In some cases the disease can have devastating effects; rendering a woman or adolescent unable to care for herself or her family, attend school or social functions, maintain her career or personal obligations. Endometriosis affects not only the patient but can impact everyone around her.
This is a typical comment: “a woman with endometriosis often feels her life is a battleground: she must fight with pain simply to meet her obligations each day, fight to maintain her dignity in the work place despite numerous absences and sick leaves, constantly fight with physicians who are uninformed, etc.”
Endometriosis is an unsolved problem and women today are still being misdiagnosed and suffering from horrible and ineffective treatments.
Most of the patients experience pain and/or either infertility or the threat of infertility. In some cases, even though women suffering from endometriosis are not trying to get pregnant, they feel a great fear and sadness that they will never be able to conceive.
Endometriosis is a chronic disease that patients deal with every day, it is not just a one time pain. This is the backdrop of endometriosis that patients live with.
Many patients suffering from endometriosis feel that their medical and emotional support needs are not being adequately addressed. They seek support in other women with endometriosis, spouses or partners, friends or extended family, and feel that health care providers are the least supportive.
This disease often goes undiagnosed. Usually, the biggest problem is getting endometriosis diagnosed in the first place. In fact studies have shown that the average delay in actual diagnosis is upwards of 9 years.
During that time, patients must be forced to “doctor shop” to find a physician who will take their symptoms seriously; are referred to psychiatrists by some physicians claiming that the pain is “all in their head”; are accused of “drug seeking” are told that they are “too old” or “too young” to have the disease or are subjected to other invalidated claims like “you had a baby, you can’t have endo”. Patients suffer from luck of social support from friends and family, and many other injustices.
Even once diagnosed through surgery, many are still not offered proper treatment or support. Some are surgically diagnosed but disease is left intact; others are surgically diagnosed and treated, but all disease is not removed. Still others are placed on medical therapy or told to “get pregnant” following surgery. Neither is curative, and certainly, “prescribed pregnancy” is not an effective means of managing endometriosis, nor does it help a patient suffering from endometriosis-related infertility. Hysterectomies are still widely performed; these are not always helpful for women with endometriosis outside their reproductive organs.
Patients want health care providers to listen to them, believe them, be knowledgeable about endometriosis, provide information, not have a condescending attitude, and to recognize that each woman is an individual. These themes are also reflected in this advice to health care professionals:
• listen
• believe
• educate yourselve about endometriosis
Infertility is a common condition.
Approximately 1/6 of all married couples are without offspring contrary to their will, even though the exact number depends inevitably on how this condition is defined.
Usually infertility is not due to only one reversible cause, but is also due to biological, social and economic reasons.
What is sure, however, is that the sole determinant factor of fertility of a couple is the woman’s age. We would like to characteristically mention that for women up to the age of 25, the cumulative conception rate is 60% in 6 months time and 80% in one year, whereas for couples where the woman is 35 years or older, the conception rates are 60% in one year and 80% in two years, in other words their fertility is half the rate.
The number of couples that seek medical consultation and treatment for reasons of infertility is growing.
The problem of infertility, besides its medical hypostasis, surely has social, ethical and financial extensions which are not predictable.
The Take Home Baby Rate depends on the rate of conception as well as the survival of the gestation, which in the case of infertility is determined to a large extent by the rate of miscarriages.
By convention, when one refers to a patient as infertile, this means a low rate of conception, since infertility is rarely absolute (sterility).
As mentioned above, in normal people, age represents the most determinant factor for the rate of conception.
When all the other factors are constant, a couple in which the woman is 25 years old or less has 5 to 6 chances to conceive the year following the discontinuation of contraceptive measures.
If pregnancy is not achieved by then, despite the occurrence of a normal menstrual cycle and normal s*xual life, most experts would accept that this couple has an infertility problem and would recommend investigation and treatment.
If there is a medical history of menstrual disorders, the evaluation of the woman’s fertility should consider the time period necessary to display all 12 or 13 ovulations which women with normal menstrual cycles have in one year.
It is clear that if one woman has 4 ovulations in one year, she will need 3 times more time to achieve the same possibility to becoming pregnant in comparison to a woman with a normal menstrual cycle. In this case it is not worth delaying the medical investigation of the patient for 1year.
Likewise, if there is a history of Pelvic Inflammatory Disease (PID), severe appendicitis (especially in the case of peritonitis), or if the spouse has a history of testitis, or a history of cryptorchidism, the investigation must commence even sooner.
A more difficult problem is to define infertility in a couple with a relatively old woman.
At first, someone could think to delay the investigation for the reason that a 35 years old woman or older needs more time to achieve a certain conception rate.
On the other hand, the slope of the curve that gives the correlation of the risk for childlessness as a function of age gets more abrupt as women approach the age of 40.
Therefore, there is little time to lose in such couples and in our practice we are more offensive in recommending investigation and treatment when the patient is older than 35.
There seems to be no benefit in waiting beyond one year and in most women (especially those with some diagnostic signs in their medical history) we recommend they begin their investigation after 6 months of unprotected s*xual intercourse.
Mammography is the most reliable means of detecting breast cancer before a mass can be palpated in the breast. Some breast cancers can be identified by mammography as early as 2 years before reaching a size detectable by palpation.
Although false-positive and false-negative results are occasionally obtained with mammography, the experienced radiologist can interpret mammograms correctly in approximately 90% of cases. For women with a history of mammographically occult lesions or otherwise at high risk for harboring cancer that is not detectable by mammogram, magnetic imaging resonance (MRI) and ultrasound may be warranted but they are not recommended for screening the general population.
Other than for screening, indications for mammography are as follows: (a) to evaluate each breast when a diagnosis of potentially curable breast cancer has been made, and at yearly intervals thereafter; (b) to evaluate a questionable or ill-defined breast mass or other suspicious change in the breast; (c) to search for an occult breast cancer in a woman with metastatic disease in axillary nodes or elsewhere from an unknown primary; (d) to screen at regular intervals a selected group of women who are at high risk for developing breast cancer (see below); (e) to screen women prior to cosmetic operations or prior to biopsy; and (f) to follow women who have been treated with breast-conserving surgery and radiation.
Patients with a dominant or suspicious mass must undergo biopsy regardless of mammographic findings. The mammogram should be obtained prior to biopsy so that other suspicious areas can be noted and the contralateral breast can be checked. Mammography is never a substitute for biopsy because it may not reveal clinical cancer in a very dense breast, as may be seen in young women with fibrocystic change, and it often does not reveal medullary-type histology breast cancer.
Endometriosis is a disease primarily of the female reproductive system that is often misdiagnosed, and the result of misdiagnosis can have devastating consequences to the sufferer. It is a common and often debilitating condition. It most frequently affects women in their reproductive years.
Endometriosis is a disease affecting an estimated 77 million women and teens worldwide. It is a leading cause of infertility, chronic pelvic pain and hysterectomy. At the time of tubal ligation 2-5% of women will have endometriosis, while between 25-50% of infertile women have been reported to have endometriosis. Endometriosis affects approximately 6-7% of all females, 30-40% of whom are infertile.
"Endometriosis is defined as the abnormal growth of endometrial cells - the same cells that make up the lining of the uterus and are shed monthly in the menstrual process - outside the uterus" (Schrotenboer and Subak- Sharpe, 74)
These wayward cells can position themselves in the lower abdomen on areas such as the female organs and the stomach, and occasionally they can be found in such remote places as the lungs. On these locations the cells act as though they are uterine cells, adjusting to the changing hormone levels of the menstrual cycle. But unlike uterine cells, they have no passage-way out of the body so they stay where they are and they continue their cycle, causing scarring and adhesions as the body attempts to protect itself from the harm. (Schrotenboer and Subak-Sharpe, at al., 74-76)
Except of the trophoblast, endometriosis is the only example of a benign proliferative process that invades and distorts or even destroys otherwise normal organs. The rate at which proliferation and invasion occur is governed by unknown factors, and these processes are unpredictable. Therefore, the natural course of the disease in any individual patient cannot be predicted.
Elounda Kriti, Myconos and Santorini following my steps... well in this case art imitates life!!!
The genus Chlamydia contains three species that infect humans: Chlamydia psittaci, Chlamydia trachomatis, and Chlamydia pneumoniae (formerly the TWAR agent). C. psittaci is widely distributed in nature, producing genital, conjunctival, intestinal, or respiratory infections in many mammalian and avian species. Genital infections withC. psittaci have been well characterized in several species and cause complications such as abortion and infertility. Although mammalian strains of C. psittaci are not known to infect humans, avian strains occasionally do so, causing pneumonia and the systemic illness known as psittacosis.
C. pneumoniae is a fastidious chlamydial species that appears to be a frequent cause of upper respiratory tract infection and pneumonia, primarily in children and young adults, and is a cause of recurrent respiratory infections in older adults. No animal reservoir has been identified for C. pneumoniae; it appears to be a human pathogen spread via the respiratory route through close personal contact. To date, all strains of C. pneumoniae studied have been serologically homologous.
C. trachomatis is exclusively a human pathogen and was identified as the cause of trachoma in the 1940s. Since then, C. trachomatis has been recognized as a major cause of sexually transmitted and perinatal infection.
Chlamydiae are obligate intracellular parasites. They possess both DNA and RNA, have a cell wall and ribosomes similar to those of gram-negative bacteria, and are inhibited by antibiotics such as tetracycline. Chlamydiae are classified as bacteria belonging to their own order (Chlamydiales).
Recent studies using monoclonal antibodies to and nucleotide sequencing of the major outer-membrane protein have delineated at least 20 serotypes of C. trachomatis. According to the serovar classification system of Wang and Grayston, strains associated with trachoma have generally been those of the A, B, Ba, and C serovars, while serovars D through K have largely been associated with sexually transmitted and perinatally acquired infections. Serovars L1, L2, and L3 produce lymphogranuloma venereum (LGV) and hemorrhagic proctocolitis. The LGV strains demonstrate unique biologic behavior in that they are more invasive than the other serovars, produce disease in lymphatic tissue, grow readily in cell culture systems and macrophages, and are fatal when inoculated intracerebrally into mice and monkeys. Non-LGV strains of C. trachomatis characteristically produce superficial infections involving the columnar epithelium of the eye, genitalia, and respiratory tract.
C. trachomatis has been reported as an infrequent cause of endocarditis, peritonitis, pleuritis, and possibly periappendicitis and may occasionally cause respiratory infections in older children and adults. Immunosuppressed patients with pneumonia have had, in some cases, either serologic or cultural evidence of C. Trachomatis infection, but more data are necessary to define the role of Chlamydia in these patients.
The first person known to have described the "female prostate" in Western medical literature was Reinier De Graaf (1641-1673) in the year 1672. He described it as a collection of functional glands and ducts surrounding the female urethra. He said the glands and ducts produced a "pituitoserous juice;" meaning it produces a thick mucous that is pale yellow or transparent in color. He said the function of this fluid was to make "women more libidinous with its pungency and saltiness and lubricates their s*xual parts in agreeable fashion during coitus." Despite his observation modern Western medicine did not fully accept the concept of a "female prostate" until 2001 when the Federative Committee on Anatomical Terminology agreed to use this term in their next edition of Histology Terminology.
The incidence of endometriosis appears to be increasing. Such increase is real, as well as apparent. The real increase is probably due to the current trend of postponing conception well into the fourth decade of life. The apparent increase is due to both the frequent and indicated use of diagnostic laparoscopy as well as the heightened awareness of this disease complex by gynecologists.
In 1949 Meigs found that 5 to 15% of patients undergoing pelvic operations had endometriosis. This incidence increased to 18% of all gynecologic laparotomies as reported in 1978. Presently, it is estimated that one third to one half of all patients undergoing major gynecologic procedures have findings of endometriosis.
From the early report of Meigs, it was noted that women who defer pregnancy to a later age and belong to higher socioeconomic groups were more frequently found in those who had endometriosis. Thus with increasing numbers of women working and pursuing careers and the accompanied deferment of pregnancies into the fourth decade of life, the incidence of endometriosis is likely to increase further.
Contrary to traditionally held views, endometriosis is more common in teenagers than hitherto believed. Endometriosis accounted for 65% and 47% of 43 and 140 symptomatic teenagers, respectively who underwent laparoscopy.
Endometriosis has also been frequently found in women who have undergone elective tubal sterilization. Endometriosis was found in 21 % of 54 women who had tubal ligation. In another study, endometriosis was found in 74% of women whose tubes were sterilized within 4 cm from the proximal end, but only 20% if the tubes were interrupted more than 4 cm from the proximal end. Although endometriosis generally regresses with the menopause, when cyclic ovarian activity ceases, postmenopausal endometriosis was found in 1.3% of 903 patients operated on for endometriosis.
There is a familial incidence of endometriosis with a 7% relative risk of developing it if a first degree female relative has it. The incidence of severe endometriosis in the familial group is higher (61.1%) than in the non familial group (23.8%).
Contrary to the former belief that endometriosis affects whites more often than blacks, it is now clear that black women are as frequently affected by endometriosis as their counterparts. therefore endometriosis should be considered in black patients who present with pelvic pain but do not fit the diagnosis of pelvic inflammatory disease.
Regardless of the origin of the disease, the lesion is more apt to occur and become clinically significant in women who have postponed childbearing, as prolonged cyclic ovarian function, uninterrupted by pregnancies, results in a continuous stimulus to proliferation and extension of the disease.
Women striken with endometriosis also experience a host of other complications as well; for example: irritable bowel syndrome, immune deficiency dysfunction, and perhaps most disheartening of all, primary and/or secondary infertility.
Endometriosis is one of the leading causes of infertility among women. This is one of the most poorly understood, misdiagnosed diseases today.
There is no known cure for endometriosis available at this time. There are only means of suppressing the disease for a limited time and ways of treating the pain associated with it.
According to Plato, in the old days, human nature was not as it is today, but different. Human sexes were not just two but existed a third one called “androgen”, which was derived from those two. Androgens had great power and immense arrogance and they dared to oppose the gods. This is why Zeus wanting to preserve human race but make humans weaker and stop their debauchery, divided androgens in two different beings, a man and a woman. Due to that division, every human desires to be reunited with his other half and if by chance they find it, they feel extraordinary friendship and intimacy and love and they don’t want to be separated not even for a moment. So they spend their lives together, without even knowing what they found in each other. One should not imagine that the reason for their joy is just s*xual coitus. It is apparent that their souls seek something else, something that they cannot express but they both deeply feel and let it show. That desire for reunification, for becoming one with your other half due to the initial nature of humans, is called “Eros”. This is how humans seek to become complete once again.
Becoming complete once again by Eros in the way described above is not a process of Heterodetermination. It is not a process of defining ourselves through our differences and try to complete ourselves by adapting elements borrowed from others. It is a process of fusion of two complete beings and transformation into a superior one. It takes a complete man and a complete woman to form an androgen.
Fighting for all Greecs, the Athenians at Marathon destroyed the force of the gold bearing Persians
An increased insidence of Pap smears indicative of CIN IV to III lesions in teenaged ptaients, suggests that even teen agers should be encouraged to have a Pap Smear at least once per year. It is common knowledge that most teenagers are sexually active and for many s*xual activity begins at the age of 14. Those patients must be treated as adults and not children. Screening tests must be performed the same as in the case of adults and information concerning cervical cancer, gynecologic infections and infertility must be provided. This way, serious negative effects may be avoided.
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