Polycystic ovary syndrome (PCOS) is a condition that affects a woman’s hormone levels.
Women with PCOS produce higher-than-normal amounts of male hormones. This hormone imbalance causes them to have irregular and infrequent periods making getting pregnant is hard for them.
Those women also have hair growth on the face and body, and baldness. And it can contribute to long-term health problems like diabetes mellitus and hypertension.
Birth control pills and diabetes drugs can help fix the hormone imbalance and improve symptoms.
It’s a different entity from PCO like picture which is discovered accidently during ultrasound which causes no symptoms.
It is a well-known and a common condition worldwide, but the reported incidence varies worldwide with high prevalence among women from south Asia.
What is PCOS?
PCOS is a “syndrome,” or group of symptoms that affects the ovaries and ovulation. Its three main features are:
• Cysts in the ovaries
• High levels of male hormones
• Irregular or skipped periods
In PCOS, many small, fluid-filled sacs grow inside the ovaries. The word “polycystic” means “many cysts.”
PCOS is a problem with hormones that affects women during their childbearing years (ages 15 to 44). It involves cysts in the ovaries, which are the women’s reproductive organs secreting estrogen, progesterone and a small amount of male hormones. The balance between these hormones regulate the menstrual cycle, ovulation and normal fertility.
Women with PCOS have extra male hormones which disrupt the menstrual cycle, so women with PCOS get fewer periods than usual with lack of ovulation resulting in conception difficulty.
What causes it?
Doctors don’t know exactly what causes PCOS. They believe that high levels of male hormones prevent the ovaries from producing hormones and making eggs normally.
Genes, insulin resistance, and inflammation have all been linked to excess androgen production.
It’s likely that many genes — not just one — contribute to the condition.
Insulin is a hormone the pancreas produces to help the body use sugar from foods for energy. When cells can’t use insulin properly, the body’s demand for insulin increases. The pancreas makes more insulin to compensate. Extra insulin triggers the ovaries to produce more male hormones. Obesity is a major cause of insulin resistance. Both obesity and insulin resistance can increase your risk for type 2 diabetes.
Women with PCOS often have increased levels of inflammation in their body. Being overweight can also contribute to inflammation.
Symptoms of PCOS
Some women start seeing symptoms around the time of their first period. Others only discover they have PCOS after they’ve gained a lot of weight or they’ve had trouble getting pregnant.
The most common PCOS symptoms are:
• Irregular periods. A lack of ovulation prevents the uterine lining from shedding every month. Some women with PCOS get fewer than eight periods per year.
• Heavy bleeding. The uterine lining builds up for a longer period of time, so the periods you do get can be heavier than normal.
• Hair growth. More than 70 percent of women with this condition grow hair on their face and body — including on their back, belly, and chest. Excess hair growth is called hirsutism.
• Acne. Male hormones can make the skin oilier than usual and cause breakouts on areas like the face, chest, and upper back.
• Weight gain. Up to 80 percent of women with PCOS are overweight or obese.
• Male-pattern baldness. Hair on the scalp gets thinner and fall out.
• Darkening of the skin. Dark patches of skin can form in body creases like those on the neck, in the groin, and under the breasts.
• Headaches. Hormone changes can trigger headaches in some women.
Long term consequences of PCOS:
• Type 2 diabetes mellitus
• Hypertension
• Dyslipidemia
• Cardiovascular diseases
• Endometrial carcinoma
How PCOS is diagnosed?
Doctors diagnose PCOS if women have at least two of three main symptoms
• High androgen levels diagnosed by blood tests or causing excess body hair growth
• Irregular periods with decreased or absent ovulation
• Cysts in the ovaries.
A pelvic exam, blood tests, and ultrasound can confirm the diagnosis.
Pregnancy and PCOS
PCOS interrupts the normal menstrual cycle and makes it harder to get pregnant. This condition can also increase the risk for pregnancy complications. Women with PCOS are at increased risk to deliver their baby prematurely. They’re also at greater risk for miscarriage, high blood pressure, and gestational diabetes.
However, women with PCOS can get pregnant using fertility treatments that improve ovulation. Losing weight and lowering blood sugar levels can improve your odds of having a healthy pregnancy.
How PCOS is treated?
You need to know that there is no curative treatment for PCOS and the available treatment are guided by the symptoms caused by PCOS.
1. Diet and lifestyle tips to treat PCOS
Treatment for PCOS usually starts with lifestyle changes like weight loss, diet, and exercise.
Losing just 5 to 10 percent of your body weight can help regulate your menstrual cycle and improve PCOS symptoms. Weight loss can also improve cholesterol levels, lower insulin, and reduce heart disease and diabetes risks.
Exercise is even more beneficial when combined with a healthy diet. Diet plus exercise helps you lose more weight than either intervention alone, and it lowers your risks for diabetes and heart disease.
2. Menstrual irregularities
Taking birth control pills which contains estrogen and progestin daily can restore a normal hormone balance, regulate ovulation, relieve symptoms like excess hair growth, and protect against endometrial cancer.
3. Hair removal medicines
A few treatments can help get rid of unwanted hair or stop it from growing. Sometimes your doctor may give you a long course of treatment to get rid of the excess hair also Laser hair removal and electrolysis can be used to get rid of unwanted hair on your face and body.
4. Pregnancy issues
For women with PCOS who seeking pregnancy there are two ways of management of this condition starting mainly by medical route and sometimes some women need more interventions like surgery.
Medical treatments include regular drugs which trigger the ovulation and follow up by using ultrasound and measurements of certain hormone levels, some doctors add metformin during induction of ovulation believing that it increases your response to induction medications.
The surgical route was used widely over the past decades through ovarian drilling which is a procedure that makes tiny holes in the ovary with a laser or thin heated needle to restore normal ovulation, but nowadays it’s restricted to certain cases.

What is endometriosis?
Is when the tissue that makes up the uterine lining (the lining of the womb) is present on other organs inside your body. These uterine linings respond the monthly produced hormones from the ovaries and undergo thickening and bleeding which sometimes form cysts known as (chocolate cysts). Endometriosis is usually found in the lower abdomen, or pelvis, but can appear anywhere in the body.
Women with endometriosis often have lower abdominal pain, pain with periods, or pain with sexual intercourse, and may report having a hard time getting pregnant. On the other hand, some women with endometriosis may not have any symptoms at all.
Endometriosis is estimated to affect between 3% and 10% of reproductive-aged women. Endometriosis can only be truly diagnosed by a doctor performing a laparoscopy (a surgery where a doctor looks in the abdomen with a camera usually through the belly button) and taking a sample of a suspected abnormality.
Symptoms of endometriosis
• Chronic pain at the pelvis lasting for more than 6 months, which is usually cyclic in nature.
• Painful periods which sometimes be heavy.
• Painful sexual intercourse.
• Pain during defecation or with bowel movements
• Pain during urination with blood passing with urine sometimes
• May present for the first time by difficulty to get pregnant.
How does endometriosis happen?
There are several different ideas regarding the causes of endometriosis.
• One idea is that during period, some of the blood and tissue from the uterus travels back through the fallopian tubes and into the abdominal cavity. This is called retrograde menstruation.
• Another idea is that some cells in the body outside of the uterus can change to become the same kind of cells that line the uterus.
• Another possible explanation is that the cells from the lining of the uterus travel through the blood vessels or through the lymphatic system to reach other organs or body areas.
• Also, endometriosis can spread at the time of surgery. For example, a woman with endometriosis that undergoes a cesarean section could inadvertently have some endometriosis cells attach to the abdominal incision so that she has endometriosis in the scar from the surgery.
• Interestingly, nearly all women have some degree of retrograde menstruation, but only a few women will get endometriosis. This may be due to differences in a woman’s immune system. Also, endometriosis is much more common if a close relative also has endometriosis, so there may be genes that influence endometriosis.
Complications of endometriosis
• Chronic pelvic pain
• Adhesions inside the pelvic cavity which may lead to intestinal or ureteric obstruction
• Failure to conceive
Endometriosis seems to impair fertility in 2 ways: first, by causing distortion of the fallopian tubes so that they are unable to pick up the egg after ovulation, and second, by creating inflammation that can adversely affect the function of the ovary, egg, fallopian tubes or uterus.
How is Endometriosis Diagnosed?
The most important is the telling your doctor about the symptoms you have focusing on the duration of these symptoms and its relation to your periods. Your doctor may ask for pain diaries for 2 months before confirming the diagnosis.
The pelvic examination done by your doctor will help in confirming diagnosis.
The available investigations to diagnose endometriosis:
• Pelvic ultrasound which may reveal presence of chocolate cysts or adhesions.
• Magnetic resonance of the pelvis will also confirm the presence of these cysts and adhesions also
• Diagnostic laparoscopy which is done through tiny holes at the abdomen where a camera can pass through it and see inside your abdominal and pelvic cavity and can also take biopsies from suspicious areas to help in diagnosis confirmation.
• Blood tests which may help in diagnosis like measuring of CA125 which is usually Increased  in cases of endometriosis but it is not specific to it.
Treatment of endometriosis
You should know that there is no curative treatment for endometriosis but there are many different lines which help in treating your pain and improve Your chance to get pregnant
1. Medical treatment
• May start with analgesics for 3 months
• The second option is birth control pills or progesterone only pills taken in a continuous manner for 6 months
• Mirena which is medicated intrauterine contraceptive device can be inserted inside Your womb and may be used for 5 years.
• GnRH analogues which is a hormonal injections can be prescribed for 6 months and leading to a considerable reduction in the size of endometriosis lesions and relieving the symptoms.
2. Surgical treatment:
• Usually employed for excision of chocolate cysts and removal of the adhesions through laparoscope.
• The last option could be removal of the uterus and both ovaries to treat the pain but this is not routinely done and its preserved for severe cases not responding to all other treatment options. 

There is no doubt that inflammation of the cervix (cervicitis) is a disease that attacks all ladies in the world without exception.

Dr.Wael El Banna made a group of videos Which spread in all Arab countries, which include detailed explanation for the reasons, symptoms , types and management of these cases , we advise to see these videos in the links below

In Dr.Wael EL Banna clinic we have the honor to present a program for treatment of these cases which may lead to chronic cervicitis which may also a cause of infertility or cancer cervix.

For the pregnant woman , cervicitis may lead to rupture in the membrane covering the baby which may lead to fetal death or maternal morbidities.

The program is:
1- cervical and vaginal swabs
2- complete evaluation of the symptoms the women suffer from
3- Put the plan of treatment according to tests, and advise the
patient to change her pattern of health.
4- Regular cervical treatment sessions .
5- For the pregnant woman , she needs regular follow up and treatment of infection using different treatment programs that do not affect the fetus.

For some women, the vaginal muscles involuntarily or persistently contract when they attempt vaginal penetration. This is called vaginismus. The contractions can prevent sexual intercourse or make it very painful. When a woman has vaginismus, her vagina’s muscles squeeze or spasm when something is entering it, like a tampon or a penis. It can be mildly uncomfortable, or it can be painful.
Vaginismus doesn’t interfere with sexual arousal, but it can prevent penetration.
A gentle pelvic exam typically shows no cause of the contractions. No physical abnormalities contribute to the condition.
It’s not your fault, and it’s nothing to be ashamed of. Nevertheless, these disorders can interfere with your relationships and your quality of life.
Experts don’t know exactly how many women suffer from vaginismus, but the condition is considered to be uncommon.
There are different types of vaginismus that can affect women at different ages.
1. Primary vaginismus
This is a lifetime condition in which the pain has always been present. It will be difficult to use a tampon and to undergo a gynecological exam.
It is often experienced by women during their first attempt at intercourse. The male partner is unable to insert his penis into the vagina. He may describe a sensation like “hitting a wall” at the vaginal opening.
There may be pain, generalized muscle spasms, and the woman may temporarily stop breathing. The symptoms are reversed when the attempt at vaginal entry is stopped.
2. Secondary vaginismus
This develops after a woman has already experienced normal sexual function. It has not always been present. It can occur at any stage of life, and it may not have happened before.
It usually stems from a specific event, such as an infection, menopause, a traumatic event, development of a medical condition, relationship issues, surgery, or childbirth.
Even after any underlying medical condition is corrected, pain can continue if the body has become conditioned to respond in this way.
Causes of vaginismus
Often there’s no obvious explanation, but some things thought to cause vaginismus include:
• fear that your vagina is too small
• a bad first sexual experience
• an unpleasant medical examination
• a belief that sex is shameful or wrong
• a painful medical condition, like thrush
What happens at your appointment?
At your appointment at our clinic, you may ask to be seen by a female doctor, and you can bring someone you trust along for support. Your doctor will ask you about your symptoms and may ask to examine your vagina.
The examination is usually very quick. Your doctor will take a quick look to rule out other conditions, like an infection. It’s unlikely they’ll need to perform an internal examination of your vagina.
Our lead in this issue is based on a strong scientific background through using an advanced American program for management of such conditions. Treatment is usually effective and you may see progress in a matter of weeks.
• Firstly, both partners will be evaluated.
• Secondly, a psychological assessment may be done searching for the possible causes of this condition.
• Thirdly, you may be given local vaginal or oral treatments
• Lastly, minor surgeries may be appropriate for some cases to help in managing the condition.
Our program of management of cases of vaginismus is considered one of the top management programs in the Middle East in treating such increasing condition which usually declined by our culture.