Oophoritis is an inflammatory process of paired female genital glands. It can be one-sided or two-sided. It often occurs with simultaneous inflammation of the fallopian tubes, in acute or chronic form. With acute inflammation, there are pronounced pains in the lower abdomen, fever, dysuria, and whiteness. The chronic form is characterized by pain syndrome and menstrual disorders (metrorrhagia). Accumulation of pus in the ovary can lead to pelvioperitonitis, in the long–term prognosis – the risk of secondary infertility as a result of ovarian dysfunction. With oophoritis, the diagnostic search includes gynecological examination, ultrasound, hysterosalpingoscopy, bacteriological studies, according to indications – diagnostic laparoscopy.
Oophoritis is a disease that is dangerous for a woman’s reproductive system. Oophoritis (from oophoron – ovary) is an inflammation of the ovaries – paired female genital glands, which is often accompanied by inflammation of the fallopian (fallopian) tubes – salpingitis. Both one ovary (unilateral inflammation of the ovary) and both at once (bilateral inflammation of the ovaries) can be affected. Usually, the inflammatory process is common to the appendages of the uterus (fallopian tubes and ovaries) and is called salpingoophoritis or adnexitis (from adnexa – appendages).
Ovarian inflammation may have a specific nature if it is caused by pathogens of gonorrhea, trichomoniasis, chlamydia, mycoplasmosis, tuberculosis, and non–specific – if it is caused by conditionally pathogenic microflora (E. coli, staphylococci, candida, streptococci, etc.). Hypothermia, menstruation, childbirth, surgical termination of pregnancy can provoke inflammation of the ovaries and its exacerbations, the use of IUDs, diagnostic and surgical manipulations on the genitals. More often, ovarian inflammation develops a second time, as a consequence of the ascent of infection from the cervical canal, uterus, and fallopian tubes. Less often, the pathogens of ovarian inflammation can penetrate into the sex glands through blood and lymph (for example, in tuberculosis).
With inflammation of the ovaries, the infectious process from the uterine cavity gradually spreads to the fallopian tubes, first affecting the mucous membrane, then the muscular and serous layers. The fallopian tube thickens, lengthens, inflammation leads to the release of pus and the formation of adhesions inside it. Then the ovaries are involved in the inflammatory process, their tissues melt under the action of pus from the fallopian tubes. There is a soldering of the inflammatory-altered fallopian tube and ovary, therefore, the symptoms of oophoritis and salpingitis are not isolated separately. Sometimes, with inflammation of the ovaries, pathological changes spread to the surrounding peritoneum (periadnexitis). The accumulated inflammatory exudate can be transparent and form hydrosalpinx in the fallopian tube or purulent – pyosalpinx, the accumulation of pus in the ovary forms a piovar. With the further spread of the infectious process, it goes beyond the ovary with the development of pelvioperitonitis.
Ovarian inflammation can develop acutely, subacutely and in a chronic form with its own characteristics of the course.
The acute form of ovarian inflammation is characterized by the following symptoms:
- permanent, one- or two-sided, severe pain in the lower abdomen, giving to the lower back and sacrum;
- frequent urination with pains and cuts;
- sometimes copious purulent and serous discharge from the genital tract;
- fever, fever, general malaise;
- sharp pain during sexual contact;
- bleeding between periods.
During gynecological examination, the ovaries are enlarged, very painful. Acute ovarian inflammation requires hospitalization and hospital treatment. The subacute form of ovarian inflammation is rarely observed, usually with tuberculosis or mycotic infection. Acute inflammation of the ovaries with timely and proper treatment can result in complete recovery. Untreated acute inflammation of the ovaries acquires a prolonged chronic course, with periods of exacerbations.
Periods of exacerbation of chronic ovarian inflammation are characterized by:
- dull, aching pains in the vagina, lower abdomen, groin area, increasing before menstruation, against the background of colds, from hypothermia;
- menstrual cycle disorders, ovarian dysfunction;
- the presence of scanty, but constant secretions (whites);
- disorders of sexual function (decreased libido, pain during sexual intercourse);
- absence of pregnancy despite regular sexual activity.
On examination, the ovaries are enlarged, sensitive to palpation. As a rule, chronic inflammation of the ovaries is accompanied by changes in the neuropsychic state of a woman: irritability and poor sleep, decreased performance and fatigue.
Chronic oophoritis can occur without an acute stage. Some STDs (for example, gonorrhea) are often asymptomatic in women and the inflammation of the ovaries caused by them, having a latent course, quickly turns into a chronic form. With prolonged inflammation of the ovaries, changes occur in the fallopian tubes, leading to their obstruction, adhesions may form around the ovaries, secondary functional infertility occurs.
Complications that develop after ovarian inflammation are always dangerous for a woman’s reproductive function: violation of the menstrual cycle and ovarian function, adhesions and blocked fallopian tubes, ectopic pregnancy, spontaneous miscarriage, infertility, violation of sexual function, inflammatory processes in other organs (pyelonephritis, cystitis, colitis).
The symptoms of ovarian inflammation are quite blurred, in acute form they resemble the symptoms of acute abdominal pain in various diseases: appendicitis, ectopic pregnancy, endometriosis, ovarian cyst, peritonitis, etc. Due to these circumstances, the diagnosis of oophoritis is often difficult.
Reliable diagnosis of ovarian inflammation is based on the results:
- gynecological anamnesis data (the presence of previously transferred inflammation of the uterine appendages, STDs, abortions, complications of childbirth, intrauterine diagnostic procedures), and anamnesis of the present disease (the nature and localization of pain, the presence of secretions, hypothermia, general well-being);
- laboratory tests (with ovarian inflammation, there is an increased level of leukocytes in general blood and urine tests; smears from the vagina and urethra);
- gynecological examination (with inflammation of the ovaries, their enlargement and soreness, impaired mobility of the uterine appendages are determined);
- Ultrasound diagnostics of pelvic organs;
- bacteriological examination, PCR diagnostics, ELISA. If a specific (gonorrheal or tuberculous) inflammation of the ovaries is suspected, additional studies are carried out;
- hysterosalpingoscopy (reveals gross anatomical changes in the fallopian tubes that occur with chronic inflammation of the ovaries);
- laparoscopy is the most informative method of diagnosing ovarian inflammation (it makes it possible to directly examine the uterus, fallopian tubes and ovaries, differentiate the diagnosis). Indications for laparoscopy are prolonged infertility, chronic pain in the lower abdomen of unknown origin, inflammation of the ovaries, not amenable to complex treatment. With chronic inflammation of the ovaries, laparoscopy reveals a violation of the patency of the fallopian tubes, their infection, adhesions, the presence of formations in the fallopian tubes and ovaries (pyosalpinx, pioovar), adhesions in the pelvis. The severity of changes in the pelvic organs depends on the duration of chronic ovarian inflammation and the frequency of relapses.
Treatment of oophoritis
Ovarian inflammation should be treated after a complete differentiated diagnosis. Therapy of ovarian inflammation depends on the stage of the course of the disease (acute, subacute, chronic), the causes that caused it, the nature of the symptoms.
Acute inflammation of the ovaries is treated in a hospital: bed rest, in the first days – cold on the lower abdomen, painkillers and desensitizing drugs, antibiotics, sulfonamides, calcium chloride, restoratives. In the subacute stage of ovarian inflammation, physiotherapy procedures are carefully added. In the stage of chronic ovarian inflammation, various types of physiotherapy and balneotherapy are indicated.
Chronic and advanced forms of ovarian inflammation are treated longer and more difficult than cases of timely treatment of patients, and can lead to complications requiring surgical intervention (oophorectomy, adnexectomy). After the diagnosis of ovarian inflammation and the determination of the pathogen, the doctor prescribes an individual course of treatment. As a rule, drug therapy for ovarian inflammation is supplemented with non-drug therapy. Recently, there has been a growing interest in non-drug therapy, which gynecology uses in the treatment of ovarian inflammation, while the use of antibiotics is limited.
The choice of an antibiotic in the treatment of ovarian inflammation is determined by the pathogen isolated during bacposev and its sensitivity to this drug. The use of antibacterial drugs in the treatment of chronic ovarian inflammation is justified in the following cases:
- recurrence of chronic inflammation of the ovaries, if the clinical manifestations of a pronounced increase in the inflammatory process;
- if treatment with antibiotics and sulfonamides was not carried out in the acute or subacute stage of chronic ovarian inflammation;
- if in the process of physiotherapy and general restorative therapy, an exacerbation of chronic inflammation of the ovaries occurs.
The purpose of treatment of chronic ovarian inflammation is to provide anti-inflammatory, antimicrobial effect, anesthesia, increase the immune reactivity of the body, restoration of functional disorders of the genitals, as well as hormonal, nervous, vascular disorders of the body that have arisen against this background.
Usually, a course of potent antibiotics for ovarian inflammation is supplemented with physiotherapy procedures (magnetotherapy, electrophoresis, laser therapy) to reduce the risk of adhesions and further obstruction of the fallopian tubes. With inflammation of the ovaries, mud therapy, hirudotherapy and gynecological massage are also prescribed. Analgesic methods for ovarian inflammation (acupuncture, physiotherapy) reduce and stop pain sensations that negatively affect the activity of the body as a whole. With exacerbations of chronic ovarian inflammation, immunomodulatory drugs are used to increase the body’s defenses.
There are many folk methods of treating ovarian inflammation (mainly herbal medicine), which can be used prophylactically or as additional to the main treatment. Treatment of ovarian inflammation can be long, but it must be completed. If STIs have been identified, the sexual partner should also undergo a simultaneous course of treatment (in order to avoid the development of prostatitis, infertility). It is better to stop sexual activity during the treatment of ovarian inflammation.
Prevention of ovarian inflammation is very important. Women need to avoid hypothermia, fatigue, stress, and follow the rules of personal hygiene. Prophylactically, you need to consult a gynecologist at least 2 times a year. A healthy lifestyle, proper nutrition, the exclusion of accidental sexual relations, abortions will help prevent the development of ovarian inflammation and concomitant complications.