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INFLAMMATORY DISEASES OF FEMALE GENITAL ORGANS

The problem of inflammatory processes of the genitals has always been the focus of attention of obstetrician-gynecologists for the following reasons:

• in frequency they take first place in gynecology;

• their consequences are very diverse and include various violations of the menstrual and reproductive functions (infertility, miscarriage, ectopic pregnancy), as well as general damage to organs involving other organs and systems in the pathology up to disability;

• if they are present, intrauterine infections or infection of the fetus always occur with various violations of its development, up to and including CMV or death;

• constant changes in etiological factors, the ratios of micro- and macroorganisms lead to the transformation of the clinical course and treatment of this pathology;

• The rapid increase in the incidence of sexually transmitted inflammatory diseases has determined the high infection rate of young girls and women.

Inflammatory diseases of the genitals (VZG) are caused by the microbial flora, in which the role of opportunistic microbes and pathogens of a specific infection has increased in recent years. HMV develops due to the interaction of macro- and microorganisms, which is influenced by the immunobiological characteristics of the body, along with the nature, dose and virulence of the microbial flora, as well as the initial state of the female genital organs. Of significant importance is the significant increase worldwide in the number of strains of microorganisms resistant to the effects of antibiotics.

Classification of VZG is carried out according to a number of principles:

• on etiology - nonspecific and specific VZG;

• by the structure of the pathology - gynecological inflammatory processes of the genitals; VZG associated with the complicated course of pregnancy, childbirth and the postpartum period; postoperative inflammatory complications;

• by localization - lesions of the lower and upper genitalia;

• according to the clinical course - acute local and general infection, chronic general and local infection.

One of the most important factors of VZG is an infection, the determination of which is carried out using bacterioscopic, bacteriological and other special research methods. It is important to determine the type of vegetative microbial flora and its antibiotic resistance. The development and further spread of infection occurs when a sufficient number of microorganisms enter the body with the proper virulence while weakening its defenses. Vegetative microflora in inflammatory diseases of the female genital organs is characterized by polymorphism. A large number of microorganisms also lives in the vagina of a healthy woman: rod-shaped and coccal, aerobic and anaerobic microflora. Even the presence of pathogenic pathogens in the absence of clinical signs of infection is not a reason to consider this a pathological process. At the same time, under certain conditions of the macroorganism, VZG can be caused by endogenous opportunistic microflora and saprophytes (opportunistic infections).

It is known that the microecological environment of the vagina, cervical canal and uterine cavity has significant differences, which are also expressed in the age aspect. This is due to the anatomical and physiological characteristics of each organ and is associated with endogenous factors (hormonal, immune) that change with age and with various physiological and pathological conditions of the body (pregnancy, the postpartum period, phases of the menstrual cycle, the presence of extragenital diseases).

The microflora in ADH is not only characterized by polymorphism, but also by the presence of associations in which the dominant pathogen must always be determined. The results of studies of the etiology and epidemiology of VZG indicate that in recent years, along with persistent pathogens (staphylococci, streptococci, enterobacteria, green protea, anaerobic and aerobic cocci), sexually transmitted infections (gonococci, chlamydia, trichomonas, viruses, mycoplasmas, etc.). An important feature of all types of pathogens of VZG is the change in their biological properties with the development of antibiotic-resistant and antibiotic-dependent forms, which determines the variety of clinical forms and significantly complicates the treatment. In this aspect, it should be emphasized that the stereotyped, unjustifiably widespread use of antibiotics and other antibacterial agents leads to a rapid increase in the number of resistant microbes that cause VZG.

Of great importance for the appearance of VZG are the pathways of the introduction and spread of microbes.
For the development of a purulent process, pathogens must penetrate through the damaged epithelium of the mucous membranes of the genital tract. With a large number of virulent microbes and the weakness of the body's defenses, a significant spread of the process can occur and it can become common from the local one. The transmission of infection to the upper genital organs of a woman can occur by contact (passive) using sperm, Trichomonas, as well as hematogenous and lymphogenous. Particular importance is attached to the ability of microbes to attach to sperm, trichomonads, which depends on the vaginal environment (pH, Dederlein sticks, etc.).

Generalization of the inflammatory processes of the genitals is facilitated by intrauterine interventions (hysteroscopy, uterine probing); abortions and diagnostic curettage of the endometrium; the postpartum period; the use of intrauterine contraceptives. The risk of infections when using the IUD is especially great in the first months of their use, in pregnant women and with frequent changes in sexual partners. The frequency of ADH in women with IUD is several times higher than without them.

With the indicated risk factors for OCD, the biological defense mechanisms of the female reproductive system are violated.

In the process of phylogenesis and ontogenesis, physiological barriers have formed that ensure the resistance of the female genital organs to the possible effects of various pathogenic factors, including infectious agents, both exogenous and endogenous. Such protective mechanisms include, first of all, the anatomical and physiological characteristics of the female genital organs, in particular, a clear distinction between the lower and upper sections. First of all, this is achieved by separation of the vagina and the external environment. The peculiar structure of the muscles of the perineum and pelvic floor ensures the closure of the genital gap and the creation of the so-called vulvar ring. This is facilitated by the specific discharge of the large glands of the vestibule.

The second biological barrier is the acidic reaction of the vaginal contents, due to the presence of lactic acid, resulting from the splitting of the glycogen of the epithelium of the vaginal mucosa under the influence of lactobacilli and other microorganisms. In addition to the acidic environment, the formation of hydrogen peroxide and the deficiency of glucose, which lactobacilli use for life, interfere with the propagation of pathogenic microorganisms. The biological defense mechanism described above is called "the ability of the vagina to self-clean"; it is characteristic mainly of women of childbearing age,

In case of violation of the described barriers of the lower part of the reproductive system, there is another barrier protecting its upper part - the cervix, which has a mucous plug in its channel and a pronounced narrowing of the lumen in the area of ​​the internal pharynx and isthmus.

Protection of the upper genital organs from pathogenic microorganisms is also caused by cyclic detachment of the functional layer of the endometrium, peristaltic contractions of the fallopian tubes with flickering of the cilia on the surface of the tube epithelium towards the side of the womb of the uterine cavity, and resistance to infection of the germinal epithelium covering the surface of the ovaries.

Resistance of female genital organs to infection is largely due to age-related functional characteristics of the female body. In women of childbearing age, it is not the same during the menstrual cycle and decreases markedly during ovulation and menstruation. At this time, prerequisites are created for the development of inflammatory changes in the genitals, primarily in connection with the emergence of conditions for the introduction of infection and its penetration into the upper parts of the reproductive system.

In childhood and senility, the value of the described barrier mechanisms decreases markedly.

The fullness of the barrier functions of the female reproductive system depends on the state of the endocrine, immune, nervous, vascular, enzymatic and other body systems. Of paramount importance is the function of the ovaries. Only sufficient production of steroid hormones ensures self-cleaning of the vagina, the normal state of the cervix and the mechanisms of protection of the female reproductive system.
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INFLAMMATORY DISEASES OF FEMALE GENITAL ORGANS

  1. Female genital inflammatory diseases
    Inflammatory diseases of the female genital organs (VZPO) occupy the first place in the structure of gynecological diseases. About 40% of gynecological patients in the hospital have VZPO. The cause of all inflammatory diseases of the genitals are microbes, which most often enter the body of a woman through sexual contact. Pathogens can also spread by the lymphogenous, hematogenous route,
  2. INFLAMMATORY DISEASES OF THE LOWER DEPARTMENT OF FEMALE GENITAL ORGANS
    Chlamydial infection - up to 60-70% of patients with VZNE are infected with chlamydia. It is transmitted only sexually. Has a lot to do with gonococci. Chlamydia - Gr (-) intracellular bacteria tropic to the cylindrical epithelium (cervical canal, fallopian tubes, bartholin gland ducts, urethra and paraurethral passages). The incubation period is 20-30 days. There is no bright clinic, initially there is a tendency to
  3. INFLAMMATORY DISEASES OF THE LOWER DEPARTMENT OF FEMALE GENITAL ORGANS
    Chlamydial infection - up to 60-70% of patients with VZNE are infected with chlamydia. It is transmitted only sexually. Has a lot to do with gonococci. Chlamydia - Gr (-) intracellular bacteria tropic to the cylindrical epithelium (cervical canal, fallopian tubes, bartholin gland ducts, urethra and paraurethral passages). The incubation period is 20-30 days. There is no bright clinic, initially there is a tendency to
  4. INFLAMMATORY DISEASES OF THE UPPER DEPARTMENT OF FEMALE GENITAL ORGANS.
    Acute salpingo-oophoritis (in first place in frequency). The infectious process passes to the ovary during ovulation, when after the release of the egg the wound surface is exposed, that is, the entrance gate to the infection. Clinic: pains of various nature and severity of the lower abdomen, the process is usually bilateral. Symptoms of intoxication (fever, chills, weakness, malaise, etc.).
  5. INFLAMMATORY DISEASES OF THE UPPER DEPARTMENT OF FEMALE GENITAL ORGANS.
    Acute salpingo-oophoritis (in first place in frequency). The infectious process passes to the ovary during ovulation, when after the release of the egg the wound surface is exposed, that is, the entrance gate to the infection. Clinic: pains of various nature and severity of the lower abdomen, the process is usually bilateral. Symptoms of intoxication (fever, chills, weakness, malaise, etc.).
  6. Inflammatory diseases of the female genital organs (bacterial vaginosis, chlamydial infection)
    Factors contributing to the spread of infection are intrauterine interventions: abortion, diagnostic curettage, hysterosal pingography, probing of the uterine cavity, placement and removal of an intrauterine contraceptive. Bacterial vaginosis. This disease is caused by a violation of the biocenosis of the normal microflora of the vagina. The main complaint of a woman is to increase the allocation
  7. Inflammatory diseases of the female genital organs (viral infections, candidal colpitis)
    Viral infections. Herpes virus of the second serotype and human papillomavirus cause inflammation of the cervix. Cytomegalovirus infection proceeds in the form of carriage, but has a damaging effect on the fetus, causing, in addition to miscarriages, malformation of the fetus. All viral infections are latent, difficult to treat, prone to relapses and exacerbations. With herpetic infection during
  8. Sexually transmitted diseases of the female genital organs
    One of the negative phenomena of our modernity is the rapid increase in the frequency and number of sexually transmitted diseases. This is facilitated by changes in the orientation of sexual behavior of young people, the widespread use of contraceptives, the expansion of international tourism, prostitution, the resistance of pathogens to antibacterial agents and the absence of etiopathogenetic
  9. 2. General information about inflammatory diseases of the female reproductive system.
    Infectious damage, depending on the localization, causes inflammation: • of the vagina (colpitis); • external genitalia (vulvitis); • large gland of the vestibule (bartholinitis); • cervix (cervicitis); • inner lining of the cervical canal (endocervicitis); • the inner lining of the uterus (endometritis); • fallopian tubes (salpingitis); • ovaries (oophoritis);
  10. Genital inflammatory diseases
    Inflammatory diseases of the female genital organs are the most common gynecological pathology. They most often become the main cause of infertility in women. These diseases, caused by various microorganisms, arise as a result of infectious processes in the urethra, vulva (external genitalia of a woman), vagina, uterus, fallopian tubes and ovaries. Usually,
  11. Inflammatory diseases of the internal genital organs in girls and girls
    Definition of a concept. Inflammatory diseases of the internal genitalia in girls and girls include endocervicitis, endometritis, salpingoophoritis, perimetritis, pelvioperitonitis. As with vulvovaginitis, inflammatory processes of the internal genital organs are divided into non-specific (more often) and specific (rarely). According to localization, salpingoophoritis is most often found. Frequency. For the last
  12. Inflammatory diseases of the external genitalia in girls and girls
    Definition of a concept. Inflammatory diseases of the genitals in girls and girls are inflammation of the external genitalia and vagina, uterine appendages and, less commonly, the uterus of various etiologies. At the same time, age-specificity of forms of inflammatory diseases takes place: during childhood, it is most often vulvovaginitis, and during puberty, inflammation of the uterus and sometimes the uterus. 3.4.1.
  13. Malignant diseases of the female genital organs
    Female genital malignancies
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