5_6131853542106860233

10/28/21, 6:15 PM LONG EXAM 1 Gynecology September batch Customized program OCTOBER 28, 2021
LONG EXAM 1 Gynecology

September batch Customized
program OCTOBER 28, 2021
Choose the best answer
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1. 25 yr old nulligravid, with primary amenorrhea, has tanner stage 5 breasts, no

cervix and uterus on internal examination. Which of the following should NOT be
in your list of possible diagnosis?
(1 Point)
Turner's syndrome
Androgen Insensitivity syndrome
Mayer Rokitansky Kuster Hauser syndrome
2. Type of precocious puberty where the female patient develops masculine

secondary sexual characteristics
(1 Point)
idiopathic
factitious/iatrogenic
heterosexual
hormonal
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3. Which of the following describes the procedure when you perform inspection with
visualization of the external genitalia? *
(1 Point)
Young children may be examined in the frog leg position.
All of the above
An infant may be examined in the lithotomy position.
Lithotomy is not generally used for girls 4 to 5 years of age.
4. 50 year old nulligravid, experiencing postmenopausal prolonged heavy bleeding.

She has BMI 30 kg/m2, hypertensive and diabetic. What is your primary diagnosis?
(1 Point)
AUB - L
AUB - M
AUB - O
AUB - A
5. For patients with primary amenorrhea, and disorder of sexual development,

karyotype of 46 XY, gonadectomy is done for what medical reason?
(1 Point)
prevention of development of gonadoblastoma
prevention of development of masculine features
to facilitate development of breasts
prevention of development of endometrioma
6. A.G. noted to have primary amenorrhea. On examination, there was a bulging

membrane at the introitus. What is the best treatment for her? *
(1 Point)
Observe
Do a pelvic ultrasound
Do a cruciate incision at the hymen
Give antibiotics
7. What is the relative size ratio of cervix to uterus in a child? *

(1 Point)
2 to 1
1 to 2
None of the above
Equal size
8. This medication is effective for patients with AUB since it is a cyclooxygenase

inhibitor, and thus block the formation of both thromboxane and the prostacyclin
pathway
(1 Point)
Danazol
GnRH agonists
non-steroidal anti-inflammatory agents
oral contraceptive pills
9. What is the first major diagnostic decision of the obstetrician with respect to the
newborn? *
(1 Point)
Abdominal examination
Assessment of the ovaries
Identification of the uterus
Gender assignment
10. This gonadotropin provides the major survival factor that rescues the follicles from
their programmed death (atresia) and allows them to start growing, increasing in
size and beginning to synthesize steroids
(1 Point)
LH
FSH
estrogen
progesterone
11. This condition is characterized by a triad of café-au-lait spots, polyostotic fibrous

dysplasia, and cysts of the skull and long bones, and presents with signs of
precocious puberty. Patients also have facial asymmetry, bony defects and a
lifetime increased risk of malignancy.
(1 Point)
congenital adrenal hyperplasia
Asherman syndrome
swyer syndrome
McCune-Albright syndrome
12. Bone age in cases of precocious puberty is determined via:

(1 Point)
DEXA scan
hand wrist films
bone absorptiometry testing
blood calcium levels
13. Present in individuals with ovaries that have as SRY antigen present and majority
are true hermaphrodites *
(1 Point)
Ovotestes
Accessory ovary
Unicornuate uterus
Vaginal agenesis
14. This event is an absolute requirement for the final maturation of the oocyte and
the initiation of the follicular rupture.
(1 Point)
FSH surge
LH surge
estradiol peak
ovulation
15. Which of the following statement/s is/are TRUE regarding the general approach in
a gynecologic examination of pediatric patients? *
(1 Point)
Many gynecologic conditions in children can be diagnoses by rectal examination.
One excellent technique is for the physician to sit not stand during the initial encounter.
Poor interaction during the first visit will not interfere with future physician-patient
interactions.
Efforts should be devoted to a hurried approach.
16. A mother of a 4 y/o girl was worried about her daughter. Her daughter was noted
to have discomfort at the vulvar area associated with vaginal discharge. How will
you visualize the vagina and cervix? *
(1 Point)
Do a rectal examination
Utilize the lithotomy position
Accomplished with the insertion of speculum
Use an otoscope or ophthalmoscope as a magnifying instrument
17. 35 year old G2P2 (2002), experiencing prolonged heavy bleeding. She has
symmetrically enlarged uterus and severe dysmenorrhea. What is your primary
diagnosis?
(1 Point)
AUB - A
AUB - M
AUB - O
AUB - P
18. Components of a complete pediatric examination, EXCEPT: *

(1 Point)
History
Rectal exam (if necessary)
Invasive visualization of the vagina and cervix
Inspection with visualization of the external genitalia
19. Why was the dominant follicle "selected"?

(1 Point)
it is characterized by a well-vascularized theca layer thus allowing a better access of the

gonadotropins to their target receptors (preferential delivery of FSH and LDL substrate.)
it is preprogrammed to be selected by natural selection
It has the highest LH receptors
It is the largest follicle in the cohort
20. A 6 y/o girl, wearing a tight fitting pants and shirt, was brought to your
clinic. She has vaginal discharge associated with pruritus. She usually wipes
her genital area from posterior to anterior. What is your diagnosis? *
(1 Point)
Cervicitis
Lichen sclerosus
Labial adhesions
Vulvovaginitis
21. Which type of leiomyoma can cause abnormal uterine bleeding

(1 Point)
parasitic
subserous
intramural
submucous
22. Which of the following is NOT an indication for pelvic examination in the
adolescent? *
(1 Point)
Dysfuctional uterine bleeding
Delayed puberty
None of the above
Pelvic pain
23. This gonadotropin provides the critical signal for the recruitment of a cohort of
preantral follicles (cyclic recruitment)
(1 Point)
LH
FSH
estrogen
progesterone
24. follicular phase corresponds to

(1 Point)
proliferative phase
luteal phase
secretory phase
menstrual phase
25. Which of the following is an example of WHO type 1 amenorrhea?

(1 Point)
Sheehan syndrome
Prematire ovarian insufficency
PCOS
Pregnancy
26. Treatment for vaginal agenesis wherein a neovagina is built by utilizing labial skin
and results in a vaginal pouch whose axis is directly posterior *
(1 Point)
Abbe-McIndoe
Williams procedure
Strassman Metroplasty
Vecchietti procedure
27. Determine the correct Tanners staging: Breast: (+) breast budding; Pubic hair:
labial hair spreads over mons pubis
(1 Point)
B2, PH2
B2, PH3
B3, PH3
B3, PH2
28. basal levels of LH > 5 mIU/ml is diagnostic of:

(1 Point)
GnRH-dependent precocious puberty
GnRH-independent precocious puberty
29. Which of the following statement/s is TRUE in performing rectal exam in pediatric
patient? *
(1 Point)
Always included in the gynecologic examination in a child.
Normal prepubertal uterus and ovaries are not palpable on rectal examination.
All of the above
Many gynecologic conditions in children can be diagnosed by rectal examination.
30. Which of the following conditions exhibits cryptomenorrhea?

(1 Point)
Mayer Rokitansky Kuster Hauser synrome
Asherman syndrome
Swyer syndrome
Imperforate hymen
31. Treatment of GnRH-dependent precocious puberty:

(1 Point)
estrogen
surgery
GnRH agonist
levonorgestrel
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32. What is the typical appearance of the lesions present in Lichen sclerosus? *
(1 Point)
Hourglass or figure-8 formation involving the genital and perianal area
Translucent vertical midline line
Grapelike masses from the vagina
Red donut-like structure
33. Which of the following statement/s should be considered when you visualize the
vagina and cervix in pediatric patients? *
(1 Point)
Accomplished without the use of any insertion of instruments
All of the choices
Use otoscope or ophthalmoscope as a magnifying instrument and light source.
One method is to utilize the knee chest position.
34. Primary amenorrhea is considered if patient has not menstruated at what age in
years?
(1 Point)
12
13
14
15
35. A 7 y/o girl was noted to have nocturnal vulvar and perianal itching. What should
be included in your examination to confirm your diagnosis? *
(1 Point)
Perform examination under anesthesia using a lighted Killian nasal speculum and a
fiberoptic scope which are useful for examining the prepubertal vagina
Do a rectal examination
Dabbing of the vulvar skin with clear cellophane adhesive tape ideally before the child
has arisen in the morning and tape is subsequently examined under the microscope.
Recurrent vulvar and perianal itching may be indications for vaginosopy
36. 25 yr old nulligravid, with primary amenorrhea, has tanner stage 5 breasts, no
cervix and uterus on internal examination. What is the best diagnostic procedure
that you should request for to rule in your diagnosis?
(1 Point)
abdominal ultrasound
karyotyping
Complete blood count, platelet count, blood typing
cranial CT scan
37. Excess ovarian tissue noted near a normally placed ovary and connected to it *
(1 Point)
Accessory ovary
Polycystic ovary
Ovarian cyst
Supernumerary ovary
38. A 5 y/o girl was brought to your clinic. She was noted to have vaginal
discharge and erythema. What will you utilize in performing a gynecologic
exam to visualize the external genitalia? *
(1 Point)
She may be examined in the frog leg position.

Place her on her mother's lap
Utilize knee chest position
Place her in lithotomy position.
39. Most common cause of GnRH-dependent precocious puberty

(1 Point)
idiopathic
CNS lesions
Primary hypothyroidism
Granulosa cell tumor
40. 19 year old nulligravid, with primary amenorrhea; Breast: Tanner stage 4; Uterus
present on internal exam; karyotype: 46 XX; BMI: 18 kg/m2; Which of the following
is your primary consideration?
(1 Point)
Swyer syndrome
anorexia nervosa
Kallman syndrome
Ashermans syndrome
41. 20 year old nulligravid, with primary amenorrhea; Breast: tanner stage 0; Uterus:
absent; karyotype: 46 XY; Which of the following should NOT be in your list of
possible diagnosis?
(1 Point)
Androgen insensitivity syndrome
agonadism
17 alpha-hydroxylase deficiency
17,20 desmolase deficiency
42. Which of the following cases can expect delayed menarche?

(1 Point)
11 year old female doing ballet for 4 years now
10 year old female with BMI of 28 kg/m2
9 year old female with karyotype 46 X0
12 year old female with Mayer Rokitansky Kuster Hauser syndrome
43. What is the predominant hormone in the luteal phase?

(1 Point)
estrogen
progesterone
testosterone
LH
44. 25 year old G2P0 (0020), amenorrheic for 1 year after she underwent dilatation
and curettage for spontaneous abortion; Which of the following is your primary
consideration?
(1 Point)
Swyer syndrome
Mayer Rokitansky Kuster Hauser syndrome
Kallman syndrome
Ashermans syndrome
45. Third ovary that is separated from the normally situated ovaries *
(1 Point)
Supernumerary ovary
Accessor ovary
Ovarian cyst
Polycystic ovary
46. mean interval between breast budding and menarche is:

(1 Point)
5.5 yrs +/- 1 year
2.3 +/- 1 month
2.3 yrs +/- 1 year
3 yrs +/- 3 months
47. What is the goal of treatment in patients with vaginal agenesis? *

(1 Point)
Observation
Creation of a vagina when patient is sexually active
Create a cruciate incision at the hymen
Treatment of infection
48. AUB secondary to intrauterine foreign bodies or trauma

(1 Point)
AUB-I
AUB-E
AUB-N
AUB-O
49. 16 yr old nulligravid complaining of prolonged heavy menses. Blood work-up for
coagulation factors, complete blood count , platelet count and peripheral blood
smear are all normal. What is your primary diagnosis?
(1 Point)
AUB-O
AUB-M
AUB-C
AUB-P
50. This condition is characterized by a triad of café-au-lait spots, polyostotic fibrous

dysplasia, and cysts of the skull and long bones, and presents with signs of
precocious puberty. Patients also have facial asymmetry, bony defects and a
lifetime increased risk of malignancy. Identify which type of precocious puberty
this condition can cause:
(1 Point)
51. These are the proteolytic enzymes that cause tissue breakdown of the
endometrium during menses
(1 Point)
matrix metalloproteinase
aromatase enzyme
17 hydroxy dehydrogenase
52. This enzyme inhibits the menstrual blood from clotting

(1 Point)
plasmin
aromatase
17 hydroxydehydrogenase
53. Ovulation occurs __ hours after the initial rise in LH

(1 Point)
16
24
32
40
54. Which hormone can rescue the corpus luteum during the first few days following
conception, to maintain production of progesterone?
(1 Point)
estrogen
FSH
LH
hCG
55. 28 year old G1P1, with irregular heavy menses; maintained on Aspirin due to
congenital heart disease. transvaginal Ultrasound findings are normal; What is
your primary diagnosis?
(1 Point)
AUB-C
AUB-O
AUB -I
AUB- E
56. Most common cause of ambiguous genitalia *

(1 Point)
Diethylstilbestrol
Congenital Adrenal Hyperplasia
Virilizing luteoma
Adrenal Tumor
57. Which of the following is NOT included in the general approach in a gynecologic
exam of a child? *
(1 Point)
Always be in a hurry to finish the examination
Establish rapport with patient
Avoid destruction and negative experience
Gentleness and patience with the time spent
58. The initial endocrinologic change associated with the onset of puberty is:
(1 Point)
activation of the positive gonadotropin response to increasing levels of estradiol
midcycle gonadotropic surge and ovulation.
episodic secretions of LH occur during sleep and while awake.
the occurrence of episodic pulses of LH occurring during sleep
59. AS A RULE, the first thing to RULE OUT in a patient of reproductive age who
experiences AUB, should be:
(1 Point)
blood cancer
uterine cancer
pregnancy
ovulatiory disorders
60. Determine the correct Tanners staging: Breast: (+) secondary mound formed by
areola; Pubic hair: labial hair inverse triangle formation
(1 Point)
B4, PH4
B5, PH5
B4, PH5
B5, PH4

(1 Point)
Sheehan syndrome
PCOS
Pregnancy
62. What is the most common gynecologic problem in the prepubertal female
about 80-90% of children? *
(1 Point)
Labial Adhesions
Cervicovaginitis
Lichen Sclerosus
Vulvovaginitis
63. Which of the following cases with AUB warrant an endometrial biopsy?
(1 Point)
45 year old nulligravid, diabetic
16 year old with PCOS
30 year old with thin endometrium and submucous myoma
17 year old with von Willebrand disease
64. Treatment for vaginal agenesis, EXCEPT: *

(1 Point)
Intestinal vaginoplasty
Williams procedure
Abbe Mcindoe
65. A.G. noted to have primary amenorrhea. On examination, there was a bulging
membrane at the introitus. What is your diagnosis? *
(1 Point)
Labial fusion
Imperforate hymen
Congenital adrenal hyperplasia
Vaginal agenesis
66. True or complete precocious puberty is also known as:

(1 Point)
67. What treatment is best for adolescents diagnosed with AUB-O?

(1 Point)
cyclic progestogen
curettage
Levonorgestrel intrauterine system
GnRH agonists
68. A 2 yr old female was brought to your clinic due to vaginal bleeding. On
inspection, she has Tanner 2 breasts. Her height is taller than most 2 year olds. On
abdominal ultrasound, a 6 cm solid ovarian mass was noted. What is your most
likely diagnosis?
(1 Point)
69. 18 year old nulligravid, with heavy uterine bleeding, diagnosed with von
Willebrand disease; What si your primary diagnosis?
(1 Point)
AUB-O
AUB-M
AUB-P
AUB- C
70. Maximum GnRH pulse frequency in the luteal phase

(1 Point)
1 GnRH pulse/minute
1 GnRH pulse/60 minutes
1 GnRH pulse/3 hours
71. A mother of a 4 y/o girl was worried about her daughter. Her daughter was noted
to have discomfort at the vulvar area associated with foul smelling vaginal
discharge. Your gynecologic examination in the clinic is inadequate. What is the
next best step to do? *
(1 Point)
Perform the examination under anesthesia
Send the patient home
Be quick in performing your gynecologic examination
Do coercive measures
72. Primary amenorrhea should be considered in girls who have not menstruated
within __ years of breast development.
(1 Point)
73. A synthetic androgen used for treatment of AUB

(1 Point)
Danazol
GnRH agonists
74. Involves the removal of the septum by a wedge incision and the reunification of
the two cavities during laparotomy *
(1 Point)
Cruciate incision
Vecchietti procedure
Williams procedure
75. A 5 y/o girl was brought to your clinic due to vaginal discharge. The child is
susceptible to vulvar infection. What is the physiologic reason why this child will
be susceptible to vulvar infection? *
(1 Point)
The vagina of a child is rich in glycogen, lactobacilli, and a sufficient level of antibodies
to help resist infection.
There is a significant geographic barrier between the vagina and anus.
The vulvar and vaginal epithelium lack the protective effects of estrogen and thus are
sensitive to irritation or infection.
The vaginal epithelium of a prepubertal child has an acidic pH, which provides an
excellent medium for bacterial growth.
76. What is the condition that is associated with a single cervix, a single horn of the
uterus with the fallopian tube of the side entering it are seen and ovaries may be
present on the opposite side? *
(1 Point)
Unicornuate uterus
Transverse vaginal septum
Absence of cervix and uterus
Septate uteri
77. This medication is effective for patients with AUB since it inhibits ovarian steroid
production at the hypothalamatic-pituitary level. Side effects include menopausal
symtoms
(1 Point)
Danazol
GnRH agonists
78. Which of the following is NOT a differential diagnosis in prepubertal females

with vaginal bleeding? *
(1 Point)
Sexual abuse
Foreign bodies
Urethral prolapse
Imperforate hymen
79. Mechanism of action of pharmacologic doses of estrogen used to treat acute

heavy menstrual bleeding:
(1 Point)
High doses of estrogen are potent inhibitors of fibrinolysis
High doses of estrogen are cyclooxygenase inhibitors and thus block the formation of
both thromboxane and the prostacyclin pathway.
Estrogen can block ovarian steroid production
estrogen in pharmacologic doses causes rapid growth of the endometrium.
80. At the OPD, a mother brought her 4y/o daughter for consultation due to foul
smelling bloody vaginal discharge associated with genital area pruritus. What
is your primary consideration? *
(1 Point)
Labial adhesions
Lichen sclerosus
Foreign bodies
Mycotic vulvovaginitis

(1 Point)
Sheehan syndrome
PCOS
Pregnancy
82. Length of secretory phase is 14 days because:

(1 Point)
folliculogenesis completes in 14 days
it corresponds to the life span of the corpus luteum
estrogen naturally declines in 14 days after ovulation
progesterone rises in response to folliculogenesis
83. Clitoral anomaly usually seen in association with extrophy of the bladder *
(1 Point)
Bifid clitoris
Labial fusion
None of the above
Clitoral fusion
84. Which of the following is NOT a normal gynecologic finding in a prepubertal

child? *
(1 Point)
Vaginal epithelium appears redder and thinner.

Vaginal secretions have an acidic pH.
Vagina is 4-6cm long.
85. 20 year old nulligravid, experiencing irregular heavy menses. She has facial acne
and hirsutism. Internal exam findings are normal. What is your primary diagnosis?
(1 Point)
AUB - A
AUB - M
AUB - O
AUB - P
86. which enzyme converts androgen to estrogen?

(1 Point)
aromatase
17-hydroxyprogesterone oxalase
5-alpha-dehydrogenaase
87. Precocious puberty secondary to use of hormone cream or adult medications

containing estrogen:
(1 Point)
idiopathic
factitious/iatrogenic
heterosexual
hormonal
88. A 45 year old G3P3 (3003) with heavy menstrual bleeding secondary to multiple
large myoma uteri. What is the preferred treatment?
(1 Point)
hysterectomy
myomectomy
dilatation and curettage
89. Window of implantation is typically defined as:

(1 Point)
days 16-18 of a 28 day menstrual cycle
90. Maximum GnRH pulse frequency in the follicular phase

(1 Point)
1 GnRH pulse/minute
1 GnRH pulse/3 hours
91. According to the 2 cell-2 gonadotropin theory, conversion of androgen to

estrogen takes place inside which cell?
(1 Point)
granulosa
theca
cumulus
antral
92. Treatment of choice for patients with Septate uteri which is often associated with
miscarriage problems *
(1 Point)
Creation of neovagina
Manual dilation of vagina
Simple incision at the edges of the septum
Hysteroscopic resection of septum
93. A 6 y/o girl, wearing a tight fitting pants and shirt, was brought to your
clinic. She has vaginal discharge associated with pruritus. She usually wipes
her genital area from posterior to anterior. Behavioral reasons that
predispose her to your diagnosis, EXCEPT? *
(1 Point)
anatomic proximity of the rectum and vagina
poor perineal hygiene
child's clothing
child lacks fat pads and pubic hair
94. Rapid cell proloferation and the filling of the triangular space between the two
uterine cornu *
(1 Point)
first stage of Musset's 3 stage process
second stage of Musset's 3 stage process
third stage of Musset's 3 stage process
95. This refers to number of antral follicles in the ovaries which determines the
capacity of the ovary to provide oocytes that are capable of being fertilized.
(1 Point)
follicular cohort
dominant follicle
initial recruitment
ovarian reserve
96. AUB secondary to low PGF2alpha/PGE ratio

(1 Point)
AUB-C
AUB-O
AUB -I
AUB- E
97. Which of the following is the correct sequence for pubertal development?
(1 Point)
breast budding -> pubic hair ->growth spurt ->menarche
breast budding -> growth spurt ->pubic hair ->menarche
menarche-> growth spurt ->pubic hair -> breast budding
breast budding -> pubic hair ->menarche --> growth spurt
98. Which of the following cases can expect early menarche?

(1 Point)
11 year old female doing ballet for 4 years now
10 year old female with BMI of 28 kg/m2
9 year old female with karyotype 46 X0
12 year old female with Mayer Rokitansky Kuster Hauser syndrome
99. AAUB secondary to localized overgrowths of endometrial tissue, containing

glands, stroma, and blood vessels, covered with epithelium.
(1 Point)
AIB-M
AUB-P
AUB-L
AUB-A
100. What is the predominant hormone in the follicular phase?

(1 Point)
estrogen
progesterone
testosterone
LH
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10/28/21, 6:15 PM LONG EXAM 1 Gynecology September batch Customized program OCTOBER 28, 2021

LONG EXAM 1 Gynecology

1. 25 yr old nulligravid, with primary amenorrhea, has tanner stage 5 breasts, no

Androgen Insensitivity syndrome

Mayer Rokitansky Kuster Hauser syndrome

2. Type of precocious puberty where the female patient develops masculine

Young children may be examined in the frog leg position.

All of the above

An infant may be examined in the lithotomy position.

Lithotomy is not generally used for girls 4 to 5 years of age.

4. 50 year old nulligravid, experiencing postmenopausal prolonged heavy bleeding.

5. For patients with primary amenorrhea, and disorder of sexual development,

prevention of development of gonadoblastoma

prevention of development of masculine features

to facilitate development of breasts

prevention of development of endometrioma

6. A.G. noted to have primary amenorrhea. On examination, there was a bulging

Do a cruciate incision at the hymen

7. What is the relative size ratio of cervix to uterus in a child? *

None of the above

8. This medication is effective for patients with AUB since it is a cyclooxygenase

non-steroidal anti-inflammatory agents

oral contraceptive pills

Assessment of the ovaries

Identification of the uterus

11. This condition is characterized by a triad of café-au-lait spots, polyostotic fibrous

congenital adrenal hyperplasia

12. Bone age in cases of precocious puberty is determined via:

hand wrist films

bone absorptiometry testing

blood calcium levels

Many gynecologic conditions in children can be diagnoses by rectal examination.

Efforts should be devoted to a hurried approach.

Utilize the lithotomy position

Accomplished with the insertion of speculum

Use an otoscope or ophthalmoscope as a magnifying instrument

18. Components of a complete pediatric examination, EXCEPT: *

Rectal exam (if necessary)

Invasive visualization of the vagina and cervix

Inspection with visualization of the external genitalia

19. Why was the dominant follicle "selected"?

it is characterized by a well-vascularized theca layer thus allowing a better access of the

it is preprogrammed to be selected by natural selection

It has the highest LH receptors

It is the largest follicle in the cohort

21. Which type of leiomyoma can cause abnormal uterine bleeding

Dysfuctional uterine bleeding

None of the above

24. follicular phase corresponds to

25. Which of the following is an example of WHO type 1 amenorrhea?

Prematire ovarian insufficency

28. basal levels of LH > 5 mIU/ml is diagnostic of:

GnRH-dependent precocious puberty

GnRH-independent precocious puberty

Always included in the gynecologic examination in a child.

All of the above

Many gynecologic conditions in children can be diagnosed by rectal examination.

30. Which of the following conditions exhibits cryptomenorrhea?

Mayer Rokitansky Kuster Hauser synrome

31. Treatment of GnRH-dependent precocious puberty:

Hourglass or figure-8 formation involving the genital and perianal area

Translucent vertical midline line

Grapelike masses from the vagina

Red donut-like structure