General gynecological examination

After receiving anamnestic data, they proceed to an objective study to determine the general condition of the patient and her gynecological status.

In a standing position, the patient is determined by the features of her constitution. They measure height and weight, determine the development of the muscular system, skeleton, fat layer, skin condition. Positive signs include good development of the muscular system, especially the abdominal muscles, good tissue turgor, elasticity (and not pastiness) of the subcutaneous fat layer, correct (in the form of a straight) line of thigh closure. A slit-like indentation at the level of the navel indicates the divergence of the rectus abdominis muscles. Defects in the structure of the skeleton, especially of the spine (kyphosis, scoliosis, lordosis) are noted (if any); deformities of the skull and chest are also noted - thickening of the costal cartilage; find out if there is a curvature of the limbs - signs of rickets. Pay attention to scars, hernias, the presence of edema, skin rashes, varicose veins, to the general properties of the skin (smooth or wrinkled), dryness, pigmentation.

After examination, the examining physician proceeds to study the state of the internal organs: he percusses and auscultates the heart and lungs, defining their boundaries, palpates and percusses the liver, spleen, and kidneys. We should also not forget about the oral cavity, the condition of the teeth, gums, tonsils. Temperature and arterial blood pressure are measured immediately. The usual techniques are used to study the state of the nervous system, as well as - in the process of research and from a conversation with the patient - her psyche. It is very important to determine the state of the endocrine system. The thyroid and breast glands should be examined.

Special gynecological examination

Physical examination methods ... Before embarking on a gynecological examination, you need to create the necessary environment and conditions for it. For a special examination, it is desirable to have a gynecological chair, but, on the advice of D.O. Ott, you can use a wooden table and two stools located at one end of the table. The woman lies on the edge of the table with legs bent at the knees. In this case, Ott's leg holders known from obstetrics or standard leg holders are used, attached to a wooden table or available with a gynecological chair. If it is necessary to study at home, the leg holders are rolled up from ordinary sheets.

The position of the patient on the table can be twofold. The first position (position) is called when a woman lies horizontally on her back, her legs are bent only at the knee joints and rest on leg supports or stools. In the second position (position), the woman brings the hips and bent knees to the stomach; they can be strengthened with Ott leg holders. In this position, the vagina is shortened, and the cervix becomes more accessible for examination. During the study, the patient should breathe freely and not strain.

Sometimes the lateral position of the patient is used, and the overlying leg is bent at the knee joint and is slightly brought to the stomach. This position is convenient for examining the anus and perineum.

In the study of urogenital fistulas, the knee-elbow or knee-thoracic position is sometimes used, in which the woman kneels and rests on her elbows. In this position, the abdominal viscera move away from the diaphragm, and negative pressure is created in the abdominal cavity. Sometimes it is necessary to put the woman under study in the Trendelenburg position (head down). This provision applies primarily to transactions.

For gynecological examination, preparation of the doctor's hands and preparation of the patient are necessary. In this study, the patient must be guaranteed against introducing infection into the genital tract, which is possible during mass examinations of women. It is best to carry out the research with rubber gloves. After any examination, the doctor washes his gloved hands with soap and water and treats them with a piece of cotton wool soaked in a disinfectant solution. Before the gynecological examination, the patient must empty the bladder or, if necessary, urine is released with a catheter. Catheters - metal, rubber or glass - must be sterilized by boiling along with other instruments required for examination. The external genitals of a woman before a gynecological examination should be washed with a stream of warm water from Esmarch's mug, and with purulent discharge, it is necessary to douch the vagina with a weak (1: 10000) solution of potassium permanganate.

Palpation of the abdomen... The gynecologist uses this research method very often. Palpation is performed in several ways. It can be done with the woman on her back, on her side or standing. It is necessary to palpate with warm hands, and palpation should be started not from the place where the patient feels pain, but from a distant one, following the patient's facial expressions. Palpation can be done with two hands or with one.

The first technique is palpation with two hands, the palms of which are placed symmetrically on the stomach. With slow, careful movements, the palms plunge deeply and move in different directions. Palpation examines the thickness of the abdominal wall, soreness, tension or divergence of the rectus muscles, the presence of tumors deep in the abdominal cavity. With deep palpation, a pulsating aorta can be felt.

You can palpate with one hand to examine a limited area of \u200b\u200bthe abdomen. Palpation is carried out systematically, starting from the epigastric region and ending with hypogastrium, probing the epigastric, umbilical and suprapubic regions; palpate the edge of the liver, spleen. It must be remembered that the internal female genital organs are palpable only in an enlarged state.

The palpation of the kidneys, retroperitoneal tumors is performed with two hands, one of which is placed under the lower back.

The presence of ascitic fluid is diagnosed as follows. Both hands are laid flat on the side walls of the abdomen, with one hand making a jerky movement; while the other hand feels these shocks (fluctuation). On palpation of the abdomen, soreness characteristic of inflammatory processes of the abdominal organs can be found at known points. Such painful points can be found in the area of \u200b\u200bthe gallbladder and the appendix (McBurney's point, etc.). When determining the tension of the abdominal wall, it is necessary to remember about its slight tension (subdefence) during an ectopic pregnancy (Braude's symptom). In some cases, if the results of conventional palpation are unclear, Pagenstecher's techniques (two-handed palpation using the method of pushing movements), Obraztsov-Strazhesko's techniques (percussion palpation) and others are used.

Percussion of the abdomen... Percussion of the abdomen is used to determine the contours of the tumor or individual organs of the abdominal cavity. All tumors and encapsulated pus accumulations give dullness; intestines, stomach - tympanic sound. In the presence of free fluid in the abdominal cavity (including blood during an ectopic pregnancy), a tympanic sound can be heard in the middle of the abdomen, and dullness in sloping places; when the position of the patient changes, the boundaries of dullness change. The bladder also makes a dull sound when overfilled, so it is necessary to empty the bladder before each examination. Percussion is best done in five directions, starting from the navel, as recommended by G. G. Genter.

Percussion can sometimes contribute to the differential diagnosis between inflammatory tumors. To this end, GG Genter suggested percussion spina ilii ant. super. With parametrites closely adjacent to the pelvic wall, a dull sound is heard; with sactosalpinx (saccular inflammation of the tube with purulent, serous or bloody contents), a tympanic sound remains. With tumors or exudates in the pelvis with extensive intestinal adhesions, there may be a discrepancy between the percussion border and palpation; the latter will be higher.

If tumors and exudates come from the small pelvis, then the dullness, defined below the navel, goes directly to the pelvic area.

Auscultation of the abdomen... Auscultation of the abdomen in gynecology is performed much less frequently than in obstetrics. It is used, for example, for the differential diagnosis between long term pregnancy and a large tumor emanating from the pelvis: the absence of fetal heartbeat speaks against pregnancy. Auscultation is also used to determine the presence or absence of intestinal motility, for example, when it is obstructed. When blowing pipes, used to diagnose infertility, auscultation of the abdomen allows you to catch the whistling noise from air entering from the pipe into the abdominal cavity (if the pipes are passable). Auscultation can also catch the rubbing noise of the peritoneum in combination with tuberculosis of the female genital organs with tuberculous peritonitis. Finally, in large uterine fibroids, auscultation of the abdomen determines a gentle murmur due to the presence of dilated vessels in the tumor.

Examination of the abdomen and external genitals... The patient lies in the first position on the table or in the gynecological chair. First, an external examination of the abdomen is performed. Attention is drawn to its configuration, size, skin with their pathological features: scars, fistulous holes, hernial protrusions, expansion of the saphenous veins, pigmentation, the state of the navel, protrusions from deep-seated tumors, abdominal hairiness, swelling of the abdominal wall, etc.

When examining the external genitals, the degree of their development is determined, it turns out if there are any features of infantilism (narrow genital slit, protrusion of the small lips and clitoris); in adolescents, the form of pubic hairiness is noted. If the hairiness ends above the pubis horizontally, then this is typical for the female type, if the hairiness rises along the white line towards the navel, then it belongs to the male type and is found in infantile and intersex people. Further, the large and small lips are examined (size, edema, ulcers, tumors, varicose growths, condylomas). Examining the genital slit, pay attention to the degree of closure of the latter, to the perineal tears and scars. Slightly spreading the genital gap, examine the hymen and the vestibule of the vagina: the clitoris, the external opening of the urethra and paraurethral passages, the area of \u200b\u200bthe excretory ducts of the Bartholin glands. In giving birth, forcing the patient to push, it is determined whether there is prolapse or prolapse of the vaginal walls.

Belly measurement... Measurement. abdomen in gynecology is rarely done. It may be needed for large tumors to monitor their growth, with ascites - to monitor the increase or decrease in the latter. Measurement of the abdominal circumference is made with a measuring tape at the level of the navel or at the level of the largest width of the tumor.

Bimanual exploration... Bimanual vaginal, combined or internal examination is performed with the fingers of one hand inserted into the vagina, with the other hand fixing the uterus with appendages through the abdominal wall. Before a bimanual examination, the bladder and rectum must be emptied. The study is performed on a gynecological table or chair in the first or second position of the woman; most often the study is carried out in the second position. The second position, of course, is necessary for the study of the uterus, the state of the appendages. Bimanual examination is often performed with the right hand, with the left hand being the outside. DO Ott recommended to insert the left hand into the vagina, and palpate from the outside with the right hand. But it's best to learn to explore equally with your right and left hand. The study is carried out with one or two fingers (one - in nulliparous and in girls with an extended hymen). The position of the fingers of the examiner's hand: the index and middle fingers are extended, the ring and little fingers are pressed to the palm, the thumb is pulled back. The index and middle fingers are palpable, on the tips of which, according to some authors, the "eye" of the gynecologist is placed.

When starting the examination, the doctor puts on rubber gloves, washed and disinfected, stands between the thighs of the lying woman, slightly bending over her and resting his right foot on a bench or table bar. Spreading the small and large lips with the thumb and forefinger of the left hand, the doctor inserts the fingers of the right hand into the vagina, squeezing the perineum somewhat downward. It is necessary to avoid contact of the thumb with the clitoris and urethra, which are the most sensitive areas. When inserted into the vagina, the fingers should slide along the back wall of it.

Bimanual research should be carried out according to a specific plan.

1. Examine the external genitalia, while paying attention to the area of \u200b\u200bthe urethra and Sken's passages with a simultaneous light massage of the urethra; examine the excretory duct of the Bartholin gland (an attempt is made to squeeze out a secret from it), the scaphoid fossa and the perineum.

2. Introducing fingers into the vagina, determine the length and width of it, the degree of moisture, folds of the mucous membrane, the presence of a septum (when it is bifurcated), tumors, scars and infiltrates. Through the front wall, a cord is usually palpable, the thickness of the little finger is the urethra, especially sharply protruding with the infiltration of its walls (chronic para-urethritis).

When examining the vaginal fornix, their depth is determined; especially deep is the posterior fornix, in which sperm accumulates during intercourse. The displacement of the mucous membrane of the vaults, the presence of tumors, protrusions, soreness or absence of it when pressed, especially through the posterior vault, the presence (or absence) of tumors or exudate in the Douglas space are determined.

3. After examining the vagina with your fingers, touch the vaginal part of the cervix. Determine its size, shape (conical, cylindrical, cylindrical-conical), the shape of the external uterine pharynx: in those who have not given birth, the pharynx is round, in those who have given birth - in the form of a transverse slit. The presence of ruptures and scars on the cervix after childbirth, the presence or absence of ovula Nabothi, tumors, eversion (ectropion), erosions are noted. The position of the neck is also noted (displacement to the bosom, to the sacral cavity, lateral); the pathological position of the cervix is \u200b\u200boften found with displacements of the uterus.

4. When examining the uterus with two fingers of the right hand, the vaginal part of it is fixed, raising the uterus anteriorly and upward and bringing its bottom towards the fingers of the left outer hand. At the same time, the fingers of the outer hand gently press on the abdominal wall, trying to feel the back surface of the body of the uterus. Thus, the uterus is located between the two hands. When examining the uterus, it is necessary to determine its size, shape, position, consistency, sensitivity and mobility.

The length of the uterus, which is normally 7-10 cm with the cervix, is longer in a woman who has given birth than in a woman who has not given birth. The fundus of the uterus does not go beyond the entrance to the small pelvis. Under physiological conditions, a decrease in the uterus is observed in the climacteric period and in menopause, as well as with infantility and atrophy. An increase in the uterus is observed with its tumors. The uterus of adult women is pear-shaped, flattened from front to back.

Under normal conditions, the uterus is in a certain position, which partly changes with a change in the position of the body (from lying to standing and vice versa), under tension, with overflow of the bladder, rectum, etc. Between the cervix and the body of the uterus there is an angle open anteriorly ... The body of the uterus is also bent at an angle facing anteriorly, and in addition, the entire uterus is tilted anteriorly.

Having determined the size of the uterus, it is necessary to note its consistency (soft during pregnancy, dense with uterine fibroids). It is also important to determine the sensitivity of the uterus. A normal uterus is not sensitive to pressure; in pathological cases (endometritis, ovarian tumors), soreness may appear. Soreness can also be observed when the uterus moves during a bimanual examination, which may depend on inflammation of the appendages of the uterus or inflammatory adhesions around it.

Finally, the degree of mobility of the uterus is determined. Normally, especially in those giving birth, it is quite mobile. When the uterus drops or falls out, its mobility will be excessive. Limited mobility is observed with exudates in the pelvic cavity, infiltrates of peri-uterine tissue, adhesions with tumors of organs adjacent to the uterus, or with tumors in it itself.

After examining the uterus, they move on to feeling the appendages of it - the tubes and ovaries, the ligamentous apparatus of the uterus, as well as the peritoneal tissue and peritoneum. With healthy appendages, the tubes are rarely probed - in 1/5, the ovaries - in only 1/3 of women. To study the appendages and parametria, the fingers of the inner hand are located in one of the lateral arches, while the outer hand is placed at the level of the fundus of the uterus, but to the right or left of the midline. The researcher seeks to bring both hands together in order to feel the appendages or infiltration with converging fingers. It should be noted the shape, size, consistency, soreness and mobility of the tubes, ovaries, tumor or infiltrate. In inflammatory processes of the appendages, it is sometimes not possible to separately probe the ovary and the tube; only a tumor described as a conglomerate is defined. Exudates in the small pelvis, as well as blood during an ectopic pregnancy, accumulate almost always in the Douglas space, pushing the uterus anteriorly and protruding the posterior vaginal wall or fornix.

It should be remembered that overflow of the bladder, rectum, or sigmoid colon can simulate swelling of the uterus or appendages. Extragenital tumors can also be located in the pelvic cavity.

After the appendages, the accessible ligaments of the uterus are examined. You can feel the round ligaments going from the rib of the uterus towards the inner opening of the inguinal canal, and the sacro-uterine ligaments going from the posterior surface of the uterus (at the level of the internal os) posteriorly. In inflammatory processes, the sacro-uterine ligaments can be thickened due to infiltration; with some forms of underdevelopment of the uterus or anomalies of its position, they can be shortened.

Perimetral tissue, peritoneum of the small pelvis and perimetry are palpable only if they have infiltrates (inflammatory or cancerous) or perimetric (peritoneal) adhesions and cords, as well as fresh or thickening exudates. Limited mobility of the uterus is also one of the signs of the development of parametric infiltrates or perimetric adhesions and exudates of adhesive or exudative perimetritis).

Rectal examination... In cases where vaginal examination is insufficient due to tumors or exudate in the Douglas space, infiltrates in the parametria, adhesions of the posterior surface of the uterus, as well as in virgins, the vaginal examination is supplemented by a bimanual rectal examination.

Rectal examination is considered mandatory for cervical cancer, since it also makes it easier to detect infiltrates in the parameters.

In some cases (to study the features of the recto-vaginal septum), a combined recto-vaginal examination is performed, in which the index finger is inserted into the vagina, and the middle finger is inserted into the rectum; the outer hand palpates the pelvic organs through the abdominal wall. In rare cases, to study the vesicouterine space, the thumb is inserted into the anterior fornix of the vagina, and the index finger is inserted into the rectum. Rectal examination is performed after an enema, always wearing a rubber glove. The index finger is smeared with petroleum jelly or lightly soaped. Using fingertips is unhygienic.

Inflammation of the appendages in women is an infectious pathology, while the process affects the ovaries or fallopian tubes, but not the uterus itself. The penetration of the pathogen into the body occurs in various ways.

The disease can continue without symptoms for a long time, sometimes characterized by the appearance of pain in the lower abdomen and menstrual irregularities. Treatment is aimed at destroying the pathogen and restoring the function of the uterine appendages.

Causes of occurrence

Why do women develop inflammation of the appendages, and what is it? In medicine, this disease is called salpingo-oophoritis. If the inflammation affects only the fallopian tubes, then salpingitis is diagnosed. An inflammatory process that affects only the ovaries is called oophoritis.

The development of the inflammatory process in the uterine appendages occurs under the influence of pathogenic and opportunistic microorganisms. There are two types of disease:

• specific adnexitiscaused by diphtheria bacteria, tuberculosis bacillus, gonococci;
• nonspecific salpingo-oophoritiscaused by viruses, fungi, Escherichia coli, streptococci, staphylococci, mycoplasmas, chlamydia and other microorganisms.

The penetration of infection into the uterine appendages can occur in the following ways:

• ascending (pathogenic microbes from the vagina penetrate the uterus, bypassing the cervical canal, into the tubes, and then can enter the ovaries);
• descending (there is already inflammation in the abdominal cavity, which gradually passes to healthy tissues);
• hematogenous (microbes enter the fallopian tubes and ovaries with blood from other internal organs).

The likelihood of inflammation of the appendages increases when provoking factors act on the body:

• hypothermia;
• weakening of immunity;
• using such a method of contraception as an intrauterine device;
• unprotected sex;
• childbirth or abortion.

• sharp;
• chronic;
• latent (asymptomatic, or sluggish).

The disease can be diagnosed at any age. Both young girls who are not sexually active and older women who have entered menopause seek help from doctors.

Symptoms of inflammation of the appendages

In the case of the development of inflammation of the appendages in women, the presence of certain symptoms depends on certain factors:

• pathogenicity of the trapped microorganism, its type;
• from the course of the disease, whether it is an acute process, with pronounced symptoms, or chronic, with erased, barely noticeable symptoms;
• the ability of the girl's body to resist microorganisms and fight the inflammatory process, from the state of the immune system.

In acute form women complain of the following symptoms:

• tense abdomen in the lower sections;
• sometimes radiating to the legs or lower back;
• increased body temperature (it can reach 39 degrees);
• changes in the menstrual cycle (the occurrence of sudden bleeding or delayed menstruation);
• vaginal discharge that differs from normal (it can be greenish-purulent or yellowish, profuse or frothy).

An incompletely cured disease in the acute period can turn into chronic inflammation of the appendages, the symptoms of which depend on the period of remission or exacerbation. Every second woman with chronic adnexitis has the following pathological changes:

• menstrual irregularities;
• sexual dysfunction;
• concomitant diseases of the urinary organs (,), etc.

During the period of exacerbation, all the symptoms characteristic of acute adnexitis are renewed.

Chronic adnexitis

Chronic adnexitis develops as a result of untimely or poor-quality treatment of the acute form of the disease, it proceeds with periodic seasonal exacerbations. This form of inflammation of the appendages is characterized by the presence of dull, aching pains in the lower abdomen, radiating into the vagina and lumbar region. Palpation of the abdomen determines moderate pain.

In connection with the structural and functional changes in the ovaries (lack of ovulation, hypoestrogenism), chronic inflammation of the appendages in women is accompanied by a violation of the menstrual cycle, which is manifested by oligomenorrhea (poor menstruation), polymenorrhea (heavy menstruation), algomenorrhea (painful menstruation). Also, patients may complain about the absence or decrease in sex drive, the appearance of pain during intercourse.

Diagnostics

The above symptoms can also be present in other diseases of the genital organs, therefore, only a gynecologist can make an accurate diagnosis after examining the patient, anamnesis, the results of laboratory and instrumental studies:

• Ultrasound of the uterus and appendages;
• PCR diagnostics (vaginal smear), which allows to establish genital infections;
• colposcopy (examination of the vagina and its walls);
• bacterial sowing;
• tomography;
• laparoscopy.

Signs of inflammation of the appendages can be determined by the results of a blood test. In inflammatory processes, the blood formula changes significantly. In addition, during a gynecological examination at an appointment with a gynecologist, a woman feels severe pain in the ovaries and uterus.

Effects

Any inflammation of the appendages is dangerous because the following complications are possible:

• growing into a chronic form;
• infertility, as a result of adhesions, in which there is obstruction of the fallopian tubes and anovulation;
• rather high risk of ectopic conception;
• purulent complication (tubo-ovarian formation) - purulent fusion of the ovaries and tubes, followed by an abscess.

Prevention

1. Regularly visit a gynecologist, without resisting examination on a chair, take smears.
2. Avoid hypothermia by dressing for the weather, changing after swimming, and avoiding sitting on cold objects.
3. If termination of pregnancy is necessary, do it early or with medication, or a mini-abortion (avoid scraping).
4. Heal teeth, intestines and other foci of chronic infection.
5. Use barrier methods of contraception.
6. Timely treat gynecological diseases.
7. Follow the rules of a healthy diet.
8. Observe the rules of intimate hygiene.
9. Avoid douching.
10. Avoid stress.

Thus, inflammation of the appendages is a serious disease that requires timely treatment, which requires strict adherence to medical prescriptions.

Treatment of inflammation of the appendages

When diagnosing inflammation of the appendages, treatment in women should be comprehensive: a combination of medications with physiotherapy, gynecological massage, osteopathy, physiotherapy.

The main point in the treatment of inflammation is antibiotics. They are selected with a broad spectrum of action and maximum half-life. In addition, the woman herself needs to monitor her lifestyle (proper nutrition, abstinence from sexual activity, physical education, smoking and alcohol should be stopped).

The disease cannot be started, since the inflammatory process soon turns into a chronic stage, which leads to infertility.

Antibiotics for inflammation of the appendages

Antibiotics for inflammation of the appendages are the first and main condition that must be met for a favorable outcome of the disease. How to treat inflammation of the appendages, the dosage and number of doses for each specific woman is determined by a specialist, however, we will give you the most often prescribed pairs of medicines:

1. Nitroimidazole derivatives (for example, Metronidazole) for the purpose of eliminating anaerobic flora that can live in an oxygen-free environment, such as gonococci (pathogens of gonorrhea);
2. Inhibitor-protected penicillins (Amoxiclav), 3-generation cephalosporins (Ceftriaxone), macrolides (Erythromycin), etc., which affect the aerobic (living in an oxygen environment) flora;
3. Antifungal medications (eg Diflucan, Nystatin).

The first three to four days before the normalization of the condition, all these drugs are administered in the form of injections. Then you can switch to tablet forms and reduce the dose.

Concomitant treatment

In addition to the appointment of antibacterial drugs, detoxification therapy is carried out (intravenous infusion of saline solutions, glucose, hemodesis, rheopolyglucin and others in a volume of 2 - 3 liters).

Relief of pain, and reduction of the inflammatory process is carried out with the help in the form of tablets. These are Diclofenac, Ibuprofen, Ketarol and other drugs. Be sure to prescribe vitamins C and B, as well as pills for allergies.

When removing an acute process and in the treatment of chronic inflammation of the appendages without exacerbation, physiotherapy is widely used: electrophoresis of copper and zinc in the phases of the menstrual cycle, electrophoresis with lidase or iodine, ultrasound, high-frequency pulsed currents (SMT, DDT). Also in rehabilitation treatment, immunomodulators, autohemotherapy, injections of aloe, FIBS, Longidaza and others are used. With chronic adnexitis, spa treatment is indicated - mud, paraffin, medicinal baths and douching.

Suppositories for inflammation of the appendages

To reduce symptoms such as inflammation, pain, swelling, and temperature, special suppositories are used that can relieve inflammation. Candles can also be prescribed that are able to strengthen the immune system, and this is very important for any disease. Also, such drugs cleanse the body of harmful substances.

All suppositories are prescribed by a doctor, but in any case, such treatment will be additional.

Folk remedies

At home, you can use some folk recipes:

1. Take 4 teaspoons of finely chopped buckthorn roots, chernobylnik and peony, add 3 teaspoons each of the roots of the burnet and elecampane. After that, pour 2 tablespoons of the resulting mixture with half a liter of boiling water. Simmer for half an hour over low heat, and then let cool for half an hour. Then strain and add some honey for taste. The remedy should be taken half a glass 3-4 times a day.
2. One tablespoon chopped dry grass of the upland uterus pour a glass of boiling water... Insist 2 hours. Strain. Take 1/3 cup 3 times a day half an hour before meals. The course of treatment is 1 month. After a month of treatment for adnexitis with a borax uterus, it is advisable to drink another infusion for 2 months - from the grass of the field. 1 tbsp. l. Pour herbs with a glass of boiling water, leave for 4 hours, drain. Drink 1 tsp. 30 minutes before meals 4 times a day.
3. Buldenezh should be harvested at the very beginning of flowering (until insects start to grow in them). Tincture of them has excellent antiseptic, anti-inflammatory and analgesic properties. A liter jar is filled with inflorescence balls, poured with vodka and sent to a dark, cool place for 15 days. The lower abdomen is rubbed with this tincture, and the inflorescences are applied in the form of compresses.
4. Take flowers of coltsfoot, sweet clover, centaury in equal proportions... Mix, pre-chop, pour boiling water, let it brew for an hour, then strain the broth through cheesecloth and drink half a glass twice a day. Abstinence from sexual intercourse is recommended during treatment.

Remember that folk remedies are only an adjunct, and can in no way replace the drug therapy prescribed by a specialist.

Ovarian apoplexy is one of the gynecological diseases that cause the appearance of the clinical picture of an acute abdomen. This dangerous pathology, in the absence of timely medical care, can lead to very serious complications. However, the occurrence of lower abdominal pain is not a rare symptom. Almost all women from time to time experience pain in this area associated with certain phases of the menstrual cycle. But ovarian apoplexy is exactly the disease in which it is worth paying attention to pain and seeking qualified medical help as early as possible. Knowing the symptoms of ovarian apoplexy helps to diagnose this pathology in a timely manner.

Diagnostic methods and symptoms of ovarian apoplexy

The main clinical symptom of ovarian apoplexy, like other gynecological diseases that determine the clinical picture of an acute abdomen, is sudden pain in the lower abdomen. The occurrence of pain syndrome in this case is explained by irritation of the receptor field of the ovarian tissue, the effect of the outflowing blood on the peritoneum, as well as spasm in the ovarian artery basin. In addition to the pain syndrome with apoplexy, a woman is worried about weakness, nausea and vomiting, dizziness and fainting. But depending on the form of pathology, the clinical picture of ovarian apoplexy may differ slightly.

Ovarian apoplexy symptoms:

• symptoms of ovarian apoplexy with painful form;
• symptoms of ovarian apoplexy with hemorrhagic form;
• the main methods for diagnosing ovarian apoplexy.

Symptoms of ovarian apoplexy with pain

The painful form of ovarian apoplexy is observed when hemorrhage occurs directly into the tissue of the follicle or corpus luteum. In this case, there is no bleeding into the abdominal cavity. With this form of the disease, the main symptom of ovarian apoplexy is pain in the lower abdomen, which does not radiate, and may be accompanied by nausea and vomiting. There are no signs of bleeding into the abdominal cavity. When examining the patient, the color of the skin and mucous membranes remains normal, the pulse and blood pressure do not change. On palpation, painful sensations are noted in the iliac region on the right. On a gynecological examination, the uterus is normal in size, the affected ovary may be slightly enlarged and painful on palpation.

Symptoms of ovarian apoplexy with hemorrhagic form

A mild hemorrhagic form of rupture of ovarian tissue is clinically very similar to a painful form, but in moderate and severe forms, the symptoms of ovarian apoplexy are somewhat different, since they are associated with intra-abdominal bleeding. Pain syndrome occurs acutely, often appears during physical exertion or sexual intercourse, radiates to the rectum, leg, lower back and external genitals. The patient is also worried about weakness, dizziness, nausea and vomiting. The patient's skin and mucous membranes are pale, and cold clammy sweat may occur. Blood pressure is lowered, tachycardia occurs, which is explained by blood loss. Palpation is determined by a sharp pain in the iliac region, with a bimanual gynecological examination on the side of apoplexy, a painful, slightly enlarged ovary is palpated.

The main methods for diagnosing ovarian apoplexy

To diagnose ovarian apoplexy, the following laboratory and instrumental research methods are used:

• complete blood count: moderate leukocytosis in painful form, decreased hemoglobin level, leukocytosis in hemorrhagic form;
• ultrasound examination: a small amount of hypoechoic fluid with a finely dispersed suspension in the Douglas space with painful form, a significant amount of fine and medium dispersed fluid in the abdominal cavity, with hyperechoic structures of irregular shape in hemorrhagic form of ovarian apoplexy;
• laparoscopic examination: there is a stigma of ovulation - a small spot raised above the surface of the ovary with signs of bleeding, in the form of a cyst of the corpus luteum or the corpus luteum itself with a rupture or defect.

Bimanual gynecological examination is central to assessing the condition of the ovaries. Symptoms arising from physiological or pathological processes in the ovaries usually correspond to the findings of a physical examination. Some ovarian diseases are asymptomatic, so the physical examination data may be the only information at the first stage of the examination.
For the correct interpretation the results of the study, it is necessary to know the palpation characteristics of the ovaries at different periods of life.

IN premenstrual ovaries should not be palpable. If they can be probed, their pathology should be assumed and further in-depth examination should be carried out.

IN reproductive age normal ovaries are palpable in about half of women. The most important characteristics are: size, shape, consistency (dense or cyst-like) and mobility. In women of reproductive age who take oral contraceptives, the ovaries are palpable less often, are smaller and more symmetrical than in women who do not use these means.

In patients in the postmenopausal age, the ovaries are functionally inactive except for the production of small amounts of androgens. The ovaries no longer respond to gonadotropic stimulation and therefore their superficial follicular activity gradually decreases, stopping in most cases within three years from the onset of natural menopause. In women close to the onset of natural menopause, residual functional cysts are more often found. In general, palpable ovarian enlargement in the postmenopausal period requires a more critical assessment than in young women, since in this age group the frequency of ovarian malignancies is higher.

About 1/4 of all ovarian tumors in the postmenopausal period are malignant, while at reproductive age, only 10% of tumors are malignant. In the past, the degree of risk was considered so great that detection of any enlargement of the ovary in the postmenopausal period (the so-called palpable postmenopausal ovary syndrome) served as an indication for surgical intervention. The advent of more sensitive diagnostic imaging of the pelvic organs has changed routine tactics. Mandatory removal of minimally enlarged ovaries in postmenopausal women is no longer recommended.

If the patient has natural menopause lasts 3 to years and transvaginal ultrasound reveals the presence of a simple unicameral cyst less than 5 cm in diameter, further management of such a patient may consist in repeated ultrasound examinations (including transvaginal ones) to monitor the condition of the cyst. Larger lesions or complex ultrasound structures are best treated with surgery.

Functional ovarian cysts - these are not tumors, but rather normal anatomical variations resulting from normal ovarian activity. They can proceed as asymptomatic formations of appendages or be accompanied by symptoms that require additional research and, possibly, certain treatment.

When ovarian follicle does not rupture at the end of its maturation, ovulation does not occur and follicular cyst may occur. The consequence of this will be the lengthening of the follicular phase of the cycle and, as a result, secondary amenorrhea. Follicular cysts are lined with normal granulosa cells from the inside, and the fluid contained within them is rich in estrogen.

Follicular cyst becomes clinically significant when it is large enough to cause pain, or when it persists for more than one menstrual period. It is not entirely clear why the granulosa cells lining the follicular cysts persist beyond the time that ovulation should occur and continue to function during the second half of the cycle. The cyst can grow, reaching a diameter of 5 cm or more, and continues to fill with estrogen-rich follicular fluid coming from a thickened layer of phanular cells. Symptoms caused by a follicular cyst can manifest as mild to moderate unilateral pain in the lower abdomen and changes in menstrual patterns.

The latter may be the result of both a failed subsequent ovulation, and an excess amount of estradiol produced inside the follicle. Excessive estrogen saturation of the body in the absence of ovulation hyperstimulates the endometrium and causes irregular bleeding. A bimanual gynecological examination may reveal a unilateral painful mobile cystic formation of the appendages.

Having received such data during the initial examination, the physician must decide whether to undertake further in-depth examination and decide on treatment. Ultrasound of the pelvic organs is recommended for patients of reproductive age with a cyst size of more than 5 cm in diameter. This examination reveals a single-chamber simple cyst with no signs of blood or soft tissue elements inside and no signs of growths outside. Most patients do not require ultrasound confirmation. Instead, the woman should be reassured and re-examined in 6-8 weeks.

Inflammatory processes that occur in the female genital organs are dangerous because they can quickly spread to the entire system, causing serious changes in the structure of tissues, disrupting the natural state of the uterus and appendages. In women, inflammation of the uterus, ovaries is often the cause of ectopic pregnancy, infertility and other complications. Early diagnosis and treatment of such pathologies can prevent the transition of the disease to a chronic form. If unusual discharge, pain in the lower abdomen appears, it is necessary to clarify the diagnosis as soon as possible.

The ovaries are the endocrine glands in which the female sex hormones, estrogens and progesterone are produced. Hormonal imbalance can be the cause of breast tumors, irregularities in the cycle and the nature of menstruation, the onset of early menopause. Serious diseases of the uterus are the consequences of hormonal disorders.

Ovarian inflammation (oophoritis) disrupts the functioning of the entire reproductive system. The process can affect only one organ (unilateral inflammation) or spread to both (bilateral). Often this disease is accompanied by inflammation of the fallopian tubes (salpingitis). In this case, adnexitis occurs, a simultaneous inflammation of the ovaries and tubes. In the first stage, the inflammatory process occurs only in the mucous membrane, but then spreads to the tissues.

Causes and types of ovarian inflammation

Ovarian inflammation is caused by infection. Depending on the nature of the infection causing the disease, two types of oophoritis are distinguished: non-specific and specific.

Non-specific. The causative agents of infection are opportunistic microbes. They are always present in the human body and are activated when immunity is weakened, hypothermia, stress. These microbes are staphylococci, streptococci, E. coli, candida fungi.

Specific. Inflammation is caused by sexually transmitted infections (syphilis, chlamydia, trichomoniasis, gonorrhea), as well as tuberculosis pathogens.

Ovarian inflammation can occur as a result of the following processes:

• penetration of infection from the external genital organs through the cervix, uterine cavity and fallopian tubes;
• infection from the intestines and urinary organs if personal hygiene is not followed;
• spread of infection to the ovaries with intestinal inflammation or appendicitis;
• infection during abortion, installation of an intrauterine device, operations on the pelvic organs;
• transmission of infection through the blood or lymph from other organs prone to inflammation (for example, with angina).

Addition: The onset of oophoritis is facilitated by factors such as weakening of the immune system, hypothermia, uncontrolled intake of certain medications, overwork, stress, lack of nutrition.

Video: Causes and prevention of ovarian inflammation

Forms and symptoms of the disease

Ovarian inflammation in women can exist in acute, subacute, and chronic forms. In this case, the symptoms are similar, but expressed to different degrees.

Acute inflammation. Has pronounced signs that usually force a woman to urgently see a doctor.

Subacute inflammation. This form is found in patients with tuberculosis. The symptoms of the disease are the same as in the acute form, but it is more difficult to recognize them, since they are masked by the symptoms of the underlying disease.

Chronic inflammation. If a woman does not consult a doctor in a timely manner, the treatment is not completed, the disease can turn into a chronic form, in which the symptoms are smoothed out. There are periods of temporary improvement in the condition, followed by an exacerbation of the disease.

Symptoms in the acute form of the disease

Signs of acute inflammation are:

1. Severe pain in the lower abdomen, on one side or both. The pain is felt not only in the ovarian area, but also spreads to the groin area. There are aching pains in the sacrum, lower back. Painful sensations intensify before menstruation, as well as with hypothermia.
2. Increased body temperature, chills. It is not possible to bring down the temperature with the help of conventional antipyretic drugs. Temperature jumps are observed.
3. Headache, aching joints and muscles.
4. Frequent and painful urination.
5. Profuse discharge from the genitals. They can be transparent, white, yellow, brown, green, with blood or pus.
6. Bleeding between periods.
7. Violation of the menstrual cycle.
8. Digestive upset.
9. Painful sensations during intercourse.
10. Insomnia, irritability, fatigue.

Palpation of the ovaries is difficult due to their swelling and soreness.

Features of the chronic form of inflammation

If the inflammation becomes chronic, then it periodically worsens. Usually, the reason is colds or infectious diseases, physical or mental stress, indigestion, diseases of the genitourinary system. If a woman smokes or often drinks alcohol, then the risk of exacerbations increases.

In some cases, relapse of the disease does not occur, the woman is only worried about the discharge and the irregular onset of menstruation. This course of inflammation of the ovaries is typical, for example, in gonorrhea. However, gradually there is a thickening of the walls of the fallopian tubes, the formation of adhesions in the ovaries.

With a one-sided process, pain is localized at the site of inflammation. If it occurs on the right side, the symptoms of oophoritis may be confused with symptoms of appendicitis. A thorough diagnosis of the disease is required.

Often, inflammation on one side extends to the other ovary. In women with chronic ovarian inflammation, a persistent, scanty discharge (leucorrhoea) is a common symptom. Usually, patients go to a doctor for examination and treatment if pregnancy does not occur.

The consequences of ovarian inflammation

The greatest danger is bilateral chronic ovarian inflammation. Its symptoms are not as pronounced as in the acute form. The woman periodically feels healthy, the treatment is not completed. As a result, ovarian dysfunction (a violation of hormone production) can form. This condition is characterized by the woman's lack of ovulation, the possibility of conception. At the same time, there is an irregular onset of menstruation, fluctuations in their intensity and duration.

Ovarian dysfunction, hormonal disorders can cause diseases of the mammary glands, as well as pathological changes in the tissues of the uterus, up to the appearance of malignant tumors. Inflammation causes complications such as obstruction of the fallopian tubes, miscarriage, ectopic pregnancy, inflammatory diseases of the kidneys and intestines.

Oophoritis diagnostics

It is not always possible to establish the presence of oophoritis only on the basis of symptoms, since a similar picture is observed in diseases such as appendicitis, ectopic pregnancy, peritonitis, neoplastic diseases of the uterus and ovaries. To clarify the diagnosis, you need to know about the presence and methods of treatment of previous diseases, the nature and time of the onset of ailments, the existence of complications in a woman during childbirth, abortion, and intrauterine procedures. The localization of pain, the nature of the discharge, the existence of other signs of inflammation are specified.

During a gynecological examination reveals the presence of swelling and soreness of the ovaries, changes in the mobility of the appendages.

Lab tests blood, urine and vaginal smear allow you to determine the presence of an inflammatory process by an increased content of leukocytes.

Ultrasound pelvic organs is done to clarify the nature of the disease.

Bacteriological analysis smear. Allows you to find out the type of opportunistic microorganisms and their sensitivity to various antibiotics.

ELISA (enzyme-linked immunosorbent assay) - determination of the type of infection by the presence of antibodies in the blood corresponding to it. The method allows you to approximately assess the nature of the infection. It is used to detect chlamydia, mycoplasmosis, trichomoniasis and other latent infections.

PCR (polymerase chain reaction) - a method that allows with 100% accuracy to determine the type of viruses that caused inflammation by their DNA (including detecting the human papillomavirus, herpes, the causative agent of tuberculosis, chlamydia and others).

Hysterosalpingoscopy. The method is used to detect structural changes resulting from inflammation. The organs are filled with a special liquid, and then with the help of ultrasound they observe its progress through the pipes, clarify their patency.

Laparoscopy. Allows you to examine the uterus, tubes, ovaries. The most effective diagnostic method. An optical device with a camera is inserted through a small opening in the abdominal wall.

Oophoritis treatment

The method of treatment depends on the form of the disease and the type of infection that causes it.

In acute form, treatment is carried out in stationary conditions. A woman must comply with bed rest. Cold compresses are applied to the lower abdomen. Antibacterial, analgesic, antipyretic drugs, and general tonic drugs are used. Antibiotics for treatment are selected depending on the sensitivity of the pathogen.

In the subacute form of the disease, quartz irradiation of the site of inflammation is used. For chronic inflammation, medication is used, as well as physiotherapy and therapeutic baths.

The following methods are used:

1. Hirudotherapy - treatment with leeches to remove adhesions, relieve swelling and inflammation.
2. Electrophoresis - the introduction of drugs through the skin using a weak direct electric current.
3. Gynecological massage. Allows you to eliminate adhesions, increase the tone of the uterus, restore its normal location.
4. Magnetotherapy - treatment with a magnetic field of low frequency. It has anti-inflammatory and analgesic effects.
5. Laser therapy, IR, UV irradiation - optical methods for eliminating microorganisms.

Note: If inflammation of the ovaries is a result of a sexually transmitted infection, then both sexual partners should be treated at the same time. Sexual intercourse should be avoided at this time.

In the treatment of advanced chronic diseases, one has to deal with the presence of complications that require surgical intervention.

Video: Complications of ovarian inflammation

For the prevention of oophoritis, it is necessary to timely treat any inflammatory processes in the body, strengthen immunity, lead a healthy lifestyle, use condoms, and regularly undergo gynecological examinations.