Ovulation Calendar

Ovulation is the relaeased of a single,mature egg from the ovary and is available to be fertilized.
Each woman is born with millions eggs that are awaiting ovulation to begin.
Usually the ovulation occurs regularly around day 14 of a 28 day menstrual cycle.
An egg lives 12-24 hours after leaving the ovary.Normally only one egg is released each time of ovulation.
Ovulation can be affected by stress,illness or disruption of normal routines.
A menstrual period can occur even if ovulation has not occured.

A woman's montly cycle is measured from the first day of her menstrual period until the first day of her next period.A woman's cycle normally is between 28-32 days,but some wemen can have a shorter or much longer cycles.

Your fertile period starts about 4-5 days before ovulation and ends about 24-48 hours,this becose sperm can live in the body for approximately 4 to 5 days and 24-48 hours after being released.

In Vitro Fertilization

As fertility treatment it can be ussed hormones treatment for male and woman,artificial insemination and in vitro fertilization.
If the male have a sperm allergy,low sperm count or poor sperm mobility,artificial insemination can help to conceve.In this procedure the sperm from the male (partner or from a doner) is collected and manually placed in the woman's uterus .An other option is the intrauterine insemination where the sperm is placed directly in the woman's uterus using a catheter,giving the sperm the start in the race to the egg.
If this procedure fails the In Vitro Fertilization is necessary.
In Vitro Fertilization includes five steps:
-Ovarian stimulation:he woman have to take fertility drugs (hormons) from 8 to 14 daysto stimulate her ovaries to produce several eggs per menstrual cycle instead of one.
-Egg retrieval:transvaginal ultrasound aspiration or laposcopic surgery.
-Insemination:it will be choose the most potential egg for pregnancy placed in vitro culture.They will separate the male sperm from his semen and the most "mobile" sperm is added to the egg.
-Fertilization and Embryo culture:from 1 to 5 days the evolution it will be observed ,and in 2-3 days it can be said if the development is normal or not.the embryos can be placed in the uterus from 1 to 6 days after fertilization.
-Embryo transfer:the embryos are transfered to the woman uterus.

Vaginal Discharge

Vaginal discharge may be bloodstained or otherwise.Here we are only concerned with a withe cream,yellow or greenish discharge which is often loosely and wrongly called "leucorrhea".
The complaint of discharge depends very much on the ideas,powers of observation and fastidiousness of individual women.The vulva and vagina are normally moistened by secretion and woman who are overanxious,introspective,or suffering from fears of venereal disease and cancer tend to exaggerate this into something pathological.On the other hand it is not uncommon to find women denying the existence ot an obviously pathological discharge found during examination.
A woman sometimes complains of discharge when she really means vulval odour.
Vulval odour is a normal secondary sex character arising partly from the secretion of Bartholin's glands(two glands located below and to the left and right of the opening of the vagina) but mainly as a result of the acion of bacteria on the secretion of apocrine glands.
providing a reasonable standard of cleanliness is maintained,vulval odour is never apparent to bystanders and those women who complain of it have a disorder of the mind rather than the body.
The idea usually arises from a misinterpretation of some innocent remark of an acquintance and thereafter becomes an obsesion difficult to eradicate.
Despite the fact that nothing more than regular washing is necessary for hygienic purposes.Exist today advertisement to diferent deodorants or spray to clean women genitals but this have an opposite effect if they destroy natural odour and makeover they are harmful as they are unecessary.
The slight discharge normally seen at the vulva and in the vagina is a mixture of the following,all of wich vary in amount and character with ovarian function.
The amount of vaginal discharge ordinarily present in the adult is such that the itoitus feels confortably moist but there is not enough to leave more than an occasional stain on underclothing.
It is normally increased to the extent of becoming noticeable in the following circumstances at the time of ovulation when there is the ovulation cascade from the cervix.During few days premenstrually when there is increased secretion from all parts of genital tract,during pregnancy there is an increase in vaginal and cervical discharge,and during sexual excitement when there is outpouring of Bartholin's secretion on to the vulva.

Genital Infections-Phyogenic Infections

We will talk about infections that affect individual organs.

VULVITIS:
Vulvitis is an infection of abrasions and wounds.
Local injuries or abrasions resulting from sanitary towels and tight underclothing(often impregnated whit irritant detergents left from washing) are common source of vulval dermatitis.
Excoriation of the skin can also be caused by vaginal discharge and by ammonia liberated by ureaspliting organisms when the vulva is exposed to constant leakage of urine.All this lesions can become secondarily infected to cause local pain and tenderness.
The treatment consists of rest,warm baths and removal of the cause.

1.INTERTRIGO:
Intertrigo-lack of cleanliness leads to a collection of irriting sebum and other secretions in the skin folds and secondary infection follows.The only treatment required is care over hygiene.
Inattention to the skin in the area of clitoris can result in the collection of a concretion of smegma resembling a small stone under the prepuce.This have to be removed.
2.FURUNCULOSIS:
Infection of vulval hair follicles leads to boils and carbuncles which are sometimes recurrent.Glycosuria(the excretion of glucose in urine) must be excluded in such cases.Otherwise,reccurent boils means the pathogenic staphylococci are being harboured in a carrier site (for exemple the nose or axilla) of the patient or of a close associate.This have to be found and eliminated.
For the vulval skin the remedies are scrupulous attention to cleanliness regular application of chlorhexidine cream or swabbing whit a solution of hexachlorophene.
During a phase of active furunculosis a full course of treatment whit penicillin or of other antibiotic appropriate to te infecting organism,should be given systemically,not locally.
3.INFECTION OF SEBACEOUS AND APOCRINE GLANDS:
Single abscesses,often representing secondary infection of retention cyst of an apocrine or sebaceous glands,have the clinical characteristics of a boil and are treated in the same way.
4.INFANTILE AND SENILE VULVITIS:
When the vulval epithelium is thin and inactive as in childhood and old age any of the organisms to  which it is normally,resistant can set up a simple vulvitis.This sometimes leads to labial adhesions.

Dysmenorrhea-painful menstruation

Dysmenorrhea means painful menstruation but the term is often used to cover two essentially different symptoms.These are:
-A pain wich is utherine origin and directly due to menstruation.This is known as true dysmenorrhea.
-A pain which arises in a organ or tissue other than the uterus and which is merely associated with menstruation.
A pain which is equally severe before,throughout and after menstruation is lakely to have its origin in the psyche,no pelvic lesion can cause such.
Menstrual disconfort is typically midle or bilateral in the lower abdomen or back,but can be unilateral.
One sided dysmenorrhea experianced in the lower abdomen has only four possible bases:one horn of a malformed uterus,endometriosis which a unilateral distribution,a small fibroid at the uterotubal junction-the site of origin of uterine contractions,or spasm or distension in the colon.
Not less then 50% of wemen are said to experiance some disconfort in relation to manstruation,and 5-10% of girls in their late teens and early twenties are incapacitated for several hours each month.
Circumstances wich lead to nervous tension may make dysmenorrhea worse even if they do not cause it.This include unhappiness at home or at work,unsatisfied sex life,fear or loss of employment,or anxiety over examinations.

In true dysmenorrhea the pain sensation arise in the uterus and is related to muscle contractions.It is experianced a few hours before and after the onset of menstruation and rarely lasts in a severe form for longer than 12 hours.
During a severe attack the patient looks drawn and pale and may sweat,nausea and vomiting are common,there may be diarrhea and rectal and blodder tenesmus.All this features suggest an upset in the autonomic nervous system.

Prevention:
Unfavourable environmental factors,malnutrition,general ill health and any errors in the patient's mode of life should be corrected.
Regular physical activity of some kind is to be encouraged both between and during mensatruation.
While the pain is at its highest the girl may have to lie down relief from warmth applied to the lower abdomen.

Treatment:
The drugs most commonly employed to relieve pain and induce sleep were aspirin,paracetamol and codeine in various combinations.Proprietary antispasmodics can be effective if given 2 days before the expected date of the period has started Buscopan 20mg four times daily may be tried

Hormone therapy:
Anovulatory cycle are always painless so suppression of ovulation gives certain relief from true dysmenorrhea.This is best achieved by means of one of the progesteron-oestrogen oral contraceptive preparations

Syphilis-Stages and Manifestation

Syphilis is caused by an organism named spirocheta pallida,and can be found in all stages:primary,secondary and tertiary.Exist an other classification too,as:early,latent,late and congenital stage.The syphilitic infection presents a risk for doctors and nurses exposed,if there is a break in their skin or mucous membrane.
Ordinarily,however,the entry of the spirochete is determinated by sexual contact whit an infected partner.This is true even when the primary stage is on the breast,in the mouth or on the lips,the last sites being determinated by genito-oal coitus rather than by kissing or by drinking from infected containers-as used to be suggested.
We will talk about syphilitic case as a result of sexual intercourse.

The primary stage is found most commonly on the labia majora,labia minora,clitoris,urethral orifice or cervix,but it may be anywhere on the lower genital tract,even the vaginal wall.The signs appears usually in 10-20 days after exposure but the incubation period can be modified by penicillin therapy for gonorrhea and can be as long as 90 days.
The first manifestation is a small papule which quickly breaks down to form an ulcer,the classical features of which are a sharply defined serpiginous outline and a brownish red colour.
In practice the signs are so slight that can pass unnoticed.Indeed,any sort of discrete relatively painless ulceration on the vulva may be a primary syphilitic sign.

The first form(primary stage) heals spontaneously in 1-8 weeks and soon afterwards the secondary stage of syphilis,which resolts from entry of the spirochaetes into the bloodstream,is manifestated by:general systemic upset with lassitude,anorexia,headache,pustular skin rashes which are typically non-irritant,occasional loss of hair,white mucous patches in the mouth and moist and necrotic warts on the vulva and around the anus.
Sometimes secondary manifestation occur before the primary heals,or they may not occur at all.
The first and second stages can last up to 2 years,and all this time the woman(and the man infected0 is a source of infection.

In untreated syphilis the tertiary stage occupies many years during which the organisms of infection attack bones,joints,eyes,blood vesels,the heart and the central nervous system.Tertiary syphilis is also characterized by the formation of localized granulomas in any part of the body.Granulomas on the genital tract are rare but,when they do occur,are most often found on the vulva.They are not painful unless secondarly infected.this late form are rarely seen nowadays.

Menstruation-Disturbances associated with Menstruation

The menarche is a late feature of puberty.The first period may be short or long,thereafter the cycle is often irregular,periods occuring sometimes every few month,sometimes too frequently.A more or less regular rhythm is usually established within 2-3 years.
During active reproductive era menstruation occurs at approximately 28-day interdals.Each woman tends to have her own rhythm although it may change after marriage or chieldbearing.Any regular cycle of 3-5 weeks is arbitrarily accepted as normal.
There are wide variations in the duration and amount of blood loss.The duration is the most often from 3 to 5 days.
The menstrual flow is called menses.It begins as a pink discharge consisting of cervical mucus and blood and is rich in leucocytes.It is havier in the second and third days when it is dark red in colour and consists of blood,endometrial and cervical secretion,endometrial debris and bacteria.
The discharge has a chracteristic odour caused partly by bacterial action and degeneration,and partly by accompanying secretions of sebaceous and apocrine glands on the vulva.
The total loss of blood varies from 5 to 60 or 80 ml.Small clots are noticed occasionally by 50% of women.

General disturbances associated with menstruation:
Menstruation is frequently accompanieted by minor physical and nervous disturbances.It is estimated that only 20% of wemen are completely free from disconfort.general manifestations mainly occur premenstrually and include a feeling of lethargy and tiredness,malaise,depression,excitability and irritability,headache,fullness and tenderness of the breasts,inability to concentrate and impairment of efficiency and both mental and physical activities.
Other changes:tendency to constipation(with abdominal distention) premenstrually and more frequent motion during menstruation.Nausea and vomiting may occur.Skin changes include shadows under the eyes and few acne spots on the face,back or chest.
One-third of women temporarily gain 1,4kg or more in weight premenstrually.

Management of normal menstruation:
The menstrual discharge is contained either by menas of sanitary pad applied to the vulva or by an absorbant tampon placed within the vagina.In either case regular and frequent chanfge are necessary.
Intravaginal tampons are popular becose they are confortable.It is said that they shorten the apparent duration of the period by 24 hours becose the last day of the flow ordinarily consists only of drainage from the vagina.Their disavantages are:
-they cannot be used unless the hymen is torn or streched
-they are inefficient if the flow is heavy
-you can do toxic shock syndrome(TSS).it can be reduced by using pads at night.
Vaginal douching with deodorant powders or sprays as a hygienic measure at the end of a period,or at any other time,is unnecessary and potentially hurmful becose is washed away the natural protective discharges.The vagina can take care of itself.