Vaccinating Against Cancer<\/h1>\r\n<\/div>\r\nCan a vaccine prevent[pb_glossary id=\"5605\"] cancer[\/pb_glossary]? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.\r\n\r\nCervical Cancer<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary]<\/strong> occurs when cells of the [pb_glossary id=\"5235\"]cervix[\/pb_glossary] (neck of the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the [pb_glossary id=\"5235\"]cervix[\/pb_glossary] and the appearance of normal and abnormal cervical cells when examined with a microscope.\r\n\r\n[caption id=\"attachment_5323\" align=\"alignnone\" width=\"1024\"]![\"18.9.2](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1024px-Blausen_0221_CervicalDysplasia-2.png\")
Figure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em>[\/caption]\r\nCervical Cancer Prevalence and Death Rates<\/h1>\r\nWorldwide, cervical [pb_glossary id=\"5605\"]cancer[\/pb_glossary] is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.\r\nSymptoms of Cervical Cancer<\/h2>\r\nEarly in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.\r\nCervical Cancer Causes and Risk Factors<\/h2>\r\nMore than 90 per cent of cases of cervical cancer are caused at least in part by [pb_glossary id=\"5324\"]human papillomavirus[\/pb_glossary] (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.\r\n\r\n[caption id=\"attachment_5325\" align=\"aligncenter\" width=\"857\"]![\"18.9.3](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/HPV-and-Cervical-Cancer-by-OpenStax-2.jpg\")
Figure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em>[\/caption]\r\n\r\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.\r\nDiagnosis of Cervical Cancer<\/h2>\r\nDiagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0[pb_glossary id=\"5326\"]Pap smear[\/pb_glossary].<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.\r\nPrevention of Cervical Cancer<\/h2>\r\nIt is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The [pb_glossary id=\"4353\"]vaccine[\/pb_glossary] protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).\r\n\r\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.\r\nTreatment of Cervical Cancer<\/h2>\r\nTreatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or [pb_glossary id=\"5029\"]chemotherapy[\/pb_glossary]. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.\r\n\r\nVaginitis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary]<\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the [pb_glossary id=\"5152\"]vulva[\/pb_glossary], as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with [pb_glossary id=\"5149\"]sexual intercourse[\/pb_glossary].\r\nCauses of Vaginitis<\/h2>\r\nAbout 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms<\/span>[\/pb_glossary]<\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>[pb_glossary id=\"5332\"]candidiasis[\/pb_glossary] <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span>\r\n\r\n\r\n[caption id=\"attachment_5331\" align=\"aligncenter\" width=\"792\"]![\"18.9.3](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Candida-by-NIH-on-Flickr-2.jpg\")
Figure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em>[\/caption]\r\n\r\n<\/div>\r\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.\r\nDiagnosis of Vaginitis<\/h2>\r\nDiagnosis of [pb_glossary id=\"5328\"]vaginitis[\/pb_glossary] typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low [pb_glossary id=\"4330\"]pH[\/pb_glossary], whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.\r\nPrevention of Vaginitis<\/h2>\r\nPrevention of vaginitis includes wearing loose cotton underwear that helps keep the [pb_glossary id=\"5152\"]vulva[\/pb_glossary] dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.\r\nTreatment of Vaginitis<\/h2>\r\nThe appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.\r\n\r\n \t- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\r\n \t
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\r\n \t
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\r\n<\/ul>\r\n\r\n
Endometriosis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary]<\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.\r\n\r\n[caption id=\"attachment_5334\" align=\"aligncenter\" width=\"1024\"]![\"18.9.5](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Blausen_0349_Endometriosis-2.png\")
Figure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em>[\/caption]\r\nSigns and Symptoms of Endometriosis<\/h2>\r\nThe main symptom of [pb_glossary id=\"5333\"]endometriosis[\/pb_glossary] is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during [pb_glossary id=\"5310\"]menstruation[\/pb_glossary]. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers [pb_glossary id=\"4860\"]inflammation[\/pb_glossary]. Pain can also occur from internal scar tissue that binds internal organs to each other.\r\n\r\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.\r\nCauses of Endometriosis<\/h2>\r\nThe causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from [pb_glossary id=\"2381\"]mutations<\/span>[\/pb_glossary]<\/span>\u00a0in several [pb_glossary id=\"5521\"]gene<\/span>s<\/span>[\/pb_glossary]<\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span>\r\n\r\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the [pb_glossary id=\"5102\"]uterus[\/pb_glossary] through the [pb_glossary id=\"5101\"]oviducts<\/span>[\/pb_glossary]<\/span>, rather than through the <\/span>[pb_glossary id=\"5143\"]vagina[\/pb_glossary]<\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and [pb_glossary id=\"5006\"]autoimmune[\/pb_glossary] responses.<\/span>\r\nDiagnosis of Endometriosis<\/h2>\r\nDiagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.\r\n\r\n[caption id=\"attachment_5335\" align=\"aligncenter\" width=\"516\"]![\"18.9.6](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1024px-Blausen_0602_Laparoscopy_02-2.png\")
Figure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em>[\/caption]\r\nTreatment of Endometriosis<\/h2>\r\nThe most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs ([pb_glossary id=\"4686\"]NSAIDS[\/pb_glossary]), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary] may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.\r\n\r\nFeature: My Human Body<\/h1>\r\n<\/div>\r\nA [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the [pb_glossary id=\"5235\"]cervix[\/pb_glossary]. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.\r\n\r\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary], she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or [pb_glossary id=\"5605\"]cancer[\/pb_glossary], she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.\r\n\r\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.\r\n\r\nPap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.\r\n\r\n\r\n18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\n![\"18.9.1](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/a-nurse-giving-a-young-girl-a-vaccine-shot-or-scaled-3.jpg\")
Figure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
Cervical Cancer<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary]<\/strong> occurs when cells of the [pb_glossary id=\"5235\"]cervix[\/pb_glossary] (neck of the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the [pb_glossary id=\"5235\"]cervix[\/pb_glossary] and the appearance of normal and abnormal cervical cells when examined with a microscope.\r\n\r\n[caption id=\"attachment_5323\" align=\"alignnone\" width=\"1024\"] Figure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em>[\/caption]\r\nCervical Cancer Prevalence and Death Rates<\/h1>\r\nWorldwide, cervical [pb_glossary id=\"5605\"]cancer[\/pb_glossary] is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.\r\nSymptoms of Cervical Cancer<\/h2>\r\nEarly in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.\r\nCervical Cancer Causes and Risk Factors<\/h2>\r\nMore than 90 per cent of cases of cervical cancer are caused at least in part by [pb_glossary id=\"5324\"]human papillomavirus[\/pb_glossary] (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.\r\n\r\n[caption id=\"attachment_5325\" align=\"aligncenter\" width=\"857\"] Figure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em>[\/caption]\r\n\r\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.\r\nDiagnosis of Cervical Cancer<\/h2>\r\nDiagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0[pb_glossary id=\"5326\"]Pap smear[\/pb_glossary].<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.\r\nPrevention of Cervical Cancer<\/h2>\r\nIt is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The [pb_glossary id=\"4353\"]vaccine[\/pb_glossary] protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).\r\n\r\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.\r\nTreatment of Cervical Cancer<\/h2>\r\nTreatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or [pb_glossary id=\"5029\"]chemotherapy[\/pb_glossary]. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.\r\n\r\nVaginitis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary]<\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the [pb_glossary id=\"5152\"]vulva[\/pb_glossary], as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with [pb_glossary id=\"5149\"]sexual intercourse[\/pb_glossary].\r\nCauses of Vaginitis<\/h2>\r\nAbout 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms<\/span>[\/pb_glossary]<\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>[pb_glossary id=\"5332\"]candidiasis[\/pb_glossary] <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span>\r\n\r\n\r\n[caption id=\"attachment_5331\" align=\"aligncenter\" width=\"792\"] Figure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em>[\/caption]\r\n\r\n<\/div>\r\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.\r\nDiagnosis of Vaginitis<\/h2>\r\nDiagnosis of [pb_glossary id=\"5328\"]vaginitis[\/pb_glossary] typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low [pb_glossary id=\"4330\"]pH[\/pb_glossary], whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.\r\nPrevention of Vaginitis<\/h2>\r\nPrevention of vaginitis includes wearing loose cotton underwear that helps keep the [pb_glossary id=\"5152\"]vulva[\/pb_glossary] dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.\r\nTreatment of Vaginitis<\/h2>\r\nThe appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.\r\n\r\n \t- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\r\n \t
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\r\n \t
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\r\n<\/ul>\r\n\r\n
Endometriosis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary]<\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.\r\n\r\n[caption id=\"attachment_5334\" align=\"aligncenter\" width=\"1024\"] Figure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em>[\/caption]\r\nSigns and Symptoms of Endometriosis<\/h2>\r\nThe main symptom of [pb_glossary id=\"5333\"]endometriosis[\/pb_glossary] is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during [pb_glossary id=\"5310\"]menstruation[\/pb_glossary]. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers [pb_glossary id=\"4860\"]inflammation[\/pb_glossary]. Pain can also occur from internal scar tissue that binds internal organs to each other.\r\n\r\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.\r\nCauses of Endometriosis<\/h2>\r\nThe causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from [pb_glossary id=\"2381\"]mutations<\/span>[\/pb_glossary]<\/span>\u00a0in several [pb_glossary id=\"5521\"]gene<\/span>s<\/span>[\/pb_glossary]<\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span>\r\n\r\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the [pb_glossary id=\"5102\"]uterus[\/pb_glossary] through the [pb_glossary id=\"5101\"]oviducts<\/span>[\/pb_glossary]<\/span>, rather than through the <\/span>[pb_glossary id=\"5143\"]vagina[\/pb_glossary]<\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and [pb_glossary id=\"5006\"]autoimmune[\/pb_glossary] responses.<\/span>\r\nDiagnosis of Endometriosis<\/h2>\r\nDiagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.\r\n\r\n[caption id=\"attachment_5335\" align=\"aligncenter\" width=\"516\"] Figure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em>[\/caption]\r\nTreatment of Endometriosis<\/h2>\r\nThe most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs ([pb_glossary id=\"4686\"]NSAIDS[\/pb_glossary]), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary] may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.\r\n\r\nFeature: My Human Body<\/h1>\r\n<\/div>\r\nA [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the [pb_glossary id=\"5235\"]cervix[\/pb_glossary]. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.\r\n\r\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary], she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or [pb_glossary id=\"5605\"]cancer[\/pb_glossary], she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.\r\n\r\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.\r\n\r\nPap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.\r\n\r\n\r\n18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\nFigure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
Symptoms of Cervical Cancer<\/h2>\r\nEarly in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.\r\nCervical Cancer Causes and Risk Factors<\/h2>\r\nMore than 90 per cent of cases of cervical cancer are caused at least in part by [pb_glossary id=\"5324\"]human papillomavirus[\/pb_glossary] (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.\r\n\r\n[caption id=\"attachment_5325\" align=\"aligncenter\" width=\"857\"] Figure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em>[\/caption]\r\n\r\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.\r\nDiagnosis of Cervical Cancer<\/h2>\r\nDiagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0[pb_glossary id=\"5326\"]Pap smear[\/pb_glossary].<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.\r\nPrevention of Cervical Cancer<\/h2>\r\nIt is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The [pb_glossary id=\"4353\"]vaccine[\/pb_glossary] protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).\r\n\r\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.\r\nTreatment of Cervical Cancer<\/h2>\r\nTreatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or [pb_glossary id=\"5029\"]chemotherapy[\/pb_glossary]. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.\r\n\r\nVaginitis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary]<\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the [pb_glossary id=\"5152\"]vulva[\/pb_glossary], as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with [pb_glossary id=\"5149\"]sexual intercourse[\/pb_glossary].\r\nCauses of Vaginitis<\/h2>\r\nAbout 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms<\/span>[\/pb_glossary]<\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>[pb_glossary id=\"5332\"]candidiasis[\/pb_glossary] <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span>\r\n\r\n\r\n[caption id=\"attachment_5331\" align=\"aligncenter\" width=\"792\"] Figure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em>[\/caption]\r\n\r\n<\/div>\r\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.\r\nDiagnosis of Vaginitis<\/h2>\r\nDiagnosis of [pb_glossary id=\"5328\"]vaginitis[\/pb_glossary] typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low [pb_glossary id=\"4330\"]pH[\/pb_glossary], whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.\r\nPrevention of Vaginitis<\/h2>\r\nPrevention of vaginitis includes wearing loose cotton underwear that helps keep the [pb_glossary id=\"5152\"]vulva[\/pb_glossary] dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.\r\nTreatment of Vaginitis<\/h2>\r\nThe appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.\r\n\r\n \t- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\r\n \t
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\r\n \t
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\r\n<\/ul>\r\n\r\n
Endometriosis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary]<\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.\r\n\r\n[caption id=\"attachment_5334\" align=\"aligncenter\" width=\"1024\"] Figure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em>[\/caption]\r\nSigns and Symptoms of Endometriosis<\/h2>\r\nThe main symptom of [pb_glossary id=\"5333\"]endometriosis[\/pb_glossary] is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during [pb_glossary id=\"5310\"]menstruation[\/pb_glossary]. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers [pb_glossary id=\"4860\"]inflammation[\/pb_glossary]. Pain can also occur from internal scar tissue that binds internal organs to each other.\r\n\r\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.\r\nCauses of Endometriosis<\/h2>\r\nThe causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from [pb_glossary id=\"2381\"]mutations<\/span>[\/pb_glossary]<\/span>\u00a0in several [pb_glossary id=\"5521\"]gene<\/span>s<\/span>[\/pb_glossary]<\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span>\r\n\r\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the [pb_glossary id=\"5102\"]uterus[\/pb_glossary] through the [pb_glossary id=\"5101\"]oviducts<\/span>[\/pb_glossary]<\/span>, rather than through the <\/span>[pb_glossary id=\"5143\"]vagina[\/pb_glossary]<\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and [pb_glossary id=\"5006\"]autoimmune[\/pb_glossary] responses.<\/span>\r\nDiagnosis of Endometriosis<\/h2>\r\nDiagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.\r\n\r\n[caption id=\"attachment_5335\" align=\"aligncenter\" width=\"516\"] Figure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em>[\/caption]\r\nTreatment of Endometriosis<\/h2>\r\nThe most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs ([pb_glossary id=\"4686\"]NSAIDS[\/pb_glossary]), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary] may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.\r\n\r\nFeature: My Human Body<\/h1>\r\n<\/div>\r\nA [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the [pb_glossary id=\"5235\"]cervix[\/pb_glossary]. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.\r\n\r\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary], she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or [pb_glossary id=\"5605\"]cancer[\/pb_glossary], she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.\r\n\r\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.\r\n\r\nPap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.\r\n\r\n\r\n18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\nFigure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
Figure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em>[\/caption]\r\n\r\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.\r\nDiagnosis of Cervical Cancer<\/h2>\r\nDiagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0[pb_glossary id=\"5326\"]Pap smear[\/pb_glossary].<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.\r\nPrevention of Cervical Cancer<\/h2>\r\nIt is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The [pb_glossary id=\"4353\"]vaccine[\/pb_glossary] protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).\r\n\r\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.\r\nTreatment of Cervical Cancer<\/h2>\r\nTreatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or [pb_glossary id=\"5029\"]chemotherapy[\/pb_glossary]. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.\r\n\r\nVaginitis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary]<\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the [pb_glossary id=\"5152\"]vulva[\/pb_glossary], as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with [pb_glossary id=\"5149\"]sexual intercourse[\/pb_glossary].\r\nCauses of Vaginitis<\/h2>\r\nAbout 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms<\/span>[\/pb_glossary]<\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>[pb_glossary id=\"5332\"]candidiasis[\/pb_glossary] <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span>\r\n\r\n\r\n[caption id=\"attachment_5331\" align=\"aligncenter\" width=\"792\"] Figure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em>[\/caption]\r\n\r\n<\/div>\r\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.\r\nDiagnosis of Vaginitis<\/h2>\r\nDiagnosis of [pb_glossary id=\"5328\"]vaginitis[\/pb_glossary] typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low [pb_glossary id=\"4330\"]pH[\/pb_glossary], whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.\r\nPrevention of Vaginitis<\/h2>\r\nPrevention of vaginitis includes wearing loose cotton underwear that helps keep the [pb_glossary id=\"5152\"]vulva[\/pb_glossary] dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.\r\nTreatment of Vaginitis<\/h2>\r\nThe appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.\r\n\r\n \t- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\r\n \t
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\r\n \t
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\r\n<\/ul>\r\n\r\n
Endometriosis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary]<\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.\r\n\r\n[caption id=\"attachment_5334\" align=\"aligncenter\" width=\"1024\"] Figure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em>[\/caption]\r\nSigns and Symptoms of Endometriosis<\/h2>\r\nThe main symptom of [pb_glossary id=\"5333\"]endometriosis[\/pb_glossary] is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during [pb_glossary id=\"5310\"]menstruation[\/pb_glossary]. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers [pb_glossary id=\"4860\"]inflammation[\/pb_glossary]. Pain can also occur from internal scar tissue that binds internal organs to each other.\r\n\r\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.\r\nCauses of Endometriosis<\/h2>\r\nThe causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from [pb_glossary id=\"2381\"]mutations<\/span>[\/pb_glossary]<\/span>\u00a0in several [pb_glossary id=\"5521\"]gene<\/span>s<\/span>[\/pb_glossary]<\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span>\r\n\r\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the [pb_glossary id=\"5102\"]uterus[\/pb_glossary] through the [pb_glossary id=\"5101\"]oviducts<\/span>[\/pb_glossary]<\/span>, rather than through the <\/span>[pb_glossary id=\"5143\"]vagina[\/pb_glossary]<\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and [pb_glossary id=\"5006\"]autoimmune[\/pb_glossary] responses.<\/span>\r\nDiagnosis of Endometriosis<\/h2>\r\nDiagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.\r\n\r\n[caption id=\"attachment_5335\" align=\"aligncenter\" width=\"516\"] Figure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em>[\/caption]\r\nTreatment of Endometriosis<\/h2>\r\nThe most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs ([pb_glossary id=\"4686\"]NSAIDS[\/pb_glossary]), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary] may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.\r\n\r\nFeature: My Human Body<\/h1>\r\n<\/div>\r\nA [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the [pb_glossary id=\"5235\"]cervix[\/pb_glossary]. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.\r\n\r\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary], she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or [pb_glossary id=\"5605\"]cancer[\/pb_glossary], she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.\r\n\r\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.\r\n\r\nPap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.\r\n\r\n\r\n18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\nFigure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
Treatment of Cervical Cancer<\/h2>\r\nTreatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or [pb_glossary id=\"5029\"]chemotherapy[\/pb_glossary]. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.\r\n\r\nVaginitis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary]<\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the [pb_glossary id=\"5152\"]vulva[\/pb_glossary], as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with [pb_glossary id=\"5149\"]sexual intercourse[\/pb_glossary].\r\nCauses of Vaginitis<\/h2>\r\nAbout 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms<\/span>[\/pb_glossary]<\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>[pb_glossary id=\"5332\"]candidiasis[\/pb_glossary] <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span>\r\n\r\n\r\n[caption id=\"attachment_5331\" align=\"aligncenter\" width=\"792\"] Figure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em>[\/caption]\r\n\r\n<\/div>\r\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.\r\nDiagnosis of Vaginitis<\/h2>\r\nDiagnosis of [pb_glossary id=\"5328\"]vaginitis[\/pb_glossary] typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low [pb_glossary id=\"4330\"]pH[\/pb_glossary], whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.\r\nPrevention of Vaginitis<\/h2>\r\nPrevention of vaginitis includes wearing loose cotton underwear that helps keep the [pb_glossary id=\"5152\"]vulva[\/pb_glossary] dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.\r\nTreatment of Vaginitis<\/h2>\r\nThe appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.\r\n\r\n \t- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\r\n \t
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\r\n \t
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\r\n<\/ul>\r\n\r\n
Endometriosis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary]<\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.\r\n\r\n[caption id=\"attachment_5334\" align=\"aligncenter\" width=\"1024\"] Figure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em>[\/caption]\r\nSigns and Symptoms of Endometriosis<\/h2>\r\nThe main symptom of [pb_glossary id=\"5333\"]endometriosis[\/pb_glossary] is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during [pb_glossary id=\"5310\"]menstruation[\/pb_glossary]. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers [pb_glossary id=\"4860\"]inflammation[\/pb_glossary]. Pain can also occur from internal scar tissue that binds internal organs to each other.\r\n\r\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.\r\nCauses of Endometriosis<\/h2>\r\nThe causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from [pb_glossary id=\"2381\"]mutations<\/span>[\/pb_glossary]<\/span>\u00a0in several [pb_glossary id=\"5521\"]gene<\/span>s<\/span>[\/pb_glossary]<\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span>\r\n\r\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the [pb_glossary id=\"5102\"]uterus[\/pb_glossary] through the [pb_glossary id=\"5101\"]oviducts<\/span>[\/pb_glossary]<\/span>, rather than through the <\/span>[pb_glossary id=\"5143\"]vagina[\/pb_glossary]<\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and [pb_glossary id=\"5006\"]autoimmune[\/pb_glossary] responses.<\/span>\r\nDiagnosis of Endometriosis<\/h2>\r\nDiagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.\r\n\r\n[caption id=\"attachment_5335\" align=\"aligncenter\" width=\"516\"] Figure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em>[\/caption]\r\nTreatment of Endometriosis<\/h2>\r\nThe most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs ([pb_glossary id=\"4686\"]NSAIDS[\/pb_glossary]), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary] may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.\r\n\r\nFeature: My Human Body<\/h1>\r\n<\/div>\r\nA [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the [pb_glossary id=\"5235\"]cervix[\/pb_glossary]. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.\r\n\r\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary], she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or [pb_glossary id=\"5605\"]cancer[\/pb_glossary], she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.\r\n\r\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.\r\n\r\nPap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.\r\n\r\n\r\n18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\nFigure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
Vaginitis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary]<\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the [pb_glossary id=\"5152\"]vulva[\/pb_glossary], as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with [pb_glossary id=\"5149\"]sexual intercourse[\/pb_glossary].\r\nCauses of Vaginitis<\/h2>\r\nAbout 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms<\/span>[\/pb_glossary]<\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>[pb_glossary id=\"5332\"]candidiasis[\/pb_glossary] <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span>\r\n\r\n\r\n[caption id=\"attachment_5331\" align=\"aligncenter\" width=\"792\"] Figure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em>[\/caption]\r\n\r\n<\/div>\r\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.\r\nDiagnosis of Vaginitis<\/h2>\r\nDiagnosis of [pb_glossary id=\"5328\"]vaginitis[\/pb_glossary] typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low [pb_glossary id=\"4330\"]pH[\/pb_glossary], whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.\r\nPrevention of Vaginitis<\/h2>\r\nPrevention of vaginitis includes wearing loose cotton underwear that helps keep the [pb_glossary id=\"5152\"]vulva[\/pb_glossary] dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.\r\nTreatment of Vaginitis<\/h2>\r\nThe appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.\r\n\r\n \t- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\r\n \t
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\r\n \t
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\r\n<\/ul>\r\n\r\n
Endometriosis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary]<\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.\r\n\r\n[caption id=\"attachment_5334\" align=\"aligncenter\" width=\"1024\"] Figure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em>[\/caption]\r\nSigns and Symptoms of Endometriosis<\/h2>\r\nThe main symptom of [pb_glossary id=\"5333\"]endometriosis[\/pb_glossary] is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during [pb_glossary id=\"5310\"]menstruation[\/pb_glossary]. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers [pb_glossary id=\"4860\"]inflammation[\/pb_glossary]. Pain can also occur from internal scar tissue that binds internal organs to each other.\r\n\r\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.\r\nCauses of Endometriosis<\/h2>\r\nThe causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from [pb_glossary id=\"2381\"]mutations<\/span>[\/pb_glossary]<\/span>\u00a0in several [pb_glossary id=\"5521\"]gene<\/span>s<\/span>[\/pb_glossary]<\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span>\r\n\r\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the [pb_glossary id=\"5102\"]uterus[\/pb_glossary] through the [pb_glossary id=\"5101\"]oviducts<\/span>[\/pb_glossary]<\/span>, rather than through the <\/span>[pb_glossary id=\"5143\"]vagina[\/pb_glossary]<\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and [pb_glossary id=\"5006\"]autoimmune[\/pb_glossary] responses.<\/span>\r\nDiagnosis of Endometriosis<\/h2>\r\nDiagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.\r\n\r\n[caption id=\"attachment_5335\" align=\"aligncenter\" width=\"516\"] Figure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em>[\/caption]\r\nTreatment of Endometriosis<\/h2>\r\nThe most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs ([pb_glossary id=\"4686\"]NSAIDS[\/pb_glossary]), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary] may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.\r\n\r\nFeature: My Human Body<\/h1>\r\n<\/div>\r\nA [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the [pb_glossary id=\"5235\"]cervix[\/pb_glossary]. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.\r\n\r\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary], she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or [pb_glossary id=\"5605\"]cancer[\/pb_glossary], she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.\r\n\r\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.\r\n\r\nPap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.\r\n\r\n\r\n18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\nFigure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
Figure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em>[\/caption]\r\n\r\n<\/div>\r\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.\r\nDiagnosis of Vaginitis<\/h2>\r\nDiagnosis of [pb_glossary id=\"5328\"]vaginitis[\/pb_glossary] typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low [pb_glossary id=\"4330\"]pH[\/pb_glossary], whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.\r\nPrevention of Vaginitis<\/h2>\r\nPrevention of vaginitis includes wearing loose cotton underwear that helps keep the [pb_glossary id=\"5152\"]vulva[\/pb_glossary] dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.\r\nTreatment of Vaginitis<\/h2>\r\nThe appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.\r\n\r\n \t- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\r\n \t
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\r\n \t
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\r\n<\/ul>\r\n\r\n
Endometriosis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary]<\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.\r\n\r\n[caption id=\"attachment_5334\" align=\"aligncenter\" width=\"1024\"] Figure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em>[\/caption]\r\nSigns and Symptoms of Endometriosis<\/h2>\r\nThe main symptom of [pb_glossary id=\"5333\"]endometriosis[\/pb_glossary] is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during [pb_glossary id=\"5310\"]menstruation[\/pb_glossary]. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers [pb_glossary id=\"4860\"]inflammation[\/pb_glossary]. Pain can also occur from internal scar tissue that binds internal organs to each other.\r\n\r\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.\r\nCauses of Endometriosis<\/h2>\r\nThe causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from [pb_glossary id=\"2381\"]mutations<\/span>[\/pb_glossary]<\/span>\u00a0in several [pb_glossary id=\"5521\"]gene<\/span>s<\/span>[\/pb_glossary]<\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span>\r\n\r\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the [pb_glossary id=\"5102\"]uterus[\/pb_glossary] through the [pb_glossary id=\"5101\"]oviducts<\/span>[\/pb_glossary]<\/span>, rather than through the <\/span>[pb_glossary id=\"5143\"]vagina[\/pb_glossary]<\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and [pb_glossary id=\"5006\"]autoimmune[\/pb_glossary] responses.<\/span>\r\nDiagnosis of Endometriosis<\/h2>\r\nDiagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.\r\n\r\n[caption id=\"attachment_5335\" align=\"aligncenter\" width=\"516\"] Figure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em>[\/caption]\r\nTreatment of Endometriosis<\/h2>\r\nThe most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs ([pb_glossary id=\"4686\"]NSAIDS[\/pb_glossary]), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary] may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.\r\n\r\nFeature: My Human Body<\/h1>\r\n<\/div>\r\nA [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the [pb_glossary id=\"5235\"]cervix[\/pb_glossary]. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.\r\n\r\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary], she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or [pb_glossary id=\"5605\"]cancer[\/pb_glossary], she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.\r\n\r\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.\r\n\r\nPap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.\r\n\r\n\r\n18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\nFigure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
Treatment of Vaginitis<\/h2>\r\nThe appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.\r\n\r\n \t- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\r\n \t
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\r\n \t
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\r\n<\/ul>\r\n\r\n
Endometriosis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary]<\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.\r\n\r\n[caption id=\"attachment_5334\" align=\"aligncenter\" width=\"1024\"] Figure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em>[\/caption]\r\nSigns and Symptoms of Endometriosis<\/h2>\r\nThe main symptom of [pb_glossary id=\"5333\"]endometriosis[\/pb_glossary] is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during [pb_glossary id=\"5310\"]menstruation[\/pb_glossary]. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers [pb_glossary id=\"4860\"]inflammation[\/pb_glossary]. Pain can also occur from internal scar tissue that binds internal organs to each other.\r\n\r\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.\r\nCauses of Endometriosis<\/h2>\r\nThe causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from [pb_glossary id=\"2381\"]mutations<\/span>[\/pb_glossary]<\/span>\u00a0in several [pb_glossary id=\"5521\"]gene<\/span>s<\/span>[\/pb_glossary]<\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span>\r\n\r\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the [pb_glossary id=\"5102\"]uterus[\/pb_glossary] through the [pb_glossary id=\"5101\"]oviducts<\/span>[\/pb_glossary]<\/span>, rather than through the <\/span>[pb_glossary id=\"5143\"]vagina[\/pb_glossary]<\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and [pb_glossary id=\"5006\"]autoimmune[\/pb_glossary] responses.<\/span>\r\nDiagnosis of Endometriosis<\/h2>\r\nDiagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.\r\n\r\n[caption id=\"attachment_5335\" align=\"aligncenter\" width=\"516\"] Figure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em>[\/caption]\r\nTreatment of Endometriosis<\/h2>\r\nThe most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs ([pb_glossary id=\"4686\"]NSAIDS[\/pb_glossary]), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary] may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.\r\n\r\nFeature: My Human Body<\/h1>\r\n<\/div>\r\nA [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the [pb_glossary id=\"5235\"]cervix[\/pb_glossary]. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.\r\n\r\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary], she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or [pb_glossary id=\"5605\"]cancer[\/pb_glossary], she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.\r\n\r\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.\r\n\r\nPap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.\r\n\r\n\r\n18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\nFigure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
Endometriosis<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary]<\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.\r\n\r\n[caption id=\"attachment_5334\" align=\"aligncenter\" width=\"1024\"] Figure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em>[\/caption]\r\nSigns and Symptoms of Endometriosis<\/h2>\r\nThe main symptom of [pb_glossary id=\"5333\"]endometriosis[\/pb_glossary] is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during [pb_glossary id=\"5310\"]menstruation[\/pb_glossary]. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers [pb_glossary id=\"4860\"]inflammation[\/pb_glossary]. Pain can also occur from internal scar tissue that binds internal organs to each other.\r\n\r\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.\r\nCauses of Endometriosis<\/h2>\r\nThe causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from [pb_glossary id=\"2381\"]mutations<\/span>[\/pb_glossary]<\/span>\u00a0in several [pb_glossary id=\"5521\"]gene<\/span>s<\/span>[\/pb_glossary]<\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span>\r\n\r\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the [pb_glossary id=\"5102\"]uterus[\/pb_glossary] through the [pb_glossary id=\"5101\"]oviducts<\/span>[\/pb_glossary]<\/span>, rather than through the <\/span>[pb_glossary id=\"5143\"]vagina[\/pb_glossary]<\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and [pb_glossary id=\"5006\"]autoimmune[\/pb_glossary] responses.<\/span>\r\nDiagnosis of Endometriosis<\/h2>\r\nDiagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.\r\n\r\n[caption id=\"attachment_5335\" align=\"aligncenter\" width=\"516\"] Figure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em>[\/caption]\r\nTreatment of Endometriosis<\/h2>\r\nThe most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs ([pb_glossary id=\"4686\"]NSAIDS[\/pb_glossary]), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary] may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.\r\n\r\nFeature: My Human Body<\/h1>\r\n<\/div>\r\nA [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the [pb_glossary id=\"5235\"]cervix[\/pb_glossary]. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.\r\n\r\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary], she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or [pb_glossary id=\"5605\"]cancer[\/pb_glossary], she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.\r\n\r\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.\r\n\r\nPap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.\r\n\r\n\r\n18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\nFigure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
Causes of Endometriosis<\/h2>\r\nThe causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from [pb_glossary id=\"2381\"]mutations<\/span>[\/pb_glossary]<\/span>\u00a0in several [pb_glossary id=\"5521\"]gene<\/span>s<\/span>[\/pb_glossary]<\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span>\r\n\r\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the [pb_glossary id=\"5102\"]uterus[\/pb_glossary] through the [pb_glossary id=\"5101\"]oviducts<\/span>[\/pb_glossary]<\/span>, rather than through the <\/span>[pb_glossary id=\"5143\"]vagina[\/pb_glossary]<\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and [pb_glossary id=\"5006\"]autoimmune[\/pb_glossary] responses.<\/span>\r\nDiagnosis of Endometriosis<\/h2>\r\nDiagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.\r\n\r\n[caption id=\"attachment_5335\" align=\"aligncenter\" width=\"516\"] Figure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em>[\/caption]\r\nTreatment of Endometriosis<\/h2>\r\nThe most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs ([pb_glossary id=\"4686\"]NSAIDS[\/pb_glossary]), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary] may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.\r\n\r\nFeature: My Human Body<\/h1>\r\n<\/div>\r\nA [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the [pb_glossary id=\"5235\"]cervix[\/pb_glossary]. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.\r\n\r\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary], she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or [pb_glossary id=\"5605\"]cancer[\/pb_glossary], she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.\r\n\r\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.\r\n\r\nPap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.\r\n\r\n\r\n18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\nFigure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
Figure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em>[\/caption]\r\nTreatment of Endometriosis<\/h2>\r\nThe most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs ([pb_glossary id=\"4686\"]NSAIDS[\/pb_glossary]), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary] may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.\r\n\r\nFeature: My Human Body<\/h1>\r\n<\/div>\r\nA [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the [pb_glossary id=\"5235\"]cervix[\/pb_glossary]. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.\r\n\r\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary], she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or [pb_glossary id=\"5605\"]cancer[\/pb_glossary], she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.\r\n\r\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.\r\n\r\nPap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.\r\n\r\n\r\n18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\nFigure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
Feature: My Human Body<\/h1>\r\n<\/div>\r\nA [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the [pb_glossary id=\"5235\"]cervix[\/pb_glossary]. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.\r\n\r\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete [pb_glossary id=\"5336\"]hysterectomy[\/pb_glossary], she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or [pb_glossary id=\"5605\"]cancer[\/pb_glossary], she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.\r\n\r\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.\r\n\r\nPap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.\r\n\r\n\r\n18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\nFigure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
18.9 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\nReferences<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nHealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\nFigure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n\nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\nFigure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\nCervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\nSymptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\nFigure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\nOther risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\nDiagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\nPrevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\nEven in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\nCauses of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\nMost of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\nPrevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\nTreatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
\n- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\nFigure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\nSigns and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\nAnother problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\nAt the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\nDiagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\nFigure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\nTreatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\nAccording to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\nIf you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n18.9 Summary<\/span><\/h1>\n<\/header>\n\n\n- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n
\n18.9 Review Questions<\/span><\/h1>\n<\/header>\n\n\n- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
- \r\n \t
- [pb_glossary id=\"5319\"]Cervical cancer[\/pb_glossary] occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of [pb_glossary id=\"5605\"]cancer[\/pb_glossary] in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\r\n \t
- Most cases of cervical cancer occur because of infection with [pb_glossary id=\"5324\"]human papillomavirus (HPV)[\/pb_glossary], so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A [pb_glossary id=\"5326\"]Pap smear[\/pb_glossary] can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\r\n \t
- [pb_glossary id=\"5328\"]Vaginitis[\/pb_glossary] is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with [pb_glossary id=\"5775\"]microorganisms[\/pb_glossary], typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\r\n \t
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\r\n \t
- [pb_glossary id=\"5333\"]Endometriosis[\/pb_glossary] is a disease in which endometrial tissue grows outside the [pb_glossary id=\"5102\"]uterus[\/pb_glossary]. This tissue may bleed during the [pb_glossary id=\"5310\"]menstrual period[\/pb_glossary] and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to [pb_glossary id=\"4813\"]infertility[\/pb_glossary].<\/li>\r\n \t
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n 18.9 Review Questions<\/span><\/h1>\r\n<\/header>\r\n
\r\n- \r\n \t
- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\r\n \t
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\r\n \t
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\r\n \t
- How is cervical cancer treated?<\/li>\r\n \t
- Define vaginitis and identify its symptoms.<\/li>\r\n \t
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\r\n \t
- How is vaginitis diagnosed and treated?<\/li>\r\n \t
- What is endometriosis, and what are its symptoms?<\/li>\r\n \t
- Discuss possible causes of endometriosis.<\/li>\r\n \t
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\r\n \t
- [h5p id=\"651\"]<\/li>\r\n \t
- In the case of infection with Trichomonas vaginalis<\/em>, why is the woman\u2019s sexual partner usually treated at the same time?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n
\r\n 18.9 Explore More<\/span><\/h1>\r\n<\/header>\r\n
\r\n\r\nhttps:\/\/youtu.be\/KOz-bNhEHhQ\r\nWhat is HPV and how can you protect yourself from it? - Emma Bryce, TED-Ed, 2019.<\/p>\r\nhttps:\/\/youtu.be\/6HeQ4iEqAUk\r\n
Endometriosis - The Mystery Disease of Women | C\u00e9cile Real | TEDxBinnenhof, TEDx Talks, 2016.<\/p>\r\nhttps:\/\/youtu.be\/ryNjSP5VVI8\r\n
The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen, TEDxTalks, 2015.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 18.9.1<\/strong>\r\n\r\na-nurse-giving-a-young-girl-a-vaccine-shot-or<\/a> by CDC\/ Judy Schmidt from Public Health Image Library (PHIL) #9424<\/a> is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).\r\n\r\nFigure 18.9.2<\/strong>\r\n\r\n1024px-Blausen_0221_CervicalDysplasia<\/a> by Blausen Medical Communications, Inc.<\/a> on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.3<\/strong>\r\n\r\nHPV and Cervical Cancer by OpenStax<\/a>\u00a0by OpenStax College<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.4<\/strong>\r\n\r\nCandida by NIH on Flickr<\/a> from the NIH Image Gallery<\/a> on Flickr<\/a> is used under a CC BY NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.\r\n\r\nFigure 18.9.5<\/strong>\r\n\r\nBlausen_0349_Endometriosis<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 18.9.6<\/strong>\r\n\r\n1024px-Blausen_0602_Laparoscopy_02<\/a> by BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a CC BY\u00a0 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n
References<\/h2>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure <\/span>27.16<\/span>\u00a0<\/span>Development of cervical cancer [digital image].\u00a0 In Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\r\n
Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\n
HealthLink BC. (n.d.). Pap test: British Columbia specific information. https:\/\/www.healthlinkbc.ca\/medical-tests\/hw5266<\/p>\r\n
TED-Ed. (2019, July 9). What is HPV and how can you protect yourself from it? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=KOz-bNhEHhQ&feature=youtu.be<\/p>\r\n
TEDx Talks. (2016, April 14). Endometriosis - The mystery disease of women | C\u00e9cile Real | TEDxBinnenhof.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=6HeQ4iEqAUk&feature=youtu.be<\/p>\r\n
TEDx Talks. (2015, July 27). The brain and ovarian hormones | Marwa Azab | TEDxMontrealWomen. YouTube. https:\/\/www.youtube.com\/watch?v=ryNjSP5VVI8&feature=youtu.be<\/p>","rendered":"
<\/p>\n
Figure 18.9.1 An ounce of prevention is worth a pound of cure.<\/em><\/figcaption><\/figure>\n \nVaccinating Against Cancer<\/h1>\n<\/div>\n
Can a vaccine prevent cancer<\/a>? In the case of cervical cancer, it\u00a0can<\/em>. Cervical cancer is one of three disorders of the female reproductive system described in detail in this concept. Of the three, only cervical cancer can be prevented with a vaccine.<\/p>\n
\nCervical Cancer<\/h1>\n<\/div>\n
Cervical cancer<\/a><\/strong> occurs when cells of the cervix<\/a> (neck of the uterus<\/a>) grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body, such as the abdomen or lungs. Figure 18.9.2 shows the location of the cervix<\/a> and the appearance of normal and abnormal cervical cells when examined with a microscope.<\/p>\n
Figure 18.9.2 Cancer of the cervix \u2014 the location of which is shown in the drawings on the left and top right \u2014 can be identified by abnormal cervical cells, as shown on the bottom right. CIN stands for cervical intraepithelial neoplasia, which means cancerous cells within the epithelium of the cervix. The designations CIN 1, CIN 2, and CIN 3 refer to the severity of the abnormal cells, with CIN 1 being the least severe, and CIN 3 being the most severe.<\/em><\/figcaption><\/figure>\n Cervical Cancer Prevalence and Death Rates<\/h1>\n
Worldwide, cervical cancer<\/a> is the second most common type of cancer in females (after breast cancer) and the fourth-most common cause of cancer death in females. In Canada and other high-income nations, the widespread use of cervical cancer screening has detected many cases of precancerous cervical changes and has dramatically reduced rates of cervical cancer deaths. About 75% of cervical cancer cases occur in developing countries, where routine screening is less likely because of cost and other factors. Cervical cancer is also the most common cause of cancer death in low-income countries.<\/p>\n
Symptoms of Cervical Cancer<\/h2>\n
Early in the development of cervical cancer, there are typically no symptoms. As the disease progresses, however, symptoms are likely to occur. The symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Unfortunately, by the time symptoms start to occur, cervical cancer has typically progressed to a stage at which treatment is less likely to be successful.<\/p>\n
Cervical Cancer Causes and Risk Factors<\/h2>\n
More than 90 per cent of cases of cervical cancer are caused at least in part by human papillomavirus<\/a> (HPV)<\/strong>, which is a sexually transmitted virus that also causes genital warts. Figure 18.9.3 shows how HPV infection can cause cervical cancer by interfering with a normal cell division checkpoint. When HPV is not present, cervical cells containing mutations are not allowed to divide, so the cervix remains healthy. When HPV is present, however, cervical cells with mutations may be allowed to divide, leading to uncontrolled growth of mutated cells and the formation of a tumor.<\/p>\n
Figure 18.9.3 The presence of HPV may allow cervical cells with mutations to divide, resulting in the formation of a tumor.<\/em><\/figcaption><\/figure>\n Other risk factors for cervical cancer include smoking, a weakened immune system (for example, due to HIV infection), use of birth control pills, becoming sexually active at a young age, and having many sexual partners. However, these risk factors are less important than HPV infection. Instead, the risk factors are more likely to increase the risk of cervical cancer in females who are already<\/em> infected with HPV. For example, among HPV-infected women, current and former smokers have roughly two to three times the incidence of cervical cancer as non-smokers. Passive smoking, or secondhand smoke, is also associated with an increased risk of cervical cancer, but to a lesser extent.<\/p>\n
Diagnosis of Cervical Cancer<\/h2>\n
Diagnosis of cervical cancer is typically made by looking for microscopic abnormal cervical cells in a smear of cells scraped off the cervix. This is called a\u00a0Pap smear<\/a>.<\/strong>\u00a0If cancerous cells are detected or suspected in the smear, this test is usually followed up with a biopsy to confirm the Pap smear results. Medical imaging (by CT scan or MRI, for example) is also likely to be done to provide more information, such as whether the cancer has spread.<\/p>\n
Prevention of Cervical Cancer<\/h2>\n
It is now possible to prevent HPV infection with a vaccine. The first HPV vaccine was approved by the U.S. Food and Drug Administration in 2006. The vaccine<\/a> protects against the strains of HPV that have the greatest risk of causing cervical cancer. It is thought that widespread use of the vaccine will prevent up to 90% of cervical cancer cases. Current recommendations are for females to be given the vaccine between the ages of nine and 26. (Boys should be vaccinated against HPV, as well, because the virus may also cause cancer of the penis and certain other male cancers.) The vaccine is effective only if it is given before <\/em>HPV infection has occurred. Using condoms during sexual intercourse can also help prevent HPV infection and cervical cancer, in addition to\u00a0preventing pregnancy and sexually transmitted infections (such as HIV).<\/p>\n
Even in women who have received the HPV vaccine, there is still a small risk of developing cervical cancer. Therefore, it is recommended that women continue to be examined with regular Pap smears.<\/p>\n
Treatment of Cervical Cancer<\/h2>\n
Treatment of cervical cancer generally depends on the stage at which the cancer is diagnosed, but it is likely to include some combination of surgery, radiation therapy, and\/or chemotherapy<\/a>. Outcomes of treatment depend largely on how early the cancer is diagnosed and treated. For surgery to cure cervical cancer, the entire tumor must be removed with no cancerous cells found at the margins of the removed tissue on microscopic examination. If cancer is found and treated very early when it is still in the microscopic stage, the five-year survival rate is virtually 100%.<\/p>\n
\nVaginitis<\/h1>\n<\/div>\n
Vaginitis<\/a><\/strong>\u00a0is inflammation of the vagina \u2014 and sometimes the vulva<\/a>, as well. Symptoms may include a discharge that is yellow, gray, or green; itching; pain; and a burning sensation. There may also be a foul vaginal odor and pain or irritation with sexual intercourse<\/a>.<\/p>\n
Causes of Vaginitis<\/h2>\n
About 90% of cases of vaginitis are caused by infection with microorganisms<\/span><\/a><\/span>. Most commonly, vaginal infections are caused by the yeast <\/span>Candida albicans<\/em> (see Figure 18.9.4). Such infections are referred to as vaginal <\/span>candidiasis<\/a> <\/strong>or more commonly as a yeast infection.\u00a0Candida albicans <\/em>is one of the most common opportunistic infections in the world and can affect not only the vagina, but any of the mucus membranes and skin.\u00a0 Other possible causes of vaginal infections include bacteria, especially <\/span>Gardnerella vaginalis<\/em>, and some single-celled parasites, notably the protist parasite\u00a0<\/span>Trichomonas vaginalis<\/em>, which is usually transmitted through vaginal intercourse. The risk of vaginal infections may be greater in women who wear tight clothing, are taking antibiotics for another condition, use birth control pills, or have improper hygiene. Poor\u00a0hygiene\u00a0allows organisms that are normally present in the stool (such as yeast) to contaminate the vagina.<\/span><\/p>\n
\nFigure 18.9.4 The yeast Candida albicans \u2014 shown here growing on a culture plate \u2014 is one of the most common causes of vaginitis.<\/em><\/figcaption><\/figure>\n<\/div>\n Most of the remaining cases of vaginitis are due to irritation by \u2014 or allergic reactions to \u2014 various products. These irritants may include condoms, spermicides, soaps, douches, lubricants, and even semen. Using tampons or soaking in hot tubs may be additional causes of this type of vaginitis.<\/p>\n
Diagnosis of Vaginitis<\/h2>\n
Diagnosis of vaginitis<\/a> typically begins with symptoms reported by the patient. This may be followed by a microscopic examination or culture of the vaginal discharge in order to identify the specific cause. The colour, consistency, acidity, and other characteristics of the discharge may be predictive of the causative agent. For example, infection with Candida albicans<\/em>\u00a0may cause a cottage cheese-like discharge with a low pH<\/a>, whereas infection with\u00a0Gardnerella vaginalis<\/em>\u00a0may cause a discharge with a fish-like odor and a high pH.<\/p>\n
Prevention of Vaginitis<\/h2>\n
Prevention of vaginitis includes wearing loose cotton underwear that helps keep the vulva<\/a> dry.\u00a0Yeasts and bacteria that may cause vaginitis tend to grow best in a moist environment. It is also important to avoid the use of perfumed soaps, personal hygiene sprays, and douches, all of which may upset the normal pH and bacterial balance in the vagina. To help avoid vaginitis caused by infection with\u00a0Trichomonas vaginalis<\/em>, the use of condoms during sexual intercourse is advised.<\/p>\n
Treatment of Vaginitis<\/h2>\n
The appropriate treatment of vaginitis depends on the cause. In many cases of vaginitis, there is more than one cause, and all of the causes must be treated to ensure a cure.<\/p>\n
- \n
- Yeast infections of the vagina are typically treated with topical anti-fungal medications, which are available over the counter. The medications may be in the form of tablets or creams that are inserted into the vagina. Depending on the particular medication used, treatment may involve one, three, or seven days of applications.<\/li>\n
- Bacterial infections of the vagina are usually treated with antibiotics. These may be taken orally as pills, or applied topically to the vagina in creams.<\/li>\n
- Trichomonas vaginalis<\/em> infections of the vagina are generally treated with a single dose of an oral antibiotic. Sexual partners should be treated at the same time, and intercourse should be avoided for at least a week until both partners have completed treatment, and have been followed-up by a physician.<\/li>\n<\/ul>\n\n
Endometriosis<\/h1>\n<\/div>\n
Endometriosis<\/a><\/strong> is a disease in which endometrial tissue, which normally grows inside the uterus, grows outside it, as shown in Figure 18.9.5. Most often, the endometrial tissue grows around the ovaries, Fallopian tubes, and uterus. In rare instances, the tissue may grow elsewhere in the body. The areas of endometriosis typically bleed each month during the menstrual period, and this often results in inflammation, pain, and scarring. An estimated six to ten per cent of women are believed to have endometriosis. It is most common in women during their thirties and forties, and only rarely occurs before menarche or after menopause.<\/p>\n
Figure 18.9.5 In endometriosis, endometrial tissue may grow outside the uterus and cause health problems such as pain, bleeding, scarring, and infertility.<\/em><\/figcaption><\/figure>\n Signs and Symptoms of Endometriosis<\/h2>\n
The main symptom of endometriosis<\/a> is pelvic pain, which may range from mild to severe. There appears to be little or no relationship between the amount of endometrial tissue growing outside the uterus and the severity of the pain. For many women with the disease, the pain occurs mainly during menstruation<\/a>. However, nearly half of those affected have chronic pelvic pain. The pain of endometriosis may be caused by bleeding in the pelvis, which triggers inflammation<\/a>. Pain can also occur from internal scar tissue that binds internal organs to each other.<\/p>\n
Another problem often associated with endometriosis is infertility, or the inability to conceive or bear children. Among women with endometriosis, up to half may experience infertility. Infertility can be related to scar formation or to anatomical distortions due to the abnormal endometrial tissue. Other possible symptoms of endometriosis may include diarrhea or constipation, chronic fatigue, nausea and vomiting, headaches, and heavy or irregular menstrual bleeding.<\/p>\n
Causes of Endometriosis<\/h2>\n
The causes of endometriosis are not known for certain, but several risk factors have been identified, including a family history of endometriosis. Daughters or sisters of women with endometriosis have about six times the normal risk of developing the disease themselves. It has been suggested that endometriosis results from mutations<\/span><\/a><\/span>\u00a0in several gene<\/span>s<\/span><\/a><\/span>. It is likely that endometriosis is multifactorial, involving the interplay of several factors.<\/span><\/p>\n
At the physiological level, the predominant idea for how endometriosis comes about is retrograde menstruation. This\u00a0happens\u00a0when some of the endometrial debris from a woman\u2019s menstrual flow exits the uterus<\/a> through the oviducts<\/span><\/a><\/span>, rather than through the <\/span>vagina<\/a><\/span>. The debris then attaches itself to the outside of organs in the abdominal cavity, or to the lining of the abdominal cavity itself. Retrograde menstruation, however, does not explain all cases of endometriosis, so other factors are apparently involved. Suggestions include environmental toxins and autoimmune<\/a> responses.<\/span><\/p>\n
Diagnosis of Endometriosis<\/h2>\n
Diagnosis of endometriosis is usually based on self-reported symptoms and a physical examination by a doctor, often combined with medical imaging, such as ultrasonography. The only way to definitively diagnose endometriosis, however, is through visual inspection of the endometrial tissue. This can be done with a surgical procedure called laparoscopy, shown in Figure 18.9.6, in which a tiny camera is inserted into the abdomen through a small incision. The camera allows the physician to visually inspect the area where endometrial tissue is suspected.<\/p>\n
Figure 18.9.6 Visually inspecting the abdomen for endometrial growths is the most reliable way to diagnose endometriosis.<\/em><\/figcaption><\/figure>\n Treatment of Endometriosis<\/h2>\n
The most common treatments for endometriosis are medications to control the pain, and surgery to remove the abnormal tissue. Frequently used pain medications are non-steroidal inflammatory drugs (NSAIDS<\/a>), such as naproxen. Opiates may be used in cases of severe pain. Laparoscopy can be used to surgically treat endometriosis, as well as to diagnose the condition. In this type of surgery, an additional small incision is made to insert instruments that the surgeon can manipulate externally in order to burn (cauterize) or cut away the endometrial growths. In younger women who want to have children, surgery is conservative to keep the reproductive organs intact and functional. However, with conservative surgery, endometriosis recurs in 20\u201340% of cases within five years of the surgery. In older women who have completed childbearing, hysterectomy<\/a> may be undertaken to remove all or part of the internal reproductive organs. This is the only procedure that is likely to cure endometriosis and prevent relapses.<\/p>\n
\nFeature: My Human Body<\/h1>\n<\/div>\n
A Pap smear<\/a> is a method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix<\/a>. It is the most widely used screening test for this type of cancer, and it is very effective. The test may also detect vaginal infections and abnormal endometrial cells, but it is not designed for these purposes.<\/p>\n
According to HealthLink BC<\/a>, females should start receiving routine Pap smears by age 25. Because most cases of cervical cancer are caused by infection with human papillomavirus (HPV)<\/a>, which is a sexually transmitted infection, there is little or no benefit to screening people who have not had sexual contact. Starting at age 25, general guidelines are for Pap smears to be repeated every three years until age 69. Screening may be discontinued after 69 years of age, if the last three Pap smears were normal. If a woman has a complete hysterectomy<\/a>, she no longer has a cervix and there is no need for further Pap smears. On the other hand, if a woman has had a history of abnormal Pap smears or cancer<\/a>, she will likely be screened more frequently. Pap smears can be done safely during the first several months of pregnancy, and resumed about three months after childbirth. Generally, better results are obtained if Pap smears are not done during menstruation.<\/p>\n
If you\u2019ve never had a Pap smear, knowing what to expect may help prepare you for the procedure. The patient lies on the examining table with her feet in \u201cstirrups\u201d to hold the legs up and apart. An instrument called a speculum is inserted into the vagina to hold back the vaginal walls and give access to the cervix. A tiny amount of tissue is brushed off the cervix and smeared onto a microscope slide. The speculum is then removed, and the procedure is over. The slide is later examined under a microscope for abnormal cells. Some women experience light spotting or mild diarrhea after a Pap smear, but most have no lasting effects.<\/p>\n
Pap smears are uncomfortable and may be somewhat painful for some women. If you experience pain during a Pap smear, tell your health care provider. Many steps can be taken to minimize the pain, which might include using a smaller speculum, using warm instruments and a lubricant, and applying a topical anesthetic such as lidocaine to the cervix before obtaining the smear. Any pain is generally very brief, and the potential reward is worth it. Pap tests are estimated to reduce up to 80% of cervical cancer deaths. One of the lives saved could be your own.<\/p>\n
\n\n\n 18.9 Summary<\/span><\/h1>\n<\/header>\n
\n- \n
- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Vaginitis<\/a> is inflammation of the vagina. A discharge is likely, and there may be itching and pain. About 90% of cases of vaginitis are caused by infection with microorganisms<\/a>, typically by the yeast Candida albicans<\/em>. A minority of cases are caused by irritants or allergens in soaps, spermicides, or douches.<\/li>\n
- Diagnosis of vaginitis may be based on characteristics of the discharge, which can be examined microscopically or cultured. Treatment of vaginitis depends on the cause and is usually an oral or topical anti-fungal or antibiotic medication.<\/li>\n
- Endometriosis<\/a> is a disease in which endometrial tissue grows outside the uterus<\/a>. This tissue may bleed during the menstrual period<\/a> and cause inflammation, pain, and scarring. The main symptom of endometriosis is pelvic pain, which may be severe. Endometriosis may also lead to infertility<\/a>.<\/li>\n
- Endometriosis is thought to have multiple causes, including genetic mutations. Retrograde menstruation may be the immediate cause of endometrial tissue escaping the uterus and entering the pelvic cavity. Endometriosis is usually treated with surgery to remove the abnormal tissue and medication for pain. If surgery is more conservative than hysterectomy, endometriosis may recur.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n
\n\n 18.9 Review Questions<\/span><\/h1>\n<\/header>\n
\n- \n
- What is cervical cancer? Worldwide, how prevalent is it, and how does it rank as a cause of cancer deaths?<\/li>\n
- Identify symptoms of cervical cancer. What are causes of \u2014 and risk factors for \u2014 cervical cancer?<\/li>\n
- What roles can Pap smears and HPV vaccines play in preventing cervical cancer cases and cervical cancer deaths?<\/li>\n
- How is cervical cancer treated?<\/li>\n
- Define vaginitis and identify its symptoms.<\/li>\n
- What are some of the causes of vaginitis? Which cause is responsible for most of the cases?<\/li>\n
- How is vaginitis diagnosed and treated?<\/li>\n
- What is endometriosis, and what are its symptoms?<\/li>\n
- Discuss possible causes of endometriosis.<\/li>\n
- How is endometriosis treated? Which treatment is most likely to prevent recurrence of the disorder?<\/li>\n
- \n\n
- Most cases of cervical cancer occur because of infection with human papillomavirus (HPV)<\/a>, so the HPV vaccine is expected to greatly reduce the incidence of the disease. Other risk factors include smoking and a weakened immune system. A Pap smear<\/a> can diagnose cervical cancer at an early stage. Where Pap smears are done routinely, cervical cancer death rates have fallen dramatically. Treatment of cervical cancer generally includes surgery, which may be followed by radiation therapy or chemotherapy.<\/li>\n
- Cervical cancer<\/a> occurs when cells of the cervix grow abnormally and develop the ability to invade nearby tissues or spread to other parts of the body. Worldwide, cervical cancer is the second-most common type of cancer<\/a> in females and the fourth-most common cause of cancer death in females. Early on, cervical cancer often has no symptoms. Later, symptoms (such as abnormal vaginal bleeding and pain) are likely.<\/li>\n
![1024px-Blausen_0221_CervicalDysplasia<\/a> by](\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0221_CervicalDysplasia.png\"){kind=link}
![HPV and Cervical Cancer by OpenStax<\/a>\u00a0by](\"https:\/\/commons.wikimedia.org\/wiki\/File:Figure_28_02_08.JPG\"){kind=link}
![Blausen_0349_Endometriosis<\/a> by](\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0349_Endometriosis.png\"){kind=link}
![1024px-Blausen_0602_Laparoscopy_02<\/a> by](\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0602_Laparoscopy_02.png\"){kind=link}