Different Kinds of Ovarian Cysts

MOTHER: ● Follicular Cyst - Around the midpoint of your

COMMON GYNECOLOGIC PROBLEMS
Ms. Abulencia | Feb. 7, ‘22 | Prelim
Ovarian Cysts
- Fluid filled sac or pockets in an ovary.
- There are 2 ovaries, with the size and shape
as an almond and is seen at each side of the
uterus. The eggs, which develop and mature
in the ovary are released in a monthly cycle
most specifically during the childbearing years.
- There can be little or no discomforts at all and
can be considered as harmless. Majority
disappears without any treatment at all.
However, what is very painful is when the cyst
would be ruptured.
menstrual cycle, an egg bursts out of its follicle
and travels down the fallopian tube. A follicular
cyst begins when the follicle doesn’t rupture or
release its egg, but continues to grow.
○ During the menstrual cycle, the egg
grows in a sac and we call this
“follicle.” The sac is located in the
ovaries and if the follicle breaks,
opens and releases egg, normally it
happens. However, if it does not break
the fluid inside the follicle will be
formed as a cyst in the ovary.

How is it Diagnosed?
● Ultrasound examination- done through
tranvaginal or transabdominal ultrasound.
Viewed through the sound waves and it will
show the shape, size and location of the cyst.
It can also be seen whether the cyst is solid or ● Corpus Luteum Cyst - When a follicle
filled with fluids. releases its egg, it begins producing estrogen
○ Transabdominal Ultrasound- ask the and progesterone for conception. This follicle
patient to drink a lot of water until they is now called the “corpus luteum.” Sometimes,
feel urinating before starting the fluid accumulates inside the follicle, causing
procedure. the corpus luteum to grow into a cyst.
○ Transvaginal Ultrasound- ask the ○ Abnormal change in the follicle of the
patient to urinate first before ovary after the egg has been released
performing the procedure. and caused the egg escape, opening
● Blood test- Detects the presence or the to the seal off. The fluid then
substance of CA 125. accumulates in the follicle and a
CA 125 Test corpus luteum cyst will develop.
○ Measures the amount of the protein
CA 125 (cancer antigen 125) in your
blood.
○ May be used to monitor certain
cancers during and after treatment.
May be used to look for early signs of
ovarian cancer in people with a very
high risk of the disease.
○ If increased, there is a presence of
ovarian cancer. ● Dermoid Cyst - Also called as “Teratomas,”
Symptoms: can contain tissue, such as hair, skin or teeth,
➔ Pelvic Pain- a dull or sharp ache in the lower because they form from embryonic cells.
abdomen on the side of the cyst. (Pain w/ They’re rarely cancerous.
fever or vomiting). Severe pain can be felt
once the cyst bursts or ruptures.
➔ Fullness or heaviness in your abdomen
➔ Bloating

1

● Cystadenomas - Develops on the surface of
an ovary and might be filled with a watery or a
mucous material.
○ A noncancerous growth that can
develop at the outer surface of the
ovaries. Once they have removed this
from the abdomen, they are measured
and ruptured to take the fluid or the
rest as a specimen to be taken at the
laboratory.
Papillary Serous Cystadenomas
● Endometriomas - Develops as a result of a
condition in which the uterine endometrial cells
grow outside the uterus (endometriosis). Some
of the tissue can attach to the ovary and form
a growth.
○ The growth is sometimes in a
chocolate or dark brownish color.
Treatment:
➔ Birth Control Pills- oral contraceptives to stop
ovulation and prevent further development of
the cyst. A useful treatment in reduction of the
risk for ovarian cyst. Higher during the post
menopausal stage.
➔ Laparoscopy- If the cyst is small, the result of
the imaging test will rule out the cancer.
However, laparoscopy will be performed to
surgically remove the cyst. There is a tiny
incision that will be done specifically in the
navel and inserting the instrument that will be
responsible in removing the cyst.
➔ Laparotomy- Done when there is an enlarged
cyst. Having a large incision in the abdomen,
this is a traditional type of surgery. Then
immediately conduct biopsy once identified if
the cyst is cancerous or not. Hysterectomy can
also be performed, it is the removal of the
ovary and the uterus if necessary.
Risk Factors:
● Hormonal problems- clomiphene, a drug that
causes you to ovulate.
● Pregnancy- The cyst forms when you ovulate
and stays at the ovary and throughout the
pregnancy.
● Endometriosis
● A severe pelvic infection
● A previous ovarian cyst
Prevention:
● Regular pelvic examination help ensure that
changes in your ovaries are diagnosed as
early as possible.
● Alert to changes in your monthly cycle,
including unusual menstrual symptoms,
especially ones that persist for more than a
few cycles.
● Talk to your doctor about changes that
concern you.
Additional:
Cystectomy- The removal of the cyst from the ovary.
Oophorectomy- The removal of the ovary.
Pelvic Pain
- Refers to the pain in the region of the women’s
internal reproductive organs. It can be
presence in either the sex and can stem from
other causes.
2
Causes of Pelvic Pain: Endometriosis
● Ectopic Pregnancy - Painful disorder in which the tissue that lines
● Miscarriage the endometrium is growing outside of the
● Pelvic Inflammatory Disease uterus. Evident in the fallopian tubes and
● Menstrual Cramps/ Ovulation tissue lining in the pelvis.
● Development of Ovarian Cysts, Fibroids or
presence of cancer
Problems of the reproductive system, such as:
● Endometriosis- painful disorder when the
tissue grows outside of the uterus.
● Adenomyosis- tissue that normally lines the
endometrial tissue that grows in the muscular
walls of the uterus. May thickened and
breakdown leading to bleeding during
menstrual cycle.
● Uterine Fibroids- non cancerous growth of the
uterus during childbearing years. Another
name is Myomas or Leiomyomas, which is
associated with the increased risk of uterine
cancers.
● Scar tissue (adhesions) in the pelvic area after
an infection or surgery. There are scar tissue
that cause internal organs to stuck together
and should not supposed to be like that.

Diagnosis: - Tissue may thicken and breakdown during

● Blood Test menstrual cycle. So if the tissue is irritated, it
● Urinalysis develops scars.
● Pregnancy Test
● Abdominal Pelvic X-ray Diagnosis:
● Laparoscopy ● Pelvic Exam- The doctor palpates the area on
● Hysterectomy the pelvis for any abnormalities especially if
● Vaginal Cultures there is cyst or scars in the uterus.
● Ultrasound- transvaginal as recommended.
Symptoms: ● Magnetic Resonance Imaging (MRI)- uses
➔ Ranges from mild to severe/ from dull to magnetic field and radiowaves, which helps in
sharp. surgical planning that informs the doctor about
➔ Severe cramping during periods. the location and size of endometrial implants
➔ During sex. or problems.
➔ When urinating or having a bowel movement. ● Laparoscopy- will be needing general
➔ Certain postures or positions. anesthesia to incise and view using
➔ If chronic, it can make it hard to sleep, work, or laparoscope which visualizes the internal
enjoy life leading to depression. reproductive organs.

Treatment: Symptoms:
➔ Birth control pills or hormone treatment for ➔ Painful periods (dysmenorrhea)- cramping and
problems related to periods. pelvic pain.
➔ Surgery to remove a growth, cyst or tumor. ➔ Pain during intercourse
➔ Medicine to treat the problem, such as an ➔ Pain w/ bowel movements or urination
antibiotic for infection or medicine for irritable ➔ Excessive bleeding
bowel syndrome. ➔ Infertility
➔ Pain relievers called NSAIDs, like ibuprofen ➔ Other signs and symptoms: fatigue, diarrhea,
(such as Advil or Motrin) or naproxen (such as constipation, nausea, vomiting especially
Aleve). during menstrual periods.

3
Causes:
● Retrograde menstruation- menstrual blood
containing endometrial cells flows back to the
fallopian tube.
● Transformation of peritoneal cells- known as
Induction Theory, wherein the hormones and
immune factors promote the transformation of
peritoneal cells, thus these cells lines the inner
side of the abdomen into the endometrial line
cells.
● Embryonic cell transformation- something to
do with hormones such as estrogen being
transformed in the embryonic cells as an early
stage of development and implants during
puberty.
● Surgical scar implantation
● Endometrial cell transport- blood vessels and
the tissues or the lymphatic system may have
transport endometrial cells to the other parts of
the body.
● Immune system disorder- unable to recognize
and destroy the endometrial tissues which is
growing outside of the uterus.
Risk Factors:
● Never giving birth
● Starting your period at an early age
● Menopause at an older age
● Short menstrual cycles
● Heavy menstrual periods
● Having higher levels of estrogen
● Low body mass index
● Relatives w/ endometriosis
● Any medical condition
● Reproductive tract abnormalities
Uterine Fibroids
- A noncancerous growth of the uterus which
appears during childbearing years. Myomas or
Leiomyomas, which is associated with the
increased risk of uterine cancers.
Symptoms:
➔ Heavy menstrual bleeding
➔ Prolonged menstrual periods
➔ Pelvic pressure or pain
➔ Frequent urination
➔ Difficulty emptying the bladder
➔ Constipation
➔ Backache or leg pains
➔ Genetic changes
➔ Hormones- there can be fibroids containing
more estrogen and progesterone receptors
than in the normal uterine muscles.
➔ Other growth factors: substances that may
contain tissues like insulin growth factor.
➔ Extracellular Matrix (ECM)- increase in fibroids
and makes them more fibrous.
Polycystic Ovarian Syndrome (PCOS)
- Common gynecologic problem.
- A condition in which the ovaries produce
abnormal amounts of androgens (male sex
hormones present in women should only be in
small amounts).
- Also describe as numerous small cysts that
forms in the ovaries. These are numerous
small collections of fluid (follicles) and fail to
regularly release eggs from the ovaries.
- Early diagnosis and treatment along w/ weight
loss may reduce the risk of long term
complications such as hypertension, type 2
diabetes and heart disease. Basically, it
requires proper medical attention or surgical
treatment.
- Having PCOS does not mean that women
cannot get pregnant as it is treatable. But if not
treated for a long time, it can cause infertility.
- PCOS is a hormonal imbalance thus, it
interferes the growth and the release of egg.
Symptoms:
➔ Irregular periods
➔ Excess androgen- which causes acne,
baldness, hirsutism or excess of hair in a male
like pattern, etc.
➔ Polycystic ovaries
➔ Excess insulin- having resistance in insulin,
the blood sugar level can rise and body might
produce more insulin and the androgen
production will cause difficulty for ovulation.
➔ Low-grade inflammation
➔ Heredity- there are certain genes that are
linked with PCOS.
4
Abnormal Uterine Bleeding (AUB)
- “Dysfunctional Uterine Bleeding”
- Bleeding is caused by the imbalance in
hormones that control the menstrual cycle.
- May be associated with:
In a young, pre-pubertal girl:
- Injury
- Sexual abuse
- A blood clotting problem
- Early puberty
- Severe vaginal irritation (bubble bath, etc).
In a women of reproductive age:
- Hormone imbalance
- Tubal or ectopic pregnancy
- Molar pregnancy- H.mole
- Placenta previa
- Uterine fibroids
- Certain kinds of cysts and tumors (rarely
cancerous)
- Endometriosis
- Birth control pills
- IUD (Intrauterine Device)
In post- menopausal women:
- Effects of hormone replacement therapy
- Cancer
- Certain kinds of cysts and tumors (not
cancerous)
- Atrophic vaginitis (irritation and drying of
vaginal walls)
- Weakened pelvic floor muscles causing
prolapse
Genital Tract Infections
Pelvic Inflammatory Disease
- An infection of the female reproductive organs.
- Most often occurs when sexually transmitted
bacteria spread from your vagina to your
uterus, fallopian tubes or ovaries.
Symptoms:
➔ Pain
➔ Abnormal or heavy vaginal discharge
➔ Abnormal uterine bleeding
➔ Pain during intercourse
➔ Fever, sometimes w/ chills
➔ Painful, frequent or difficult urination
Risk Factors:
● Being a sexually active woman younger than
25 years old.
● Having multiple sexual partners.
● Being in a sexual relationship with a person
who has more than one sex partner.
● Having sex without a condom.
● Douching (cleaning the vagina) regularly,
which upsets the balance of good versus
harmful bacteria in the vagina and might mask
symptoms.
● Having a history of pelvic inflammatory
disease or a sexually transmitted infection.
Complications:
● Ectopic pregnancy. PID is a major cause of
tubal (ectopic) pregnancy.
● Infertility due to the damage to the
reproductive organs.
● Chronic pelvic pain
● Tubo-ovarian abscess (A tubo-ovarian
abscess is a pocket of pus that forms because
of an infection in a fallopian tube and ovary.)

Prevention:
● Practice safe sex.
● Talk to your doctor about contraception.
● Get tested.
● Request that your partner be tested.
Diagnosis and Treatment:
● Don’t douche or clean the vaginal area.
● Evaluation of abnormal uterine bleeding
includes ultrasound, endometrial biopsy or
Diagnosis:
D&C.
● Medical history
● Treatment typically includes, a trial of
● Signs and symptoms
hormonal birth control using oral, injection or
● Pelvic exam
IUD delivery to reduce bleeding, cramps and
● Blood and urine tests
pain. Other prescription medication may be
● Ultrasound
prescribed to either slow bleeding down.
● Laparoscopy
● Surgical procedures such as hysteroscopy,
● Endometrial biopsy
uterinel ablation, uterine artery embolization,
hysterectomy, laparotomy, laparoscopy and
Treatment:
robotic assistance.
● Antibiotics
5
 ● Treatment for your partner
● Temporary abstinence

Vulva and Vagina Skin Disorders

Bartholin cyst- removal of this should be scheduled at

the last procedure after delivery, to disinfect everything
in the room and the instruments used as it may cause
infection.
Sexual Assault in Women
- Bartholin’s glands- located on each side of
- “Any sexual act, attempt to obtain a sexual act,
the vaginal opening, secrete fluid that helps
unwanted sexual comments or advances, or
lubricate the vagina.
acts t otraffic women’s sexuality, using
- The openings of these glands become
coercion, threats of harm or physical force, by
obstructed, causing fluid to back up into the
any person, regardless of the relationship with
gland resulting in painless swelling called a
the victim, in any setting, including but not
“Bartholin’s Cyst.”
limited to home, school, prison, the streets and
- If fluid within the cyst becomes infected, you
at work.”
may develop a collection of pus surrounded by
inflamed tissue (abscess). The abscess should
Effects of Sexual Assault:
be removed thus, after the procedure
● Unwanted pregnancy
antibiotics are given to prevent further sign of
● Unsafe abortion- infection if the used
infection.
instruments are not cleaned or sterilized.
● STIs including HIV/AIDS
Symptoms:
● Post traumatic stress disorder
➔ Tender, painful lump near the vaginal opening
● Suicide
➔ Discomfort while walking or sitting
● Eating disorders
➔ Pain during intercourse
● Substance abuse
➔ Fever
● Sexual dysfunction
● Infertility
Treatment:
● Pelvic pain and UTI
● Sitz baths
● Self harm
● Surgical drainage
● Flashbacks
● Antibiotics
● Depression
● Marsupialization- a surgical procedure that
removes cysts in a way that makes them less
Additional:
likely to return.
● Rape- physical force or otherwise coerced
penetration even if slightly of the vulva or
anus, using a penis, other body parts or an
object.
● Sexual harassment- intimidation, bullying or
coercion of sexual nature, or unwelcome or
inappropriate promise or rewards in exchange
of sexual favors.

6
 ● Groping- touching or fondling of another
person in sexual way without the person’s
consent.
● Elderly sexual assault- sexually victimization
of elderly individual.
● Child sexual abuse- involves an adult or
order adolescent sexually abusing a child
(asking or pressuring a child to engage in
sexual activities, indecent exposure of genitals
to a child).
● Domestic violence
Risk Factors:
Women being victimized:
● Being young
● Consuming alcohol or drugs
● Having previously been raped or sexually
abused; having many sexual partners
● Involvement in sex work
● Becoming more educated and economically
empowered
● Poverty
● If the victim presents within 72 hours of
penetrative assault, and is HIV negative upon
initial testing, and consents to PEP
(post-exposure prophylaxis) treatment to
prevent HIV after a possible exposure.
Step 6
● Provide counseling on post-traumatic stress to
victim and guardian.
● Assess safety of the victim.
● Refer to other support services, such as the
Victim Support Unit in the Police.
Step 7
● Advice on dates for follow up visits.
● Record findings and treatment in examination
record and provide a copy to the victim for
submission to the poilce, if appropriate.
● Record all findings and treatment in health
passport.

Management:
Step 1
● Assess and treat serious injuries first.
● Obtain verbal consent to conduct physical
examination.
● Take full history and document all findings.
● Conduct full physical examination and
document all findings.
● Document all facts regarding the assault.

Step 2
● Manage physical effects of the assault such as
wounds and bruises including antibiotics to
prevent wound infection, tetanus booster if
required, medication for pain relief or anxiety.

Step 3
● Provide emergency contraception if the victim
has started menarche and presents within 72
hours post-assault.

Step 4
● Treat presumptively for STIs (or conduct
laboratory investigations if available):
○ Benzathine Penicillin
○ Gentamycin
○ Erythromycin
○ Metronidazole

Step 5
● Provide HIV testing and counseling
● Conduct an HB baseline reading (if available)