Inflammations of the Gynecological System

Inflammations of the gynecological system may involve any part. Vulvitis is an infection of the outer geni­talia which may stem from poor hygiene or spe­cific contact infections. Medical treatment usu­ally corrects.

Clitoritis is inflammation limited to this part. It may result from the constricting folds of the skin enveloping the clitoris so that minor operative procedure known as female cir­cumcision is necessary.

Infection of the vulvo­vaginal or Bartholin glands is rather common. This is called Bartholinitis. It may occur on one side or both. When the infection proceeds to abscess formation, the condition is known as a Bartholin abscess. The end result of either may be a collection of fluid within an enlarged gland with obstructed outlet, known as Bartho­lin cyst. Infection of this gland demands medi­cal treatment, but operative treatment may be nccessary to drain an abscess. Bartholin cyst is treated by surgical removal.

Vaginitis is inflammation of the lining wall of the vagina. This may ensue from germ in­fection, from mechanical irritation (as in the newly-wed), or from infections higher in the tract draining into the vagina. Treatment of vaginitis entails the use of medicated supposi­tories, douches, medications, and eradication of infections higher in the system.

Cervicitis is a common disease wherein the cervix may be slightly or massively inflamed. Cervicitis may be acute but more often is chronic. Cervical erosions and ulcerations may be associated. Cervicitis is not so common in women who have not borne children. But with the enlargement and stretching of this small opening to a 4- to 5-inch diameter at the time of childbirth, there may result injured tissue which does not ward off infection well. It is imperative that chronic cervicitis be fully treated since the cervix remains a most com­mon site of cancer in the female, and it is well known that chronic irritation predisposes to ma­lignant change. Acute cervicitis may be treated by medical measures such as medications, sup­positories, and douchings. Chronic cervicitis usu­ally demands more extensive procedures. Cau­tery of the cervix is one surgical means of eradicating chronic inflammation from this area. Cervical conization is a commoner method of treating chronic cervicitis. Figure shows how a cone-shaped piece of tissue is removed from the cervical opening by use of a special electric cautery instrument. Healing then takes place so that the cervix resumes its normal function and appearance. In some severe and long-standing cases of chronic cervicitis, amputation of the cervix may be necessary. This is called trache- Iectomy, but is generally not to be performed in the child-bearing years because the uterus usually cannot retain a pregnancy to full term when the cervix is absent.

Endometritis is inflammation of the lining of the uterus. This may be acute or chronic and may be associated with infections higher in the system or an extension of cervicitis. Abnormal menstrual bleeding commonly gives insight to this condition. Treatment entails the proper eradication of inflammations of associated parts, as w’ell as the endometritis. Medical measures may alleviate this condition, but more often surgical treatment is necessitated. This is accom­plished by dilatation and curettage (D & C). Under anesthesia the cervical opening is dilated and then the entire lining of the uterus curetted (scraped) from its bed. This then proceeds to regeneration of the endometrium, just as nor­mally occurs with each menstrual cycle.

Salpingitis is inflammation of a fallopian tube. It may involve either side or both, and may be acute or chronic. It most often ensues from infection ascending through the uterine canal. If the disease progresses to form a pus pocket within the tube, it is known as pyo- salpinx (pus-tube). Such process may then become arrested and the offending germs de­stroyed so that there remains a tube distended with sterile fluid; this is called hydrosalpinx (water-tube). Most cases of salpingitis, how­ever, subside without any residual abnormality. But some heal with scarring to obliterate the tube’s opening; if this is on both sides the woman is then infertile. Treatment of salpingitis is com­monly accomplished by medical measures but often operation for removal of the inflamed tube is indicated. Removal of a fallopian tube is called salpingectomy (tube-out).

Oophoritis is inflammation of an ovary. This occurs by extension of infection via a fallopian tube, or from an adjacent abdominal organ. The hormonal function of the ovary is usually dis­turbed. Treatment is most often successful by medical means. Commonly the tube and the ovary on one side become markedly inflamed and progress to abscess formation, known as tubo-ovarian abscess. This requires operation for drainage and/or removal of the parts.

Abscesses of the pelvis may develop from infections of the gynecological system or from infections or perforations of other abdominal organs. Untreated appendicitis, for example, may progress to form pelvic abscesses around the gynecological system. Rarely these will per­forate spontaneously into the rectum or the va­gina, but more often surgical drainage through the abdomen or the vagina is necessary.