Ross & Wilson Anatomy and Physiology in Health and Illness (210 page)

Genital herpes

One form of the herpes virus, Herpes simplex 2 (HSV2) is associated with genital infections. Initial infection tends to present as clusters of small, painful ulcers on the external genitalia. There is often fever and headache. Recurrences of the disease occur because the virus establishes itself within the dorsal root ganglion, from where it can be reactivated from time to time.

Diseases of the female reproductive system

Learning outcomes

After studying this section, you should be able to:

describe the causes and consequences of pelvic inflammatory disease

discuss the disorders of the vulva

define the term imperforate hymen

outline the causes and effects of cervical carcinoma

discuss the main pathologies of the uterus and uterine tubes

describe the causes and effects of ovarian disease

describe the causes of female infertility

discuss the principal disorders of the female breast.

Pelvic inflammatory disease (PID)

This condition is usually a consequence of sexually transmitted infections. It usually begins as vulvovaginitis and may spread upwards to the cervix, uterus, uterine tubes and ovaries. Upward spread can also occur when infection is present in the vagina before a surgical procedure, childbirth or miscarriage, especially if some of the products of conception are retained.

Complications of PID include:

•
infertility due to obstruction of uterine tubes

•
peritonitis

•
intestinal obstruction due to adhesions between the bowel and the uterus and/or uterine tubes

•
bacteraemia, which may lead to meningitis, endocarditis or suppurative arthritis.

Vulvar dystrophies

Atrophic dystrophy

This is thinning of vulvar epithelium and the formation of fibrous tissue, occurring after the menopause due to oestrogen withdrawal. It predisposes to infection, especially in debilitated women, and to malignant epithelial neoplasia.

Vulvar intraepithelial neoplasia (VIN)

This refers to early neoplastic (cancerous) changes in epithelial cells of the vulva. It is commonest in younger women, often those infected with human papilloma virus, and may proceed to malignancy (see also cervical intraepithelial neoplasia, below).

Imperforate hymen

This congenital abnormality may not be noticed until the onset of menstruation. When complete (imperforate), the hymen forms a barrier in the vagina. Blood accumulates in the vagina, uterus and uterine tubes with each menstrual cycle, and it may enter the peritoneal cavity and cause peritonitis. The uterine tubes may become obstructed by coagulated blood, leading to infertility.

Disorders of the cervix

Cervical carcinoma

Dysplastic changes, referred to as
cervical intraepithelial neoplasia
(CIN) begin in the deepest layer of cervical epithelium, usually at the junction of the stratified squamous epithelium of the lower third of the cervical canal with the secretory epithelium of the upper two-thirds. Dysplasia may progress to involve the full thickness of epithelium. Not all dysplasias develop into malignant disease, but it is not possible to predict how far development will go, and whether it will remain static or regress. Early detection with a screening programme can allow abnormal tissue to be removed before it becomes malignant. Established malignancy is staged according to how extensive the tumour is. Stage I refers to disease confined to the cervix. Stages II through IV reflect increasing spread, including involvement of the rectum, bladder and structures outwith the pelvis. Early spread is via lymph nodes and local spread is commonly to the uterus, vagina, bladder and rectum. In the late stages spread via the blood to the liver, lungs and bones may occur.

The disease takes 15 to 20 years to develop and it occurs mostly between 35 and 50 years of age. It is likely that a significant proportion of cases are due to the transmission of some sexually transmitted carcinogen. Risk factors include having frequent sexual intercourse with multiple partners from an early age, all of which increase the likelihood of being exposed to a carcinogenic agent. Barrier contraceptives protect against the disease. The human papillomavirus (HPV), which causes genital warts, is strongly associated with this cancer (see also
p. 362
).