2 - Gynae - Menstrual Cycle and its disorders - Postcoital bleeding + Dysmenorrhea

Question 1

define post coital bleed ?

when, only, is this normal? what must be r’o?

Answer 1

PV bleed post coital that isn’t menstrual
first intercourse
must r/o cervical cancer

Question 2

aetiology of PC bleed

• when is cervix more likely to bleed after mild trauma?
• 3 things accounting for most cases?
• 3 other poss causes?

Answer 2

• when not covered in healthy squamous epithelium
• cervical ectropions, benign polyps, and invasive cervical cancer
• vaginitis, cervicitis, vaginal wall bleeding, usually if atrophic

Question 3

mgmt of PC bleed. 
-1 st thing? 
-if polyp?
-if smear normal?
if not?

Answer 3

inspect cervix and take smear

if polyp - avulse and send for histo, normally w’o anaesthesia

if smear normal - ectropion can be frozen w cryotherapy

if not - colposcopy done to r’o malignancy

Question 4

what is dysmenorrhea? ass w high ? in where??? and is due to ? and uterine ?

Answer 4

painful menstruation
PG levels in endometrium
due to contraction and uterine ischaemia

Question 5

difference between 1’ and 2’ dysmenorrhea?

Answer 5

1’ - no organic cause found, usually at start of menstruation and v common (50%, 10% severe) esp in adolescents.
2’ - due to pelvic pathology. often before and is relieved by menstruation. Deep dyspareunia and HMB/IMB common

Question 6

1’ dys - mgmt?

Answer 6

usually responds to NSAIDs or ovulation suppression (COCP)
reassurance in young
pelvic pathology more likely if trt fails

Question 7

2’ dys - mgmt?

Answer 7

USS and laparoscopy useful
most significant causes:
-fibroids, adenomyosis, endometriosis, PID and ovarian tumours - trt these