Female genital disease

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Female genital disease
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Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

Contents

Diagnosis

Female genital diseases are usually diagnosed by healthcare personnel in a healthcare setting. Diagnosis may be made using laboratory tests, physical examinations, and/or clinical signs and symptoms. [1] [2]

Barriers to diagnosis

Historically, discussions surrounding feminine reproductive and sexual health have been subject to social stigma within Western society. [3] Women in Western society may avoid discussing problems relating to the female reproductive system, including problems related to female sexual health, with their healthcare providers. [3] As a result, diagnosis of female genital diseases may be delayed or missed. Social determinants of health including economic and logistical burden of seeking healthcare may also interfere with timely diagnosis of female genital disease. [4]

Gender considerations

Individuals who have female genitals and/or reproductive organs but who do not identify as women may experience additional difficulties in seeking diagnosis of female genital diseases. Societal discrimination, [5] gender dysphoria, [6] and insufficient transgender healthcare education [5] [7] are some reasons that transgender individuals may be unable to obtain medical care for female genital diseases.

Women's history in clinical trials

Medical professionals use a variety of resources that assist them in creating clinical decisions in providing care to the population, with one of the more utilized sources are known as clinical trials. Clinical trials are used to analyze the efficacy and safety of medications, medical intervention, and medical procedures. Historically, women representation in clinical trials has been suboptimal, oftentimes being excluded from trials due to "potential maternal-fetal liability", [8] "have less experience, and are more costly to engage". [9] However, through limiting the number of women eligible for various stages of these trials, outcomes and the burden of disease have been underrepresented in females, either underreported or not adjusted for. For example, due to the fact that women have different drug efficacies and safety profiles to men, it is estimated "in 2005 that eight out of ten prescription drugs were withdrawn from the US market because of women's health issues". [10] Clinical trials that focused on preventative care, such as screenings, diagnostics, and health services in have an adjusted relative difference of 8.48% in female enrollment. [11] Fortunately, over the years we have seen a rise in women participants, with an average of 60.0% females enrolled in clinical trials in 2018, up 18.9% from the lowest year of participants, in 2002, with a median of 41.1%. [11]

Therefore, as we diminish the number of women who are a part of clinical trials, then guidelines that are used by medical professional stem majority from male subjects; this can then led into a variety of other factors to consider when making medical decisions towards women in the acute inpatient or chronic ambulatory care setting such as social and financial difference that can impact the care women receive. Importantly so, we decrease the number of studies that are geared towards women's reproductive issues, such as genital disease. In efforts to encourage women to participate in clinical research, the National Institute of Health (NIH) launched the women's health initiative in 1991 that focuses clinical trials and observational studies on post-menopausal women over a 15 year period of time. [12] [13] Additionally, by broadening what "women's health" encompasses, including not only reproductive and genital health, childbearing, and menstruation but also osteoporosis, breast cancer, and other disease states where women bear higher burden than men, the NIH can focus funding on these conditions. [12]

Perception

In society, having a disease related to a person’s genitalia continues to be a stigma today.  The stigma comes with shame and embarrassment that is not only internalized, but also emphasized by others through loss of support and discrimination.  Some of that shame is rooted in spirituality and societal perception.  In a study done in Lagos, Nigeria regarding uterine fibroids, majority of the women who participated in the study (67.0%) “perceived [uterine] fibroids as a spiritual problem” and believe that the best course of treatment is done spiritually through places of worship such as churches and mosques.  The majority of women who participated in the study knew that uterine fibroids existed and were associated with obesity. [14]   In both developed and developing countries, individuals with female genital diseases experience shame through perception of these diseases by healthcare providers and the general public. In a multisite study in the United States focusing on English and Spanish speaking women regarding perception, knowledge, and experiences with vaginal prolapse, these women had feelings of shame regarding their condition since they blamed themselves for their condition and felt that their condition was “unnatural or less like a woman”.  One woman mentioned that they were humiliated by a physician for their condition.  Given the stigma regarding genital diseases, a common theme from the participants was that they did not know that vaginal prolapse can occur in women. [15]  Another study in India was done where researchers called people recently diagnosed with sexually transmitted infections regarding the stigma towards their condition. Researchers found that 49 out of 487 people wanted to participate in their study, which they inferred was related to the "shame and stigma in the Indian population". [16]

Classification by type of disease

Malformation

Malformations can be congenital. They are classified by location of the malformation, such as uterine malformation.

Inflammation or infection

An example is oophoritis.

Classification by location

Diseases of the vulva

Bartholin's cyst

A Bartholin's cyst is an abscess of a Bartholin's gland. Bartholin's glands are located within the labia, or the skin folds surrounding the vaginal opening. [17] Bartholin's cysts can be painful and may require drainage or surgical removal in order to resolve. [17]

Vulvodynia

Vulvodynia is a chronic pain condition which involves the sensation of pain in the area surrounding the vaginal opening in response to physical stimulation such as vaginal penetration. [18] This condition can be distressing to people who have it as it can interfere with intimacy. [18] There is no standardized treatment for vulvodynia, but some options include pelvic floor physical therapy and pharmacologic pain management. [18]

Disease of the vagina

Vaginal prolapse

Vaginal prolapse, otherwise known as pelvic organ prolapse, is when a person’s vagina descends due to pelvic organ pressure or due to tissue injury and/or muscle weakness. [19] Some of the risk factors include previous pelvic surgeries as well as activities and conditions that increase intrabdominal pressure such as childbirth, obesity, and older age. Symptoms of vaginal prolapse are vaginal bulge, urinary and fecal incontinence, and sexual dysfunction. [19] [20] Treatment for vaginal prolapse can be either conservative or surgical according to Kapoor et. al. Some of the conservative treatments include Kegel exercises that strengthen the pelvic floor and pessaries which aim to put the vagina in a normal position. [21] Surgical treatment options include colpocleisis, vaginal reconstruction, and abdominal sacrocolpopexy. Colpocleisis is a obliterative procedure that would remove the possibility of vaginal intercourse. Therefore, a person's desire to get pregnant is considered when deciding treatment for this condition. [20]

Bacterial vaginosis

Bacterial vaginosis is a condition that occurs when there is an overgrowth of normal bacteria in the vagina. [22] The community of bacteria that normally exists in the vagina is called the vaginal flora. The flora serves as a defense against the invasion and colonization of opportunistic pathogens including bacterial vaginosis, fungi, viruses, and protozoa. [23] Historically, it was believed that the bacterium Gardnerella caused bacterial vaginosis, but studies have shown that bacterial vaginosis can be caused by a variety of bacteria. [24] Women are at an increased risk of having bacterial vaginosis if they smoke cigarettes, recently used antibiotics, use an intrauterine device, have multiple sexual partners, and practice vaginal douching. [22]

Trichomoniasis

Trichomoniasis, also known as "trich", is a sexually transmitted infection caused by a protozoan parasite called trichomonas vaginalis. It is the most common protozoal infection in the United States. This motile organism is not exclusive to women, but can also be found in the prostate and urethra of men. Individuals are at an increased risk of contracting trich if they have a history of sexually transmitted infections, have new or multiple sex partners, abuse IV drugs, and do not use any type of protection during sex. [25]

Disease of the cervix

Cervicitis

Cervicitis is inflammation of the cervix in individuals with a uterus, most commonly identified in those presenting as women. While some patients report pus and mucus like discharge, a majority of individuals with this condition do not present with any symptoms. Less than half of the cases of cervicitis are linked to either Neisseria gonorrhoeae or Chlamydia trachomatis, likely sexually transmitted. However, more than half have unknown infectious etiology. [26] Complications can result in pelvic inflammatory disease, difficulties bearing pregnancy, and endometriosis. Due to these adverse outcomes, the CDC recommends that women undergo routine nucleic acid amplification technique (NAAT) testing, which can aid in the detection of chlamydia and gonorrhea. [27]

Diseases of the uterus

Uterine malformation

Uterine malformations are sometimes referred to as congenital uterine anomalies. [28] [29] A uterine malformation is an abnormality in the development of a person's uterus. This condition can result in fertility problems such as increased risk of miscarriage. [28] [29]

Uterine fibroids

Uterine fibroids, also known as uterine leiomyomas, are solid growths of noncancerous smooth muscle cells that are located on the uterus. There is no cause, but risk factors such as family history, reproductive issues, hormones, and viruses are associated with fibroid growth. [30] [31] Previous research suggested an association between diet and hormonal changes that has the potential to form fibroids and give them the environment to grow. [31] Despite other research contradicting this statement, further research stated that low fruit and vegetable intake as well as Vitamin D insufficiency and food contaminants have been correlated to fibroid formation and growth. In most cases, uterine fibroids are asymptomatic and therefore will not need treatment. Giuliani et. al found that asymptomatic uterine fibroids are present in 70% of individuals who were diagnosed with it, suggesting that it plays a role in epidemiologic studies underestimating its prevalence. [32] Uterine fibroids are treated if the person is experiencing symptoms such as anemia, infertility, and pelvic and back pain. These treatments aim to decrease the uterine fibroid size, prevent their growth, and improve symptoms the person deals with. [31] Treatments that are currently being used to treat uterine fibroids are medications, surgeries such as hysteroscopy and laparoscopy, and radiologic treatments such as radiofrequency ablation. Most of these treatments affect a person's ability to get pregnant.

Endometriosis

Endometriosis is when a person has their uterine endometrial tissue that is growing somewhere besides its normal location, most commonly at the pelvic peritoneum. [33] This can also be regarded as "lesions outside of the uterus". [34] This condition has been described as "benign and estrogen dependent", therefore impacting those who produce estrogen. Other locations where this may occur, although more rare, include ovaries, pericardium, rectovaginal septum, bladder, and more. Most commonly, this can be associated with pelvic pain and infertility. [34]

Diseases of the fallopian tubes

Salpingitis

Salpingitis, or salpingitis isthmica nodosa, is a disease involving inflammation within the fallopian tubes. [35] This condition can be caused by infections, such as sexually transmitted infections. Salpingitis may be associated with fertility problems, such as infertility and ectopic pregnancy. [35]

Ectopic pregnancy

Ectopic pregnancy, or tubal ectopic pregnancy, is a condition that occurs when a developing pregnancy implants outside of the uterus, such as in the fallopian tubes. [36] This condition is an emergency and can be fatal to the pregnant person. [36] Treatment usually involves a salpingectomy, or the removal of the affected fallopian tube. [36]

Diseases of the ovaries

Oophoritis

Oophoritis is a condition affecting one or both of the ovaries which results in inflammation. Oophoritis can be caused by an infection or by an autoimmune disease called primary ovarian insufficiency. [37]

Sexually transmitted infections

A sexually transmitted infection (STI) is an infection caused by a virus, fungus, bacteria, or parasite that is spread through sexual contact. STIs are very common and can be passed from one person to another through vaginal, oral, and anal sex. [38]

Complications

Sexually transmitted infections can impact female reproductive health worldwide. Women experience a larger impact on their health compared to men because of how exposed and vulnerable their urogenital anatomy is. The vaginal mucosa is thin and can be easily penetrated by infectious agents. Some complications that women experience from STIs are infertility, chronic pelvic pain, increased peripartum morbidity, and increased peripartum mortality. [39]

Economic burden

In 2018, $15.9 billion was spent on lifetime medical cost attributable to STIs such as chlamydia, trichomoniasis, gonorrhea, genital herpes, syphilis, human papillomavirus (HPV), HIV, and hepatitis B. When HIV is not included in the cost, STIs in women account for about three fourths of lifetime direct medical costs annually. [40]

See also

Male genital disease

Related Research Articles

<span class="mw-page-title-main">Bacterial vaginosis</span> Excessive growth of bacteria in the vagina

Bacterial vaginosis (BV) is an infection of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urination may occur. Itching is uncommon. Occasionally, there may be no symptoms. Having BV approximately doubles the risk of infection by a number of sexually transmitted infections, including HIV/AIDS. It also increases the risk of early delivery among pregnant women.

<span class="mw-page-title-main">Pelvic inflammatory disease</span> Infection of uterus, fallopian tubes, ovaries or the inner surface of pelvis

Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no symptoms. Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.

<span class="mw-page-title-main">Vagina</span> Part of the female genital tract in many animals

In mammals and other animals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen. At the deep end, the cervix bulges into the vagina. The vagina allows for copulation and birth. It also channels menstrual flow, which occurs in humans and closely related primates as part of the menstrual cycle.

Dyspareunia is painful sexual intercourse due to medical or psychological causes. The term dyspareunia covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.

<span class="mw-page-title-main">Hysterectomy</span> Surgical removal of the uterus

Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes (salpingectomy), and other surrounding structures. The term “partial” or “total” hysterectomy are lay-terms that incorrectly describe the addition or omission of oophorectomy at the time of hysterectomy. These procedures are usually performed by a gynecologist. Removal of the uterus renders the patient unable to bear children and has surgical risks as well as long-term effects, so the surgery is normally recommended only when other treatment options are not available or have failed. It is the second most commonly performed gynecological surgical procedure, after cesarean section, in the United States. Nearly 68 percent were performed for conditions such as endometriosis, irregular bleeding, and uterine fibroids. It is expected that the frequency of hysterectomies for non-malignant indications will continue to fall given the development of alternative treatment options.

A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the location of organs in the pelvic region. It can also be used to administer medications locally in the vagina or as a method of contraception.

<span class="mw-page-title-main">Female reproductive system</span> Reproductive system of human females

The female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. The human female reproductive system is immature at birth and develops to maturity at puberty to be able to produce gametes, and to carry a fetus to full term. The internal sex organs are the vagina, uterus, fallopian tubes, and ovaries. The female reproductive tract includes the vagina, uterus, and fallopian tubes and is prone to infections. The vagina allows for sexual intercourse and childbirth, and is connected to the uterus at the cervix. The uterus or womb accommodates the embryo which develops into the fetus. The uterus also produces secretions which help the transit of sperm to the fallopian tubes, where sperm fertilize ova produced by the ovaries. The external sex organs are also known as the genitals and these are the organs of the vulva including the labia, clitoris, and vaginal opening.

Heavy menstrual bleeding (HMB), previously known as menorrhagia or hematomunia, is a menstrual period with excessively heavy flow. It is a type of abnormal uterine bleeding (AUB).

<span class="mw-page-title-main">Vaginal bleeding</span> Medical condition

Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.

<span class="mw-page-title-main">Pelvic organ prolapse</span> Descent of the pelvic organs from their normal positions

Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions into the vagina. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting. Injury incurred to fascia membranes and other connective structures can result in cystocele, rectocele or both. Treatment can involve dietary and lifestyle changes, physical therapy, or surgery.

<span class="mw-page-title-main">Endometritis</span> Medical condition

Endometritis is inflammation of the inner lining of the uterus (endometrium). Symptoms may include fever, lower abdominal pain, and abnormal vaginal bleeding or discharge. It is the most common cause of infection after childbirth. It is also part of spectrum of diseases that make up pelvic inflammatory disease.

<span class="mw-page-title-main">Uterine prolapse</span> Medical condition

Uterine prolapse is a form of pelvic organ prolapse in which the uterus and a portion of the upper vagina protrude into the vaginal canal and, in severe cases, through the opening of the vagina. It is most often caused by injury or damage to structures that hold the uterus in place within the pelvic cavity. Symptoms may include vaginal fullness, pain with sexual intercourse, difficulty urinating, and urinary incontinence. Risk factors include older age, pregnancy, vaginal childbirth, obesity, chronic constipation, and chronic cough. Prevalence, based on physical exam alone, is estimated to be approximately 14%.

<span class="mw-page-title-main">Reproductive medicine</span> Branch of medicine

Reproductive medicine is a branch of medicine concerning the male and female reproductive systems. It encompasses a variety of reproductive conditions, their prevention and assessment, as well as their subsequent treatment and prognosis.

A vaginal disease is a pathological condition that affects part or all of the vagina.

Genital leiomyomas are leiomyomas that originate in the dartos muscles, or smooth muscles, of the genitalia, areola, and nipple. They are a subtype of cutaneous leiomyomas that affect smooth muscle found in the scrotum, labia, or nipple. They are benign tumors, but may cause pain and discomfort to patients. Genital leiomyoma can be symptomatic or asymptomatic and is dependent on the type of leiomyoma. In most cases, pain in the affected area or region is most common. For vaginal leiomyoma, vaginal bleeding and pain may occur. Uterine leiomyoma may exhibit pain in the area as well as painful bowel movement and/or sexual intercourse. Nipple pain, enlargement, and tenderness can be a symptom of nipple-areolar leiomyomas. Genital leiomyomas can be caused by multiple factors, one can be genetic mutations that affect hormones such as estrogen and progesterone. Moreover, risk factors to the development of genital leiomyomas include age, race, and gender. Ultrasound and imaging procedures are used to diagnose genital leiomyomas, while surgically removing the tumor is the most common treatment of these diseases. Case studies for nipple areolar, scrotal, and uterine leiomyoma were used, since there were not enough secondary resources to provide more evidence.

<span class="mw-page-title-main">Vaginal anomalies</span> Congenital defect; abnormal or absent vagina

Vaginal anomalies are abnormal structures that are formed during the prenatal development of the female reproductive system and are rare congenital defects that result in an abnormal or absent vagina.

References

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