If a woman experiences pelvic pain, discomfort during sexual intercourse particularly during deep penetration, pelvic mass, excessive menstrual bleeding, irregular periods or infertility, she may have a treatable gynecological disorder.
Having ruled out pregnancy, your doctor will take a thorough history, conduct a detailed physical exam, carry out a panel of blood test and a series of imaging study such as an abdominopelvic ultrasound, CT scan or MRI, hysterosalpingogram or diagnostic laparoscopy etc. to arrive at a diagnosis.
Gyneacological disorders that may result in the above mentioned symptoms are:
- Fibroids
- Ovarian cyst
- Endometriosis
- Pelvic adhesions
Fibroids are benign masses that arise from the overgrowth of tissue in the muscular layer of the uterus. They are non-cancerous and do not increase the risk of cancer. They can be classified as subserosal, mural and submucosal. They primarily affect women of reproductive age and affect 70% of women by age 50.
Ovarian cyst is a fluid filled sac arising from the ovary, in most cases these are non-cancerous and are picked up incidentally however in small number of cases can result in the symptoms listed earlier. Ovarian cyst can complicate if left untreated resulting in massive heamorrhage if ruptured.
Endometriosis is the presence of endometrial tissue (the tissue that normally lines the inside of the uterus and shed during menstruation) in an abnormal location such as the ovaries and bladder. 30-40% of women with endometriosis will have some degree of infertility directly linked to the endometriosis. A very small percentage of women with endometriosis can have deposits in distant sites such as the lung.
Pelvic adhesions occur as a result of the body’s response to healing following any inflammation in the pelvic region, such as a ruptured ovarian cyst, endometriosis or previous ectopic pregnancy. Pelvic adhesions can also arise from a non-gyneacological cause such as a history of ruptured appendicitis or diverticulitis.
Do note however that although the above may result in a degree of infertility, should you become pregnant with the following disorders untreated, it can result in increased complications during the pregnancy and at the time of child’s birth.
Your doctor may have started pharmacotherapy such as painkillers or oral contraceptive in order to relieve some of the symptoms you are experiencing. If these conservative measures prove to be futile or you may be trying to conceive for longer than a year with no success then surgery may be needed. Surgery can be open or minimally invasive. Open surgery is generally recommended for extensive disease and involves a midline incision whereas laparoscopic surgery involves making small puncture incisions also called a key hole surgery. After surgery there may be some slight vaginal discharge of possibly a dark red color (in some cases it may be a bright red color) in the early stages, but this is not a cause for concern and will subside on its own.
The risk associated with surgery is low and includes anesthetic complications such as reaction to medications used or urinary retention especially following spinal anesthesia. With respect to the surgery, there can be bleeding during and after surgery. Damage to nearby structure during surgery, such as nerves, blood vessels and bladder. Infection occurring immediately or shortly after surgery. For patients who underwent a laparoscopic procedure you may experience some back and chest pain, as well as abdominal pain, shoulder pain, and bloating due to the carbon dioxide gas used during the operation becoming trapped in the abdominal cavity. These symptoms will likely subside on their own. However, if patients can’t endure them, they should consult with their physician regarding appropriate medication to help relieve the symptoms. To reduce your chances of developing a complication it is important to follow the instructions of your doctor before and after surgery.