The document discusses vulval pain syndrome (VPS), which includes enigmatic causes of vulval pain that comprise a heterogeneous group of women who are difficult to manage. VPS can be classified as dysaesthetic vulvodynia or vestibulodynia. Dysaesthetic vulvodynia involves chronic discomfort characterized by burning, stinging or irritation without visible signs. Vestibulodynia involves severe pain on vestibular touch or entry with tenderness localized within the vestibule. Management of VPS involves vulvar care, topical therapies, oral medications like antidepressants, biofeedback, injections, diet modification and surgery.
Vulvodynia is chronic vulvar pain without a visible cause that has been present for at least 3 months. It is classified as localized or generalized. Localized vulvodynia involves pain in the vulvar vestibule, while generalized vulvodynia causes stinging or burning anywhere in the vulva. Diagnosis involves ruling out other causes through history, exam, and tests. Treatment is multimodal and includes behavioral changes, pelvic floor physical therapy, psychological interventions, various medications, and sometimes surgery. The goal is to set realistic expectations as improvement may take months and different treatments may need to be tried.
This document discusses chronic pelvic pain (CPP), which is defined as intermittent or constant pain in the lower abdomen or pelvis lasting at least 6 months. CPP has many potential causes including endometriosis, adhesions, pelvic congestion syndrome, irritable bowel syndrome, interstitial cystitis, and nerve entrapment syndromes. A thorough history, exam, and testing are needed to evaluate CPP and identify potential causes. Treatment is multidisciplinary and may include medications, physiotherapy, laparoscopy, and hysterectomy depending on the underlying etiology. Managing CPP requires a multidisciplinary approach and treatment of any associated psychological factors.
Role of hysteroscopy in Infertility, Dr Rajesh GajbhiyeRajesh Gajbhiye
Hysteroscopy plays an important role in the evaluation and treatment of intrauterine abnormalities found in infertile women. Diagnostic hysteroscopy is considered the gold standard for diagnosing conditions like submucous fibroids, uterine septum, intrauterine adhesions, and endometrial polyps that are common in infertile patients. Surgical treatment of these abnormalities by hysteroscopy has been shown to improve pregnancy rates compared to diagnostic hysteroscopy alone. Additionally, performing hysteroscopy before IVF treatment or endometrial scratching prior to a cycle has been associated with higher success rates, though more research is still needed to confirm these findings.
1. Ulipristal acetate is a selective progesterone receptor modulator approved for treatment of uterine fibroids. It binds to progesterone receptors and blocks their action, reducing fibroid size and symptoms without affecting estrogen levels.
2. Studies showed ulipristal acetate effectively controlled bleeding and reduced fibroid volumes more rapidly than leuprolide acetate. It maintained fertility without significant safety issues.
3. Long term treatment with ulipristal acetate provided sustained control of bleeding and pain, with shrinkage of fibroid volumes maintained during off treatment periods. Quality of life was improved.
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
This document provides information on progestins and their use in treating endometriosis. It focuses on dienogest, a new hybrid progestin. It discusses dienogest's pharmacological properties, advantages over other treatments like GnRH agonists, and clinical trial results showing its efficacy and safety. Long-term use of up to 52 weeks is shown to control symptoms with minimal side effects. Dienogest also allows for prompt return of fertility and ovulation after treatment.
This document provides an overview of intrauterine insemination (IUI). Some key points include:
IUI is a first-line, non-invasive fertility treatment that involves placing processed sperm directly into the uterus. Success rates range from 6-20% depending on the stimulation protocol used. Factors like age, infertility duration and etiology, and semen quality impact success rates. Strict monitoring is important to minimize risks of ovarian hyperstimulation syndrome while maximizing pregnancy chances. Proper sperm processing techniques and timing of insemination relative to ovulation are also important considerations for IUI.
This document discusses adenomyosis, including its definition, pathogenesis, clinical presentation, diagnostic modalities, and treatment options. Adenomyosis is defined as the benign invasion of endometrial glands and stroma into the myometrium. It most commonly presents in women aged 30-45 with symptoms like dysmenorrhea, heavy menstrual bleeding, and dyspareunia. Diagnosis can be made using ultrasound, MRI, or biopsy. Treatment involves conservative management, medical therapy like progestins or GnRH agonists, or surgical options such as hysterectomy or uterine-sparing procedures.
Vulvodynia is chronic vulvar pain without a visible cause that has been present for at least 3 months. It is classified as localized or generalized. Localized vulvodynia involves pain in the vulvar vestibule, while generalized vulvodynia causes stinging or burning anywhere in the vulva. Diagnosis involves ruling out other causes through history, exam, and tests. Treatment is multimodal and includes behavioral changes, pelvic floor physical therapy, psychological interventions, various medications, and sometimes surgery. The goal is to set realistic expectations as improvement may take months and different treatments may need to be tried.
This document discusses chronic pelvic pain (CPP), which is defined as intermittent or constant pain in the lower abdomen or pelvis lasting at least 6 months. CPP has many potential causes including endometriosis, adhesions, pelvic congestion syndrome, irritable bowel syndrome, interstitial cystitis, and nerve entrapment syndromes. A thorough history, exam, and testing are needed to evaluate CPP and identify potential causes. Treatment is multidisciplinary and may include medications, physiotherapy, laparoscopy, and hysterectomy depending on the underlying etiology. Managing CPP requires a multidisciplinary approach and treatment of any associated psychological factors.
Role of hysteroscopy in Infertility, Dr Rajesh GajbhiyeRajesh Gajbhiye
Hysteroscopy plays an important role in the evaluation and treatment of intrauterine abnormalities found in infertile women. Diagnostic hysteroscopy is considered the gold standard for diagnosing conditions like submucous fibroids, uterine septum, intrauterine adhesions, and endometrial polyps that are common in infertile patients. Surgical treatment of these abnormalities by hysteroscopy has been shown to improve pregnancy rates compared to diagnostic hysteroscopy alone. Additionally, performing hysteroscopy before IVF treatment or endometrial scratching prior to a cycle has been associated with higher success rates, though more research is still needed to confirm these findings.
1. Ulipristal acetate is a selective progesterone receptor modulator approved for treatment of uterine fibroids. It binds to progesterone receptors and blocks their action, reducing fibroid size and symptoms without affecting estrogen levels.
2. Studies showed ulipristal acetate effectively controlled bleeding and reduced fibroid volumes more rapidly than leuprolide acetate. It maintained fertility without significant safety issues.
3. Long term treatment with ulipristal acetate provided sustained control of bleeding and pain, with shrinkage of fibroid volumes maintained during off treatment periods. Quality of life was improved.
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
This document provides information on progestins and their use in treating endometriosis. It focuses on dienogest, a new hybrid progestin. It discusses dienogest's pharmacological properties, advantages over other treatments like GnRH agonists, and clinical trial results showing its efficacy and safety. Long-term use of up to 52 weeks is shown to control symptoms with minimal side effects. Dienogest also allows for prompt return of fertility and ovulation after treatment.
This document provides an overview of intrauterine insemination (IUI). Some key points include:
IUI is a first-line, non-invasive fertility treatment that involves placing processed sperm directly into the uterus. Success rates range from 6-20% depending on the stimulation protocol used. Factors like age, infertility duration and etiology, and semen quality impact success rates. Strict monitoring is important to minimize risks of ovarian hyperstimulation syndrome while maximizing pregnancy chances. Proper sperm processing techniques and timing of insemination relative to ovulation are also important considerations for IUI.
This document discusses adenomyosis, including its definition, pathogenesis, clinical presentation, diagnostic modalities, and treatment options. Adenomyosis is defined as the benign invasion of endometrial glands and stroma into the myometrium. It most commonly presents in women aged 30-45 with symptoms like dysmenorrhea, heavy menstrual bleeding, and dyspareunia. Diagnosis can be made using ultrasound, MRI, or biopsy. Treatment involves conservative management, medical therapy like progestins or GnRH agonists, or surgical options such as hysterectomy or uterine-sparing procedures.
Ovulation Induction - Simplified - Dr Dhorepatil BharatiBharati Dhorepatil
What are factors to be considered
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of FSH & LH
Trigger
Luteal phase support
Pregnancy rate/cycle
This document discusses vulvodynia, specifically vulvar vestibulitis syndrome (VVS). It defines VVS as a chronic condition characterized by severe pain on vestibular touch or attempted vaginal entry. The causes are unclear but may be multifactorial, and treatments include reassurance, medical options like topical creams or antidepressants, behavioral therapies, and surgery like vestibulectomy in some cases. Diagnosis involves assessing for tenderness localized within the vestibule using a cotton swab test.
Carbetocin is a synthetic oxytocin analogue that is longer acting than oxytocin. It has a half-life of 40 minutes compared to 4-10 minutes for oxytocin. Studies show carbetocin is as effective or more effective than oxytocin in preventing postpartum hemorrhage following both vaginal and cesarean deliveries. It requires only a single dose rather than continuous infusion and does not cause uterine receptor desensitization like oxytocin. The WHO recommends carbetocin as an effective first-line uterotonic for preventing excessive bleeding after childbirth.
1. Clomiphene citrate is commonly used as the first line treatment for ovulation induction, working by depleting estrogen receptors in the brain and inducing a luteinizing hormone surge. It has a success rate of inducing ovulation in 60-80% but the live birth rate per cycle is only around 15%.
2. Aromatase inhibitors like letrozole are sometimes used as an alternative to clomiphene citrate for ovulation induction, working by inhibiting the conversion of androgens to estrogens. They have fewer side effects than clomiphene citrate and may reduce risks of multiple pregnancy and miscarriage.
3. When clomiphene citrate treatment fails, gonad
SAVE UTERUS COMPAIGN, Dr.Sharda Jain, Dr. Ila Gupta Lifecare Centre
This document discusses the overuse and misuse of hysterectomies in India. It summarizes the following key points:
1. Hysterectomy rates in India are much higher than in Western countries, often performed unnecessarily for benign conditions or without adequate diagnostic evaluation and consideration of alternative treatments.
2. Removal of the uterus at a young age can have negative long-term impacts on a woman's health like early menopause, increased risks of heart disease and osteoporosis.
3. More conservative treatments for conditions like heavy menstrual bleeding exist, like medical therapies and uterine balloon therapy, that can avoid unnecessary hysterectomies in many cases.
4. Guidelines in Western countries
Laparoscopy still remains an important diagnostic and therapeutic tool in the management of subfertile women. Optimal and prudent use of this minimally invasive technique may avert costly treatment like IVF but overzealous and unindicated use may compromise future fertility. The evidence indicates that laparoscopic surgery improves fertility outcomes for conditions like mild to moderate endometriosis, myomectomy for submucosal fibroids, and tubal surgery. However, more high-quality randomized controlled trials are needed to provide stronger evidence and guidelines for clinical practice in reproductive surgery.
This document discusses recurrent pregnancy loss and provides information on definitions, incidence, causes, investigations, and guidelines. Some key points:
- Recurrent pregnancy loss is defined as 3 or more clinically recognized pregnancy losses before 20 weeks. The incidence is about 1 in 300 pregnancies.
- Common causes include genetic factors in the parents or embryo, anatomic abnormalities, endocrine/immune/infectious factors, and inherited thrombophilias.
- Investigations should include parental karyotyping after 2 losses, and karyotyping of pregnancy tissues is recommended by RCOG guidelines to provide counseling and predict outcomes of future pregnancies.
- Biomarkers and ultrasound can provide information on predicting outcomes,
Significant increase in live birth rate is found when IUI is done with stimulation compared with IUI in natural cycle in women with Unexplained Infertility .
Management of infertility Nice Guidelines 2013 : Dr. Sharda Jain Dr. Jyoti ...Lifecare Centre
1) The guidelines provide recommendations for the management of infertility including advice and counseling, lifestyle changes, ovulation induction, IUI, IVF criteria and genetic counseling.
2) Key recommendations include weight loss and lifestyle changes for PCOS, a maximum of 6 months of ovulation induction before considering other options, offering 3 cycles of IVF to those under 40 who have not conceived after 2 years, and genetic counseling and testing before ICSI.
3) The guidelines aim to optimize treatment effectiveness while minimizing risks like multiple pregnancies and OHSS.
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
MODERATOR
DR SHARDA JAIN
DR JYOTI AGARWAL
DR ILA GUPTA
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
FIRST LINE THERAPY - CLOMIPHENE CITRATE & LETROZOLE BY DR SHASHWAT JANIDR SHASHWAT JANI
Dr. Shashwat Jani discusses ovulation induction using clomiphene citrate and letrozole. He explains that clomiphene citrate works by blocking estrogen receptors in the pituitary and hypothalamus, increasing FSH levels and causing the development of multiple follicles. However, it has anti-estrogenic side effects and a lower pregnancy rate than letrozole. Letrozole inhibits the aromatase enzyme, reducing estrogen levels and stimulating the hypothalamic-pituitary axis to induce mono-follicular development with fewer side effects and a higher pregnancy success rate than clomiphene citrate.
Recent 2018 ESHRE & ASRM evidence based guidelines for PCOS assementAtef Darwish
This document discusses recommendations for assessing polycystic ovary syndrome (PCOS). It covers diagnostic criteria including irregular menstrual cycles, hyperandrogenism, polycystic ovarian morphology on ultrasound, and anti-Müllerian hormone levels. It also discusses assessing cardiovascular, metabolic, and reproductive health risks associated with PCOS, including insulin resistance, impaired glucose tolerance, diabetes, and obesity. Ethnic variations in PCOS presentation and long-term health risks are also addressed.
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Management of INFERTILITY in PCOD Difficulties & SolutionsMade Easy , Dr....Lifecare Centre
This document discusses the management of infertility in patients with polycystic ovarian syndrome (PCOS). It begins by outlining the types of patients seen, including those with anovulatory infertility, obesity, and menstrual irregularities. The challenges of PCOS treatment in women aged 20-40 are then presented, including concerns about infertility, pregnancy loss, and risks during pregnancy like preeclampsia and gestational diabetes. Treatment options for infertility in PCOS patients are then discussed, including clomiphene citrate, gonadotropins, laparoscopic ovarian drilling, and metformin. Protocols for ovarian stimulation with clomiphene citrate and gonadotropins are also presented.
1. The document discusses various methods for evaluating tubal patency in infertile patients, including hysterosalpingography (HSG), laparoscopy, and tests like Chlamydia antibody testing.
2. HSG is the most common screening test but has limitations like radiation exposure and false positives. Findings on HSG like mucosal rugae can provide prognostic information.
3. Laparoscopy allows direct visualization but is more invasive. It remains the gold standard for diagnosing conditions like endometriosis.
4. For treatment, IVF is now often preferred over surgery for moderate to severe tubal damage, while laparoscopic surgery may be considered for milder issues
This document discusses female infertility. It defines primary and secondary infertility and outlines the typical initial investigations for an infertile couple, including investigating male factors, testing for ovulation, and testing tubal patency using procedures like laparoscopy and hysteroscopy. Some of the key causes of female infertility discussed include ovulatory disorders like polycystic ovary syndrome, tubal damage, endometriosis, and unexplained infertility.
Vaginismus is an involuntary spasm of the outer third of the vagina that interferes with sexual intercourse. It has psychological and physical causes and can develop from traumatic experiences, sexual abuse, or religious beliefs. Treatment involves breaking the pain-anxiety cycle through sex education, muscle relaxation exercises, and the gradual insertion of dilators under the woman's control to desensitize the vagina to penetration. The goal is to help the woman feel comfortable owning her body and sharing it through a process that respects her pace and limits anxiety, with success rates of around 90% through systematic desensitization. Surgery is rarely needed and may worsen the condition.
Prof. Narendra Malhotra has had an extensive career in obstetrics and gynecology. He is the president of multiple organizations, has published and presented numerous papers, and has authored and edited several books. He specializes in high risk obstetrics, ultrasound, laparoscopy, infertility treatment and genetics. He currently practices in Agra, India and is the managing director of Global Rainbow Health Care.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Vulvodynia is a chronic pain condition that causes discomfort or pain in the vulvar area. It is often misdiagnosed because many doctors attribute the symptoms to other issues like sexual dysfunction or mental health problems. To diagnose vulvodynia, doctors will do a physical exam using cotton swabs to stimulate the area and look for an extreme pain response. While there is no cure, many treatment options can provide relief, including eliminating irritants, managing yeast infections, topical creams, antidepressants or anticonvulsants, physical therapy, and surgery. Seeking support from organizations like the National Vulvodynia Association can help women cope with the psychological impact of this condition.
Este documento describe las enfermedades de transmisión sexual (ETS) en el contexto del abuso sexual y ofrece recomendaciones para su diagnóstico, tratamiento y prevención. Detalla las manifestaciones clínicas de varias ETS y el impacto que pueden tener, incluidas complicaciones graves como infertilidad, cáncer y VIH/SIDA. Además, enfatiza la importancia de evaluar a la víctima y al agresor para identificar riesgos, iniciar profilaxis oportuna y brindar asesoramiento y apoyo psicológ
Ovulation Induction - Simplified - Dr Dhorepatil BharatiBharati Dhorepatil
What are factors to be considered
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of FSH & LH
Trigger
Luteal phase support
Pregnancy rate/cycle
This document discusses vulvodynia, specifically vulvar vestibulitis syndrome (VVS). It defines VVS as a chronic condition characterized by severe pain on vestibular touch or attempted vaginal entry. The causes are unclear but may be multifactorial, and treatments include reassurance, medical options like topical creams or antidepressants, behavioral therapies, and surgery like vestibulectomy in some cases. Diagnosis involves assessing for tenderness localized within the vestibule using a cotton swab test.
Carbetocin is a synthetic oxytocin analogue that is longer acting than oxytocin. It has a half-life of 40 minutes compared to 4-10 minutes for oxytocin. Studies show carbetocin is as effective or more effective than oxytocin in preventing postpartum hemorrhage following both vaginal and cesarean deliveries. It requires only a single dose rather than continuous infusion and does not cause uterine receptor desensitization like oxytocin. The WHO recommends carbetocin as an effective first-line uterotonic for preventing excessive bleeding after childbirth.
1. Clomiphene citrate is commonly used as the first line treatment for ovulation induction, working by depleting estrogen receptors in the brain and inducing a luteinizing hormone surge. It has a success rate of inducing ovulation in 60-80% but the live birth rate per cycle is only around 15%.
2. Aromatase inhibitors like letrozole are sometimes used as an alternative to clomiphene citrate for ovulation induction, working by inhibiting the conversion of androgens to estrogens. They have fewer side effects than clomiphene citrate and may reduce risks of multiple pregnancy and miscarriage.
3. When clomiphene citrate treatment fails, gonad
SAVE UTERUS COMPAIGN, Dr.Sharda Jain, Dr. Ila Gupta Lifecare Centre
This document discusses the overuse and misuse of hysterectomies in India. It summarizes the following key points:
1. Hysterectomy rates in India are much higher than in Western countries, often performed unnecessarily for benign conditions or without adequate diagnostic evaluation and consideration of alternative treatments.
2. Removal of the uterus at a young age can have negative long-term impacts on a woman's health like early menopause, increased risks of heart disease and osteoporosis.
3. More conservative treatments for conditions like heavy menstrual bleeding exist, like medical therapies and uterine balloon therapy, that can avoid unnecessary hysterectomies in many cases.
4. Guidelines in Western countries
Laparoscopy still remains an important diagnostic and therapeutic tool in the management of subfertile women. Optimal and prudent use of this minimally invasive technique may avert costly treatment like IVF but overzealous and unindicated use may compromise future fertility. The evidence indicates that laparoscopic surgery improves fertility outcomes for conditions like mild to moderate endometriosis, myomectomy for submucosal fibroids, and tubal surgery. However, more high-quality randomized controlled trials are needed to provide stronger evidence and guidelines for clinical practice in reproductive surgery.
This document discusses recurrent pregnancy loss and provides information on definitions, incidence, causes, investigations, and guidelines. Some key points:
- Recurrent pregnancy loss is defined as 3 or more clinically recognized pregnancy losses before 20 weeks. The incidence is about 1 in 300 pregnancies.
- Common causes include genetic factors in the parents or embryo, anatomic abnormalities, endocrine/immune/infectious factors, and inherited thrombophilias.
- Investigations should include parental karyotyping after 2 losses, and karyotyping of pregnancy tissues is recommended by RCOG guidelines to provide counseling and predict outcomes of future pregnancies.
- Biomarkers and ultrasound can provide information on predicting outcomes,
Significant increase in live birth rate is found when IUI is done with stimulation compared with IUI in natural cycle in women with Unexplained Infertility .
Management of infertility Nice Guidelines 2013 : Dr. Sharda Jain Dr. Jyoti ...Lifecare Centre
1) The guidelines provide recommendations for the management of infertility including advice and counseling, lifestyle changes, ovulation induction, IUI, IVF criteria and genetic counseling.
2) Key recommendations include weight loss and lifestyle changes for PCOS, a maximum of 6 months of ovulation induction before considering other options, offering 3 cycles of IVF to those under 40 who have not conceived after 2 years, and genetic counseling and testing before ICSI.
3) The guidelines aim to optimize treatment effectiveness while minimizing risks like multiple pregnancies and OHSS.
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
MODERATOR
DR SHARDA JAIN
DR JYOTI AGARWAL
DR ILA GUPTA
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
FIRST LINE THERAPY - CLOMIPHENE CITRATE & LETROZOLE BY DR SHASHWAT JANIDR SHASHWAT JANI
Dr. Shashwat Jani discusses ovulation induction using clomiphene citrate and letrozole. He explains that clomiphene citrate works by blocking estrogen receptors in the pituitary and hypothalamus, increasing FSH levels and causing the development of multiple follicles. However, it has anti-estrogenic side effects and a lower pregnancy rate than letrozole. Letrozole inhibits the aromatase enzyme, reducing estrogen levels and stimulating the hypothalamic-pituitary axis to induce mono-follicular development with fewer side effects and a higher pregnancy success rate than clomiphene citrate.
Recent 2018 ESHRE & ASRM evidence based guidelines for PCOS assementAtef Darwish
This document discusses recommendations for assessing polycystic ovary syndrome (PCOS). It covers diagnostic criteria including irregular menstrual cycles, hyperandrogenism, polycystic ovarian morphology on ultrasound, and anti-Müllerian hormone levels. It also discusses assessing cardiovascular, metabolic, and reproductive health risks associated with PCOS, including insulin resistance, impaired glucose tolerance, diabetes, and obesity. Ethnic variations in PCOS presentation and long-term health risks are also addressed.
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Management of INFERTILITY in PCOD Difficulties & SolutionsMade Easy , Dr....Lifecare Centre
This document discusses the management of infertility in patients with polycystic ovarian syndrome (PCOS). It begins by outlining the types of patients seen, including those with anovulatory infertility, obesity, and menstrual irregularities. The challenges of PCOS treatment in women aged 20-40 are then presented, including concerns about infertility, pregnancy loss, and risks during pregnancy like preeclampsia and gestational diabetes. Treatment options for infertility in PCOS patients are then discussed, including clomiphene citrate, gonadotropins, laparoscopic ovarian drilling, and metformin. Protocols for ovarian stimulation with clomiphene citrate and gonadotropins are also presented.
1. The document discusses various methods for evaluating tubal patency in infertile patients, including hysterosalpingography (HSG), laparoscopy, and tests like Chlamydia antibody testing.
2. HSG is the most common screening test but has limitations like radiation exposure and false positives. Findings on HSG like mucosal rugae can provide prognostic information.
3. Laparoscopy allows direct visualization but is more invasive. It remains the gold standard for diagnosing conditions like endometriosis.
4. For treatment, IVF is now often preferred over surgery for moderate to severe tubal damage, while laparoscopic surgery may be considered for milder issues
This document discusses female infertility. It defines primary and secondary infertility and outlines the typical initial investigations for an infertile couple, including investigating male factors, testing for ovulation, and testing tubal patency using procedures like laparoscopy and hysteroscopy. Some of the key causes of female infertility discussed include ovulatory disorders like polycystic ovary syndrome, tubal damage, endometriosis, and unexplained infertility.
Vaginismus is an involuntary spasm of the outer third of the vagina that interferes with sexual intercourse. It has psychological and physical causes and can develop from traumatic experiences, sexual abuse, or religious beliefs. Treatment involves breaking the pain-anxiety cycle through sex education, muscle relaxation exercises, and the gradual insertion of dilators under the woman's control to desensitize the vagina to penetration. The goal is to help the woman feel comfortable owning her body and sharing it through a process that respects her pace and limits anxiety, with success rates of around 90% through systematic desensitization. Surgery is rarely needed and may worsen the condition.
Prof. Narendra Malhotra has had an extensive career in obstetrics and gynecology. He is the president of multiple organizations, has published and presented numerous papers, and has authored and edited several books. He specializes in high risk obstetrics, ultrasound, laparoscopy, infertility treatment and genetics. He currently practices in Agra, India and is the managing director of Global Rainbow Health Care.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Vulvodynia is a chronic pain condition that causes discomfort or pain in the vulvar area. It is often misdiagnosed because many doctors attribute the symptoms to other issues like sexual dysfunction or mental health problems. To diagnose vulvodynia, doctors will do a physical exam using cotton swabs to stimulate the area and look for an extreme pain response. While there is no cure, many treatment options can provide relief, including eliminating irritants, managing yeast infections, topical creams, antidepressants or anticonvulsants, physical therapy, and surgery. Seeking support from organizations like the National Vulvodynia Association can help women cope with the psychological impact of this condition.
Este documento describe las enfermedades de transmisión sexual (ETS) en el contexto del abuso sexual y ofrece recomendaciones para su diagnóstico, tratamiento y prevención. Detalla las manifestaciones clínicas de varias ETS y el impacto que pueden tener, incluidas complicaciones graves como infertilidad, cáncer y VIH/SIDA. Además, enfatiza la importancia de evaluar a la víctima y al agresor para identificar riesgos, iniciar profilaxis oportuna y brindar asesoramiento y apoyo psicológ
Este documento describe el liquen escleroso y atrófico, una enfermedad dermatológica que afecta principalmente la vulva de las mujeres. Se caracteriza por la presencia de pápulas púrpuras, pruriginosas y brillantes que dejan zonas de atrofia. Su causa es desconocida pero puede estar relacionada con factores genéticos e inmunitarios. El diagnóstico requiere una biopsia y el tratamiento incluye corticoides tópicos y tacrolimus para aliviar los síntomas
El documento describe diferentes patologías de la vulva, vagina y cuello uterino. Incluye lesiones preinvasoras como el liquen escleroso de la vulva y las CIN de cuello uterino, así como tumores invasores como el carcinoma epidermoide y adenocarcinoma de cuello uterino. También describe patologías del cuerpo uterino como los miomas, hiperplasia endometrial y tumores como el leiomiosarcoma y coriocarcinoma.
The document discusses complete denture impressions. It begins with an introduction stating there has been disagreement over impression procedures since 1850 due to many being developed empirically. It then defines key terms like impression, preliminary impression, final impression, and impression material.
The document reviews the literature on impression techniques dating back to the 18th century. It discusses early methods and materials used like beeswax, gutta percha, plaster of paris, and zinc oxide eugenol. The mucous membrane anatomy is explained. Biological considerations for maxillary and mandibular impressions are provided, highlighting important anatomical landmarks and structures.
This document discusses hypospadias, a congenital anomaly where the urethra opens on the underside of the penis instead of at the tip. It covers the embryology, risk factors, classifications, clinical features, and various surgical treatment options for hypospadias repair. The goals of treatment are to position the urethral meatus at the tip of the penis, correct any penile curvature, and provide adequate skin coverage. Complications can include meatal stenosis, fistula formation, infection, and procedure failure. Careful patient selection and appropriate surgical technique are emphasized to achieve the best outcomes.
precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks
Vertigo is caused by abnormalities in the vestibular system and can have many underlying causes. It is useful to classify vertigo into four main groups: positional vertigo, vertigo as an isolated symptom, vertigo with deafness and tinnitus, and vertigo with neurological signs. Common causes of positional vertigo include benign paroxysmal positional vertigo and disequilibrium of aging. Vertigo as an isolated symptom can be due to conditions like vestibular neuronitis. Vertigo accompanied by deafness and tinnitus is often caused by Meniere's disease or labyrinthitis. Neurological causes of vertigo include tumors, multiple sclerosis, and vertebrobasilar insufficiency.
This document discusses the function of the lower intestinal tract and urinary system. It describes the anatomy and physiology of defecation and urination. Common fecal elimination problems like constipation, fecal impaction, and diarrhea are defined. Factors that influence defecation and urinary elimination are identified. Nursing assessments, diagnoses, and interventions related to maintaining normal bowel and urinary function are outlined.
FISSURE IN ANO/ANAL FISSURE
A case presentation of chronic anal fissures and a brief discussion and management. Suitable for all in the health care provision business.
1. Nematodes are roundworms that can infect humans and animals. Common human nematode infections include intestinal nematodes like ascariasis, trichuriasis, hookworm infections, and tissue-dwelling nematodes like filariasis.
2. Intestinal nematode infections are transmitted via ingestion of infective eggs from soil or food contaminated with human feces. They often cause asymptomatic infection but can also result in abdominal pain, diarrhea, and malnutrition.
3. Diagnosis is via identification of eggs in stool samples. Treatment involves anthelmintic medications like mebendazole or albendazole. Prevention relies on improved sanitation and hygiene to reduce transmission.
Vulvovaginal infections can be caused by bacteria, fungi, parasites or other irritants. Bacterial vaginosis is caused by an imbalance of normal vaginal bacteria with overgrowth of certain bacteria like Gardnerella vaginalis. Candida vulvovaginitis is usually caused by an overgrowth of Candida albicans yeast. Lactobacillus vaginitis involves overgrowth of lactobacillus bacteria. Atrophic vaginitis is caused by low estrogen levels drying the vaginal tissues. Contact vulvovaginitis results from allergic or irritating reactions to soaps, condoms or other products. Children can get vulvovaginitis from bacteria, fungi or irritants
This document discusses the examination of the abdomen for acute abdominal pain. It begins by defining acute abdomen as abdominal symptoms that lead patients to the emergency room, excluding obvious injuries. The objectives are to distinguish between medical and surgical causes, obtain a thorough history, identify life-threatening issues, and conduct further evaluations including exams and tests. Specific examination techniques are outlined to assess various potential causes of abdominal pain.
This document provides information on performing a physical examination of the gastrointestinal (GI) system. It discusses collecting a history related to nutrition, swallowing, the upper GI tract, digestion, and elimination. The physical exam involves inspection, auscultation, percussion, and palpation of the abdomen to examine the liver, spleen, masses, tenderness and other structures and functions. Key steps and findings of the exam are outlined.
The document discusses urinary tract infections (UTIs) in children. Key points include:
- UTIs are common in children, especially young girls. They can cause kidney damage if not treated.
- Symptoms vary by age but include fever, vomiting, poor appetite, and irritability in infants, and bedwetting or pain with urination in older children.
- Diagnosis requires a urine test and treatment is usually antibiotics. Recurrent infections may indicate underlying issues like reflux.
- Risk factors include age under 1 year old, female sex, congenital anomalies, and uncircumcised males.
This document discusses genital prolapse, defined as the protrusion of a pelvic organ beyond normal anatomical boundaries. It describes the three main types - uterine, vaginal, and vault prolapse. Risk factors include congenital weakness, childbirth injuries, and menopause. Symptoms include feeling of something coming down and bearing down. Examination is done with the patient in lateral or Sims position while bearing down or coughing. Treatment options discussed are pessary use and surgery. Pessaries can be used during pregnancy, as a test for surgery, or for symptomatic relief in unfit patients.
Abdominal pain is a common complaint in pregnancy that can be caused by conditions directly related to pregnancy or unrelated. It can be difficult to determine the cause without investigations. Causes in the first trimester include abortion, molar pregnancy, and ectopic pregnancy. In the second trimester, potential causes are abortion, incarcerated retroverted uterus, complications of amniocentesis, preterm labor, and fibroid degeneration. The third trimester may involve round ligament pain, placental abruption, preeclampsia, and uterine rupture. A careful history, exam, and potential ultrasound or laparoscopy are needed to diagnose the source of abdominal pain in pregnancy.
The document provides an overview of the human reproductive system, including both male and female anatomy and physiology. It describes the processes of gamete formation, fertilization, pregnancy, and childbirth. It also discusses some common reproductive health issues like erectile dysfunction, STDs (chlamydia, gonorrhea, herpes, HIV/AIDS), and their symptoms and treatment. The reproductive system allows humans to sexually reproduce and continue the human species through the union of egg and sperm.
Chronic vulvar pain is common, affecting 4-8% of women at any given time. The most common cause is vulvodynia, defined as chronic vulvar discomfort or burning pain without an identifiable cause. Localized provoked vestibulodynia, characterized by pain with gentle touch in the vulvar introitus, is the most common presentation of vulvodynia. Management of vulvodynia is multidisciplinary and includes genital skin care, topical desensitization therapies, pelvic floor physiotherapy, pain modifying medications, and psychological support to reduce pain and improve quality of life. Regular review and a supportive patient-clinician relationship are important parts of managing this chronic condition.
The document discusses the management of overactive bladder for gynecologists. It defines overactive bladder based on symptoms of urgency, with or without urge incontinence, usually with frequency and nocturia. It notes that overactive bladder significantly impacts quality of life through physical, psychological, social, sexual, and occupational problems. Treatment options include lifestyle changes, behavioral therapy, medications, minimally invasive procedures, and surgery. Common medications used are anticholinergic agents like trospium chloride, oxybutynin, tolterodine, solifenacin, and darifenacin.
Digestive diseases include conditions of the esophagus, stomach, duodenum, jejunum, ileum, large intestine, and rectum. Gastritis is inflammation of the stomach that can be caused by Helicobacter pylori bacteria, autoimmune processes, nonsteroidal anti-inflammatory drugs, alcohol, or unknown reasons. Peptic ulcer disease affects one in eight Americans and is mainly caused by H. pylori infection or nonsteroidal anti-inflammatory drugs, which damage the stomach lining and allow acid to cause ulcers.
This document discusses irritable bowel syndrome (IBS) and its relationship to endometriosis. IBS is a common gastrointestinal disorder characterized by abdominal pain and altered bowel habits. It predominantly affects females. Endometriosis, which affects 12-23% of menstruating women, can cause similar symptoms to IBS. Women with endometriosis are six times more likely to be diagnosed with IBS. The management of IBS focuses on developing a therapeutic relationship with the patient, diet modifications, increasing fiber intake, alternative therapies like peppermint oil and herbal supplements, and probiotics which may improve symptoms. Surgery has no role in treating IBS.
The document discusses ectopic pregnancy, which occurs when a fertilized egg implants and grows outside the uterus, usually in the fallopian tubes. It notes that ectopic pregnancies have increased in incidence due to factors like PID, IUD use, and ART. The document covers the signs, symptoms, risk factors, diagnosis, and management of ectopic pregnancies. It emphasizes the importance of early diagnosis and treatment to prevent life-threatening tubal rupture.
This document defines various types of abortions and provides statistics, causes, and management approaches. It discusses induced, threatened, inevitable, incomplete, complete, septic, missed, and recurrent abortions. Induced abortions are defined and their complications described. Management of threatened, inevitable, and incomplete abortions includes resuscitation, evacuation using MVA or augmentation, and antibiotics. Septic abortions can cause immediate or late complications and are managed with resuscitation, antibiotics, evacuation, and haematenics. Recurrent pregnancy losses are defined as 3 or more consecutive losses and can have genetic, endocrine, anatomic, infectious, or immunologic causes.
This document discusses endometriosis, defined as the presence of functioning endometrial tissue outside the uterus. It most commonly involves the ovaries and pelvic peritoneum. Theories for its development include retrograde menstruation and celomic metaplasia. Symptoms include pelvic pain and infertility. Diagnosis involves laparoscopy and histological examination of biopsied lesions. Staging uses the revised American Fertility Society classification from I to IV. Treatment aims to manage pain and preserve fertility, and may involve surgery, medical therapy such as hormonal contraceptives, or assisted reproduction.
2. Vulval pain syndromeVulval pain syndrome
The term vulval pain syndrome comprisesThe term vulval pain syndrome comprises
enigmatic causes of vulval pain andenigmatic causes of vulval pain and
include a heterogeneous group of womeninclude a heterogeneous group of women
who are difficult to manage.who are difficult to manage.
VPS can be classified as following –VPS can be classified as following –
1. Dysaesthetic vulvodynia1. Dysaesthetic vulvodynia
2. Vestibulodynia [Vulval vestibulitis]2. Vestibulodynia [Vulval vestibulitis]
3. Dysaesthetic vulvodyniaDysaesthetic vulvodynia
This term was introduced by ISSVDThis term was introduced by ISSVD
{international society for study of vulval{international society for study of vulval
diseases}.diseases}.
It is defined as ‘chronic vulvar discomfort’It is defined as ‘chronic vulvar discomfort’
characterized by burning , stinging,characterized by burning , stinging,
rawness or irritation of vulva .rawness or irritation of vulva .
It may be generalized or localized ;It may be generalized or localized ;
provoked or unprovoked pain.provoked or unprovoked pain.
It’s a constant neuralgic type of pain.It’s a constant neuralgic type of pain.
4. Dysaesthetic vulvodynia {contd}Dysaesthetic vulvodynia {contd}
Clinical examination is normal.Clinical examination is normal.
Women are typically premenopausal orWomen are typically premenopausal or
postmenopausal.postmenopausal.
They have a long history of multiple orThey have a long history of multiple or
inappropriate use of topical agents.inappropriate use of topical agents.
There is h/o superficial dyspareunia which is notThere is h/o superficial dyspareunia which is not
usually reported as these women are lessusually reported as these women are less
sexually active.sexually active.
Sexual dysfunction is common.Sexual dysfunction is common.
5. Dysaesthetic vulvodynia {contd}Dysaesthetic vulvodynia {contd}
There may be h/o rectal, perineal orThere may be h/o rectal, perineal or
urethral discomfort.urethral discomfort.
It may be associated with other chronicIt may be associated with other chronic
pain syndromes like glossodynia orpain syndromes like glossodynia or
chronic low backache.chronic low backache.
There is great level of psychologicalThere is great level of psychological
distress as compared to otherdistress as compared to other
vulvodynias.vulvodynias.
6. VestibulodyniaVestibulodynia
It is defined asIt is defined as
-Severe pain on vestibular touch or vaginal-Severe pain on vestibular touch or vaginal
entry.entry.
-Tenderness localized within the vestibule-Tenderness localized within the vestibule
on pressure.on pressure.
-Physical findings of erythema confined to-Physical findings of erythema confined to
the vestibule.the vestibule.
7. Vestibulodynia{ contd}Vestibulodynia{ contd}
Clinical examinationClinical examination
demonstratesdemonstrates
tenderness within thetenderness within the
vestibulevestibule
Common test used isCommon test used is
the cotton swab testthe cotton swab test
8. Vestibulodynia{ contd}Vestibulodynia{ contd}
Another test is to use algesiometer whereAnother test is to use algesiometer where
variable degrees of pressure is applied.variable degrees of pressure is applied.
Vestibular erythema may or may not be presentVestibular erythema may or may not be present
and if present the degree of redness does notand if present the degree of redness does not
correlate with the degree of symptoms.correlate with the degree of symptoms.
Gynaecological examination is painful.Gynaecological examination is painful.
There is tampon intolerance.There is tampon intolerance.
There may be h/o use of multiple topicalThere may be h/o use of multiple topical
medications.medications.
9. Vestibulodynia{ contd}Vestibulodynia{ contd}
Women typically are Caucasians , aged 20-24Women typically are Caucasians , aged 20-24
years who present with h/o provoked pain oryears who present with h/o provoked pain or
superficial dyspareunia.superficial dyspareunia.
Pain may be present from the first attemptedPain may be present from the first attempted
sexual intercourse or after a period of normalsexual intercourse or after a period of normal
sexual activity.sexual activity.
Fear , anger and frustration are commonlyFear , anger and frustration are commonly
encountered in these womenencountered in these women
A period of at least 6 months is given beforeA period of at least 6 months is given before
labeling the condition as vestibulodynialabeling the condition as vestibulodynia
10. AssessmentAssessment
Most imperative to exclude the following diseasesMost imperative to exclude the following diseases
before arriving at the diagnosis of VPS-before arriving at the diagnosis of VPS-
The common ones are-The common ones are-
-Inflammatory vulval diseases like Lichen-Inflammatory vulval diseases like Lichen
Sclerosus and Eczema.Sclerosus and Eczema.
-Tight posterior fourchette and Fragile Fissured-Tight posterior fourchette and Fragile Fissured
Vulval SyndromeVulval Syndrome
-Symptomatic Dermographism-Symptomatic Dermographism
11. AssessmentAssessment
Less common causes are –Less common causes are –
-Apthous ulceration-Apthous ulceration
-Erosive Lichen Planus-Erosive Lichen Planus
-Bullous Disorders-Bullous Disorders
-Herpes Simplex infections-Herpes Simplex infections
-Pudendal Canal syndrome-Pudendal Canal syndrome
12. AetiologyAetiology
Exact cause is not known . The following are theExact cause is not known . The following are the
possible causes-possible causes-
1. Candida infection - leads to the generation of1. Candida infection - leads to the generation of
an immune response causing inflammation andan immune response causing inflammation and
pain even in absence of an active infection.pain even in absence of an active infection.
2. Iatrogenic - like use of topical agents for pain2. Iatrogenic - like use of topical agents for pain
like antifungal creams, soaps, bubble baths andlike antifungal creams, soaps, bubble baths and
hygiene sprays etc.hygiene sprays etc.
3. Psychological disorders - like stress and3. Psychological disorders - like stress and
anxiety leading to increased pain perception.anxiety leading to increased pain perception.
13. Aetiology contd.Aetiology contd.
4.Genetic predisposition - more common in4.Genetic predisposition - more common in
Caucasians and is less common in Blacks andCaucasians and is less common in Blacks and
Asian population.Asian population.
5.Dietary factors - high oxalate diet causing5.Dietary factors - high oxalate diet causing
increase in urinary excretion of oxalates leadingincrease in urinary excretion of oxalates leading
to burning micturition & vulvodynia.to burning micturition & vulvodynia.
6.Hormonal causes - include estrogen deficiency6.Hormonal causes - include estrogen deficiency
and oral contraceptive pill intake.Mucosaland oral contraceptive pill intake.Mucosal
atrophy makes nerve endings superficialatrophy makes nerve endings superficial
14. Aetilogy contd.Aetilogy contd.
7. Tension in levator ani muscles could be one of7. Tension in levator ani muscles could be one of
the causes.the causes.
8. It may be a part of Complex Regional Pain8. It may be a part of Complex Regional Pain
Syndrome {CRPS} like fibromyalgia , interstitialSyndrome {CRPS} like fibromyalgia , interstitial
cystitis,overactiv ebladder,irritable bowel syn. Thecystitis,overactiv ebladder,irritable bowel syn. The
cause being ‘Wind Up’ phenomenon in whichcause being ‘Wind Up’ phenomenon in which
there is increased activity in the dorsal horn cellsthere is increased activity in the dorsal horn cells
of spinal cord after repetitive activation of theof spinal cord after repetitive activation of the
primary afferent C-fibers.primary afferent C-fibers.
15.
16. ManagementManagement
Spontaneous recovery may occur sometimes .Spontaneous recovery may occur sometimes .
Management options include –Management options include –
-Vulvar care-Vulvar care
-Topical therapy-Topical therapy
-Oral medications-Oral medications
-Biofeedback and Physical therapy-Biofeedback and Physical therapy
-Intralesional injections-Intralesional injections
-Interferon therapy-Interferon therapy
-Low oxalate diet-Low oxalate diet
-Surgical treatment-Surgical treatment
-Multidisciplinary approach-Multidisciplinary approach
17. Vulvar careVulvar care
100% cotton under wears.100% cotton under wears.
No under wears at night.No under wears at night.
No soaps to be used on vulva.No soaps to be used on vulva.
Use of plain water.Use of plain water.
Use of lubricants before intercourse like KY jelly.Use of lubricants before intercourse like KY jelly.
Use of natural oils like olive oil, sweet almond oilUse of natural oils like olive oil, sweet almond oil
and wheat gram oil.and wheat gram oil.
Vulva should be patted dry after washing.Vulva should be patted dry after washing.
If dryness is more use of Vaseline is advised.If dryness is more use of Vaseline is advised.
19. Oral medicationsOral medications
Antidepressants are the first line therapy.They block re-Antidepressants are the first line therapy.They block re-
uptake of serotonin & noradrenalin and relieve pain byuptake of serotonin & noradrenalin and relieve pain by
inhibition of Na channel. Most commonly used–inhibition of Na channel. Most commonly used–
AmitriptylineAmitriptyline
Dose -5-10mg before bedtime. May be increasedDose -5-10mg before bedtime. May be increased
weekly by 10-25mg depending on response. Maximumweekly by 10-25mg depending on response. Maximum
dose 150mg/nightdose 150mg/night
Side effects are-Side effects are-
-dry mouth-dry mouth
-drowsiness-drowsiness
-constipation-constipation
-overdose results in seizures, MI, thrombocytopenia.-overdose results in seizures, MI, thrombocytopenia.
# Less commonly used antidepressants are Nortriptyline,# Less commonly used antidepressants are Nortriptyline,
Desipramine, Venlafaxine.Desipramine, Venlafaxine.
20. Anticonvulsants contdAnticonvulsants contd
Carbamazepine is also usedCarbamazepine is also used
Starting dose is 100mg orally at night, increased to 200-Starting dose is 100mg orally at night, increased to 200-
400mg BD . Maximum dose is 1200mg.400mg BD . Maximum dose is 1200mg.
Side effects areSide effects are
- dizziness- dizziness
- drowsiness and confusion- drowsiness and confusion
- blurred vision- blurred vision
- rash- rash
- increased liver transaminases- increased liver transaminases
- agranulocytosis and thrombocytopenia.- agranulocytosis and thrombocytopenia.
# Less commonly used anticonvulsant is Topiramate# Less commonly used anticonvulsant is Topiramate
# Other drugs used are Tramadol and analogue of# Other drugs used are Tramadol and analogue of
Codeine.Codeine.
21. AnticonvulsantsAnticonvulsants
Gabapentin started at a dose ofGabapentin started at a dose of
- 300mg OD for 3 days followed by300mg OD for 3 days followed by
- 300mg BD for 3 days followed by300mg BD for 3 days followed by
- 300mg TDS300mg TDS
- Maximum dose is 3600mg/day and no more thanMaximum dose is 3600mg/day and no more than
1200mg should be given at a time .Dose adjustment is1200mg should be given at a time .Dose adjustment is
required in renal insufficiency.required in renal insufficiency.
- A time of 3-8 wks is required for the drug to becomeA time of 3-8 wks is required for the drug to become
effective.effective.
# Side effects are-# Side effects are-
- SomnolenceSomnolence
- DizzinessDizziness
- GIT symptomsGIT symptoms
- Mild peripheral edemaMild peripheral edema
- Gait and balance problems in elderly.Gait and balance problems in elderly.
22. Biofeedback and physical therapyBiofeedback and physical therapy
It involves measuring nerve and muscleIt involves measuring nerve and muscle
tension of pelvic floor by a meter ortension of pelvic floor by a meter or
colored light Patient has to self assesscolored light Patient has to self assess
the tension and try to relax.the tension and try to relax.
In a study conducted by Hartmann andIn a study conducted by Hartmann and
Nelson a group of women with vulvodyniaNelson a group of women with vulvodynia
undergoing physical therapy were studied.undergoing physical therapy were studied.
71% women showed 50% improvement in71% women showed 50% improvement in
symptoms .symptoms .
23. Intralesional injectionsIntralesional injections
Includes trigger point injections of steroidsIncludes trigger point injections of steroids
and Bupivacaine in a dose of 20-40mgand Bupivacaine in a dose of 20-40mg
Triamcinalone with 25% BupivacaineTriamcinalone with 25% Bupivacaine
monthly.monthly.
Injections may also be given as aInjections may also be given as a
pudendal block.pudendal block.
24. Interferon therapyInterferon therapy
Includes intravestibular injections of 1.5Includes intravestibular injections of 1.5
million units of interferon – alpha.million units of interferon – alpha.
Disadvantages –Disadvantages –
- only short term relief- only short term relief
- extremely painful- extremely painful
- not routinely available.- not routinely available.
25. Low oxalate dietLow oxalate diet
Avoid foods like spinach, beetroot, wheatAvoid foods like spinach, beetroot, wheat
germ, chocolate, tea etc.germ, chocolate, tea etc.
Calcium citrate supplementation - to bindCalcium citrate supplementation - to bind
the oxalates and increase their urinarythe oxalates and increase their urinary
excretion.excretion.
26. Surgical treatmentSurgical treatment
Last mode of treatment , used when otherLast mode of treatment , used when other
treatment options fail.treatment options fail.
Modified Vestibulectomy- PROCEDURE OFModified Vestibulectomy- PROCEDURE OF
CHOICE.CHOICE.
Preoperative psychological counseling and postPreoperative psychological counseling and post
operative sex therapy increases the success ofoperative sex therapy increases the success of
surgery.surgery.
other surgical procedures areother surgical procedures are
- Local Excision- Local Excision
- Perineoplasty and LASER Vaporisation- Perineoplasty and LASER Vaporisation
# They are less effective than Vestibulectomy and# They are less effective than Vestibulectomy and
hence are not commonly used.hence are not commonly used.
32. Multidisciplinary approachMultidisciplinary approach
This employs the following-This employs the following-
- Clinical Psychologists- Clinical Psychologists
- Pain Management teams- Pain Management teams
- Psychosexual Counselors- Psychosexual Counselors
- Clinicians- Clinicians
- Physiotherapists- Physiotherapists
- Partner support is a must.- Partner support is a must.
33. Pain managementPain management
The `Pain Gate Theory ’ of Melzack andThe `Pain Gate Theory ’ of Melzack and
Wall’s is employed. The theory states thatWall’s is employed. The theory states that
the pain messages from the gates ofthe pain messages from the gates of
spinal cord travel to the brain . Thesespinal cord travel to the brain . These
gates tend to be more in women withgates tend to be more in women with
stress, tension and anxiety.stress, tension and anxiety.
Therapies like relaxation , exercise andTherapies like relaxation , exercise and
mobility close these gates and hencemobility close these gates and hence
relieve the pain.relieve the pain.
34. Key points for clinical practiceKey points for clinical practice
A detailed history and clinical examinationA detailed history and clinical examination
is necessary for diagnosis of these twois necessary for diagnosis of these two
groups.groups.
Surgical option is only available forSurgical option is only available for
Vestibulodynia.Vestibulodynia.
Tricyclic antidepressants are the first lineTricyclic antidepressants are the first line
management for Dysaesthetic Vulvodynia.management for Dysaesthetic Vulvodynia.
A multidisciplinary approach is beneficialA multidisciplinary approach is beneficial
for chronic patients.for chronic patients.