Vaginal gynecopathy
1. Vaginitis: Vaginitis is vaginal inflammation caused by infection of pathogenic microorganisms (including gonococcus, mold, trichomonas and other microorganisms). Vaginitis can be divided into senile vaginitis, trichomonal vaginitis, fungal vaginitis, gonorrhea vaginitis, amebic vaginitis, Haemophilus vaginalis vaginitis, infantile vaginitis, pneumovaginitis and nonspecific vaginitis.
Vaginal tumor: Vaginal malignant tumor is often secondary, which can spread directly from cervical cancer, endometrial cancer, ovarian cancer and choriocarcinoma. In addition, bladder cancer, urethral carcinoma's disease or rectal cancer can often metastasize to vagina. Primary malignant tumor of vagina is very rare, accounting for about 1% of malignant tumor of female reproductive organs. Mainly squamous cell carcinoma and choriocarcinoma, others such as adenocarcinoma, sarcoma and malignant melanoma are even less common. Many obstetricians and gynecologists have only seen a few patients in medical practice, and secondary vaginal cancer is more common. The possibility of secondary vaginal cancer should be considered and ruled out before the diagnosis of primary tumor.
Gynecological diseases of uterus
1. Uterine leiomyoma: Uterine leiomyoma is the most common benign tumor in female reproductive system, and it is common in 35-50 years old. According to statistics, about 20% of women over the age of 35 suffer from uterine fibroids, but most of them are small and asymptomatic, and the incidence of clinically reported fibroids is far lower than the actual situation. The symptoms of hysteromyoma include irregular menstruation, abdominal mass, and compression symptoms. Uterine fibroids are often associated with ovule tube ovarian lesions, and are also easy to coexist with uterine adenocarcinoma and cervical cancer. Drinking boiled water in winter and eating a certain amount of fruit every day can prevent uterine fibroids.
2. Cervical erosion: The normal cervical surface is covered by a layer of squamous epithelium, and the surface is smooth and pink. Chronic inflammation of deep cervical tissue caused by infection makes the superficial epithelium fall off due to malnutrition, and the exfoliated surface of epithelium is gradually covered by columnar epithelium of cervical canal. The columnar epithelium is very thin and can be seen through the blood vessels and red stroma below, so the surface is red, which is cervical erosion. Cervical erosion is a common lesion of chronic cervicitis. Due to the different degree of inflammatory stimulation, the columnar epithelium of cervical mucosa grows slowly, flat and smooth, which is simple erosion. The columnar epithelium grows fast, and the formation of glandular hyperplasia is glandular erosion. If the gland expands, it can be follicular erosion, accompanied by interstitial hyperplasia, forming small protrusions and uneven columnar epithelium, forming papillary erosion. The above types can often be mixed. Cervical erosion is the most common gynecological disease.
3. Cervical polyp: Cervical polyp is a manifestation of chronic cervicitis, which is more common in married women. Cervical polyp is one or several small papules with pedicles that grow on the cervix. Most of the roots of small papules are attached to the external cervix, and only a few grow in the cervical canal. Polyps are water-drop-shaped, the diameter is generally below 1cm, the pedicle is slender, the color is bright red, the quality is soft and fragile, and it is easy to bleed after contact. Cervical polyps are mostly a manifestation of chronic cervicitis, which is formed by the proliferation of cervical mucosa under the stimulation of inflammation.
4. Cervical hypertrophy: Cervical hypertrophy is a chronic cervicitis. Due to the long-term stimulation of chronic inflammation, cervical tissue is congested and edematous, and cervical glands and interstitial hyperplasia. The gland tube is squeezed by the surrounding proliferative tissue, which makes it difficult to discharge the mucus produced by the gland and forms a retention cyst. Superficial glandular cysts protrude from the surface of the cervix and are easy to observe, while deep glandular cysts often thicken and enlarge the cervix to varying degrees, commonly known as cervical hypertrophy.
Gynecological endocrinology
Three "killers" of irregular menstruation
First, amenorrhea (medical terminology: amenorrhea)
In the following pages, the term "amenorrhea" is used in all cases involving amenorrhea. Amenorrhea can be divided into primary amenorrhea and secondary amenorrhea. We will introduce the two most common causes of amenorrhea elsewhere, pregnancy and menopause.
Secondary amenorrhea is defined as a previously normal individual who has no menstrual cycle for more than 90 days (three menstrual cycles disappear). Menstruation must be checked if it disappears for more than 3 months.
Primitive amenorrhea occurs at the age when girls should menstruate. Different people have their first menstruation at different times, and most people have menstruation at the age of 16. A young girl, if her peers have menstruation and she doesn't, she must have a prenatal examination.
The causes of primary amenorrhea will be discussed later.
The following organs are related to the occurrence of normal menstrual cycle
(1) endometrium
⑵ Ovary
(3) pituitary gland
(4) Hypothalamus (a special area of the brain) 1, endometrium The endometrium is usually thick (stimulated by estrogen) or thin (decreased estrogen secretion). Also known as "female reproductive organs" and "standard menstrual period".
ovary
Menstrual period depends on the secretion of ovarian hormones. No menstrual period usually leads to anovulation (the ovaries don't release any egg cells). Also known as "standard ovary".
There are several possibilities:
(1) does not form follicles and does not produce estrogen. In this case, the endometrium will be very thin.
⑵ Follicles are formed, but they cannot divide, and estrogen is also produced, but they are not opposed to progesterone. In this case, the endometrium will become thicker. In the latter case, one or more follicles are usually associated with estrogen.
Acoustic navigation and ranging system can show the existence of follicles, and blood test can show the level of estrogen in blood.
3. Pituitary gland
The pituitary gland can secrete many hormones to control our body functions. Three of them are closely related to menstrual function. They are follicle stimulating hormone (FSH), luteinizing hormone (LH) and prolactin. The levels of these three hormones can be known by blood test. Also called "pituitary cycle and menstrual cycle".
If FSH and LH levels increase and estrogen levels decrease, then the problem is usually the ovary. Ovary can not cause FSH and LH response, but the continuous increase of FSH and LH levels can cause ovarian response.
If FSH levels are normal and estrogen and LH levels are elevated, the diagnosis of polycystic ovary disease can be ruled out (see polycystic ovary).
If FSH, LH and estrogen are all decreased, then pituitary or hypothalamic diseases can be ruled out.
Higher prolactin levels also require further examination.
Blood examination combined with microscopic diagnosis of endometrium can provide medical practitioners with exact information about the causes of amenorrhea.
The treatment of amenorrhea depends on the needs of pregnancy. If you want to have children, you should do hormone therapy such as ovulation induction therapy to regulate the menstrual cycle. For women with thickened endometrium, it is important to regulate the normal menstrual cycle and prevent future endometrial cancer [Remember: if your endometrium is thick, it means that you don't have cancer, but it may develop into incurable cancer many years later (more than ten years).
Pituitary tumor, it is important to remember that only a few people with high prolactin level can develop pituitary tumor.
colporrhagia
Vaginal bleeding is one of the most common symptoms of gynecological diseases of female genitalia, and its causes are various. In addition to normal menstruation, vaginal bleeding can also occur due to inflammation of reproductive organs, pathological pregnancy, endocrine diseases, trauma and tumors. Therefore, if a female friend has abnormal vaginal bleeding, she should go to the hospital immediately to find out the cause of the bleeding.
Clinical manifestations and differential points:
1. Regular vaginal bleeding.
⑴ Increased menstrual flow: mainly manifested as normal menstrual cycle, but more menstrual flow or prolonged menstrual period. This type of bleeding is mostly related to hysteromyoma, adenomyosis or the placement of intrauterine devices.
⑵ Menstrual bleeding: It occurs between two menstrual cramps and generally lasts for 3~4 days. Generally, the amount of bleeding is less than the amount of menstruation, and occasionally it may be accompanied by pain or discomfort in the lower abdomen. This bleeding is caused by the temporary decrease of follicular rupture and estrogen level during menstruation, which is also called ovulation bleeding.
⑶ Dropping blood before or after menstruation: A small amount of vaginal bleeding after menstruation lasts for several days, and it often keeps dripping. Can be seen in ovulation menstrual disorders or the side effects of placing intrauterine devices. A similar situation may also occur in endometriosis.
6. Irregular vaginal bleeding
(1) Contact bleeding: vaginal bleeding immediately after sexual intercourse or vaginal examination, with bright red color and more or less amount, which is common in acute cervicitis, early cervical cancer, cervical polyp or submucous myoma of uterus.
⑵ Postmenopausal vaginal bleeding: If the patient is a woman of childbearing age and has symptoms such as lower abdominal pain and nausea, pregnancy-related diseases, such as abortion, ectopic pregnancy or trophoblastic diseases, should be considered first; If the patient is a female with no sexual life history in adolescence or a perimenopausal woman with other symptoms, anovulatory dysfunctional uterine bleeding should be considered. For the latter, reproductive tract malignant tumor should be excluded first.
⑶ Postmenopausal vaginal bleeding: Generally, the amount of bleeding is small, which can be continuous or repeated. Occasionally accompanied by lower abdominal pain. First of all, consider endometrial cancer, which can also be seen in senile vaginitis or endometritis.
⑷ Vaginal bleeding after trauma: It is common after riding injury, with more or less bleeding and vulvar pain.
routine examination
Gynecological double river needle examination: you can know the general situation of female vulva, vagina, cervix, uterus and accessories.
Electronic colposcopy: it can locate cervical inflammation, precancerous lesions and preoperative sites of cervical cancer, and can enlarge the lesion site 10 ~ 30 times. It is the most intuitive and important gynecological examination equipment at present, and it is also a common means of gynecological cancer screening.
Gynecological ultrasound examination: it has been widely used in the field of obstetrics and gynecology, used to diagnose pelvic diseases and assist positioning treatment.
Application of gynecological laboratory detection technology: multifunctional fluorescence immunoassay, DNA technology detection; Microbiological examination of bacterial culture and radioimmunoassay of blood endocrine fluid play an important role in the diagnosis of gynecological infectious diseases (including bacterial, microbial and viral infections), endocrine diseases and immune diseases.