Pelvic pain Flashcards
Vulval causes of dyspareunia?
atrophy, vulvitis, bartholinitis, dystrophy, neoplasm
Vaginal causes of dyspareunia?
Vaginal atrophy/atresia, inperforate hymen, septum, oestrogen deficiency - menopause, neoplasm, infection/vaginitis, vaginismus
Urethral causes of dyspareunia?
Urethritis, caruncle, diverticulum
Which gynae areas are associated to superficial and deep dyspareunia?
superficial = vulva, vagina, urethra. deep = cervix, uterus, fallopian tubes, ovary
Cervical 2 causes of dyspareunia?
Cervicitis, carcinoma
Uterine 3 causes of dyspareunia?
endometriosis, retroversion, prolapse
Fallopian tube 2 causes of dyspareunia?
Ectopic, salpingitis
What do you look for on vaginal examination of someone with dyspareunia? What ligament should you examine and why?
vaginismus with cuscos speculum, cervical excitation, obvious pain. Uterosacral ligament as nodules could mean endometriosis
How do you confirm diagnosis of endometriosis?
Diagnostic laparoscopy with potential biopsy if suspicious
What is a frozen pelvis and how is it caused
Endometriosis when they cause fibrous lesions occluding the pouch of douglas
Possible theories of endometriosis development?
Retrograde menstruation, vascular and lymphatic dissemination, immune weakness, coelemic epithelium transformation
Symptoms of endometriosis?
Dysmenorrhoea, dyspareunia, irregular cycles, infertility, pelvic pain, dyschezia
Conservative treatment of endometriosis?
Progestogen, danazol
Radical treatment of endometriosis?
TAH, BSO, resection of bowel deposits or colostomy, resection of part of the bowel
Danazol is an anti-oestrogenic, progestational and androgenic drug, what side effects would you expect?
Hot flushes, vaginal dryness, hot flushes, mood swings, tender breasts, weight gain, water retention, hirtuism, acne, deep voice
Side effects of LHRH analogues used to treat endometriosis?
Anti-oestrogenic = menopausal, hot flushes, loss of libido // osteoporosis
What makes LHRH analogues different to normal LH?
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
How does endometriosis effect fertility?
Adhesions effect tubo-ovarian function
How does endometriosis lead to heavy, painful periods?
Adenomyosis
What is the treatment for adenomyosis?
TAH/BSO
