DOC I HAVE ATROPHIC VAGINITIS
Vaginal atrophy is the thinning of the vaginal wall of a woman appearing during or after menopause (the end of menstrual cycles).
Menopause in women usually occur between the age of 45 - 55 years old.
The cause of atrophic vaginitis is the decline of estrogens level in the female as she reaches menopause.
The loss of estrogen cause the lining of the vagina to become thinner and dryer.
Symptoms and signs of Atrophic Vaginitis are:
1.Irritation and itchiness from the dryness of the vaginal wall
2.Pain on sexual intercourse ( dyspareunia) as result of the dryness and lack of lubrication
3.Atrophic urethritis (inflammation of the opening of the bladder) -there is discomfort and frequent passing of urine with resultant urinary tract infections
4.Other menopausal symptoms such as hot flushes and night sweats, mood changes and tiredness
5. The vaginal mucosa is dry thin and shiny and bleeds easily.
The vagina is thus prone to infections.
The Pap smear show presence of small blue staining basal and parabasal cells in the mucosa of the vagina and cervix
The treatment of Atrophic Vaginitis is:
If the patient do not show any discomfort from the dryness and thinning of the vaginal wall , no treatment is necessary.
In Patients with symptoms, treatment involves:
1.Oestrogens is an effective treatment for vaginal atrophy -reducing dryness and discomfort but must be used with precaution as it can cause stroke and thrombosis and endometrial cancer of the uterus.
It can prevent osteoporosis if taken early enough.
It however do not cause breast cancer or heart disease.
Estrogens can be given in the form of oral pills and skin implants.
2.Combined estrogen and progesterone therapy also reduce the effect of menopause such as vaginal atrophy, dryness of the internal lining of the genital tract and the skin and hot flushes.
It has been found that there is an increased risk of heart attack, cancer of the breast , thrombosis, and stroke.
Because of all these risks, female hormone replacement therapy has fallen out of favor.
Instead of chemical hormones , natural plant female hormones such as primrose, soy, etc are used instead to reduce the symptoms of menopause.
3.Topical estrogen cream can be applied to the lining of the vagina once a week to reduce the dryness and discomfort in the vaginal wall.
4. Other moisturizer such as KY Vaginal moisturizer can also be used to reduce the dryness in atrophic vaginitis.
Prognosis of Atrophic Vaginitis is good if precautions are taken to prevent the dangerous side effects of female hormonal treatment.
Monday, May 23, 2011
Saturday, May 21, 2011
A Family Doctor's Tale - BARTHOLIN CYST
DOC I HAVE A BARTHOLIN CYST
Bartholin cyst is an acute cystic inflammation of the Bartholin gland at the vulva region in females.
Bartholin Gland lies behind the bulb of the vestibule which is the erectile tissue of the female.
When stimulated the bartholin gland which is covered by the erectile tissue(the bulb of the vestibule) will produce a mucoid discharge through a 2 cm duct opening in the vaginal orifice lateral to the hymen.
This mucoid discharge act as a lubricant during the sexual act.
Bartholin cyst occurs when the duct is blocked and forms a painless cyst occurring in the lower half of the vulval wall.
Normally only 1 bartholin gland is affected, rarely two at the same time.
If infection is present an acute abscess results.
Bartholin cyst and abscess can be usually caused by the following:
1.when the duct of the Bartholin gland is blocked by dirt or dead cell or injury.
The fluid which is produced by the gland then cause the gland to swell and forms a painless cyst occurring in the lower half of the vulval wall.
2.A Bartholin abscess occurs when a cyst becomes infected by a number of bacteria.
These bacterial organisms may be:
a.sexually transmitted diseases such as gonorrhea and chlamydia
b.Escherichia coli and other bacteria normally found in the intestinal tract
Many of these abscesses may be infected by more than one micro-organism.
Symptoms of Bartholin cyst or abscess are:
1.swelling of the labia on one side, near the entrance to the vagina.
2.significant pain may indicate an abscess has formed.
Large cysts can be painful because their size may press against the vulva wall and the nerves.
3.Bartholin's abscess forms a swollen area with extremely tender and reddened skin
4.Walking and sitting may be very painful because of the swollen tender abscess may rub against the opposite vulva wall.
5.Vaginal discharge is present especially if the infection is caused by a sexually transmitted organism.
Diagnosis of Bartholin's cyst or abscess is usually made by:
1.physical examination :
a. presence of a lump at the lower part of the vulva wall
The vulva may show inflammation and excoriation of lining
b.A painful swollen and red lump suggests that an abscess has formed.
2..Vulva and vaginal swab to culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.
3. biopsy of the suspicious vulva swelling to exclude other causes of vulva problem such as tumor
Treatment of Bartholin cyst or abscess involves the following:
1.Small Bartholin's cyst
sitz baths
2.Recurrent cysts or painful abscesss
antibiotics and sitz baths
Approprate Antibiotics is given for infections especially after the results of the bacterial culture
3.Bartholin's abscesses and cysts that are large and painful
a.Incision and drainage of the abscess which is pus enclosed within an enclosed space.
Since antibiotics cannot adequately enter the enclosed space, incision of the enclosed bag of pus under local anesthetic followed by drainage of a Bartholin's abscess must be done .
After the infected material is drained, the abscess cavity is packed
with gauze keeping the cavity open and promotes further drainage.
Antibiotics and painkillers can be given to relieve the pain after the anesthetic wears off.
The gauze packing is removed after 24 hours.
b.Another surgery called marsupialization can be carried out for recurrent Bartholin cyst or abscess.
After cutting into the cyst wall, drainage of the fluid from the cyst is done.
Then the lining of the cyst wall is sutured to the overlying skin in such a way as to create a permanent hole which acts as a drain site.
This operation usually prevents recurrence of the cyst.
Prognosis of Bartholin cyst:
Prognosis is usually good with medical treatment and surgery.
Most patients have relief after the 24 hours of drainage.
Prevention of Bartholin cyst:
1.Proper hygience after urination, sexual intercourse and bathing
2.Use of lubricants during sexual intercourse
3.Prompt treatment with sitz baths can prevent the formation of an abscess.
4.Safe sex practices with a single partner can decrease the spread of sexually transmitted diseases
Bartholin cyst is an acute cystic inflammation of the Bartholin gland at the vulva region in females.
Bartholin Gland lies behind the bulb of the vestibule which is the erectile tissue of the female.
When stimulated the bartholin gland which is covered by the erectile tissue(the bulb of the vestibule) will produce a mucoid discharge through a 2 cm duct opening in the vaginal orifice lateral to the hymen.
This mucoid discharge act as a lubricant during the sexual act.
Bartholin cyst occurs when the duct is blocked and forms a painless cyst occurring in the lower half of the vulval wall.
Normally only 1 bartholin gland is affected, rarely two at the same time.
If infection is present an acute abscess results.
Bartholin cyst and abscess can be usually caused by the following:
1.when the duct of the Bartholin gland is blocked by dirt or dead cell or injury.
The fluid which is produced by the gland then cause the gland to swell and forms a painless cyst occurring in the lower half of the vulval wall.
2.A Bartholin abscess occurs when a cyst becomes infected by a number of bacteria.
These bacterial organisms may be:
a.sexually transmitted diseases such as gonorrhea and chlamydia
b.Escherichia coli and other bacteria normally found in the intestinal tract
Many of these abscesses may be infected by more than one micro-organism.
Symptoms of Bartholin cyst or abscess are:
1.swelling of the labia on one side, near the entrance to the vagina.
2.significant pain may indicate an abscess has formed.
Large cysts can be painful because their size may press against the vulva wall and the nerves.
3.Bartholin's abscess forms a swollen area with extremely tender and reddened skin
4.Walking and sitting may be very painful because of the swollen tender abscess may rub against the opposite vulva wall.
5.Vaginal discharge is present especially if the infection is caused by a sexually transmitted organism.
Diagnosis of Bartholin's cyst or abscess is usually made by:
1.physical examination :
a. presence of a lump at the lower part of the vulva wall
The vulva may show inflammation and excoriation of lining
b.A painful swollen and red lump suggests that an abscess has formed.
2..Vulva and vaginal swab to culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.
3. biopsy of the suspicious vulva swelling to exclude other causes of vulva problem such as tumor
Treatment of Bartholin cyst or abscess involves the following:
1.Small Bartholin's cyst
sitz baths
2.Recurrent cysts or painful abscesss
antibiotics and sitz baths
Approprate Antibiotics is given for infections especially after the results of the bacterial culture
3.Bartholin's abscesses and cysts that are large and painful
a.Incision and drainage of the abscess which is pus enclosed within an enclosed space.
Since antibiotics cannot adequately enter the enclosed space, incision of the enclosed bag of pus under local anesthetic followed by drainage of a Bartholin's abscess must be done .
After the infected material is drained, the abscess cavity is packed
with gauze keeping the cavity open and promotes further drainage.
Antibiotics and painkillers can be given to relieve the pain after the anesthetic wears off.
The gauze packing is removed after 24 hours.
b.Another surgery called marsupialization can be carried out for recurrent Bartholin cyst or abscess.
After cutting into the cyst wall, drainage of the fluid from the cyst is done.
Then the lining of the cyst wall is sutured to the overlying skin in such a way as to create a permanent hole which acts as a drain site.
This operation usually prevents recurrence of the cyst.
Prognosis of Bartholin cyst:
Prognosis is usually good with medical treatment and surgery.
Most patients have relief after the 24 hours of drainage.
Prevention of Bartholin cyst:
1.Proper hygience after urination, sexual intercourse and bathing
2.Use of lubricants during sexual intercourse
3.Prompt treatment with sitz baths can prevent the formation of an abscess.
4.Safe sex practices with a single partner can decrease the spread of sexually transmitted diseases
Thursday, May 19, 2011
A Family Doctor's Tale - POLYCYSTIC OVARIAN SYNDROME
DOC I HAVE POLYCYSTIC OVARIAN SYNDROME
Polycystic ovarian syndrome (PCOS) is a hormonal disease that causes women to have a combination of symptoms:
1.Oligomenorrhea -less menses than before
2.Obesity
3.Hirsutism -skin is more hairy
4.Infertility
Most women with PCOS have some small cysts in the ovaries hence the name Polycystic ovarian syndrome.
However cysts in the ovaries can be caused by a number of other illness than PCOS.
It is the characteristic symptoms rather than the presence of the cysts that is important in the the diagnosis of PCOS.
PCOS occurs in 5% to 10% of women and is present in all races.
It is the main cause of infertility in women.
Symptoms of polycystic ovarian syndrome are:
1.menstrual disturbances -
a.fewer than normal menstrual periods (oligomenorrhea),
b.the absence of menstruation for more than three months (secondary amenorrhea)
c.heavy bleeding (menorrhagia).
2.excess hair growth on the body (hirsutism),
3.obesity -excess weight gain,
4.infertility - due to irregular or no release of eggs from the ovaries
5.multiple, small cysts in the ovaries.
Other symptoms are:
1.skin discolorations,
2.high cholesterol levels,
3.elevated blood pressure
4.raised insulin levels
5.raised androgen levels
6.oily skin,
7.dandruff,
The causes of polycystic ovarian syndrome (PCOS) are unknown but could be due to :
1.Genetic - Women with PCOS often have a mother or sister with the condition,
2. environmental factors:
a.exposure to male hormones
b chronic inflammation of the body from childhood illnesses
The diagnosis of PCOS is based on:
1.clinical signs and symptoms as above
2.Serum male hormones (DHEA and testosterone) are usually raised
3.Blood luteining hormone which is secreted by the pituitary gland in the brain is usually raised
4.Ultrasound can also detect cysts in the ovaries
5.CT scan and MRI detect cysts but are used mainly to exclude ovarian or adrenal gland tumors
The complications associated with PCOS are:
1. high blood pressure
2.diabetes
3.heart disease
4.cancer of the uterus (endometrial cancer).
5.infertility
6. abnormal levels of LDL ("bad") cholesterol and blood triglycerides
Treatment of PCOS is as follows:
1. Oral contraceptic pill with low androgenic (male hormone) side effects can help to regulate menses and reduce the risk of cancer of the uterus
2.Oral Progesterone treatment used intermitently can induce regular menses
3.spironolactone (Aldactone) can reduce water retention and acne
4. clomiphene (Clomid) can be given to infertile women with PCOS to induce ovulation (cause egg production)
5.Metformin used to treat type 2 diabetes reduce the action of insulin and reduce the symptoms and complications of PCOS such as irregular periods, ovulation induction, weight loss, prevention of type 2 diabetes
6.gonadotropin hormones injection can help women who wish to have babies and do not want to be on Clomid treatment which cause multiple pregnancies
7.weight loss in obese females with PCOS can cause menstrual cycles to be normal and increases the possibility of pregnancy.
Weight loss can help reduce or prevent the complications associated with PCOS, including diabetes and heart disease.
8. ovarian drilling (some ovarian tissue is removed bypassing an electric current through a needle inserted into the ovary)can induce ovulation in women who are not responding to other treatments
Prognosis is good for patient to regulate menses but not so good for infertility.
Polycystic ovarian syndrome (PCOS) is a hormonal disease that causes women to have a combination of symptoms:
1.Oligomenorrhea -less menses than before
2.Obesity
3.Hirsutism -skin is more hairy
4.Infertility
Most women with PCOS have some small cysts in the ovaries hence the name Polycystic ovarian syndrome.
However cysts in the ovaries can be caused by a number of other illness than PCOS.
It is the characteristic symptoms rather than the presence of the cysts that is important in the the diagnosis of PCOS.
PCOS occurs in 5% to 10% of women and is present in all races.
It is the main cause of infertility in women.
Symptoms of polycystic ovarian syndrome are:
1.menstrual disturbances -
a.fewer than normal menstrual periods (oligomenorrhea),
b.the absence of menstruation for more than three months (secondary amenorrhea)
c.heavy bleeding (menorrhagia).
2.excess hair growth on the body (hirsutism),
3.obesity -excess weight gain,
4.infertility - due to irregular or no release of eggs from the ovaries
5.multiple, small cysts in the ovaries.
Other symptoms are:
1.skin discolorations,
2.high cholesterol levels,
3.elevated blood pressure
4.raised insulin levels
5.raised androgen levels
6.oily skin,
7.dandruff,
The causes of polycystic ovarian syndrome (PCOS) are unknown but could be due to :
1.Genetic - Women with PCOS often have a mother or sister with the condition,
2. environmental factors:
a.exposure to male hormones
b chronic inflammation of the body from childhood illnesses
The diagnosis of PCOS is based on:
1.clinical signs and symptoms as above
2.Serum male hormones (DHEA and testosterone) are usually raised
3.Blood luteining hormone which is secreted by the pituitary gland in the brain is usually raised
4.Ultrasound can also detect cysts in the ovaries
5.CT scan and MRI detect cysts but are used mainly to exclude ovarian or adrenal gland tumors
The complications associated with PCOS are:
1. high blood pressure
2.diabetes
3.heart disease
4.cancer of the uterus (endometrial cancer).
5.infertility
6. abnormal levels of LDL ("bad") cholesterol and blood triglycerides
Treatment of PCOS is as follows:
1. Oral contraceptic pill with low androgenic (male hormone) side effects can help to regulate menses and reduce the risk of cancer of the uterus
2.Oral Progesterone treatment used intermitently can induce regular menses
3.spironolactone (Aldactone) can reduce water retention and acne
4. clomiphene (Clomid) can be given to infertile women with PCOS to induce ovulation (cause egg production)
5.Metformin used to treat type 2 diabetes reduce the action of insulin and reduce the symptoms and complications of PCOS such as irregular periods, ovulation induction, weight loss, prevention of type 2 diabetes
6.gonadotropin hormones injection can help women who wish to have babies and do not want to be on Clomid treatment which cause multiple pregnancies
7.weight loss in obese females with PCOS can cause menstrual cycles to be normal and increases the possibility of pregnancy.
Weight loss can help reduce or prevent the complications associated with PCOS, including diabetes and heart disease.
8. ovarian drilling (some ovarian tissue is removed bypassing an electric current through a needle inserted into the ovary)can induce ovulation in women who are not responding to other treatments
Prognosis is good for patient to regulate menses but not so good for infertility.
Tuesday, May 17, 2011
A Family Doctor's Tale - MISCARRIAGE
DOC I HAVE A MISCARRIAGE
Miscarriage or spontaneous abortion is defined as the premature expulsion of contents from a pregnant uterus.
About 10-15 per cent of all pregnancies ends in spontaneous abortion.
Spontaneous abortion is most likely to occur between the 6th and 10th week of pregnancy.
Causes of miscarriage:
1.Fetus development:
most common cause is the fetus is unable to develop a heart or brain to sustain living and hence dies on its own with fetus remnants being expelled from the womb
2.Hormonal
low progesterone secretion prevents the the placenta to attach securely to the wall of the womb and hence the the detached fetus is expelled from the womb
3.Iatrogenic:
attempts by pregnant mothers to induce an abortion by taking poisons, ergometrine, hormones, chinese medicines may sometimes be successful
4.Maternal factors:
In later pregnancies, maternal factors like acute illness, hypertension, endocrine disease like diabetes, uterine abnormalities may play a part in spontaneous abortion
Signs and Symptoms:
1.Threatened Abortion:
vaginal bleeding occurs during the first 28 weeks of pregnancy, starting from the uterus with uterine contractions and without dilatation of the cervical os.
2. Inevitable Abortion:
miscarriage is inevitable if uterine contractions are strong and the cervical os is open.
3.Complete Abortion:
This occurs when the products of conception are passed out through the vagina.
It is incomplete abortion if the miscarriage is partial.
4.Missed Abortion:
This happened when the dead embryo and placenta are not passed spontaneously.
If there is incomplete abortion there is a danger of septic abortion.
5.Septic Abortion:
There is fever, rapid heart beat, foul smelling vaginal discharge, tender uterus and leucocytosis , all symptoms of septicemia.
The cause is usually E. coli or clostridium bacteria.
Habitual abortion :
This occurs when the uterus has cervical incompetance or is bicornuate
Investigations and diagnosis of abortion need to be confirmed by :
1. Vaginal examination
2.Ultrasound scan of the uterus
3. Blood human placenta lactogen and human choriongenic hormones should be helpful to determine the strength of the pregnancy
4.High vaginal swab is important to determine cause of infection
5.Dilation and curretage of missed abortion
Treatment of Miscarriage:
1. Threatened abortion :
Bed rest is very important
Avoid sexual intercourse
2. Incomplete Abortion:
Treatment of shock
Dilation and currettage of the uterus
3.Septic Abortion:
Appropriate antibiotics should be given
4.Missed Abortion:
Dilatation and currettage
5.Habitual Abortion:
a suture should be sewn around the cervical os to tighten the opening and prevent the embryo sac to slip through the os .
Miscarriage or spontaneous abortion is defined as the premature expulsion of contents from a pregnant uterus.
About 10-15 per cent of all pregnancies ends in spontaneous abortion.
Spontaneous abortion is most likely to occur between the 6th and 10th week of pregnancy.
Causes of miscarriage:
1.Fetus development:
most common cause is the fetus is unable to develop a heart or brain to sustain living and hence dies on its own with fetus remnants being expelled from the womb
2.Hormonal
low progesterone secretion prevents the the placenta to attach securely to the wall of the womb and hence the the detached fetus is expelled from the womb
3.Iatrogenic:
attempts by pregnant mothers to induce an abortion by taking poisons, ergometrine, hormones, chinese medicines may sometimes be successful
4.Maternal factors:
In later pregnancies, maternal factors like acute illness, hypertension, endocrine disease like diabetes, uterine abnormalities may play a part in spontaneous abortion
Signs and Symptoms:
1.Threatened Abortion:
vaginal bleeding occurs during the first 28 weeks of pregnancy, starting from the uterus with uterine contractions and without dilatation of the cervical os.
2. Inevitable Abortion:
miscarriage is inevitable if uterine contractions are strong and the cervical os is open.
3.Complete Abortion:
This occurs when the products of conception are passed out through the vagina.
It is incomplete abortion if the miscarriage is partial.
4.Missed Abortion:
This happened when the dead embryo and placenta are not passed spontaneously.
If there is incomplete abortion there is a danger of septic abortion.
5.Septic Abortion:
There is fever, rapid heart beat, foul smelling vaginal discharge, tender uterus and leucocytosis , all symptoms of septicemia.
The cause is usually E. coli or clostridium bacteria.
Habitual abortion :
This occurs when the uterus has cervical incompetance or is bicornuate
Investigations and diagnosis of abortion need to be confirmed by :
1. Vaginal examination
2.Ultrasound scan of the uterus
3. Blood human placenta lactogen and human choriongenic hormones should be helpful to determine the strength of the pregnancy
4.High vaginal swab is important to determine cause of infection
5.Dilation and curretage of missed abortion
Treatment of Miscarriage:
1. Threatened abortion :
Bed rest is very important
Avoid sexual intercourse
2. Incomplete Abortion:
Treatment of shock
Dilation and currettage of the uterus
3.Septic Abortion:
Appropriate antibiotics should be given
4.Missed Abortion:
Dilatation and currettage
5.Habitual Abortion:
a suture should be sewn around the cervical os to tighten the opening and prevent the embryo sac to slip through the os .
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