; the
blisters or ulcers are grouped into crops; blisters usually form first and then open to form ulcers;
blisters may be painless, slightly tender or very painful

The best time to examine the breast is usually one week after the menstrual period begin; at
this time the breast tissue is less likely to be swollen or tender.

A vertical strip pattern, or a circular or wedge pattern is one of the preferred methods of
self-palpation of the breast tissue for breast self-examination.
The most common cause of postmenopausal bleeding is Hormone Replacement Therapy; the
estrogen in the replacement therapy relieves the symptoms of menopause and decreases the
risk of osteoporosis; the estrogen can also stimulate the uterine lining to grow and the lining is
shed, post-menopausal bleeding occurs; about 5-10% of postmenopausal bleeding is due to
endometrial cancer or its precursors.

Trichomoniasis is spread through sexual contract. Parasite cannot survive in mouth or rectum.
Women sx: painful intercourse, itching in inner thighs, greenish-yellow vaginal discharge, vaginal
and vulvar itching, vaginal odor. Men: burning urination, itching urethra, slight urethral
discharge. In men it normally does not cause symptoms and resolves itself in a few weeks.

Three main types of vaginitis are bacterial vaginosis, vagina candidiasis, and trichomoniasis; a
woman may have any combination of vaginal infections at one time; vaginal candidiasis or yeast
infection is caused by a fungus called Candida which is normally present in the rectum and
vagina; in candidiasis there is overgrowth of the fungus; not all candida vaginitis is odorless.