Introduction
Conditions affecting the female reproductive system can become life-threatening. These emergencies are relatively common and may lead to significant short-term and long-term complications.
Anatomy & Physiology
External Structures
- Mons pubis – fatty tissue over the pubic bone
- Prepuce – skin fold covering the clitoris
- Clitoris – nerve-rich erectile structure
- Labia majora/minora – protective folds around vaginal and urethral openings
- Perineum – area between the vagina and anus
- Vestibule – space containing urethral and vaginal openings
- Vagina – passage for menstruation, intercourse, and childbirth
- Bartholin glands – provide lubrication
Internal Structures
- Cervix – lower uterus opening into the vagina
- Uterus – site of fetal development and labor contractions
- Fallopian tubes – site of fertilization and egg transport
- Ovaries – produce eggs and hormones
Gynecologic Conditions
Normal Reproductive Processes
- Menstruation – cyclical shedding of the uterine lining (24–35 day cycle)
- Menarche – first menstrual period (typically ages 11–14)
- Menopause – cessation of menstruation (around ages 40–50) with hormonal changes
Ovarian & Uterine Cycles
- Follicular phase (days 1–13) – follicle development
- Luteal phase (days 14–28) – post-ovulation hormonal changes
- Proliferative phase – uterine lining builds
- Secretory phase – lining breaks down if no pregnancy occurs
Common Conditions
- PMS – physical and emotional symptoms before menstruation
- Mittelschmerz – mild ovulatory pain
- Amenorrhea – absence of menstruation due to pregnancy, stress, illness, or low body fat
Emergent Gynecologic Conditions
Bleeding Disorders
- Dysmenorrhea – painful menstruation (primary or secondary)
- Dysfunctional uterine bleeding – abnormal bleeding unrelated to pregnancy or disease
- Hypermenorrhea – excessive or prolonged bleeding
- Polymenorrhea – cycles shorter than 24 days
- Metrorrhagia – irregular spotting between periods
Pregnancy & Reproductive Emergencies
- Ectopic pregnancy – implantation outside the uterus; risk of rupture and hemorrhage
- Endometritis – infection of uterine lining
- Endometriosis – uterine tissue outside the uterus causing chronic pain and infertility
- PID (Pelvic Inflammatory Disease) – infection of reproductive organs leading to pain, fever, and infertility risk
Other Conditions
- Vaginitis – vaginal inflammation from infection
- Bacterial vaginosis – imbalance of vaginal bacteria causing discharge and odor
- Bartholin abscess – infected gland near vaginal opening
- Ovarian cyst rupture – sudden pain with possible internal bleeding
- Ovarian torsion – twisting of ovary causing severe pain and emergency
- Tubo-ovarian abscess – severe pelvic infection with pus formation
- Uterine prolapse – descent of uterus due to weakened support structures
- Toxic shock syndrome – severe bacterial infection causing shock and organ failure
Sexually Transmitted Infections
- Chlamydia – often asymptomatic; can lead to PID
- Gonorrhea – genital infection with discharge and pelvic pain
- Syphilis – multi-stage infection causing systemic damage if untreated
- Herpes (HSV-1/HSV-2) – recurrent painful blisters
- HPV – genital warts and potential cancer risk
- Trichomoniasis – frothy, foul-smelling vaginal discharge
Sexual Assault Considerations
- Prioritize patient safety, privacy, and emotional support
- Avoid unnecessary examination or evidence destruction
- Preserve clothing and potential evidence appropriately
- Use calm, respectful, trauma-informed communication
- Encourage transport without forcing compliance
Prehospital Care Overview
General Management
- Maintain airway, breathing, and circulation
- Treat for shock when present
- Provide oxygen and IV fluids as indicated
- Rapid transport to appropriate facility
Condition-Specific Care
- Ectopic pregnancy – treat as emergency hemorrhage/shock
- PID/endometritis – supportive care; antibiotics in hospital
- Ovarian torsion/cyst rupture – pain and shock management, urgent transport
- Uterine prolapse – cover tissue, do not reposition
- Foreign bodies – do not remove; transport safely
Key Point
Most gynecological emergencies require rapid stabilization, shock management, infection control, and urgent transport for definitive hospital care.