Gynecology And Obstetrics-

Diseases of the uterus and cervix

There are a variety of diseases of the uterus, often with many different causes. Here you will find a selection of the most common diseases and common operations on the uterus.
The uterus is one of the female reproductive organs and is located in the small pelvis. Normally only the size of a pear, during pregnancy it grows into the largest muscle in the human body.

The diseases of the uterus and cervix

The following is an overview of the diseases of the uterus and the cervix, broken down according to:

Infection and inflammation of the uterus
Benign uterine tumors
Malignant uterine tumors
Operations on the uterus
Other diseases of the uterus

Infection and inflammation of the uterus

Cervicitis

Cervicitis is the medical term for inflammation of the cervix. The inflammation of the cervix is triggered by bacteria or viruses: Chlamydia are the most common cause of cervical inflammation, other possible germs are group A streptococci and the herpes simplex virus. Gonococci ("gonorrhea") rarely cause cervical inflammation.
Inflammation of the cervix can be completely without symptoms and is usually not painful. However, a yellowish, sticky discharge often occurs. On vaginal examination with the speculum, redness and yellowish secretion can be seen. A smear is taken to determine which pathogen it is. Depending on the pathogen, suitable antibiotic or antiviral therapy is then carried out.
You can find detailed information at: Inflammation of the cervix (cervicitis)

Clamydial infection

Chlamydia infection is the most common sexually transmitted bacterial infection and affects between one and ten percent of all women, depending on age and risk behavior. The problem with chlamydial infection is that most infected people hardly notice the infection.
Nevertheless, in up to 40% of the cases, the infection can ascend into the fallopian tubes within weeks and a few months, where the infection damages and sticks the fine mucous membrane of the fallopian tubes. As a result, ectopic pregnancies occur more frequently, and after many years of undiscovered chlamydial infection, infertility due to sticky fallopian tubes is also possible.
Statutory health insurance women under the age of 25 have had the opportunity since 2008 to take part in a chlamydia screening, which is carried out by taking a urine sample at the gynecologist.
You can find detailed information at: Clamydial infection

Endometritis

Endometritis describes the inflammation of the inner lining of the uterus, the endometrium. It usually develops from cervicitis (inflammation of the cervix) with gonococci or clamydia, as these pathogens are able to rise and cause infections of all of the woman's internal genital organs.
Inflammation of the uterine lining is also possible due to pathogens in the normal skin or intestinal flora and group A streptococci, but then actually only occurs after vaginal interventions or after childbirth. Typical symptoms include bleeding disorders such as intermenstrual bleeding or spotting.
If the infection spreads from the endometrium to the muscles of the uterus, the affected patient develops pain in the lower abdomen and a high fever. Depending on the pathogen, the therapy is carried out with a suitable antibiotic.
You can find detailed information at: Uterine inflammation

Benign uterine tumors

Fibroids

Fibroids are benign growths on the muscles of the uterus that are very common. About 30% of women over the age of 30 have one or more fibroids. In most cases, the fibroids are located in the uterine wall, rarely in the cervix.
In many cases they don't cause symptoms. With the appropriate size, however, they can cause severe pain during the menstrual period (dysmenorrhea). However, the fibroids can also grow directly below the lining of the uterus and then trigger vaginal bleeding, which either occurs independently of the menstrual bleeding or increases it (hypermenorrhea).
Fibroids that grow on the outer wall of the uterus can put pressure on the bladder, rectum or ureter and lead to defecation disorders and frequent urination or congestion up to the kidneys. If the stem of such an external myoma is rotated, it is very painful.
Depending on the size and type of myoma, various problems can arise during pregnancy (premature abortion, infertility, pain, need for a caesarean section).
Fibroids grow depending on the female sex hormone estrogen. This explains why they get bigger during pregnancy and get smaller after menopause. The diagnosis is made through an ultrasound scan. Therapy can either be through hormonal treatment, which is not possible in young patients, or through surgery. Fibroids that do not cause symptoms do not need treatment.
You can find detailed information at: Myoma

Uterine cyst

A uterine cyst is not uncommon. Most uterine cysts are completely harmless and have no symptoms. However, symptoms such as bleeding disorders can sometimes occur.
If cysts in the uterus are symptomatic and cannot be reduced by medication, or if they are suspicious of a malignant event, then it is usually advisable to have them removed.
You can find detailed information at: Uterine cyst

Polyps of the uterus

A uterine polyp is a benign change in the lining of the uterus that is usually harmless. These are stalk-like growths of the uterine lining that protrude into the uterine cavity.
Polyps can occur at any age; young women are affected much less often than women shortly before, during or after menopause. It affects 3-16% of all women.
Many women are affected by polyps, but do not necessarily need therapy if they are free of symptoms. The typical symptom of uterine polyps is vaginal bleeding, which occurs independently of normal menstrual bleeding, or a brownish-colored discharge from the vagina that is always present. With very large polyps, pain can also occur.
The diagnosis is made through a transvaginal (through the vagina) ultrasound examination. With adequate therapy, polyps can be completely cured. Uterine polyps are treated by removing them during a uterine specimen. Degeneration is possible, but rare.
You can find detailed information at: Polyps of the uterus - how dangerous are they?

Malignant uterine tumors

Uterine cancer

A uterine cancer (endometrial cancer) is a malignant tumor of the uterus. Usually the cancer develops from the cells of the lining of the uterus.
After breast cancer, uterine cancer is the most common gynecological cancer. Each year around 17 out of 100,000 women are diagnosed with this condition. It typically occurs in women who have already passed the menopause (between 60 and 70 years of age), and only very rarely (around 2%) are affected patients under 40 years of age.
The main symptom of endometrial cancer is vaginal bleeding. Uterine cancer is detected at an early stage in 75% of cases and therefore has a fairly good prognosis.
The treatment consists of the surgical removal of the uterus and, depending on the extent of the tumor, surrounding structures. Depending on the type of tumor, radiation therapy, chemotherapy or hormone therapy will be carried out after the operation. If the tumor has progressed too far for surgery, radiation therapy is given.
You can find detailed information at: Uterine cancer

cervical cancer

In Germany about 10 out of 100,000 women develop cervical cancer every year, this type of cancer is one of the most common gynecological cancers.
Cancer precursors of the cervix are 50 to 100 times more common. Due to the high incidence of cervical cancer, health insurance companies pay regular cancer screening examinations, during which a smear is taken from the cervix and examined for malignant cells and their precursors.
An infection with HPV (Human Papilloma Virus) is a risk factor for the development of this cancer, which is why, since 2007, a vaccination "against cervical cancer" for girls from 12 to 17 years of age has been paid for by the health insurance companies. This vaccination is aimed primarily against the high-risk types 16 and 18, which are responsible for 70% of all cervical cancers.
In the early stages, cervical cancer is largely asymptomatic. Spotting or bleeding during or after sexual intercourse is possible. Later, you may experience bright red, watery discharge. In the late stages, there are symptoms when urinating, defecating, pain, lymphedema of the legs and bleeding from the vagina, bladder or rectum.
Precursors of cervical cancer can be treated by conization (removal of a cone of tissue from the cervix that contains the affected tissue). In cervical cancer, the radical nature of the operation must be adapted to the stage. If the lymph nodes are affected, radiation therapy is then carried out, which can be combined with chemotherapy. The 5-year survival rate is good in the early stages (85-90%), but decreases significantly with increasing spread. This is precisely why it is absolutely necessary to attend the cancer screening appointments with the gynecologist.
You can find detailed information at: cervical cancer

Operations on the uterus

Uterine scraping

The uterine scraping is a small gynecological operation that can often be performed on an outpatient basis. Indications for a uterine scraping are for example:

irregular and very heavy menstrual periods
sudden bleeding after menopause
Abnormalities in the transvaginal ultrasound as part of the preventive examinations or after a miscarriage

The procedure can be performed under local anesthesia, but is usually performed under general anesthesia and usually takes no longer than ten to fifteen minutes.
You can find detailed information at: Uterine scraping

Hysterectomy

A hysterectomy is performed based on various clinical situations present. A common reason for a uterus to be removed is benign growths of the uterus called myomas. However, malignant diseases such as cervical cancer or endometrial cancer, which are also cancer of the uterus, can also be reasons for having the uterus removed.
You can find detailed information at: Hysterectomy

Other diseases of the uterus

Endometriosis

Endometriosis is the appearance of the lining of the uterus (endometrium) outside the uterine cavity. It is estimated that one in ten women is affected, and women of childbearing age are particularly common. The scattered uterine lining is hormone-dependent and often causes discomfort as part of the menstrual period. Typical symptoms are increased menstrual pain, chronic pelvic pain and cycle-dependent back pain as well as pain during sexual intercourse and infertility.
An ultrasound examination can provide an indication of the diagnosis, but a definitive diagnosis is only possible as part of a laparoscopy, which is also the operative side of the treatment. On the conservative side, progestin supplements can be used.
You can find detailed information at: Endometriosis

Uterine prolapse and uterine subsidence

Uterine subsidence (Descensus uteri) and prolapse (uterine prolapse) describe two degrees of severity of the same clinical picture. Exact data on the frequency are not available, estimates assume that up to 30% of women have at least a slight sagging of the uterus, but this does not cause any symptoms.
Usually the uterus is at the end of the vaginal vault and is tilted back slightly. When the uterus is lowered, the uterus holding apparatus is so weak that it is lowered towards the pelvic floor following the force of gravity; when the uterus is prolapsed, the vaginal wall is everted and this with the uterus protrudes outwards through the vaginal entrance. The cause of a lowering of the uterus is a chronic stretching of the pelvic floor and / or defects in the muscle or connective tissue of the pelvic floor.
Risk factors are frequent pregnancies and births and other diseases that cause high pressure within the abdominal cavity (e.g. obesity, constipation, heavy physical work, etc.).
Symptoms of a lowering of the uterus are an increasing feeling of pressure in the lower abdomen and pelvic floor, problems with urination, constipation and stool and / or urinary incontinence. Therapy can be conservative or surgical, depending on the extent of the symptoms and the wishes of the patient. Conservative therapy includes repositioning the lowered uterus with ring or cube pessaries, which are used by the patient, as well as pelvic floor training. Various surgical methods of lowering the uterus are available for surgical therapy, which are used individually depending on the patient's findings.
You can find detailed information at: