Gynaecological problems are menstrual disorders and non-menstrual disorders, including absent, scanty, and rare menstruation, pain, and other conditions. It also covers inflammatory and non-inflammatory diseases of the breast, ovaries, and cervix. It affect the female reproductive system.
Every woman suffers from this at some point in her life. There is a very important impact of gynecological disorders on female’s sexual function. These must not be taken lightly as they can adversely affect the ability of woman to produce children or in some cases may threaten their lives.
Common Gynecological Conditions are :
Dysmenorrhea or painful periods : Dysmenorrhea refers to painful periods, sufficient to incapacitate daily activities. It is of two types, primary and secondary dysmenorrhea.
In primary dysmenorrhea, there is no associated pelvic disease. It is mostly confined to adolescents and in ovulatory cycles. The pain subsides on its own once the woman gets pregnant or after delivery. It usually appears within 2 years of menarche. Family history such as mother or sister having similar complaint may be present. The pain usually begins few hours before or just with the onset of menstruation and usually lasts for few hours, may extend for the entire day. The pain is spasmodic i.e. the patient experiences painful contractions in the lower abdomen, which may radiate to the back and medial aspect of thighs.
Secondary dysmenorrhea occurs in association with underlying pelvic disease. Common causes include chronic pelvic infection, pelvic endometriosis, uterine fibroids, placement of copper-T in uterus etc. The patients are usually in their thirties and have had children. The typical characteristic of pain is that it is dull, situated in back and in front, and does not radiate anywhere. It occurs 3-5 days prior to the period and relieves with the onset of bleeding.
Amenorrhea means absence of menstruation. It is of two types physiological and pathological. Physiological amenorrhea occurs before puberty i.e. before the onset of menarche, during pregnancy, during lactation and after menopause. Pathological amenorrhea occurs when there is some associated disease and it is subdivided into cryptomenorrhea, primary amenorrhea, and secondary amenorrhea.
Cryptomenorrhea- There occurs periodic endometrial shedding and bleeding but the menstrual blood fails to come out of the vagina due to some obstruction in the passage, commonest cause of obstruction being imperforate hymen.
Primary amenorrhea
The normal upper age limit for menarche is 15 years. A girl who fails to have menstrual periods by the age of 16 years is no more delayed menarche, and is identified as a case of primary amenorrhea. The causes may be developmental anomalies like absence of vagina, chromosomal abnormalities like Turner’s syndrome, thyroid and adrenal dysfunction.
Secondary amenorrhea
It is the absence of menstruation in a woman for 6 months or more in whom normal menstruation has already been established. Some of the causes are tubercular endometriosis, polycystic ovarian disease, tumors of ovaries, stress, hypothyroidism, malnutrition, diabetes etc.
Polycystic Ovarian Syndrome (PCOS) : PCOS is the most common problem amongst young girls in this era. Stressful and sedentary lifestyles are the major reasons. It is a syndrome marked by amenorrhea, hirsutism, and obesity associated with enlarged ovaries having multiple cysts.
It is characterized by excessive testosterone production by ovaries mainly. Ovaries are enlarged and there occurs presence of multiple follicular cysts measuring 2-9 mm in diameter. Patients complain of increasing obesity especially abdominal obesity, menstrual abnormalities, infertility, presence of hirsutism and acne. The patients also develop insulin resistance and are more prone to diabetes.
Fibroids are the most common benign tumor of the uterus and also the most common solid benign tumor in a female. At least, twenty percent of the women at the age of thirty have fibroids in their wombs. Fortunately, most of them (fifty percent) remain asymptomatic. These are more common in women who have no children or in women who became infertile after one child. The prevalence is highest between 35-45 years of age.
Symptoms include heavy menstrual bleeding, irregular bleeding, dysmenorrhea, and infertility, and painful sexual intercourse, recurrent pregnancy loss in the form of miscarriage or pre-term labor, lower abdominal or pelvic pain, and abdominal enlargement.
Endometriosis
refers to a condition where the lining of the uterus (endometrium) is present in abnormal sites such as the muscle layer of the uterus, ovaries, tubes and occasionally beyond the pelvis. Symptoms include painful periods, painful sex, excessive vaginal bleeding during and in between periods, infertility, and nausea, diarrhea or constipation, migraine and tiredness during periods.
Pelvic Inflammatory Disease :
It is a disease of upper genital tract. It is a spectrum of infection and inflammation of the upper genital tract organs typically involving the uterus, fallopian tubes, pelvic peritoneum, and surrounding structures. It constitutes a health hazard both in the developed and developing countries. It is a major problem in the reproductive health of young women.
Vaginitis : It is the infection and inflammation of vagina. It is very common during childhood, as there is lack of estrogen, estrogenic vaginal defense is lost, and infection occurs easily. The most common cause of vaginitis during reproductive age group is infection by microscopic organisms.
Trichomonas vaginitis
is caused by organism Trichomonas vaginalis. There is sudden profuse and offensive vaginal discharge, irritation, and itching around vagina, painful urination, and increased frequency of urination. The discharge is thin, greenish-yellow, and frothy with a very bad odor. Treatment is tablet metronidazole 200 mg thrice daily given for one week.
Candida vaginitis
or moniliasis is caused by organism Candida albicans. There is vaginal discharge with severely intense vulvovaginal itching and painful sexual intercourse. The discharge is thick, curdy white in color and in flakes, often adherent to vaginal wall.
Menopause is permanent ceasation of menstruation at the end of reproductive life due to loss of ovarian activity. It is confirmed following stoppage of menstruation for twelve consecutive months without any other pathology. The age of menopause ranges between 45-55 years.
Following menopause, the organs of the reproductive system shrink in size; there is loss of bone mass by about 3-5% per year. The women become susceptible to osteoporosis. Risk of cardiovascular disease is high in postmenopausal women. The characteristic symptom of menopause is hot flushes. Hot flush is characterized by sudden feeling of heat followed by profuse sweating. There may be anxiety, headache, insomnia, irritability, and depression.
Other symptoms include painful sexual intercourse, lack of sexual drive, vaginal infections and dryness, painful urination, stress incontinence, and recurrent urinary tract infections. All these changes occur due to estrogen deficiency following menopause.
Leucorrhea
is strictly defined as an excessive normal vaginal discharge. This means that the white discharge is excessive but is not infective. The excess secretion is evident from staining of the undergarments (brownish yellow on drying) or the need to wear a pad. It is non-infective and does not have a bad odor.
It is nonirritant and does not cause itching. It may occur physiologically during puberty, ovulation and around the date of menstrual cycle. It also occurs during pregnancy and sexual excitement. It also occurs in cases of prolapsed uterus, retroverted uterus, chronic pelvic inflammation and oral contraceptive pill use.
Painful sexual intercourse : Painful sexual intercourse also called as dyspareunia means that the coital act is difficult or painful. Dyspareunia is the most common sexual dysfunction. Causes may be narrow vagina, tough hymen, vulval infection, urethral disease, vaginitis, endometriosis, pelvic inflammatory disease etc.
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