The site provides background information. Adequate diagnosis and treatment of the disease are possible under the supervision of a conscientious physician. Any drugs have contraindications. Consultation required
Inflammation of the ovaries (oophoritis) is an acute or chronic pathological process that affects the tissue of the female sex glands, causing a breakdown of their function. In the overwhelming majority of cases, this ailment develops not independently, but in combination with the inflammatory process within the fallopian tubes (so-called adnexitis). In foreign literature, acute inflammation of the ovaries is usually combined with inflammation of the fallopian tubes (salpingitis) in one common clinical syndrome – inflammation in the pelvis.
In most cases, inflammation of the ovaries and uterine appendages occurs as a result of the penetration of various infectious agents, more often the causative agents of venereal diseases. For this reason, oophoritis and salpingitis usually develops in young women under the age of 25 years living an active sex life and not using barrier methods of contraception (condoms).
Inflammation of the ovaries, triggered by pathogenic bacteria or viruses, is a dangerous and serious illness that causes reproductive disorders (infertility), as well as hormonal disruptions due to changes in endocrine activity ovary. In case of aggressive course of the disease, local or widespread purulent complications may occur, representing an immediate threat to the life of the woman.
- inflammation in the ovaries and fallopian tubes is one of the most common causes of female infertility;
- inflammation of the ovaries quite often occurs on the background of the asymptomatic course of certain sexually transmitted diseases (chlamydia);
- pelvic inflammatory disease is more common among young women;
- isolated lesion of the ovaries infectious or inflammatory process practically does not occur;
- inflammation of the ovaries may occur in response to the inflammatory process in other organs;
- hormonal disruptions increase the likelihood of penetration of infectious agents into the upper parts of the female reproductive system;
- stress is a factor that significantly weakens the protective potential of the female body and increases the risk of damage to the fallopian tubes and ovaries.
Anatomy of the uterus
Female genital organs are conventionally divided into upper and lower sections. This separation simplifies the systematization of the clinical manifestations of certain genital infections, and also allows a better understanding of the penetration mechanisms of pathogenic agents.
The lower divisions of the female genital organs are represented by:
- Vulva. The vulva is called the small and large labia, performing the role of the entrance to the vagina, the clitoris, and the mouth of the urethra.
- Vagina. The vagina is a tubular muscular-elastic organ that performs sexual, reproductive, protective, and excretory functions. Normally, the vaginal environment is not sterile and is formed by the Doderlein bacilli and a number of other saprophytic (non-pathogenica) microorganisms. Due to this, the vagina has its own microflora, which contributes to its protection when it enters and the development of any infections.
- Cervix. The cervix is a part of the uterus located between the vagina and the uterus. A canal passes through the cervix and is normally closed and contains cervical mucus, which protects the overlying structures from infection.
The upper sections of the female genital organs are represented by:
- The ovaries. The ovaries are paired female gonads, which are located in the pelvic cavity and perform reproductive and hormonal functions. Produce steroid sex hormones (estrogen and progesterone). In the ovaries, the process of maturation of the egg.
- Uterus. The uterus is a muscular organ located in the pelvic cavity. Performs reproductive function (gestation) and menstrual (detachment of the inner mucosa). Through the fallopian tubes, the uterus is connected to the abdominal cavity, and through the cervical canal to the vagina and the external environment.
- Uterine (fallopiana) pipes. The fallopian tubes are a paired organ, which is located in the pelvic cavity and connects the uterus with the abdominal cavity. In the lumen of the fallopian tubes, fertilization of the egg occurs, and their main function is to transport the embryo or egg to the uterus.
The fallopian tubes loosely adhere to the ovaries, and there is a small space between them. The connection between these two organs is formed by the fringe of the fallopian tubes (small pointed outgrowths), one of which (ovarian fringe) is in direct contact with the ovary.
The ovaries are supplied by the ovarian artery, originating from the abdominal aorta, as well as by the branches of the uterine artery. Venous blood flows through the ovarian vein, which forms the ovarian plexus, into which blood also flows from the fallopian tubes. Knowledge of the characteristics of the blood supply allows you to better understand the possible mechanisms of penetration of infectious agents to the ovaries.
The ovaries are innervated by nerve branches from the inferior hypogastric plexus. The ovaries are not covered by the peritoneum, but they are in close contact with it. These facts are of great importance for understanding the mechanisms of pain in the development of the inflammatory process.
Next to the ovaries is the bladder, intestinal loops, appendix, rectum. These formations may not directly adhere to the ovaries, but in some conditions they may be the initial source of infection or inflammation.
Causes of Ovarian Inflammation
The most common cause of inflammation in the ovaries is infection penetration. However, this is not the only reason that can provoke this disease. The inflammatory process is a protective mechanism that occurs in response to the action of a damaging factor and is aimed at reducing damage. Based on this, it can be assumed that the inflammatory response may occur in response to many pathological situations.
Ovarian inflammation can occur in the following situations:
- Infections. In most cases, the inflammatory process in the ovaries occurs due to the penetration of an infection, which can be of a bacterial, viral or fungal nature. Most often, oophoritis is associated with venereal diseases, but it can also occur with tuberculosis, and with some non-specific infectious processes. It should be understood that the infection rarely covers only the ovaries and usually affects either the uterus, or fallopian tubes, or both organs at the same time and only after that covers the ovaries. However, in some cases, the infection can penetrate into the ovaries and from other organs by direct contact with an infectious and inflammatory focus or by carrying pathogenic agents along with the blood flow.
- Mechanical damage. Trauma to the ovaries, fallopian tubes, or uterus can cause an inflammatory process that can envelop the ovaries, and also significantly weaken local immunity and become a factor predisposing to infection.
- Inflammation of neighboring organs. The ingestion of biologically active pro-inflammatory substances in the ovaries can trigger the occurrence of some inflammatory reaction.
- Necrosis and inflammation of tumors (tumors). With the development of some tumors, a necrotic process can occur that can trigger an inflammatory response.
Sexually Transmitted Infections
In most cases, the inflammatory process in the pelvic cavity, covering the fallopian tubes and ovaries, is associated with sexually transmitted infections. Most often, the disease is associated with a bacterial lesion caused by the causative agents of gonorrhea or chlamydia, but other pathogenic agents may occur.
Oophoritis can be caused by the following pathogens:
- Gonococci Gonococci are the causative agents of gonorrhea – one of the most common sexually transmitted diseases. These microorganisms penetrate the sexual system during unprotected sexual contact with an infected partner. Initially, they infect the lower parts of the genital tract, but with a weakening of local or general immunity, as well as the development of a number of predisposing factors, they can penetrate the uterine cavity, go to the fallopian tubes and cause infection of the ovaries.
- Chlamydia. Chlamydia is the causative agent of chlamydia, a common venereal disease characterized by a hidden course. Like gonorrhea, this ailment is transmitted during unprotected sexual contact, but unlike it, chlamydia rarely causes any very troubling symptoms. For this reason, this infection is often diagnosed already at the stage of development of various complications, including oophoritis.
- Trichomonas. Trichomonas vaginalis are the causative agents of trichomoniasis – a genital infection, which according to the World Health Organization is the most common among people. As well as chlamydia, trichomoniasis of the lower genital tract is often asymptomatic or with minor clinical manifestations. This creates prerequisites for the spread of the infectious process in the uterine cavity and its appendages. Trichomoniasis rarely affects the ovaries, but the damage to the fallopian tubes caused by it can, in one way or another, cause an inflammatory reaction in the female genital glands with impaired function.
- Mycoplasma. Mycoplasmas are small bacteria that can cause mycoplasmosis. These microorganisms are conditionally pathogenic, in other words, they can cause disease only with a significant violation of a woman’s general condition and with a decrease in her local or general immunity. They are transmitted during sexual intercourse, as well as in certain types of household contacts. For mycoplasmosis is characterized by chronic low-symptomatic course. Penetration into the upper parts of the reproductive system is accompanied by the appearance of signs of severe damage to the genitals.
In most cases, these pathogens penetrate into the region of the fallopian tubes and ovaries in an ascending manner from the lower parts of the urogenital system. This happens gradually and under certain circumstances.
Initially, the infectious process affects the external genitalia (small and large labia and adjacent glands), as well as the urethra and vagina. It should be noted that normally the vagina is populated with Doderlein’s bacilli, which form its normal environment and perform a protective function, since they do not allow pathogenic microorganisms to colonize this organ. However, in some situations, the vaginal microflora and its protective potential may be impaired, which creates prerequisites for the development of infection.
Risk factors for infection of the lower genital organs are:
- incorrect use of antibiotics;
- vaginal douching;
- lack of personal hygiene;
- hormonal diseases;
- diseases of the immune system;
- frequent change of sexual partners;
- unprotected sex.
The spread of infection from the vagina into the uterine cavity is difficult, because between them is the cervix with a narrow channel filled with mucus, impermeable to most microorganisms. The formation of this mucus depends on the hormonal levels, as well as on the state of the cervix and vagina. With significant inflammatory processes, as well as after any intrauterine manipulations, the cervical barrier may be broken.
A risk factor for the spread of infection in the upper parts of the female reproductive system are:
- therapeutic or diagnostic curettage of the uterus;
- installation of intrauterine contraceptives (spirals);
- spontaneous abortion;
All these factors are due to the fact that dilatation of the cervical canal and removal of the mucus plug opens the way for infectious agents in the vaginal cavity.
Further, the infectious process encompasses the uterine mucosa, and then the fallopian tubes and ovaries. In some conditions, pathogenic agents can cause the formation of purulent infectious-inflammatory lesions in the uterus, which is fraught with a serious violation of the general condition and is associated with a high risk of developing systemic complications.
Additionally, the hematogenous route of penetration of infectious agents into the ovaries is considered. This is due to the peculiarities of the blood supply to the ovaries, which receive part of the arterial blood from the branches of the uterine artery. Due to this, pathogens that are capable of being briefly or for a long time in human blood can be introduced into the ovaries together with the bloodstream from the lower parts of the reproductive system.
It is assumed that the inflammatory process in the ovaries can be triggered not only by bacteria, but also by viruses. There are a number of studies that indicate that at least two sexually transmitted viral infections can provoke inflammation in the uterine appendages.
Inflammation of the ovaries can be caused by the following pathogens:
- Herpes simplex virus type 2. The herpes simplex virus of the second type, also known as genital herpes, can enter the body through skin defects, as well as through the mucous membranes of the genital organs during unprotected sexual contact with an infected person. It has the ability to integrate into human cells, due to which a complete cure becomes impossible. Due to scanty symptoms, genital herpes is a fairly common infection. During the period of activation, the virus causes local foci of necrosis of the mucous membrane, which provokes an acute inflammatory reaction.
- Cytomegalovirus.Cytomegalovirus comes from the same family as the herpes simplex virus. Able to infect many organs, including the genitourinary system. In most cases, it does not pose a particular danger, however, against the background of reduced immunity, it can cause serious complications. May cause inflammation of the pelvic organs, alone or in combination with a number of other pathogens (usually bacterial).
It should be understood that the possibility of viral damage to the ovaries at the moment is not fully proven, and there is a possibility that viruses penetrate into the region of the uterine appendages only after the onset of the inflammatory process caused by the initial infection.
Separately, it is necessary to mention the human immunodeficiency virus (HIV), which itself does not affect the upper parts of the female reproductive system, but due to its ability to weaken the immune system creates prerequisites for infection with other pathogens. In addition, on the background of HIV infection, especially at the stage of acquired immunodeficiency syndrome (AIDS), optimal conditions are created for the infection of the genital organs, including the ovaries, not only with aggressive pathogenic microorganisms, but also conditionally pathogenic, which are normally harmless to humans.
Tuberculosis is a common infectious disease caused by mycobacterium tuberculosis. In most cases, this disease affects the lungs, but in some cases, foci may also form in other organs.
Usually, infection with tuberculosis occurs by inhalation of sputum particles containing tubercle bacillus (airborne transmission), however, it is possible penetration of the pathogen when eating contaminated food (milk and dairy products), and also through the skin (seldom). Under conditions of reduced immunity or impaired body resistance, the tubercle bacillus begins to multiply and develop in the tissues of the lungs, provoking a specific inflammatory reaction. As a result, a primary complex is formed, from which pathogens along with the blood flow can get into the bones, kidneys, eyes, skin and genitals.
The penetration of Mycobacterium tuberculosis into the genitals is due to the peculiarities of their blood supply. Since the fallopian tubes and ovaries receive blood from the branches of the uterine and ovarian arteries, at their intersection (so-called anastomoses) blood flow slows down, and this creates ideal conditions for the penetration of bacteria into these organs. The hematogenous pathway is associated with predominantly bilateral lesion of the uterine appendages.
Sexually transmitted infection with tuberculosis is considered impossible, since the environment of the vagina is extremely unfavorable for mycobacterium tuberculosis. However, if the pathogen enters the injured or inflamed mucous membranes of the lower parts of the reproductive system, primary infection of the genitals may occur.
The main problem of tuberculous damage to the fallopian tubes and ovaries is that this disease in most cases is asymptomatic. Women rarely seek medical help because of this infection. This leads to the fact that against the background of a long course of illness, various complications and irreparable structural and functional damage develop.
Mechanical damage to the mucous membrane of the uterus and fallopian tubes
The inflammatory process, as mentioned above, is a kind of protective reaction of the body, which is aimed at reducing the damaging effects of any traumatic factor. Thus, an inflammatory reaction in the area of the uterine appendages can trigger not only bacterial or viral infection, but also mechanical damage.
Mechanical damage to the ovaries and fallopian tubes is possible in the following situations:
- Bumps in the abdomen. Exposure to a short but strong pulse can cause a contusion of many internal organs, including the uterus, fallopian tubes, and ovaries. Under the action of a damaging factor, local structural damage may occur, possibly partial or complete destruction of vessels with impaired local blood circulation. To minimize the effects, the body triggers an inflammatory response, which in some cases can cause even more severe damage.
- Penetrating injuries to the abdomen. Penetrating injuries to the abdomen can cause damage to the upper female genital organs, which can cause an inflammatory process. In addition, most penetrating injuries are potentially infected.
- Surgical intervention on the abdominal and pelvic organs. Any surgical intervention, no matter how minimally invasive it is, to some extent injures the internal organs. Strong pressure on the genitals through surgical instruments, their dissection or cautery may provoke an inflammatory reaction. In addition, do not forget about foreign materials that may be in the area of operation (suture material, various prostheses, stents, gases and solutions) and also cause inflammation.
- Invasive gynecological procedures. Gynecological procedures that involve instrumental effects on the internal genital organs (abortions, scraping) are associated with some injuries that directly provoke an inflammatory reaction. In addition, they reduce local immunity and create prerequisites for the penetration of infectious agents.
Intrauterine devices, which are a common method of contraception, are also one of the factors, which almost three times increase the risk of infectious and inflammatory complications in the pelvic organs. This is due to the fact that the helix weakens the local immunity and contributes to the infection of sexually transmitted infections and, in addition, can itself act as a carrier of pathogenic bacteria.
Inflammation of neighboring organs
The defeat of the ovaries may be associated with an inflammatory process that engulfs the adjacent organs. Most often this is caused by the passage of bacteria from the primary infectious focus through the wall of the organ, but it can occur for a number of other reasons.
The ovaries may be involved in the inflammatory process if the following organs are affected:
- Colon. Inflammation of the large intestine, known as colitis, usually occurs due to an imbalance between the normal and pathogenic intestinal microflora (pathogenic bacteria begin to prevail). In some cases, the intestinal wall can be depleted, it can form sores and even through holes (which leads to the development of peritonitis and is extremely dangerous). In addition, the inflammatory process in the intestine is accompanied by edema, slowing blood flow and impaired function. Under the influence of these factors, there is a risk of pathogens passing through the intestinal wall to neighboring organs – the peritoneum, ovaries and fallopian tubes, and other parts of the intestine.
- Appendix. Inflammation of the appendix (appendicitis) is one of the most common surgical pathologies. There are several theories explaining the mechanism of development of this disease, but regardless of the initial cause, the developing inflammatory reaction affects the entire thickness of the muscular wall of the organ and covers the part of the serous membrane covering it. The pathological reaction arising from this is quite massive, and when in contact with other organs, it can also cover them.
- Bladder. Bladder Infection (cystitis) in some cases can cause inflammation in the ovaries. However, in the overwhelming majority of cases, the ovaries become involved in the inflammatory process not because of contact with the bladder, but because of parallel lesions of the internal genital organs and bladder with sexually transmitted infections.
- Peritoneum. The peritoneum is a serous membrane that covers most abdominal organs and lines the walls of the abdominal cavity itself. Despite the fact that the ovaries are not covered by the peritoneum, an infectious-inflammatory process on the surface of the peritoneum can cause damage to the ovaries. However, much more often it happens the other way around, and inflammation of the ovaries causes local inflammation of the peritoneum – pelvioperitonitis. It should be understood that peritonitis (inflammation of the peritoneum) is an extremely serious condition that requires immediate medical treatment.
It should be noted that the inflammatory process, which covers several closely spaced organs, can cause their adhesion and the formation of adhesions, which causes severe functional impairment. In addition, with significant activity of the inflammatory response, the formation of pathological fistulas (channels) between neighboring bodies (for example, between the rectum and the vagina or the uterus).
Symptoms of ovarian inflammation
The clinical manifestations of ovarian inflammation are quite diverse, but they are not specific, since they are similar to the symptoms of diseases of other pelvic organs.
Symptoms of ovarian inflammation are formed by the inflammatory reaction itself, which, in one way or another, changes the function and structure of the organ, as well as infectious agents, which in most cases are the cause of oophoritis.
Ovarian inflammation is accompanied by the following symptoms:
- lower abdominal pain;
- disruption of the gastrointestinal tract;
- pathological discharge from the genital tract;
- violation of the menstrual cycle;
- painful intercourse;
- hormonal disorders;
- pain in the upper abdomen;
- muscle tension of the anterior abdominal wall.
Lower abdominal pain
Abdominal pain is the main symptom of acute inflammation of the ovaries and fallopian tubes. There are pains due to some increase in the size of the body due to edema, as well as due to the effect of pro-inflammatory biologically active substances on sensitive nerve endings. Since the ovaries are innervated by the branches of the hypogastric nerve plexus, the resulting pain sensation is usually pulling, aching. When involved in the inflammatory process visceral (covering organs) peritoneum pain intensity increases slightly, and the occurrence of reflex vomiting is possible. If the infectious and inflammatory focus covers the parietal (parietal) the peritoneum, the pain is significantly increased, it becomes sharp, there is a reflex muscle tension.
The duration of the pain varies depending on the activity of the inflammation and on the treatment being taken. Usually, pain is present for at least 2 to 3 days, but not more than 3 to 4 weeks.
An increase in body temperature is a nonspecific reaction of the body that occurs in response to the penetration of some foreign protein. Fever is aimed at creating conditions that are unfavorable for the pathogenic agent, but optimal for the functioning of the immune system. Body temperature rises as a result of exposure to a number of biologically active substances formed in the inflammatory focus on the structures of the central nervous system. Fragments of pathogens, particles of foreign proteins, as well as pyrogens (substances that can increase body temperature) formed during immune reactions.
There are three stages of development of fever:
- Rise in temperature. The rate of temperature rise depends on the nature and properties of the pathogen. With a sharp rise, there is a feeling of chills, which indicates the activation of heat-saving mechanisms (reduction of sweating, goose bumps, reduction of peripheral vessels). Body temperature increases due to increased thermogenesis (muscle tremors, accelerated nutrient metabolism).
- Stage plateau. At the plateau stage (keep body temperaturea) the chill sensation disappears and the body temperature stabilizes. Depending on the pathogen, the body temperature during inflammation of the ovaries can rise to 37.5 – 38 or even up to 39 degrees. With the development of complications, the body temperature may exceed 39 degrees.
- Reduced temperature. Decrease in body temperature can occur both gradually and abruptly. The body temperature decreases after eliminating the action of pyrogenic substances, while taking certain medications, as well as when the body is very depleted.
Disruption of the gastrointestinal tract
Inflammation of the ovaries or other parts of the upper genital tract can cause various disorders of the gastrointestinal tract.
The following disorders of the gastrointestinal tract may occur:
- Nausea and vomiting.Nausea and vomiting occur reflexly, in response to intense pain stimulation of the hypogastric nerve plexus. In addition, nausea is one of the possible consequences of an increase in temperature and general intoxication of the body. Vomiting is usually not abundant, not associated with food intake. Abundant, unreliable vomiting indicates possible complications (peritonitis).
- Diarrhea.Diarrhea occurs due to intoxication of the body, as well as due to irritation of the intestinal inflammatory focus.
- The urge to defecate. Frequent urge to defecate occur due to irritation of the ampullary part of the rectum by the inflammatory focus in the genitals and in the area of the peritoneum located in the pelvis.
Pathological discharge from the genital tract
Normally, discharge from the genital tract is a small amount of odorless, transparent or whitish mucus, the discharge of which is not accompanied by any unpleasant sensations.
In the presence of infectious and inflammatory lesions within the upper or lower genital organs, various abnormal vaginal discharge, often indicating ailment, often arise. The nature of the discharge depends on the nature and properties of the pathogen, as well as on the location of the lesion and the body’s resistance.
It should be understood that the discharge can be formed in the vagina, cervix and in the uterus. Infectious-inflammatory process limited to the fallopian tubes or ovaries is extremely rarely accompanied by secretions from the genital tract, since in this case pathological fluids drain more often into the pelvic cavity.
The following variants of pathological discharge from the genital tract are possible:
- Purulent discharge. Purulent discharge is a specific sign indicating the bacterial nature of the pathogens. They are a yellowish-green viscous liquid, the amount of which may vary depending on the severity of the process and the aggressiveness of the pathogen. For purulent discharge characteristic unpleasant smell of rotten fish. When attaching an anaerobic microflora, purulent discharges become frothy, since these microorganisms produce gas, which foams pus.
- Serous discharge. Serous secretions are characteristic of viral lesions of the cervix and uterus. Occur due to the expansion of blood vessels and the exit of the plasma from the bloodstream during the inflammatory reaction. Usually, such secretions are transparent or slightly yellowish, odorless.
- Bloody issues. Spotting occurs when vessels are melted by pathogenic agents or when their integrity is destroyed during an inflammatory reaction. The bleeding is usually scanty, not large, represented by dark blood, occurring regardless of the menstrual period. The discharge may be accompanied by lower abdominal pain.
Violation of the menstrual cycle
The menstrual cycle is a periodic change in the genitals of a woman, aimed at maintaining readiness for conception. This process is regulated by the hormones of the ovaries, hypothalamus and pituitary.
At the heart of the menstrual cycle is the periodic renewal of the mucous membrane of the uterus and the maturation of the egg. This happens in several phases, each of which is regulated by certain hormones. Initially, detachment of the uterine mucosa occurs (endometrium), which is accompanied by bleeding. Subsequently, under the action of sex hormones in the uterus, regeneration of the mucous layer begins, and in the ovaries a dominant follicle is formed. Subsequently, by the time of ovulation, when the follicle breaks and the level of estrogen and progesterone rises, the uterine mucous membrane becomes much thicker, and the egg that leaves the follicle (which at this stage is more correct to call the first-order oocyte) migrates through the fallopian tubes into the uterine cavity. If during this period fertilization does not occur, then this cycle is repeated anew.
With inflammation of the ovaries, the menstrual cycle can be disturbed for the following reasons:
- damage to the uterine lining;
- decrease in the level of sex hormones due to dysfunction of the ovaries;
- ovulation disorders;
- endometrial regeneration disorder.
When inflammation of the ovaries, the following options are possible menstrual disorders:
- lack of discharge during menstruation;
- scanty discharge during menses;
- copious discharge during menses;
- long menstrual cycle;
- pain during menstruation.
The inflammatory process in the pelvic cavity is often accompanied by pain during intercourse. This is usually associated with a lesion of the vagina, but it can also occur if the upper parts of the reproductive system are affected.
Morbidity during sexual intercourse is associated with excessive dryness of the vagina, resulting either from an inflammatory lesion of the vagina itself, or due to a decrease in the level of the sex hormone estrogen. As a result, due to insufficient moisture, friction increases and a painful sensation arises during sex. This leads to the fact that a woman’s sexual desire decreases (libido decreases), mood is disturbed, depression may develop.
Hormonal disorders in inflammation of the ovaries are not always found, but in some situations it is quite possible. They arise because of the structural and functional rebuilding of the body, which leads to a decrease in the synthesis of sex hormones (estrogen and progesterone).
Since one normally functioning ovary is able to maintain the level of sex hormones within the physiological norm, hormonal disorders occur only with bilateral lesion of the organ or with the defeat of the only working ovary.
Hormones are known to regulate many physiological processes in the human body. With a decrease in the level of sex hormones, a disorder of sexual and reproductive function occurs, as well as disorders in the central nervous system (mood changes, depression, manic-depressive states), of cardio-vascular system (heart rhythm disorders, high blood pressure) and from the side of metabolism (obesity occurs, cholesterol levels increase). Of course, some of these manifestations can develop only in the case of a protracted inflammatory process, accompanied by hormonal disruption.
Infertility is one of the most frequent consequences of the inflammatory process in the uterine appendages and often serves as the main reason for a woman to seek medical help.
Infertility in the defeat of the ovaries is associated with impaired production of eggs, as well as with developing hormonal disorders. However, infertility occurs much more often due to damage to the fallopian tubes, which in most cases accompanies oophoritis. Because of the inflammatory reaction, the fallopian tubes narrow, functional and structural changes occur in them, which lead to partial or complete obstruction for the egg cell and spermatozoa.
Muscle tension of the anterior abdominal wall
Muscle tension of the anterior abdominal wall occurs when parietal involvement in the inflammatory process (parietal) peritoneum. Muscle contraction occurs reflexively, in response to strong pain stimulation emanating from the inflammatory focus. Due to muscular tension, tension and irritation of the peritoneum is reduced, which makes it possible to somewhat ease the pain sensation.
In addition to the above symptoms, the inflammatory process with localization in the ovaries and fallopian tubes may be accompanied by a number of other signs, which in most cases occur already at the stage of development of complications.
Inflammation of the uterus may be accompanied by the following signs of a complicated course:
- Pain in the upper abdomen and in the right hypochondrium. A painful sensation in the right hypochondrium, which arose against the background of lower abdominal pain, temperature and other signs of damage to the female reproductive system, indicates the occurrence of perihepatitis – inflammation of the liver capsule (Fitz-Hugh-Curtis syndrome). Characterized by some impaired liver function, increased levels of liver enzymes, and sometimes – yellowness of the skin and mucous membranes.
- Abdominal swelling on the part of the lesion. The occurrence of abdominal swelling on the part of the affected ovary, which can be determined visually or during palpation, indicates the development of tubo-ovarian abscess – a cavity filled with purulent contents. It is a potentially dangerous condition that requires surgical treatment.
Diagnosis of ovarian inflammation
Diagnosing ovarian inflammation is challenging because the disease has symptoms similar to some other ailments, and also because the inflammatory response is rarely limited to the ovaries alone, involving the uterine tubes, uterus, and other parts of the genital system. This creates additional difficulties in diagnosing the disease.
Before the start of any diagnostic procedures, a conversation with a doctor is conducted, during which the main symptoms, their time of onset, intensity, and main characteristics are ascertained. Data is collected on surgical operations performed, on known acute and chronic diseases. The doctor finds out whether the menstrual cycle is regular, when there were the last menstruation, what the amount of discharge during the menstruation is, whether the menstruation is accompanied by painful or unpleasant sensations.
The inflammatory process in the area of the uterus is suspected in the presence of the following symptoms:
- lower abdominal pain;
- pathological discharge from the genital tract;
- increased body temperature;
- hormonal disorders;
- violation of the menstrual cycle;
- recent venereal diseases;
- frequent change of sexual partners;
- age up to 25 years;
- non-use of barrier contraception methods (condoms);
- the presence of intrauterine device;
- recent intrauterine manipulations (abortion, scraping, setting spiral).
However, it is impossible to make a diagnosis based only on these signs. A more detailed examination with the use of various methods of instrumental and laboratory diagnostics is necessary.
The diagnosis of oophoritis is based on the following procedures:
- gynecological examination;
- Ultrasound of the pelvic organs;
- microbiological examination.
Gynecological examination involves a visual examination of the external genital organs, vagina and vaginal part of the cervix. This procedure is performed when a woman is in a gynecological chair with divorced legs. The doctor inserts a special instrument into the vagina, called a vaginal speculum, which allows you to push the walls of the organ apart, perform a visual inspection and take the necessary materials for further analysis.
With isolated inflammation of the ovaries, the gynecological examination does not reveal any abnormalities. However, since in the absolute majority of cases with this ailment other departments of the reproductive system are involved in the infectious-inflammatory process, a number of non-specific signs are determined upon examination.
The gynecological examination revealed the following signs:
- redness of the vaginal mucosa;
- swelling of the vaginal mucosa and vaginal part of the cervix;
- the presence of ulcers on the surface of the vaginal mucosa;
- the presence of purulent or frothy discharge in the cavity of the vagina or in the posterior fornix of the vagina;
- traces of pathological secretions at the mouth of the cervical canal.
After the examination, a bimanual examination is conducted, during which the doctor inserts the index and middle fingers into the woman’s vagina and feels the cervix. With the other hand, the doctor palpates the upper edge of the uterus through the abdominal wall. Through this procedure, the doctor can assess the mobility of the uterus, the degree of softening of the cervix, determine the area of pain, to identify any bulk formation.
By bimanual palpation in women with a sufficiently thin anterior abdominal wall, the ovaries can be palpated, which in case of inflammation is enlarged and painful.
Ultrasound of the pelvic organs
Ultrasound examination of the pelvic organs is an extremely informative method, which allows, without surgical intervention, to determine the degree of damage to the internal organs.
When ultrasound of the pelvic organs revealed the following changes:
- Enlarged ovaries in size. During the inflammatory reaction, edema occurs, which leads to an increase in body size. Normal ovarian sizes are on average 25 mm wide, 30 mm long, and 15 mm thick.
- Thickening of the fallopian tubes. Since the inflammatory process that engulfs the ovaries, in most cases involves the fallopian tubes, ultrasound reveals signs of salpingitis (tubal inflammation). Normally, the fallopian tubes are almost invisible by ultrasound, but due to the thickening of the wall during inflammation, they become noticeable.
- Smooth ovarian surface. Normally, the surface of the ovaries is slightly bumpy due to the formation of follicles. When ovarian dysfunction, as well as due to edema, the surface of the organ is smoothed.
- Strengthening echostructure. The enhancement of the echo structure of the ovaries occurs due to the formation of fibrosis sites in the thickness of the ovaries.
- Signs of inflammation in the uterus. The inflammatory process in the uterus is a frequent symptom that accompanies oophoritis. This is detected by ultrasound on the thickening of the endometrium, on the areas of fibrosis in the uterus, as well as on hypoechoic formations in the wall of the organ.
Laparoscopy is a minimally invasive diagnostic method that allows you to directly visualize the surface of the ovaries, and which allows you to immediately perform some therapeutic operations.
Laparoscopy is carried out by introducing the chamber and some manipulators into the abdominal cavity through small punctures in the anterior abdominal wall. Thanks to the injection of gas (in diagnostic operations – oxygen, in surgical interventions – carbon dioxide) and the presence of an optical system with illumination, the doctor may directly consider the organs of interest. This procedure is performed under sterile conditions of the operating room under general anesthesia.
When diagnosing inflammation of the uterine appendages, laparoscopy is the “gold standard” because it allows you to quickly establish the diagnosis, determine the degree of structural changes in the organs, and also perform the necessary surgical intervention. In addition, after this study, patients quickly return to their normal activities.
Laparoscopy can detect the following signs of damage to the uterus:
- pus in one of the fallopian tubes;
- fresh (easily shareda) adhesions in the uterine appendages;
- sticky (fibrous exudatea) on the surface of the ovaries and fallopian tubes;
- enlarged ovaries in size;
- bleeding of the ovaries when pressed.
In addition to examining the pelvic organs, other organs of the abdominal cavity are examined during laparoscopy in order to exclude other possible pathologies, as well as to determine the extent of the inflammatory response.
Despite all the advantages of laparoscopy as a method for diagnosing oophoritis and other inflammatory diseases of the upper genital tract, using it as a routine method of examination is irrational. This is due, firstly, to the rather large cost of the procedure, and secondly, to a number of risks and possible side effects.
Microbiological examination of the contents of the cervical canal, vaginal cavity or uterine cavity is an extremely informative method of laboratory diagnosis. This procedure allows you to establish the nature of the pathogen and on the basis of these data plan treatment.
There are the following methods for identifying and identifying pathogenic agents:
- Bacterioscopic method. The basis of bacterioscopy is the study of stained smears obtained by placing the material under investigation on a glass slide under a light microscope. This method allows to detect gonococci, chlamydia, Trichomonas, and some other pathogens. In addition, smear microscopy can be used to evaluate the extent of the inflammatory response.
- Bacteriological method. The bacteriological method allows extremely accurate identification of pathogens and detection of their sensitivity to antimicrobials, but it requires a lot of time. Bacteriological examination is carried out by seeding the pathological material obtained from the patient on special media that are placed in a thermostat for several days. At the same time, pathogenic bacteria begin to multiply actively, which makes it possible to identify them further by a number of signs.
Treatment of ovarian inflammation
The basis of drug treatment is the use of pharmacological drugs that can destroy the causative agents of the disease, as well as agents with anti-inflammatory and immunomodulatory effects.