Inflammatory diseases in women
Inflammatory diseases in women are much more common than other diseases of the genitals. They can be caused by various bacteria: staphylococcus aureus, streptococcus, intestinal escherichia, gonococcus, tubercle bacillus( mycobacterium), trichomonads, fungi, as well as anaerobic bacteria, etc. Inflammation of the pelvic organs is characterized by a permanent or recurring infection of internal female reproductive organs and is one of the mostfrequent causes of pelvic pain in women. Infection usually begins in the cervix, extends into the uterus and fallopian tubes and then captures the pelvic cavity. In most cases, correct treatment leads to complete recovery in about a week, although the recurrence of the disease is observed frequently. In the absence of treatment, inflammation of the pelvic organs can lead to serious complications, including a life-threatening abscess of the abdominal cavity, infection of the abdominal cavity( peritonitis), and blood infection. In addition, inflammation of the pelvic organs can lead to the formation of scar tissue in the fallopian tube, which greatly increases the risk of infertility and ectopic pregnancy( which occurs when a fertilized egg remains in the fallopian tube rather than passes into the uterus).
The occurrence and course of the inflammatory process depends on the nature of the pathogen and the characteristics of the protective forces of the body of women. If the protective forces of the body are broken, generalization of the process( sepsis) can occur. During the inflammatory process, distinguish between acute, subacute and chronic stages. Inflammatory diseases of the genitals often have a very long course. As a result of repeated exacerbations of a long-term inflammatory process, the glucocorticoid function of the adrenal cortex is often reduced and the gonadotropic function of the pituitary gland changes, and sometimes symptoms of a violation of the thyroid gland function or the nervous system are observed, they are accompanied by various vascular disorders.
Inflammatory diseases of internal genital organs( uterus, ovaries, tubes, pelvic peritoneum) are accompanied by menstrual dysfunction( various menstruation disorders) and reproductive function( infertility, spontaneous abortion, etc.).
• Various vectors of infection, especially chlamydia and gonorrhea, can be transmitted by the sexual partner and cause inflammation of the pelvic organs.
• Less often, pelvic inflammatory disease is associated with the use of intrauterine contraceptives or may occur after a false pregnancy, a full pregnancy, or gynecological procedure such as intra-uterine biopsy or curettage.
• Risk factors include sexual activity at a young age and a large number of sexual partners. Using condoms reduces risk.
• Sometimes the infection can spread from other organs( for example, as a complication of appendicitis).
• Dull pain in the lower abdomen or back.
• Pain during sexual intercourse.
• Weak fever, possibly with chills.
• Irregular or unusually heavy menstruation or lack of it.
• Excessive discharge from the vagina with a bad smell.
• Frequent, painful urination.
• Loss of appetite.
• Nausea and vomiting.
• Pelvic examination is necessary. Inflammation of the pelvic organs can be difficult to diagnose because it can sometimes not be distinguished from other types of infection, for example appendicitis.
• Based on the analysis of swabs of vaginal discharge, the main pathogens of infection can be identified. However, the patient may be infected with gonorrhea or chlamydia, even if the culture can not be isolated.
• Pelvic examination with a small flexible hose inserted through a small incision in the abdomen( laparoscopy) can be performed to confirm the diagnosis or drain the abscess.
• If there is a suspicion of pelvic inflammatory disease, antibiotics are often prescribed immediately, because delayed treatment is dangerous. Therapy can be refined after the results of laboratory studies become known.
• The issue of hospitalization in more serious cases may be considered, if the diagnosis is doubtful: flax if the patient is a pregnant woman or a teenager or if the infection does not go through outpatient treatment. Treatment may include intravenous antibiotics and surgical drainage of the abscess. The burst abscess is life-threatening and may require a complete hysterectomy with removal of the ovaries.
• Surgery may also be necessary in difficult cases or in recurrent infections that are not amenable to antibiotic treatment. A successfully cured woman can again get an infection from a sexual partner, so all partners, even in the absence of symptoms, should undergo a course of treatment for gonorrhea and chlamydia.
Vulvitis is an inflammation of the vulva and the entrance to the vagina. Primary vulvitis is rare, occurs with unscrupulous content and trauma to the genitals. Secondary vulvitis is observed in diabetes mellitus, genitourinary and intestinal fistula, with irritation of the external genital organs. Inflammatory diseases of the genital organs can be non-specific and specific( tuberculosis, gonorrhea) etiology. It should be emphasized that in the era of antibiotics the so-called conditionally pathogenic microflora became the causative agent of various severe septic diseases( for example, the proteus group, intestinal eserichia, etc.).
Sometimes inflammatory diseases develop due to the transition of infection from neighboring organs( appendicitis, tiflitis).However, as a rule, inflammatory diseases occur when there is a violation of the integrity of the uterine tissues( after abortion and childbirth).
The causes of vulvitis can be: irritation with whites, menstruation, masturbation, dirty underwear, dirty hands.
In an acute period, there are itching, burning, abundant discharge, redness and swelling of small and large labia, soreness after urination( irritation of inflamed tissues with urine).The diagnosis is made on the basis of patient complaints, changes in the vulva detected during examination and bacteriological examination( diabetes must be excluded).
Signs of vulvitis: sensation of tickling of external parts, turning into pain during walking and urination, inflammation of small and large labia, appearance of whitish yellowish-greenish color and unpleasant odor.
For the prevention of vulvitis, it is very important to observe the rules of personal hygiene with the hygiene of the sexual partner.
Traditional medicine recommends 2-3 times a day to wash the labia with soap and soap, and add a little potash to the water. Compresses from lead water, or a cloth with boric petrolatum, are applied to the genital slit. A good effect is given by washing with silver water 2-3 times a day.
Treatment of the underlying disease that caused vulvitis. In an acute period, it is recommended that the external genital organs be washed with a solution of potassium permanganate, decoction of chamomile or a solution of boric acid, warm sedentary baths with a solution of potassium permanganate or chamomile broth, irradiation on the outer genital area of the UFO.
Vulvovaginitis is an inflammation of the vulva and vagina. It is observed mainly in childhood and much less often in adults. Its causes can be violations of hygiene rules, permanent traumatization, chronic tonsillitis, exudative diathesis.
In the acute stage, burning, itching and abundant discharge. In the chronic stage, inflammation phenomena decrease. On examination, puffiness and hyperemia of the vulva and mucous membrane of the vagina are noted( in girls it is established with the help of vaginoscopy), serous-purulent or pus-like discharge( especially in the presence of foreign bodies).
Treatment is the same as with vulvitis.
Vaginitis( colpitis) - inflammation of the mucous membrane of the vagina due to infection with various microorganisms, metabolic disorders, insufficiency of hormones in the body( premature menopause, after removal of the ovaries, in old age), and chemical or mechanical trauma.
Mucocutaneous and purulent discharge, a feeling of heaviness in the lower abdomen, tenderness in the vagina, burning, itching. On examination, hyperemia of the mucosa, edema, and sometimes small nodules on it and the vaginal part of the cervix( granulosa colpitis) are noted. With senile colpitis, there are signs of age-related atrophy, the mucous membrane of the vagina is smooth, pale, sometimes hyperemic with bleeding areas. To determine the cause of colpitis, a bacterio-rioscopic examination of the secretions is necessary.
Treatment. Elimination of the moments contributing to the appearance of colpitis, restorative therapy, treatment of the external genital organs with a solution of potassium permanganate or decoction of chamomile. With fungal colpitis - douching with a solution of sodium hydrogencarbonate, the introduction of a 20% solution of borax in the vagina in glycerin, balls with nystatin.
Condyloma spiky( benign - multiple growths on the surface of the vulva and vagina).May extend to the perineum, vagina, cervix. The cause of the appearance of condyloma is a filtering virus, the development of the process is promoted by abundant discharge from the genital tract with colpitis and endocervicitis. Especially quickly genital warts proliferate during pregnancy.
Most often localized on the external genitalia, perineum, around the anus. In cases of necrosis of genital warts and attachment of secondary infection, a purulent discharge appears. Condylomata of the vagina and cervix during pregnancy and childbirth may be the cause of bleeding. The diagnosis is based on examination. It is necessary to differentiate from syphilitic condylomas having a wide base.
Treatment. With small condylomata apply powder with resorcinol and boric acid or treated with resorcinol solution on 70% ethyl alcohol. It is necessary to pre-lubricate the skin around the condylomas with petroleum jelly.
Rp.: Resorcini _
Acidi borici aa 15.0 M.D. S. Powder
Rp.: Resorcini 1.5
Spiritus aethylici 70% 50.0 M.D. S. Exterior
In case of extensive lesion, warts are removed surgically or by electrocoagulation.
Trichomoniasis is a specific disease caused by a vaginal trichomonas( protozoa);transmitted sexually. Most often observed trichomoniasis colpitis, often trichomonads also cause urethritis, cervicitis, proctitis.
In the acute stage, pronounced itching, burning, heaviness in the lower abdomen. At survey: a hyperemia of a mucous membrane of a vagina, plentiful pus-like foamy allocation.
In the chronic stage, the hyperemia disappears, but abundant characteristic discharges remain. The course of the disease is long, there is a tendency to relapse.
The diagnosis is based on microscopic examination of vaginal discharge.
Treatment is carried out simultaneously by a sick woman and her husband. Therapy of concomitant diseases and functional disorders is needed, as well as the impact on existing trichomonias. Assign metronidazole( flagel, trichopolum, orvagil, clion).The drug is used internally for the treatment of acute and chronic trichomoniasis in women and men. Dosage: 0.25 g 2 times a day for 7-10 days. The total dose for a course of treatment for adults is 5 g. Metronidazole is contraindicated in pregnancy, especially in the first 3 months.
Simultaneously with the use of metronidazole, it is recommended that the external genital organs be washed and the vagina syringed with decoction of chamomile or a solution of potassium permanganate. There are also tablets of metronidazole for 0.5 g for insertion into the vagina. Relatively high antitrihomonadnoy activity has trihomonatsid. It is applied inside and locally. Inside, appoint 0.3 g per day( 2-3 times) after meals for 3-5 days. Children dose reduced according to age.
Endocervicitis - inflammation of the mucous membrane of the cervical canal. It can occur with the penetration of various bacteria( staphylococci, streptococci, gonococci, intestinal eserichia, etc.).Endocervicitis is often combined with the inflammatory process in other parts of the reproductive system - colpitis, salpingoophoritis, erosion of the cervix.
Mucocutaneous discharge from the vagina. There are no painful sensations. Clinical signs are few. In acute stage, hyperemia is determined around the external throat and mucopurulent discharge. In the chronic stage of hyperemia, there is almost no excretion. With a prolonged course of the process, hypertrophy( thickening) of the cervix - cervicitis develops. To determine the etiology of the process, microscopic examination of vaginal discharge is necessary.
Treatment depends on the nature of the pathogen: in gonorrhea and trichomoniasis, appropriate therapy is prescribed;with viral en-docervicitis - tetracycline;with nonspecific endocervicitis, douching with a solution of potassium permanganate, decoction of chamomile, as well as a synthomycin or streptocid emulsion. Physiotherapy is shown in the chronic stage of endocervicitis.
Cervical erosion - defect of the integumentary epithelium of the vaginal part of the cervix. The formation of erosion occurs under the influence of pathological discharge from the cervical canal, which cause maceration and subsequent desquamation( sluschivanie) of multilayered planar epithelium.
Purulent or mucopurulent discharge from the vagina. When examining the cervix with the help of mirrors, hyperemia is determined around the external throat, more often on the posterior lip of the cervix. The surface of erosion can be smooth or velvety, sometimes there is bleeding when touched.
Diagnosis is made when examining the cervix using mirrors. Mandatory colposcopy, with the help of which the question of the need for a targeted biopsy with subsequent histological examination is being decided. Erosion of the cervix should be differentiated from cervical cancer, tuberculosis and syphilitic ulcers.
Treatment. Along with the therapy of endocervicitis, treatment of concomitant diseases of the genital organs is necessary. Apply tampons with fish oil, sea buckthorn oil, emulsions containing sulfonamides and antibiotics. With prolonged non-healing erosion, electrocoagulation is shown( after the biopsy data).
Endometritis is an inflammation of the mucous membrane and muscular membranes of the uterus.
Acute endometritis is characterized by lower abdominal pain, fever, purulent or purulent-bloody discharge from the uterus.
With a two-handed palpation study, the uterine soreness is noted, the increase and softness of its consistency. In chronic endometritis, pain, prolonged bloody discharge, temperature, as a rule, normal, pain in the uterus is absent. The diagnosis is based on anamnesis( out-of-hospital abortion, postpartum period), temperature increase, gynecological examination data.
Metritis is an inflammation of all the membranes of the uterus. Develops with the progression of endometritis, often a manifestation of a generalized septic infection.
The clinical picture of endometritis is reminiscent, but is more severe and often accompanied by pelvioperitonitis.
Parametritis - inflammation, periarticular fiber, is most often observed after childbirth, abortion and other interventions( sounding, expansion of the dairy of the uterus).
In the so-called lateral parametritis, the infiltrate is located next to the uterus and reaches the bone wall of the pelvis. The lateral arch of the corresponding side is smoothed. Consistency of the infiltrate is dense, with suppuration, fluctuation is determined. With anterior parametritis, the infiltrate is located anterior to the uterus, while the posterior one is posterior. The acute stage is characterized by pain, fever, chills, increased heart rate, violation of appetite and sleep. There may be dysuric phenomena, constipation, irregular menstruation. With suppuration of the infiltrate, the clinical picture is typical for purulent septic processes. Diagnosis is based on these symptoms and laboratory data.
Pelvioperitonitis is an inflammation of the peritoneum of the small pelvis.
Characterized by acute pain in the abdomen, nausea, vomiting, bloating, stool and gas retention, increased temperature, increased heart rate. The tongue is dry, coated with white coating. When palpation of the abdomen, there is a tension in the muscles of the anterior abdominal wall in the lower part, a positive symptom of Blumberg-Shchetkin. In the blood, increased ESR, leukocytosis, a shift of the white blood formula to the left. With the current( erased) course, there may be a small amount of symptoms or a lack of some of them. This often makes diagnosis difficult. With pelvioperitonitis, there may be a build-up of pus in the Douglas space. An abscess can spontaneously open into the vagina or rectum.
Vaginal examination is of great importance, in which the protrusion of the posterior fornix is marked by exudate. Patients with pelvic peritonitis require special observation in connection with the possibility of the transition of pelvic peritonitis to diffuse peritonitis, in which an emergency operation is necessary.
Salpingoophoritis( adnexitis) - inflammation of the uterine appendages. Isolated damage to the tube or ovary is very rare, usually the inflammatory process captures the tube and ovary, spreading often to the pelvic peritoneum.
In the acute stage, there are pains in the lower abdomen, vomiting, fever. There may be a violation of the menstrual cycle( meno- and metrorrhagia).When vaginal examination is palpated, the enlarged painful appendages of the uterus( from one or both sides).Because of the sharp soreness sometimes it is not possible to clearly define their boundaries. In the blood, leukocytosis, increased ESR, a shift to the left of the white blood formula. The process can be accompanied by pelvioperitonitis.
In the subacute stage, the temperature decreases, pain decreases, the general condition improves, and the blood counts normalize. The disease does not always end with recovery;During the transition of the salpingo-oophoritis to the chronic stage, periodic exacerbations accompanied by pain, fever, menstrual dysfunction are diagnosed, based on the history and objective research data, taking into account all the above symptoms and the results of bacteriological examination of smears from the vagina, cervix and urethrachannel
Treatment of inflammatory diseases of nonspecific etiology In acute phase: rest, cold on stomach, intravenous solution of chlorinecalcium peroxide or a solution of calcium gluconate, antibacterial therapy - penicillin IM in 300 000- 500 000 units after 3 hours Other antibiotics are also used( it is necessary to determine the sensitivity of microflora to antibiotics.) Semisynthetic penicillins: oxacillin, methicillin, upmicillin are especially effective.severe cases of broad-spectrum antibiotics( cephalosporins and aminoglycosides) should always be taken into account. Treatment should be comprehensive and conducted against a background of general strengthening therapy, the appointment of vitamins, painkillers, antihistamines. In subacute and chronic stage, physiotherapy is used: electrophoresis of calcium chloride and potassium iodide, diathermy, mud therapy. In the presence of saccate tumor-like formations of the uterine appendages, surgical treatment is indicated.
Traditional medicine recommends such patients treatment, which is shown when menstruation is delayed. In addition, you should use:
• parsley in any form several times a day( roots and aerial parts);
• Anise seeds, finely ground, with honey in equal amounts by weight. Take 3-4 times a day;
• a decoction of parsley, or a decoction of the onion husk, or a decoction of nettle roots instead of water to drink. You can cook a decoction of peeled onions and cloves, pour one liter of boiling water, boil for 5 minutes, cool, strain.
• Monogamous, abstinence or condom use protects against sexually transmitted infections.
• After small gynecological procedures such as curettage, avoid washing under the shower, using tampons, baths and sexual intercourse for at least seven days.
If you have symptoms of pelvic inflammatory disease, especially high fever with severe pain in the lower abdomen, immediately consult a therapist or gynecologist.