63. Non-inflammatory diseases of external and internal female genital organs.

Question 1

what are the non inflammatory diseases of the female genital tract ?

Answer 1

uterus :
asherman syndrome 
endometriosis 
endometrial polyps
retroverted uterus 
dysmenorrhea 

ovarian:
ovarian cysts
pcos

external
female genital prolapse
vaginismus
vesicovaginal fistula

Question 2

what is asherman syndrome ?

Answer 2

uterine condition that occurs when scar tissue (adhesions) form inside the uterus and/or the cervix.
in many cases the front and back walls of the uterus stick to one another

Question 3

what is the cause of asherman syndrome ?

Answer 3

Trauma to the basal layer, after a dilation and curettage (D&C) performed after a miscarriage, or delivery, or for surgical termination of pregnancy

C section

myomectomy

IUD

chronic endometritis - from genital tuberculosis

Question 4

what are the signs and symptoms of asherman syndrome

Answer 4

secondary amenorrhea or

oligomenorrhoea

abnormal uterine bleeding

periodic abdominal pain due to retention of blood in the uterus

pain during menstruation or ovulation

infertility

recurrent miscarriage

Question 5

what are the complications of asherman syndrome ?

Answer 5

infertility

miscarriage

Question 6

how is asherman syndrome diagnosed ?

Answer 6

Progesterone withdrawal test: bleeding does not occur following progestin withdrawal

hysterosalpingography will reveal the extend of the scar - honeycomb appearance of uterus

hystereoscopy

Question 7

treatment for asherman syndrome ?

Answer 7

operative hysteroscopy during adhesion dissection
give antibiotic afterwards
estrogen to improve quality of uterine lining

repeat hysteroscopy check that your uterus is free from adhesions.

It’s possible for adhesions to reoccur following treatment, so doctors recommend waiting a year before trying to conceive

Question 8

what are the signs and symptoms of ovarian cysts

Answer 8

asymptomatic

tender adnexa

palpable cyst

lower abdominal pain

metrorrhagia or pain with menstruation (dysmenorrhea)

======

if PCOS -virilisation 
 infertility , 
acne ,
 obesity and metabolic syndrome 
acnathosis nigiricans 
androgenic alopecia

Question 9

what are the different types of ovarian cysts ?

Answer 9

functional cysts :
follicular cysts
corpus luteum cysts
theca lutein cysts

=========

non functional
endometriosis - choc cyst

dermoid cysts - dermoid is composed only of dermal and epidermal elements (which are both ectodermal in origin) = hair follicles, skin tissue, and glands

cystadenomas.

in polycystic ovary syndrome (PCOS) - are actually immature follicles not cysts. The follicles have developed from primordial follicles and have arrested

cysts caused by hypothyroidism

Question 10

what are the complication of ovarian cysts and their treatmnet ?

Answer 10

ruptured ovarian cyst - corpus lute cyst
= sudden onset of unilateral abdominal pain
minimal vaginal bleeding
severe hemorrhage - hypovolemic shock (rare)

Hemodynamically unstable patients: blood transfusion ringer saline
emergency exploratory laparoscopy - suturing and cauterisation
oophorectomy if only intractable hemorrhage

Hemodynamically stable patients - analgesics and monitoring

=======
ovarian torsion

Ovarian cysts, especially: 
Cysts > 5 cm
Dermoid cysts (teratoma) 

obstruction of ovarian veins - edema of fallopian tubes and ovary

worsening of the edema of fallopian tube - compression of ovarian artery - ovarian necrosis - which is uncommon because th ovaries receive dual blood supply fro ovarian and uterine artery

Sudden-onset unilateral lower abdominal and/or pelvic pain
Nausea and vomiting

in all cases - emergency laparoscopy
Oophorectomy should only be performed if the ovary is frankly necrotic or gangrenous

Ovarian cystectomy or drainage

========

infertility

========

benign cyst adenoma can develop into malignant

Question 11

diagnosis for ovarian cysts ?

Answer 11

bimanual examination
ultrasound
CT scan

to see if ruptured - culdocentesis

needle biopsy if needed to know the type of cyst

Question 12

what are the treatment for ovarian cysts

Answer 12

pcos- explained

NSAIDs or paracetamol if painful

functional cysts resolves spontaneously

Treatment for dermoid cyst is complete surgical removal

====
chocolate cysts - explained

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hypothyroidism -synthetic long-acting form of thyroxine, known as levothyroxine

Question 13

when do functional cysts occur

Answer 13

before menopause

Question 14

what is endometriosis ?

Answer 14

the endometrium tissue — seen outside your uterus.

most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis

Question 15

what are the signs and symptoms of endometriosis ?

Answer 15

Up to one-third of patients are asymptomatic.
Chronic pelvic pain that worsens before the onset of menses.
Dysmenorrhea
Pre- or postmenstrual bleeding
Dyspareunia
Infertility
Dyschezia

Question 16

cause of endometriosis?

Answer 16

Endometriosis is a heritable condition that is influenced by both genetic and environmental factors.

Retrograde menstruation

prolonged exposure to estrogen; for example, in late menopauseor early menarche

After a surgery, such as a hysterectomy or C-section, endometrial cells may attach

Question 17

a complication of endometriosis?

Answer 17

INFERTILITY

Endometriosis in the uterotubal junction - ectopic

adenomyosis

Question 18

HOW DO WE DIAGNOSE endometriosis?

Answer 18

ultrasound - identify chocolate cysts
Nodules in bladder or rectovaginal septum

laparoscopy - biopsy taken to confirm

and, once ovarian cancer has been ruled out, a positive CA-125 may confirm the diagnosis

Question 19

treatment of endometriosis?

Answer 19

pain - NSAIDS
continuous combined hormonal contraceptives

intrauterine device with levonorgestrel - progestin therapy

if severe symptoms add
gnrh agonist (buserelin)
======

if wanting to be pregnant - laparoscopic excision and ablation of endometrial tissue and cyst

gnrh agonist or IVF

=====
Second-line: open surgery with hysterectomy

Question 20

what is the cause of endometrial polyps

Answer 20

there have been no definitive cause
have been linked to grow in response to circulating estrogen

risk: hypertension
women over 40
obesity 
tamoxifen or hormone replacement therapy
lynch syndrome

Question 21

what are the symptoms of endometrial polyps ?

Answer 21

often cause no symptoms

metrorrhagia

hypermenorrhea

If the polyp protrudes through the cervix into the vagina, pain (dysmenorrhea)

infertility

Question 22

what are the diagnosis of endometrial polyps ?

Answer 22

vaginal ultrasound

hysterosalpingography

hysteroscopy- biopsy is needed

Question 23

what is the treatment of uterine polyps ?

Answer 23

waiting on small polyps resolve on their own , and also asymptomatic just need follow up observation

Polyps can be surgically removed using hysteroscopy and curettage

Question 24

complications of uterine polyps ?

Answer 24

usually benign some may become precancerous or cancerous

increase risk of misscarrge in women undergoing IVF

also in pregnancy it can cause problems with presentation

infertility if the develop near fallopian tubes

there can be torsion or necrosis of the uterine polyp which can cause acute abdomen

Question 25

what are the reasons for anterior vaginal wall prolapse ? and complications

Answer 25

cystocele - bladder into vagina
urethrocel - urethera into vagina

child birth , heavy lifting , marfan syndrome , chronic cough
wearing of the connective tissue between the vagina and bladder

urinary retention

Question 26

what are the reasons for posterior vagina wall prolapse ? and what are the complication ?

Answer 26

enterocoele - small intestine into vagina
retrocele -rectum into vagina

caused by child birth
chronic constipation
weight lifting
chronic cough in smokers and copd

defection problems

Question 27

atypical vaginal prolapsed are ?

Answer 27

uterine prolapse prolapse (childbirth , menopause loss of estrogen) - uterus into vagina

vaginal vault prolapse (roof of vagina) - after hysterectomy MAJOR PROBLEM DUE TO THE UTEROSACRAL LIGAMENT not being reattached to the vagina

Question 28

diagnosis of genital prolapse ?

Answer 28

pelvic examination

CT

Question 29

what is the management of these prolapses ?

Answer 29

non surgical - kegel excersises
pessary

surgical - colporrhaphy

Question 30

what is a retroverted uterus ?

Answer 30

a uterus that is orientated posteriorly in respect to the normal slightly anteverted uterus (towards the bladder

Question 31

what is the cause of retroverted uterus ?

Answer 31

from birth 
pelvic surgery 
pelvic adhesion
endometriosis 
endometrial fibroids 
PID
labour and child birth

Question 32

what is the diagnosis of retroverted uterus ?

Answer 32

routine pelvic examination

TVS ultrasound

Question 33

what are the symptoms of of retroverted uterus ?

Answer 33

usually no symptoms pain with sexual intercurse

dysmenorrhea, intestinal problems

Question 34

what is the treatment fro retroverted uterus

Answer 34

treatment rarely needed

kegel excercises,

vaginal pessary ,

laparoscopic
reposition

Question 35

what is vaginismus ?

Answer 35

condition in which involuntary muscle spasm prevents vaginal penetration.
This often results in pain with attempts at sex.

Question 36

what are the causes of vaginismus ?

Answer 36

fear that penetration will hurt

risk factors : sexual assault
vaginitis
prior episiotomy

Question 37

what are the treatment of vaginismus ?

Answer 37

psychological
kegel expressies
hegar dilators

Question 38

what is a vesicovaginal fistula ?

Answer 38

abnormal tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.

Question 39

causes of vesicovaginal fistula ?

Answer 39

congenital anomaly

prolonged labor presses the unborn child tightly against the pelvis, cutting off blood flow to the vesicovaginal wall. The affected tissue may necrotize leaving a hole.

rape

Question 40

treatment for vesicovaginal fistula ?

Answer 40

typically repaired either transvaginally or laparoscopically