Overview
This lecture covers the anatomy, physiology, and common emergencies of the female reproductive system, along with EMT assessment and management of gynecologic emergencies, including sexual assault.
Female Reproductive Anatomy & Physiology
- Female reproductive system includes internal (ovaries, fallopian tubes, uterus, cervix, vagina) and external (vaginal opening, labia, clitoris, perineum) structures.
- Ovaries produce eggs; fallopian tubes connect ovaries to uterus; uterus supports fetal development.
- Puberty starts with menarche (onset of menstruation, ages 11-16); menopause marks end of menstruation (~50 years old).
- Ovulation is monthly egg release; fertilization occurs in the fallopian tubes; menstruation occurs if no fertilization within ~14 days post-ovulation.
- Female hormones from ovaries control ovulation and menstruation.
Gynecologic Pathophysiology
- Gynecologic emergencies include infections (PID, STDs), trauma, abnormal bleeding, ectopic pregnancy, and cancer.
- PID (pelvic inflammatory disease) is infection of upper reproductive organs, often with lower abdominal pain and abnormal discharge.
- Risk factors for PID: multiple partners, history of STDs or PID, under 26, IUD use.
- Common STDs: chlamydia (often asymptomatic, can cause PID), bacterial vaginosis (can affect pregnancy outcomes), gonorrhea (can spread and become serious).
Assessment & Management
- Scene safety, standard precautions, and detailed documentation are critical in gynecologic emergencies.
- Primary assessment: check stability, AVPU scale, airway, breathing, circulation, and signs of shock.
- Obtain sensitive, thorough history (including menstrual, sexual, contraceptive history); use OPQRST for abdominal pain.
- Secondary assessment: vitals, inspect abdomen for tenderness/distention, observe and document vaginal bleeding and discharge.
- Limit physical exam; only inspect genitalia if necessary for care.
Emergency Care & Special Considerations
- Maintain patient privacy and dignity; involve a female EMT if possible.
- For external bleeding, use sanitary pads and document saturation; never pack dressings inside the vagina.
- Treat pain and shock as needed; sexual assault victims require gentle handling, minimal exam, and evidence preservation.
- Encourage victims not to clean themselves; offer to contact rape crisis center.
Review Questions & Key Points
- Narrowest part of uterus: cervix.
- Outermost cavity: vagina.
- Menstruation starts about 14 days after ovulation if no fertilization.
- Menarche is the onset of menstruation.
- PID’s most common sign: lower abdominal pain.
- Always treat and transport for excessive vaginal bleeding.
- Rohypnol ("roofies") is a sedative used in drug-facilitated sexual assault.
- Preserve evidence; discourage victims from cleaning up after assault.
Key Terms & Definitions
- PID (Pelvic Inflammatory Disease) — Infection of upper female reproductive tract, often leading to pain and potential infertility.
- Menarche — First menstrual period, indicating reproductive capability.
- Menopause — End of menstruation, typically around age 50.
- Ectopic pregnancy — Pregnancy outside the uterus, often in the fallopian tube.
- OPQRST — Onset, Provocation, Quality, Radiation, Severity, Time; used to assess pain.
Action Items / Next Steps
- Review vital sign assessment and gynecologic history-taking techniques.
- Complete any assigned readings from Chapter 24.
- Practice documenting detailed and sensitive patient histories.
- Prepare for quizzes on reproductive anatomy, PID, and management of sexual assault victims.