Benign gynecological disorders

What is it about ?

Benign gynecological conditions are diseases without serious consequences that affect the lips, vagina, uterus and ovaries, which can cause symptoms (symptomatic conditions) and which often require treatment. However, some of these conditions do not give any symptoms (they are asymptomatic). They are then discovered by chance, during a gynecological examination. This is a group of conditions that cannot spread to other parts of the body (which cannot metastasize) such as malignant tumors. We are only talking about the most common here.

How to recognize them?

Lip and vaginal disorders

Many skin conditions (birthmarks, benign tumors of small blood vessels, benign connective tissue tumors, …) that appear on other parts of the body can also appear on the lips and in the vagina.

Sclero-atrophic lichen (or morphea in drops) is a skin disease that mainly affects women after menopause. The condition is characterized by areas of light coloring, well demarcated, accompanied by small sores and small bleeding on the genitals, but not in the vagina. If left untreated, the skin condition can narrow the opening of the vagina and cause pain during sex.

Lichen planus is an inflammatory disease that affects the mucous membranes of the mouth and vagina. Erosions (lesions, small ulcers) present inside the vagina then bleed after intercourse, causing a burning sensation and pain. Insertion of the speculum during pelvic examination may cause bleeding.

Conditions of the cervix

The main symptoms are a smelly white discharge, vaginal bleeding, and light loss of blood after sex.

A cyst of Naboth (or egg of Naboth) is caused by the closure of a gland in the cervix. Symptoms are rare. The cyst looks like a glass bead and is usually discovered by chance during a pelvic exam (e.g. during a smear).

A cervical polyp is a polyp of the cervix. A polyp looks like a small mushroom, with a foot and a cap. Its dimensions can vary from a few millimeters to several centimeters.

Condylomas are small warts caused by infection with HPV (human papillomavirus). The virus is transmitted sexually. Warts sometimes look like little cauliflower.

Disorders of the body of the uterus

The main symptom is abnormal bleeding outside of the menstrual period (menorrhagia). Bleeding can also occur after menopause.

An endometrial polyp grows on the inner wall of the uterus (the endometrium). It mainly occurs in postmenopausal women and women on hormone therapy for breast cancer. The main symptom is vaginal bleeding. The polyp can also be discovered by chance, during an ultrasound of the uterus.

Endometrial hyperplasia is a thickening of the inner lining of the uterus. It occurs mainly during the period of premenopause. Endometrial hyperplasia causes heavy and prolonged bleeding.

Myomas (or fibroids) are benign tumors of the muscle tissue of the uterus. They most often occur between the ages of 40 and 50. They can sometimes measure up to 10 cm. They are usually not the cause of symptoms. Myomas that lie against the inner wall of the uterus, on the other hand, can cause heavy vaginal bleeding, which can sometimes lead to anemia. Large myomas sometimes put pressure on the bladder or bowel. In this case, you suffer from stomach aches and an overwhelming urge to go to the bathroom.

Ovarian disorders

Ovarian cysts are cysts that form on the ovary. They affect 5 to 10 in 100 women of childbearing age and 3 to 15 in 100 women after menopause. They are more common in women who use a hormonal IUD. Cysts are usually not the cause of symptoms. Sometimes a feeling of pressure or pain is felt in the lower abdomen. You have to urinate more often because of the pressure on the bladder. A twist or rupture of the cyst can trigger severe pain. The cyst can also become infected. An abscess can even develop on the ovary. The abscess is always accompanied by fever.

How is the diagnosis made?

Most conditions are diagnosed during a routine pelvic exam. In most cases, the doctor then performs a smear. He can observe certain lesions using a speculum. If in doubt, he will refer you to the gynecologist for an ultrasound and, if necessary, a biopsy (taking a piece of suspect tissue for additional laboratory analysis).

What can your doctor do?

Since these conditions are mild in nature, it is not always necessary to treat them.

Condylomas can be treated in different ways: electrocoagulation (we ‘burn’ the condyloma), application of podophyllin (a product that blocks the growth of skin cells), cryotherapy (we ‘freeze’ the condyloma), …

Endometrial hyperplasia is treated with medication. In the event of heavy bleeding or development of a malignant lesion, the uterus is sometimes removed.

If the myoma is asymptomatic, regular monitoring is sufficient. If the myoma is growing rapidly, it is best to remove it. If the woman no longer wishes to become pregnant, the uterus is removed (hysterectomy). Otherwise, we just remove the myoma (myomectomy).

The little ones ovarian cystss that are not suspicious do not require treatment and often go away on their own. Large cysts should be monitored. Any cyst larger than 10 cm in diameter will preferably be removed.

Long-term treatment (several years) of lichen sclerosus involves applying a cortisone cream and a soothing ointment, which relieves symptoms and slows progression. As the lichen planus, this condition requires annual follow-up, as it can progress to cancer.

Want to know more?

• Screening for cervical cancer: simple and effective – mongeneraliste.be – SSMG – Société Scientifique de Médecine Générale
• Ultrasound here Where to find on this page of Cliniques St Luc UCL
• Biopsy – Health Passport
• Uterine fibroma (images and video) – Health Passport

Source

Foreign clinical practice guidelines ” Benign gynecological lesions and tumors‘(2000), updated on 10.08.2017 and adapted to the Belgian context on 19.12.2017 – ebpracticenet