Diseases and Disorders of the Female Reproductive System

Women are commonly dealing with many different diseases and disorders that pertain to the reproductive system. Here are some of the most common:

  1. Vulvovaginitis (pronounced:vul-vo-vah-juh-ni-tus) is an inflammation of the vulva and vagina. It may be caused by irritating substances such as laundry soap, bubble baths or poor hygiene such as wiping from back to front. Symptoms include redness and itching in these areas and sometimes vaginal discharge. It can also be caused by an overgrowth of candida, a fungus normally present in the vagina.
  2. Nonmenstrual vaginal bleeding is most commonly due to the presence of a foreign body in the vagina. It may also be due to urethral prolapse, a condition in which the mucous membranes of the urethra protrude into the vagina and forms a tiny, donut shaped mass of tissue that bleeds easily. It can also be due to a straddle injury or vaginal trauma from sexual abuse.
  3. Ectopic Pregnancy occurs when a fertilized egg or zygote doesn't travel into the uterus, but instead grows rapidly in the fallopian tube. Women with this condition can develop severe abdominal pain and should see a doctor because surgery may be necessary.
  4. Ovarian tumors,although rare, can occur. Women with ovarian tumors may have abdominal pain and masses that can be felt in the abdomen. Surgery may be needed to remove the tumor.
  5. Ovarian cysts are noncancerous sacs filled with fluid or semi-solid material. Although they are common and generally harmless, they can become a problem if they grow very large. Large cysts may push on surrounding organs, causing abdominal pain. In most cases, cysts will pass or disappear on their own and treatment is not necessary. If the cysts are painful and occur frequently, a doctor may prescribe birth control pills to alter their growth and occurrences. Surgery is also an option if they need to be removed.
  6. Polycystic ovary syndrome is a hormone disorder in which too many hormones are produced by the ovaries. This condition causes the ovaries to become enlarged and develop many fluid filled sacs or cysts. It often first appears during the teen years. Depending on the type and the severity of the condition, it may be treated with drugs to regulate hormone balance and menstruation.
  7. Trichomonas vaginalis inflammatory condition of the vagina usually a bacterial infection also called vaginosis.
  8. Dysmenorrhea is painful periods.
  9. Menorrhagia is when a woman has very heavy periods with excess bleeding.
  10. Oligomenorrhea is when a woman misses or has infrequent periods, even though she has been menstruating for a while and is not pregnant.
  11. Amenorrhea is when a girl has not started her period by the time she is 16 years old or 3 years after puberty has started, has not developed signs of puberty by 14, or has had normal periods but has stopped menstruating for some reasons other than pregnancy.
  12. Toxic shock syndrome is caused by toxins released into the body during a type of bacterial infection that is more likely to develop if a tampon is left in too long. It can produce high fever, diarrhea, vomiting, and shock.
  13. Candidasis symptoms of yeast infections include itching, burning and discharge. Yeast organisms are always present in all people, but are usually prevented from "overgrowth" (uncontrolled multiplication resulting in symptoms) by naturally occurring microorganisms.

At least three quarters of all women will experience candidiasis at some point in their lives. The Candida albicans organism is found in the vaginas of almost all women and normally causes no problems. However, when it gets out of balance with the other "normal flora," such as lactobacilli (which can also be harmed by using douches), an overgrowth of yeast can result in noticeable symptoms. Pregnancy, the use of oral contraceptives, engaging in vaginal sex after anal sex in an unhygienic manner, and using lubricants containing glycerin have been found to be causally related to yeast infections. Diabetes mellitus and the use of antibiotics are also linked to an increased incidence of yeast infections. Candidiasis can be sexually transmitted between partners. Diet has been found to be the cause in some animals. Hormone Replacement Therapy and Infertility Treatment may be factors.

There are also cancer's of the female reproductive system, such as:

  1. Cervical cancer
  2. Ovarian cancer
  3. Uterine cancer
  4. Breast cancer

Medical terminology of various female diseases of the pelvis and the genitals:



Following diseases and conditions are described in details below.

1. Cervical dysplasia

2. Birth Control

3. Sexually transmitted diseases.

4.Endometriosis

5.Infertility

6.Menopause

7.Vaginal discharge or leucorrhoea




Cervical dysplasia

Introduction:

Cervical dysplasia is a condition characterized by the abnormal growth of cells on the surface of the cervix, indicating either precancerous or cancerous cells. The condition is classified as low-grade or high-grade, depending on the extent of the abnormal cell growth. Low-grade cervical dysplasia progresses very slowly and typically resolves on its own. High-grade cervical dysplasia can lead to cervical cancer. Without treatment, 30 - 50% of cases of severe cervical dysplasia progress to invasive cancer. The risk of cancer is lower for mild dysplasia. Currently, 11% of U.S. women report that they do not have regular cervical cancer screenings.

Signs and Symptoms:

Cervical dysplasia often produces no symptoms and is usually discovered during an annual Pap smear.

Occasional signs and symptoms of the condition can include:

  • Genital warts
  • Abnormal bleeding
  • Spotting after intercourse
  • Vaginal discharge
  • Low back pain

It is important to note that these symptoms are not unique to cervical dysplasia and they may indicate a different problem. If you are experiencing any of these signs or symptoms, you should see your doctor for an accurate diagnosis.

Causes:

The precise cause of cervical dysplasia is not known. Studies have found a strong association between cervical dysplasia and infection with human papillomavirus (HPV), but additional factors (still unknown) must also be at play in order for cervical cells to change and become precancerous.

Risk Factors:

The following may increase an individual's risk for developing cervical dysplasia:

  • Human papillomavirus (HPV) infection
  • Genital warts
  • Smoking
  • Early onset of sexual activity (younger than 18 years old)
  • Giving birth before age 16
  • Multiple sexual partners
  • Having a partner whose former partner had cervical cancer
  • History of one or more sexually transmitted diseases, such as genital herpes or HIV
  • Having suppressed immune function from, for example, HIV or the use of chemotherapeutic medications to treat cancer
  • Long-term use (5 or more years) of birth control pills
  • Being born to a mother who took diethylstilbestrol (DES) to become pregnant or to sustain pregnancy (this drug was used many years ago to promote pregnancy but it is no longer used for these purposes)
  • Low levels of folate (vitamin B9) in red blood cells
  • Dietary deficiencies in vitamin A, beta-carotene, selenium, vitamin E, and vitamin C (scientific data is not entirely conclusive at this time; see section on Nutrition and Dietary Supplements)

Diagnosis:

If any of the symptoms mentioned earlier are present, the physician will perform a physical, including an abdominal, back, and pelvic examination. As part of the pelvic exam, a Pap smear will be performed to detect precancerous or cancerous cells in the cervix. A Pap smear is also performed annually for screening purposes even when no symptoms are present. This test may be performed more or less often than once a year, depending on your individual medical history and risk factors for cervical cancer. For example, a woman who has had abnormal Pap smears in the past may need more tests than a woman who has always had normal Pap smears. But, if you have had normal pap smears 3 years in a row and you are over age 30, your doctor may perform a pap smear test only every 2 - 3 years, and only when your doctor suggests it is safe to wait that long between tests. If there are any questionable or unclear results from the Pap smear, a gynecologist will perform one of the following tests:

  • Colposcopy -- Colposcopy is a procedure in which the physician uses a viewing tube with a magnifying lens to examine the abnormal cell growth in the cervix.
  • Biopsy -- Biopsy is when a small sample of tissue is removed from the cervix and examined under a microscope for any signs of cancer.

Preventive Care:

While there is no established strategy for preventing cervical dysplasia, regular Pap smears are the most effective and reliable method of identifying the condition in its early stages. Such early detection is key to preventing the condition from progressing to cervical cancer. Women should begin receiving annual Pap smears as soon as they become sexually active or no later than age 21. Women whose mothers took DES during pregnancy are advised to begin regular Pap smears at age 14, at the onset of their first menstrual period, or as soon as they become sexually active, whichever comes first.

Barrier contraceptives, such as condoms, may offer some degree of protection from cervical dysplasia.

The FDA has approved a vaccine, Gardasil, for human papillomavirus (HPV) for females 9 - 26 years of age to prevent cervical cancer. The Center for Disease Control' s National Immunization Program (NIP) and the federal Advisory Committee on Immunization Practices have recommended the use of the vaccine. Although the vaccine could prevent up to 70% of cervical cancer cases, it cannot prevent infection with every virus that causes cervical cancer. Routine Pap tests to screen for cervical cancer remain very important.

Some lifestyle modifications may also help prevent the development of cervical dysplasia:

  • Practicing safe sex
  • Not smoking
  • Eating a diet rich in beta-carotene, vitamin C, and folate (vitamin B9) from fruits and vegetables. Cruciferous vegetables, such as cabbage, cauliflower, and broccoli, are especially important in preventing cancers such as cervical cancer.

Treatment Approach:

An important consideration in deciding whether or not to treat cervical dysplasia is how the treatment may affect future fertility. There are no good studies investigating infertility after treatment for cervical dysplasia, but there is some evidence of increased risk of preterm delivery among pregnant women. Surgical removal of abnormal tissue is still the treatment of choice for cervical dysplasia. Medications are not used to treat cervical dysplasia, and few complementary or alternative therapies have been evaluated for their effectiveness in treating the condition. Several studies indicate, however, that the development and progression of cervical dysplasia may be related to certain nutritional deficiencies, including folate, beta-carotene, and vitamin C.

Medications

Medications are not used to treat cervical dysplasia.

Surgery and Other Procedures

Surgical removal of abnormal tissue is the most common method of treating cervical dysplasia. Ninety percent of these procedures can be done in an outpatient setting. These procedures include:

  • Cryocauterization -- Cryocauterization uses extreme cold to destroy abnormal cervical tissue. This is the simplest and safest procedure, and it usually destroys 99% of the abnormal tissue. Cryocauterization is frequently performed without anesthesia.
  • Laser therapy -- Lasers destroy abnormal cervical tissue with less scarring than cryocauterization. Lasers are more costly than cryocauterization, are performed with local anesthesia, and have a 90% cure rate.
  • Loop electrosurgical excision (LEEP) -- During a LEEP, a thin loop wire excises visible patches of abnormal cervical tissue. LEEP is performed with local anesthesia and has a 90% cure rate.
  • Cervical conization -- During a cervical conization, a small cone-shaped sample of abnormal tissue is removed from the cervix. Cervical conization requires general anesthesia and has a 70 - 98% cure rate, depending on whether cancer cells have spread beyond the cervix.

Nutrition and Dietary Supplements

Following these nutritional tips may help reduce the chances of developing cervical dysplasia, however, any nutritional interventions should be cleared by your doctor. Some nutrients can interfere with certain medications and procedures.

  • Eat calcium rich foods, including beans, almonds, and dark green leafy vegetables (such as spinach and kale).
  • Eat more cruciferous vegetables, such as cabbage, broccoli, and cauliflower.
  • Eat antioxidant rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
  • Avoid refined foods such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy is present), or beans for protein.
  • Use healthy cooking oils, such as olive oil or vegetable oil.
  • Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
  • Avoid coffee and other stimulants, alcohol, and tobacco.
  • Drink 6 - 8 glasses of filtered water daily.
  • Exercise moderately, for 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

  • Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil daily, to help decrease inflammation and improve general health.
  • A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium. Folic acid is important in preventing cervical dysplasia and should be part of a multivitamin supplement.
  • Digestive enzymes, 1 - 2 tablets 3 times daily with meals.
  • Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
  • N-acetyl cysteine, 200 mg daily, for antioxidant effects.
  • Acidophilus (Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) daily, when needed for maintenance of gastrointestinal and immune health.
  • Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) 3 times daily, for antibacterial/antifungal activity, gastrointestinal health and immunity.
  • Methylsulfonylmethane (MSM), 3,000 mg twice a day, to help decrease inflammation.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

  • Green tea (Camelia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. You may also prepare teas from the leaf of this herb.
  • Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for inflammation, immune and antibacterial/antifungal activity.
  • Bromelain (Ananus comosus) standardized extract, 40 mg 3 times daily, for pain and inflammation.
  • Turmeric (Curcuma longa) standardized extract, 300 mg 3 times a day, for inflammation. May increase bleeding time so if you are using blood thinning medication, talk to your doctor before using turmeric.
  • Reishi mushroom (Ganoderma lucidum), 150 - 300 mg 2 - 3 times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops 2 - 3 times a day.

Several population-based studies suggest that eating a diet rich in the following nutrients from fruits and vegetables may protect against the development of cervical cancer:

Beta-carotene

Some controversial clinical studies suggest that individuals deficient in beta-carotene may be more likely to develop cancerous or precancerous cervical lesions, but this relationship remains inconclusive. Other studies indicate that oral supplementation with beta-carotene may promote a decline in the signs of cervical dysplasia. Despite these promising results, the benefit of using beta-carotene supplements to prevent the development of cervical dysplasia or cervical cancer has not been proven.

Supplemental beta-carotene may increase the risk of lung cancer, prostate cancer, intracerebral hemorrhage, and cardiovascular and total mortality in people who smoke cigarettes or have a history of high-level exposure to asbestos. Beta-carotene from foods does not seem to have this effect.

Folate (Vitamin B9)

Like beta-carotene, some evidence suggests that folate (also known as vitamin B9) deficiencies may contribute to the development of cancerous or precancerous lesions in the cervix. Researchers also theorize that folate consumed in the diet may improve the cellular changes seen in cervical dysplasia by lowering homocysteine (a substance believed to contribute to the severity of cervical dysplasia) levels. The benefit of using dietary folate to prevent or treat cervical dysplasia has not been sufficiently proven.

Castor Oil Packs

Dampen a cloth with castor oil and apply to the abdomen. Cover with saran wrap and then apply a heating pad over this pack. Used for 1 - 3 hours, castor oil packs can reduce cramping and pain in some patients.

Other Considerations:

Pregnancy

  • Cases of cervical dysplasia may advance during pregnancy, but treatment can generally be deferred until after delivery.
  • A biopsy to diagnose cervical dysplasia is safe to perform during pregnancy.
  • Treatment with cervical conization may adversely affect fertility.

Prognosis and Complications

Pap smears are essential to detecting precancerous lesions as well as early stages of cervical cancer. The regular use of Pap smears as a screening test has prevented millions of cases of cervical cancer and has saved a similar number of lives. Despite their value, they are not always 100% accurate. Up to 2% of women with normal Pap smear results actually have high-grade cervical dysplasia at the time of evaluation. In some rare cases, Pap smears may produce "false positive" results, meaning that a healthy woman may be falsely diagnosed with cervical dysplasia. Despite these errors, Pap smears are the most effective and reliable method of identifying cervical dysplasia.

Cervical cancer, a major complication of cervical dysplasia, is the leading cause of death in many developing and poorer countries and accounts for 4,800 deaths in the United States every year. Most cervical cancer deaths occur in women who have not had a Pap smear. Cervical cancer constitutes more than 10% of cancers worldwide, and it is the second leading cause of death in women between the ages of 15 - 34.

With early identification, treatment, and consistent follow-up, nearly all cases of cervical dysplasia can be cured. Without treatment, many cervical dysplasia cases progress to cancer. Women who have been treated for cervical dysplasia have a lifetime risk for recurrence and malignancy. Fortunately, while the incidence of cervical dysplasia has been on the rise, the incidence of cervical cancer has declined dramatically. This may be due to improved screening techniques, which identify cases of cervical dysplasia in the early stages, before they have progressed to cancer.

Types of Birth Control

Birth control is a regimen of one or more actions, devices, or medications followed in order to deliberately prevent or reduce the likelihood of a woman becoming pregnant. Methods and intentions typically termed birth control may be considered a pivotal ingredient to family planning. Mechanisms which are intended to reduce the likelihood of the fertilization of an ovum by a sperm may more specifically be referred to as contraception. Contraception differs from abortion in that the former prevents fertilization, while the latter terminates an already established pregnancy. Methods of birth control which may prevent the implantation of an embryo if fertilization occurs are medically considered to be contraception. It is advised to talk with a doctor before choosing a contraceptive. If you have genetics problems or blood conditions, such as factor V leiden, certain contraceptives can be deadly.

TypeProcedureMethodEffectivenessRisks
AbstinenceRefrain from sexual intercourseNo sperm in vagina100%None
Rhythm MethodIntercourse is avoided for about an 8-day span every month in middle of her cycle, from about five days before ovulation to three days after ovulation.fertilization is only possible during 8-day span in middle of menstrual cycle70-80%None
WithdrawalThe man withdraws his penis from the vagina at just the right moment before ejaculation.sperm are unable to enter vagina if male penis is removed at the right time70-80%None
Tubal Ligation (tubectomy)Oviducts are cut and tiedNo eggs in oviductAlmost 99%About 75% Irreversible
Hormonal IUD (intrauterine device)Flexible, plastic coil inserted by physicianReleases small amounts of progesterons. In most cases, stops egg from developing and being releasedAbout 99%May cause infections, uterine perforation
Oral ContraceptiveHormone medication taken dailyStops release of FSH and LHMore than 90%Blood clots, especially in smokers
Contraceptive ImplantsTubes of progesterone implanted under the skinStops release of FSH and LHMore than 90%None known
Contraceptive InjectionsInjections of hormonesStops release of FSH and LHAbout 99%Possible osteoporosis
DiaphragmLatex cup inserted into vagina to cover cervix before intercourseBlocks entrance of sperm into uterusWith spermicide, about 90%Latex or spermicide allergy
Cervical CapLatex cup held by suction over cervixDelivers spermicide near cervixAlmost 85%UTI, latex or spermicide allergy
Female CondomPolyurethane liner fitted inside vaginaBlocks entrance of sperm into uterus and prevents STD’sAlmost 85%None
Male Condomsoft sheath, made of latex or animal membrane, encloses penis, trapping ejaculated spermBlocks entrance of sperm into vagina and prevents STD's90%None
Jellies, Cream, FoamsSpermicidal products inserted before intercourseKills large number of spermAbout 75%UTI, allergy to spermicides
Natural Family PlanningKeep record of ovulation using various methodsAvoid sexual intercourse near ovulationAbout 70%None known
DoucheVagina cleansed after intercourseWashes out spermLess than 70%None known
Plan B PillPill taken after intercoursePrevents release of egg, fertilization of egg, or egg from attaching to uterusAbout 89%Same as oral contraceptive


Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are diseases or infections that have a significant probability of transmission between humans by means of sexual contact: vaginal intercourse, oral sex, and/or anal sex. Many STDs are (more easily) transmitted through the mucous membranes of the penis, vulva, and (less often) the mouth. The visible membrane covering the head of the penis is a mucous membrane, though, for those who are circumcised it is usually dry and produces no mucus (similar to the lips of the mouth). Mucous membranes differ from skin in that they allow certain pathogens (viruses or bacteria) into the body (more easily).

The probability of transmitting infections through sex is far greater than by more casual means of transmission, such as non-sexual contact—touching, sharing cutlery, and shaking hands. Although mucous membranes exist in the mouth as well as in the genitals, many STDs are more likely to be transmitted through oral sex than through deep kissing. Many infections that are easily transmitted from the mouth to the genitals or from the genitals to the mouth, are much harder to transmit from one mouth to another. With HIV, genital fluids happen to contain a great deal more of the pathogen than saliva. Some infections labeled as STDs can be transmitted by direct skin contact. Herpes simplex and HPV are both examples. Depending on the STD, a person who has has the disease but has no symptoms may or may not be able to spread the infection. For example, a person is much more likely to spread herpes infection when blisters are present than when they are absent. However, a person can spread HIV infection at any time, even if he/she has not developed symptoms of AIDS.

All sexual behaviors that involve contact with the bodily fluids of another person should be considered to hold some risk of transmission of sexually transmitted diseases. Most attention has focused on controlling HIV, which causes AIDS, but each STD presents a different situation.

As may be noted from the name, sexually transmitted diseases are transmitted from one person to another by certain sexual activities rather than being actually caused by those sexual activities. Bacteria, fungi, protozoa or viruses are still the causative agents. It is not possible to catch any sexually transmitted disease from a sexual activity with a person who is not carrying a disease; conversely, a person who has an STD received it from contact (sexual or otherwise) with someone who is infected.

Although the likelihood of transmitting diseases by sexual activities varies a great deal, in general, all sexual activities between two (or more) people should be considered as being a two-way route for the transmission of STDs (i.e. "giving" or "receiving" are both risky).

Prevention of Sexually Transmitted Diseases

Although healthcare professionals suggest that safer sex, such as the use of condoms, as the most reliable way of decreasing the risk of contracting sexually transmitted diseases during sexual activity, safer sex should by no means be considered an absolute safeguard. The transfer of and exposure to bodily fluids, such as blood transfusions and other blood products, sharing injection needles, needle-stick injuries (when medical staff are inadvertently jabbed or pricked with needles during medical procedures), sharing tattoo needles, and childbirth are all avenues of transmission. These means put certain groups, such as doctors, haemophiliacs and drug users, particularly at risk.


Human Papillomavirus (HPV)

There are over 100 types of this virus which is often asymptomatic. Nearly 3 out of 4 Americans between ages 15 and 49 have been infected. It can be contracted through one partner and remain dormant allowing it to be transmitted to another. Some types can cause cervical cancer.

Genital HPV infection is a sexually transmitted disease that is caused by human papillomavirus. Human papillomavirus is the name of a group of viruses that includes more than 100 different strains. More than 30 of these are sexually transmitted and they can infect the genital area of men and women. Approximately 20 million people are currently infected with HPV and at least 50% of sexually active men and women will acquire HPV at some point in their lives. By age 50 at least 80% of women will have acquired HPV and about 6.2 million Americans get a new HPV infection each year. Most people who have HPV don't know that they are infected. The virus lives in the skin or mucous membranes and usually causes no symptoms. Commonly some people get visible genital warts or have pre-cancerous changes in the cervix, vulva, anus, or penis. Very rarely, HPV results in anal or genital cancers. Genital warts usually appear soft, moist, pink, or flesh colored swellings. They can be raised, flat, single, or multiple, small or large and sometimes cauliflower shaped. Warts may not appear for weeks or months or not at all and the only way to diagnose them is by visible inspection. Most women are diagnosed with HPV on the basis of abnormal pap tests and there are no tests available for men. There is no cure for HPV. The surest way to eliminate risk for HPV is to refrain from any genital contact with another individual. For those who choose to be sexually active, a long term monogamous relationship with an uninfected partner is the strategy most likely to prevent future HPV infections.The next best way to help reduce risk is using a condom but the effectiveness is unknown.

What is the connection between HPV and cervical cancer? All types of HPV cause mild pap test abnormalities which do not have serious consequences. Approximately 10 of the 30 identified HPV types can lead to development of cervical cancer. Research as shown that for most women, 90% cervical HPV infection becomes undetectable within two years. Although only a small proportion of women have persistent infection, persistent infection with the high risk types of HPV is the main risk factor for cervical cancer.

A pap test can detect pre-cancerous and cancerous cells on the cervix. Regular pap testing and careful medical follow up, with treatment if necessary, can help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop into life threatening cervical cancer. The pap test used in the U.S. cervical cancer screening programs is responsible for greatly reducing deaths from cervical cancer.



Endometriosis

Endometriosis is the most common gynecological diseases, affecting more than 5.5 million women in North America alone! The two most common symptoms are pain and infertility. In this disease a specialized type of tissue that normally lines the inside of the uterus,(the endometrium) becomes implanted outside the uterus, most commonly on the fallopian tubes, ovaries, or the tissue lining the pelvis. During the menstrual cycle, hormones signal the lining of the uterus to thicken to prepare for possible pregnancy. If a pregnancy doesn't occur, the hormone levels decrease, causing the thickened lining to shed.

When endometrial tissue is located in other parts it continues to act in it's normal way: It thickens, breaks down and bleeds each month as the hormone levels rise and fall. However, because there's nowhere for the blood from this mislocated tissue to exit the body, it becomes trapped and surrounding tissue becomes irritated. Trapped blood may lead to growth of cysts. Cysts in turn may form scar tissue and adhesions. This causes pain in the area of the misplaced tissue, usually the pelvis. Endometriosis can cause fertility problems. In fact, scars and adhesions on the ovaries or fallopian tubes can prevent pregnancy. Endometriosis can be mild, moderate or severe and tends to get worse over time without treatment. The most common symptoms are:

  1. Painful periods Pelvic pain and severe cramping, intense back pain and abdominal pain.
  2. Pain at other times Women may experience pelvic pain during ovulation, sharp deep pain in pelvis during intercourse, or pain during bowel movements or urination.
  3. Excessive bleeding Heavy periods or bleeding between periods.
  4. Infertility Approximately 30-40% of women

The cause of endometriosis remains mysterious. Scientists are studying the roles that hormones and the immune system play in this condition. One theory holds that menstrual blood containing endometrial cells flows back through the fallopian tubes, takes root and grows. Another hypothesis proposes that the bloodstream carries endometrial cells to other sites in the body. Still another theory speculates that a predisposition toward endometriosis may be carried in the genes of certain families.

Other researchers believe that certain cells present within the abdomen in some women retain their ability to specialize into endometrial cells. These same cells were responsible for the growth of the woman's reproductive organs when she was an embryo. It is believed that genetic or environmental influences in later life allow these cells to give rise to endometrial tissue outside the uterus.

Experts estimate that up to one in ten American women of childbearing age have endometriosis. There is some thinking that previous damage to cells that line the pelvis can lead to endometriosis. There are several ways to diagnose endometriosis:

  1. Pelvic exam
  2. Ultrasound
  3. Laparoscopy Usually used, most correct diagnosis
  4. Blood test

Endometriosis can be treated with:

  1. Pain medication
  2. Hormone therapy
    1. Oral contraceptives
    2. Gonadotropin-releasing hormone(Gn-Rh)agonists and antagonists
    3. Danazol(Danocrine)
    4. Medroxyprogesterone(Depo-Provera)
  3. Conservative surgery which removes endometrial growths.
  4. Hysterectomy

Infertility

Infertility is the inability to naturally conceive a child or the inability to carry a pregnancy to term. There are many reasons why a couple may not be able to conceive without medical assistance. Infertility affects approximately 15% of couples. Roughly 40% of cases involve a male contribution or factor, 40% involve a female factor, and the remaining 20% involve both sexes. Healthy couples in their mid-20s having regular sex have a one-in-four chance of getting pregnant in any given month. This is called "Fecundity".

Primary vs. secondary

According to the American Society for Reproductive Medicine, infertility affects about 6.1 million people in the United States, equivalent to 10% of the reproductive age population. Female infertility accounts for one third of infertility cases, male infertility for another third, combined male and female infertility for another 15%, and the remainder of cases are "unexplained.

"Secondary infertility" is difficulty conceiving after already having conceived and carried a normal pregnancy. Apart from various medical conditions (e.g. hormonal), this may come as a result of age and stress felt to provide a sibling for their first child. Technically, secondary infertility is not present if there has been a change of partners.

Factors of Infertility

Factors relating to female infertility are:

  • General factors
    • Diabetes mellitus,thyroid disorders,adrenal disease
    • Significant liver,kidney disease
    • Psychological factors
  • Hypothalamic-pituitary factors:
    • Kallmann syndrome
    • Hypothalamic dysfunction
    • Hyperprolactinemia
    • Hypopituitarism
  • Ovarian factors
    • Polycystic ovary syndrome
    • Anovulation
    • Diminished ovarian reserve
    • Luteal dysfunction
    • Premature menopause
    • Gonadal dysgenesis (Turner syndrome)
    • Ovarian neoplasm
  • Tubal/peritoneal factors
    • Endometriosis
    • Pelvic adhesions
    • Pelvic inflammatory disease(PID, usually due to chlamydia)
    • Tubal occlusion
  • Uterine factors
    • Uterine malformations
    • Uterine fibroids (leiomyoma)
    • Asherman's Syndrome
  • Cervical factors
    • Cervical stenosis
    • Antisperm antibodies
    • Insufficient cervical mucus (for the travel and survival of sperm)
  • Vaginal factors
    • Vaginismus
    • Vaginal obstruction
  • Genetic factors
    • Various intersexuality|intersexed conditions, such as androgen insensitivity syndrome.

Combined Infertility

In some cases, both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these factors. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance.

Unexplained Infertility

In about 15% of cases of infertility, investigation will show no abnormalities. In these cases abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilization, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized that egg quality is of critical importance.

[edit]Diagnosis of Infertility

Diagnosis of infertility begins with a medical history and physical exam. The healthcare provider may order tests, including the following:

  • hormone testing, to measure levels of female hormones
  • laparoscopy or fertiloscopy, which allows the provider to see the pelvic organs
  • ovulation testing, which detects the release of an egg from the ovary blod test.
  • Pap smear and Chlamydia test, to check for signs of infection or dysplasia
  • pelvic exam, to look for abnormalities or infection
  • Tubal patency test by ultrasound or special X ray examination called HSG.
  • Sperm examination.


Treatment

  • Fertility medication which stimulates the ovaries to "ripen" and release eggs (e.g. Clomifene|clomifene citrate,FSH, LH which stimulates ovulation)
  • Surgery to restore potency of obstructed fallopian tubes (tuboplasty)
  • Donor insemination which involves the woman being artificially inseminated or artificially inseminated with donor sperm.
  • In vitro fertilization (IVF) in which eggs are removed from the woman, fertilized and then placed in the woman's uterus, bypassing the fallopian tubes. Variations on IVF include:
    • Use of donor eggs and/or sperm in IVF. This happens when a couple's eggs and/or sperm are unusable, or to avoid passing on a genetic disease.
    • Intracytoplasmic sperm injection (ICSI) in which a single sperm is injected directly into an egg; the fertilized egg is then placed in the woman's uterus as in IVF.
    • Zygote intrafallopian transfer(ZIFT) in which eggs are removed from the woman, fertilized and then placed in the woman's fallopian tubes rather than the uterus.
    • Gamete intrafallopian transfer(GIFT) in which eggs are removed from the woman, and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilization to take place inside the woman's body.
  • Other assisted reproductive technology (ART):
    • Assisted hatching
    • Fertility preservation
    • Freezing (cryopreservation) of sperm, eggs, & reproductive tissue
    • Frozen embryo transfer (FET)
  • Alternative and complimentary treatments
    • Acupuncture Recent controlled trials published in Fertility and Sterility have shown acupuncture to increase the success rate of IVF by as much as 60%. Acupuncture was also reported to be effective in the treatment of female anovular infertility, World Health Organization, Acupuncture: Review and Analysis of Reports on Controlled Trials (2002).
    • Diet and supplements
    • Healthy lifestyle


Menopause

 Menopause is the transition period in a woman's life when her ovaries stop producing eggs, her body produces less estrogen and progesterone, and menstruation becomes less frequent, eventually stopping altogether.

Causes

Menopause is a natural event that normally occurs between the ages of 45 and 55.

Once menopause is complete (called postmenopause) and you have not had a period for 1 year, you are no longer at risk of becoming pregnant.

The symptoms of menopause are caused by changes in estrogen and progesterone levels. The ovaries make less of these hormones over time. The specific symptoms and how significant (mild, moderate, or severe) they are varies from woman to woman.

A gradual decrease of estrogen generally allows your body to slowly adjust to the hormonal changes. Hot flashes and sweats are at their worst for the first 1 - 2 years. Menopause may last 5 or more years.

Estrogen levels may drop suddenly after some medical treatments, as is seen when the ovaries are removed surgically (called surgical menopause). Chemotherapy and anti-estrogen treatment for breast cancer are other examples. Symptoms can be more severe and start more suddenly in these circumstances.

As a result of the fall in hormone levels, changes occur in the entire female reproductive system. The vaginal walls become less elastic and thinner. The vagina becomes shorter. Lubricating secretions from the vagina become watery. The outside genital tissue thins. This is called atrophy of the labia.


Symptoms »

In some women, menstrual flow comes to a sudden halt. More commonly, it slowly stops over time. During this time, the menstrual periods generally become either more closely or more widely spaced. This irregularity may last for 1 - 3 years before menstruation finally ends completely. Before this the cycle length may shorten to as little as every 3 weeks.

Common symptoms of menopause include:

  • Heart pounding or racing
  • Hot flashes
  • Night sweats
  • Skin flushing
  • Sleeping problems (insomnia)

Other symptoms of menopause may include:

  • Decreased interest in sex, possibly decreased response to sexual stimulation
  • Forgetfulness (in some women)
  • Irregular menstrual periods
  • Mood swings including irritability, depression, and anxiety
  • Urine leakage
  • Vaginal dryness and painful sexual intercourse
  • Vaginal infections
  • Joint aches and pains
  • Irregular heartbeat (palpitations)

Exams and Tests

Blood and urine tests can be used to measure changes in hormone levels that may signal when a woman is close to menopause or has already gone through menopause. Examples of these tests include:

A pelvic exam may indicate changes in the vaginal lining caused by declining estrogen levels. The doctor may perform a bone density test to screen for low bone density levels that occur with osteoporosis.

Treatment

Treatment with hormones may be helpful if you have severe symptoms such as hot flashes, night sweats, mood issues, or vaginal dryness.

Discuss the decision to take hormones thoroughly with your doctor, weighing your risks against any possible benefits. Pay careful attention to the many options currently available to you that do not involve taking hormones. Every woman is different. Your doctor should be aware of your entire medical history when considering prescribing hormone therapy.

If you have a uterus and decide to take estrogen, you must also take progesterone to prevent endometrial cancer (cancer of the lining of the uterus). If you do not have a uterus, progesterone is not necessary.

HORMONE THERAPY

Several major studies have questioned the health benefits and risks of hormone replacement therapy, including the risk of developing breast cancer, heart attacks, strokes, and blood clots.

Current guidelines support the use of HT for the treatment of hot flashes. Specific recommendations:

  • T may be started in women who have recently entered menopause.
  • HRT should not be used in women who started menopause many years ago.
  • The medicine should not be used for longer than 5 years.
  • Women taking HT should have a baseline low risk for stroke, heart disease, blood clots, or breast cancer.

To reduce the risks of estrogen therapy and still gain the benefits of the treatment, your doctor may recommend:

  • Using estrogen or progesterone regimens that do not contain the form of progesterone used in the study
  • Using a lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream rather than a pill)
  • Having frequent and regular pelvic exams and Pap smears to detect problems as early as possible
  • Having frequent and regular physical exams, including breast exams and mammograms

See also: Hormone therapy for more information about taking hormone therapy.

ALTERNATIVES TO HT

There are some medications available to help with mood swings, hot flashes, and other symptoms. These include low doses of antidepressants such as paroxetine (Paxil), venlafaxine (Effexor), bupropion (Wellbutrin), and fluoxetine (Prozac), or clonidine, which is normally used to control high blood pressure. Gabapentin is also effective for reducing hot flashes.

LIFESTYLE CHANGES

The good news is that you can take many steps to reduce your symptoms without taking hormones:

  • Avoid caffeine, alcohol, and spicy foods
  • Dress lightly and in layers
  • Eat soy foods
  • Get adequate calcium and vitamin D in food and/or supplements
  • Get plenty of exercise
  • Perform Kegel exercises daily to strengthen the muscles of your vagina and pelvis
  • Practice slow, deep breathing whenever a hot flash starts to come on (try taking six breaths per minute)
  • Remain sexually active
  • See an acupuncture specialist
  • Try relaxation techniques such as yoga, tai chi, or meditation
  • Use water-based lubricants during sexual intercoursBack to Top

Possible Complications

Postmenopausal bleeding may occur. This bleeding is often nothing to worry about. However, your health care provider should always check any postmenopausal bleeding, because it may be an early sign of other problems, including cancer.

Decreased estrogen levels are also associated with the following long-term effects:

  • Bone loss and eventual osteoporosis in some women
  • Changes in cholesterol levels and greater risk of heart disease


When to Contact a Medical Professional

Call your health care provider if:

  • You are spotting blood between periods
  • You have had 12 consecutive months with no period and suddenly vaginal bleeding or spotting begins again


Prevention

Menopause is a natural and expected part of a woman's development and does not need to be prevented. However, there are ways to reduce or eliminate some of the symptoms of menopause.

You can reduce your risk of long-term problems such as osteoporosis and heart disease by taking the following steps:

  • Control your blood pressure, cholesterol, and other risk factors for heart disease.
  • Do NOT smoke. Cigarette use can cause early menopause.
  • Eat a low-fat diet.
  • Get regular exercise. Resistance exercises help strengthen your bones and improve your balance.
  • If you show early signs of bone loss, talk to your doctor about medications that can help stop further weakening.
  • Take calcium and vitamin D.

Vaginal discharge

Leukorrhea or leucorrhoea  is a medical term that denotes a thick, whitish or yellowish vaginal discharge.

There are many causes of leukorrhea, the usual one being estrogen imbalance. The amount of discharge may increase due to vaginal infection or STDs, in which case it becomes more yellow and foul-smelling; it is usually a non-pathological symptom secondary to inflammatory conditions of vagina or cervix.

Vaginal discharge is normal for a woman, and all women are different. Causes of change in discharge include infection, malignancy, and hormonal changes. It sometimes occurs before a girl has her first period, and is considered a sign of puberty.It can be a natural defense mechanism the vagina uses to maintain its chemical balance, as well as to preserve the flexibility of the vaginal tissue. The term "physiologic leukorrhea" is used to refer to leukorrhea due to estrogen stimulation


Physiologic leukorrhea

Leukorrhea may occur normally during pregnancy. This is caused by increased bloodflow to the vagina due to increased estrogen. Female infants may have leukorrhea for a short time after birth due to their in-uterine exposure to estrogen.

Inflammatory leukorrhea

It may also result from inflammation or congestion of the vaginal mucosa. In cases where it is yellowish or gives off an odor, a doctor should be consulted since it could be a sign of several disease processes, including an organic bacterial infection or STD.

After delivery, leukorrhea accompanied by backache and foul-smelling lochia (post-partum vaginal discharge, containing blood, mucus, and placental tissue) may suggest the failure of involution (the uterus returning to pre-pregnancy size) due to infection. Investigations: wet smearGram stain, culture, pap smear and biopsy.

( Data and pictures have been taken and modified from other websites like 
www.wikipedia.org )

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