Gynecological Health: Infections and Menstrual Disorders

Gynecological Infections and Defense Mechanisms

The body maintains health through defense mechanisms such as the vaginal flora, cervical mucus, and menses. However, these defenses can be diminished during specific life stages or cycles, including ovulation, pregnancy, infancy, and menopause.

Classification of Infections

• Low Infections: These affect the vulva, vagina, and cervix. Common conditions include Vulvitis (often caused by C. albicans or Human Papillomavirus) and Vaginitis (caused by C. albicans, Trichomonas vaginalis, or Gardnerella).
• High Infections: These involve the uterus, fallopian tubes, ovaries, and abdominal cavity. Examples include Cervicitis, endometritis, salpingitis, oophoritis, and peritonitis.

Pelvic Inflammatory Disease (PID)

Types of Pelvic Inflammatory Disease (EPI) include gonorrhea, pyogenic, and tuberculous infections. Propagation occurs through canalicular, lymphatic, or hematogenous routes.

Factors Influencing Vaginal Flora

• Pregnancy and Oral Contraceptives (OCP): Increased estrogen levels boost Lactobacillus and acidity, which decreases vaginal pH but may increase fungal colonization.
• Sexual Activity: Semen is very alkaline and can alter the vaginal environment.
• Buffers: These can promote the development of anaerobic bacteria.
• IUDs: These devices can alter cervical mucus and provide a canalicular pathway for bacteria.
• Surgical Trauma and Diabetes: Metabolic disorders and trauma can lead to decreased Lactobacilli.
• Antibiotics: These medications can eliminate the normal bacterial flora.

Sexually Transmitted Diseases (STDs)

• Bacterial: Gonorrhea, Syphilis, Chlamydia.
• Fungi: Candida.
• Protozoa: Trichomoniasis.
• Viruses: Herpes (HSV-1, HSV-2), Papillomavirus, Hepatitis, and AIDS.

Pelvic Pain and Related Conditions

Dysmenorrhea and Premenstrual Tension

Dysmenorrhea is classified as Primary (symptoms include pain, headaches, fainting, nausea, and facial pallor) or Secondary (often associated with Endometriosis or organic causes).

Premenstrual Tension Syndrome presents with symptoms such as congestion, pelvic and breast pain, edema, weight gain, headache, migraine, nausea, and altered character. The etiology is typically a hormonal imbalance. Treatment may include progesterone, anxiolytics, and diuretics.

Endometriosis and Dyspareunia

Endometriosis diagnosis is achieved through gynecological examination, ultrasound, nuclear magnetic resonance, and laparoscopy. Causes are categorized as Internal (adenomyoma) or External (pleural, endometrial, lymphatic, and vascular embolization).

Dyspareunia etiology includes organic factors, endometriosis, cervical lacerations, defective sutures, or psychological factors. In some cases, a hysterectomy may be performed.

Understanding Menstrual Disorders

Menstrual disorders may arise from organic causes, such as cancer (Ca) and endometrial polyps, or functional causes.

Functional Menstrual Issues

• Amenorrhea (Absence of Menses): Can be Physiological, Primary, or Secondary, including amenorrheic episodes. Pathogenesis involves hypoestrogenism, uterine factors, hypothalamus dysfunction, hyperprolactinemia, or iatrogenic causes.
• Menstrual Excess: Includes functional metrorrhagia, hypermenorrhea, hypomenorrhea, menorrhagia, oligoamenorrhea, and metrorrhagia.

These disorders are frequently observed during puberty and premenopause.