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Benign Diseases of the Female 14 Reproductive Tract
Paula J. Adams Hillard
The causes of abnormal bleeding vary by age, with anovulatory bleeding most likely in adolescents and perimenopausal women.
Pelvic masses in adolescents are most commonly functional or benign neoplastic ovarian masses, whereas the risks of malignant ovarian tumors increase with age.
Although pelvic ultrasonography is an excellent technique for imaging pelvic masses and ultrasonographic characteristics may suggest reassuring characteristics of an ovarian mass, the possibility of malignancy must be kept in mind.
Vulvovaginal symptoms of any sort in a young child should prompt the consideration of possible sexual abuse.
Most uterine leiomyomas are asymptomatic, although bleeding, pressure symptoms, or pain may necessitate medical or surgical management.
Benign gynecologic conditions can present with a variety of signs and symptoms that vary by age. In this chapter, the most likely causes of specific signs and symptoms, as well as diagnosis and management, are described for each age group: prepubertal, adolescent, reproductive age, and postmenopausal women. The common gynecologic problems include those that cause pain, bleeding, pelvic masses (which may be symptomatic or asymptomatic), as well as vulvar and vaginal symptoms. Benign conditions of the female genital tract include anatomic lesions of the uterine corpus and cervix, ovaries, fallopian tubes, vagina, and vulva. A classification of benign lesions of the vulva, vagina, and cervix appears in Table 14.1. Leiomyoma, polyps, and hyperplasia are the most common benign conditions of the uterus in adult women. Benign uterine leiomyoma (uterine fibroids) are presented in Chapter 15. Benign tumors of the ovaries are listed in Table 14.2. Malignant diseases are presented in Chapters 35–40.
Prepubertal Bleeding Prior to menarche, which normally does not occur before nine years of age, any bleeding requires evaluation. To appropriately evaluate a young girl with vaginal bleeding, a practitioner should understand the events of puberty (1–4). The hormonal changes that control the
Table 14.1 Classification of Benign Conditions of the Vulva, Vagina, and Cervix
Mesonephric, paramesonephric, and urogenital sinus cysts
Adenosis (related to in utero diethylstilbestrol exposure)
Pelvic organ prolapse/Disorders of pelvic support
Table 14.2 Benign Ovarian Tumors