Gynecologic pain

Gynecological pain is one of the most severe pains that can bother a woman. Many women - up to 90% - have suffered from gynecological pain at some point in their lives. Therefore, it is very important to understand the causes of this pain and methods of dealing with it.

[ 1 ]

Endometriosis

This is the most common cause of pain that women experience in the abdominal area and below. It can also radiate to the back.

[ 2 ], [ 3 ], [ 4 ], [ 5 ]

What is endometriosis?

Endometriosis is an abnormal growth of endometrial cells, the tissue that lines the uterus. They grow much further into the uterus than they should. Endometrial cells are specialized cells that multiply each month during the menstrual cycle. These growths are most often found on the ovaries, fallopian tubes, the outer surface of the uterus or intestines, and the lining of the pelvic cavity.

They can also grow in the vagina, cervix, bladder, although this is less common than in other pelvic areas. Very rarely, endometriosis cells can grow outside the pelvis, on the liver, in old scars, and even in or around the lungs - or the brain. Endometrial cells are benign growths. They are not cancerous.

Who suffers from endometriosis?

Endometriosis affects women most often during their reproductive years. The exact prevalence of endometriosis is unknown, as many women with the condition experience no visible symptoms. Experts estimate that endometriosis affects more than one million women (estimated to be between 3% and 18% of women) in the United States. It is one of the leading causes of pelvic pain and the reason for laparoscopic surgery and hysterectomy for this pain.

Studies show that 20% to 50% of women are treated for infertility due to endometriosis and up to 80% of women suffer from chronic pelvic pain due to the condition. Although most cases of endometriosis are diagnosed in women around 25-35 years of age, it can occur in girls as young as 11 years old. Endometriosis is extremely rare in postmenopausal women.

Scientists write that endometriosis is more common in white women compared to African-American and Asian women. Recent studies suggest that endometriosis is the most common disease, which affects tall, thin women with a low body mass index (BMI). Girls who choose to give birth for the first time after 30-40 years are more at risk of developing endometriosis.

Causes of endometriosis

They still remain not fully understood. But there are several theories about how endometriosis occurs and develops. One of the main causes of this disease that affects women is retrograde menstruation. This medical term refers to a condition in which blood containing small particles of the endometrium enters the fallopian tubes and abdominal cavity. A doctor can determine this condition by taking a smear from the woman's vagina during an examination. If a woman has a weakened immune system, a predisposition to genital anomalies, as well as viral infections, and injuries to the uterine area, the risk of endometriosis is even higher.

Smoking, alcohol abuse, elevated levels of estrogen hormones (sex hormones), and diseases of the genital organs increase the risk of developing endometriosis.

What are the symptoms of endometriosis?

Most women who suffer from endometriosis do not experience any symptoms of the disease. For those who do, symptoms include pain (usually pelvic) and infertility (inability to become pregnant within a year with regular unprotected intercourse). Pelvic gynecological pain usually bothers a woman during or just before menstruation and becomes weaker after menstruation. Some women experience pain during intercourse (dyspareunia) or cramping during intercourse and/or pain during bowel movements and/or urination. Even a gynecological examination by a gynecologist can be painful for such a woman.

The intensity of pain can vary from month to month and varies greatly from woman to woman. Some women experience progressively worsening symptoms, while others may have pain that is manageable without any treatment. Pelvic gynecological pain in women with endometriosis depends on where the endometriotic tissue is located.

Other symptoms associated with endometriosis pain include:

• pain in the abdomen, especially in the lower part
• diarrhea and/or constipation
• lower back pain
• irregular or heavy menstrual bleeding
• blood in urine.

Rare symptoms of endometriosis include chest pain or coughing up blood due to endometriosis cells invading the lungs and headache and/or endometriosis cells invading the brain.

Diagnosis of gynecological pain in endometriosis

Endometriosis can be diagnosed based on symptoms of pelvic pain and an exam in the doctor's office. Sometimes, during a rectovaginal test (one finger is inserted into the vagina and the other is inserted into the rectum), the doctor can feel nodules of endometriosis behind the uterus and along the ligaments that attach to the pelvic wall. In some cases, these nodules cannot be felt, but the doctor's exam itself can cause vaginal pain or discomfort.

Unfortunately, neither symptoms nor medical examinations can be relied upon to definitively establish a diagnosis of endometriosis. Then studies such as ultrasound, for example, will help. It can be useful to exclude other diseases besides endometriosis. For a more accurate diagnosis, a direct visual examination of the inside of the pelvic organs and abdominal cavity, as well as a tissue biopsy, are needed.

Another accurate way to diagnose endometriosis may be laparotomy (small incisions in the abdomen) or laparoscopy.

Laparoscopy is the most common surgical procedure used to diagnose endometriosis. Laparoscopy is performed under general anesthesia and, in some cases, local anesthesia. It is usually performed as an outpatient procedure (the patient goes home the same day).

Pelvic ultrasound and laparoscopy are also important to rule out malignancies (such as ovarian cancer), which can cause symptoms that mimic those of endometriosis.

[ 6 ], [ 7 ]

How to treat endometriosis?

Endometriosis can be treated with medications and/or surgery. The goals of endometriosis treatment may be to reduce or eliminate pain and increase fertility. Nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen sodium) are used to treat endometriosis and pelvic pain. They are usually prescribed to help relieve pelvic pain and menstrual cramps. Since endometriosis with pelvic pain most often occurs during the reproductive years, many medical treatments involve interrupting the normal cyclical production of hormones in the ovaries. Oral contraceptives and hormone treatment with progestins and estrogens in appropriate doses are then used.

Surgical treatment of endometriosis may be prescribed by a doctor when the symptoms of endometriosis are very severe or when the body has responded inadequately to treatment with hormones or anti-inflammatory drugs. Surgery is usually prescribed for gynecological pain caused by endometriosis, anatomical distortions of the pelvic organs, or intestinal or urinary tract obstruction.

Hormonal imbalances

Hormonal imbalances may be the second most common cause of gynecological pain. Women often do not associate these pains with imbalances in the production of certain hormones. However, this is true.

Symptoms of Hormonal Imbalance

Symptoms associated with hormonal disorders in women can manifest themselves most between the ages of 20 and 40. And the older a woman is, the more severe these symptoms are, especially if no one has paid attention to them for years. Here is how symptoms of hormonal imbalance associated with gynecological pain can manifest themselves:

• allergy symptoms (difficulty breathing)
• depression, fatigue and anxiety
• endometriosis
• fibrocystic mastopathy
• sudden hair loss on the head and hair growth on the face
• headache, dizziness and confusion
• increased sexual appetite
• osteoporosis
• PMS
• urinary incontinence
• weakened immunity, frequent colds
• uterine fibroids
• weight gain, fluid retention and swelling
• the appearance of early and premature wrinkles on the skin

Hormonal imbalance symptoms are primarily caused by a weak relationship between estrogen and progesterone levels in the body. The two female hormones, estrogen and progesterone, barely maintain a delicate balance of doses and ratios. Changes in this balance can have dramatic health consequences and reveal symptoms of hormonal imbalance.

The amount of hormones a woman's body produces from month to month depends on factors such as stress, diet, exercise, and most importantly, ovulation or lack thereof.

During the first 10-12 days of the menstrual cycle, the female body produces estrogen. When ovulation occurs, the ovaries produce progesterone. However, if ovulation does not occur, estrogens are still produced, but they are no longer in balance with the progesterone needed to induce ovulation. This condition leads to symptoms of hormonal imbalance - the estrogen-progesterone ratio drops to a very low level, although these hormones are produced in the body. But in very small quantities.

Causes of Hormonal Imbalance and Associated Gynecological Pain

There are several causes of hormonal imbalance, but in most cases the main cause is estrogen dominance or increased levels of estrogen in the body and a lack of progesterone. Other causes of gynecological pain with hormonal imbalance are taking birth control pills, stress, abuse of cosmetics and non-organic animal products.

There are also important causes such as genetics (heredity), obesity and tumors. Causes of gynecological pain due to hormonal imbalance can be lack of exercise, pregnancy, lactation period, production of autoantibodies and sedentary lifestyle. Of all these causes, obesity is the number one cause for medical reasons, and hormonal imbalance during pregnancy is the number one cause of hormonal imbalance due to lifestyle changes.

[ 8 ]

Diagnostics

How can a woman identify the symptoms of hormonal imbalance? This can be done quickly and effectively, by conducting a hormonal test at the first signs of the menstrual cycle in women of reproductive age or signs of menopause. The hormonal balance test takes only a few minutes. First of all, it is necessary to check the level of the hormones estrogen and progesterone and their ratio.

[ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ]

Treatment of hormonal imbalance

For women in menopause, this may be hormone replacement therapy. For women of reproductive age, this is usually taking hormonal drugs in the ratios recommended by the doctor. For gynecological pain associated with hormonal imbalance, painkillers and a special diet can also help.

Gynecological pain due to abnormal structure of the genitals

Features of the anatomical structure of the genitals

Due to improper development of the genitals, a woman may experience gynecological pain. The most common and serious deviation among the genitals are uterine defects. Almost 5% of female infertility is explained by anatomical defects of the uterus. These defects are congenital and acquired. Congenital defects of the genitals are those associated with incomplete formation of the uterus during the embryonic period, and its changes such as a bicornuate uterus and septa inside it.

Acquired defects are those that develop during a woman's life, such as uterine fibroids, polyps, and intrauterine adhesions. Acquired defects of the genitals may also include pelvic organ prolapse or prolapse of the uterus and/or vaginal walls.

Symptoms

Functional and anatomical defects can prevent a woman from becoming pregnant and carrying a child to term, but they can also be accompanied by severe gynecological pain. With uterine defects, women can also suffer from abnormal bleeding or spontaneous abortion.

Diagnosis of anatomical defects and associated pain

Ultrasound examination of the uterus after using saline solution

[ 14 ], [ 15 ], [ 16 ], [ 17 ], [ 18 ], [ 19 ], [ 20 ]

Hysterosalpingogram

This method uses X-rays and a special chemical dye to detect defects in the uterus.

Hysteroscopy

This method uses a fiber optic telescope that is inserted into the uterine cavity.

Laparoscopy

This method involves using a small fiber-optic telescope that is inserted through an incision near the belly button into the abdomen.

Treatment of anatomical defects of the uterus

As a rule, anatomical defects can only be corrected through plastic surgery.

Vulvodynia

First of all, this disease is characterized by pain in the perineum and pain at the entrance to the vagina.

The pain, burning, or irritation associated with vulvodynia can make a woman's life so miserable that even sex becomes unthinkable. The condition can last for months or years.

Women with vulvodynia suffer from chronic pain in the vulva area for no apparent reason. Until recently, doctors did not even recognize vulvodynia as a real pain syndrome. Even today, many women are unable to get diagnosed with the condition. They may also remain isolated from their surroundings because vulvodynia is not an easy subject to discuss. Researchers are still working hard to uncover the causes of vulvodynia and find better ways to treat it.

Types of vulvodynia

Vulvodynia affects the condition of the vulva, the external female genitalia: the labia, clitoris and vagina.

There are two main subtypes of vulvodynia:

• Generalized vulvodynia is pain in different areas of the vulva that bothers a woman at different times. Pain in the vulva may be constant or occur at the same time every day. Even simple fingering can aggravate gynecological pain.
• Vulvar vestibulitis – literally translated, it sounds like pain in the vestibule – that is, the entrance to the vagina. This type of pain – severe and burning – occurs only after touching or pressure, for example, during sexual intercourse.

Possible Causes of Vulvodynia

Doctors still cannot name most of the causes of vulvodynia. They have no evidence that infections that cause sexually transmitted diseases can cause vulvodynia, as scientists claimed several decades ago.

Causes of vulvodynia may include:

• Damage to or irritation of a nerve in the uterine area
• An abnormal response of germ cells to infection or injury
• Genetic factors that make the vulva insensitive to chronic inflammation
• Increased sensitivity of the vagina to yeast infection
• Muscle spasms
• Allergy or irritation to chemicals (or other substances)
• Hormonal imbalance
• Sexual violence
• Frequent use of antibiotics

Symptoms of vulvodynia and associated gynecological pain

Symptoms of vulvodynia usually begin suddenly and can last from several months to several years.

• Burning, tingling, abrasive sensation in the vulva area
• Throbbing pain in the vaginal area or entrance
• Itching in the vagina
• Inflamed or swollen vulva

Symptoms of vulvodynia may appear:

• All the time or from time to time
• During activities such as exercise, socializing, or walking - or even while relaxing
• While riding a bike, inserting tampons, or sitting in one place for a long time In one specific area of the vulva or throughout the entire vulva

Burning pain of a gynecological nature is the most common symptom of vulvodynia. Some women describe it as a stabbing pain or an unbearable pain as if acid had been poured on the skin.

Treatment of vulvodynia

Medicines

• Local anesthetics such as lidocaine, novocaine
• Hormonal creams with estrogens
• Tricyclic antidepressants
• Anticonvulsants
• Interferon injections

Therapy

Physical therapy for vulvodynia pain includes exercises to strengthen the pelvic muscles and reduce muscle spasms.

Biofeedback to help you learn to relax your vaginal muscles to reduce gynecological pain

Women with vulvodynia need to figure out what works best when it comes to treatment, and they may have to try several medications before finding the best combination. Here are some things women can do to help relieve or control vulvodynia symptoms.

• Use dermatologically approved detergents and do not use fabric softeners or fragrances when washing your underwear.
• Use 100% white cotton underwear, cotton menstrual pads and tampons.
• Avoid getting shampoo on the vulva area.
• Avoid scented creams and soaps, pads or tampons, creams with high concentrations of spermicides.
• Avoid hot tubs or pools with high chlorine levels.
• Rinse your vulva with cool water after each urination and intercourse.
• Avoid foods that make waste products irritate the genitals. These include greens, legumes, berries, chocolate, and nuts.
• Wear loose clothing and avoid tight pants and skirts; do not wear synthetic tights.
• Keep the vulvar area clean and dry.

It should be taken into account that gynecological pain is necessarily associated with the health of the reproductive system. Therefore, it is necessary to avoid inflammation of the pelvic organs, especially chronic, and also regularly visit an oncologist for malignant and benign tumors in the genitals.

What is acute gynecological pain?

This is pain in the lower abdomen or back that occurs suddenly, does not last long, but is accompanied by a strong pain symptom. Also, a woman may have a fever, her intestines may not work well, weakness and fatigue may occur. It feels as if life is gradually leaving the woman. If you have ever experienced such a condition, you should never tolerate it, you must consult a gynecologist at the antenatal clinic about what to do. And it is better to immediately call an ambulance.

The causes of this condition may be serious abnormalities in the functioning of the female reproductive system: inflammation of the appendages or uterus, ectopic pregnancy, as well as rupture of a neoplasm on the ovary (cyst) or its twisting, the causes may also be other diseases that require an immediate call to the doctor.

Gynecological pains can be not only acute, but also chronic, that is, lasting a long time and constantly. These pains are localized in women in the lower abdomen and can last for several years. The causes of chronic pain are completely different from the causes of acute pain, so we consider them separately. Doctors register chronic pains associated with gynecology in every fifth or sixth woman.

They are most often caused not by a single disease, but by a whole complex of reasons, so such pains should be given special attention and not tolerated, but diagnosed and treated. Sometimes it happens that the diagnosis of chronic gynecological pain is difficult, and the causes are difficult to identify, and sometimes it is not possible at all. Let's consider the main causes of gynecological pain in more detail.