week 2 // disorder of reproductive system 3.

pap smear
o procedure to test for cervical cancer in women
1. gynecologic infections o involved collecting cells from cervix
o detection via par smear gives greater chance at cute
normal o BISA JUGA detect changes in cervical cells that suggest cancer may develop
- vaginal flora o why?
o includes multiple aerobic and anaerobes, cuman mostly anaerob o used for screening for cervical cancer
o exist in a symbiotic relationship with host and ALTERABLE depend on o who?
microenvironment o beginning at age 21, kl udh intercourse lah kl nggak ntar bisa
o SOME produce substaces eg. lactic acid and hydrogen peroxide to inhibit dibilang taking someone elses virginity
nonindigenous organisms o how?
o bacteriocins -> antibacterial compounds o every 3 years for women ages 21 to 65
o secretory leukocyte protease inhibitor -> protection from toxic o age 30, older -> every 5 years if combined w/ testing for HPV ot
substances ; protects local tissues against toxic inflam products & infection might consider HPV testing instead
- vaginal pH o risk, may require more frequent
o 4 – 4.5  diagnosis of cervical cancer / pap smear that showed
o Lactobacillus spp. produce lactic acid, fatty acid, other acids precancerous cells
o other bacteria jg add organic acifs from protein catabolism & anaerobic  exposure to diethylstilbestrol (DES) before birth // form
bacteria donate by amino acid fermentation of estrogen
o glycogen  HIV infection
 provide nutrients for many vaginal flora  weakened immune system due to organ transplant, chemo
 converted to glycogen or chronic corticosteroid use
o menopause -> glycogen contents & vaginal epithelial cells diminish, jd  history of smoking
decrease substrate for acid prod ---- pH rise, biasa 6 – 7.5 o risks
altered flora o possible to receive false-negative results, bisa krn
- kan decrease / low prevalence of lactobacillus -> gaada yg protect against vaginal  inadequate collection of cells
pathogens (ini terutrama di young girls sm menopause yg ga HORMONE  small number of abnormal cells
REPLACEMENT)  blood/inflammatory cells obscruing the abnormal cells
- altered lower repro tract flora -> may lead to infection o prepare
- menstrual change jg bisa alter krn hormone changes // menstrual fluid -> nutrient o avoid intercourse, douching / using vaginal medicines or
source to some bacterial species spermicidal foams, creams or jellies, BISA obscure abnormal cells
o jgn schedule pas lg mens
bacterial vaginosis o what to expect
- what happens? o insert speculum into vagina, holds the walls of vagina apart supaya
o vaginal flora’s symbiotic relatiionship SHIFTS, gatau kenapa dimana aenarob doctor bisa easily liat cervix
species overgrow and include Gardnerella vaginalis, Ureaplasma o then sample is takin using soft brush & flat scraping device
urealyticum, Mobiluncus species, Mycoplasma hominis & Prevotella species (spatula)
- ↓ or no hydrogen peroxide producing Lactobacillus spp // cuman gadiketahui knp gini o result
- risk  normal – negative
o sexual contact w/ multiple new partners. lowered risk -> condom use  abnormal
- most common cause of VAGINAL DISCHARGE among reproductive-aged women  positive result -> depend on type of cell
- DISCHARGE -> nonirritating, malodorous vaginal discharge discovered blm tentu cancer

2. vaginal bleeding atypical squamous cells of undetermined significance (ASCUS)

o premenopausal - squamous normalnya ada thin & flat, cuman ini abnormal
o postmenopausal - abnormal BUT don’t suggest precancerous cells
o causes? - bisa liquid-based test -> buat cek virus yg promote cancer HPV
 polyps:
squamous intrepithelial lesion
- may be precancerous
 - changes -> low grade (size, shape dll suggest precancerous lesion)
- high grade-> change develop into cancer much sooner
atypical glandular cells
- glandular cell produce mucus & grow in opening of cervix and within uterus
- may appear to be slughtly abnormal cuman gajelas sebenernya dia cancerous or not
- further testing
o fusi duktus Muller kiri&kanan selesai pd usia kehamilan 12 minggu
o kanalisasi -> selesai pd kehamilan 5 bulan
o gagal fusi
 vertikal antara duktus Muller & sinus urogenital bakal nyebabin
gangguan kanalisasi organ genitalia
 lateral -> nyebabin terjadinya duplikasi organ
o gangguan resorpsi -> nyebabin terbentuknya septum

squamous cell cancer or adenocarcinoma cells

- appear abnormal -> cancerous!!
- scc -> cancer arising in flat surface cell of vagina/cervix
- adeno -> cancer arising in glandular cells

4. congenital anomalies

kelainan pada genitalia eksterna:

- hipertrofi labialis
o pembesaran pd either 1 or both labia yg dapat nyebabin:
 iritasi, infeksi kronik and nyeri yg dapat mempengaruhi aktivitas
seksual atau segala yg nimbulkan penekanan pd vulva
 dapat menimbul stres psikososial
o tapi ga smua bisa ngalamin masalah2 itu
o edukasi kalau bukan kelainan yg bisa menyebabkan dampak serius
o treat -> jgn gunakan pakaian terlalu ketat dan slalu jaga kebersihan vulva
o gangguan berulang, dianjurkan labioplasti
o pascatindakan:
 hindari gesekan antar daerah vulva dgn paha pada saat berjalan
 jaga daerah vulva dalam keadaan kering untuk jamin proses
penyembuhan dgn baik
- himen imperforatus
o selaput dara yang tidak memiliki lubang (hiatus heminalis)
o umumnya tidak bakal disadari sebelum perempuan ngalamin menarke
o epid: 1:1000 – 1:10000
o findings
 darah mens yang dihasilkan tiap bulan ga bisa ngalir dan terkumpul
di vagina (hematokolpos)
 lama2 makin banyak bisa bikin himen menonjol keliuar & bisa
tampak kebiruan
 hematokolpos
 darah haid akan mengisi kavum uteri (hematometra)
 dapat ngisi tuba falopii (hematosalping)
 diagnosis gampang
 penanganan -> himenektomi dengan perlindungan antibiotic
 setelah penanganan -> posisi fowler supaya darah haid yang
terkumpul ngalir keluar
- anomali pd uterus, serviks dan vagina
o disebabkan oleh mechanism CAFÉ (canalization, agenesis, fusion, embryonic
rests)
o krn terjadi defek pd proses fusi lateral & vertikal dari sinus urogenitalis &
duktus Muller