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●Dysmenorrhea○painful menstruation■attributed to prostaglandin activity■increased leukotriene levels○one of the most common complaints○pain prevents normal activity and requires medication○3 types of dysmenorrhea:■primary (no organic cause)■secondary (pathologic cause)●endometriosis, adenomyosis, pelvic inflammatory disease, cervical stenosis, fibroids, andendometrial polyps■membranous (cast of endometrial cavity shed as a single entity●rare; it causes intense cramping pain due to passage of a cast of the endometrium through an undilated cervix○Clinical Findings■almost always is associated with ovulatory cycles, it does not usually occur at menarche but rather later in adolescence■14–26% of adolescents miss school or work■pain occurs on the first day of the menses - about the time the flow begins●may not be present until the second day.■Nausea■Vomiting■Diarrhea■Headache■No significant pelvic disease■When symptomatic - generalized pelvic tenderness, perhaps more so in the area of the uterus than in the adnexa.■Occasionally, ultrasonography or laparoscopy is necessary to rule out pelvic abnormalities such as endometriosis, pelvic inflammatory disease, or an accident in an ovarian cyst.○Treatment■continuous heat to the abdomen in addition to NSAIDs decreases pain significantly●Ibuprofen and Naproxen are prefered - First Line■Severe Pain●Codeine or stronger pain medications●cyclooxygenase-2 (COX-2)○Rofecoxib, valdecoxib, and lumiracoxib are effective for treating primary dysmenorrhea■must be used at the earliest onset of symptoms, usually at the onset of, and sometimes 1–2 days prior to, bleeding or cramping■Cyclic administration of oral contraceptives, usually in the lowest dosage but occasionally with increased estrogen, prevents pain in most patients who do not obtain relief from antiprostaglandins or cannot tolerate them●given for 6–12 months. Many women continue to be free of pain after treatment has beendiscontinued●Cystocele aka Anterior Vaginal Prolapse○vaginal wall weakens and stretches and allows the bladder to bulge into the vagina○Causes- ■childbirth ■chronic constipation■violent coughing■heavy lifting■Overweight■Age■hysterectomy (increased vag weakness)
○Sx■felling of fullness or pressure in vagina■increased discomfort when you strain/cough/bear down■feeling of incomplete empty■repeated bladder infection■pain or urinary leak during sex■bulge of tissue into vaginal opening○Prevention■Kegels■prevent constipation■avoid heavy lifting■avoid wt gain ●Rectocele aka Posterior Vaginal Prolapse○When thin tissue of vagina separates the vaginal and rectum allowing vaginal wall to bulge○Sx■soft bulge of tissue in vaginal■difficult BM■sensation of rectal pressure■incomplete emptying after BM■sexual concerns-dyspareunia○Causes■