Endometriosis and Dysmenorrhoea Flashcards
What is dysmenorrhoea?
Pelvic pain during menstruation. Usually cramping, suprapubic pain.
What is dyspareunia?
Pain with sexual intercourse (divided into superficial and deep)
What is dyschezia?
Pain with defecation
What is mid cycle pain?
Pain usually felt in an iliac fossa due to ovulation (Mittelschmerz)
Where is dysmenorrhoea usually felt?
- Suprapubic
- thighs
- low back
- iliac fossae
What proportion of women experience severe (8-10/10) dysmenorrhea?
18-21%
What is primary dysmenorrhoea?
Cause unknown; thought to be related to prostaglandin release causing uterine contraction and myometrial angina
What is secondary dysmenorrhoea?
- Endometriosis
- Adenomyosis
- Intracavity mass (IUD, polyp, fibroid)
- Cervical stenosis: haematometra
- Isolated endometrial pocket post endometrial ablation / non communicating uterine horn
What are the superficial causes of dyspareunia?
- Thrush (candidiasis)
- Skin conditions
- Vestibulodynia
What are the skin conditions which may cause superficial dyspareunia?
- Atrophic vaginitis
- Contact dermatitis
- Lichen planus
- Lichen sclerosis
What are the causes of mid - deep dyspareunia?
- Endometriosis
- Adenomyosis
- Adhesions
- Ovarian cysts
- Pelvic floor (spasm, trigger points)
Examination features in dyspareunia work up?
Does anything reproduce pain with sex?
- Cottonbud prodding if localised tenderness at introitus
- VE:
- -prominent tender pelvic floor?
- -palpate outwards 360 degrees
- -assess uterus for bimanual tenderness
What is endometriosis?
Presence of endometrial glands and stoma outside the uterus
What proportion of women have endometriosis?
60-70% women with cyclical pelvic pain symptoms; 10-15% women of reproductive age
What are the theories of endometriosis?
- Implantation spread (retrograde menses)
- Coelomic metaplasia
- Congenital rest cells
- Iatrogenic implantation
- Metastatic spread (lymphatic and haematogenous)
- Direct spread
