Common Reproductive Health Concerns for Women

• Menstrual Disorders

• Uterine fibroids

• Endometriosis

• Uterine Fibroids

• Infertility

• Breastfeeding problems

• Gynecologic Cancer

• Breast Cancer

• HIV/AIDS

• Cystitis - Urinary problems 

• Female genital skin conditions

•  Leucorrhoea - White Discharge 

• Polycystic Ovary Syndrome (PCOS) or Ovarian Cyst

• Sexually Transmitted Diseases (STDs)

• Sexual Violence

Menstrual disorders include: Dysmenorrhea refers to painful cramps during menstruation. Premenstrual syndrome refers to physical and psychological symptoms occurring prior to menstruation. Menorrhagia is heavy bleeding, including prolonged menstrual periods or excessive bleeding during a normal-length period.

Bleeding from the uterus that occurs in-between periods, occurs every few weeks, or is painful.

Painful or irregular periods can have causes that aren't due to underlying disease. Examples include physical stress, psychological stress, medication side effects 

See a doctor immediately if you:

Bleed severely

Feel weak

Have chest pain

Make an appointment to see a doctor if you:

Bleed for seven days or more

Get your period fewer than every 21 days

Soak through one or more tampons or pads every hour

Can't do daily activities because of heavy bleeding or pain

Pass blood clots larger than a pound coin

Bleed after menopause

Premenstrual Syndrome (PMS)

PMS is any unpleasant or uncomfortable symptom during your cycle that may temporarily disturb normal functioning. These symptoms may last from a few hours to many days, and the types and intensity of symptoms can vary in individuals.

Premenstrual Dysphoric Disorder (PMDD) is a much more severe form of PMS which affects approximately 3%-8% of women of reproductive age.

PMS Symptoms

Although each individual may experience symptoms differently, the most common symptoms of PMS can include any of the following:

• Psychological symptoms (depression, anxiety, irritability)

• Gastrointestinal symptoms (bloating)

• Fluid retention (swelling of fingers, ankles and feet)

• Skin problems (acne)

• Headache

• Vertigo

• Fainting

• Muscle spasms

• Heart palpitations

• Allergies

• Infections

• Vision problems

• Eye infections

• Decreased coordination

• Diminished libido (sex drive)

• Changes in appetite

• Hot flashes

Simple modifications in lifestyle can help eliminate or reduce the severity of symptoms, including:

• Exercising 3 to 5 times each week

• Eating a well-balanced diet that includes whole grains, vegetables and fruit, and a decreasing salt, sugar, caffeine and alcohol intake

• Getting adequate sleep and rest

Amenorrhea

Amenorrhea is characterized by absent menstrual periods for more than three monthly menstrual cycles. There are two types of amenorrhea:

Types of Amenorrhea

• Primary amenorrhea: Menstruation does not begin at puberty.

• Secondary amenorrhea: Normal and regular menstrual periods that become increasingly abnormal and irregular or absent. This may be due to a physical cause typically of later onset.

Amenorrhea can occur for a number of reasons as part of the normal course of life, such as pregnancy, breastfeeding or menopause. Or, it may occur as a result of medications or a medical problem including:

• Ovulation abnormality

• Birth defect, anatomical abnormality or other medical condition

• Eating disorder

• Obesity

• Excessive or strenuous exercise

• Thyroid disorder

If at least three consecutive menstrual periods are missed or if you've never had a menstrual period and are 16 years or older, it is important to see a healthcare professional. As with any condition, early diagnosis and treatment is very important.

Dysmenorrhea

Dysmenorrhea is characterized by severe and frequent menstrual cramps and pain associated with menstruation. The cause of dysmenorrhea is dependent on if the condition is primary or secondary. With primary dysmenorrheal, women experience abnormal uterine contractions resulting from a chemical imbalance in the body. Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis. Other possible causes may include:

• pelvic inflammatory disease (PID)

• uterine fibroids

• abnormal pregnancy (i.e., miscarriage, ectopic)

• infection, tumors, or polyps in the pelvic cavity

Any woman can develop dysmenorrhea, but those who are at increased risk include:

• Smokers

• Those who consume excessive alcohol during their period

• Women who are overweight

• Women who started menstruating before the age of 11

Dysmenorrhea Symptoms

The most common symptoms may include:

• Cramping or pain in the lower abdomen

• Low back pain or pain radiating down the legs

• Nausea

• Vomiting

• Diarrhea

• Fatigue

• Weakness

• Fainting

• Headaches

Menorrhagia

Menorrhagia is the most common type of abnormal uterine bleeding and is characterized by heavy and prolonged menstrual bleeding. In some cases, bleeding may be so severe that daily activities are disrupted.

Other types of this condition, also called dysfunctional uterine bleeding, may include:

• Polymenorrhea: Too frequent menstruation.

• Oligomenorrhea: Infrequent or light menstrual cycles

• Metrorrhagia: Any irregular, non-menstrual bleeding as in bleeding which occurs between menstrual periods

• Postmenopausal bleeding: Any bleeding that occurs more than one year after the last normal menstrual period at menopause

Menorrhagia Causes

There are several possible causes of menorrhagia, including:

• Hormonal imbalance

• Pelvic inflammatory disease (PID)

• Uterine fibroids

• Abnormal pregnancy; i.e., miscarriage, ectopic (tubal pregnancy)

• Infection, tumors or polyps in the pelvic cavity

• Certain birth control devices; i.e., intrauterine devices (IUDs)

• Bleeding or platelet disorders

• High levels of prostaglandins (chemical substances used to control muscle contractions of the uterus)

• High levels of endothelins (chemical substances used to dilate blood vessels)

• Liver, kidney or thyroid disease

Menorrhagia Symptoms

Typical symptoms of menorrhagia are when a woman has soaked through enough sanitary napkins or tampons to require changing every hour, and/or a woman’s menstrual period lasts longer than 7 days in duration. Other common symptoms include spotting or bleeding between menstrual periods, or spotting or bleeding during pregnancy.

A diagnosis can only be certain when the physician has ruled out other menstrual disorders, medical conditions or medications that may be causing or aggravating the condition.

Other diagnostic procedures may include:

• Blood tests

• Pap test

• Ultrasound: An imaging technique that uses high-frequency sound waves to create an image of the pelvic organs.

• Magnetic resonance imaging (MRI): A diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of the reproductive organs.

• Laparoscopy: A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the physician can often detect abnormal growths.

• Hysteroscopy: A visual examination of the canal of the cervix and the interior of the uterus using a hysteroscope inserted through the vagina.

• Biopsy (endometrial): Tissue samples are removed from the lining of the uterus with a needle or during surgery to determine if cancer or other abnormal cells are present.

• Dilation and curettage (D&C): A common gynecological surgery that consists of widening the cervical canal with a dilator and scraping the uterine cavity with a curette – a spoon-shaped surgical tool used to remove tissue.

Your doctor may suggest a psychiatric evaluation to rule out other possible conditions, or ask you to track your symptoms in a journal to better assess the timing, severity, onset and duration of symptoms.

A specific treatment plan will be determined by your doctor based on factors such as:

• Your age, overall health and medical history

• Extent of the condition

• Possible cause of the condition

• Current symptoms

• Your tolerance for specific medications, procedures or therapies

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.

Non-cancerous growths in the uterus that can develop during a woman's childbearing years.

The cause of fibroids isn't well understood. Risk factors include a family history of fibroids, obesity or early onset of puberty.

Symptoms include heavy menstrual bleeding, prolonged periods and pelvic pain. In some cases, there are no symptoms.

Treatments include medication and removal of the fibroid.

People may experience:

Pain areas: in the abdomen, lower back, or pelvis

Menstrual: abnormal menstruation, heavy menstruation, irregular menstruation, painful menstruation, or spotting

Also common: abdominal distension or cramping

Endometriosis (en-doe-me-tree-O-sis) is an often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial-like tissue may be found beyond the area where pelvic organs are located.

With endometriosis, the endometrial-like tissue acts as endometrial tissue would — it thickens, breaks down and bleeds with each menstrual cycle. But because this tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.

Endometriosis can cause pain — sometimes severe — especially during menstrual periods. Fertility problems also may develop. Fortunately, effective treatments are available.

Symptoms

The primary symptom of endometriosis is pelvic pain, often associated with menstrual periods. Although many experience cramping during their menstrual periods, those with endometriosis typically describe menstrual pain that's far worse than usual. Pain also may increase over time.

Common signs and symptoms of endometriosis include:

• Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into a menstrual period. You may also have lower back and abdominal pain.

• Pain with intercourse. Pain during or after sex is common with endometriosis.

• Pain with bowel movements or urination. You're most likely to experience these symptoms during a menstrual period.

• Excessive bleeding. You may experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding).

• Infertility. Sometimes, endometriosis is first diagnosed in those seeking treatment for infertility.

• Other signs and symptoms. You may experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The severity of your pain may not be a reliable indicator of the extent of your condition. You could have mild endometriosis with severe pain, or you could have advanced endometriosis with little or no pain.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.

Although the exact cause of endometriosis is not certain, possible explanations include:

• Retrograde menstruation. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.

• Transformation of peritoneal cells. In what's known as the "induction theory," experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial-like cells.

• Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial-like cell implants during puberty.

• Surgical scar implantation. After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.

• Endometrial cell transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.

• Immune system disorder. A problem with the immune system may make the body unable to recognize and destroy endometrial-like tissue that's growing outside the uterus.

Risk factors

Several factors place you at greater risk of developing endometriosis, such as:

• Never giving birth

• Starting your period at an early age

• Going through menopause at an older age

• Short menstrual cycles — for instance, less than 27 days

• Heavy menstrual periods that last longer than seven days

• Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces

• Low body mass index

• One or more relatives (mother, aunt or sister) with endometriosis

• Any medical condition that prevents the passage of blood from the body during menstrual periods

• Disorders of the reproductive tract

Infertility

The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.

For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as by damaging the sperm or egg.

Even so, many with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise those with endometriosis not to delay having children because the condition may worsen with time.

Cancer

Ovarian cancer does occur at higher than expected rates in those with endometriosis. But the overall lifetime risk of ovarian cancer is low to begin with. Some studies suggest that endometriosis increases that risk, but it's still relatively low. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in those who have had endometriosis.

Infertility means not being able to get pregnant after at least one year of trying (or 6 months if the woman is over age 35). If a woman keeps having miscarriages, it is also called infertility. Female infertility can result from age, physical problems, hormone problems, and lifestyle or environmental factors.

Most cases of infertility in women result from problems with producing eggs. In primary ovarian insufficiency, the ovaries stop functioning before natural menopause. In polycystic ovary syndrome (PCOS), the ovaries may not release an egg regularly or they may not release a healthy egg.

About a third of the time, infertility is because of a problem with the woman. One third of the time, it is a problem with the man. Sometimes no cause can be found.

Common breastfeeding problems

If you have any problems with breastfeeding, it's important to ask for help from your midwife, health visitor or a breastfeeding specialist as soon as possible.

That way issues like sore nipples or breast engorgement can be sorted out early.

Here are some of the problems breastfeeding mums sometimes have, plus tips on how to tackle them.

Sore or cracked nipples

Sore nipples usually happens because your baby is not well positioned and attached at the breast.

Putting up with it could make pain or discomfort worse, so it's important to get help from your midwife, health visitor or breastfeeding specialist as soon as you can.

Not enough breast milk

When you first start breastfeeding, you may worry that your baby is not getting enough milk. It can take a little while before you feel confident that your baby is getting what they need.

Offering your baby both breasts at each feed and alternating which breast you start with will help to stimulate your milk supply. So will keeping your baby close and holding them skin to skin.

Breast engorgement

Breast engorgement is when your breasts get too full of milk. They may feel hard, tight and painful.

Engorgement can happen in the early days when you and your baby are still getting used to breastfeeding. It can take a few days for your milk supply to match your baby's needs.

Engorgement can also happen when your baby is older and not feeding so frequently, perhaps when they start having solid foods.

Baby is not latching on properly

Breastfeeding is a skill that you and your baby need to learn together. It may take you both a while to get the hang of it.

If you are finding breastfeeding painful or your baby does not seem to be satisfied after feeds, they may not be latching onto the breast properly.

Too much breast milk

Occasionally women make too much breast milk and their babies struggle to cope.

It's best to get your midwife, health visitor or breastfeeding specialist to watch a feed to see if they can spot why this is happening. They can also show you different positions to help your baby cope with large amounts of milk.

Breastfeeding and thrush

Thrush infections can sometimes happen when your nipples become cracked or damaged. This means the candida fungus that causes thrush can get into your nipple or breast.

Blocked milk duct

If breast engorgement continues, it can lead to a blocked milk duct. You may feel a small, tender lump in your breast.

Frequent feeding from the affected breast may help. If possible, position your baby with their chin pointing towards the lump so they can feed from that part of the breast.

Mastitis

Mastitis (inflammation of the breast) happens when a blocked milk duct is not relieved. It makes the breast feel hot and painful, and can make you feel very unwell with flu-like symptoms.

It's important to carry on breastfeeding. Starting feeds with the tender breast may help.

Breast abscess

If mastitis is not treated, or if it does not respond to treatment, it can lead to a breast abscess.

Gynecologic cancer is any cancer that starts in a woman’s reproductive organs. Cancer is always named for the part of the body where it starts. Gynecologic cancers begin in different places within a woman’s pelvis, which is the area below the stomach and in between the hip bones.

Types of Gynecologic Cancer

• Cervical cancer begins in the cervix, which is the lower, narrow end of the uterus. (The uterus is also called the womb.)

• Ovarian cancer begins in the ovaries, which are located on each side of the uterus.

• Uterine cancer begins in the uterus, the pear-shaped organ in a woman’s pelvis where the baby grows when she is pregnant.

• Vaginal cancer begins in the vagina, which is the hollow, tube-like channel between the bottom of the uterus and the outside of the body.

• Vulvar cancer begins in the vulva, the outer part of the female genital organs.

Each gynecologic cancer is unique, with different signs and symptoms, different risk factors (things that may increase your chance of getting a disease), and different prevention strategies. All women are at risk for gynecologic cancers, and risk increases with age. When gynecologic cancers are found early, treatment is most effective.

What Is Breast Cancer?

Breast cancer is a type of cancer that starts in the breast. It can start in one or both breasts.

Cancer starts when cells begin to grow out of control. 

Breast cancer occurs almost entirely in women, but men can get breast cancer, too.

It’s important to understand that most breast lumps are benign and not cancer (malignant). Non-cancer breast tumors are abnormal growths, but they do not spread outside of the breast. They are not life threatening, but some types of benign breast lumps can increase a woman's risk of getting breast cancer. Any breast lump or change needs to be checked by a health care professional to find out if it is benign or malignant (cancer) and if it might affect yours future cancer risk.

Where breast cancer starts

Breast cancers can start from different parts of the breast. The breast is an organ that sits on top of the upper ribs and chest muscles. There is a left and right breast and each one has mainly glands, ducts, and fatty tissue. In women, the breast makes and delivers milk to feed newborns and infants. The amount of fatty tissue in the breast determines the size of each breast.

The breast has different parts:

• Lobules are the glands that make breast milk. Cancers that start here are called lobular cancers.

• Ducts are small canals that come out from the lobules and carry the milk to the nipple. This is the most common place for breast cancer to start. Cancers that start here are called ductal cancers.

• The nipple is the opening in the skin of the breast where the ducts come together and turn into larger ducts so the milk can leave the breast. The nipple is surrounded by slightly darker thicker skin called the areola. A less common type of breast cancer called Paget disease of the breast can start in the nipple.

• The fat and connective tissue (stroma) surround the ducts and lobules and help keep them in place. A less common type of breast cancer called phyllodes tumor can start in the stroma.

• Blood vessels and lymph vessels are also found in each breast. Angiosarcoma is a less common type of breast cancer that can start in the lining of these vessels. The lymph system is described below.

A small number of cancers start in other tissues in the breast. These cancers are called sarcomas and lymphomas and are not really thought of as breast cancers.

How breast cancer spreads

Breast cancer can spread when the cancer cells get into the blood or lymph system and then are carried to other parts of the body. 

The lymph (or lymphatic) system is a part of your body's immune system. It is a network of lymph nodes (small, bean-sized glands), ducts or vessels, and organs that work together to collect and carry clear lymph fluid through the body tissues to the blood. The clear lymph fluid inside the lymph vessels contains tissue by-products and waste material, as well as immune system cells.

The lymph vessels carry lymph fluid away from the breast. In the case of breast cancer, cancer cells can enter those lymph vessels and start to grow in lymph nodes. Most of the lymph vessels of the breast drain into:

• Lymph nodes under the arm (axillary lymph nodes)

• Lymph nodes inside the chest near the breastbone (internal mammary lymph nodes)

• Lymph nodes around the collar bone (supraclavicular [above the collar bone] and infraclavicular [below the collar bone] lymph nodes)

If cancer cells have spread to your lymph nodes, there is a higher chance that the cells could have traveled through the lymph system and spread (metastasized) to other parts of your body. Still, not all women with cancer cells in their lymph nodes develop metastases, and some women with no cancer cells in their lymph nodes might develop metastases later.

Overview

Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight infection and disease.

HIV is a sexually transmitted infection (STI). It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years before HIV weakens your immune system to the point that you have AIDS.

There's no cure for HIV/AIDS, but medications can dramatically slow the progression of the disease.

Symptoms

The symptoms of HIV and AIDS vary, depending on the phase of infection.

Primary infection (Acute HIV)

Some people infected by HIV develop a flu-like illness within two to four weeks after the virus enters the body. This illness, known as primary (acute) HIV infection, may last for a few weeks. Possible signs and symptoms include:

• Fever

• Headache

• Muscle aches and joint pain

• Rash

• Sore throat and painful mouth sores

• Swollen lymph glands, mainly on the neck

• Diarrhoea

• Weight loss

• Cough

• Night sweats

These symptoms can be so mild that you might not even notice them. However, the amount of virus in your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily during primary infection than during the next stage.

Clinical latent infection (Chronic HIV)

In this stage of infection, HIV is still present in the body and in white blood cells. However, many people may not have any symptoms or infections during this time.

This stage can last for many years if you're not receiving antiretroviral therapy (ART). Some people develop more severe disease much sooner.

Symptomatic HIV infection

As the virus continues to multiply and destroy your immune cells — the cells in your body that help fight off germs — you may develop mild infections or chronic signs and symptoms such as:

• Fever

• Fatigue

• Swollen lymph nodes — often one of the first signs of HIV infection

• Diarrhoea

• Weight loss

• Oral yeast infection (thrush)

• Shingles (herpes zoster)

• Pneumonia

Progression to AIDS

Thanks to better antiviral treatments, most people with HIV don't develop AIDS. Untreated, HIV typically turns into AIDS in about 8 to 10 years.

When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop opportunistic infections or opportunistic cancers — diseases that wouldn't usually cause illness in a person with a healthy immune system.

The signs and symptoms of some of these infections may include:

• Sweats

• Chills

• Recurring fever

• Chronic diarrhoea

• Swollen lymph glands

• Persistent white spots or unusual lesions on your tongue or in your mouth

• Persistent, unexplained fatigue

• Weakness

• Weight loss

• Skin rashes or bumps

When to see a doctor

If you think you may have been infected with HIV or are at risk of contracting the virus, see a doctor as soon as possible.

Causes

HIV is caused by a virus. It can spread through sexual contact or blood, or from mother to child during pregnancy, childbirth or breast-feeding.

How does HIV become AIDS?

HIV destroys CD4 T cells — white blood cells that play a large role in helping your body fight disease. The fewer CD4 T cells you have, the weaker your immune system becomes.

You can have an HIV infection, with few or no symptoms, for years before it turns into AIDS. AIDS is diagnosed when the CD4 T cell count falls below 200 or you have an AIDS-defining complication, such as a serious infection or cancer.

How HIV spreads

To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. This can happen in several ways:

• By having sex. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. The virus can enter your body through mouth sores or small tears that sometimes develop in the rectum or vagina during sexual activity.

• By sharing needles. Sharing contaminated IV drug paraphernalia (needles and syringes) puts you at high risk of HIV and other infectious diseases, such as hepatitis.

• From blood transfusions. In some cases, the virus may be transmitted through blood transfusions. Blood banks now screen the blood supply for HIV antibodies, so this risk is very small.

• During pregnancy or delivery or through breast-feeding. Infected mothers can pass the virus on to their babies. Mothers who are HIV-positive and get treatment for the infection during pregnancy can significantly lower the risk to their babies.

How HIV doesn't spread

You can't become infected with HIV through ordinary contact. That means you can't catch HIV or AIDS by hugging, kissing, dancing or shaking hands with someone who has the infection.

HIV isn't spread through the air, water or insect bites.

Risk factors

Anyone of any age, race, sex or sexual orientation can be infected with HIV/AIDS. However, you're at greatest risk of HIV/AIDS if you:

• Have unprotected sex. Use a new latex or polyurethane condom every time you have sex. Anal sex is more risky than is vaginal sex. Your risk of HIV increases if you have multiple sexual partners.

• Have an STI. Many STIs produce open sores on your genitals. These sores act as doorways for HIV to enter your body.

• Use IV drugs. People who use IV drugs often share needles and syringes. This exposes them to droplets of other people's blood.

Complications

HIV infection weakens your immune system, making you much more likely to develop many infections and certain types of cancers.

Infections common to HIV/AIDS

• Pneumocystis pneumonia (PCP). This fungal infection can cause severe illness. Although it's declined significantly with current treatments for HIV/AIDS, in the U.S. PCP is still the most common cause of pneumonia in people infected with HIV.

• Candidiasis (thrush). Candidiasis is a common HIV-related infection. It causes inflammation and a thick, white coating on your mouth, tongue, oesophagus or vagina.

• Tuberculosis (TB). In resource-limited nations, TB is the most common opportunistic infection associated with HIV. It's a leading cause of death among people with AIDS.

• Cytomegalovirus. This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. A healthy immune system inactivates the virus, and it remains dormant in your body. If your immune system weakens, the virus resurfaces — causing damage to your eyes, digestive tract, lungs or other organs.

• Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal meningitis is a common central nervous system infection associated with HIV, caused by a fungus found in soil.

• Toxoplasmosis. This potentially deadly infection is caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the parasites in their stools, which may then spread to other animals and humans. Toxoplasmosis can cause heart disease, and seizures occur when it spreads to the brain.

Cancers common to HIV/AIDS

• Lymphoma. This cancer starts in the white blood cells. The most common early sign is painless swelling of the lymph nodes in your neck, armpit or groin.

• Kaposi's sarcoma. A tumor of the blood vessel walls, Kaposi's sarcoma usually appears as pink, red or purple lesions on the skin and mouth. In people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect the internal organs, including the digestive tract and lungs.

Other complications

• Wasting syndrome. Untreated HIV/AIDS can cause significant weight loss, often accompanied by diarrhoea, chronic weakness and fever.

• Neurological complications. HIV can cause neurological symptoms such as confusion, forgetfulness, depression, anxiety and difficulty walking. HIV-associated neurocognitive disorders (HAND) can range from mild symptoms of behavioural changes and reduced mental functioning to severe dementia causing weakness and inability to function.

• Kidney disease. HIV-associated nephropathy (HIVAN) is an inflammation of the tiny filters in your kidneys that remove excess fluid and wastes from your blood and pass them to your urine. 

• Liver disease. Liver disease is also a major complication, especially in people who also have hepatitis B or hepatitis C.

Prevention

• There's no vaccine to prevent HIV infection and no cure for AIDS. But you can protect yourself and others from infection.

• To help prevent the spread of HIV:

• Use treatment as prevention (TasP). If you're living with HIV, taking HIV medication can keep your partner from becoming infected with the virus. If you make sure your viral load stays undetectable — a blood test doesn't show any virus — you won't transmit the virus to anyone else. Using TasP means taking your medication exactly as prescribed and getting regular checkups.

• Use post-exposure prophylaxis (PEP) if you've been exposed to HIV. If you think you've been exposed through sex, needles or in the workplace, contact your doctor or go to the emergency department. Taking PEP as soon as possible within the first 72 hours can greatly reduce your risk of becoming infected with HIV. You will need to take medication for 28 days.

• Use a new condom every time you have sex. Use a new condom every time you have anal or vaginal sex. Women can use a female condom. If using a lubricant, make sure it's water-based. Oil-based lubricants can weaken condoms and cause them to break. 

• Tell your sexual partners if you have HIV. It's important to tell all your current and past sexual partners that you're HIV-positive. They'll need to be tested.

• Use a clean needle. If you use a needle to inject drugs, make sure it's sterile and don't share it. Take advantage of needle-exchange programs in your community. Consider seeking help for your drug use.

• If you're pregnant, get medical care right away. If you're HIV-positive, you may pass the infection to your baby. But if you receive treatment during pregnancy, you can significantly cut your baby's risk.

• Consider male circumcision. There's evidence that male circumcision can help reduce the risk of getting HIV infection.

What Can Be Considered “Normal Vaginal Discharge” or “Leukorrhea”?

Vaginal discharge (medically known as leukorrhea), refers to the natural secretions that are released from a women’s vagina. These secretions are responsible for lubrication and the prevention of infection. The type, color, and volume of discharge varies from person to person, as well as time based on the individual’s menstrual cycle. However, vaginal discharge generally follows this timeline:

• Days 1-5 of the menstrual cycle: The time when menstrual bleeding takes place

• Days 6-14 of the menstrual cycle: Discharge is  generally, usually milky white or yellowish in color, and rather sticky in consistency

• Days 14-25 of the menstrual cycle: Discharge is influenced by ovulation therefore smooth and runny (similar in texture and color to egg whites) initially and then returns to the former milky white or yellowish color once ovulation is complete

• Days 25-28 of the menstrual cycle: Discharge reduce and halt altogether as the monthly menstrual bleeding begins

What Does the Color of the Discharge Tell Us?

• Various shades of red: Bleeding begins at each menstrual cycle, which usually takes place approximately every 28 days or between 21-35 days for some women, and lasts around 3 to 5 days. However, if there is vaginal bleeding at times outside menstruation, medical attention should be immediately sought

• Various shades of white: Any color between white to pale yellow is considered normal; however, should there be any accompanying irregular signs or symptoms present, such as a foul smell, itchiness, or thick clumps, excessive discharge amounts or vaginal pain. Anything that is outside of an individual’s normal is reason enough to seek medical attention to ensure there is no sign of infection or need for treatment

• Various shades of yellow and green: Saturated yellow, pale green, or saturate green coloration of the discharge could mean a bacterial infection or potentially a sexually transmitted infection. Medical attention should be immediately sought should these colors be present, especially in cases where the discharge is frothy, sticky, or has an intense pungent odor

• Transparent: This is normal. The discharge is generally clear or pale white, smooth to the touch much like egg whites

• Various shades of gray: Grayish coloration is a clear sign of a vaginal bacterial infection — especially when other symptoms are also present such as a pungent odor, itchiness, irritation, and redness at the opening of the vagina. Should any of these symptoms be present, medical attention should be sought immediately

Common Irregular Vaginal Discharge Linked to Infections

Vaginal infections will generally present with specific vaginal discharge and accompanying symptoms; however, although Health Care Providers can often diagnose based on symptoms and patient assessment alone, confirmatory testing may be required. If you are treated and the symptoms do not resolve in 2-3 days return to be seen for further testing. The 3 most common disorders related to irregular discharge are:

TYPE OF INFECTION

VULVOVAGINAL CANDIDIASIS (YEAST INFECTION)

• GENERALLY, THIS IS A RESULT OF A CANDIDA ALBICANS INFECTION, ALTHOUGH SOME CASES CAN BE CAUSED BY OTHER TYPES OF INFECTION.

FACTORS THAT CAN INCREASE THE RISK OF A FUNGAL INFECTION INCLUDE DIABETES, PROLONGED EXPOSURE TO ANTIBIOTIC MEDICATION, ELEVATED ESTROGEN LEVELS OR AN INCREASE IN ESTROGEN LEVELS DUE TO EXTERNAL FACTORS (SUCH AS THE USE OF THE CONTRACEPTIVE PILL AND PREGNANCY), AND A WEAKENED IMMUNE SYSTEM (HIV INFECTION,  OR PROLONGED USE OF STEROID MEDICATION).

Discharge has a thick and lumpy consistency, with vaginal itching or burning sensation. Both are quite common. There may also be a stinging sensation when urinating and pain during intercourse. Redness is found with an internal examination of the vagina.

BACTERIAL VAGINOSIS

• RESULTING FROM POOR BACTERIUM THAT MULTIPLIES AT AN ABNORMALLY FAST PACE WHEN COMPARED TO THE USUAL HEALTHY BACTERIUM PRESENT IN THE VAGINA, THUS CAUSING AN INFECTION TO DEVELOP.

IT IS ASSOCIATED WITH HAVING MULTIPLE OR A NEW SEXUAL PARTNER, WASHING THE INSIDE OF THE VAGINA TOO VIGOROUSLY, UNPROTECTED SEX, AND THE LOSS OF THE LACTOBACILLI.

Many women may  not have symptoms but those who do will experience irregular discharge, including gray coloration; a pungent, fishy odor; itchiness; a stinging sensation when urinating; and pain during intercourse. Vaginal inflammation or a burning sensation in the vagina are uncommon symptoms of this condition.

Sexual intercourse should be avoided during treatment.

TRICHOMONIASIS

• CAUSED BY THE TRICHOMONAS VAGINALIS (TV) PARASITE, WHICH IS GENERALLY CONTRACTED DURING SEXUAL INTERCOURSE.

The discharge will be a foamy green with a pungent odor. There will be a burning sensation and itching around the vaginal entrance and internally. As well, there will be a stinging sensation when urinating, pain or bleeding during intercourse, inflammation, and vaginal redness. Distinctive red spots also appear at the entrance to the vagina and cervix, which is known as strawberry cervix.

• Any sexual partners should also receive treatment for the condition.

At Which Point Should You Seek Medical Attention?

Women should seek medical attention if their discharge takes on a different color, pungent odor, irregular texture, or if any of the following vaginal symptoms are present:

• Redness, itching, pain, or irritation of the vagina or cervix

• Discharge takes on a foamy texture or is lumpy

• Discharge is a yellow, green, or gray color

• There is bleeding from the vagina in between menstruation

• There is a pungent odor

Generally, an infection or hormonal imbalance is the cause of discharge abnormalities, which sometimes requires medical treatment. If you observe vaginal discharge irregularities or any other symptoms that may signal an issue with the reproductive organ, be sure to seek medical attention.

Overview

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.

The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.

Symptoms

Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain.

Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two of these signs:

• Irregular periods. Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods.

• Excess androgen. Elevated levels of male hormones may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.

• Polycystic ovaries. Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.

PCOS signs and symptoms are typically more severe if you're obese.

When to see a doctor

See your doctor if you have concerns about your menstrual periods, if you're experiencing infertility or if you have signs of excess androgen such as worsening hirsutism, acne and male-pattern baldness.

Causes

The exact cause of PCOS isn't known. Factors that might play a role include:

• Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar, your body's primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your body might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation.

• Low-grade inflammation. This term is used to describe white blood cells' production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems.

• Heredity. Research suggests that certain genes might be linked to PCOS.

• Excess androgen. The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne.

Complications

Complications of PCOS can include:

• Infertility

• Gestational diabetes or pregnancy-induced high blood pressure

• Miscarriage or premature birth

• Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver

• Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease

• Type 2 diabetes or prediabetes

• Sleep apnea

• Depression, anxiety and eating disorders

• Abnormal uterine bleeding

• Cancer of the uterine lining (endometrial cancer)

Obesity is associated with PCOS and can worsen complications of the disorder.