There are two ovaries, one on each side, in the lower portion of the abdomen.
The ovary provides the female egg cell which passes each month down the Fallopian tube to the uterus. The ovary also develops glandular substances important for establishing the female body structure and the functions peculiar to women.
The ovary may become twisted on the tissues which support it, which will affect its blood supply and bring on pain and swelling. Blocking of the ovarian ducts may cause the formation of ovarian cysts as large collections of fluid. Pain may arise, and it will become necessary to open the abdomen and to get rid of such cysts.
Ovaries may become infected by any of the germs that are carried in the blood or that pass through the ovary by extension from other organs and tissues. Infections are responsible for more than 90 per cent of disturbances of the ovary. If pus forms in the Fallopian tubes, it may extend over to the ovary. Pain, swelling, high fever and similar symptoms demand attention. Again, adequate use of antibiotic drugs in many instances brings about complete relief.
Tumors of all kinds can affect the ovary, including cancer.
The doctor cannot determine from any examination that he can carry on from the outside of the body the exact nature of such tumors. In the examination of the ovary he may insert a finger into the rectum; he may press on the abdomen from the outside; he may take X-ray pictures; in cases of extreme doubt, when diagnosis is important, the abdomen may be opened in an exploratory operation, to find out exactly what is wrong.
Oral or vaginal metronidazole (Flagyl) and vaginal clindamycin (Cleocin) are the recommended regimens for creating bacterial vaginosis. Single-dose metronidazole ard clindamycin are less effective but can be used if compliance is a problem.
Many topical and systemic therapies are now available for yeast infections. The efficacy of oral and topical therapies is equivalent, although side effects are more common with systemic therapy. Treatment with topical azoles results in cure in 80% to 90% of patients. The efficiency of oral regimens, especially single-dose fluconazole, has made them very popular among patients. Unless an infection is complicated, it is reasonable to treat according to patient preference.
In complicated cases (e.g., recurrence, diabetes), treatment should be with a topical agent for 14 days. In most cases, sexual partners need not be treated. However, Candida can be transmitted sexually, and partner treatment should be considered in recurrent or resistant cases.
Systemic therapy with metronidazole (Flagyl) is the treatment of choice in cases of trichomoniasis, and the 2 g single-dose oral regimen is very effective. An alternative is 500 mg orally twice daily for 7 days. Topical preparations of metronidazole do not penetrate the urethra or periurethral glands, which can serve as reservoirs for infection and relapse. Sexual partners should be treated simultaneously. Male partners of women with trichomoniasis have detectable infection about one third of the time.
Menstruation is the periodic bleeding from the uterus. The period represents the development of an egg cell by the ovaries and the passing of this egg cell into the uterus. The uterus gets ready for the egg cell by a congestion, and the bleeding is the sign that there has not been a pregnancy and that the congestion is disappearing from the uterus. In fact, one poetic doctor said that menstruation is the weeping of the uterus at its failure to become pregnant. Girls in the United States mature between twelve and sixteen years of age, although some are earlier and some later. In other countries girls may mature much sooner – this apparently being true in the hot countries. Failure to menstruate may be associated with a variety of symptoms. If the appearances of maturity are unusually delayed, a young girl should be taken to the doctor for a careful and complete examination to find out the cause.
When pregnancy occurs, menstruation stops until after the child is born.
Formerly, many girls were incapacitated during menstruation because of pain and, customarily, sedatives and pain-relieving drugs were used. The newer attitude toward this normal function has freed women from this terror, and dysmenorrhea is not as frequent as formerly. The relationship between the mind and menstruation is more clearly established and a condition known as premenstrual tension has been described, for which special treatment is also available. Ordinarily a young woman need not change her habits greatly during this period. Most doctors believe that strenuous exercise should be avoided, tub baths may not be desirable, but many women do not permit menstruation to interfere with any of their ordinary habits.
A wet-mount preparation is performed by combining vaginal discharge and one or two drops of normal saline on a microscope slide. Several microscope fields should be examined for motile trichomonads and for the clue cells of bacterial vaginosis. The sensitivity of these tests is about 60% for trichomoniasis and bacterial vaginosis, but the specificity is 98%. Other possible findings on the wet-mount examination include fungal hyphae (candidiasis), numerous white blood cells (trichomoniasis), and parabasal cells (atrophic vaginitis).
Potassium Hydroxide (KOH) Preparation
To perform a “KOH prep,” a sample of vaginal discharge is combined with one or two drops of 10% to 20% potassium hydroxide (KOH) on a microscope slide. The whiff test is performed at this point by smelling for a fishy amine odor, which occurs in bacterial vaginosis. Once the slide has been dried by flame or air, it is examined under low power for candidal hyphae, spores, and mycelia. Scanning for these fungal elements is about 60% sensitive for candidiasis.
The pH level of vaginal secretions is measured by placing litmus paper in pooled secretions or against the vaginal wall. Normal vaginal pH is 3.8 to 4.2, whereas in bacterial vaginosis, the pH is above 4.5 in about 90% of cases. The vaginal pH can also be elevated in trichomoniasis and atrophic vaginitis, but to a lesser degree.
Cultures are not typically done to diagnose vaginitis but can be helpful in cases in which the diagnosis is in question or when treatment has failed. Cultures for T. vaginalis on Diamond’s medium and DNA probes have sensitivities of 90% and 95% respectively.
Cultures can also be useful in cases of candidiasis but many women without vulvovaginal candidiasis are colonized with Candidal. Many clinicians will treat presumptively for yeast if vaginal pH is normal and non-diagnostic organisms are found on microscopy.
Cultures for G. vaginalis are not helpful for diagnosis, since they are positive in 50% of women without symptoms. Diagnostic cards (Femcard) have recently been introduced that can detect elevated pH and amines in vaginal fluid. These cards have a sensitivity of 87%, and a specificity of 92%.
In general, Amsel’s criteria can be useful, and the presence of three of these criteria is 90% sensitive for bacterial vaginosis:
• Thin, homogeneous discharge
• Positive whiff test
• Clue cells
• Vaginal pH greater than 4.5