What is the powdery leucorrhea?

It is well known that leucorrhea is a barometer of women's health. Normal leucorrhea should be colorless and transparent. Once a woman's leucorrhea is abnormal, it is very likely that there is a health risk in her body. So what is the matter with powdery leucorrhea? Does powdery leucorrhea mean that the woman has gynecological diseases or other infections? What problems should be paid attention to when leucorrhea is powdery?

Pelvic inflammatory disease refers to inflammation of the female reproductive organs, connective tissue around the uterus, and pelvic peritoneum. Chronic pelvic inflammatory disease is often caused by incomplete treatment of the acute phase. It has a long duration and is a stubborn disease. Bacteria retrogradely infect the pelvic cavity through the uterus and fallopian tubes. But in real life, not all women will suffer from pelvic inflammatory disease, only a few will develop it. This is because the female reproductive system has a natural defense function that can resist bacterial invasion under normal circumstances. Pelvic inflammatory disease will only occur when the body's resistance decreases or the female's natural defense function is destroyed due to other reasons.

Causes

1. Postpartum or post-abortion infection

After delivery, the mother is weak, the cervix fails to close in time due to lochia discharge, there is a placenta detachment surface in the uterine cavity, or the birth canal is damaged during delivery, or there are placenta and fetal membrane residues, or if she has sexual intercourse too early after delivery, pathogens invade the uterine cavity and easily cause infection; vaginal bleeding lasts too long during spontaneous abortion or medical abortion, or there are tissues remaining in the uterine cavity, or the aseptic operation of the artificial abortion operation is not strict, etc., all of which can cause post-abortion infection.

2. Infection after intrauterine surgery

For example, during the placement or removal of an intrauterine contraceptive device, curettage, hydrotubation, hysterosalpingography, hysteroscopy, submucosal myomectomy, etc., due to preoperative sexual intercourse or lax surgical disinfection or inappropriate selection of preoperative indications, acute infection may occur and spread after the operation; some patients do not pay attention to personal hygiene after the operation, or do not follow the doctor's orders after the operation, which can also cause bacterial ascending infection and cause pelvic inflammatory disease.

3. Poor menstrual hygiene

If you do not pay attention to menstrual hygiene, use unclean sanitary napkins and panty liners, take a bath during menstruation, have sexual intercourse during menstruation, etc., pathogens can invade and cause inflammation.

4. Direct spread of inflammation in adjacent organs

The most common cases are appendicitis and peritonitis. Since they are adjacent to the female internal reproductive organs, the inflammation can spread directly and cause pelvic inflammation. In chronic cervicitis, the inflammation can also spread through the lymphatic circulation and cause pelvic connective tissue inflammation.

5. Others

Acute attacks of chronic pelvic inflammatory disease, etc.

Classification

1. Hydrosalpinx and tubo-ovarian cysts

After the fallopian tube becomes inflamed, the fimbria adheres and closes, and serous fluid exudes from the tube wall and accumulates in the tube cavity to form hydrosalpinx. Sometimes, hydrosalpinx can also form after the pus of pyosalpinx is absorbed. If the ovaries are affected at the same time, a tubo-ovarian cyst will form.

2. Salpingitis

It is the most common type of pelvic inflammatory disease; the fallopian tube mucosa and interstitium are destroyed by inflammation, causing the fallopian tube to thicken and fibrose, becoming cord-like, or causing the ovaries, fallopian tubes and surrounding organs to adhere, forming a hard and fixed mass.

3. Chronic pelvic connective tissue inflammation

The inflammation most commonly spreads to the parauterine connective tissue and uterosacral ligament; the local tissue thickens, hardens, and spreads outward in a fan shape to the pelvic wall, and the uterus is fixed or pulled toward the affected side.

Clinical manifestations

There are two types of pelvic inflammatory disease: acute and chronic:

1. Acute pelvic inflammation

The symptoms are lower abdominal pain, fever, increased vaginal discharge, and persistent abdominal pain that worsens after activity or sexual intercourse. If the condition is severe, there may be chills, high fever, headache, and loss of appetite. Those who develop the disease during menstruation may experience increased menstrual flow and prolonged menstruation. If pelvic inflammatory disease forms a pelvic abscess, it may cause local compression symptoms. Compression of the bladder may cause frequent urination, painful urination, and difficulty urinating; compression of the rectum may cause rectal symptoms such as tenesmus. Further development of acute pelvic inflammatory disease can cause diffuse peritonitis, sepsis, septic shock, and in severe cases can be life-threatening.

2. Chronic pelvic inflammation

It is caused by the failure to thoroughly treat acute pelvic inflammatory disease or the patient's poor physical condition and prolonged course of the disease. The symptoms of chronic pelvic inflammatory disease are lower abdominal distension, pain and lumbar and sacral soreness, which are often aggravated by fatigue, after sexual intercourse, and before and after menstruation. The second is abnormal menstruation and irregular menstruation. When the disease lasts for a long time, some women may experience symptoms of neurasthenia such as lack of energy, general discomfort, and insomnia. It often takes a long time to heal and recurs repeatedly, leading to infertility and fallopian tube pregnancy, seriously affecting women's health.

1. Direct smear of secretions

The samples can be vaginal, cervical, or urethral secretions, or peritoneal fluid (obtained through the posterior fornix, abdominal wall, or laparoscopy), and direct thin-layer smears are made and stained with methylene blue or Gram's blue after drying. If Gram-negative diplococci are seen in polymorphonuclear leukocytes, it is a gonorrhea infection. Because the detection rate of endocervical gonorrhea is only 67%, a negative smear cannot exclude the presence of gonorrhea, while a positive smear is specific. Fluorescein monoclonal antibody dye can be used for microscopic examination of Chlamydia trachomatis. The test is positive if a star-shaped flashing fluorescent spot is observed under a fluorescence microscope.

2. Pathogen Culture

The specimens come from the same source as above and should be inoculated onto Thayer-Martin medium immediately or within 30 seconds and cultured in a 35°C incubator for 48 hours for bacterial identification. New relatively rapid chlamydial enzyme assays have replaced traditional chlamydial detection methods. Mammalian cell culture can also be used to detect Chlamydia trachomatis antigens. This method is an enzyme-linked immunosorbent assay.

Bacteriological culture can also obtain other aerobic and anaerobic strains and serve as a basis for selecting antibiotics.

3. Posterior fornix puncture

Posterior fornix puncture is one of the most commonly used and valuable diagnostic methods for gynecological acute abdomen. The contents of the abdominal cavity or the rectouterine fossa obtained through puncture, such as normal peritoneal fluid, blood (fresh, old, clotted blood, etc.), purulent secretions or pus, can further clarify the diagnosis. Microscopic examination and culture of the punctured material are even more necessary.

4. Ultrasound examination

It mainly involves B-type or grayscale ultrasound scanning and filming. This technology has an 85% accuracy in identifying masses or abscesses formed by adhesions of the fallopian tubes, ovaries and intestines. However, mild or moderate pelvic inflammatory disease is difficult to show characteristics on B-mode ultrasound images.

5. Laparoscopy

If it is not diffuse peritonitis and the patient's general condition is good, laparoscopy can be performed on patients with pelvic inflammatory disease or suspected pelvic inflammatory disease and other acute abdominal diseases. Laparoscopy can not only make a clear diagnosis and differential diagnosis, but also make a preliminary judgment on the severity of pelvic inflammatory disease.

6. Examination of male partners

This helps in the diagnosis of pelvic inflammatory disease in women. The urethral secretions of the male partner can be taken for direct smear staining or culture of gonococci. If the result is positive, it is strong evidence, especially in those who are asymptomatic or have mild symptoms. Or a higher number of white blood cells may be detected.

diagnosis

1. Minimum Standards

Cervical motion tenderness or uterine tenderness or adnexal tenderness.

2. Additional Standards

The body temperature is over 38.3℃, there is mucopurulent secretion in the cervix or vagina, a large number of white blood cells are seen in the 0.9% NaCl smear of vaginal secretions, the erythrocyte sedimentation rate is increased, and the C-reactive protein is elevated; the laboratory confirms that the cervix is ​​positive for Neisseria gonorrhoeae or Chlamydia.

3. Specific standards

Endometrial biopsy revealed histologic evidence of endometritis, transvaginal ultrasonography or magnetic resonance imaging revealed tubal wall thickening, luminal fluid, with or without concurrent pelvic effusion, or tubo-ovarian abscess, and laparoscopy revealed abnormal findings consistent with PID.

For patients with a history of acute pelvic inflammatory disease and symptoms and signs, diagnosis is usually not difficult. However, sometimes patients have many symptoms but no obvious history of pelvic inflammatory disease or positive signs. At this time, the diagnosis of chronic pelvic inflammatory disease must be made with caution to avoid making a hasty diagnosis and causing mental burden to the patient. Sometimes pelvic congestion or varicose veins within the broad ligament can also produce symptoms similar to chronic inflammation. Chronic pelvic inflammatory disease and endometriosis are sometimes difficult to distinguish. Endometriosis causes more obvious dysmenorrhea, and the feeling of typical nodules will help with diagnosis. Laparoscopy can be performed when differentiation is difficult. Hydrosalpinx or tubo-ovarian cysts need to be differentiated from ovarian cysts. In addition to a history of pelvic inflammatory disease, the former has a sausage-shaped lump with a thin cyst wall and adhesions around it; while ovarian cysts are generally more round or oval in shape, have no adhesions around them, and move freely. Pelvic inflammatory adnexal masses are adhered to the surrounding area and are immobile, which can sometimes be confused with ovarian cancer. Inflammatory masses are cystic while ovarian cancer is solid. B-mode ultrasound examination can help to differentiate them.

Acute and chronic pelvic inflammatory disease can be diagnosed based on history, symptoms, and signs. However, differential diagnosis must be done well. The main differential diagnoses of acute pelvic inflammatory disease include acute appendicitis, ectopic pregnancy, ovarian cyst pedicle torsion, etc.; the main differential diagnoses of chronic pelvic inflammatory disease include endometriosis and ovarian cancer.

1. Pelvic congestion syndrome

Symptoms include pain in the lumbar and sacral region and lower abdominal pain, radiating to the lower limbs and aggravated by standing for a long time and fatigue. Examination showed that the cervix was purple-blue, but there was no abnormality in the uterus and adnexa, which was inconsistent with the symptoms and signs of pelvic inflammatory disease. The diagnosis can be confirmed by B-ultrasound and pelvic venography.

2. Endometriosis

The main manifestation is secondary progressive dysmenorrhea, accompanied by menstrual disorders or infertility. If there are tender nodules on the posterior uterine wall, uterosacral ligament, and posterior depression, the diagnosis can be made. In addition, for patients with chronic pelvic inflammatory disease who have not been cured for a long time, the possibility of endometriosis should be considered.

3. Ovarian tumors

Ovarian malignant tumors may also manifest as a pelvic mass that is adherent to the surrounding area, immobile, and tender, and can be easily confused with an inflammatory mass. However, her general health was poor, her condition progressed rapidly, and the pain was continuous and unrelated to her menstrual cycle. Ultrasound examination can reveal an abdominal mass, which is helpful for diagnosis.

treat

1. Medication

Antibiotics are the main treatment for acute pelvic inflammatory disease, including multiple routes of administration such as intravenous infusion, intramuscular injection or oral administration. Broad-spectrum antibiotics should be used in combination with anti-anaerobic drugs, and attention should be paid to the adequate course of treatment. It can also be combined with traditional Chinese medicine treatment to achieve better results.

2. Surgery

Patients with lumps such as hydrosalpinx or tubo-ovarian cysts can undergo surgical treatment; patients with small foci of infection and repeated inflammation are also suitable for surgical treatment. The principle of surgery is to completely cure the disease and avoid the chance of recurrence of residual lesions. Adnexemectomy or salpingectomy is performed. For young women, ovarian function should be preserved as much as possible. The effect of single therapy for chronic pelvic inflammatory disease is poor, and comprehensive treatment is appropriate.

3. Physical therapy

The benign stimulation of warmth can promote local blood circulation in the pelvic cavity. Improve the nutritional status of tissues and enhance metabolism to facilitate the absorption and disappearance of inflammation. Commonly used ones are shortwave, ultrashort wave, iontophoresis (various drugs such as penicillin, streptomycin, etc. can be added), wax therapy, etc. Traditional Chinese medicine also has the method of treating stains with Chinese medicine wrapping.

4. Psychotherapy

General treatment relieves patients' mental concerns, enhances their confidence in treatment, increases nutrition, exercises the body, pays attention to the combination of work and rest, and improves the body's resistance.