STUDY - Technical - New Dacian's Medicine
Menstrual
Disorders and other common gynecological Conditions
Translation Draft
I've stretched out, I hope no more than my duvet is (referring to my available time for postings)... But I hope, again, to cope...
Diseases associated with the female reproductive tract can be classified into menstrual disorders, pelvic pain, disorders of sexual function or sterility. However, only one disorder, e.g. uterine leiomyoma, may show symptoms in one or more of these categories. In addition, sexual dysfunction can interfere with other conditions in several ways.
On the one hand, in women with conditions related to other functions of the reproductive system, the fundamental problem may simply be severe sexual dysfunction or marital conflict. On the other hand, women with severe organic disorders of the pelvis, for example pelvic inflammatory disease, may present with sexual dysfunction such as disappearance, which is actually a minor manifestation of the underlying disease.
Since normal reproductive function depends on the integrated action of the central nervous system, endocrine glands and reproductive organs, menstrual cycle abnormalities, sexual dysfunction and sterility can be the result of systemic and psychological disorders, as well as primary endocrine defects and reproductive organs. Endocrine and physiological control of puberty, reproductive life and menopause will not discuss here, focusing on the initial evaluation of women with reproductive tract disorders.
Menstrual disorders can be divided into abnormal uterine bleeding and amenorrhea. I'll start with abnormal uterine bleeding. The menstrual cycle is defined as the interval between the occurrence of a bleeding episode and the appearance of the next. In normal women, the cycle has the usual 28 +/- 3 days, the average duration of menstrual flow being 4 +/- 2 days and the usual blood loss is 40-100 ml. Between menarchers and menopause, most women suffer one or more episodes of abnormal uterine bleeding, here defined as any type of bleeding that exceeds the normal limits of frequency, duration and/ or amount of blood lost.
The decision to evaluate a patient with an abnormal type of bleeding depends on the severity and frequency of abnormal episodes. When vaginal bleeding occurs, it should be determined first if the blood comes from the uterine endometrium. Rectal, bladder, cervical and vaginal bleeding sources should be excluded. Once the origin of bleeding turns out to be uterine, a pregnancy-related condition (such as abortion or incomplete abortion or ectopic pregnancy) should be excluded by appropriate physical examination and laboratory tests.
We should also remember that uterine bleeding may also be the initial or main manifestation of generalized blood diathesis. The other causes of abnormal uterine bleeding can be divided into those associated with ovulatory cycles and those associated with anovulatory cycles.
For ovulatory cycles, menstrual bleeding is spontaneous, regular in appearance, predictable in duration and quantity of menstrual luxury and commonly associated with discomfort, due to the deprivation of progesterone at the end of the luteal phase (postovulatory) and requires first estrogen loading of the endometrium in the follicular (preovulatory) phase of the cycle. When deviation from the established type of menstrual flow occurs, but the cycles are still regular, the usual cause is the condition of the drain tract.
For example, episodes of regular, prolonged, excessive bleeding may result from abnormalities of the uterus such as submucosal leiomyoma, adenomyosis or endometrial polyps. On the other hand, predictable cyclic menstruation, characterized by bleeding in drops or mild, suggests obstruction of the drain tract, such as uterine sinechia or sclerosis of the cervix. Intermittent bleeding between cyclic ovulatory menstruation is often due to cervical or endometrial lesions. In the case of anovulatory cycles, irregular uterine bleeding in appearance, unpredictable in quantity and duration of flow and usually painless, is called dysfunctional or anovulatory uterine bleeding.
This type of bleeding is the result of disorders in normal follicular maturation with consecutive anovulation and may be transient or chronic. The transient interruption of ovulatory cycles occurs more frequently in the early years of puberty, in premenopausal or as a consequence of various stress and intercurrent disorders. Abnormal uterine bleeding, persistent throughout reproductive life, can occur in several organic diseases that affect ovarian function, most often due to estrogen icherate bleeding.
Bleeding occurs when oestrogen stimulation of the endometrium is continuous and is not interrupted by the cyclic decrease of progesterone, as can happen in polycystic ovary disease.
Amenorrhea is defined as the absence of menarche for the age of 16, regardless of the presence or absence of secondary sexual characters or as the absence of menstruation for 6 months in women with previous periodic menstruation. Amenorrhea in a woman who has never had menstruation is called primary, the cessation of menstruation being called secondary amenorrhea. Since some conditions can also cause primary and secondary amenorrhea, we opted for functional classification based on the nature of the fundamental defect, namely anatomical defects of the drain tract (uterus, cervix or vagina), ovarian insufficiency and chronic anovulation.
Anatomical defects of the drain tract include congenital defects of the vagina, hymen imperforation, transverse vaginal septum, cervical stenosis, intrauterine adhesions (sinechia), absence of the vagina or uterus and developmental abnormalities of the uterus. Diagnosis of an anatomical defect is usually done by physical examination and is confirmed by demonstrating the lack of bleeding after administration of estrogens plus a progestogen for 21 days. Pelvic ultrasound, MRI, hysterosalpingography or hysteroscopy can be helpful in defining the defect.
Causes of ovarian failure include gonadic dysgenesis, P450 17 alpha deficiency, resistant ovary syndrome and premature ovarian failure. Ovarian failure includes conditions in which the ovary is deficient in germ cells and those in which germ cells are resistant to follicle-stimulating hormone (FSH). Diagnosis of ovarian insufficiency as a cause of amenorrhea is confirmed by an increased plasma level of FSH. Women with chronic anovulation lack spontaneous ovulation, but have the ability to ovulate through appropriate therapy.
In some women with chronic anovulation, total estrogen production is appropriate, but does not secrete in a cyclical way. In others, estrogen production is deficient. Women who have adequate estrogen production and experience bleeding after the challenge with a progestogen usually have polycystic ovary disease. Other causes include ovarian and adrenal hormone-secreting tumors.
Women with a deficiency or absence of estrogenic production and therefore with the absence of bleeding from deprivation after administration of progestin, usually have hypogonadotropic hypogonadism, due to organic or functional disorders of the hypophysis or central nervous system, such as brain tumors, pituitary (especially prolactin-secreting adenoma), primary hypopituitarism or Sheehan syndrome.
Pelvic pain may originate in the pelvis or may irradiate from another region of the body. Pelvic origin is suggested by anamnesis (e.g. dysmenorrhea and disappearance) and physical examination, but a high suspicion index should be maintained for extrapelvic diseases with irradiation in the pelvis, such as appendicitis, cholecystitis, intestinal occlusion and urinary tract infections.
"Physiological" pelvic pain or pain associated with ovulation ("mittelschmerz") is the most common manifestation of pelvic pain. Many women had lower abdominal discomfort when ovulating, characteristically a deaf pain in the middle of the cycle in one of the lower abdominal quadrants, lasting from minutes to hours. This is rarely severe or disabling. Pain may come from peritoneal irritation given by follicular fluid removed in the peritoneal cavity upon ovulation. Mid-cycle onset and short duration of pain are often diagnosed.
Premenstrual or menstrual pain is considered to be at least as common. In women with normal ovulation, somatic symptoms over several days before menstruation may be insignificant or disabling. Such symptoms include edema, breast angorging and bloating or abdominal discomfort.
A complex symptom of irritability, depression and cyclic lethargy is known to premenstrual syndrome (PMS). The cause of PMS is unknown and there is no consensus on therapy. Severe or disabling uterine cramps during ovulatory menstruation and in the absence of proven pelvic diseases are called primary dysmenorrhea. It is caused by prostaglandin-induced uterine ischemia and is treated with prostaglandin synthesis inhibitors or oral contraceptives.
Let's move now on to pelvic pain due to organic causes. Severe dysmenorrhea associated with pelvic disorders is called secondary dysmenorrhea. Organic causes of pelvic pain can be classified into: 1. uterine, 2. anexial, 3. vulvar or vaginal and 4. due to pregnancy. Pain of uterine etiology is often chronic and continuous and increases in intensity at menstruation and sexual contact. Causes include uterine leiomyoma (especially submucos and degenerate leiomyoma), adenomyosis and cervical stenosis. Infection of the uterus associated with intrauterine maneuvers after dilation and curettage or associated with intrauterine devices may also cause pelvic pain.
Pelvic pain due to endometrial or cervical cancer is usually a late manifestation. In the case of anexial pain, the most common cause of pain in the appendages (trompe and ovaries) is infection. Acute salpingo-oarteritis manifests itself with lower abdominal pain, fever and chills, starting a few days after the menstrual period and usually due to infection with chlamydia or gonococcus, with or without pyogenic overinfection.
Chronic pelvic inflammatory disease results from a single or more episodes of infection and may present as sterility associated with chronic pelvic pain, which increases in intensity upon menstruation and sexual contact. On physical examination, the appendages are sensitive and an anexial thickening with or without the existence of a formation may be present. Inflammatory pelvic disease can become surgical emergency, if by breaking a tubo-ovarian abscess occurs peritonitis. Ovarian cysts or neoplasms can cause pelvic pain that becomes more severe when twisting or tearing the formation, and ectopic pregnancy should be considered when diagnosing differential.
Endometriosis of interest in the fallopian tubes, ovaries or peritoneum can cause chronic low abdominal pain and sterility, the extent of the tissue involved is not always correlated with the severity of symptoms. Pain in endometriosis typically increases during menstruation and, if the posterior ligaments of the uterus are involved, in sexual contact. Vulvar or vaginal pain is most often due to infectious vaginitis caused by Monilia, Trichomonas or bacteria and is characteristically associated with vaginal discharge and itching. Herpetic vulvitis, candyloma acuminatum and cysts or abscesses of Bartholin's glands can also cause vulvar pain.
There's also pregnancy disorder. Pregnancy should be considered in the differential diagnosis of pelvic pain during the reproductive period. imminence of abortion or incomplete abortion often manifests itself with uterine cramps (contractions), bleeding with blood clots, following a period of amenorrhea. Ectopic pregnancy can manifest itself insidiously and results in severe intraperitoneal hemorrhage and death of the pregnant woman.
Assessment of pelvic pain requires careful anamnesis and pelvic examination. They often lead to a correct diagnosis and the establishment of appropriate treatment. If the pain is severe and the diagnosis unclear, the investigation should follow the scheme described for the acute abdomen. Culdocentesis is indicated if a ruptured ectopic pregnancy is suspected. if there are any concerns about an anexial tumor formation or the patient's obesity prevents full pelvic examination, ultrasound may be useful.
Serial determinations of chorionic gonadotrophin can help in establishing the diagnosis of tubal pregnancy. Finally, laparoscopy and diagnostic laparotomy can be indicated in pains with indeterminate etiology.
I will now address sexual dysfunction. Some women with sexual dysfunction describe minor inconveniences related to the reproductive tract as a way to bring sexual problems to the attention of the doctor. On the other hand, sexual dysfunction can be considered the cause of lower abdominal discomfort or disappearance when in fact the actual etiology is organic. However, more and more women are seeking medical advice because of sexual problems that, as provenance, are at the interface between medicine and sociology.
Normal sexual response begins with sexual stimulation that causes genital vasocongestion, which leads to the lubrication of the vagina in preparation for intromission. Lubrication is determined by the formation of a transudate in the vagina and, along with genital congestion, produces the so-called orgasmic plateau before orgasm. Sexual stimuli (visual, tactile, auditory and olfactory) as well as healthy vaginal tissue are essential conditions for genital vasocongestion and vaginal lubrication. During the second stage of the sexual response, involuntary contractions of the pelvic muscles result in a pleasant cortical sensory phenomenon, known as orgasm.
Direct and indirect stimulation of the clitoris is important in producing orgasm in women. In simple terms, sexual dysfunction may be due to interference with the stimulation phase or the orgasmic phase of sexual response. Each disorder can be due to an organic or functional cause or both.
Diseases that affect neurological function, such as diabetes mellitus or multiple sclerosis, can prevent normal sexual stimulation. Local pelvic conditions such as vaginitis, endometriosis and salpingo-oarteritis may prevent normal sexual response due to consecutive disappearance. Debilitating systemic diseases such as cancer and cardiovascular disease can indirectly inhibit normal sexual response. More commonly, the impossibility of a normal sexual response is due to psychological factors affecting sexual stimulation.
Such problems include misinformation, for example the perception of sexual satisfaction as a bad thing or feelings of guilt related to previous traumatic psychological events such as incest, rape or unwanted pregnancy. In addition, women who have a history of hysterectomy or mastectomy perceive themselves as "incomplete". Stresses such as anxiety, depression, fatigue and marital or interpersonal conflicts can lead to the impossibility of vasocongestive response and the prevention of vaginal lubrication.
Women with such perception/experiences may be unable to achieve a normal sexual response unless they receive a specialist consul. Such problems are addressed by trying to identify and reduce causal stresses. Failure to reach orgasm is a specific form of sexual dysfunction. In the absence of orgasm, many women enjoy sexual encounters in varying degrees due to the pleasure of approaching in a desired relationship, especially with a loved partner. However, for other women, sexual relations with rare or absent orgasms are frustrating and unsatisfactory.
In many situations, the impossibility of achieving orgasm is due to insufficient clitoral stimulation and can be directed through proper counseling and patient education. A specific entity, "vaginismus", consists of painful, involuntary contractions of the muscles surrounding the vaginal introtuitus being a rare cause of disappearance. This is a conditioned response to a real or imaginary previous fear or a traumatic sexual experience. Treatment is directed towards the elimination of the conditional response by progressive vaginal dilation by the patient, associated with couple psychotherapy.
I will complete this post with the presentation of a few elements about reproduction without addressing the problems about sterility in detail. The approach of infertile couples always involves the evaluation of both man and woman. Anamnesis should seek information such as the frequency of sexual contact, sexual responses of both, the use of contraceptives or lubricants, previous or past medical diseases and all medications taken. Factors associated with men cover a third of sterility problems.
Therefore, one of the first procedures in the investigation of infertile couples must be sperm analysis. The initial assessment of the woman includes a documentary about normal ovulatory cycles. A history with regular, cyclic, predictable, spontaneous menstruation indicates ovulatory cycles, which can be confirmed by the basal body temperature graph, endometrial biopsy at the appropriate time or measurements of plasma progesterone during the luteal phase of the cycle.
Diagnosis of luteal phase dysfunction (low progesterone secretion in the luteal phase) can also be established by these methods. Transvaginal ultrasound is useful for assessing follicular development. If the established diagnosis is polycystic ovary disease, attempts to induce ovulation can be undertaken by a variety of methods, including administration of clomiphene, human menopausal gonadotropins (HMG), bromocriptin or agonists of the hormone-releasing hormone luteinizing hormone (LHRH) or cuneiform resection of the ovaries (commonly performed by laparoscopic cauterization or laser drilling).
The most common cause of sterility in women is tubal disease, usually due to infection (inflammatory pelvic disease) or endometriosis. Tubal disease can be assessed by obtaining a hysterosalpingography or diagnostic laparoscopy. Tubal disorders can usually be treated by tuboplasty and laparoscopic adhesionlysis lysis (in severe cases, infertility is treated through in vitro fertilization and embryo transfer). A cervical factor as the cause of sterility is identified by a postcoital examination at the appropriate time. During this examination, sperm motility is observed in cervical mucus.
Immunological etiologies of sterility can also be tested through a variety of laboratory tests. The cause of sterility is unknown in 10% of couples. In many cases of infertility it is now possible to use reproductive aids, including in vitro fertilization and embryo transfer, intratuba belet transfer, transfer of the cryoreserved egg and embryo and ovarian hyperstimulation with citrate clomifem or gonadotropins followed by intrauterine seeding.
The desire for contraception is also a common cause for women seeking treatment or medical evaluation. The most widely used methods for fertility control include 1. method of the calendar and interrupted coit, 2. barrier methods, 3. intrauterine devices, 4. oral steroid contraceptives, 5. sterilization and 6. abortion.
But, I think that's enough for this theme...
I've stretched out, I hope no more than my duvet is (referring to my available time for postings)... But I hope, again, to cope...
Diseases associated with the female reproductive tract can be classified into menstrual disorders, pelvic pain, disorders of sexual function or sterility. However, only one disorder, e.g. uterine leiomyoma, may show symptoms in one or more of these categories. In addition, sexual dysfunction can interfere with other conditions in several ways.
On the one hand, in women with conditions related to other functions of the reproductive system, the fundamental problem may simply be severe sexual dysfunction or marital conflict. On the other hand, women with severe organic disorders of the pelvis, for example pelvic inflammatory disease, may present with sexual dysfunction such as disappearance, which is actually a minor manifestation of the underlying disease.
Since normal reproductive function depends on the integrated action of the central nervous system, endocrine glands and reproductive organs, menstrual cycle abnormalities, sexual dysfunction and sterility can be the result of systemic and psychological disorders, as well as primary endocrine defects and reproductive organs. Endocrine and physiological control of puberty, reproductive life and menopause will not discuss here, focusing on the initial evaluation of women with reproductive tract disorders.
Menstrual disorders can be divided into abnormal uterine bleeding and amenorrhea. I'll start with abnormal uterine bleeding. The menstrual cycle is defined as the interval between the occurrence of a bleeding episode and the appearance of the next. In normal women, the cycle has the usual 28 +/- 3 days, the average duration of menstrual flow being 4 +/- 2 days and the usual blood loss is 40-100 ml. Between menarchers and menopause, most women suffer one or more episodes of abnormal uterine bleeding, here defined as any type of bleeding that exceeds the normal limits of frequency, duration and/ or amount of blood lost.
The decision to evaluate a patient with an abnormal type of bleeding depends on the severity and frequency of abnormal episodes. When vaginal bleeding occurs, it should be determined first if the blood comes from the uterine endometrium. Rectal, bladder, cervical and vaginal bleeding sources should be excluded. Once the origin of bleeding turns out to be uterine, a pregnancy-related condition (such as abortion or incomplete abortion or ectopic pregnancy) should be excluded by appropriate physical examination and laboratory tests.
We should also remember that uterine bleeding may also be the initial or main manifestation of generalized blood diathesis. The other causes of abnormal uterine bleeding can be divided into those associated with ovulatory cycles and those associated with anovulatory cycles.
For ovulatory cycles, menstrual bleeding is spontaneous, regular in appearance, predictable in duration and quantity of menstrual luxury and commonly associated with discomfort, due to the deprivation of progesterone at the end of the luteal phase (postovulatory) and requires first estrogen loading of the endometrium in the follicular (preovulatory) phase of the cycle. When deviation from the established type of menstrual flow occurs, but the cycles are still regular, the usual cause is the condition of the drain tract.
For example, episodes of regular, prolonged, excessive bleeding may result from abnormalities of the uterus such as submucosal leiomyoma, adenomyosis or endometrial polyps. On the other hand, predictable cyclic menstruation, characterized by bleeding in drops or mild, suggests obstruction of the drain tract, such as uterine sinechia or sclerosis of the cervix. Intermittent bleeding between cyclic ovulatory menstruation is often due to cervical or endometrial lesions. In the case of anovulatory cycles, irregular uterine bleeding in appearance, unpredictable in quantity and duration of flow and usually painless, is called dysfunctional or anovulatory uterine bleeding.
This type of bleeding is the result of disorders in normal follicular maturation with consecutive anovulation and may be transient or chronic. The transient interruption of ovulatory cycles occurs more frequently in the early years of puberty, in premenopausal or as a consequence of various stress and intercurrent disorders. Abnormal uterine bleeding, persistent throughout reproductive life, can occur in several organic diseases that affect ovarian function, most often due to estrogen icherate bleeding.
Bleeding occurs when oestrogen stimulation of the endometrium is continuous and is not interrupted by the cyclic decrease of progesterone, as can happen in polycystic ovary disease.
Amenorrhea is defined as the absence of menarche for the age of 16, regardless of the presence or absence of secondary sexual characters or as the absence of menstruation for 6 months in women with previous periodic menstruation. Amenorrhea in a woman who has never had menstruation is called primary, the cessation of menstruation being called secondary amenorrhea. Since some conditions can also cause primary and secondary amenorrhea, we opted for functional classification based on the nature of the fundamental defect, namely anatomical defects of the drain tract (uterus, cervix or vagina), ovarian insufficiency and chronic anovulation.
Anatomical defects of the drain tract include congenital defects of the vagina, hymen imperforation, transverse vaginal septum, cervical stenosis, intrauterine adhesions (sinechia), absence of the vagina or uterus and developmental abnormalities of the uterus. Diagnosis of an anatomical defect is usually done by physical examination and is confirmed by demonstrating the lack of bleeding after administration of estrogens plus a progestogen for 21 days. Pelvic ultrasound, MRI, hysterosalpingography or hysteroscopy can be helpful in defining the defect.
Causes of ovarian failure include gonadic dysgenesis, P450 17 alpha deficiency, resistant ovary syndrome and premature ovarian failure. Ovarian failure includes conditions in which the ovary is deficient in germ cells and those in which germ cells are resistant to follicle-stimulating hormone (FSH). Diagnosis of ovarian insufficiency as a cause of amenorrhea is confirmed by an increased plasma level of FSH. Women with chronic anovulation lack spontaneous ovulation, but have the ability to ovulate through appropriate therapy.
In some women with chronic anovulation, total estrogen production is appropriate, but does not secrete in a cyclical way. In others, estrogen production is deficient. Women who have adequate estrogen production and experience bleeding after the challenge with a progestogen usually have polycystic ovary disease. Other causes include ovarian and adrenal hormone-secreting tumors.
Women with a deficiency or absence of estrogenic production and therefore with the absence of bleeding from deprivation after administration of progestin, usually have hypogonadotropic hypogonadism, due to organic or functional disorders of the hypophysis or central nervous system, such as brain tumors, pituitary (especially prolactin-secreting adenoma), primary hypopituitarism or Sheehan syndrome.
Pelvic pain may originate in the pelvis or may irradiate from another region of the body. Pelvic origin is suggested by anamnesis (e.g. dysmenorrhea and disappearance) and physical examination, but a high suspicion index should be maintained for extrapelvic diseases with irradiation in the pelvis, such as appendicitis, cholecystitis, intestinal occlusion and urinary tract infections.
"Physiological" pelvic pain or pain associated with ovulation ("mittelschmerz") is the most common manifestation of pelvic pain. Many women had lower abdominal discomfort when ovulating, characteristically a deaf pain in the middle of the cycle in one of the lower abdominal quadrants, lasting from minutes to hours. This is rarely severe or disabling. Pain may come from peritoneal irritation given by follicular fluid removed in the peritoneal cavity upon ovulation. Mid-cycle onset and short duration of pain are often diagnosed.
Premenstrual or menstrual pain is considered to be at least as common. In women with normal ovulation, somatic symptoms over several days before menstruation may be insignificant or disabling. Such symptoms include edema, breast angorging and bloating or abdominal discomfort.
A complex symptom of irritability, depression and cyclic lethargy is known to premenstrual syndrome (PMS). The cause of PMS is unknown and there is no consensus on therapy. Severe or disabling uterine cramps during ovulatory menstruation and in the absence of proven pelvic diseases are called primary dysmenorrhea. It is caused by prostaglandin-induced uterine ischemia and is treated with prostaglandin synthesis inhibitors or oral contraceptives.
Let's move now on to pelvic pain due to organic causes. Severe dysmenorrhea associated with pelvic disorders is called secondary dysmenorrhea. Organic causes of pelvic pain can be classified into: 1. uterine, 2. anexial, 3. vulvar or vaginal and 4. due to pregnancy. Pain of uterine etiology is often chronic and continuous and increases in intensity at menstruation and sexual contact. Causes include uterine leiomyoma (especially submucos and degenerate leiomyoma), adenomyosis and cervical stenosis. Infection of the uterus associated with intrauterine maneuvers after dilation and curettage or associated with intrauterine devices may also cause pelvic pain.
Pelvic pain due to endometrial or cervical cancer is usually a late manifestation. In the case of anexial pain, the most common cause of pain in the appendages (trompe and ovaries) is infection. Acute salpingo-oarteritis manifests itself with lower abdominal pain, fever and chills, starting a few days after the menstrual period and usually due to infection with chlamydia or gonococcus, with or without pyogenic overinfection.
Chronic pelvic inflammatory disease results from a single or more episodes of infection and may present as sterility associated with chronic pelvic pain, which increases in intensity upon menstruation and sexual contact. On physical examination, the appendages are sensitive and an anexial thickening with or without the existence of a formation may be present. Inflammatory pelvic disease can become surgical emergency, if by breaking a tubo-ovarian abscess occurs peritonitis. Ovarian cysts or neoplasms can cause pelvic pain that becomes more severe when twisting or tearing the formation, and ectopic pregnancy should be considered when diagnosing differential.
Endometriosis of interest in the fallopian tubes, ovaries or peritoneum can cause chronic low abdominal pain and sterility, the extent of the tissue involved is not always correlated with the severity of symptoms. Pain in endometriosis typically increases during menstruation and, if the posterior ligaments of the uterus are involved, in sexual contact. Vulvar or vaginal pain is most often due to infectious vaginitis caused by Monilia, Trichomonas or bacteria and is characteristically associated with vaginal discharge and itching. Herpetic vulvitis, candyloma acuminatum and cysts or abscesses of Bartholin's glands can also cause vulvar pain.
There's also pregnancy disorder. Pregnancy should be considered in the differential diagnosis of pelvic pain during the reproductive period. imminence of abortion or incomplete abortion often manifests itself with uterine cramps (contractions), bleeding with blood clots, following a period of amenorrhea. Ectopic pregnancy can manifest itself insidiously and results in severe intraperitoneal hemorrhage and death of the pregnant woman.
Assessment of pelvic pain requires careful anamnesis and pelvic examination. They often lead to a correct diagnosis and the establishment of appropriate treatment. If the pain is severe and the diagnosis unclear, the investigation should follow the scheme described for the acute abdomen. Culdocentesis is indicated if a ruptured ectopic pregnancy is suspected. if there are any concerns about an anexial tumor formation or the patient's obesity prevents full pelvic examination, ultrasound may be useful.
Serial determinations of chorionic gonadotrophin can help in establishing the diagnosis of tubal pregnancy. Finally, laparoscopy and diagnostic laparotomy can be indicated in pains with indeterminate etiology.
I will now address sexual dysfunction. Some women with sexual dysfunction describe minor inconveniences related to the reproductive tract as a way to bring sexual problems to the attention of the doctor. On the other hand, sexual dysfunction can be considered the cause of lower abdominal discomfort or disappearance when in fact the actual etiology is organic. However, more and more women are seeking medical advice because of sexual problems that, as provenance, are at the interface between medicine and sociology.
Normal sexual response begins with sexual stimulation that causes genital vasocongestion, which leads to the lubrication of the vagina in preparation for intromission. Lubrication is determined by the formation of a transudate in the vagina and, along with genital congestion, produces the so-called orgasmic plateau before orgasm. Sexual stimuli (visual, tactile, auditory and olfactory) as well as healthy vaginal tissue are essential conditions for genital vasocongestion and vaginal lubrication. During the second stage of the sexual response, involuntary contractions of the pelvic muscles result in a pleasant cortical sensory phenomenon, known as orgasm.
Direct and indirect stimulation of the clitoris is important in producing orgasm in women. In simple terms, sexual dysfunction may be due to interference with the stimulation phase or the orgasmic phase of sexual response. Each disorder can be due to an organic or functional cause or both.
Diseases that affect neurological function, such as diabetes mellitus or multiple sclerosis, can prevent normal sexual stimulation. Local pelvic conditions such as vaginitis, endometriosis and salpingo-oarteritis may prevent normal sexual response due to consecutive disappearance. Debilitating systemic diseases such as cancer and cardiovascular disease can indirectly inhibit normal sexual response. More commonly, the impossibility of a normal sexual response is due to psychological factors affecting sexual stimulation.
Such problems include misinformation, for example the perception of sexual satisfaction as a bad thing or feelings of guilt related to previous traumatic psychological events such as incest, rape or unwanted pregnancy. In addition, women who have a history of hysterectomy or mastectomy perceive themselves as "incomplete". Stresses such as anxiety, depression, fatigue and marital or interpersonal conflicts can lead to the impossibility of vasocongestive response and the prevention of vaginal lubrication.
Women with such perception/experiences may be unable to achieve a normal sexual response unless they receive a specialist consul. Such problems are addressed by trying to identify and reduce causal stresses. Failure to reach orgasm is a specific form of sexual dysfunction. In the absence of orgasm, many women enjoy sexual encounters in varying degrees due to the pleasure of approaching in a desired relationship, especially with a loved partner. However, for other women, sexual relations with rare or absent orgasms are frustrating and unsatisfactory.
In many situations, the impossibility of achieving orgasm is due to insufficient clitoral stimulation and can be directed through proper counseling and patient education. A specific entity, "vaginismus", consists of painful, involuntary contractions of the muscles surrounding the vaginal introtuitus being a rare cause of disappearance. This is a conditioned response to a real or imaginary previous fear or a traumatic sexual experience. Treatment is directed towards the elimination of the conditional response by progressive vaginal dilation by the patient, associated with couple psychotherapy.
I will complete this post with the presentation of a few elements about reproduction without addressing the problems about sterility in detail. The approach of infertile couples always involves the evaluation of both man and woman. Anamnesis should seek information such as the frequency of sexual contact, sexual responses of both, the use of contraceptives or lubricants, previous or past medical diseases and all medications taken. Factors associated with men cover a third of sterility problems.
Therefore, one of the first procedures in the investigation of infertile couples must be sperm analysis. The initial assessment of the woman includes a documentary about normal ovulatory cycles. A history with regular, cyclic, predictable, spontaneous menstruation indicates ovulatory cycles, which can be confirmed by the basal body temperature graph, endometrial biopsy at the appropriate time or measurements of plasma progesterone during the luteal phase of the cycle.
Diagnosis of luteal phase dysfunction (low progesterone secretion in the luteal phase) can also be established by these methods. Transvaginal ultrasound is useful for assessing follicular development. If the established diagnosis is polycystic ovary disease, attempts to induce ovulation can be undertaken by a variety of methods, including administration of clomiphene, human menopausal gonadotropins (HMG), bromocriptin or agonists of the hormone-releasing hormone luteinizing hormone (LHRH) or cuneiform resection of the ovaries (commonly performed by laparoscopic cauterization or laser drilling).
The most common cause of sterility in women is tubal disease, usually due to infection (inflammatory pelvic disease) or endometriosis. Tubal disease can be assessed by obtaining a hysterosalpingography or diagnostic laparoscopy. Tubal disorders can usually be treated by tuboplasty and laparoscopic adhesionlysis lysis (in severe cases, infertility is treated through in vitro fertilization and embryo transfer). A cervical factor as the cause of sterility is identified by a postcoital examination at the appropriate time. During this examination, sperm motility is observed in cervical mucus.
Immunological etiologies of sterility can also be tested through a variety of laboratory tests. The cause of sterility is unknown in 10% of couples. In many cases of infertility it is now possible to use reproductive aids, including in vitro fertilization and embryo transfer, intratuba belet transfer, transfer of the cryoreserved egg and embryo and ovarian hyperstimulation with citrate clomifem or gonadotropins followed by intrauterine seeding.
The desire for contraception is also a common cause for women seeking treatment or medical evaluation. The most widely used methods for fertility control include 1. method of the calendar and interrupted coit, 2. barrier methods, 3. intrauterine devices, 4. oral steroid contraceptives, 5. sterilization and 6. abortion.
But, I think that's enough for this theme...
I wish you, of course, a
good day!
Dorin, Merticaru