Disturbances of Menstruation and Sexual Function in Women

Complaints related to the female reproductive tract can be categorized as disorders of menstruation, pelvic pain, disturbances in sexual function, or infertility. Furthermore, sexual dysfunction can be interdigitated with other complaints in several ways.

Since normal reproductive functions depend on the integrate action of the central nervous system, the endocrine glands, and the reproductive organs, sexual dysfunction, and infertility can have the result of systemic and psychological disorders as well as of primary defects in endocrine and reproductive organs.

Disturbances in menstruation; Disorders of menstruation can be divided into abnormal uterine bleeding and amenorrhea.

Abnormal bleeding; In normal women the cycle averages 28 +- 3 days, the mean duration of menstrual flow is 4+- 2 days, and the average blood loss is 40 to 100 mL. Between menarche and menopause most women experience one or more episodes of abnormal uterine bleeding. The decision to evaluate a patient with an abnormal bleeding pattern depends on the severity and frequency of the abnormal episodes. When uterine bleeding is suspected, it is essential to establish first that the blood observed by the patient is derived from the uterine endometrium. Rectal, bladder, cervical, and vaginal sources of bleeding must be excluded. Once the bleeding is documented to be uterine in origin a pregnancy-related disorder (such as threatened or incomplete abortion or ectopic pregnancy) must be excluded by physical examination and appropriate laboratory test.

The abnormal bleeding can be associated with either two conditions such as;

Ovulatory cycles; menstrual bleeding with ovulatory cycles is spontaneous, regular in onset, predictable in duration and amount of flow, and frequently associated with discomfort. This prolonged, excessive bleeding episodes unassociated with a bleeding diathesis can result from abnormalities of the uterus such as submucous leiomyomas, adenomyosis, or endometrial polyps. Intermittent bleeding between cyclic ovulatory menses is often due to cervical or endometrial lesions.

Anovulatory cycles; Uterine bleeding that is irregular in occurrence, unpredictable as to amount and duration of flow, and usually painless is called dysfunctional uterine bleeding. This type of bleeding is the result of a failure of normal follicular maturation with consequent anovulation and may be either transient or chronic.

Pelvic pain; Many women experience low abdominal discomfort with ovulation, typically a dull aching pain at midcycle in one lower quadrant lasting from minutes to hours. It is rarely severe or incapacitating. The relationship of the pain to the process of ovulation is unknown. It may result from peritoneal irritation by follicular fluid released into the peritoneal cavity at ovulation. The onsets at midcycle and short duration of pain are often diagnostic.
Amenorrhea; Amenorrhea is failure of menarche by age 16, regardless of the presence absence of secondary sexual characteristics, or the absence of menstruation for 6 months in a women previous periodic menses. Amenorrhea is a woman who has never menstruated is term primary; cessation of menses is term secondary amenorrhea. Some other factors are anatomic defects of the outflow tract, hormone-secreting ovarian and adrenal tumors.



The normal sexual response begins with sexual arousal which causes genital vasocongestion that results in vaginal lubrication in preparation for intromission. The lubrication is due to the formation of a transudate in the vagina and in conjunction with genital congestion produces the so-called orgasmic platform prior to orgasm. Sexual stimuli as well as healthy vaginal tissue are prerequisites for genital vasocongestion and vaginal lubrication. During the second stage of sexual response, involuntary contractions of the muscles of the pelvis result in a pleasurable cortical sensory phenomenon known as orgasm.

In simple terms, sexual dysfunction can be due to inference with the arousal or orgasmic phases of the sexual response. Either disorder can be due to an organic or functional cause or both. Illness that impairs neurologic function such as diabetes mellitus or multiple sclerosis can impact normal sexual arousal. Local pelvic diseases such as vaginitis, endometriosis and salpingo-oophoritis may preclude normal sexual response. Stresses such as anxiety, depression, fatigue, and matrial or interpersonal conflicts may lead to failure of the vasocongestive response and impact normal vaginal lubrication. Failure to achieve orgasm is a specific form of sexual dysfunction.