Changes the female reproductive
system Changes in female sexual organs are much more common than
those of male sex organs. This is especially true of infections and
inflammatory diseases. Because of their anatomy, the female genital tract is
more vulnerable to pathogens than the male.
Vulva and Vagina
Vulvitis and Vaginitis infections are very common. They are often fungal
infections or parasites rather than bacteria, because most bacteria can not
survive due to the acidic pH of vaginal secretions. The bacteria can infect
the vagina if the pH rises and so condition a lower acidity of the vagina.
Sexually transmitted diseases (STDs) such as gonorrhea, can cause
infertility. Gonorrhea is an infection of the vagina, which can spread to
the uterus and fallopian tubes. Another STD is caused by Chlamydia, a
bacterium very small, with many similarities to a virus. Such bacteria are
increasingly recognized as an important cause of 'non-specific urethritis' (Non
Specific Urethritis NSU), which can result in vaginal discharge.
Syphilis is an STD serious, although fortunately rare, but it is a bacterial
STD that can be passed to the developing fetus. Untreated syphilis causes
infertility and is eventually fatal. Herpes virus can infect the vulva
causing genital herpes.
Carcinoma of the vulva accounts for approximately 5% of gynaecologic cancers.
It usually begins in later life as a small ulcer or lump. Cancer of the
vagina is rare.
Cervix of Uterus
The extent of the membrane lining the inner cervix (endocervix) on the outer
surface (ectocervix) results in altercation common, cervical ectropion. As
the cervix secretes mucus, vaginal discharge may occur, this disease is
treated by laser surgery or electro coagulation (coagulation of tissue
usually accomplished by means of electric current, high frequency).
Neck carcinoma is one of the most common cancers affecting women. Although
it is easily detected in its early stages by means of a cervical smear, it
is still a significant cause of mortality. Cervical cancer is invasive, but
remains localized in the genital tract until very late. There is some
evidence that infection with herpes and HIV may predispose to cervical
cancer. Some experts have also compared the cervical cancer an STD because
of a strong association between cancer and promiscuous sexual activity with
multiple partners.
Uterus
Uterine infection (endometritis) is rare during the reproductive years,
because the uterus is protected from ascending infection by acidic vaginal
secretions and the cervical mucus. Childbirth or abortion, surgical or
insertion of intrauterine contraceptive are all associated with an increased
risk of infection of the uterus.
The lack progesterone in the second half of the menstrual cycle can cause
intermenstrual bleeding or menorrhagia (heavy menses). This situation
usually is controlled with cyclic administration of progesterone.
Benign tumors of smooth muscle of the uterine wall, called fibroids and
occur in approximately 25% of women. They are usually multiple and can vary
in size from very small to 10 cm or more in diameter, but are often
asymptomatic. The most common symptom is menorrhagia, which occurs when the
endometrial surface area is greatly increased by the presence of multiple
large fibroids. Fibroids also prevent the uterus from contracting properly
to stop the menstrual flow. When the fibroids bulge into the uterine cavity,
there is an increased rate of abortion. Fibroids that cause symptoms can be
removed surgically.
Endometrial carcinoma is the third most common gynaecological cancer. This
cancer usually presents in women over 55 years of age. The bleeding is
usually the earliest symptom and any unexplained vaginal bleeding in
postmenopausal women should therefore be thoroughly investigated. Cancer of
the uterus spreads locally before giving metastasis to distant organs. It is
treated with surgery and radiotherapy when the spread is confined to the
pelvis or chemotherapy if metastases occur outside the pelvic region.
Damage of Fallopian tubes
The fallopian tubes are delicate structures with approximate thickness of
the tip of a pencil. For this reason can be easily blocked blockade may be
due to a healing process due to infection or previous abdominal surgery, or
due to fibrous adhesions, which can distort the tubes or reduce their
mobility by connecting them to other tissues.
Pelvic inflammatory disease (pelvic
inflammatory disease, PID) due to sexually transmitted organisms such
as gonorrhea, chlamydia or other pathogen, is the main cause of tubal
infertility. Moreover, PID is associated with a risk 2 to 8 times higher in
subsequent pregnancies. Follow-up studies on the fertility of women with PID
documented by laparoscopy (in which the physician directly visualize the
uterus, fallopian tubes and pelvic cavity) showed that for each episode of
infection for at least a 10% risk of tubal infertility thereafter,
regardless of the type of organism causing the infection. The effect appears
to be additive, with the risk of tubal infertility doubling after a second
episode of PID.
Ovaries
The tumors are the most common changes of the ovaries and it may be solid
tumors or cysts filled with fluid. The vast majority of ovarian tumors are
benign (94%) and include cysts, cystadenoma, teratomas, endometriomas and
fibroids. Benign tumors can become very large and become detectable by
palpation or by visual inspection. Require surgical treatment only if they
find symptoms in response to obstruction or pressure.
Approximately 6% of ovarian tumors are malignant carcinomas. Most ovarian
carcinomas are asymptomatic for a long period of time to determine that
pressure on, or obstruction of nearby organs, such as the urinary tract.
This is the reason why ovarian cancer has a mortality rate higher than the
cervical and endometrial cancers combined, although much less common than
other gynecologic cancers. Malignant tumors are treated by surgery and
chemotherapy. It has been shown that the use of combined oral contraceptive
'Pill', even for a comparatively short time, determines a long-term
reduction in the risk of ovarian cancer.
Endometriosis
Endometriosis is a common condition in which the endometrium proliferates
and spreads outside the uterus, can then gain access to the ovaries and
other pelvic organs and cause infertility. However, this situation is often
relatively benign, and many women become pregnant usually without the
disease has been diagnosed. The cause of endometriosis is unknown, but it
has been suggested that it is a disease of angiogenesis (the formation of
new blood vessels) because in this situation the endometrium and
endometriotic plaques appear to have an activity greater than the normal
endometrium.
It is believed that endometriosis committed fertility by causing mechanical
obstruction by pelvic adhesions, distorted anatomy and ovarian or tubal
damage. In addition, the ovulatory process and capture the egg may be
disturbed. The figure below describes common sites of endometriosis.
Types of Endometriosis
There are a number of different classification of endometriosis. The most
widely used is the American Fertility Society (American
Fertility Society), In which endometriosis is classified into four
stages: minimal, mild, moderate or severe depending on the extent of
proliferation and the extent of areas heal and associated membership.
Symptoms of endometriosis may include menstrual periods, painful and
prolonged. However, there is little correlation between the severity of
symptoms and extent of disease. Some patients with extensive endometriosis
may have no symptoms whatsoever. The treatment of endometriosis depends on
its severity, whether it causes infertility and cause symptoms. Several
treatments are available, including surgery and drug treatment.
Treatment of Endometriosis
If the patient is infertile following severe
endometriosis they may require surgery to remove endometrial growths and
adhesions free. Laser surgery can be used in these cases but of course
requires specialized and expensive equipment. It has the advantage of
being a very accurate while reducing the risk of subsequent formation of
adhesions.. The main advantage of surgery in general is that if
successful, the design is possible within a few weeks after the
operation.
If the patient is infertile but endometriosis is moderate
the specialist may recommend a trial of medical treatment
before surgery to be performed complicated. As derived from normal
endometrium, endometriosis is hormone-dependent. Clinical treatment
therefore depends on suppression of secretion of female hormone for a
period of up to 6 months with medications, such as analogs of
gonadotropin-releasing hormone. During the period of suppression,
endometriosis regresses, but unfortunately all the existing treatments
prevent conception. The main problem of therapy with drugs that suppress
the time it takes (a major problem for older infertile women) and the
fact that the side effects uncomfortable 'menopause' can occur during
treatment.
