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complete eversion of the vagina with trophic ulceration, edema, and fibrosis. Treatment is surgical. Box 24-11 summarizes the symptoms and treatments of POP (p. 819 – 820). Leiomyomas, commonly called myomas or uterine fibroids, are benign smooth muscle tumors in the myometrium (Figure 24-14). Leiomyomas are the most common benign tumors of the uterus, affecting as many as 70% to 80% of all women, and most remain small, asymptomatic, and clinically insignificant.Prevalence increases in women ages 30 to 50 but decreases with menopause. The incidence of leiomyomas in black and Asian women is two to five times higher than that in white women.Complications related to leiomyomas are the number one reason for gynecologic hospitalizations (p 821). CONCEPT 2: QUESTION 41; PAGE 115Amenorrhea means lack of menstruation, and the most common causes (aside from pregnancy) are caused by hypothalamic dysfunction, polycystic ovarian syndrome, hyperprolactinemia, and ovarian failure. Primary amenorrhea is the failure of menarche and the absence of menstruation by age 13 years without thedevelopment of secondary sex characteristics or by age 15 regardless of the presence of secondary sex characteristics. Primary amenorrhea differs from delayed puberty in that most cases of delayed puberty require only reassurance, but when the diagnosis of primary amenorrhea is reached, a thorough evaluation is needed. Secondary amenorrhea is the absence of menstruation for a time equivalent to three or more cycles in women who have previously menstruated. Pregnancy is the most common condition to rule out prior to further evaluation (p.805). CONCEPT 3: QUESTION 40; PAGE 115Primary dysmenorrhea is painful menstruation associated with the release of prostaglandins in ovulatory cycles, but not with pelvic disease. Approximately 50% of all women experience dysmenorrhea, 10% of who are incapacitated for 1 to 3 days because of pain severity. Primary dysmenorrhea usually begins with the onset of ovulatory cycles, around age 15 or 16 years with prevalence highest during adolescence.In contrast, secondary dysmenorrhea is related to pelvic pathology (i.e., ovarian cysts, endometriosis), which manifests in later
reproductive years and may occur any time in the menstrual cycle (p. 804).CONCEPT 4: QUESTIONS 59-65; PAGE 117 – 118Pelvic inflammatory disease (PID) is an acute inflammatory process caused byinfection. PID may involve any organ, or combination of organs, of the upper genital tract—the uterus, fallopian tubes, or ovaries—and, in its most severe form, the entire peritoneal cavity. Inflammation of the fallopian tubes is termed salpingitis (Figure 24-6); inflammation of the ovaries is called oophoritis. Sexually transmitted microorganisms, such as chlamydia and gonorrhea, that migrate from the vagina to the uterus, fallopian tubes, and ovaries cause most cases of PID. The ascension of these microorganisms into the upper genital tractmay be facilitated by disruptions in the normal vaginal flora.Some cases of PID occur after invasive procedures, such as IUD placement, when microorganisms are pushed up into the upper genital tract.
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delayed puberty, Precocious puberty, central precocious puberty