Part 2. CHAPTER VII

PART 2

CHAPTER VII

SEXUALLY TRANSMITTED INFECTIONS AND OTHER URO-GENITAL DISEASES AND DISORDERS WITH POSSIBLE SEXUAL AND REPRODUCTIVE HEALTH SEQUALS

2.7.1. Sexually Transmitted Infections

The prevalence and pattern:

We analyzed the history of diseases, disorders, clinical signs and symptoms during the life span of the respondents suggestive of previous or current STDs. The rates of the specific infections are given in Figure 2.7.1. The most frequently reported STDs in Armenian women are Fungal infection, Trichomoniasis, and Chlamydial infection.

Almost one half (48%) from the total of 429 reported STD cases were contributed to Fungal infection, 21% to Trichomoniasis and 8% to Chlamydiosis (Table 2.7.1.). Some women reported a history of more than one STD.

In many STD cases, women were not aware that infection might exist in both partners. Only about 9% of the survey respondents admitted to a history of STDs in their sexual partners (Figure 2.7.2.).

The clinical signs, symptoms and diseases suggestive of the history of STDs:

The assessment of the clinical signs and symptoms, which might be associated with the sexually transmitted infections revealed that more than 50% of women ever had lower abdominal or back pain, 47% have had vaginal discharge, 23% have had irritation or itching of the genitals, and 16% have had history of pain or burning while passing urine (Figure 2.7.3.). Their admitted uro-genital symptoms indicate that the actual rates of the specific STDs might be higher than reported.

Figure 2.7.4. demonstrates the percentage distribution of women according to the history of genito-urinal inflammatory diseases, which might be caused by the sexually transmitted infections. A history of inflammation and/or ulceration of the uterine cervix (Cervicitis, Errosio etc.) were mentioned by 29% of the respondents. Inflammation of the ovaries (Oophoritis) was reported by more than 24% of women, inflammation of the bladder (Cystitis) by 14%. Eleven percent of women had a history of vaginal inflammation (Vaginitis, Vaginosis etc.), and about 7% had a history of inflammation of the uterine tubes (Salpingitis).

The frequency of recurrent infection:

This study shows that many women with a history of genito-urinary inflammatory diseases have had recurrent infections (Table 2.7.2.). More than one episode of bladder inflammation (Cystitis) was reported in about one third of the cases (32.5%) and recurrent inflammation of the external genitalia in almost 19%.

As demonstrated in Table 2.7.3., some women with STDs either did not receive medical care or received ineffective treatment, which indicates the lack of access to medical counseling and the low quality of care.

According to the best of the women’s knowledge, only 61% of the men with a history of STDs received treatment (Table 2.7.4.). The lack of medical counseling and care of sexual partners might explain the high frequency of recurrent STDs among the respondents of this survey.

2.7.2. Polycystic Ovarian Syndrome, Cysts and Other Benign

Genito-urinary Tumors

A total number of 73 women (5%) described the history of polycystic ovarian syndrome (POS) or ovarian cysts (Figure 2.7.5.). Polycystic ovarian syndrome is usually associated with hirsutism (excessive hairiness in women), menstrual disorder and infertility.

Fifty-nine women (4%) had a history of uterine myomas or fibromyomas. Although most of the ovarian cysts, myomas and fibromas are not malignant, they may reach a very large size producing pain, vomiting and bleeding.

Twenty-eight women (2%) had a history of the removal of endometrial or cervical polyps. In about 18% of the cases the polyps were recurrent. Endometrial or cervical polyps might result in the long-term infertility in women.

2.7.3. Menstrual Dysfunction and Other Symptoms of the Endocrine Disorders

Menstrual dysfunction:

Almost all women (99.9%) have had menstrual periods (Table 2.7.5.) except for one woman with primary amenorrhoea (in primary amenorrhoea the menstrual periods fail to appear at puberty often because of a congenital defect, e.g. “Turner’s syndrome”).

The great majority of respondents had regular menstrual cycles (85%). About 13% of women had irregular periods, including oligomenorrhoea (oligomenorrhoea is a sparse or infrequent menstruation, which is delayed for not more than 6 months).

Twenty-six women (2%) had secondary amenorrhoea (in secondary amenorrhoea the menstrual periods stop for 6 or more months after establishment at puberty). Secondary amenorrhoea might be due to a great variety of reasons, including disorders of the hypothalamus (a part of the brain), deficiency of ovarian hormones, depression etc. Menstrual disorders are usually associated with anovulation or other ovulatory disturbances, which are main causes of infertility in women.

Before the start of sexual activity more than 39% of women had painful menstrual periods, so called primary dysmenorrhoea. Primary dysmenorrhoea begins with the first period and has no apparent cause. More than 22% of women had severe dysmenorrhoea before the start of sexual activity. Its frequency decreased more than twice (10%) after the start of sexual life (Table 2.7.6.).

Hirsutism:

Two hundred and eighteen women (16%) mentioned excessive hair growth in their face or on the other unusual places of their bodies (hirsutism), which is usually associated with the polycistic ovary syndrome. The age at start of the hirsutism varied from the 9 to 43 years of age, and an average was 27 years (SD=7.1). Most women with hirsutism (84%) did not apply for medical care (Table 2.7.7.).

Galactorrhoea:

At the time of this survey 25 women (1.8%) had discharge from nipples and the same number of women (1.8%) mentioned that they had discharge in the past (Table 2.7.8.).

In most of the cases (68%) it was abnormally copious milk secretion after breast-feeding had been stopped (galactorrhoea). Excessive secretion of a hormone prolactin, which is synthesized and stored in the anterior pituitary gland stimulates milk production (functional hyperprolactinemia) and is one of the causes of female infertility. Organic hyperprolactinaemia might be related to the pituitary tumor (microadenoma of the hypophysis).