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Vaginitis

Vaginitis is a condition characterized by inflammation of the vagina and vulva, most often caused by a bacterial, fungal, or parasitic infection.

Description

Vaginitis, vulvitis, and vulvovaginitis are general terms that refer to the inflammation of the vagina and/or vulva (the external genital organs of a woman).

These conditions can be caused by bacterial, fungal, or parasitic infections; or by any type of allergic or irritation reaction to such things as spermicidal products, condoms, soaps, and bubble bath. A type of vaginitis that is caused by a low estrogen level is called atrophic vaginitis.


In general, vaginitis causes one or more of these symptoms: vaginal discharge; irritation; a burning sensation; and itching. One of the most common reasons women visit their doctor is because of a change in their vaginal discharge.

It is completely normal for a woman to have a vaginal discharge, with the amount and consistency varying during the course of the trichomoniasis. Each will be discussed separately.

Bacterial vaginosis

Bacterial vaginosis is the most common cause of vaginitis during the childbearing years. Forty percent to 50% of vaginitis cases are caused by bacterial vaginosis. The occurrence of bacterial vaginosis is difficult to determine, but studies have proposed that 10–41% of women have had it at least once.

The occurrence of bacterial vaginosis in the United States is highest among African American women and women who have had multiple sexual partners, and is lowest among Asian women and women with no history of sexual contact with men.

Bacterial vaginosis is not considered a sexually transmitted disease although it can be acquired through sexual intercourse. Recent findings indicate that bacterial vaginosis can be transmitted among women who have sex only with women, if vaginal secretions are exchanged.

Bacterial vaginosis is not caused by a particular organism but by a change in the balance of normal vaginal bacteria or by a change in the pH balance. Ninety percent of the bacteria found in a healthy vagina belong to the genus Lactobacillus. For various reasons, there is a shift in the bacterial population that results in overgrowth of other bacteria.

Patients suffering from bacterial vaginosis have very high numbers of such bacteria as Gardnerella vaginalis, Mycoplasma hominis, Bacteroides species, and Mobiluncus species; and these bacteria can be found at numbers 100–1,000 times greater than are found in the healthy vagina. In contrast, Lactobacillus bacteria are very low in number or completely absent from the vagina of women with bacterial vaginosis.

Candida vulvovaginitis

Candida vulvovaginitis also has been called vulvovaginal candidiasis, candidal vaginitis, monilial infection, or vaginal yeast infection. Twenty to 25% of the vaginitis cases are candida vulvovaginitis. It has been estimated that about 75% of all women get a vaginal yeast infection at least once. In 80–90% of the cases, candida vulvovaginitis is caused by an overgrowth of the yeast Candida albicans.

The remaining cases are caused by other species of Candida. It is not known what causes the yeast overgrowth. However, it is known that antibiotics can inadvertently kill normal bacteria in the vagina and cause an overgrowth of Candida.

Candida vulvovaginitis is not considered a sexually transmitted disease because Candida species are commonly found in the healthy vagina. It is rare to find this disease in girls before puberty and in celibate women.

Vaginal yeast infections tend to occur more frequently in women who are pregnant; diabetic and not controlling their disease; taking birth control pills, steroid drugs, or antibiotics; and those with the human immunodeficiency virus (HIV). The occurrence of four or more attacks per year is called recurrent vaginal candidiasis.

Trichomoniasis

Trichomoniasis, which is sometimes called “trich,” accounts for 15–20% of the cases of vaginitis. It is estimated that two million to three million American women get trichomoniasis each year. Unlike the previous two types of vaginitis, trichomoniasis is primarily a sexually transmitted disease in that the disease is passed from person-to-person primarily by sexual contact.

Trichomoniasis occurs in both men and women and is caused by an infection with the single-celled parasite Trichomonas vaginalis. Infection with Trichomonas vaginalis is frequently associated with other sexually transmitted diseases and helps spread the AIDS virus.

Causes and symptoms

Vaginitis is most often caused by a bacterial, fungal, or parasitic infection as described above. Other microorganisms may cause vaginitis, or it may be caused by allergic reaction, irritation, injury, low estrogen levels, and certain diseases. Common causes of bacterial vaginosis include:

• Repeated sexual intercourse over a short period of time, which raises vaginal pH and results in growth of bacteria and infection-like symptoms.
• Chronic vulvar dampness, aggravated by stress or restrictive, nonabsorbent synthetic clothing.
• Chemical irritants.
• Antibiotics, which disrupt the natural vaginal (and bowel) bacterial environment.

Additional risk factors for bacterial vaginosis include stress; a poor diet; use of an intrauterine device (IUD); being a member of a non-white race; a history of at least one prior pregnancy; first sexual activity at an early age; having multiple sex partners, and a history of sexually transmitted diseases.

Persons at an increased risk for candida vulvovaginitis include those who have had previous candida infections, have AIDS, or are diabetic; women who use douches, perfumed feminine hygiene sprays, vaginal sponges, or an IUD; those taking birth control pills, antibiotics, or corticosteroids; and those who wear tight clothing, are pregnant, or engage in frequent sexual intercourse.

The typical symptoms of vaginitis are vaginal discharge, itching, burning sensation, and irritation. Some women have few or no symptoms, while others may have pronounced symptoms.

The main symptom of bacterial vaginosis is a fishy-smelling, thin, milky-white or gray vaginal discharge. Itching and burning may also be present. The fishy smell is stronger after sexual intercourse. The symptoms of candida vulvovaginitis are itching, soreness, painful sexual intercourse, and a thick, white, curdy (like cottage cheese) vaginal discharge.

Trichomoniasis symptoms in women range from none at all to painful urination; painful sexual intercourse; and a yellow-green to gray, foul-smelling, sometimes frothy, vaginal discharge. In men, trichomoniasis may present no symptoms, or it may be associated with urethral discharge or persistent urethritis (inflammation of the urethra).

Diagnosis

Vaginitis can be diagnosed and treated by a nurse practitioner or physician. Most insurance companies cover the costs of diagnosis and treatment. To diagnose vaginitis, the doctor will examine the vagina (using a speculum to keep the vagina open) and take a sample of the vaginal discharge for tests and microscopic analysis.

Laboratory culture results should be available in two to three days, but the microscopic examination of the vaginal discharge may be performed immediately in the doctor’s office. Diagnosis may be difficult because there are many different causes of vaginitis.

Women who think that they have vaginitis should always visit their doctor to get an accurate diagnosis. Many women assume that they have a yeast infection and take over-the-counter medicines without first consulting their doctors.

To make a diagnosis of bacterial vaginosis, the doctor will check for four signs, called Amsel’s criteria. These signs are: a thin, milky-white discharge that clings to the walls of the vagina; presence of a fishy odor; a vaginal pH of greater than 4.5; and the presence of “clue cells” in the vagina.

Clue cells are vaginal cells that are covered with small bacteria. A diagnosis of candida vulvovaginitis is made after finding a normal vaginal pH (4–4.5) as well as the presence of many yeast cells in the sample of vaginal discharge or growth of yeast on laboratory media.

A trichomoniasis diagnosis is made when the parasites are found in the vaginal discharge either by microscopic examination or in laboratory cultures. The newest system for testing for trichomoniasis is the InPouch test, which is more accurate than the older wet-mount method and easier to perform.

Treatment

Herbal remedies for vaginal infections are being aggressively investigated as of 2002 in hopes of lowering the rates of sexually transmitted diseases in developing countries that cannot afford Western allopathic treatments. Chinese, Ayurvedic, naturopathic, and homeopathic treatments for vaginitis are all being studied.

One of the primary focuses of alternative treatment for vaginal conditions including vaginitis is rebalancing the normal vaginal flora. To assist with this rebalancing, Lactobacillus acidophilus and L. bifidus are recommended, either taken internally or introduced directly into the vagina. Plain yogurt with live acidophilus cultures or acidophilus powder or capsules may be eaten.

Yogurt can be inserted directly into the vagina or a tampon can be soaked in yogurt and inserted. Garlic (Allium sativum ), taken both internally and inserted into the vagina (a peeled whole clove wrapped in gauze), may be helpful due to its antibacterial and antifungal actions.

A variety of other herbs can be used as douches or in suppository form to help treat acute flare-ups of vaginal symptoms. For example, one remedy for reducing inflammation is a douche made by adding 1–2 tsp of calendula (Calendula officinalis ) to boiling water, steeping the mixture, and letting it cool before using.

Herbal remedies for yeast also include a variety of antifungal, antiseptic, or immune-strengthening agents such as tea tree oil (inserted via a soaked tampon, douche, or suppository), black walnut (Juglans nigra), pau d’arco (Tabebuia impestiginosa), echinacea (Echinacea species), and goldenseal (Hydrastis canadensis). Echinacea and goldenseal should be taken only for a limited time. As with many herbs, medical supervision may be advised for those with certain health conditions.

Persons with specific allergies may not be able to use some remedies. For example, echinacea should not be used by anyone allergic to plants in the sunflower family, and goldenseal should not be used during pregnancy or by anyone allergic to ragweed.

A boric acid douche can help to acidify the vaginal pH so that unwanted bacteria cannot survive and multiply. Because some women may be sensitive to this douche, a health professional should oversee this treatment.

Also, care must be taken to keep boric acid away from children. Vaginal pH may also be lowered by using Summer’s Eve medicated douche, which contains potassium iodide, or a vinegar douche (1 tbsp of vinegar perquart of warm water).

Home remedies for vaginitis

The Gynecological Sourcebook recommends Betadine and gentian violet for treating candida vulvovaginitis. Betadine, an antiseptic iodine solution, should not be used by pregnant women. Gentian violet is an antifungal stain.

Both solutions are messy and leave stains, and some women may be allergic to either or both of them. Oxygen Healing Therapies reports successful treatment of candidiasis with intravenous hydrogen peroxide.

Various homeopathic treatments are available over the counter or prepared for individual cases by homeopaths. Commonly cited ingredients are pulsatilla and sepia. For atrophic vaginitis, especially in menopausal women, topical application of progesterone cream can help symptoms abate by slowing the thinning of the tissue.

Dietary modification and nutritional supplementation may also be helpful in the treatment of vaginitis. Antioxidant vitamins, including A, C, and E, as well as B complex vitamins and vitamin D are recommended.

Prescriptions for Nutritional Healing notes that if atrophic vaginitis is treated with prescription estrogen ointments, the body’s need for vitamin B6 is increased. Topical application of vitamin E from prepared creams or from torn vitamin E capsules may help relieve itching.

Other home remedies for itching from The Gynecological Sourcebook include witch hazel or cottage cheese compresses; or baths with epsom salts or baking soda followed by blow-drying the vagina and dusting the vagina with cornstarch.

Allergy tests may be useful for women with yeast infections. Additionally, foods that yeast organisms thrive on should be avoided. These foods include cheese, alcohol, chocolate, soy sauce, sugar, vinegar, fruits, and any fermented foods or foods containing molds (e. g., blue cheese). Wearing cotton underwear and loose-fitting clothes and avoiding pantyhose can help keep the vagina cool and dry, thus helping to prevent some forms of vaginitis.

For recurrent yeast infections, alternative treatments recommended in The Gynecological Sourcebook include boric acid douches in declining doses; oral ingestion of acidophilus with meals; and caprylic acid and myocidin, which are fatty acids derived from antifungal oils. Cases of chronic vaginitis should be addressed on systemic level by an alternative practitioner.

Allopathic treatment

Both bacterial vaginosis and trichomoniasis require prescription medication for treatment. Candidal vulvo-vaginitis may be treated with either prescription or over-the-counter medicines.

It is not advisable to take over-the-counter medications for vaginal yeast infections if one does not in fact have a yeast infection. A survey of 390 gynecologists found that 44% of the women who were diagnosed with bacterial vaginosis had first treated themselves with over-the-counter yeast infection medications.

Bacterial vaginosis should be treated daily for one week with the antibiotics metronidazole (Flagyl, Protostat) or clindamycin (Cleocin), either as pills taken orally or in a gel or cream form inserted into the vagina.

Trichomoniasis is treated with either a large single dose of metronidazole or with a smaller dose taken twice daily for one week. Male sexual partners of women with trichomoniasis also must be treated, and intercourse should be avoided until both partners are cured.

Possible side effects of the oral antibiotics include nausea and adverse reactions to drinking alcohol during the treatment period. Following treatment, natural flora need to be built up again through introduction of acidophilus and other lactobacilli.

Candida vulvovaginitis is most often treated by the application of medicated gels, creams, or suppositories applied directly to the vagina. The antifungal drugs used to treat candida vulvovaginitis include oral fluconazole (Diflucan); butoconazole (Femstat); clotrimazole (Gynelotrimin, Mycelex); miconazole (Monistat); ticonazole (Vagistat), and nystatin (Mycostatin, Nilstat, Nystex).

Most require only one or a few days of therapy to be effective. Women who have recurrent candidal infections may receive treatment for several weeks followed by some form of a long-term preventative treatment. Ketoconazole (Nizoral) may be used to treat recurrent vaginitis.

Normal allopathic treatment of atrophic vaginitis includes either estrogen creams or low-dosage estrogen tablets. Tibolone, a synthetic steroid, is also given for the treatment of atrophic vaginitis. It appears to prevent bone loss as well as improving the condition of the vaginal lining.

Expected results

Vaginitis is a disease with minor symptoms, and most women respond well to medications. It is believed, however, that certain vaginal infections left untreated can lead to more serious conditions, such as pelvic inflammatory disease; endometritis; postsurgical infections; and spread of the AIDS virus.

Bacterial vaginosis has been identified as a risk factor in certain complications of pregnancy, including early pregnancy loss, preterm labor, and low birth weight infants. In addition, recurrent trichomonal infection appears to be associated with an increased risk of cervical cancer.

Prevention

Women may avoid vaginal infections by following these suggestions:

• Do not take over-the-counter yeast infection treatments unless the woman has been diagnosed with candidiasis before and recognizes the symptoms.
• Avoid douching because it may disturb the balance of organisms in the vagina and may spread them higher into the reproductive system.
• Do not use vaginal deodorants or sprays because they can also disturb the vagina’s natural balance.
• Thoroughly dry oneself after bathing and remove a wet bathing suit promptly.
• Avoid wearing tight clothing and wear cotton underwear. Change underwear often and avoid pantyhose made from synthetic fibers.
• Clean diaphragms, cervical caps, and spermicide applicators after every use. Use condoms to avoid sexually transmitted diseases.
• After a bowel movement, wipe the area around the anus from front to back to avoid spreading intestinal bacteria into the vagina.

Uterine fibroids

Uterine fibroids (also called leiomyomas or myomas) are benign growths of the muscle inside the uterus. They are not cancerous, nor are they related to cancer. Fibroids can cause a wide variety of symptoms, including heavy menstrual bleeding and pressure on the pelvis.

Description

Uterine fibroids are extremely common. About 25% of women in their reproductive years have noticeable fibroids. There are probably many more women who have tiny fibroids that are undetected.

Fibroids develop in women between the ages of 30–50. They are never seen in women younger than 20 years old. After menopause, if a woman does not take estrogen, fibroids shrink. It appears that African American women are much more likely to develop uterine fibroids.


Fibroids are divided into different types, depending on the location. Submucous fibroids are found in the uterine cavity; intramural fibroids grow on the wall of the uterus; and subserous fibroids are located on the outside of the uterus. Many fibroids are so large that they fit into more than one category. The symptoms caused by fibroids are often related to their location.

Causes and symptoms

No one knows exactly what causes fibroids. The growth of fibroids, however, appears to depend on the hormone estrogen. Fibroids often grow larger when estrogen levels are high, as in pregnancy. Medications that lower the estrogen level can cause the fibroids to shrink.

The signs and symptoms of fibroids include:

• Heavy uterine bleeding. This is the most common symptom, occurring in 30% of women who have fibroids. The excess bleeding usually happens during the menstrual period. Flow may be heavier, and periods may last longer. Women who have submucous or intramural fibroids are most likely to have heavy uterine bleeding.
• Pelvic pressure and pain. Large fibroids that press on nearby structures such as the bladder and bowel can cause pressure and pain. Larger fibroids tend to cause more severe symptoms.
• Infertility. This is a rare symptom of fibroids. It probably accounts for less than 3% of infertility cases. Fibroids can cause infertility by compressing the uterine cavity. Submucous fibroids can fill the uterine cavity and interfere with implantation of the fertilized egg.
• Miscarriage. This is also an unusual symptom of fibroids, probably accounting for only a tiny fraction of the miscarriages that occur.
• Pregnancy complications. Fibroids can greatly increase in size during pregnancy, because of increased levels of estrogen. They can cause pain, and even lead to premature labor.

Diagnosis

A healthcare provider can usually feel fibroids during a routine pelvic examination. Ultrasound can be used to confirm the diagnosis, but this is not generally necessary.

Treatment

There are several natural treatments that help lower estrogen levels and slow the growth of the benign tumors. One study of alternative and complementary treatments for uterine fibroids found, however, that the cost of the alternative remedies was significantly higher than the cost of conventional treatments.

Nutritional therapy

There are several things women can do nutritional-wise to avoid having fibroids or prevent them from getting bigger:

• Eat more fruits, green or sea vegetables, whole grains, nuts, and seeds.
• Eat more soy foods such as tofu, tempeh, miso, or soy burger. Soy products contain isoflavones, which help reduce high levels of estrogens in the body.
• Avoid foods with high fat or sugar content, caffeine,or alcohol.
• Avoid eating produce sprayed with insecticides.

Nutritional supplements

The following supplements may be helpful in lowering estrogen levels and controlling fibroids:

• Bromelain: reduces inflammation.
• Choline: may improve liver function.
• Flaxseed: helps reduce excessive production of estrogens and other hormones.
• Vitamin E and evening primrose oil: help to regulate hormone production and may even shrink the fibroids.
• Vitamin C and bioflavonoids: have antiinflammatory and antioxidant effects.

Herbal treatment

Kuei-chih-fu-ling-wan (Keishi-bukuryo-gan; KBG) is a traditional Chinese herbal preparation that can effectively shrink fibroid tumors in 60% of patients, according to one study conducted by Japanese scientists. KBG is a mixture of the following herbs: cassia bark (Keihi), herbaceous peony roots (Shakuyaku), peach kernels (Tounin), herbaceous fungus (Bukuryo), and root bark of peony (Botanpi).

In addition to reducing fibroid size, KBG also successfully alleviated fibroid symptoms such as severe menstrual bleedings or menstrual pain in 90% of the women in the study. These researchers suggest that KBG may work by inhibiting the production of sex hormones including estrogen.

Unlike many other presently available herbal preparations that may be effective but lack scientific evidence to support their uses, KBG is proven safe as well as having few side effects. Women with fibroids, therefore, have one more alternative treatment to hysterectomy.

There are many herbal formulas that can be used depending on specific symptoms and body types. Another herbal treatment that may also be effective is wild yam progesterone cream. However, these are potent drugs and patients should consult their doctors before trying any of these treatments.

Homeopathy

A homeopathic physician may prescribe patient-specific homeopathic remedies to control fibroid symptoms.

Allopathic treatment

Not all fibroids cause symptoms. Even fibroids that do cause symptoms may not require treatment. In the majority of cases, the symptoms are inconvenient and unpleasant, but do not result in health problems.

Occasionally, fibroids lead to such heavy menstrual bleeding that the woman becomes severely anemic. In these cases, treatment of the fibroids may be necessary. Very large fibroids are much harder to treat. Therefore, many doctors recommend treatment for moderatelysized fibroids, in order to prevent them from growing into large fibroids that cause worse symptoms.

The following are possible treatment plans:

• Observation (watchful waiting). Most women already have symptoms at the time their fibroids are discovered, but feel that they can tolerate their symptoms. Therefore, no active treatment is given, but the woman and her physician stay alert for signs that the condition might be getting worse.
• Hysterectomy. This procedure involves surgical removal of the uterus, and it is the only definitive cure for fibroids. In fact, 25% of hysterectomies are performed because of symptomatic fibroids. A gynecologist can remove a fibroid uterus during either an abdominal or a vaginal hysterectomy. The choice depends on the size of the fibroids and other factors such as previous births and previous surgeries.
• Myomectomy. In this surgical procedure only the fibroids are removed; the uterus is repaired and left in place. This is the surgical procedure many women choose if they are not finished with childbearing. At first glance, it seems that this treatment is a middle ground between observation and hysterectomy. However, myomectomy is actually a difficult surgical procedure, more difficult than a hysterectomy. Myomectomy often causes significant blood loss, and blood transfusions may be required. In addition, some fibroids are so large, or buried so deeply within the wall of the uterus, that it is not possible to save the uterus, and a hysterectomy must be done, even though it was not planned.
• Lowering estrogen levels. Since fibroids are dependent on estrogen for their growth, medical treatments that lower estrogen levels can cause fibroids to shrink. A group of medications known as GnRH antagonists can dramatically lower estrogen levels. Women who take these medications for three to six months find that their fibroids shrink in size by 50% or more. They usually experience dramatic relief of their symptoms of heavy bleeding and pelvic pain.
• Uterine artery embolization (UAE). Embolization is a newer alternative to hysterectomy that shrinks fibroids by cutting off their blood supply. In UAE, the surgeon inserts a catheter into the uterine arteries. Small particles of polyvinyl foam or other inert substances are injected through the catheter into the arteries. The particles form an embolus, or clump, that blocks the blood supply to the fibroids and causes them to shrink. UAE is still controversial, however, because it has been associated with significant complications.

Unfortunately, GnRH antagonists cause unpleasant side effects in over 90% of women. The therapy is usually used for only three months, and should not be used for more than six months because the risk of developing brittle bones (osteoporosis) begins to rise.

Once the treatment is stopped, the fibroids begin to grow back to their original size. Within six months, most of the old symptoms return. Therefore, GnRH agonists cannot be used as long-term solution.

Uterine fibroids infographic

At the moment, treatment with GnRH antagonists is used mainly in preparation for surgery (myomectomy or hysterectomy). Shrinking the size of the fibroids makes surgery much easier, and reducing the heavy bleeding allows a woman to build up her blood count before surgery.

Fibroids can cause problems during pregnancy because they often grow in size. Large fibroids can cause pain and lead to premature labor.

Fibroids cannot be removed during pregnancy because of the risk of injury to the uterus and hemorrhage. GnRH antagonists cannot be used during pregnancy. Treatment is limited to pain medication and medication to prevent premature labor, if necessary.

Expected results

Many women who have fibroids have no symptoms or have only minor symptoms of heavy menstrual bleeding or pelvic pressure. However, fibroids tend to grow over time, and gradually cause more symptoms. Many women ultimately decide to have some form of treatment. Currently, hysterectomy is the most popular form of treatment.

Prevention

Eating a healthful diet, reducing stress, and exercising regularly is the preferred preventive treatment regimen of many diseases including fibroids.

Uterine cancer

Uterine cancer can be divided into two primary forms, cervical and endometrial. Cancer of the cervix most often affects the neck of the cervix or the opening or the opening into the uterus from the vagina. Endometrial cancer affects the inside lining of the uterus.

Cervical cancer is much more prevalent than cancer of the endometrium; some estimate the incidence ratio as 3:1. Statistics from the year 2000 indicated cervical cancer was the second leading cause of cancer deaths in women ages 20-39 years, and the fifth leading cause of cancer

death in women from 40-59 years old. Unlike many other cancers, early cancer of the cervix can be identified as much as 10 or more years before the cancer invades other tissues. These visible changes in the structure and activity of the cervical cells are seen under the microscope with Papanicolaou (Pap) tests and are referred to as mild dysplasia.


Over a time period of five to 10 years, these aneh cells may disappear without treatment, or may invade into deeper tissues and progress into a true cancer. The cancerous cells then may spread to endometrium, lymph glands, and nerves in the pelvic region.

As the population ages, cancer of the endometrium is becoming more common. Statistics indicate that approximately 50% of women with postmenopausal bleeding are diagnosed with endometrial cancer.

This early symptom of irregular vaginal bleeding often allows removal of the uterus to result in cure of the disease, as endometrial cancer progresses and spreads slowly.

While all women are at risk for developing uterine cancer, specific risk factors for cervical cancer include sexual activity at an early age, and sex with multiple partners.

Infertility, diabetes, obesity, and estrogen therapy place a woman at high risk for endometrial cancer. Other risk factors for uterine cancer include: endometrial hyperplasia, sexual inactivity, undergoing menopause after age 59 years, and never having had children.

Causes and symptoms

A completed cancer awareness ribbon for sarcoma use pink for breast cancer, or peach for uterine cancer.

An important factor linked to cervical cancer is infection with one of the most common sexually transmitted diseases—warts while others have no observable symptoms.

Individuals infected with the herpes simplex virus, human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) are at increased risk for developing cancer of the cervix; the associated suppression of the immune system allows the HPV to more easily invade. Other chronic infections and erosions of the cervix also may increase the risk of cervical cancer.

While some women who have precancerous cervical changes experience no symptoms, others notice heavier or longer menstrual periods or vaginal bleeding after douching, intercourse or between periods.

Symptoms of more advances stages of uterine cancer may include a foul-smelling vaginal discharge, rectal pressure or constipation, loss of appetite, fatigue, and back or leg pain.

Diagnosis

An annual Pap test and pelvic examination beginning as soon as young woman becomes sexually active, or between the age 17-20 years, are the most important diagnostic steps for early detection of uterine cancer.

The Pap smear can pick up cervical dyplasia and the conventional physican may then perform a colposcopy and biopsy of the cervix to give a better understanding of the abnormalities.

If only a small area of the cervix is affected, the recommendation may be made for more frequent Pap tests (about every three to six months) to monitor for changes in the cells of the cervix. Additional diagnostic tests for uterine cancer may include laparoscopy, laparotomy, or vaginosonography.

In 2002, a Food and Drug Administration (FDA) advisory panel suggested adding a screening test for HPV in addition to Pap smears since HPV is such a high risk factor for cervical cancer. The screening test could help separate women at high risk for more frequent screening than women not at high risk.

Treatment

pinky uterus

After cervical dysplasia has been found, several herbal remedies and supplements may be helpful. Practitioners of herbal medicine refer to this class of herbs as emmenagogues.

It includes supplements such as selenium, and vitamins B6 and C.

While these studies make no claim that taking a multivitamin or mineral supplement can reverse advanced cervical dysplasia, taking these supplements preventively may make sense.

The woman with uterine cancer will also benefit from nutritional supplements and a diet aimed at strengthening the immune system. Echinacea and garlic supplements may not only have positive effects on immunities, but also counteract the side effects of cancer treatment.

Many trace elements, flavonoids, and other phytochemicals are provided by eating a well balanced diet that may not be provided in a pill. Even with relatively low levels of dietary intake, shiitake mushrooms, lentinus edodes, laminaria sea vegetables, and kombu kelp are believed to have anticancer properties.

The use of any supplements or specific dietary modification should be discussed with the physician treating the cancer in order to avoid any undesirable drug interactions or side effects.

Research emphatically supports the mind-body connection when considering the health of the individual with cancer. Studies have also shown the positive effects of imagery on boosting immunities and natural killer cells.

Visualization of the dominant white blood cells successfully attacking weak cancer cells can not only have a positive effect on the mood and mental status, but may also shrink tumors and extend the life of a patient with cancer. Laughter has also been found to enhance immunities and stimulate the sympathetic nervous system, pituitary gland, and the hormones that reduce stress, inflammation, and pain.

In addition to the well known effects of massage for relaxation and stress reduction, there are other physiologic effects that may help the individual with cancer.

Massage may slow the body’s release of the stress hormone cortisol, decreasing anxiety and allowing for more effective periods of sleep and regeneration. Massage has also been found to increase the production of serotonin, which can improve overall mood and immune status.

Allopathic treatment

Early stages of cervical dysplasia may require only frequent reevaluation to monitor progression or regression of the aneh cells. Regression of aneh cells may occur due to the immune response or lifestyle changes, such as discontinuing smoking or oral contraceptive use. In more advanced cases, the cervical lining may be removed via cautery, freezing or laser procedures.

Age, overall health status, and the presence of other aneh findings will impact on the selection of most appropriate treatment plan for uterine cancer. Surgery may be presented as a treatment option for invasive cancer.

Extent of the surgical procedures will depend upon the stage of the cancer. A hysterectomy, lymphadenectomy, or total pelvic exenteration may be recommended. Radiation therapy may be offered instead of or in addition to surgical removal of the affected tissues.

Depending on the individual’s disease stage, and the response and tolerance to the radiation, treatment may be provided by external beams directed over the pelvis, or by the insertion of radium tubes into the uterus and/or vagina. Chemotherapy may also be recommended, involving the infusion of tumor-fighting drugs directly into the circulatory system.

Expected results

The outcomes for the individual with uterine cancer are significantly related to the stage of the disease when cancer is found and treatment initiated. Early interventions can result in nearly 100% cure rates, while those individuals whose cancer is not discovered until aneh tissue growth has invaded surrounding organs may have less positive outcomes. Those with advanced disease may experience pain, vaginal bleeding and/or foul smelling discharge, and intestinal obstruction.

Prevention

The best preventive measure against uterine cancer is an annual pelvic examination and Pap test. In fact, a 2002 report from the College of American Pathologists stated that 80 percent of the women who die from cervical cancer had not had a Pap test in the five years preceding their diagnosis.

Recognition of risk factors for uterine cancer, along with an awareness of the early signs and symptoms of cervical dysplasia, can promote the early detection of changes in the cervical cells.

Unani-tibbi

Unani-tibbi denotes Arabic or Islamic medicine, also known as prophetic medicine. It traditionally makes use of a variety of techniques including diet, herbal treatments, manipulative therapies, and surgery. Unani-tibbi is a complete system, encompassing all aspects and all fields of medical care, from nutrition and hygiene to psychiatric treatment.

Origins

The name unani-tibbi is something of a misnomer, as literally translated from the Arabic, it means Greek medicine. This is because the early Arab physicians took their basic knowledge from the Greeks.

At the time, Greek medical knowledge was the best to be had, particularly from Galen, the renowned second-century Greek physician who treated the gladiators and Emperor Marcus Aurelius.


However, from that point onwards, Islamic medical scholars were responsible for many developments and advancements that, at the time, placed Arabic medicine firmly in the vanguard of medical science.

There followed a steady stream of Muslim medical scholars, who not only upheld the high standards that came to be known of unani-tibbi, but carried on adding to and improving the basic pool of knowledge.

Some notable scholars of the science of unani-tibbi include:

• Al Tabbari (838–870)
• Al Razi (Rhazes) (841–926)
• Al Zahrawi (930–1013)
• Ibn Al Haitham (960–1040)
• Ibn Sina (Avicenna), (980–1037)
• Ibn Al Nafees (1213–1288)
• Ibn Khaldun (1332–1395)

Medical innovations introduced by unani-tibbi physicians included:

• Avicenna was the first to describe meningitis, so accurately and in such detail, that it has scarcely required additions after 1,000 years.
• Avicenna was the first to describe intubation (surgical procedure to facilitate breathing)—Western physicians began to use this method at the end of the eighteenth century.
• The use of plaster of Paris for fractures by the Arabs was standard practice—it was “rediscovered” in the West in 1852.
• Surgery was used by the Arabs to correct cataracts.
• Ibn Al Nafees discovered pulmonary blood circulation.
• A strict system of licensing for medical practitioners was introduced in Baghdad in 931, which included taking the Hippocratic oath, and specific periods of training for doctors.
• There was a system of inspection of drugs and pharmaceuticals—the equivalent of the Federal Drug Administration (FDA)—in Baghdad 1,000 years ago.
• The European system of medicine was based on the Arabic system, and even as recently as the early nineteenth century, students at the Sorbonne had to read the canon of Avicenna as a condition to graduating.
• Unani-tibbi hospitals were, from the beginning, free to all without discrimination on the basis of religion, sex, ethnicity, or social status.
• Their hospitals allocated different wards for each classification of disease.
• Hospitals had unlimited water supplies and bathing facilities.
• Before the advent of the printing press, there were extensive handwritten libraries in Baghdad, (80,000 volumes), Cordova, (600,000 volumes), Cairo, (two million volumes), and Tripoli, (three million volumes).
• All Unani-tibbi hospitals kept patient records.
• A hospital was established for lepers.
• In 830, nurses were brought from Sudan to work in the Qayrawan hospital in Tunisia.
• A system of fountain-cooled air was devised for the comfort of patients suffering from fever.
• Avicenna described the contamination of the body by “foreign bodies” prior to infection, and Ibn Khatima also described how “minute bodies” enter the body and cause disease—well in advance of Pasteur’s discovery of microbes.
• Al Razi was the first to describe smallpox and measles. He was accurate to such a degree that nothing has been added since.
• Avicenna described tuberculosis as being a communicable disease.
• Avicenna devised the concept of anesthetics. The Arabs developed a “soporific sponge,” (impregnated with aromatics and narcotics and held under the patient’s nose), which preceded modern anesthesia.
• The Arab surgeon, Al Zahrawi was the first to describe hemophilia.
• Al Zahrawi was also the first surgeon in history to use cotton, which is an Arabic word, as surgical dressings for the control of hemorrhage.
• Avicenna accurately described surgical treatment of cancer, saying that the excision must be radical and remove all diseased tissue, including amputation and the removal of veins running in the direction of the tumor. He also recommended cautery of the area if needed. This observation is relevant even today.
• Avicenna, Al Razi, and others formed a medical association for the purpose of holding conferences so that the latest developments and advancements in the field of medicine could be debated and passed on to others.

Benefits

What began as an advanced medical system that set world standards, has now come to be regarded as a system of folk medicine. This decline coincided with the decline of the Islamic Empire and the dissolution of the caliphate (spiritual head of Islam), as these were directly responsible for the direction and impetus of Islamic scientific scholars in all fields.

Unani-tibbi practitioners still treat people with herbal remedies and manipulation, for a variety of illnesses. In the Islamic world, many of the poorer people who cannot afford allopathic medicine still resort to this traditional medicine.

There are also people who prefer unani-tibbi to allopathic medicine, as indeed, the traditional unani-tibbi remedies do not bring with them the side effects commonly experienced with allopathic drugs.

Description

Similar to Greek humoral theory, unani-tibbi considers the whole human being, spiritual, emotional, and physical. Basic to the theory is the concept of the “four humors.” These are Dum (blood), Bulghum (phlegm), Sufra (yellow bile), and Sauda (black bile). Each is further categorized as being hot and moist (blood), cold and moist (phlegm), hot and dry (yellow bile), and cold and dry (black bile).

Every individual has his/her own unique profile of humors, which must be maintained in harmony to preserve health. If the body becomes weak, and this harmony is disrupted, a physician can be called upon to help restore the balance.

This restoration may be done using correct diet and nutrition and/or the unani-tibbi system of botanical therapy, cupping, bleeding, manipulation, and massage, among others, as treatments for all disease and ailments. Herbs or substances used to treat a patient will be matched to his humor type.

Unani-tibbi employs a detailed system of diagnosis, including observation of urine and stools, palpation of the body and pulse, and observation of the skin and eyes.

It also employs a system of prophylactics in order to preserve health and ward off disease. This includes the adherance to strict hygiene rules, protection of air, food and water from contamination or pollution, sufficient rest and exercise, and attention to spiritual needs. Certain herbs are also taken on a prophylactic basis, such as black cumin and sage.

In general, unani-tibbi treatment is not expensive, and it is certainly less expensive than allopathic medicine. However, charges vary according to area and practitioner. Fees should be discussed with a practitioner before treatment begins.

Preparations

Remedies are often provided by the practitioner or are obtained from a specialized herbalist. The ingredients are mainly herbs and honey. It must be noted that the honey used will be raw and unadulterated, rather than the type found in supermarkets, which is usually heat-treated.

A famous and widely used medicinal herb is black cumin (Nigella sativa), also known as Hab Al Baraka in Arabic, which means blessed seed. Black cumin has been cultivated since Assyrian times and it is beneficial for a very long list of ailments.

It is widely mixed with other herbs for greater beneficial effect and is said to strengthen the immune system when taken over a period of time. Research has proved that it has the ability to slow the division of cancer cells.

Precautions

The achievements of the unani-tibbi practitioners of today bear little resemblance to those of their illustrious predecessors, and some of those claiming to practice traditional medicine are woefully ill-equipped to practice.

However, many Arab and Muslim doctors, after qualifying in allopathic medicine, are still treating their patients with traditional remedies and are taking the trouble to educate themselves in this ancient art.

In India, where Islamic medicine is primarily known as unani-tibbi, the government has set up a Central Council for Research in Unani Medicine (CCRUM), which also has a licensing system for these traditional practitioners.

In the Arab countries, it is known as tibb-nabawi, or prophetic medicine, and mainly utilizes herbal remedies, honey, and other bee products.

Side effects

There are no known side effects of this form of treatment.

Research and general acceptance

The herbal remedies employed by unani-tibbi are chosen for their non-toxicity and absence of side effects.

Although unani-tibbi has not been the subject of a great deal of research by modern-day scientists, it still enjoys great popularity in Muslim countries. The records left by Islamic medical scholars become more remarkable in the light of modern medicine, when their achievements and theories still hold their own next to the latest in medical technology.

The CCRUM in India is conducting research into aspects of unani-tibbi that are likely to be of particular benefit to modern society. To cite one example, an examination of the substances that were originally used as safe forms of contraception, with none of the side effects of present-day chemical contraception.

Training and certification

There are two classifications of practitioners of unani-tibbi. There are the simple folk practitioners, dispensers of herbal remedies and so on, and the highly qualified doctors and scholars who are still conducting research.

Research is currently being conducted at the King Abdul Azeez University in Riyadh, Saudi Arabia, and the Sultan Qaboos University in Oman, among others, into the efficacy of traditional herbal remedies.

The CCRUM in India issues licenses to unani-tibbi practitioners and provides funds for research.