NSG 3280
Disorders of Female Genitalia/Reproductive Function
Unit 9
● Alterations in Uterine position
○ Can occur during any reproductive years
○ Thickening of endopelvic fascia known as cardinal ligaments
■ Tearing is rare, but can be stretched during difficult/prolonged delivery
■ Congenital defects in muscles of pelvic floor
○ 2 most common
■ Uterine prolapse
● Can occur at any age, female infants (congenital)
● Primary cause: women who give birth, trauma to ligaments during
childbirth especially multiple babies
● Increased chance of infection
● Discomfort, pain, pressure, possible urinary problems
● Fixed by surgery
● Caused by
○ Age
○ Pregnancy
○ Obesity
○ Low estrogen postmenopausal
● Treatment
○ Pelvic floor exercise
○ Estrogen supplement
○ Hysterectomy (minimally invasive approach)
○ Lifestyle changes include prevention of constipation,
prevention of coughing, weight loss
○ Pessory ring, device to hold uterus in place (increased change
of infection)
● Patho
○ Descent of uterus when supporting structures relax
● Etiology
○ Tearing of uterosacral ligaments during labor/delivery or
congenital defects
● Clinical manifestation
○ Vaginal discomfort
○ Sensation of bearing down
○ Discomfort while walking/sitting
○ Difficulty urinating
○ bleeding/ulceration of cervix
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○
With protrusion of cervix outside of body, may be subject to
trauma from friction and ulceration
● Diagnosis
○ Pelvic exam and S/S
■ Retrodisplacement of uterus
● Body of uterus is displaced from unusual location overlying bladder
to position posterior in pelvis (NOT PROLAPSED)
● Condition can have 5 positions
○ Anteverted
○ Midposition
○ Anteflexed
○ Retroflexed
○ retroverted
● Etiology
○ In 20-30% of women, can be normal variation throughout life
or develop after childbirth
● S/S
○ No symptoms
○ Pelvic pain/pressure
○ Dysmenorrhea
○ Dyspareunia
○ Painful intercourse (dyspareunia)
○ Other alterations
■ Cystocele (most common)
● Caused by Injury after childbirth
● Patho
○ Protrusion of portion of urinary bladder into anteriour
vagina at weakend part of muscle
● Etiology
○ Defect in vaginal wall caused by childbirth, heavy lifting,
aging
● Diagnosis
○ Pelvic exam
● Treatment
○ Sx
○ Prosthetic mesh to support bladder
● S/S
○ Depend on degree
○ Pressure in vagina
○ Dysuria
○ Incontinence
○ Back pain
○ Fullness at vaginal opening may be observed
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