Reproductive Health: Gynaecological Conditions

Course Objectives

• Explain diagnostic and treatment procedures in management of patients with gynaecological conditions
• Participate in the care of patients with gynaecological conditions
• Provide information and counsel on STIs and HIV

Description of the Vulva

• The vulva is the outer part of the female genitals
• Components of the vulva include the labia majora (outer lips), labia minora (inner lips), clitoris, and opening of the urethra and vagina

Vulval Inflammation

• Inflammation of the vulva area characterized by swelling, redness, tenderness, and warmth to touch
• Causes: sex, allergic reactions, pregnancy, yeast infection
• Management: personal and perineal hygiene, positioning, anti-fungal cream, oral antibiotics, etc.

Vulva Irritation

• Characterized by itching, burning, or discomfort of the vulva area
• Skin of the vulva is delicate and susceptible to various conditions
• Irritation can affect a small part or the entire vulva
• If left untreated, can lead to discomfort, worry, and serious complications
• Prompt investigation and treatment are essential

Investigations

• Hysterosalpingogram (HSG): a special type of X-ray that uses an iodine-based dye injected through the cervix
• Laparoscopy: a minor surgical procedure to view the length of the tube
• General examination: check for localized tenderness and enlarged lymph glands on pelvic examination

Management of Vulva Irritation

• Oral or intravenous antibiotics to fight bacterial infection
• Sex partners may also require antibiotics and testing for STIs
• Surgery may be required to remove damaged areas or drain fluid from fallopian tubes

Complications of Vulva Irritation

• Spread of infection to other areas of the body, including uterus and ovaries
• Long-term pelvic and abdominal pain
• Tubal scarring
• Adhesions
• Blockages
• Infertility
• Abscesses in the fallopian tubes
• Ectopic pregnancy

Abnormalities of Fallopian Tube

• Normal length: 7-12 cm, diameter less than 1 cm
• Abnormalities: long tube (more than 12 cm), short tube (less than 7 cm), cul de sac (closed at one end), fallopian tube agenesis (absence of one or both fallopian tubes)

Ectopic Pregnancy

• Occurs when a fertilized ovum implants outside the normal uterine cavity
• Common cause of morbidity and mortality in women of reproductive age
• Risk factors: damage or distortion of the fallopian tube, fibroids on the outside of the uterus

Management of Ectopic Pregnancy

• Treatment tailored to the size and location of the tumors, patient's age, symptoms, desire to maintain fertility, and access to treatment
• Goals of treatment: relief of signs and symptoms, sustained reduction of tumor size, maintenance of fertility, avoidance of harm

Management of Fibroids

• Drug therapy: hormonal contraceptives, tranexamic acid, NSAIDs, hormone therapy (GnRH)
• Surgical management: myomectomy (surgical removal of fibroids while leaving the uterus in place), hysterectomy (removal of the uterus)

Fallopian Tube Abnormalities

• Inflammation, abnormalities: long and short tube, cul-de-sac in the tube, absence, ectopic pregnancy, salpingitis (inflammation of the fallopian tubes)

Salpingitis

• Inflammation of the fallopian tubes
• Type of pelvic inflammatory disease (PID)
• PID refers to an infection of the reproductive organs