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Thursday, September 23, 2010

8.(21-22) Vaginitis/Endometriosis/PID/Ovarian Tumor

Physician's Notebooks 8 - http://physiciansnotebook.blogspot.com - See Homepage
Also contains Chapter 22: Menses Pain, Endometriosis, PID & Ovaries - Scroll down - Update 15 March 2018
21. Vaginitis
is not quite pain but between itch and burn in vagina, and may have a colored or smelly discharge. If you, a woman, notice it, you should think why you got what you got because:
1) “My sex partner gave me something or he got another partner and she gave him something he gave me.”
2) “I started a new medicine or treatment that changed something in me.”
3) “My body has changed because of illness, pregnancy or aging.”
   If no sex in the past year, 1) is out; and if young, not pregnant, and healthy, 3) is out; so 2) must be in. Then think hard about what new medicine or treatment recently. If it is antibiotic, it is a vaginitis caused by the yeast germ. If a new IUD, the vaginitis is from the IUD irritation. And so forth.
   If recent sex or even in the last month, it’s a to worry. An STD vaginitis may start a day or so after sexual contact or it may be as long as month later in the case of certain infections.
   If young and no recent medicine, no bubble bath or vaccination or medication, and no new sex partner but you do have boyfriend, then the boyfriend must be playing and he caught something and now you too.
   Inspect your discharge. If bad smell, suspect foreign body in vagina (most often a forgot tampon) or trichomonas protozoa infection or bacterial infection maybe from IUD string. Trichomonas's bubbly copious discharge smells awful and itches; and an unfaithful boyfriend is the cause and metronidazole (Flagyl) pills for 5 to 7 days is a cure but unless you say “Bye-bye birdy!” the trich will be back with the boyfriend's next trick. Males who like to lick carry trich, so it pings back and pongs female partner.
   Candida yeast causes a special vaginitis. In normal vagina, yeast do not make trouble, but when a woman takes antibiotics or the birth control pill, or is subject to various stresses, the vagina inside changes and it favors overgrowth by the yeast with creamy, cheesy irritating discharge with no terrible smell but with itching and frequent stinging urination. Stopping the cause and using an anti yeast medication for a week may cure it. A useful anti-yeast-vaginitis douche – preventive and treatment – is 1 teaspoon baking soda (sodium bicarbonate) in 2 quarts warm water once a day for a week.
 
If vaginitis bugs you, stop putting things on your vulva or in your vagina, give up old boyfriends and find a new, faithful one, an Only; and stop unnecessary antibiotic.

22. Menses Pain, Endometriosis, PID and Ovary Cancer
In Endometriosis (EN), painful period is the complaint. If you are a woman who consults doctors for menstruation pain, chances are you will be labeled EN. Its name comes from endometrium, the uterus lining and “-osis”, a disease state. It is best diagnosed by getting a laparoscopy (a scope that cuts into the abdominal wall just below navel and gives view inside abdomen cavity). Endometriosis is caused by uterine lining (endometrial) cells growing around the uterine tubes and on the ovaries. It results in ovary blood-cysts with adhesions about the tubes and pains and infertility. The pains are because the cells undergo internal menstruation from the hormonal cycle.
   Menstrual pain that seems to show no anatomic disease is best treated with acetaminophen or other  NSAID.
    Endometriosis treatment is progesterone-type hormone (like in birth control pill; androgenic type hormones also used). If EN is preventing getting pregnant, then surgery to clean away adhesions and open the tubes by world class infertility surgeon and a try at pregnancy is an option. If EN is severe and does not respond to hormone and/or involves large cyst, a pelvic clean-out operation followed by hormone replacement therapy may be the best solution to a desperate problem. Whichever one chooses, one should seek expert care at University-HMO.

Pelvic Inflammatory Disease (PID) is end result of tube and ovary infection. Imagine you, a young woman who takes vacation and a strange man gets you onto a bed. When you get back home, you consider it just one of those flings. But on day-one of next menses, a terrific low abdomen pain doubles you up. All you can do is lie quiet. And you have a raging fever. Your roommate calls a doctor who thinks appendicitis (AP) and puts you in hospital. But the surgeon notes your pain and fever as being too much for AP and calls a gynecologist He (or She) takes one look at your fever curve, lightly feels your sore belly, and says “PID.” A typical story: Casual sex sans condom, and then menses with severe pain and fever.
   If PID localizes to right-side tube and ovary, it may be mistaken for appendicitis; a bad error because surgery into an acute PID can be disaster. So it is important to lead your doctor to correct diagnosis by making it yourself. You, a woman, are in the best position to do it. Always think “PID” when low abdominal pain with fever doubles you up at start of or during menses. The PID pain is worse on movement so acute attack sufferers walk very gingerly in hunched position.
   Make early self-diagnosis and seek expert care (gynecologist or infectious disease specialist at University-HMO) because timely, well-chosen, well-dosed antibiotic will cure, but delay in antibiotic, may doom PID sufferer to repeat attacks that can only be cured by a surgery that leaves a young woman unable to get pregnant and gives her the hot flashes of middle age. So get on the case from first twinge, and, better yet, prevent by just saying No to the strange man; and if you can’t, at least making use of a condom the ticket to bride.

Ovarian tumor or cyst should be picked up before it pains, in yearly screening by pelvic ultrasound. Any low abdomen pain should get ultrasound. Because of bad dying from ovarian cancer, I favor annual pelvic ultrasound, rapid laparoscopy for tissue diagnosis, and surgery, with more extensive surgery, chemotherapy and/or radiation treatment for cancer. This is not only life vs. death, it is good dying vs. bad dying because botched ovarian Ca gives the worst dying.
END OF CHAPTER. To read next now, click 8.23 Menopausal Hormone Treatments To Do or not T...






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