Polypectomy along with Diagnostic D and C. both samples to be sent for Histopathology. Treatment according to reports
Excision of polyp & histopathology advised.
Polypectomy and bx .
Polypectomy and HP examination
Abdominal hysterectomy followed by HPE of polyp
Polypectomy with D&C Get HPE done and TVS for ovaries Accordingly decide. Sometimes just correctio of hormone imbalance and D& C can bring down the ET. A call for hysterectomy to be taken only if no other option left.
firstly, exclude hormonal causes of menstrual irregularity, n treat accordingly. next, if d base of polyp can be felt in p/v, polypectomy f/b dnc. if not hystetoscopic polypectomy shud be done. consent for hysterectomy shud be taken.
Hysteroscopy with polypectomy and HPE of polyp. With the hysteroscopy you'll be able to explore endocervical and endometrial cavity and r/o other pathology and also this polyp may have some extension in endometrial cavity. According to HPE further plan of action can be decided. Definitely she'll be relieved of her symptoms after polypectomy... From my side no need of hysterectomy at this stage
polypectomy and d&c and for hpe
hyseroscopic polypectomy f/b HPE...n then manage accordingly
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Friends today I am discussing about a problem facing by females known as Painful intercourse (dyspareunia). Painful intercourse can occur for reasons that range from structural problems to psychological concerns. Many women have painful intercourse at some point in their lives. The medical term for painful intercourse is dyspareunia (dis-puh-ROO-nee-uh), defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Talk to your doctor if you're having painful intercourse. Treatments focus on the cause, and can help eliminate or lessen this common problem. Symptoms If you have painful intercourse, you might feel: Pain only at sexual entry (penetration) Pain with every penetration, including putting in a tampon Deep pain during thrusting Burning pain or aching pain Throbbing pain, lasting hours after intercourse When to see a doctor If you have recurrent pain during sex, talk to your doctor. Treating the problem can help your sex life, your emotional intimacy and your self-image. Causes Physical causes of painful intercourse differ, depending on whether the pain occurs at entry or with deep thrusting. Emotional factors might be associated with many types of painful intercourse. Entry pain Pain during penetration might be associated with a range of factors, including: Not enough lubrication. This is often the result of not enough foreplay. A drop in estrogen levels after menopause or childbirth or during breast-feeding also can be a cause. Certain medications are known to affect sexual desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills. Injury, trauma or irritation. This includes injury or irritation from an accident, pelvic surgery, female circumcision or a cut made during childbirth to enlarge the birth canal (episiotomy). Inflammation, infection or skin disorder. An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem. Vaginismus. These involuntary spasms of the muscles of the vaginal wall can make penetration painful. Congenital abnormality. A problem present at birth, such as the absence of a fully formed vagina (vaginal agenesis) or development of a membrane that blocks the vaginal opening (imperforate hymen), could cause dyspareunia. Deep pain Deep pain usually occurs with deep penetration. It might be worse in certain positions. Causes include: Certain illnesses and conditions. The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, hemorrhoids and ovarian cysts. Surgeries or medical treatments. Scarring from pelvic surgery, including hysterectomy, can cause painful intercourse. Medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful. Emotional factors Emotions are deeply intertwined with sexual activity, so they might play a role in sexual pain. Emotional factors include: Psychological issues. Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain. Stress. Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse. History of sexual abuse. Not every woman with dyspareunia has a history of sexual abuse, but if you have been abused, it can play a role. It can be difficult to tell whether emotional factors are associated with dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. You might start avoiding sexual intercourse if you associate it with the pain. Here are a few effective homeopathic treatments that can help get rid of pain during intercourse: Sepia and lycopodium: It is the top homeopathic medicine for vaginal dryness. Sepia and lycopodium are evaluated as the best cures. Sepia is suggested where vaginal dryness occurs along with itching. Pain from vaginal dryness during intercourse also calls for the use of sepia. Bellis perennis: This medicine helps cure the wounded sensation in the vagina, if intercourse is obstructed due to pain and spasms. Cactus grandiflora: This is used when the vagina shuts close during the act of intercourse. Intercourse might be simpler just before periods. Coffea: This may be used when, if the vulva and vagina are oversensitive and you feel heat as well as itchiness. Cuprum: This medicine is prescribed for cramping in the vagina and the legs, during intercourse. Ferrum: When your vagina feels dry and aches, this medicine may be prescribed. Gelsemium: This medicine is used to treat any tension preceding intercourse. These symptoms usually show an inclination towards vaginismus. Lycopodium: Dry, smoldering vaginal pain during and after intercourse may be treated with this medicine. The patient may have varicose veins in the vulva. Platina: It is consumed during solid sexual desire. It becomes hard to have sex as the vulva is to a great degree oversensitive. Intercourse is difficult and causes wounded sensation. Rhus tox: Soreness during and after intercourse, regularly joined by physical fretfulness may be treated with this medicine. Staphisagria: It is a good solution for pain after loss of virginity or in occurrences of assault or rape. Thuja: This is ideally taken when the vagina is oversensitive, making intercourse painful and troublesome. Pains include smoldering, soreness and a feeling of being wounded. It may be useful where there is a medical history of sexually transmitted diseases (STDs) as well. Argentum nitricum and sepia: These are the best homeopathic medications for vaginal dryness causing bleeding after intercourse. There are numerous homeopathic solutions for vaginal dryness catering to bleeding during intercourse. The most well known among these are argentum nitricum and sepia. Argentum nitricum is the most reasonable among homeopathic pharmaceuticals for vaginal dryness in situations where sex is painful and bleeding takes after.Dr. Rajesh Gupta10 Likes21 Answers
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Friends today I am discussing about Dyspareunia In Women. Pain during intercourse. What is dyspareunia? The word dyspareunia is derived from the Greek language, and the meanings include "difficulty in mating" or "badly mated." Dyspareunia or pain during sexual intercourse can occur both in men and women but is more common among women. The pain can range from moderate to severe and occurs in a woman's labial or vulvar areas, during or immediately after sex. The pain may also be experienced as a pelvic pain or vaginal pain and is often accompanied by a burning or throbbing sensation. What are the causes of dyspareunia? There are a variety of causes that can lead to dyspareunia: Depression, fear, and anxiety which can affect sexual arousal and lead to conditions such as vaginismus, or vaginal dryness A history of sexual abuse or trauma Stress Domestic violence The medical factors that can lead to dyspareunia include: Atrophic vaginitis or vaginal atrophy which is a common condition that causes thinning, drying or inflammation of the vaginal lining in postmenopausal women Urinary tract infections, vaginal yeast infections, or sexually transmitted diseases like candida, herpes simplex or genital warts Skin disease, such as psoriasis or lichen sclerosus. Cystitis or inflammation of the bladder wall caused by a bacterial infection Endometriosis a painful gynaecological condition, which occurs in women when the tissue that makes up the uterus lining develops elsewhere in the body. Fibroids which are often benign tumours that grow on the wall of the uterus Interstitial cystitis which is a chronic painful bladder condition Irritable bowel syndrome (IBS) which is a functional disorder of the digestive tract Ovarian cysts a condition where a build-up of fluid within an ovary occurs Pelvic inflammatory disease (PID) which causes inflammation of the female reproductive organs, usually caused by infection Uterine prolapse a condition in which one or more pelvic organs extend into the vagina The other causes that can lead to dyspareunia include: Side effects of some drugs Allergic reaction to clothing, or spermicides What are the symptoms of dyspareunia? How is dyspareunia diagnosed? The symptoms of dyspareunia include: Lack of sexual desire Inability to get aroused Pain that occurs only during sexual penetration Repeatedly experiencing pain while the partner thrusts Burning sensation along with the pain Inability to experience orgasm Pain while inserting a tampon Throbbing or burning sensation which occurs with the pain and lasts for a long time after the intercourse Diagnosis A medical evaluation for dyspareunia includes: The doctor asking in detail about your sexual history, medical and surgical history, when did your pain begin, whether it occurs in certain sexual positions. In case of multiple sex partners, the patient needs to mention if the pain occurs only with certain partners. A pelvic exam by the doctor to check for any form of infections. During the pelvic exam, the doctor may apply gentle pressure on the genital muscles with a cotton swab to identify the location of the pain. Based on the physical exam the doctor may recommend a pelvic ultrasound a visual exam of the vagina, using an instrument called a speculum What are the complications of dyspareunia? Dyspareunia does not usually cause any form of severe health complications. However, it can affect the sexual life of the person. With the right intervention and treatment, dyspareunia can be managed and even cured. What is the treatment for dyspareunia? Medical Treatment for Dyspareunia The treatment of dyspareunia varies according to the cause: In case of dyspareunia which is caused by vaginal dryness, the doctor prescribes vaginal lubricants and may also suggest adequate foreplay. In case of infections and sexually transmitted diseases, the doctor will prescribe antibiotics. In case of allergies, the doctor may prescribe topical creams. For women suffering from dyspareunia due to hormonal problems, hormonal therapy may be prescribed. Surgical intervention may be required for women suffering from problems such as abnormal endometrial tissue growth or uterine fibroids. Psychological counselling may be required for women who have suffered from sexual abuse and trauma. Exercising for Managing Dyspareunia Stretch exercises which strengthen the pelvic floor can help immensely in doing away with the symptoms of dyspareunia. Practicing yoga regularly can help in strengthening and removing the tightness of muscles that can cause the pain associated with dyspareunia. Yoga can also decrease stress levels, anxiety, depression and boost your self-image and self-confidence. Doing The Kegel Exercise Doing the Kegel exercise can help with the symptoms of dyspareunia. The Kegel exercise was named after Dr. Arnold Kegel, who has popularized them in the ‘50s.This exercise initially was meant to cure patients suffering from urinary incontinence (often after childbirth). Gradually the efficacy of Kegel’s exercise was discovered for patients who suffer from conditions like dyspareunia and vaginismus. You can easily identify the vaginal muscles which play an active part during sex with this simple exercise. Go to the bathroom and urinate a little, then stop the flow of your urine. Then start urinating again, retain the flow of urine, and stop again and then start again. Do so until you have emptied your bladder. The muscles which just acted according to your wishes are the same ones involved in dilating and contracting during sex especially during vaginal penetration. Once you identify these muscles it is important to exercise them in order to be able to contract and relax these muscles at will. This will help you gain control over the vaginal muscles keeping pain at bay during sexual penetration. This is known as Kegel’s exercise. The exercise of alternatively stopping and letting the urine flow is only for test purposes to identify the muscles which need to be exercised while performing the Kegel's exercises. Warning: Please do not do the Kegel exercise while urinating. When you are still at the stage of practicing the Kegel exercise, do not attempt a sexual intercourse with penetration. The Kegel Exercise Practice the Kegel exercise for a week or two. Find a quiet suitable place to do the exercise. You can do it after waking up in the morning and just before bedtime while lying on your bed. Follow the steps given below: Contract your pelvic muscles. Squeeze and hold for 3 seconds Then relax for another 3 seconds. Repeat the exercise for as many as 10 times each session, until you can do around 15 repetitions. Initially, a certain effort of concentration will be needed to contract the pelvic muscles only, without contracting the abdominal and gluteal muscles. When you get used to it, it will become automatic. Once you become comfortable doing these sessions quietly in bed, you can do the Kegel exercises anytime while doing some other activities for example, watching TV, working on your computer, in your car, etc. Syncing the Kegel Exercises with Breathing Exercises Once you are comfortable doing Kegel’s exercise anywhere, sync it with breathing exercises: Focus on your breathing for a few minutes. Breathe in and out deeply a couple of times to relax yourself. Then inhale deeply and hold your breath for a few seconds while strongly contracting your pelvic floor muscles. Then exhale deeply and relax these muscles. Repeat several series of this exercise. You can do this exercise in front of a mirror in order to visualize your vaginal muscles at work. This can immensely help to improve your mental awareness of this part of your body and help boost your performance when you resume your sex life. This could be due to vaginal infection. Please get examined by gynaecologist and get the vagina seabed for culture and sensitivity. Ask health queries and get free answers from doctors in 24 hrs Did you know? Dyspareunia in Women Dyspareunia affects 8 - 22% of females, making it a very frequent issue in gynecologic practice. Even without this disorder a significant proportion of women – between 6.5% and 15% – experience varying levels of pain in their genital areas particularly during sexual intercourse at some point in their life. Here are a few effective homeopathic treatments that can help get rid of pain during intercourse: Sepia and lycopodium: It is the top homeopathic medicine for vaginal dryness. Sepia and lycopodium are evaluated as the best cures. Sepia is suggested where vaginal dryness occurs along with itching. Pain from vaginal dryness during intercourse also calls for the use of sepia. Bellis perennis: This medicine helps cure the wounded sensation in the vagina, if intercourse is obstructed due to pain and spasms. Cactus grandiflora: This is used when the vagina shuts close during the act of intercourse. Intercourse might be simpler just before periods. Coffea: This may be used when, if the vulva and vagina are oversensitive and you feel heat as well as itchiness. Cuprum: This medicine is prescribed for cramping in the vagina and the legs, during intercourse. Ferrum: When your vagina feels dry and aches, this medicine may be prescribed. Gelsemium: This medicine is used to treat any tension preceding intercourse. These symptoms usually show an inclination towards vaginismus.Dr. Rajesh Gupta15 Likes22 Answers
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A 37 year old female presented with Abnormal vaginal bleeding with Vaginal discomfort. Ultrasound attached. please comment.Dr. Leena Das3 Likes14 Answers
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Definition of Dysmenorrhea *********************************** Dysmenorrhea is the term associated with the monthly blood flow or menstruation of women. It refers to the pain that some of women feel during the time of their menstruation. It is normal to have cramps at the start of menstruation period but some women feel too annoying pain to affect their routing activities. Reason of Dysmenorrhea There are normally no underlying causes of dysmenorrhea and it is very common among girls having heavy blood flow, low body weight, early started periods. But it is sometimes caused due to following Uterine fibroids (smooth muscle tumours of uterus) Ovarian cysts (fluid filled sac within ovary) Adenomyosis (abnormal presence of endometrial tissues) Endometriosis (inflammation of inner lining of uterus) Pelvic congestion (pelvic vein incompetence) Main key Symptoms of Dysmenorrhea Following are the symptoms of painful periods. Back pain Pelvis pain Lower abdomen pain Diarrhoea Nausea Headache Fatigue Constipation Dizziness Disorientation Common Types of Dysmenorrhea There are two types of Dysmenorrhea. The types of dysmenorrhea are described as follows Primary Dysmenorrhea In this type, the pain has no underlying cause and it is very common among girls. These are also known as common cramps during menstruation. The hormonal changes and ovulation is associated with this type. Secondary Dysmenorrhea This type of period pain is caused due to some problem. Endometriosis is the most common cause of secondary Dysmenorrhea. In addition, pelvis congestion, adenomyosis, leiomyoma and ovarian cysts also cause secondary dysmenorrhea. How to Diagnose Dysmenorrhea? Physical Exam Dysmenorrhea is normal in women but still doctor may perform a complete physical examination in case to check infection or abnormalities in reproductive organ of the woman, if he suspects any disorder. Imaging Scans If the cramps seem abnormal or doctors suspects any abnormality inside the woman after physical exam, he may ask for scans like Ultrasound, CT scan and even MRI of reproductive organs including uterus, ovaries, cervix and fallopian tubes to get complete details. Laparoscopy Laparoscopy is the advanced stage, though not normally needed in case of dysmenorrhea, in which a tube holding camera is passed through the uterus through small incisions in the abdominal region. The pictures and video captured by the camera help in detection of any issue like fibroids, cysts, pregnancy inside the tubes, endometriosis or any corrosion inside the reproductive organs causing pain.Dr. Nihal Ahmad15 Likes9 Answers
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CA 125 BLOOD TEST.... may be useful..... *****""""""*********""""""""************************* Normal range..0-35 units/ml May be elevated in •Benign and Malignant conditions. (mostly 75-85% EPITHELIAL Ovarian cancers.) •Elevated levels does not mean cancer is present. •Used to monitor patients being treated for Ovarian cancer.(periodically done here) *Decreasing level indicates that therapy ( inluding chemotherapy) has been effective,while increasing level indicates tumor recurrence. *Doubling or halving of previous value is important. •As one of the several tests in workup of patients suspected of tumor. • Patients with pelvic mass with level more than 65 is associated with malignancy in 90% cases. •Conditions with elevated levels Other than Ovarian cancer.. 1) pregnancy 2) Endometriosis 3)uterine fibroids 4)pancreatitis 5)Pelvic inflammatory disease 6)Cirrhosis of liver 7) normal menses. 8) others.. benign tumor or cysts of ovary malignancy of fallop tubes,endometrium,lung,breast,pancreas,GIT, Lymphomas. ****Not considered a useful screening test. *****Up to 20% of Ovarian cancer patients ,never have elevated levels, *****Most with elevated do not have cancer *****Only about 3 % patients with elevated levels have Ovarian cancer..Dr. Minakshi Pal4 Likes0 Answer