Cysts and Abscesses of Bartholin’s Gland
Infections, most commonly gonorrhea, may involve Bartholin’s duct and gland, causing obstruction that prevents the drainage of secretions. This, in turn, leads to pain and swelling on either side of the introitus. A localized fluctuant swelling in the interior portion of the labia minors indicates an occlusion of the duct opening. Pain without undue swelling indicates an occlusion of the duct opening and an active infection of the gland itself. The patient’s vital signs may be elevated. An abscess presents as a tense, hot, and tender local swelling. There may be pus or exudate in the region of the duct opening. Cysts are manifestations of chronic involvement and are normally not tender.
TREATMENT—If there is no abscess formation apparent, treat the patient with broadspectrum antibiotics. Warm saline soaks will help to localize the infection. If an abscess is present, refer the patient to a medical facility.
Salpingitis
Salpingitis, or pelvic inflammatory disease (PID), is an inflammation of the uterine tubes. It may be acute or chronic as well as unilateral or bilateral. It is almost always bacterial in origin and is commonly, though not always, caused by gonococci.
SYMPTOMS—The patient will frequently reveal a history of vaginal coitus. There may be a greenish-yellow discharge present. The patient normally experiences severe nonradiating lower abdominal cramps in acute cases. Chills, moderate fevers, and a history of menstrual irregularity are common complaints. When a patient presents with an acute abdominal condition, it is essential to diagnose it correctly. Pain accompanied by uterine bleeding and signs of shock would be suspect of ectopic pregnancy. Examination of the internal genitalia may reveal pus exuding from the cervical os or urethra, and the tender adnexal (pelvic) masses may be palpable.
TREATMENT-Whenever an acute abdominal condition is evident, transfer the patient for definitive treatment as soon as possible. Start the patient on 4.8 to 12 million units of aqueous penicillin G IM in divided doses. If the patient is allergic to penicillin, she is given Vibramycin® (doxycycline) 200 mg to start, followed by 100 mg twice a day for 7 to 10 days. Analgesics may be administered to relieve pain.
Premenstrual Tension Syndrome
This syndrome is characterized by nervousness, depression, irritability, emotional instability, headaches, and mastalgia (painful breasts). The cause of this syndrome is unknown, but may be due to fluid retention with edema of the nerve tissues.
TREATMENT—Generally, with the exception of a sympathetic ear and reassurance, no treatment is required. Mild analgesics may be prescribed to relieve headaches and mastalgia. In severe cases, limiting salt and using intermittent diuretics during the last 7 to 10 days of the menstrual cycle may be of value. The course of this syndrome is progressive and self-limiting, and it will usually clear up within the first few hours of onset of the menstrual cycle.
Dysmenorrhea
Dysmenorrhea is classified as either primary or secondary. Secondary dysmenorrhea is an acquired type and occurs most frequently as the result of an organic cause, such as salpingitis, uterine tumors, and endometriosis. Normally secondary dysmenorrhea occurs in the third and fourth decades of life. Thus, hospital corpsmen onboard ships will not normally be required to treat this type of disorder. The more frequently encountered primary dysmenorrhea is painful menses for which no organic cause can be found, Excessive release of prostaglandins from the endometrium may be one cause. Cervical obstruction and vasoconstriction are other possible causes.
SYMPTOMS—Pain may develop approximately 1 to 2 days before the onset of menses. The pain may be dull or sharp and cramping and may be referred to the legs and suprapubic regions. Associated symptoms include mastalgia, nausea, vomiting, depression, and abdominal distention.
TREATMENT—This condition is also self limiting and is best treated symptomatically. Treatment is dependent upon the severity and extent oft he symptoms. Many women have pain, but few will be incapacitated by it. The basic keynotes of patient care, understanding, sympathy, and reassurance are essential in relieving some of the patient’s anxieties. Advise the patient to engage in a program of physical exercise; however, fatigue should be avoided, as it tends to decrease the patient’s tolerance of pain. 2-38