Vaginal yeast infections, also called mycotic vaginitis, is a very common infection in women and approximately 75% of adult women is caught this infection at least once in any part of their lives. This condition mostly develops with certain reasons, such as pregnancy and use of antibiotics, and it easily responds to the treatment. In addition to pregnancy and antibiotics, other risk factors of vaginal yeast infection are excessive weight, diabetes mellitus, immune suppression, metabolic diseases, nylon underwear, local allergens and use of hormone supplements.
Signs of Vaginal Yeast Infection
Sensation of burn, irritation and itching in genital region as well as viscous white vaginal discharge that contains particles resembling milk, curd cheese or lime are common symptoms. The discharge is not malodorous. Malodorous discharge should suggest a secondary infection associating to the candidiasis. Redness and swelling may develop in vulva and vagina. Skin of vulva can be irritated due to scratching and therefore, patients may suffer burn and pain during urination.
Treatment of Vaginal Yeast Infection
Complaints are usually relieved with vaginal suppositories and cream for vulva within several days and systemic treatment is not needed.
What Helps Itching Caused by Vaginal Yeast?
There are creams for itching which can be used as instructed by the physicians. As nylon and synthetic underwear can worsen itching, patients should prefer cotton underwear. Avoiding the clothes that keep the vaginal region airtight and cause sweating for a long time such as panty hoses, leggings and tight pants will also help.
Medications for Vaginal Yeast Infections
There are some vaginal suppositories and creams that can be used upon recommendation of the physician after the condition is diagnosed following an examination by a gynecologist and obstetrician.
Is Vaginal Yeast Contagious?
Vaginal yeast infection is not a sexually transmitted condition and treatment is not necessary for the partner unless there is a chronic disease.
It implies outflow of the residues in vaginal tissue, which continuously regenerates itself, along with the cervical secretions. These discharges are critical for vaginal health and they are called physiological discharges; the amount of discharge is directly proportional to number of secretory cells, use of intrauterine device and amount of estrogen hormone. Discharges secondary to infections in vagina or cervix are not physiological and they are called vaginitis (related to vagina) and cervicitis (related to cervix).
Other than above mentioned physiological discharges, they are pathologic and they should be treated. Those can be caused by fungi, bacteria or other microorganisms while they can also be secondary to tumor formations in cervix. They should be treated properly after examined by a gynecologist and obstetrician.
Types of vaginal discharge:
Natural (physiological) discharge is clear and odorless and it looks like egg white in consistency. No itching occurs and it does not cause pain or feeling of burn during sexual intercourse. Physiological discharge is experienced at reproductive age where active hormone production continues.
If the discharge is dark yellow, green or brown colored, bloody, foamy and malodorous and associated with pain, dysuria and abnormal bleeding, this condition mostly points to a genital infection. A malodorous discharge with blood may also be indicative of cervical tumor formations.
Symptoms of Vaginal Discharge
A non-physiological discharge brings about itching and irritation and certain symptoms develop that contain, but not limited to abnormal vaginal odor, pain during sexual intercourse, pain in the groins and pelvis and swelling and edema in the external genital region.
Treatment of Vaginal Discharge
An antimicrobial treatment is prescribed according to the causative agent. Also, local therapies to alleviate pain and edema, hygiene and treatment of the partner, if required, are among the basic principles.
Myomas are benign tumor formations which are located in the uterus and originate from the uterine smooth muscle. The condition is observed in 20%-25% of the women at reproductive age. In women aged above 40, myomas are asymptomatic and observed in 45%-50% of these women. Diameter of myomas ranges from 2-3 mm to 25-30 cm. There may be a single tumor or multiple tumors. The probability of a malignant myoma is very low, around 1-2/10000. However, it is required to take this probability into consideration for rapidly growing myomas.
The exact underlying cause of myomas is not known. Increased estrogen hormone production in the ovaries gives rise to the enlargement of myomas. Therefore, myomas may enlarge in pregnant and non-menopausal women, while they tend to regress in size in menopausal women.
Symptoms of Myoma
Myomas may be incidentally detected during a gynecologic exam that is made to investigate any other condition or during an ultrasound scan that is performed for supervision of pregnancy. However, if size of the myoma increases, other symptoms may emerge, such as heavy menstrual bleeding, intermenstrual bleeding, frequent voiding and protruding belly and feeling of distensions as well as signs of anemia secondary to heavy bleeding. The pain caused by myoma is usually secondary to degeneration. A gradually worsening inguinal pain or an acute pain may develop. Sometimes, patients may complain of a cramp-like pain. Low back pain, inguinal pain and feeling of fullness in the groins are also among the symptoms of myomas.
Treatment of Myoma
It is not possible to treat a myoma with medication therapy. However, complaints can be eliminated by certain medications and the enlargement of myomas can be hindered for a while. Surgery is the principal treatment modality for myomas. The most effective option is hysterectomy-a surgical procedure to remove the uterus-, if the patient does not want to conceive any more. If the patient wants to conceive in the future, only the myoma is removed. Open or closed surgery can be preferred. In case the myoma is present in submucous location-the inner membrane of the uterus-, hysteroscopy can be performed to excise the lesion through the vaginal route.
What are potential problems caused by myoma?
Myomas do not lead to any problem in most of the pregnancies. However, the submucous myomas can result in recurrent miscarriages. One third of myomas may expand during pregnancy and this growth may cause a severe pain. Moreover, myomas may lead to fetal position anomaly, premature delivery or premature rupture of membranes, abnormal location of placenta or early placental detachment (placental abruption). Caesarean section is indicated for pregnant women who have a large myoma or whose myoma obstructs the childbirth canal. Other potential risks include massive postpartum bleeding.
Ovarian cysts are fluid-filled sacs located inside the ovary. A cyst that measures up to 3 cm in size and contains the egg, called follicle, forms inside the ovaries in each period under normal circumstances. Next, those cysts break and the egg is released. Normal or physiological follicle cysts that do not rupture may enlarge up to 5 to 10 cm in young women who have an ovulation problem, but there may be numerous small cysts (measuring 0.5 to 1 cm in size), resulting in a condition called polycystic ovary syndrome. Other than those functional cysts, benign or malignant ovarian cysts can be detected in all age groups.
Symptoms of Ovarian Cysts
Ovarian cysts do not cause any symptom and they are incidentally detected during an examination in most cases. However, the most common symptoms are irregular periods, abdominal distension, abdominal pain, digestive system disorders and urinary tract complaints. The ovarian cysts that do not expand too much do not lead to pain or abdominal distension. Presence of abdominal pain may indicate an inflammatory process in the lesion. Moreover, ovarian torsion (the cysts and the ovary twist around their own axis) can lead to an acute and painful condition.
How is Ovarian Cyst diagnosed?
The diagnosis is based on examination and ultrasound. Advanced imaging modalities, such as tomography and magnetic resonance imaging, may be required for differential diagnosis, while certain blood tests may be ordered to identify its nature.
Types of Ovarian Cysts
Excluding the common functional ovarian cysts, there are benign or malignant tumoral cysts. Moreover, the cysts may transform into an abscess due to an infection which is usually associated with pain and fever.
Treatment of Ovarian Cyst
Functional cysts are followed up for 3 to 6 months and they disappear spontaneously. If a tumor formation is suspected, they should be surgically removed along with a pathologic examination. Hormonal methods can be used for treatment of endometriomas characterized by presence of intrauterine (endometrial) tissue in ovaries, a condition called chocolate cyst, as the lesions contain brownish blood.
Is conception possible?
Ovarian cysts do not usually hinder conception, but adhesions and tubal damages secondary to infection, abscess or endometriosis as well as endometrioma may cause difficulties in terms of conception. Ovarian reserve may reduce due to the conditions that should be surgically treated, resulting in difficulties in conception.
Endometrial polyps and cervical polyps can be defined as “growths” that are located in the endometrium or the cervix, usually originate from those tissues and deemed benign in nature. Intrauterine polyps may lead to difficulty in conception or miscarriages, while they may also cause intermenstrual bleeding, heavy menstrual bleeding and anemia. Polyps can be easily diagnosed with pelvic exam and ultrasonography. Cervical polyps can be easily removed during the exam, while uterine polyps are also easily removed with a surgical approach, called hysteroscopy.
Pelvic Infection and Uterine Inflammation
Pelvic infection (inflammation) is an inflammatory condition of upper genital region that involves uterus, Fallopian tubes and ovaries secondary to upward movement of microorganisms from vagina and cervix.
A pelvic infection may lead to intra-abdominal adhesions, after it disappears. Those adhesions especially involve the Fallopian tubes, leading to distortion in their movement and anatomy and resultant conception problems. The damage to the tubes increases the risk of future ectopic pregnancy. The inflammatory materials can get into the blood circulation and cause a life threatening septic picture, if the infection is left untreated. The pelvic infection characterized by inguinal pain, discharge and fever can be diagnosed with pelvic exam, ultrasound and blood tests and it can be treated with oral or intravenous antibiotics.
The interior lining of the womb, called endometrium, is slightly hypertrophied by hormones secreted throughout the period that occurs once every 28 days on average in order to prepare the uterus for a potential pregnancy. If the conception fails, the endometrial cells falls off due to altered hormone profile and they are excreted in the menstrual blood through the vaginal route and finally, the endometrium gets thin again. If the menstrual cycle occurs once every 2 to 3 months usually due to irregular menstruation, the endometrium hypertrophies abnormally. This abnormally thickened endometrium, a condition called endometrial hyperplasia, can be detected with ultrasound imaging and it can also be seen if a uterine polyp is present. If the thickness of the endometrial wall does not reduce or if it occurs soon before the menopause or an underlying pathology is suspected, the endometrium can be examined and biopsied with hysteroscopic approach or a biopsy is directly performed and the specimen is sent to the pathology laboratory. If an endometrial hyperplasia or a malignant tumor is reported for the specimen, the most appropriate treatment or surgery option is offered to the patient by a gynecologist.
Vaginal Bleeding (irregular bleeding)
A normal menstrual bleeding occurs once every 21 to 35 days and it lasts for 2 to 7 days. Irregular menstruation is considered when the interval between two periods is shorter than 21 days or longer than 35 days. Moreover, menstrual bleeding that last longer than 7 to 10 days and measure >80 ml is also an abnormal condition. Although the most common cause include ovulation problems and impaired hormonal homeostasis, vaginal bleeding and irregular menstruation may also originate from ectopic pregnancy, premature delivery threat, uterine polyps or myomas, infections such as endometritis or cervicitis and endometrial or cervical tumors. Postmenopausal vaginal bleeding is also not normal. All abnormal vaginal bleedings require examination and ultrasound imaging; a biopsy procedure followed by a pathologic examination should be done, if required, and the condition should be treated with medical or surgical modalities in line with the definitive diagnosis.
Cervical cancer is the third most common cancer in women following breast and colon cancers at global scale and it is the tenth most common cancer in our country according to the data reported by the Ministry of Health. Cervical cancer is the only preventable cancer, but its exact cause is yet to be known. ‘Cancer precursors’ develop due to conversion of the cellular layer forming the interior os of the cervix into abnormal cells. If cancer precursors cannot be detected and treated early, they may transform into cervical cancer. A Pap smear specimen obtained during a pelvic exam is very crucial and a very easy screening method, as it may detect those cancer precursors and cancerous cells in case of a cancer. HPV infections are the most common underlying cause of the cellular changes in the cervix. National and international health authorities advise HPV immunization in two or three doses for all men and women aged 11-12 years in order to prevent the cancers originating from HPV. If the person is vaccine-naïve, the HPV vaccine can be administered up to age of 21 years in men and at any age in women. A cervical cancer can be diagnosed at an early stage through routine screening tests, such as smear and HPV, in women aged 21 to 65 years. Surgical treatment is primarily preferred for the early-stage cancer, while radiotherapy is the prioritized treatment option for advanced stages