Common Outpatient Gynecological Problems By ElSaid AbdelHady Ph
Common Outpatient Gynecological Problems By El-Said Abdel-Hady, Ph. D, MRCOG, Mansoura University.
Common complaints n n n Abnormal vaginal bleeding Vaginal discharge (Itching/vulval pain) Abdominal pain Abdominal mass Infertility Urinary problems
Abnormal vaginal bleeding Approach to diagnosis n Age of the patient n Relation to menstrual cycle n Amount of bleeding n Duration of bleeding n Effect of bleeding (social and medical)
Abnormal vaginal bleeding Approach to diagnosis n Investigations and their results n Treatment and its effect n Associated medical/surgical conditions
Abnormal vaginal bleeding n n n Pre-pubertal bleeding Adolescent bleeding Childbearing bleeding (menorrhagia, metrorrhagia and polymenorrhea) Perimenopausal bleeding Postmenopausal bleeding
Investigations n n Individualized TVS and TAS Biopsy for any persistent bleeding CT and MRI when indicated
Treatment n n n Individualized Medical Hormonal Surgical Alternative to surgery
Vaginal discharge Approach to diagnosis n Colour n Consistency n Odour n Associated symptoms
Vaginal discharge Common causes n Monilial vulvo-vaginitis (curdy white) n Trichomonal vaginitis (frothy yellow) n Bacterial vaginosis (milky white)
Vaginal discharge Treatment according to the clinical presentation n Antifungal (cream or pessaries) n Anti-protozoal (metronidazol) n Antichlamydia (spiramycin)
Recurrent discharge n n Needs recurrent courses of treatment Needs colposcopy/hysteroscopy
Abdominal pain n n Give analgesics then ask for USS if recurrent. Think of pregnancy complications during childbearing age.
Abdominal mass n n n Ask for USS Exclude pregnancy Refer to a gynecologist
Infertility Primary tests then refer n SA n HSG n S. progesterone n Laparoscopy
Urinary problems n n n Ask for urine analysis. Treat infection first, Refer if persistent.
Thank you n El-Said Abdel-Hady
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