Anteflexed And Anteverted Uterus

Figure 19-33 Chancre of primary syphilis.

Figure 19-34 Chancroid.

Figure 19-33 Chancre of primary syphilis.

Retroverted UterusSzemerem Ajak

Figure 19-35 Common uterine positions.

Figure 19-36 Sequelae of pelvic floor relaxation. A, Normal anatomy. B, Cystocele, which is a protrusion of the wall of the urinary bladder through the vagina. C, Rectocele, which is a protrusion of the rectal wall through the vagina. D, Uterine descent, which is a protrusion of the uterus through the vagina.
















Figure 19-37 Types of uterine bleeding. A, Normal 28-day cycle. Note that menstrual flow occurs on day 1 and lasts for approximately 5 days. B, Amenorrhea. After a menstrual flow of 5 days, the period does not recur. C, Menorrhagia. Note that the flow occurs at 28-day intervals, but the amount of flow is heavier, and its duration is longer than normal. D, Metrorrhagia. In this condition, flow is regular, but there is bleeding between the normal menstrual flow cycles.

Recurrence (even if not Common Rare Common infected)

*See Figure 19-32. {See Figure 19-33. {See Figure 19-34.

Useful Vocabulary

Listed here are the specific roots that are important for understanding the terminology related to diseases of the female genitalia.


Pertaining to






Rupture of the amnion




Examination of vagina (and cervix)




False pregnancy




Branch of medicine that deals with treating diseases of the genital tract in women




Surgical removal of the uterus




Uterine bleeding




Incision of an ovary




Discharge of an egg from the ovary


fallopian tube


Inflammation of the fallopian tube

Table 19-2 Clinical Features of Genital Ulcerations


Genital Herpes*

Primary Syphilis{


Incubation period

3-5 Days

9-90 Days

1-5 Days

Number of ulcers




Appearance at onset




Later appearance

Small, grouped

Round, indurated

Irregular, ragged

Ulcer pain




Inguinal adenopathy

Present, tender

Present, painless

Present, painful


Within 2 weeks

Slowly for weeks

Slowly for weeks

Recurrence (even if not Common Rare Common infected)

Writing Up the Physical Examination

Listed here are examples of the write-up for the examination of the female genitalia.

• Examination of the vulva is within normal limits. No lesions are present. The cervix appears pink, smooth, and nulliparous. There is no discharge from the external cervical os. The vaginal walls appear normal. Bimanual palpation reveals an anteverted, anteflexed uterus without masses or tenderness. The adnexa are unremarkable. Rectovaginal examination reveals a thin rectovaginal membrane without tenderness. Stool guaiac result is negative.

• Examination of the vulva reveals groups of tense vesicles and scattered erosions that are covered with exudate. The cervix is pink and multiparous. No cervical lesions are present. No discharge is present. The vagina is within normal limits. The uterus is anteverted and anteflexed. A 6 x 6 cm mass is felt within the uterus. The ovaries and tubes are unremarkable. Rectovaginal examination findings are within normal limits.

• The vulva appears within normal limits without masses or lesions. The cervix has an erosion, and there is a thick, white, cottage cheese-like discharge in the vagina. The discharge is adherent to the vaginal walls. The uterus is retroverted and cannot be adequately examined. A walnut-sized mass is felt in the left adnexa. It appears rubbery and is freely mobile. The rectovaginal examination findings are normal. Stool guaiac result is negative.

• The vulva is normal. On straining, a rectocele becomes apparent. The vagina is normal. The cervix is smooth, pink, and multiparous. The uterus is anteverted and anteflexed and is not enlarged. The adnexa are difficult to assess because of obesity of the patient. No tenderness is present.


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Eifel PJ, Berek JS, Markman M: Cancer of the cervix, vagina, and vulva. In DeVita VT, Hellman S, Rosenberg SA (eds): Cancer: Principles and Practice of Oncology, 7th ed. Philadelphia, Lippincott Williams & Wilkins, 2005.

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Practice Committee of the American Society for Reproductive Medicine: Current evaluation of amenor-rhea. Fertil Steril 82:266, 2004.

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Rollins G: Developments in cervical and ovarian cancer screening: Implications for current practice. Ann Intern Med 133:1021, 2000.

Ronco G, Cuzick J, Pierotti P, et al: Accuracy of liquid based versus conventional cytology: Overall results of new technologies for cervical cancer screening randomised controlled trial. BMJ 335:28, 2007.

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Surveillance, Epidemiology, and End Results (SEER) Program: SEER Stat Database: Incidence—SEER 9 Regs Public-Use, November 2002 Sub (1973-2000) [released April 2003, based on the November 2002 submission]. Bethesda, Md, National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch. Available at; accessed June 25, 2008.

Welch B, Howard A, Cook K: Vaginal itch. Australian Fam Physician 33:505, 2004.

Wilbur DC, Cibas ES, Merritt S, et al: ThinPrep® Processor: Clinical trials demonstrate an increased detection rate of abnormal cervical cytologic specimens. Am J Clin Pathol 101:209, 1994.


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