A pessary is a prosthetic device inserted into the vagina to reduce the protrusion of pelvic structures into the vagina. It can be a route of administration of medication and provides a slow and consistent release of the medication. Pessaries are of sizes, they may cause vaginal ulceration if they are not sized and cleansed. Depending on locale, pessaries can be fitted by health care practitioners; the term is derived from Ancient Greek: translit. Pessárion, "a piece of medication-soaked wool/lint, inserted into the vagina." Pessaries are mentioned in the oldest surviving copy of the Hippocratic Oath as something that physicians should never administer for the purposes of an abortion: "Similarly I will not give to a woman a pessary to cause abortion." A therapeutic pessary is a medical device similar to the outer ring of a diaphragm. Therapeutic pessaries are used to support the uterus, bladder, or rectum. Pessaries are a treatment option for pelvic organ prolapse. A pessary is most used to treat prolapse of the uterus.
It is used to treat stress urinary incontinence, a retroverted uterus and rectocele. Pessaries may have been used to perform abortions; the Cerclage Pessary is used to treat pregnant women with cervical incompetence in order to support the cervix and turn it backward towards the sacrum. It may be indicated in pregnancies with a history of premature labor, multiple pregnancies or mothers who are exposed to physical strain, it may be indicated in pregnant women suffering from prolapse of the genital organs. The pessary can be placed temporarily or permanently, must be fitted by a physician, physician assistant, midwife, or advanced practice nurse; some pessaries can be worn during intercourse. A pharmaceutical pessary is used as a effective means of delivery of pharmaceutical substances absorbed through the skin of the vagina, or intended to have action in the locality, for example against inflammation or yeast infection, or on the uterus. According to Pliny the Elder, Pessaries were used as birth control in ancient times.
An occlusive pessary is used in combination with spermicide as a contraceptive. The stem pessary, a type of occlusive pessary, was an early form of the cervical cap. Shaped like a dome, it covered the cervix, a central rod or "stem" entered the uterus through the os, to hold it in place. Side effects that are shared among most different types of pessaries include: risks of increased vaginal discharge, vaginal irritation, ulceration and dyspareunia. United States v. One Package of Japanese Pessaries Diaphragm Suppository
Anatomical terms of location
Standard anatomical terms of location deal unambiguously with the anatomy of animals, including humans. All vertebrates have the same basic body plan – they are bilaterally symmetrical in early embryonic stages and bilaterally symmetrical in adulthood; that is, they have mirror-image left and right halves if divided down the middle. For these reasons, the basic directional terms can be considered to be those used in vertebrates. By extension, the same terms are used for many other organisms as well. While these terms are standardized within specific fields of biology, there are unavoidable, sometimes dramatic, differences between some disciplines. For example, differences in terminology remain a problem that, to some extent, still separates the terminology of human anatomy from that used in the study of various other zoological categories. Standardized anatomical and zoological terms of location have been developed based on Latin and Greek words, to enable all biological and medical scientists to delineate and communicate information about animal bodies and their component organs though the meaning of some of the terms is context-sensitive.
The vertebrates and Craniata share a substantial heritage and common structure, so many of the same terms are used for location. To avoid ambiguities this terminology is based on the anatomy of each animal in a standard way. For humans, one type of vertebrate, anatomical terms may differ from other forms of vertebrates. For one reason, this is because humans have a different neuraxis and, unlike animals that rest on four limbs, humans are considered when describing anatomy as being in the standard anatomical position, thus what is on "top" of a human is the head, whereas the "top" of a dog may be its back, the "top" of a flounder could refer to either its left or its right side. For invertebrates, standard application of locational terminology becomes difficult or debatable at best when the differences in morphology are so radical that common concepts are not homologous and do not refer to common concepts. For example, many species are not bilaterally symmetrical. In these species, terminology depends on their type of symmetry.
Because animals can change orientation with respect to their environment, because appendages like limbs and tentacles can change position with respect to the main body, positional descriptive terms need to refer to the animal as in its standard anatomical position. All descriptions are with respect to the organism in its standard anatomical position when the organism in question has appendages in another position; this helps avoid confusion in terminology. In humans, this refers to the body in a standing position with arms at the side and palms facing forward. While the universal vertebrate terminology used in veterinary medicine would work in human medicine, the human terms are thought to be too well established to be worth changing. Many anatomical terms can be combined, either to indicate a position in two axes or to indicate the direction of a movement relative to the body. For example, "anterolateral" indicates a position, both anterior and lateral to the body axis. In radiology, an X-ray image may be said to be "anteroposterior", indicating that the beam of X-rays pass from their source to patient's anterior body wall through the body to exit through posterior body wall.
There is no definite limit to the contexts in which terms may be modified to qualify each other in such combinations. The modifier term is truncated and an "o" or an "i" is added in prefixing it to the qualified term. For example, a view of an animal from an aspect at once dorsal and lateral might be called a "dorsolateral" view. Again, in describing the morphology of an organ or habitus of an animal such as many of the Platyhelminthes, one might speak of it as "dorsiventrally" flattened as opposed to bilaterally flattened animals such as ocean sunfish. Where desirable three or more terms may be agglutinated or concatenated, as in "anteriodorsolateral"; such terms sometimes used to be hyphenated. There is however little basis for any strict rule to interfere with choice of convenience in such usage. Three basic reference planes are used to describe location; the sagittal plane is a plane parallel to the sagittal suture. All other sagittal planes are parallel to it, it is known as a "longitudinal plane".
The plane is perpendicular to the ground. The median plane or midsagittal plane is in the midline of the body, divides the body into left and right portions; this passes through the head, spinal cord, and, in many animals, the tail. The term "median plane" can refer to the midsagittal plane of other structures, such as a digit; the frontal plane or coronal plane divides the body into ventral portions. For post-embryonic humans a coronal plane is vertical and a transverse plane is horizontal, but for embryos and quadrupeds a coronal plane is horizontal and a transverse plane is vertical. A longitudinal plane is any plane perpendicular to the transverse plane; the coronal plane and the sagittal plane are examples of longitudinal planes. A transverse plane known as a cross-section, divides the body into cranial and caudal portions. In human anatomy: A transverse plane is an X-Z plane, parallel to the ground, which s
The pelvis is either the lower part of the trunk of the human body between the abdomen and the thighs or the skeleton embedded in it. The pelvic region of the trunk includes the bony pelvis, the pelvic cavity, the pelvic floor, below the pelvic cavity, the perineum, below the pelvic floor; the pelvic skeleton is formed in the area of the back, by the sacrum and the coccyx and anteriorly and to the left and right sides, by a pair of hip bones. The two hip bones connect the spine with the lower limbs, they are attached to the sacrum posteriorly, connected to each other anteriorly, joined with the two femurs at the hip joints. The gap enclosed by the bony pelvis, called the pelvic cavity, is the section of the body underneath the abdomen and consists of the reproductive organs and the rectum, while the pelvic floor at the base of the cavity assists in supporting the organs of the abdomen. In mammals, the bony pelvis has a gap in the middle larger in females than in males, their young pass through this gap.
The pelvic region of the trunk is the lower part of the trunk, between the thighs. It includes several structures: the bony pelvis, the pelvic cavity, the pelvic floor, the perineum; the bony pelvis is the part of the skeleton embedded in the pelvic region of the trunk. It is subdivided into the pelvic spine; the pelvic girdle is composed of the appendicular hip bones oriented in a ring, connects the pelvic region of the spine to the lower limbs. The pelvic spine consists of the coccyx; the pelvic cavity defined as a small part of the space enclosed by the bony pelvis, delimited by the pelvic brim above and the pelvic floor below. Each hip bone consists of 3 sections, ilium and pubis. During childhood, these sections are separate bones, joined by the triradiate cartilage. During puberty, they fuse together to form a single bone; the pelvic cavity is a body cavity, bounded by the bones of the pelvis and which contains reproductive organs and the rectum. A distinction is made between the lesser or true pelvis inferior to the terminal line, the greater or false pelvis above it.
The pelvic inlet or superior pelvic aperture, which leads into the lesser pelvis, is bordered by the promontory, the arcuate line of ilium, the iliopubic eminence, the pecten of the pubis, the upper part of the pubic symphysis. The pelvic outlet or inferior pelvic aperture is the region between the subpubic angle or pubic arch, the ischial tuberosities and the coccyx. Ligaments: obturator membrane, inguinal ligament Alternatively, the pelvis is divided into three planes: the inlet and outlet; the pelvic floor has two inherently conflicting functions: One is to close the pelvic and abdominal cavities and bear the load of the visceral organs. To achieve both these tasks, the pelvic floor is composed of several overlapping sheets of muscles and connective tissues; the pelvic diaphragm is composed of the coccygeus muscle. These arise between the symphysis and the ischial spine and converge on the coccyx and the anococcygeal ligament which spans between the tip of the coccyx and the anal hiatus; this leaves a slit for the urogenital openings.
Because of the width of the genital aperture, wider in females, a second closing mechanism is required. The urogenital diaphragm consists of the deep transverse perineal which arises from the inferior ischial and pubic rami and extends to the urogential hiatus; the urogenital diaphragm is reinforced posteriorly by the superficial transverse perineal. The external anal and urethral sphincters close the urethra; the former is surrounded by the bulbospongiosus which narrows the vaginal introitus in females and surrounds the corpus spongiosum in males. Ischiocavernosus clitoridis. Modern humans are to a large extent characterized by large brains; because the pelvis is vital to both locomotion and childbirth, natural selection has been confronted by two conflicting demands: a wide birth canal and locomotion efficiency, a conflict referred to as the "obstetrical dilemma". The female pelvis, or gynecoid pelvis, has evolved to its maximum width for childbirth—a wider pelvis would make women unable to walk.
In contrast, human male pelvises are not constrained by the need to give birth and therefore are more optimized for bipedal locomotion. The principal differences between male and female true and false pelvis include: The female pelvis is larger and broader than the male pelvis, taller and more compact; the female inlet is oval in shape, while the male sacral promontory projects further. The sides of the male pelvis converge from the inlet to the outlet, whereas the sides of the female pelvis are wider apart; the angle between
The vertebral column known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord found in all chordates has been replaced by a segmented series of bone: vertebrae separated by intervertebral discs; the vertebral column houses a cavity that encloses and protects the spinal cord. There are about 50,000 species of animals; the human vertebral column is one of the most-studied examples. In a human's vertebral column there are thirty-three vertebrae; the articulating vertebrae are named according to their region of the spine. There are twelve thoracic vertebrae and five lumbar vertebrae; the number of vertebrae in a region overall the number remains the same. The number of those in the cervical region however is only changed. There are ligaments extending the length of the column at the front and the back, in between the vertebrae joining the spinous processes, the transverse processes and the vertebral laminae.
The vertebrae in the human vertebral column are divided into different regions, which correspond to the curves of the spinal column. The articulating vertebrae are named according to their region of the spine. Vertebrae in these regions are alike, with minor variation; these regions are called the cervical spine, thoracic spine, lumbar spine and coccyx. There are twelve thoracic vertebrae and five lumbar vertebrae; the number of vertebrae in a region overall the number remains the same. The number of those in the cervical region however is only changed; the vertebrae of the cervical and lumbar spines are independent bones, quite similar. The vertebrae of the sacrum and coccyx are fused and unable to move independently. Two special vertebrae are the axis, on which the head rests. A typical vertebra consists of two parts: the vertebral arch; the vertebral arch is posterior. Together, these enclose the vertebral foramen; because the spinal cord ends in the lumbar spine, the sacrum and coccyx are fused, they do not contain a central foramen.
The vertebral arch is formed by a pair of pedicles and a pair of laminae, supports seven processes, four articular, two transverse, one spinous, the latter being known as the neural spine. Two transverse processes and one spinous process are posterior to the vertebral body; the spinous process comes out the back, one transverse process comes out the left, one on the right. The spinous processes of the cervical and lumbar regions can be felt through the skin. Above and below each vertebra are joints called facet joints; these restrict the range of movement possible, are joined by a thin portion of the neural arch called the pars interarticularis. In between each pair of vertebrae are two small holes called intervertebral foramina; the spinal nerves leave the spinal cord through these holes. Individual vertebrae are named according to their position. From top to bottom, the vertebrae are: Cervical spine: 7 vertebrae Thoracic spine: 12 vertebrae Lumbar spine: 5 vertebrae Sacrum: 5 vertebrae Coccyx: 4 vertebrae The upper cervical spine has a curve, convex forward, that begins at the axis at the apex of the odontoid process or dens, ends at the middle of the second thoracic vertebra.
This inward curve is known as a lordotic curve. The thoracic curve, concave forward, begins at the middle of the second and ends at the middle of the twelfth thoracic vertebra, its most prominent point behind corresponds to the spinous process of the seventh thoracic vertebra. This curve is known as a kyphotic curve; the lumbar curve is more marked in the female than in the male. It is convex anteriorly, the convexity of the lower three vertebrae being much greater than that of the upper two; this curve is described as a lordotic curve. The sacral curve begins at the sacrovertebral articulation, ends at the point of the coccyx; the thoracic and sacral kyphotic curves are termed primary curves, because they are present in the fetus. The cervical and lumbar curves are compensatory or secondary, are developed after birth; the cervical curve forms when the infant is able to sit upright. The lumbar curve forms from twelve to eighteen months, when the child begins to walk. Anterior surfaceWhen viewed from in front, the width of the bodies of the vertebrae is seen to increase from the second cervical to the first thoracic.
From this point there is a rapid diminution, to the apex of the coccyx. Posterior surfaceFrom behind, the vertebral column presents in the median line the spinous processes. In the cervical region these are short and bifid. In the upper part of the thoracic region they are directed obliquely downward.
The uterine appendages are the structures most related structurally and functionally to the uterus. They can be defined in different ways: Some sources define the adnexa as the fallopian tubes and ovaries. Others include the supporting tissues". Another source defines the appendages as the "regions of the true pelvis posterior to the broad ligaments". One dictionary includes the fallopian tubes and ligaments; the term "adnexitis" is sometimes used to describe an inflammation of the uterine appendages. In this context, it replaces the terms salpingitis; the term adnexal mass is sometimes used when the location of a uterine mass is not yet more known. 63% of ectopic pregnancies present with an adnexal mass. Depending on the size of the mass, it could be a medical emergency. Term "Adnexectomy" in Gynaecology is used for Salpingo-Oophorectomy. Adnexa
A pelvic examination is the physical examination of the external and internal female pelvic organs. It is called "bimanual exam" when two hands are used and "manual uterine palpation", it is used in gynecology. It can be done under general anesthesia; the examination can be uncomfortable. During the pelvic exam the vaginal wall is assessed for rugae and weak spots. In addition to a thorough pelvic exam, other tests may ordered to further determine the cause of symptoms that are concerning. During the pelvic exam, samples of vaginal fluids may be taken to screen for sexually transmitted infections or other infections; some clinicians combine a routine pelvic exam along with other preventative procedures like a breast examination and pap smear. The American College of Physicians published guidelines against routine pelvic examination in adult women who are not pregnant and lack symptoms in 2014. One exception being pelvic exams done as part of cervical cancer screening. A pelvic examination can be part of the assessment of sexual assault.
Previous to July 2014 the benefits of routine pelvic examinations were not clear and there was no consensus. Since American College of Physicians issued a guideline recommending against performing this examination to screen for conditions in asymptomatic, adult women; the ACP said that there was no evidence of benefit in support of the examination, but there was evidence of harm, including distress and unnecessary surgery. This was a strong recommendation, based on moderate-quality evidence. In 2018, the American College of Obstetricians and Gynecologists issued a committee opinion that pelvic exams should be performed for 1) symptoms of gynecologic disease, 2) screening for cervical dysplasia, or 3) management of gynecologic disorders or malignancy, using shared decision-making with the patient. ACOG concluded there is inadequate data to support recommendations for or against routine screening pelvic examination for asymptomatic, non-pregnant women with average risk for gynecologic disease.
Annual well-woman exams are an occasion for gynecologists to recognize issues like incontinence and sexual dysfunction, discuss patient concerns. The pelvic exam begins with an explanation of the procedure; the woman is asked to put on an examination gown, get on the examination table, lay on her back with her feet in stirrups. Sliding down toward the end of the table is the best position for the clinician to do a visual examination. A pelvic exam begins with an assessment of the reproductive organs that can be seen without the use of a speculum. Many women may want to'prepare' for the procedure. Douching before the exam is discouraged because cells needed from the cervix to assess for cervical cell abnormalities may be washed out. One possible reason for delaying an exam is if it is to be done during menstruation, but this is a preference of some women and not a requirement of the clinician; the woman will will be asked to put on an examination gown and lay down on the examination table. A girl or woman may ask to have another woman in the examination room during the exam.
The clinician may want to perform pelvic examination and assessment of the vagina because there are unexplained symptoms of vaginal discharge, pelvic pain, unexpected bleeding, or urinary problems. The typical external examination begins with making sure that a woman is in a comfortable position and her privacy respected. If a woman is obese, different positioning and assistance may be required to keep tissue from blocking the view of the perineal area; the pubic hair is inspected for pubic hair growth patterns. Sparse hair patterns can exist in older and in some Asian women; the labia majora are evaluated. Their position and symmetry are assessed; the expected finding in older women is that the labia majora can be smaller. The examiner is looking for ulcers, inflammation and rashes. If drainage is present from these structures, its color and other characteristics are noted. Infection control is accomplished by frequent glove changes; the labia minora are evaluated. They should appear smooth in texture and pink.
The presence of tearing and swelling is noted. Thinner and smaller labia minora are an expected finding in older women; the clitoris is assessed for size, position and inflammation. The urethral opening is inspected. No urine should leak. Urine leakage may indicate the weakening of pelvic structures; the opening should be midline and smooth. The presence of inflammation, or discharge which may indicate an infection. Excoriation can be present in obese women due to urinary incontinence; the vaginal opening is inspected for position, presence of the hymen, shape. The presence of bruising, tearing and discharge. Pelvic examinations are procedures that are designed to obtain objective, measurable descriptions of what is observed. If sexual abuse is suspected, questions regarding this is discussed after the examination and not during it; when the woman is requested to'bear down', the presence of prolapsed structures such as the bladder, rectum or uterus are documented. Prolapsed structures can appear when abdominal pressure increases or they can protrude without bearing down.
The perineum, the space between the vagina and the anus is inspected. It should be smooth and free of disease. Scars from episiotomies are visible on women; the anus is assessed for lesions, trauma. It should appear dark and moist. In an obese women, excoriation may be present due to fecal incontinence. B
Menstruation known as a period or monthly, is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The first period begins between twelve and fifteen years of age, a point in time known as menarche. However, periods may start as young as eight years old and still be considered normal; the average age of the first period is later in the developing world, earlier in the developed world. The typical length of time between the first day of one period and the first day of the next is 21 to 45 days in young women, 21 to 31 days in adults. Bleeding lasts around 2 to 7 days. Menstruation stops occurring after menopause, which occurs between 45 and 55 years of age. Periods stop during pregnancy and do not resume during the initial months of breastfeeding. Up to 80% of women report having some symptoms prior to menstruation. Common signs and symptoms include acne, tender breasts, feeling tired and mood changes; these may interfere with normal life, therefore qualifying as premenstrual syndrome, in 20 to 30% of women.
In 3 to 8%, symptoms are severe. A lack of periods, known as amenorrhea, is when periods do not occur by age 15 or have not occurred in 90 days. Other problems with the menstrual cycle include painful periods and abnormal bleeding such as bleeding between periods or heavy bleeding. Menstruation in other animals occur in primates; the menstrual cycle occurs due to the fall of hormones. This cycle results in the thickening of the lining of the uterus, the growth of an egg; the egg is released from an ovary around day fourteen in the cycle. If pregnancy does not occur, the lining is released in; the first menstrual period occurs after the onset of pubertal growth, is called menarche. The average age of menarche is 12 to 15. However, it may start as early as eight; the average age of the first period is later in the developing world, earlier in the developed world. The average age of menarche has changed little in the United States since the 1950s. Menstruation is the most visible phase of the menstrual cycle and its beginning is used as the marker between cycles.
The first day of menstrual bleeding is the date used for the last menstrual period. The typical length of time between the first day of one period and the first day of the next is 21 to 45 days in young women, 21 to 31 days in adults. Perimenopause is when fertility in a female declines, menstruation occurs less in the years leading up to the final menstrual period, when a female stops menstruating and is no longer fertile; the medical definition of menopause is one year without a period and occurs between 45 and 55 in Western countries. During pregnancy and for some time after childbirth, menstruation does not occur; the average length of postpartum amenorrhoea is longer. In most women, various physical changes are brought about by fluctuations in hormone levels during the menstrual cycle; this includes muscle contractions of the uterus that can accompany menstruation. Some may notice water retention, changes in sex drive, breast tenderness, or nausea. Breast swelling and discomfort may be caused by water retention during menstruation.
Such sensations are mild, some females notice few physical changes associated with menstruation. A healthy diet, reduced consumption of salt and alcohol, regular exercise may be effective for women in controlling some symptoms. Severe symptoms that disrupt daily activities and functioning may be diagnosed as premenstrual dysphoric disorder. Symptoms before menstruation are known as premenstrual molimina. Many women experience painful cramps known as dysmenorrhea, during menstruation. Pain results from muscle contractions. Spiral arteries in the secretory endometrium constrict, resulting in ischemia to the secretory endometrium; this allows the uterine lining to slough off. The myometrium contracts spasmodically in order to push the menstrual fluid through the cervix and out of the vagina; the contractions are mediated by a release of prostaglandins. Painful menstrual cramps that result from an excess of prostaglandin release are referred to as primary dysmenorrhea. Primary dysmenorrhea begins within a year or two of menarche with the onset of ovulatory cycles.
Treatments that target the mechanism of pain include non-steroidal anti-inflammatory drugs and hormonal contraceptives. NSAIDs inhibit prostaglandin production. With long-term treatment, hormonal birth control reduces the amount of uterine fluid/tissue expelled from the uterus, thus resulting in shorter, less painful menstruation. These drugs are more effective than treatments that do not target the source of the pain. Risk factors for primary dysmenorrhea include: early age at menarche, long or heavy menstrual periods, a family history of dysmenorrhea. Regular physical activity may limit the severity of uterine cramps. For many women, primary dysmenorrhea subsides in late second generation. Pregnancy has been demonstrated to lessen the severity of dysmenorrhea, when menstruation resumes. However, dysmenorrhea can continue until menopause. 5–15% of women with dysmenorrhea experience symptoms severe enough to interfere with daily activities. Secondary dysmenorrhea is the diagnosis given when menstruation pain is a secondary cause to another disorder.