MD (Hom.

) PREPARATORY CAMP 2019 - 20

STUDY MATERIAL GYNAECOLOGY

 Analogous structures in males and females:

Female Male
Labia Majora Scrotum
Fourchette Posterior part of penis
Glans clitoris Penis (erectile tissue)
Labia minora covering clitoris Prepuce
Bartholin’s gland Cowper’s gland
Skene’s gland Prostate gland

 Vestibule contains 6 structures: Urethral opening, Vaginal introitus, 2 ducts of bartholin’s gland and 2
ducts known as skene’s duct
 Anterior vaginal wall = 7 -7.5 cm; Posterior vaginal wall = 9cm, Deepest fornix = posterior fornix
 Vagina harbours a commensal bacteria (lactobacillus) called Doderlein’s bacillus which renders
vaginal environment acidic by converting glycogen in epithelium to lactic acid. This process is facilitated
by the level of oestrogen in blood
 Vagina does not possess any glands but the discharge is from: endocervical glands, endometrial glands
and bartholin’s gland
 Uterus is 8cm long x 6cm wide x 3-4 cm breath. The myometrium consists of 3 layers : Outer
longitudinal, inner circular and middle interlacing layer called as living ligature.
 Significance of internal os of cervix
1. Area between anatomical and histological os is called isthmus
2. At the level of internal os the uterine artery moves upwards
3. Perineum is reflected from bladder at this level so it helps in identification of lower segment in
LSCS
4. Uterosacral ligaments lie at this level and Mackenrodt’s ligament lie below this level.
 Important parts of the Fallopian tube:
1. M/c site for fertilisation, ectopic pregnancy, tubal abortion: ampulla
2. M/c site for tubal rupture and tubectomy : isthmus
3. Best prognosis for reversibility/ recanalisation of tube: Isthmo-isthmic part
 Important angles in pelvic anatomy:
1. Angle of anteflexion (angle between cervix and uterus): 120 - 130°
2. Angle of anteversion (angle between cervix and vagina) : 90°
3. Urethrovesical angle: 100°
 pH of the vagina at different stages of life:

Stages of life pH of the vagina

In a newborn child 4.5 – 7
6 weeks old child 7
Puberty Alkaline - acidic
Reproductive age group 4 – 5.5
Pregnancy 3.5 – 4.5
Late post menopause 6-8

 Endocervix is lined by tall columnar cell epithelium whereas the ectocervix is lined by Squamous cell
epithelium. The intervening zone is called transformation zone which is a dynamic one.

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 Corpus : cervix ratio in different age groups
Age Ratio
Before puberty 1:2
At puberty 2:1
In adults / reproductive age group 3:1 or 4:1
After menopause 1:1 (whole uterus and cervix atrophy)

 Development of various female Genital organs:

Structure Developemental stucture
Clitoris Genital tubercle
Labia majora Ectodermal part of genital swellings
Labia minora Ruptured part of urogenital membrane
Fallopian tubes, uterus, cervix Paramesonephric ducts (Mullerian tubes)
Vagina Mostly from Mullerian duct and partly from
urogenital sinus
Vaginal introitus Degeneration of central cells of vaginal plate
Hymen Remnants of the cells of vaginal plate
Ovary Gonadal or genital ridge
Follicles Germ cells from yolk sac
Epoophoron, paroophoron, Gaertner’s duct Wollfian duct

 Cryptomenorrhoea is caused m/c by imperforated hymen, lower transverse vaginal septum.

 Periodic lower abdomen pain and dysuria (due to overstretching of urethra) are the most important
presenting symptoms of imperforated hymen.
 American Fertility Society classification of uterine anomalies:
Class Anomaly
I. Mullerian agenesis
II. Unicornuate uterus
III. Diadelphys uterus
IV. Bicornuate uterus
V. Septate uterus
VI. Arcuate uterus
VII. DES related anomaly

 Stages of puberty: beginning of growth spurt breast budding (thelarche) pubic and axillary
hair development (pubarche) peak of growth Menstruation (menarche)
 M/c cause of precocious puberty is constitutional and the changes occur in a sequential order as
mentioned above. All the changes are at par with development.
 Hepatoblastoma, a liver tumor is a cause of precocious puberty due to excess liberation of hCG.
Another tumor to liberate hCG is Chorionic epithelioma.
 Menopause can be diagnosed by observation of 12 months of amenorrhoea with absence of any other
cause of amenorrhoea.
 Senile vaginitis is one of the m/c complications of menopause, followed by osteopenia and
osteoporosis, CAD, vasomotor diseases.
 Hormone replacement theory is contraindicated in : History of undiagnosed genital tract bleeding;
estrogen dependant neoplasm; Venous thromboembolism; Acute liver disease; Gall bladder diseases.
 Graafian follicle is named after Dutch physician and anatomist Reijnier De Graaf
 Thickness of endometrium at different stages of cycle: Stage of regeneration (just after menses) :
2mm; proliferative stage : 3-4 mm; secretory stage (21st day) : 6-8 mm.

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 The ovum is arrested at prophase stage of 1st meiotic division since intrauterine life which completes
the first meiotic division just after selection of follicle; it then completes 2nd meiotic division only after
fertilisation.
 The function of prostaglandins:
Prostaglandin Myometrial role Vascular role
PGF2α Contraction Vasoconstriction
PGE2 Contraction Vasodilatation
PGI2 Dilatation Vasodilatation

 Collection of cervical smear: Using Ayre’s spatula from squamocolumnar junction; Using cytobrush
for endocervical sampling; Using wooden spatula from anterior vaginal fornix.
 Modes of spread of pelvic infection: Through continuity and contiguity: gonococcal infection;
Through lymphatics: pyogenous infection; Through blood stream : tubercular; From adjacent organs
specially intestines.
 Clinical diagnostic criteria for PID:
Lower abdominal tenderness
Minimum criteria Cervical motion tenderness
Adnexal tenderness
Oral temperature > 38.3°C
Mucopurulent cervical and vaginal discharge
Additional criteria Raised CRP or ESR
Laboratory documentation of pelvic infection esp
by microbiology
Histopathological evidence of endometritis on
biopsy
Definitive criteria Imaging study (TVS/MRI) evidence of thickened
fluid filled tubes with TO mass
Laparoscopic evidence of PID

 M/c cause of PIDs is STDs esp. Gonorrhoea and Chlamydia infection. PID of virgin girls is d/t
Tubercular infection.
 M/c site of genital TB is Fallopian tubes. Infertility is the m/c presentation of genital TB.
 On HSG following findings are seen:
1. Rigid non peristaltic appearance of tubes as if ‘lead pipe’ or ‘golf club’ appearance
2. Beading or variation in filling ‘Maltese cross/ rosette’ appearance. (Salpingitis Isthmica
Nodosa)
3. Cornual block
4. Tobacco pouch appearance
5. Honeycomb uterus d/t Asherman’s syndrome
 Fitz Hugh Curtis Syndrome occurs in Chlamydial infection which on laparoscopy appears as ‘violin
string’ adhesions around the liver.
 Trichomonas vaginalis infection is the m/c protozoal infestation of the genital tract, whereas Candida
albicans is the m/c fungal infection of genital tract.
 Trichomoniasis occurs in alkaline vaginal medium whereas Candida infection occurs in acidic vagina.
Strawberry like appearance of the vagina in trichomoniasis whereas white coating which on removal
causes multiple oozing spots occurs in moniliasis.
 M/c cause of Bartholin’s abscess is Gonococcus infection.
 Clue cells are seen in bacterial vaginosis d/t Gardnerella vaginalis infection. Whiff test is positive for
bacterial vaginosis.
 Senile vaginitis is the m/c cause of pruritis vulvae.
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