reVITALize: Gynecology Data Definitions

ADNEXAL TORSION 

Rotation of the ovary, fallopian tube, or both that results in partial or complete vascular occlusion  

ATROPHIC VAGINITIS  

A noninfectious condition associated with hypoestrogenic states, including prepubertal and postmenopausal. Patients may present with signs or symptoms such as tissue changes, itching, burning, irritation, discharge, dryness, or inflammation.  

For classic vaginal or genitourinary symptoms associated with menopause, the term genitourinary syndrome of menopause is preferred.  

BACTERIAL VAGINOSIS  

A condition where the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria. It is sometimes accompanied by discharge, fishy odor, pain, itching, or burning.  

A diagnosis may be confirmed through laboratory testing or clinical criteria. 

CALME 

Childhood asymmetric labia majus enlargement is a common normal anatomic variant of the vulva typically presenting without pain that mimics a neoplasm. 

CANDIDA VAGINITIS/ VULVOVAGINITIS 

A fungal infection caused by a symptomatic overgrowth of Candida species. It may be characterized by vaginal or vulvar itching, burning, irritation, erythema or thick, white discharge. 

FUNCTIONAL OVARIAN CYST 

Normally occurring fluid filled sac originating from ovarian follicles and created by cyclic ovarian function. This is not a neoplasm and results from the accumulation of intrafollicular fluid.   

Some functional cysts may become symptomatic and chronic and may require treatment or intervention.  

GONAD 

An organ (i.e. normally a testis or ovary) that may produce gametes.  

HEMIVAGINA 

A congenital anomaly of a partially developed vagina that typically presents without outflow tract obstruction.  

1. May require surgical intervention to relieve obstruction.

2. Does not include transverse vaginal septum.

3. Frequently occurs with renal anomalies 

LICHEN PLANUS  

An inflammatory disorder of the genital mucosa. The classic presentation is that of white, reticulate, lacy, fern-like striae. In erosive lichen planus, deep erythematous erosions appear and often extend to the labia minora, resulting in resorption of the labial architecture.  

LICHEN SCLEROSUS  

Chronic inflammatory condition, typically of the anogenital region, often characterized by pruritis, pigmentation changes, atrophy, and fissures that may result in scarring and/or loss of normal architecture of the vulva. 

If biopsied, there is a definitive histological appearance. 

LOWER VAGINAL ATRESIA 

Occurs when the urogenital sinus fails to contribute to the inferior portion of the vagina, resulting in outflow tract obstruction.  

PELVIC INFLAMMATORY DISEASE  

An infection of the upper female genital tract including endometritis, salpingitis, oophoritis, tuboovarian abscess and/or pelvic peritonitis.  

RECURRENT CANDIDA VAGINITIS/ VULVOVAGINITIS 

Four or more episodes of candida vaginitis/vulvovaginitis in one year. 

Recurrent candida vaginitis/vulvovaginitis should be confirmed by testing. 

TRICHOMONAS VAGINITIS 

A sexually transmitted infection caused by the protozoan Trichomonas vaginalis. Patients may or may not be symptomatic. Signs and symptoms may include malodorous discharge, irritation, and erythema.  

VAGINAL DILATION 

The enlargement of the vagina to address congenital or acquired vaginal narrowing 

VAGINAL IRRIGATION

The use of fluid to rinse the vaginal canal of discharge or to dislodge a foreign object 

VAGINAL PULL THROUGH  

A reconstructive operation that provides an outflow tract for the upper vagina in the presence of lower vaginal atresia  

VAGINITIS  

The spectrum of conditions that cause vaginal signs or symptoms, such as itching, burning, irritation, dryness, inflammation, and discharge

VAGINOSCOPY  

Endoscopic inspection of the vaginal cavity with access through the vaginal opening

VULVOVAGINITIS 

The spectrum of conditions that cause vulvovaginal signs or symptoms, such as itching, burning, irritation, dryness, inflammation, and discharge

WELL-WOMAN CARE 

Comprehensive age- and interval-appropriate care to maintain or improve the health of a woman.  

BREAST AND CERVICAL ISSUES DEFINITIONS 

BREAST ISSUE DEFINITIONS 

BREAST DENSITY  

The relative proportion of fibroglandular tissue to fat in the breast as it appears on a mammogram

A dense breast has more glandular and connective tissue than fat.  

FIBROCYSTIC BREAST CHANGES  

A range of nonspecific benign changes in the ducts and stroma of the breasts that may result in palpable changes in the breast tissue and pain. This is also known as diffuse cystic mastopathy.  

INVASIVE BREAST CANCERS 

Malignant lesions that originate from breast tissue. The most common types are invasive (or infiltrating) ductal and lobular carcinoma.  

MASTODYNIA/ MASTALGIA  

Pain in one or both breasts exclusive of inflammation or evidence of structural changes; may be cyclic or noncyclic

CERVICAL ISSUE DEFINITIONS 

ABNORMAL LOWER GENITAL TRACT CYTOLOGY  

Atypical lower anogenital tract cells classified by the Bethesda System, as follows:

Squamous cell:

• ASC-US (atypical squamous cells of undetermined significance)
• ASC-H (atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion)
• LSIL (low-grade squamous intraepithelial lesion)
• HSIL (high-grade squamous intraepithelial lesion) - With features suspicious for invasion - Squamous cell carcinoma

Glandular Cell:

• AGC (atypical glandular cells, including qualifiers if listed)
• Endocervical adenocarcinoma in-situ
• Adenocarcinoma (including qualifiers if listed) 

1. Replaces the term “Abnormal Papanicolaou (PAP) Test”.

2. This categorization does not include any other result preceded by the “negative for intraepithelial lesion or malignancy” interpretation. 

ATYPICAL ENDOMETRIAL HYPERPLASIA 

A proliferation of endometrial glands relative to stroma with cytologic/nuclear atypia as classified by the World Health Organization (1994) system 

CERVICITIS  

Inflammation of the cervical epithelium and stroma due to infectious or noninfectious etiologies 

CERVICAL EVERSION/ECTROPION 

A physiologic appearance of the cervix when the endocervical columnar epithelium extends beyond the external os onto the ectocervix 

This entity should not be designated as an erosion.  

CERVICAL POLYP(S)  

Hyperplastic projection of endocervical epithelium. 

ENDOMETRIAL HYPERPLASIA 

A benign proliferation of endometrial glands relative to stroma. These lesions include simple and complex hyperplasia without atypia as defined by the World Health Organization (1994) classification system and benign hyperplasia as defined by endometrial intraepithelial neoplasia classification system.  

ENDOMETRIAL INTRAEPITHELIAL NEOPLASIA  

A premalignant lesion of the endometrium categorized according to quantitative pathologic criteria, including size of the lesion, gland-tostroma ratio and cytology 

LEUKOPLAKIA 

A nonspecific finding of lesions that appear white on visual inspection of the lower genital tract prior to the application of acetic acid. It may arise secondary to trauma, keratosis, human papilloma virus infection or even invasive keratinizing squamous carcinoma.  

Biopsy is necessary to establish the exact diagnosis.  

HIGH-RISK HUMAN PAPILLOMAVIRUS (HPV) TESTING  

Testing biologic material for the presence of oncogenic human papillomavirus (HPV) genomic or proteomic products.  

HUMAN PAPILLOMAVIRUS (HPV) GENOTYPING 

Detection of genomic human papillomavirus (HPV) nucleic acids for the presence of specific HPV types, such as 16 or 16/18. 

HUMAN PAPILLOMAVIRUS (HPV) INFECTION  

Human papillomavirus (HPV) may cause transient or persistent infection of genital tract epithelium, and can be oncogenic or non-oncogenic. Infection can be subclinical, detected by molecular methods or cytology, or clinically manifested as condyloma and/or neoplasia.  

LOWER GENITAL TRACT INTRAEPITHELIAL LESION (INTRAEPITHELIAL NEOPLASIA)  

Abnormal proliferation of squamous intraepithelial cells categorized as low-grade or high-grade intraepithelial lesions (-IL), and applies to lesions of the cervix, vagina, and vulva. The -IL nomenclature may be further qualified with appropriate intraepithelial neoplasia (-IN) terminology, which may also include the specific location, such as CIN 3 (high-grade lesion of the cervix) or VaIN 3 (highgrade lesion of the vagina). 

INFERTILITY DEFINITIONS  

AMENORRHEA  

The absence of menstruation in women of reproductive age

• Primary amenorrhea is defined as no menstruation by age 15.
• Secondary amenorrhea is defined as the absence of menses for six or more months or the length of three cycles after the establishment of regular menstrual cycles.  

ASSISTED REPRODUCTIVE TECHNOLOGY 

Treatments or procedures that include handling both oocytes and sperm and/or embryos for the purpose of establishing a pregnancy

CONTROLLED OVARIAN STIMULATION 

The administration of medications to induce single or multiple follicular development

DIMINISHED OVARIAN RESERVE 

Decreased ovarian responsiveness to exogenous stimulation in women of reproductive age compared to women of similar age 

ENDOMETRIOSIS

The growth of endometrial tissue in the body outside of the uterus

FEMALE INFERTILITY 

Infertility stemming from a female partner  

Female factors may include ovulatory disturbances, diminished ovarian reserve, pelvic abnormalities affecting the reproductive tract, or other abnormalities of the reproductive system. 

FERTILITY  

The capacity to reproduce 

FERTILITY PRESERVATION 

Therapies intended to maintain reproductive potential through protecting or preserving gametes, zygotes, embryos, or gonadal tissue  

INFERTILITY  

A disease characterized by the absence of a successful pregnancy after one year of either unprotected intercourse or insemination. Diagnosis may be considered in less than one year based on medical history, age, physical findings, or diagnostic testing. 

INTRACYTOPLASMIC SPERM INJECTION  

A procedure in which a single spermatozoon is injected into the oocyte cytoplasm

MALE INFERTILITY 

Infertility stemming from a male partner

Male factors include abnormal semen parameters, abnormal sperm function, or inability to have coitus. 

OVARIAN HYPERSTIMULATION SYNDROME 

Pathological condition characterized by ovarian enlargement and ascites that may occur after ovarian stimulation

OVARIAN RESERVE  

An indication of the number of oocytes in the ovaries  

OVULATION INDUCTION 

Ovarian stimulation in oligoovulatory or anovulatory women

POLYCYSTIC OVARIAN SYNDROME  

A heterogeneous endocrine condition in reproductive aged women commonly associated with ovulatory dysfunction, physical or biochemical evidence of androgen excess, and an increased number of antral (immature) follicles in the ovaries. This diagnosis can only be made after excluding other pathologic conditions.  

PRIMARY OVARIAN INSUFFICIENCY

A condition characterized by hypergonadotropic hypogonadism in women younger than age 40

1. Also known as premature ovarian failure

2. Includes women with premature menopause

UNEXPLAINED INFERTILITY 

Infertility due to an unidentified cause

STAGES OF DEVELOPMENT DEFINITIONS 

BLASTOCYST 

The stage of preimplantation embryo development that occurs around day four or five after fertilization. Contains a fluid filled cavity, an outer layer of cells (trophectoderm), and the inner cell mass. 

BLASTOCYST TRANSFER  

Placement of the embryo(s) in to the uterus at the blastocyst stage, typically on day five or six post-oocyte retrieval, as part of in-vitro fertilization  

EMBRYO  

The result of the division of the zygote up to 10 weeks’ gestational age (eight completed weeks after fertilization)

FERTILIZATION 

A multistep process that results in the formation of a zygote by the union of sperm and ovum

FETUS 

The result of the continued development of the embryo (beyond eight completed weeks after fertilization) until the end of pregnancy

ZYGOTE  

A single cell resulting from fertilization of an oocyte by spermatozoa 

PAIN AND BLEEDING ISSUES DEFINITIONS  

PAIN DEFINITIONS 

BLADDER PAIN SYNDROME/ INTERSTITIAL CYSTITIS

An unpleasant sensation (eg, pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms, such as increased frequency or urgency of more than six weeks’ duration, in the absence of infection or other identifiable causes 

CHRONIC PELVIC PAIN IN WOMEN 

Consists of pain symptoms perceived to originate from pelvic organs or structures typically lasting more than six months. It is often associated with negative cognitive, behavioral, sexual, and emotional consequences and with symptoms suggestive of lower urinary tract, sexual, bowel, pelvic floor, myofascial, or gynecological dysfunction.  

Cyclical pelvic pain is considered a form of chronic pelvic pain if it has significant cognitive, behavioral, sexual, and emotional consequences. 

VULVAR PAIN SYNDROME/ VULVODYNIA 

Characterized by persistent or recurrent vulvar discomfort in the absence of infectious or local obvious causes (eg, acute trauma, dermatologic conditions) 

GENERALIZED VULVAR PAIN SYNDROME  

A type of vulvar pain syndrome which is characterized by discomfort that cannot be persistently and precisely localized by point-pressure mapping by probing with a cotton-tipped applicator or similar instrument

Previous terms have included “dysesthetic vulvodynia” and “essential vulvodynia” but are no longer recommended.  

LOCALIZED VULVAR PAIN SYNDROME  

A type of vulvar pain syndrome which is characterized by discomfort that can be consistently and precisely localized by point-pressure mapping on physical examination

Mapping can be performed using a cotton-tipped applicator.  

CLITORAL PAIN SYNDROME  

A type of localized vulvar pain syndrome characterized by discomfort that can be localized by point-pressure mapping to the clitoris 

VULVAR VESTIBULAR PAIN SYNDROME 

A type of localized vulvar pain syndrome which is characterized by discomfort that is localized by point-pressure mapping to the vulvar vestibule 

Previous terms that are no longer recommended include “vulvar vestibulitis,” “vestibulodynia,” and “localized and focal vulvitis."

BLEEDING DEFINITIONS  

ABNORMAL UTERINE BLEEDING (AUB)  

Bleeding from the uterus which differs in frequency, regularity, duration, or volume from normal uterine bleeding, in the absence of pregnancy

AUB as a symptom should be further classified in etiology as follows: PALM-COEIN: Polyp; Adenomyosis; Leiomyoma; Malignancy and hyperplasia; Coagulopathy; Ovulatory dysfunction; Endometrial; Iatrogenic; and not otherwise classified. 

HEAVY MENSTRUAL BLEEDING 

A type of abnormal uterine bleeding characterized by excessive cyclic blood loss which differs from normal uterine bleeding and interferes with a woman’s physical, social, emotional, or material quality of life  

Replaces the term “menorrhagia.” 

IRREGULAR UTERINE BLEEDING  

A type of abnormal uterine bleeding characterized by unpredictable bleeding where the longest and shortest interval between bleeding episodes within a one-year time frame typically differs by more than 20 days 

The difference between the longest and shortest cycles over a one-year period varies by age. If very short (<18 day) and very long (>43 day) cycles are excluded, variation typically is less than or equal to seven to nine days, depending on age. 

IRREGULAR AND HEAVY UTERINE BLEEDING 

A type of abnormal uterine bleeding that represents the symptom of excessive uterine blood loss (in terms of volume or duration) which occurs unpredictably and interferes with a woman’s physical, social, emotional, or material quality of life

Replaces the term “menometrorrhagia.”  

INTERMENSTRUAL BLEEDING  

A type of abnormal uterine bleeding characterized by bleeding episodes in between regular episodes of cyclic uterine bleeding

NORMAL UTERINE BLEEDING 

Cyclic bleeding that occurs from the uterine corpus between menarche and menopause. The bleeding generally lasts up to eight days and occurs every 24–38 days. The cycle should occur at regular predictable intervals and the difference between the longest and shortest cycle over a one-year period should be no more than 20 days.

Normal volume may be defined quantitatively as up to 80 mL per cycle or qualitatively as volume that does not excessively interfere with a woman’s physical, social, emotional, or material quality of life.  

The 20-day difference is based on a general population of women including women with very short (<18 day) and with very long cycles (>43 day). When these women with very short and very long cycles are excluded variation is age dependent and is typically less.

The resulting breakdown by age (between 18 to 45 years) is depicted in the chart below:

PREPUBERTAL VAGINAL BLEEDING 

Any vaginal bleeding prior to puberty  

REPRODUCTIVE PLANNING DEFINITIONS  

ABORTIFACIENT  

A substance intended to cause termination of a pregnancy so that it does not result in live birth  

BIOCHEMICAL PREGNANCY LOSS

Pregnancy loss based on low and decreasing human chorionic gonadotropin (hCG) levels or transient hCG detection only 

CONTRACEPTION  

Action taken to prevent pregnancy  

CONTRACEPTIVES 

Devices or medications used to prevent pregnancy

DILATION AND EVACUATION  

A procedure that can be used after 12 weeks of pregnancy that includes cervical dilation followed by removal of uterine contents using a combination of vacuum aspiration and instruments

ECTOPIC PREGNANCY

Pregnancy outside of the endometrial cavity, diagnosed by ultrasound, surgical visualization, or histopathology  

EMERGENCY (POSTCOITAL) CONTRACEPTIVES 

Contraceptives intended to be used after sexual intercourse or rape  

The term “morning-after pill” is misleading. 

HETEROTOPIC PREGNANCY 

Concurrent pregnancy involving at least one pregnancy implanted in the uterus and at least one implanted outside of the uterine cavity 

INDUCED ABORTION 

An intervention intended to terminate a pregnancy so that it does not result in a live birth

LONG-ACTING REVERSIBLE CONTRACEPTIVES (LARC)   

Reversible contraceptives that are highly effective for at least one year following a single administration without user action  

These methods generally include intrauterine devices and implants.  

MEDICATION ABORTION 

The use of medication(s) intended to terminate a pregnancy so that it does not result in a live birth 

MISCARRIAGE/ INTRAUTERINE PREGNANCY LOSS 

Loss of a documented intrauterine pregnancy

Early miscarriage: loss of a documented intrauterine pregnancy prior to 10 weeks’ gestational age 

PREGNANCY 

A physiologic state of a woman that follows implantation of a blastocyst(s) 

Conception and pregnancy are not the same. Conception is a lay term that has no scientific validity and is not generally used in the medical literature because of its variable definition and connotation.  

RECURRENT EARLY PREGNANCY LOSS 

Two or more intrauterine pregnancy losses prior to 10 weeks' gestational age

RECURRENT PREGNANCY LOSS 

Two or more intrauterine pregnancy losses 

PREGNANCY OF UNKNOWN LOCATION 

Positive beta human chorionic gonadotropin (hCG) with nonvisualization of pregnancy by ultrasound.  

RESOLVED PREGNANCY OF UNKNOWN LOCATION  

Treated or expectantly managed pregnancy of unknown location resulting in undetectable serum human chorionic gonadotropin (hCG) 

VACUUM ASPIRATION 

Evacuation of the uterine contents using a vacuum aspirator  

Replaces the term “suction and vacuum curettage.” 

UROGYNECOLOGY AND MENOPAUSE DEFINITIONS  

UROGYNECOLOGY DEFINITIONS 

URINARY FREQUENCY AND INCONTINENCE DEFINITIONS  

ANAL INCONTINENCE 

Involuntary loss of feces, mucus, or flatus through the anus  

“Accidental bowel leakage” is an acceptable alternative term for both anal incontinence and fecal incontinence.  

DAYTIME URINARY FREQUENCY  

Number of voids (micturitions) by day (wakeful hours including last void before sleep and first void after waking and rising) 

FECAL INCONTINENCE

Involuntary loss of feces or mucus

INCREASED DAYTIME URINARY FREQUENCY 

Complaint that voiding (micturition) occurs more frequently during waking hours than previously deemed normal by the woman

MIXED URINARY INCONTINENCE  

Symptom: complaint of involuntary loss of urine associated with urgency and also with effort or physical exertion or on sneezing or coughing (combination of stress urinary incontinence and urgency urinary incontinence)

Sign: observation of stress urinary incontinence and urgency urinary incontinence  

 A sign is not required for this definition. 

NOCTURIA/ NOCTURNAL FREQUENCY 

Number of times sleep is interrupted by the need to void (micturate). Each void is preceded and followed by sleep.  

OVERACTIVE BLADDER SYNDROME  

Urinary urgency, usually accompanied by increased daytime frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology.  

STRESS URINARY INCONTINENCE  

Symptom: Complaint of involuntary loss of urine on effort or physical exertion, or on sneezing or coughing. N.B.: ‘‘activity-related incontinence’’ might be preferred in some languages to avoid confusion with psychological stress.

Sign: observation of involuntary leakage from the urethra synchronous with effort or physical exertion, or on sneezing or coughing

TWENTY-FOUR HOUR URINARY FREQUENCY

Total number of daytime voids and episodes of nocturia during a specified 24-hour period 

URINARY FREQUENCY 

The number of voids (micturitions) over a defined period of time

URINARY INCONTINENCE  

Symptom: complaint of involuntary loss of urine.

Sign: observation of involuntary leakage on examination: this may be urethral or extraurethral 

A sign is not required for this definition.  

URINARY URGENCY

Sudden, compelling desire to void (micturate) which is difficult to defer

URGENCY URINARY INCONTINENCE 

Symptom: complaint of involuntary loss of urine accompanied by or immediately preceded by urinary urgency
Sign: observation of involuntary leakage from the urethra synchronous with the sensation of a sudden, compelling desire to void that is difficult to defer  

A sign is not required for this definition.  

PROLAPSE DEFINITIONS  

ANTERIOR VAGINAL WALL PROLAPSE (CYSTOCELE) 

Descent of the anterior vaginal wall  

Most commonly involves bladder descent (cystocele) and often includes apical vaginal descent.  

PELVIC ORGAN PROLAPSE  

The descent of one or more pelvic structures: the cervix, uterus, vaginal apex, anterior vaginal wall (usually with bladder, cystocele), posterior vaginal wall (usually with rectum, rectocele), or peritoneum of the cul-de-sac (usually with small intestine, enterocele)  

The presence of any such sign should be correlated with relevant pelvic organ prolapse symptoms. More commonly, this correlation would occur at the level of the hymen or beyond.  

POSTERIOR VAGINAL WALL PROLAPSE (RECTOCELE)  

Descent of the posterior vaginal wall 

Most commonly this involves rectal protrusion into the vagina (rectocele) and may include apical vaginal descent. 

UTERINE/CERVICAL PROLAPSE  

Descent of the uterus or cervix  

MENOPAUSE DEFINITIONS

GENITOURINARY SYNDROME OF MENOPAUSE  

A collection of symptoms and signs associated with decreased estrogen and other sex steroids that can involve changes to labia majora/minora, vestibule/introitus, clitoris, vagina, urethra, and bladder. Symptoms include, but are not limited to, dryness, pain with sex that may lead to subsequent sexual dysfunction, bladder and urethral symptoms, frequent urinary tract infections, burning, itching, and irritation that is bothersome or distressing. 

Symptomatic vulvovaginal atrophy is included within this definition. 

MENOPAUSE  

The final menstrual period resulting from the physiologic permanent decline in gonadal hormone levels confirmed by 12 months of amenorrhea in women with a uterus 

For some women menstrual bleeding criteria cannot be used to define menopause and the diagnosis can be supported with criteria including symptoms or serial measurement of endocrine markers.  

PERIMENOPAUSE 

A time span that begins with the onset of intermenstrual cycle irregularities (+/- seven days) or other menopause-related symptoms and extends through menopause (the final menstrual period) to one year after menopause

PREMATURE MENOPAUSE

Menopause before age 40 

POSTMENOPAUSAL BLEEDING  

Bleeding from female genital organs 12 or more months after the final menstrual period

POSTMENOPAUSE 

The time span after menopause   

VASOMOTOR SYMPTOMS  

Flushing with or without sweating resulting from vasodilation of blood vessels primarily affecting head, neck, and upper torso 

VULVOVAGINAL ATROPHY 

Tissue changes in the vulva or vagina typically associated with low estrogen levels that may or may not be symptomatic 

“Symptomatic vulvovaginal atrophy” is included in the definition of “genitourinary syndrome of menopause”.