Female genital disease
SpecialtyGynaecology Edit this on Wikidata

Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

Diagnosis

Female genital diseases are usually diagnosed by healthcare personnel in a healthcare setting. Diagnosis may be made using laboratory tests, physical examinations, and/or clinical signs and symptoms.[1][2]

Barriers to diagnosis

Historically, discussions surrounding feminine reproductive and sexual health have been subject to social stigma within Western society.[3] Women in Western society may avoid discussing problems relating to the female reproductive system, including problems related to female sexual health, with their healthcare providers.[3] As a result, diagnosis of female genital diseases may be delayed or missed. Social determinants of health including economic and logistical burden of seeking healthcare may also interfere with timely diagnosis of female genital disease.[4]

Gender considerations

Individuals who have female genitals and/or reproductive organs but who do not identify as women may experience additional difficulties in seeking diagnosis of female genital diseases. Societal discrimination,[5] gender dysphoria,[6] and insufficient transgender healthcare education[5][7] are some reasons that transgender individuals may be unable to obtain medical care for female genital diseases.

Women's history in clinical trials

Medical professionals use a variety of resources that assist them in creating clinical decisions in providing care to the population, with one of the more utilized sources are known as clinical trials. Clinical trials are used to analyze the efficacy and safety of medications, medical intervention, and medical procedures. Historically, women representation in clinical trials has been suboptimal, oftentimes being excluded from trials due to "potential maternal-fetal liability",[8] "have less experience, and are more costly to engage".[9] However, through limiting the number of women eligible for various stages of these trials, outcomes and the burden of disease have been underrepresented in females, either underreported or not adjusted for. For example, due to the fact that women have different drug efficacies and safety profiles to men, it is estimated "in 2005 that eight out of ten prescription drugs were withdrawn from the US market because of women's health issues".[10] Clinical trials that focused on preventative care, such as screenings, diagnostics, and health services in have an adjusted relative difference of 8.48% in female enrollment.[11] Fortunately, over the years we have seen a rise in women participants, with an average of 60.0% females enrolled in clinical trials in 2018, up 18.9% from the lowest year of participants, in 2002, with a median of 41.1%.[11]

Therefore, as we diminish the number of women who are a part of clinical trials, then guidelines that are used by medical professional stem majority from male subjects; this can then led into a variety of other factors to consider when making medical decisions towards women in the acute inpatient or chronic ambulatory care setting such as social and financial difference that can impact the care women receive. Importantly so, we decrease the number of studies that are geared towards women's reproductive issues, such as genital disease. In efforts to encourage women to participate in clinical research, the National Institute of Health (NIH) launched the women's health initiative in 1991 that focuses clinical trials and observational studies on post-menopausal women over a 15 year period of time.[12][13] Additionally, by broadening what "women's health" encompasses, including not only reproductive and genital health, childbearing, and menstruation but also osteoporosis, breast cancer, and other disease states where women bear higher burden than men, the NIH can focus funding on these conditions.[12]

Perception

In society, having a disease related to a person’s genitalia continues to be a stigma today.  The stigma comes with shame and embarrassment that is not only internalized, but also emphasized by others through loss of support and discrimination.  Some of that shame is rooted in spirituality and societal perception.  In a study done in Lagos, Nigeria regarding uterine fibroids, majority of the women who participated in the study (67.0%) “perceived [uterine] fibroids as a spiritual problem” and believe that the best course of treatment is done spiritually through places of worship such as churches and mosques.  The majority of women who participated in the study knew that uterine fibroids existed and were associated with obesity.[14]  In both developed and developing countries, individuals with female genital diseases experience shame through perception of these diseases by healthcare providers and the general public. In a multisite study in the United States focusing on English and Spanish speaking women regarding perception, knowledge, and experiences with vaginal prolapse, these women had feelings of shame regarding their condition since they blamed themselves for their condition and felt that their condition was “unnatural or less like a woman”.  One woman mentioned that they were humiliated by a physician for their condition.  Given the stigma regarding genital diseases, a common theme from the participants was that they did not know that vaginal prolapse can occur in women.[15]  Another study in India was done where researchers called people recently diagnosed with sexually transmitted infections regarding the stigma towards their condition. Researchers found that 49 out of 487 people wanted to participate in their study, which they inferred was related to the "shame and stigma in the Indian population".[16]

Classification by type of disease

Malformation

Malformations can be congenital. They are classified by location of the malformation, such as uterine malformation.

Inflammation or infection

An example is oophoritis.

Classification by location

Diseases of the vulva

Bartholin's cyst

A Bartholin's cyst is an abscess of a Bartholin's gland. Bartholin's glands are located within the labia, or the skin folds surrounding the vaginal opening.[17] Bartholin's cysts can be painful and may require drainage or surgical removal in order to resolve.[17]

Vulvodynia

Vulvodynia is a chronic pain condition which involves the sensation of pain in the area surrounding the vaginal opening in response to physical stimulation such as vaginal penetration.[18] This condition can be distressing to people who have it as it can interfere with intimacy.[18] There is no standardized treatment for vulvodynia, but some options include pelvic floor physical therapy and pharmacologic pain management.[18]

Disease of the vagina

Vaginal prolapse

Vaginal prolapse, otherwise known as pelvic organ prolapse, is when a person’s vagina descends due to pelvic organ pressure or due to tissue injury and/or muscle weakness.[19] Some of the risk factors include previous pelvic surgeries as well as activities and conditions that increase intrabdominal pressure such as childbirth, obesity, and older age. Symptoms of vaginal prolapse are vaginal bulge, urinary and fecal incontinence, and sexual dysfunction.[19][20] Treatment for vaginal prolapse can be either conservative or surgical according to Kapoor et. al. Some of the conservative treatments include Kegel exercises that strengthen the pelvic floor and pessaries which aim to put the vagina in a normal position.[21] Surgical treatment options include colpocleisis, vaginal reconstruction, and abdominal sacrocolpopexy. Colpocleisis is a obliterative procedure that would remove the possibility of vaginal intercourse. Therefore, a person's desire to get pregnant is considered when deciding treatment for this condition.[20]

Bacterial vaginosis

Bacterial vaginosis is a condition that occurs when there is an overgrowth of normal bacteria in the vagina.[22] The community of bacteria that normally exists in the vagina is called the vaginal flora. The flora serves as a defense against the invasion and colonization of opportunistic pathogens including bacterial vaginosis, fungi, viruses, and protozoa.[23] Historically, it was believed that the bacterium Gardnerella caused bacterial vaginosis, but studies have shown that bacterial vaginosis can be caused by a variety of bacteria.[24] Women are at an increased risk of having bacterial vaginosis if they smoke cigarettes, recently used antibiotics, use an intrauterine device, have multiple sexual partners, and practice vaginal douching.[22]

Trichomoniasis

Trichomoniasis, also known as "trich", is a sexually transmitted infection caused by a protozoan parasite called trichomonas vaginalis. It is the most common protozoal infection in the United States. This motile organism is not exclusive to women, but can also be found in the prostate and urethra of men. Individuals are at an increased risk of contracting trich if they have a history of sexually transmitted infections, have new or multiple sex partners, abuse IV drugs, and do not use any type of protection during sex.[25]

Disease of the cervix

Cervicitis

Cervicitis is inflammation of the cervix in individuals with a uterus, most commonly identified in those presenting as women. While some patients report pus and mucus like discharge, a majority of individuals with this condition do not present with any symptoms. Less than half of the cases of cervicitis are linked to either Neisseria gonorrhoeae or Chlamydia trachomatis, likely sexually transmitted. However, more than half have unknown infectious etiology.[26] Complications can result in pelvic inflammatory disease, difficulties bearing pregnancy, and endometriosis. Due to these adverse outcomes, the CDC recommends that women undergo routine nucleic acid amplification technique (NAAT) testing, which can aid in the detection of chlamydia and gonorrhea.[27]

Diseases of the uterus

Uterine malformation

Uterine malformations are sometimes referred to as congenital uterine anomalies.[28][29] A uterine malformation is an abnormality in the development of a person's uterus. This condition can result in fertility problems such as increased risk of miscarriage.[28][29]

Uterine fibroids

Uterine fibroids, also known as uterine leiomyomas, are solid growths of noncancerous smooth muscle cells that are located on the uterus. There is no cause, but risk factors such as family history, reproductive issues, hormones, and viruses are associated with fibroid growth.[30][31] Previous research suggested an association between diet and hormonal changes that has the potential to form fibroids and give them the environment to grow.[31] Despite other research contradicting this statement, further research stated that low fruit and vegetable intake as well as Vitamin D insufficiency and food contaminants have been correlated to fibroid formation and growth. In most cases, uterine fibroids are asymptomatic and therefore will not need treatment. Giuliani et. al found that asymptomatic uterine fibroids are present in 70% of individuals who were diagnosed with it, suggesting that it plays a role in epidemiologic studies underestimating its prevalence.[32] Uterine fibroids are treated if the person is experiencing symptoms such as anemia, infertility, and pelvic and back pain. These treatments aim to decrease the uterine fibroid size, prevent their growth, and improve symptoms the person deals with.[31] Treatments that are currently being used to treat uterine fibroids are medications, surgeries such as hysteroscopy and laparoscopy, and radiologic treatments such as radiofrequency ablation. Most of these treatments affect a person's ability to get pregnant.

Endometriosis

Endometriosis is when a person has their uterine endometrial tissue that is growing somewhere besides its normal location, most commonly at the pelvic peritoneum.[33] This can also be regarded as "lesions outside of the uterus".[34] This condition has been described as "benign and estrogen dependent", therefore impacting those who produce estrogen. Other locations where this may occur, although more rare, include ovaries, pericardium, rectovaginal septum, bladder, and more. Most commonly, this can be associated with pelvic pain and infertility.[34]

Diseases of the fallopian tubes

Salpingitis

Salpingitis, or salpingitis isthmica nodosa, is a disease involving inflammation within the fallopian tubes.[35] This condition can be caused by infections, such as sexually transmitted infections. Salpingitis may be associated with fertility problems, such as infertility and ectopic pregnancy.[35]

Ectopic pregnancy

Ectopic pregnancy, or tubal ectopic pregnancy, is a condition that occurs when a developing pregnancy implants outside of the uterus, such as in the fallopian tubes.[36] This condition is an emergency and can be fatal to the pregnant person.[36] Treatment usually involves a salpingectomy, or the removal of the affected fallopian tube.[36]

Diseases of the ovaries

Oophoritis

Oophoritis is a condition affecting one or both of the ovaries which results in inflammation. Oophoritis can be caused by an infection or by an autoimmune disease called primary ovarian insufficiency.[37]

Sexually transmitted infections

A sexually transmitted infection (STI) is an infection caused by a virus, fungus, bacteria, or parasite that is spread through sexual contact. STIs are very common and can be passed from one person to another through vaginal, oral, and anal sex.[38]

Complications

Sexually transmitted infections can impact female reproductive health worldwide. Women experience a larger impact on their health compared to men because of how exposed and vulnerable their urogenital anatomy is. The vaginal mucosa is thin and can be easily penetrated by infectious agents. Some complications that women experience from STIs are infertility, chronic pelvic pain, increased peripartum morbidity, and increased peripartum mortality.[39]

Economic burden

In 2018, $15.9 billion was spent on lifetime medical cost attributable to STIs such as chlamydia, trichomoniasis, gonorrhea, genital herpes, syphilis, human papillomavirus (HPV), HIV, and hepatitis B. When HIV is not included in the cost, STIs in women account for about three fourths of lifetime direct medical costs annually.[40]

See also

Male genital disease

References

  1. ↑ Curry A, Williams T, Penny ML (September 2019). "Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention". American Family Physician. 100 (6): 357–364. PMID 31524362.
  2. ↑ Rolla E (2019-04-23). "Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment". F1000Research. 8: 529. doi:10.12688/f1000research.14817.1. PMC 6480968. PMID 31069056.
  3. 1 2 Kingsberg SA, Schaffir J, Faught BM, Pinkerton JV, Parish SJ, Iglesia CB, et al. (April 2019). "Female Sexual Health: Barriers to Optimal Outcomes and a Roadmap for Improved Patient-Clinician Communications". Journal of Women's Health. 28 (4): 432–443. doi:10.1089/jwh.2018.7352. PMC 6482896. PMID 30714849.
  4. ↑ Allahqoli L, Dehdari T, Rahmani A, Fallahi A, Gharacheh M, Hajinasab N, et al. (November 2022). "Delayed cervical cancer diagnosis: a systematic review". European Review for Medical and Pharmacological Sciences. 26 (22): 8467–8480. doi:10.26355/eurrev_202211_30382. PMID 36459029. S2CID 254150320.
  5. 1 2 Stenzel AE, Moysich KB, Ferrando CA, Starbuck KD (December 2020). "Clinical needs for transgender men in the gynecologic oncology setting". Gynecologic Oncology. 159 (3): 899–905. doi:10.1016/j.ygyno.2020.09.038. PMC 7721990. PMID 33004214.
  6. ↑ Carbonnel M, Karpel L, Cordier B, Pirtea P, Ayoubi JM (October 2021). "The uterus in transgender men". Fertility and Sterility. 116 (4): 931–935. doi:10.1016/j.fertnstert.2021.07.005. PMID 34364678. S2CID 236960487.
  7. ↑ van Heesewijk J, Kent A, van de Grift TC, Harleman A, Muntinga M (August 2022). "Transgender health content in medical education: a theory-guided systematic review of current training practices and implementation barriers & facilitators". Advances in Health Sciences Education. 27 (3): 817–846. doi:10.1007/s10459-022-10112-y. PMC 9374605. PMID 35412095.
  8. ↑ Steinberg JR, Turner BE, Weeks BT, Magnani CJ, Wong BO, Rodriguez F, et al. (June 2021). "Analysis of Female Enrollment and Participant Sex by Burden of Disease in US Clinical Trials Between 2000 and 2020". JAMA Network Open. 4 (6): e2113749. doi:10.1001/jamanetworkopen.2021.13749. PMC 8214160. PMID 34143192.
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  11. 1 2 Steinberg JR, Turner BE, Weeks BT, Magnani CJ, Wong BO, Rodriguez F, et al. (June 2021). "Analysis of Female Enrollment and Participant Sex by Burden of Disease in US Clinical Trials Between 2000 and 2020". JAMA Network Open. 4 (6): e2113749. doi:10.1001/jamanetworkopen.2021.13749. PMC 8214160. PMID 34143192.
  12. 1 2 Schiebinger L (October 2003). "Women's health and clinical trials". The Journal of Clinical Investigation. 112 (7): 973–977. doi:10.1172/JCI19993. PMC 198535. PMID 14523031.
  13. ↑ "History of Women's Participation in Clinical Research". Office of Research on Women's Health. U.S. National Institutes of Health. Retrieved 2023-08-01.
  14. ↑ Adegbesan-Omilabu MA, Okunade KS, Gbadegesin A (2014). "Knowledge of, Perception of, and Attitude towards Uterine Fibroids among Women with Fibroids in Lagos, Nigeria". Scientifica. 2014: 809536. doi:10.1155/2014/809536. PMC 3976850. PMID 24757580.
  15. ↑ Dunivan GC, Anger JT, Alas A, Wieslander C, Sevilla C, Chu S, et al. (November 2014). "Pelvic organ prolapse: a disease of silence and shame". Female Pelvic Medicine & Reconstructive Surgery. 20 (6): 322–327. doi:10.1097/SPV.0000000000000077. PMC 4213231. PMID 25185629.
  16. ↑ Suvirya S, Shukla M, Pathania S, Banerjee G, Kumar A, Tripathi A (November 2018). "Stigma Associated with Sexually Transmitted Infections among Patients Attending Suraksha Clinic at a Tertiary Care Hospital in Northern India". Indian Journal of Dermatology. 63 (6): 469–474. doi:10.4103/ijd.IJD_145_18 (inactive 2023-08-02). PMC 6233032. PMID 30504974.{{cite journal}}: CS1 maint: DOI inactive as of August 2023 (link)
  17. 1 2 Illingworth B, Stocking K, Showell M, Kirk E, Duffy J (May 2020). "Evaluation of treatments for Bartholin's cyst or abscess: a systematic review". BJOG. 127 (6): 671–678. doi:10.1111/1471-0528.16079. PMID 31876985. S2CID 209482566.
  18. 1 2 3 Bohm-Starke N, Ramsay KW, Lytsy P, Nordgren B, Sjöberg I, Moberg K, Flink I (May 2022). "Treatment of Provoked Vulvodynia: A Systematic Review". The Journal of Sexual Medicine. 19 (5): 789–808. doi:10.1016/j.jsxm.2022.02.008. PMID 37057558.
  19. 1 2 Aboseif C, Liu P (2023). "Pelvic Organ Prolapse". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 33085376. Retrieved 2023-08-01.
  20. 1 2 Murphy AM, Clark CB, Denisenko AA, D'Amico MJ, Vasavada SP (August 2021). "Surgical management of vaginal prolapse: current surgical concepts". The Canadian Journal of Urology. 28 (S2): 22–26. PMID 34453425.
  21. ↑ Kapoor DS, Thakar R, Sultan AH, Oliver R (October 2009). "Conservative versus surgical management of prolapse: what dictates patient choice?". International Urogynecology Journal and Pelvic Floor Dysfunction. 20 (10): 1157–1161. doi:10.1007/s00192-009-0930-x. PMID 19543676. S2CID 20047692.
  22. 1 2 Kairys N, Garg M (2023). "Bacterial Vaginosis". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 29083654. Retrieved 2023-07-26.
  23. ↑ Amabebe E, Anumba DO (2018-06-13). "The Vaginal Microenvironment: The Physiologic Role of Lactobacilli". Frontiers in Medicine. 5: 181. doi:10.3389/fmed.2018.00181. PMC 6008313. PMID 29951482.
  24. ↑ Greenbaum S, Greenbaum G, Moran-Gilad J, Weintraub AY (April 2019). "Ecological dynamics of the vaginal microbiome in relation to health and disease". American Journal of Obstetrics and Gynecology. 220 (4): 324–335. doi:10.1016/j.ajog.2018.11.1089. PMID 30447213. S2CID 53669915.
  25. ↑ Schumann JA, Plasner S (2023). "Trichomoniasis". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 30521247. Retrieved 2023-07-26.
  26. ↑ Lusk MJ, Konecny P (February 2008). "Cervicitis: a review". Current Opinion in Infectious Diseases. 21 (1): 49–55. doi:10.1097/QCO.0b013e3282f3d988. PMID 18192786. S2CID 20331324.
  27. ↑ Dionne-Odom J, Marrazzo J (June 2020). "Cervicitis: Balancing the Goals of Empiric Therapy and Antimicrobial Stewardship to Improve Women's Health". Sexually Transmitted Diseases. 47 (6): 387–388. doi:10.1097/OLQ.0000000000001183. PMC 8711327. PMID 32421298. S2CID 218691864.
  28. 1 2 Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ (October 2011). "Reproductive outcomes in women with congenital uterine anomalies: a systematic review". Ultrasound in Obstetrics & Gynecology. 38 (4): 371–382. doi:10.1002/uog.10056. PMID 21830244. S2CID 40113681.
  29. 1 2 Kim MA, Kim HS, Kim YH (October 2021). "Reproductive, Obstetric and Neonatal Outcomes in Women with Congenital Uterine Anomalies: A Systematic Review and Meta-Analysis". Journal of Clinical Medicine. 10 (21): 4797. doi:10.3390/jcm10214797. PMC 8584292. PMID 34768344.
  30. ↑ Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M (November 2018). "Burden, Prevalence, and Treatment of Uterine Fibroids: A Survey of U.S. Women". Journal of Women's Health. 27 (11): 1359–1367. doi:10.1089/jwh.2018.7076. PMC 6247381. PMID 30230950.
  31. 1 2 3 Datir SG, Bhake A (November 2022). "Management of Uterine Fibroids and Its Complications During Pregnancy: A Review of Literature". Cureus. 14 (11): e31080. doi:10.7759/cureus.31080. PMC 9719606. PMID 36475121.
  32. ↑ Giuliani E, As-Sanie S, Marsh EE (April 2020). "Epidemiology and management of uterine fibroids". International Journal of Gynaecology and Obstetrics. 149 (1): 3–9. doi:10.1002/ijgo.13102. hdl:2027.42/154526. PMID 31960950. S2CID 210842764.
  33. ↑ Giudice LC, Kao LC (November 2004). "Endometriosis". Lancet. 364 (9447): 1789–1799. doi:10.1016/S0140-6736(04)17403-5. PMID 15541453. S2CID 208788714.
  34. 1 2 Parasar P, Ozcan P, Terry KL (March 2017). "Endometriosis: Epidemiology, Diagnosis and Clinical Management". Current Obstetrics and Gynecology Reports. 6 (1): 34–41. doi:10.1007/s13669-017-0187-1. PMC 5737931. PMID 29276652.
  35. 1 2 Barkwill D, Tobler KJ (2023). "Salpingitis Isthmica Nodosa". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 33085312. Retrieved 2023-07-31.
  36. 1 2 3 Al Wattar BH, Solangon SA, de Braud LV, Rogozińska E, Jurkovic D (July 2023). "Effectiveness of treatment options for tubal ectopic pregnancy: A systematic review and network meta-analysis". BJOG. 131 (1): 5–14. doi:10.1111/1471-0528.17594. PMID 37443463. S2CID 259857257.
  37. ↑ Levit E, Singh B, Nylander E, Segars JH (July 2023). "A Systematic Review of Autoimmune Oophoritis Therapies". Reproductive Sciences. doi:10.1007/s43032-023-01299-5. PMID 37500976. S2CID 260246899.
  38. ↑ "STD Diseases & Related Conditions". U.S. Centers for Disease Control and Prevention. 2023-07-07. Retrieved 2023-07-27.
  39. ↑ Van Gerwen OT, Muzny CA, Marrazzo JM (August 2022). "Sexually transmitted infections and female reproductive health". Nature Microbiology. 7 (8): 1116–1126. doi:10.1038/s41564-022-01177-x. PMC 9362696. PMID 35918418.
  40. ↑ Chesson HW, Spicknall IH, Bingham A, Brisson M, Eppink ST, Farnham PG, et al. (April 2021). "The Estimated Direct Lifetime Medical Costs of Sexually Transmitted Infections Acquired in the United States in 2018". Sexually Transmitted Diseases. 48 (4): 215–221. doi:10.1097/OLQ.0000000000001380. PMC 10684254. PMID 33492093. S2CID 231703480.
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