The difference between primary and secondary dysmenorrhea

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Alterations of the Female Reproductive System

40. What is the difference between primary and secondary dysmenorrhea?

Primary dysmenorrhea refers to painful menstrual periods without pelvic complications, and starts a few years after menarche. The primary cause is prostaglandin overproduction, leading to excessive uterine contractions. The symptoms include cramping in the lower abdomen, which may be felt on the thighs or the back. Contrastingly, secondary dysmenorrhea arises from underlying complications such as fibroids, endometriosis, or pelvic inflammatory disease. It also starts later in a woman’s life, and, as they age, the symptoms become increasingly severe.

42. What is the difference between endometriosis and adenomyosis?

Endometriosis is when ectopic endometrial tissue grows outside the uterus, such as the pelvis lining, the ovaries, or the fallopian tube. The endometrium responds to changes in hormone levels, causing pain, inflammation, and infertility. On the other hand, adenomyosis refers to endometrial tissue infiltration into the uterine wall, further characterized by an expanded uterus and heavy menstruation. While the two result from misplaced endometrial tissue, one occurs outside the uterus in endometriosis and the other in muscles in adenomyosis. The treatment differs based on severity and infertility-related complications.

52. “Oh no! My cousin could not get pregnant and have a baby after she had Gonorrhea!” says Ms. Sokol when she learns that she has Gonorrhea. After Ms. Sokol leaves, a student nurse says, “Gonorrhea is treatable with antibiotics. How could Gonorrhea interfere with pregnancy?”

Gonorrhea is a sexually transmitted disease, and, if left untreated, may move up the reproductive tract and cause pelvic inflammatory disease (PID). The illness will either result in scarring or block the fallopian tubes, preventing egg passage. When the tubes are damaged, it also increases the risk of infertility and an ectopic pregnancy. The subclinical infection may also cause complications. Hence, timely diagnosis and treatment are necessary to prevent permanent damage to a patient’s reproductive system.

55. A physician assistant says, “I understand the normal ovarian cycle and the formation of the dominant follicle during the ovarian cycle. But what goes wrong when a woman develops an ovarian follicular cyst?”

Ovarian follicular cyst is when a dominant follicle doesn’t rupture and release its ovum at ovulation. Rather than rupturing, the follicle will fill with fluid and swell. Generally benign, the cysts will deflate spontaneously without treatment. Endocrine function disruption can interrupt the possibility of follicular rupture. Enlarged or ruptured cysts, though most commonly symptomatic, can be related to pelvic pressure or pain.

57. Mrs. Kepler had vaginal bleeding 3 years after menopause and was diagnosed with uterine cancer. She says, “I guess I am not totally unlucky; I hear the death rate is higher with ovarian cancer. Please tell me why the ovarian cancer death rate is higher.”

Ovarian cancer will be diagnosed late, as it has fewer early symptoms and no good screening habits. Uterine cancer, however, gets diagnosed early due to abnormal vaginal bleeding, which results in early consultation with the physician. Thus, Uterine cancer has a greater chance of getting diagnosed and treated early, resulting in improved survival. The silent growth of ovarian cancer inside the abdominal cavity before diagnosis. Delayed diagnosis implies advanced disease and hence poorer survival.

Chapter 26: Alterations of the Male Reproductive System

20. What is the difference between phimosis and paraphimosis?

Phimosis is inability to retract the foreskin over the glans penis due to shortening or scarring of the foreskin. Phimosis is a typical observation in young children and can spontaneously improve with increasing age or require treatment if symptomatic. Paraphimosis is when the retraction of the foreskin has resulted in it not being able to be returned to its normal anatomical position, causing constriction and swelling of the glans. Paraphimosis is an emergency as it can cause ischemia due to compromise of blood supply. Phimosis is usually non-emergent but emergent when it results in infection or obstruction of micturition.

21. What is the difference between delayed and precocious puberty in boys?

Delayed puberty in men is a failure of testicular development before the age of 14 years due to hormonal or genetic reasons. It results from constitutional delay of growth, chronic illness, or disorders of the hypothalamic-pituitary-gonadal axis. Precocious puberty is an expression of secondary sexual characteristics before 9 years of age, usually secondary to the earlier activation of the same hormonal axis. Both conditions affect body and emotional maturation and can be referred for medical care. The two differ only in the timing and cause of activation of the hormones.

32. Mr. Montoya was diagnosed with BPH. He says, “Tell me why it takes so long for me to empty my bladder.”

Benign prostatic hyperplasia, or BPH, is the enlargement of the prostate gland over the urethra. The urethra is squeezed when the prostate enlarges, and it becomes increasingly complex for the urine to flow out of the body. Narrowing reduces the rate of urine flow and produces incomplete bladder emptying. The bladder muscles tighten more forcefully, and frequency and pressure ensue. Pressure tires out the bladder, and it is harder again to urinate.

35. Mr. Singh went to a clinic because he had a scrotal mass. Afterward, he says, “That doctor says I have a hydrocele and not to worry, but I am not sure he knows what he is doing! Why did he put a flashlight in back of my scrotum and look at it?”

A flashlight was also used to perform a transillumination test to differentiate between solid and fluid masses. Hydrocele fluid of the scrotum would allow light transmission and give off a red color. This indicates the mass as being fluid-filled and benign. Solid masses such as testicular cancer would not allow light to pass and would not glow. The test is a rapid, non-operative means of determining the character of scrotal mass.

36. Mr. Watson, age 33, noticed that his right testicle was enlarged. It did not hurt. His physician palpated Mr. Watson’s testes, discovered a firm mass in the enlarged testicle, and made an appointment for Mr. Watson to have an ultrasound examination. Mr. Watson says, “I know my doctor is concerned that I might have testicular cancer, but why did he ask me if I had undescended testicles when I was an infant? And why did he feel my groin after he found the mass in my testicle?”

Undescended testes, or cryptorchidism, is a known risk factor for future testicular cancer. The doctor got Mr. Watson’s history to determine his risk level. Palpation of the groin rounds out lymphadenopathy or metastasis mass-on exam. Testicular cancer does not metastasize through normal lymphatic pathways nor commonly begin in inguinal areas. Physical exam and history decide the level of cancer staging and influence treatment.

Chapter 27: Sexually Transmitted Infections

22. What is the difference between condylomata acuminata and condylomata lata?

Condylomata acuminata are genital warts caused by human papillomavirus (HPV), especially types 6 and 11. They are soft, flesh-colored papules observed on the vulva, anus, or penis. Condylomata lata are flat lesions, secondarily syphilitic and moist, caused by Treponema pallidum. They are highly infectious and usually develop on mucous membranes or folds of skin. Both are sexually transmitted diseases, but caused by different diseases and agents.

33. “Our son says he got gonorrhea from his girlfriend, but she did not have any symptoms,” says Mrs. Alvid. “Is that really possible?”

The majority of individuals infected with Gonorrhea are asymptomatic, particularly women. Symptomatic carriers can spread the bacteria during sex. Silent transmission is one of the reasons Gonorrhea remains prevalent as an STI. Symptomatic treatment and partner notification are the key measures in detecting infection early in screening. Being asymptomatic does not imply that the infection is non-pathogenic since it will also progress to cause serious complications.

37. Mr. Bowers has a large syphilitic chancre on his penis and will receive penicillin today. He asks, “Is that sore going to make a scar?”

Syphilitic chancres are typically aseptic ulcers that can occur at the infection site during the primary stage. The lesion will be cured uneventfully after penicillin treatment. However, slight scarring can occur unless treated too late, especially if it is inflamed or infected. Treatment early on averts long-term skin alteration. The patient’s healing process will tend to cure the sore completely.

38. Ms. Bagai developed genital herpes and took valacyclovir as prescribed. Four months later, she has another outbreak. She says, “I took all my medicine the first time, just as the nurse practitioner told me to do, and I have not had sex since then. Why do I have herpes again?” Ms. Ward, age 21, came to a nurse practitioner for her yearly check-up. The nurse practitioner noticed abnormal redness of Ms. Ward’s cervix and took a swab to test for Gonorrhea and Chlamydia. The test was negative for Gonorrhea and positive for Chlamydia.

Genital herpes is caused by the herpes simplex virus, which enters latency in nerve cells after initial infection. The virus will recur after treatment by creating outbreaks. Stress, illness, or hormonal changes trigger reactivation. Antiviral drugs like valacyclovir reduce the outbreak’s frequency and severity but not the virus’s healing. New outbreak can occur without new sexual contact.

39. Why did the nurse practitioner test for both Gonorrhea and Chlamydia?

Both diseases co-occur as a standard practice because they are common bacterial STIs transmitted by the same route. Both diseases co-exist in the same majority of patients suffering from one disease. Both have screenings that give complete diagnoses and cures. Both might not even express any symptoms, but result in serious complications like PID in case of no treatment. Dual screening is the world’s widespread practice to promote sexual health and prevention of re-infection.

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