Pelvic pain

Question 1

Vulval causes of dyspareunia?

Answer 1

atrophy, vulvitis, bartholinitis, dystrophy, neoplasm

Question 2

Vaginal causes of dyspareunia?

Answer 2

Vaginal atrophy/atresia, inperforate hymen, septum, oestrogen deficiency - menopause, neoplasm, infection/vaginitis, vaginismus

Question 3

Urethral causes of dyspareunia?

Answer 3

Urethritis, caruncle, diverticulum

Question 4

Which gynae areas are associated to superficial and deep dyspareunia?

Answer 4

superficial = vulva, vagina, urethra. deep = cervix, uterus, fallopian tubes, ovary

Question 5

Cervical 2 causes of dyspareunia?

Answer 5

Cervicitis, carcinoma

Question 6

Uterine 3 causes of dyspareunia?

Answer 6

endometriosis, retroversion, prolapse

Question 7

Fallopian tube 2 causes of dyspareunia?

Answer 7

Ectopic, salpingitis

Question 8

What do you look for on vaginal examination of someone with dyspareunia? What ligament should you examine and why?

Answer 8

vaginismus with cuscos speculum, cervical excitation, obvious pain. Uterosacral ligament as nodules could mean endometriosis

Question 9

How do you confirm diagnosis of endometriosis?

Answer 9

Diagnostic laparoscopy with potential biopsy if suspicious

Question 10

What is a frozen pelvis and how is it caused

Answer 10

Endometriosis when they cause fibrous lesions occluding the pouch of douglas

Question 11

Possible theories of endometriosis development?

Answer 11

Retrograde menstruation, vascular and lymphatic dissemination, immune weakness, coelemic epithelium transformation

Question 12

Symptoms of endometriosis?

Answer 12

Dysmenorrhoea, dyspareunia, irregular cycles, infertility, pelvic pain, dyschezia

Question 13

Conservative treatment of endometriosis?

Answer 13

Progestogen, danazol

Question 14

Radical treatment of endometriosis?

Answer 14

TAH, BSO, resection of bowel deposits or colostomy, resection of part of the bowel

Question 15

Danazol is an anti-oestrogenic, progestational and androgenic drug, what side effects would you expect?

Answer 15

Hot flushes, vaginal dryness, hot flushes, mood swings, tender breasts, weight gain, water retention, hirtuism, acne, deep voice

Question 16

Side effects of LHRH analogues used to treat endometriosis?

Answer 16

Anti-oestrogenic = menopausal, hot flushes, loss of libido // osteoporosis

Question 17

What makes LHRH analogues different to normal LH?

Answer 17

They have a substituted AA which results in prolonged attachment to LHRH receptor and therefore dramatic increase in FSH and LH till they burn out and cause no ovulation, no ovarian hormones and no stimulation of endometriosis

Question 18

How does endometriosis effect fertility?

Answer 18

Adhesions effect tubo-ovarian function

Question 19

How does endometriosis lead to heavy, painful periods?

Answer 19

Adenomyosis

Question 20

What is the treatment for adenomyosis?

Answer 20

TAH/BSO