Cause of secondary dysmenorrhea in a young female :
Ans. is a, d and c i.e. Tuberculosis; Endometriosis; and Subserous fibroid Dysmenorrhea means painful menstruation of sufficient magnitude so as to incapacitate day to day activities. Primary (Spasmodic) There is no identifiable pelvic pathology Spasmodic dysmenorrhea manifests as cramping pain most pronounced on the first and second day of menstruation. It rarely lasts for more than 12 hoursdeg Pain is felt mainly in the hypogastriumdeg and is referred to inner and front of thigh (it never extends below the level of knee and back of leg). Area supplied by iliohypogastric and ilioinguinal nerves (T12, Ll and L2) are affected. Mainly seen in girls between 18 - 24 yearsdeg and begins to decline beyond 30 yrs. of age It is nearly always cured by pregnancy Secondary (Congestive) Pain occurring in presence of pelvic pathology Congestive dysmenorrhea manifests as diffuse dullache in the pelvis, accompanied by backache. It is thought to be the result of increasing tension in the pelvic tissue associated with inflammation exacerbated by premenstrual engorgement. The pain is at its height during the 2 or 3 days proceeding menstruation and slowly relieved as congestion is reduced with the onset of menstruation. Causes : - Uterine or vaginal anomalies with obstruction of menstrual flow - imperforate hymendeg - transverse vaginal septumdeg - Congenital malformations - bicornuate uterusdeg - sepatate uterusdeg - Asherman's syndromedeg Endometrial polypdeg - Uterine fibroicf2 - IUCDdeg - Chronic PIOdeg - Pelvic congestion syndromedeg - Broad ligament varicocoeledeg - Endometriosisdeg Adenomyosisdeg In the question cause of secondary dysmenorrhea in a young female is asked - Adenomyosis is observed frequently in elderly woman (ruling out Options 'b') - Fibroid are seen in approximately 20% of women over 20 years of age. Endometriosis is most commonly seen between the ages of 30 and 40 years. It can however occur at any time between menarche and menopause. even before 20 years. - Tuberculosis : A virgin having symptom and signs of chronic pelvic infection, should be assumed to have tuberculosis unless it is proved to the contrary. Extra Edge Causes of unilateral spasmodic dysmenorrhea : One horn of malformed uterus. Endometrosis with unilateral distribution. Small fibroid at the utero tubal junction.
TB
Subserous fibroid
Endometriosis
All