Textbook Question
The main hormone of the postovulatory phase is
(a) Progesterone
(b) Estradiol
(c) Estrogen
(d) Luteinizing hormone
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27. The Reproductive System
Anatomy of the Female Reproductive System
2:18 minutesProblem 22
Textbook Question
Gina Marciano, a 44-year-old mother of eight children, visited her physician complaining of a 'bearing down' sensation in her pelvis, low backache, and urinary incontinence. A vaginal examination showed that the external os of her cervix was just inside the vaginal orifice and her perineum exhibited large keloids (masses of scar tissue). What do you think Gina's problem is and what caused it? (Be anatomically specific.)
Verified step by step guidance1
Step 1: Understand the symptoms described in the problem. Gina is experiencing a 'bearing down' sensation in her pelvis, low backache, and urinary incontinence. These symptoms suggest a structural issue in the pelvic region, likely involving the uterus or surrounding tissues.
Step 2: Analyze the findings from the vaginal examination. The external os of her cervix is located just inside the vaginal orifice, which indicates uterine prolapse. Uterine prolapse occurs when the uterus descends into the vaginal canal due to weakened pelvic floor muscles and ligaments.
Step 3: Consider the anatomical causes of uterine prolapse. The pelvic floor muscles and connective tissues, such as the uterosacral and cardinal ligaments, are responsible for supporting the uterus. Multiple pregnancies (Gina has eight children) can weaken these structures over time, increasing the risk of prolapse.
Step 4: Examine the presence of large keloids on the perineum. Keloids are masses of scar tissue that form after injury or trauma. In Gina's case, these may have resulted from perineal tears or episiotomies during childbirth, which could further compromise the integrity of the pelvic floor.
Step 5: Conclude that Gina's problem is uterine prolapse caused by weakened pelvic floor muscles and ligaments due to multiple pregnancies and childbirth-related trauma. The urinary incontinence is likely secondary to the prolapse, as the descent of the uterus can exert pressure on the bladder and urethra.
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Key Concepts
Here are the essential concepts you must grasp in order to answer the question correctly.
Pelvic Organ Prolapse
Pelvic organ prolapse occurs when pelvic organs, such as the bladder, uterus, or rectum, descend into the vaginal canal due to weakened pelvic support structures. This condition can lead to symptoms like a 'bearing down' sensation, urinary incontinence, and discomfort. In Gina's case, the position of her cervix suggests a possible uterine prolapse, which is common in women with multiple pregnancies.
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Keloids and Scar Tissue Formation
Keloids are raised scars that form due to an overproduction of collagen during the healing process. They can occur after surgery, injury, or inflammation and may cause discomfort or aesthetic concerns. In Gina's situation, the presence of large keloids on her perineum may indicate previous trauma or surgical interventions, contributing to her pelvic issues.
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Anatomy of the Female Pelvis
Understanding the anatomy of the female pelvis is crucial for diagnosing conditions like prolapse. The pelvic floor consists of muscles, ligaments, and connective tissues that support pelvic organs. In Gina's case, the anatomical changes due to childbirth and potential weakening of these structures can explain her symptoms of low backache and urinary incontinence.
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