SALPINGITIS

The fallopian tubes extend from the uterus, one on each side, and both open near
an ovary. During ovulation, the released egg (ovum) enters a fallopian tube and is
swept along by tiny hairs towards the uterus.
Salpingitis is inflammation of the fallopian tubes. Almost all cases are caused by
bacterial infection, including sexually transmitted diseases such as gonorrhoea
and chlamydia. The inflammation prompts extra fluid secretion or even pus to
collect inside the fallopian tube. Infection of one tube normally leads to infection
of the other, since the bacteria migrates via the nearby lymph vessels.
Salpingitis is one of the most common causes of female infertility. Without
prompt treatment, the infection may permanently damage the fallopian tube so
that the eggs released each menstrual cycle can't meet up with sperm. Scarring
and blockage of the fallopian tubes is the most frequent long-term complication
of pelvic inflammatory disease (PID) and so this condition can sometimes be
referred to as PID. However, the umbrella term of PID includes other infections of
the female reproductive system, such as the uterus and ovaries.

Causes of salpingitis
In nine out of 10 cases of salpingitis, bacteria are the cause. Some of the most
common bacteria responsible for salpingitis include:
chlamydia
gonococcus (which causes gonorrhoea)
mycoplasma
staphylococcus
streptococcus.
The bacteria must gain access to the woman's reproductive system for infection
to take place. The bacteria can be introduced in a number of ways, including:
sexual intercourse
insertion of an IUD (intra-uterine device)
miscarriage
abortion
childbirth
appendicitis.
Symptoms
In milder cases, salpingitis may have no symptoms. This means the fallopian tubes
may become damaged without the woman even realising she has an infection.
The symptoms of salpingitis may include:
abnormal vaginal discharge, such as unusual colour or smell
spotting between periods
dysmenorrhoea (painful periods)
pain during ovulation
uncomfortable or painful sexual intercourse
fever
abdominal pain on both sides
lower back pain
frequent urination
nausea and vomiting
the symptoms usually appear after the menstrual period.

Types of salpingitis
Salpingitis is usually categorised as either acute or chronic. In acute salpingitis, the
fallopian tubes become red and swollen, and secrete extra fluid so that the inner
walls of the tubes often stick together. The tubes may also stick to nearby
structures such as the intestines. Sometimes, a fallopian tube may fill and bloat
with pus. In rare cases, the tube ruptures and causes a dangerous infection of the
abdominal cavity (peritonitis). Chronic salpingitis usually follows an acute attack.
The infection is milder, longer lasting and may not produce many noticeable
symptoms.

Lifestyle risk factors of salpingitis

Lifestyle factors that significantly increase a woman's risk of contracting salpingitis
include:
engaging in sexual intercourse without a condom
prior infection with a sexually transmitted disease.
Complications of salpingitis
Without treatment, salpingitis can cause a range of complications, including:
Further infection - the infection may spread to nearby structures, such as
the ovaries or uterus.
Infection of sex partners - the woman's partner or partners may contract
the bacteria and become infected too.
Tubo-ovarian abscess - about 15 per cent of women with salpingitis develop
an abscess, which requires hospitalisation.
Ectopic pregnancy - a blocked fallopian tube prevents the fertilised egg
from entering the uterus. The embryo then starts growing inside the
confined space of the fallopian tube. The risk of ectopic pregnancy for a
woman with prior salpingitis or other form of pelvic inflammatory disease
(PID) is around one in 20.
Infertility - the fallopian tube may become deformed or scarred to such an
extent that the egg and sperm are unable to meet. After one bout of
salpingitis or other PID, a woman's risk of infertility is about 15 per cent.
This rises to 50 per cent after three bouts.

Diagnosis of salpingitis
Diagnosing salpingitis involves a number of tests, including:
general examination - to check for localised tenderness and enlarged lymph
glands
pelvic examination - to check for tenderness and discharge
blood tests - to check the white blood cell count and other factors that
indicate infection
mucus swab - a smear is taken to be cultured and examined in a laboratory
so that the type of bacteria can be identified
laparoscopy - in some cases, the fallopian tubes may need to be viewed by
a slender instrument inserted through abdominal incisions.

Treatment for salpingitis

Treatment depends on the severity of the condition, but may include:
 antibiotics - to kill the infection, which is successful in around 85 per cent of
cases
hospitalisation - including intravenous administration of antibiotics
surgery - if the condition resists drug treatment.

PARAMETRITIS
The - inflammation of the tissue parauterine. Occurs most often after various
interventions in the uterus (abnormal births, abortions, gynecological surgery).
Pathogenic or conditionally pathogenic flora enters the parameter in the trauma
of the uterus, or - less frequently - lymphogenous or hematogenous route from
the adjacent foci of infection (adnexitis, endocervicitis, colpitis). After the
introduction of infection in the parameters of the produced diffuse inflammatory
infiltrate, which can fester (at the present level of care rarely happens), dissolve,
or to acquire a chronic course. Infiltrate is usually located in certain areas, from
the anterior neck to the lateral edges of the bladder to the anterior abdominal
wall, from the anterolateral parts of the cervix - the crural arch and the lateral
abdomen, posterolateral parts of the neck - to the walls of the pelvis, from the
back of the neck - to direct intestine.

Clinic parametritis
One of the first symptom is a persistent fever (with festering, it can take
intermittent). Initially, the general condition of the patient is practically not
changed, then there are growing signs of intoxication, and - headache, weakness,
lethargy, weakness. There are complaints of a dull ache in lower abdomen, a
feeling of pressure in the rectum can join dizuricheskie phenomena and difficulty
of defecation.

Diagnosis parametritis
In the blood of the patients are usually observed only persistent increase in ESR.
With the development of abscesses infiltrate with neutrophilic leukocytosis occur
shift to the left, dysproteinemia, etc. In bimanual study determined shortening
and smoothing of the posterior or lateral vaginal vault, a more pronounced by the
defeat (or uniformly - in total infiltration). The uterus is not fully contoured, as
included in the inflammatory infiltrate in part or in whole.
Then the side of the uterus is defined infiltrate myagkovataya first, and later - a
dense consistency. Signs of peritoneal irritation are absent. Palpation of the
abdomen at the beginning of the disease is painless and maloboleznenna, when a
festering belly to become sensitive to palpation. Complications can arise when
late diagnosis of infiltration and the development of abscesses - a breakthrough
of abscess in the free abdominal cavity, rectum, and bladder.

Treatment parametritis
Treatment should begin with a broad spectrum antibiotic drug, or
fluoroquinolone (ciprofloxacin) in combination with metronidazole for 5-7 days.
The woman is on strict bed rest, cold, shown on the lower abdomen, intravenous
infusion of calcium chloride and 150 ml of 3% solution. If festering abscess is
opened through the posterior vaginal vault or from the anterior abdominal wall
(extraperitoneal). With chronicity of the process can be used in daily prednisone
dose of 20 mg for 10 days followed by NSAIDs, with normalization of blood
parameters are shown in the lower abdomen ultrasound, light heat, candles with
indomethacin. The disease is characterized long reverse development. After 4-6
months showed a spa treatment with the use of mud vaginal tampons, irrigation,
or hydrogen sulfide baths, pelvic massage.

RETRO-UTERUS or RETROVERTED UTERUS

The vagina isnt positioned vertically within the pelvis it is angled towards the
lower back. In most women, the uterus is tipped forward so that it lies over the
bladder, with the top (fundus) towards the abdominal wall. Another normal
variation found in some women is the upright uterus, where the fundus is straight
up.
About one quarter of women have a retroverted uterus. This means the uterus is
tipped backwards so that its fundus is aimed toward the rectum. While a
retroverted uterus doesnt cause problems in most cases, some women
experience symptoms including painful sex.
Other names for retroverted uterus include tipped uterus, retroflexed uterus and
uterine retrodisplacement.

Symptoms of a retroverted uterus

Generally, a retroverted uterus does not cause any problems. If problems do
occur, it will probably be because the woman has an associated disorder like
endometriosis. A disorder like this could cause the following symptoms:
Painful sexual intercourse
The woman-on-top position during sex usually causes the most discomfort
Period pain (particularly if the retroversion is associated with
endometriosis).

A range of causes for a retroverted uterus

Some of the causes of a retroverted uterus include:
Natural variation generally, the uterus moves into a forward tilt as the
woman matures. Sometimes, this doesnt happen and the uterus remains
tipped backwards.
Adhesions an adhesion is a band of scar tissue that joins two (usually)
separate anatomic surfaces together. Pelvic surgery can cause adhesions to
form, which can then pull the uterus into a retroverted position.
Endometriosis the endometrium is the lining of the uterus. Endometriosis
is the growth of endometrial cells outside the uterus. These cells can cause
retroversion by gluing the uterus to other pelvic structures.
Fibroids these small, non-cancerous lumps can make the uterus
susceptible to tipping backwards.
Pregnancy the uterus is held in place by bands of connective tissue called
ligaments. Pregnancy can overstretch these ligaments and allow the uterus
to tip backwards. In most cases, the uterus returns to its normal forward
position after childbirth, but sometimes it doesnt.

Sexual problems
In most cases of retroverted uterus, the ovaries and fallopian tubes are tipped
backwards too. This means that all of these structures can be butted by the head
of the penis during intercourse. This is known as collision dyspareunia. The
woman-on-top position usually causes the most pain. It is possible for vigorous
sex in this position to injure or tear the ligaments surrounding the uterus.

Fertility issues
It is thought that a retroverted uterus has no bearing on a womans fertility.

Retroverted uterus and pregnancy

In most cases, a retroverted uterus doesnt interfere with pregnancy. After the
first trimester, the expanding uterus lifts out of the pelvis and, for the remainder
of the pregnancy, assumes the typical forward-tipped position.
In a small percentage of cases, the growing uterus is snagged on pelvic bone
(usually the sacrum). This condition is known as incarcerated uterus. The
symptoms usually occur somewhere between weeks 12 and 14, and can include
pain and difficulties passing urine.

Diagnosis of a retroverted uterus

A retroverted uterus is diagnosed by routine pelvic examination. Sometimes, a
woman may discover that she has a retroverted uterus during a Pap test. If you
are experiencing symptoms such as painful sex, the first action taken by your
doctor may include a range of tests to find out if other conditions are causing your
retroverted uterus, such as endometriosis or fibroids.

Treatment for a retroverted uterus

If a retroverted uterus is causing problems, treatment options can include:
Treatment for the underlying condition such as hormone therapy for
endometriosis.
Exercises if movement of the uterus isnt hindered by endometriosis or
fibroids, and if the doctor can manually reposition the uterus during the
pelvic examination, exercises may help. However, the medical profession is
divided over whether or not pelvic exercises are worthwhile as a long-term
solution. In many cases, the uterus simply tips backwards again.
 Pessary a small silicone or plastic device can be placed either temporarily
or permanently to help prop the uterus into a forward lean. However,
pessaries have been linked with increased risk of infection and
inflammation. Another drawback is that sexual intercourse is still painful for
the woman, and the pessary may cause discomfort for her partner too.
Surgery using laparoscopic (keyhole) surgery techniques, the uterus can
be repositioned so that it sits over the bladder. This operation is relatively
straightforward and usually successful. In some cases, the surgical removal
of the uterus (hysterectomy) may be considered.
Treatment options for incarcerated uterus includes hospitalisation, the
insertion of a urinary catheter to empty the bladder, and a series of
exercises (such as pelvic rocking) to help free the uterus.

PROLAPSE OF UTERUS
Your uterus (or womb) is normally held in place inside your pelvis with various
muscles, tissue, and ligaments. Because of pregnancy, childbirth or difficult labor
and delivery, in some women these muscles weaken. Also, as a woman ages and
with a natural loss of the hormone estrogen, her uterus can drop into the vaginal
canal, causing the condition known as a prolapsed uterus.
o Muscle weakness or relaxation may allow your uterus to sag or come
completely out of your body in various stages:

o First degree: The cervix drops into the vagina.

o Second degree: The cervix drops to the level just inside the opening
of the vagina.
o Third degree: The cervix is outside the vagina.
o Fourth degree: The entire uterus is outside the vagina. This condition
is also called procidentia. This is caused by weakness in all of the
supporting muscles.
Other conditions are usually associated with prolapsed uterus. They
weaken the muscles that hold the uterus in place:
 o Cystocele: A herniation (or bulging) of the upper front vaginal wall
where a part of the bladder bulges into the vagina. This may lead to
urinary frequency, urgency, retention, and incontinence (loss of
urine).
o Enterocele: The herniation of the upper rear vaginal wall where a
small bowel portion bulges into the vagina. Standing leads to a
pulling sensation and backache that is relieved when you lie down.
o Rectocele: The herniation of the lower rear vaginal wall where the
rectum bulges into the vagina. This makes bowel
movements difficult, to the point that you may need to push on the
inside of your vagina to empty your bowel.

Causes
The following conditions can cause a prolapsed uterus:
Pregnancy/childbirths with normal or complicated delivery through the
vagina
Weakness in the pelvic muscles with advancing age
Weakening and loss of tissue tone after menopause and loss of
natural estrogen
Conditions leading to increased pressure in the abdomen such as
chronic cough (with bronchitis and asthma), straining (with constipation),
pelvic tumors (rare), or an accumulation of fluid in the abdomen
Being overweight or obese with its additional strain on pelvic muscles
Major surgery in the pelvic area leading to loss of external support
Smoking
Other risk factors include:
Excess weight lifting
Being Caucasian

Prolapsed Uterus Symptoms

Symptoms of a prolapsed uterus include:
A feeling of fullness or pressure in your pelvis (you may describe it as a
feeling of sitting on a small ball)
 Low back pain
Feeling that something is coming out of your vagina
Painful sexual intercourse
Difficulty with urination or moving your bowels
Discomfort walking

When to Seek Medical Care

Notify your health care provider if you experience any of the following symptoms:
You feel the cervix near the opening of the vaginal canal or you feel
pressure in your vaginal canal and the feeling of something coming out of
your vagina.
You suffer persistent discomfort from urinary dribbling or the urge to have
a bowel movement (rectal urgency).
You have continuing low back pain with difficulty in walking, urinating, and
moving your bowels.

Exams and Tests

Your health care provider can diagnose uterine prolapse with a medical history
and physical examination of the pelvis.
The doctor may need to examine you in standing position and while you are
lying down and ask you to cough or strain to increase the pressure in your
abdomen.
Specific conditions, such as ureteral obstruction due to complete prolapse,
may need an intravenous pyelogram (IVP) or renal sonography. Dye is
injected into your vein, and a series of X-rays are taken to view its progress
through your bladder.
Ultrasound may be used to rule out other pelvic problems. In this test, a
wand is passed over your abdomen or inserted into your vagina to create
images with sound waves.
Prolapsed Uterus Treatment
Treatment depends on how weak the supporting structures around your uterus
have become.

Self-Care at Home
You can strengthen your pelvic muscles by performing Kegel exercises. You do
these by tightening your pelvic muscles, as if trying to stop the flow of urine.
This exercise strengthens the pelvic diaphragm and provides some support. Have
your health care provider instruct you on the proper ways to isolate
and exercise the muscles.

Medications
Estrogen (a hormone) cream or suppository ovules or rings inserted into the
vagina help in restoring the strength and vitality of tissues in the vagina. But
estrogen is only for use in select postmenopausal women.

Surgery
Depending on your age and whether you wish to become pregnant, surgery can
repair the uterus or remove it. When indicated, and in severe cases, your uterus
can be removed with a hysterectomy. During the surgery, the surgeon can also
correct the sagging of the vaginal walls, urethra, bladder, or rectum. The surgery
may be performed by an open abdominal procedure, through the vagina, or
through small incisions in the abdomen or vagina with specialized instruments.

Other Therapy
If you do not want surgery or are a poor candidate for surgery, you may decide to
wear a supportive device, called a pessary, in your vaginal canal to support the
falling uterus. You can use this temporarily or permanently. They come in various
shapes and sizes and must be fitted to you. If your prolapse is severe, a pessary
may not work. Also, pessaries can be irritating inside your vagina and may cause a
foul-smelling discharge.
 PELVIC INFLAMMATORY DISEASES
Pelvic inflammatory disease (PID) is an infection of a womans reproductive
organs -- uterus, fallopian tubes, cervix and ovaries. It usually happens when a
sexually transmitted infection (STI), like chlamydia or gonorrhea, isnt treated
quickly.
PID affects about 5% of women in the United States. Its most common in sexually
active women ages 15 to 24. Your odds of getting PID are higher if you:
Have sex with more than one partner or your partner has sex with other
people
Have had PID or an STI before
Recently got an intrauterine device (IUD) to keep from getting pregnant
Douche (wash out your vagina with water or other fluids)
Its important to call your doctor right away if you think you have PID. If its not
treated, you might have trouble getting pregnant or be at risk of an ectopic
pregnancy (a pregnancy that happens outside the womb).

How Do I Know If I Have PID?

PID doesnt always cause symptoms, but you might notice some of the following:
Pain in your lower belly and pelvis
Heavy discharge from your vagina with an unpleasant odor
Bleeding between periods
Pain during sex
Pain when you pee or trouble peeing
Fever and chills
See your doctor right away or go to the emergency room if you have any of these:
Serious pain low in your belly
Vomiting
Signs of shock, like fainting
Temperature higher than 101 F

How Is It Diagnosed?
Your doctor will do a pelvic exam, where shell see if your reproductive organs are
sensitive or painful. Shell also take samples of fluid from your vagina and cervix
to look for signs of infection, and she may want to take a sample of your pee
or blood as well.
She may also recommend an ultrasound to find out more about your reproductive
organs. An ultrasound is when sound waves are used to make detailed images
inside your body.

What's the Treatment?

PID can be cured, but theres no way to undo any scarring or other damage that
may have been done. Thats why its important to see your doctor and start
treatment right away.
Antibiotics usually will get rid of the infection. Its important to take all
the medication as your doctor prescribed it, even if your symptoms get better.
Your partner should be tested (and treated) for an STI as well. You shouldnt have
sex until youre both finished with the antibiotics to make sure you dont get the
infection again.
You might need to be treated in a hospital if your doctor isnt sure whats causing
your symptoms or you:
Are pregnant
Need to take antibiotics intravenously (directly in your bloodstream
through an IV)
Have a high fever or nausea or vomiting
In rare cases, if you have an abscess (a swollen area of tissue thats filled with pus)
on one of your fallopian tubes or ovaries, you might need surgery to drain it. But
antibiotics may be tried first to see if they help prior to surgery.

How Can I Protect Myself?

The only sure way to avoid PID is not to have sex. But if youre sexually active, you
can do a few things to lower your chances:
Have sex with one partner who has been tested for an STI and who only has
sex with you.
Use condoms every time.
Dont douche.
 Get tested right away if you think you have an STI or youve had sex with
someone who has one.

URINARY INCONTINENCE