Godwin I. Meniru

Vaginal leiomyoma co-existing with broad ligament and multiple uterine leiomyomas.

Abstract A 48 year old African American woman presented with bladder pressure leading to the diagnosis of broad ligament and multiple uterine leiomyomas. She was also found to have a lateral vaginal wall mass which was confirmed to be a leiomyoma. Unlike uterine leiomyomas, vaginal leiomyomas are uncommon and are most often found in Caucasian women. Cases of such co-existing tumors are rare and their etiologic relationship is uncertain.

Spontaneous prolonged hypertonic uterine contractions (essential uterine hypertonus) and a possible infective etiology

Abstract The management of a pregnant woman presenting with prolonged hypertonic uterine contractions (essential uterine hypertonus) and mildly elevated temperature at term is described. Histology of the placenta, cord and membranes, following delivery, revealed evidence of chorioamnionitis, funisitis and deciduitis. Our findings raise the possibility that essential uterine hypertonus may have an infective or inflammatory component to its etiology.

Female circumcision: at our doorsteps and beyond

Recent trends in international travel and emigration have brought the practice of female circumcision, also known as female genital mutilation, to the awareness of an increasing number of physicians and public policy agencies in developed countries. The main reason for the continuation of this practice is deeply held tradition. The high incidence of complications attending the procedure leads to a poor quality of life and potential life-threatening problems. Female circumcision serves no biologically useful purpose and perpetuates the subjugation and social deprivation of females. Suggestions for the eradication of this custom include universal education of females and public enlightenment campaigns; legislation tends to send the practice underground. This review is aimed at providing objective background information on female circumcision to residents in obstetrics and gynecology. An effective solution to this problem requires not just knowledge but also wisdom in order to offer a compassionate approach to the management of these women. The American womens health care specialist should be well informed on this issue because of the increasing likelihood of contact with these women. It is also hoped that health care providers will become sensitized to the point of designing and participating actively in effective schemes for the worldwide eradication of this practice.

Comprehensive preventive health care in female-factor infertility: Issues problems and proposals

Presently available information on the causation and management of infertility disorders is sufficient for the formulation of some tentative proposals for the provision of preventive reproductive health care to females. This should be aimed at preventing the initiation of the infertility-associated disorder in the first place (primary prevention), at detecting and preventing overt manifestations of disease (secondary prevention) and/or halting or slowing disease progression, and at reducing long-term morbidity and preventing mortality (tertiary prevention). This review will suggest ways to implement such preventive strategies with respect to the care of women with endometriosis, polycystic ovary syndrome, tubal pathology, and hypoestrogenism. We will also discuss the prevention of iatrogenic problems encountered during infertility management such as multiple pregnancy, ovarian hyperstimulation syndrome, postoperative pelvic adhesions, and delayed referral for subspecialist care. These primary care issues should be considered by all physicians who care for females from infancy, through adolescence, to the reproductive and postreproductive age periods. We hope that dialogue and future developments will lead to further refinement of our present proposals.

The female reproductive system

Introduction The female reproductive system is made up of the sex organs and associated structures, both remote and near. The female genital tract provides an avenue for the transport of spermatozoa from their point of deposition in the vagina to the place where fertilization of the released oocyte occurs. The function of the ovaries is regulated such that one of them produces an oocyte each month. The release of the oocyte from the ovary is timed to correspond to the period when the reproductive tract is best suited for implantation if this oocyte happens to become fertilized. If fertilization and/or implantation do not occur, the changes in the reproductive tract are rapidly reversed to allow a new cycle of changes to commence. This ensures that the possibility of fertilization and implantation is always maintained in each new cycle. The female sex organs The female sex organs can be broadly grouped into two: the internal and external genitalia (Table 2.1 and Figures 2.1–2.3). The vulva is another name for the external genitalia. The mons pubis (or mons veneris) is the hair bearing area of skin overlying the pubic symphysis (which is the joint formed between the two pubic bones in front). Underneath the skin is a pad of fat which provides some cushioning between the pubic bones of both partners during sexual intercourse. This hair bearing skin extends backwards on either side of the vaginal introitus (vaginal opening) to become the labia majora.