The term dysmenorrhea (from &?, difficult, fiyv, month, and fiieiv} to flow) signifies painful menstruation, and is used to define suffering of whatever kind associated with the performance of the function of menstruation. In spite of the many theories advanced to explain the occurrence of pain accompanying, preceding, or following the monthly flow, we are still ignorant of the cause. Authorities are not agreed as to the frequency of pain among normal women. Theoretically the woman should be conscious of menstruation only by the discharge of blood from the vulva; as a matter of fact a considerable proportion of women have some sort of discomfort.
<Callout type="important" title="Important">Dysmenorrhea can significantly impact daily life and may indicate underlying pelvic issues.</Callout>
Menstrual molimina are the local and general disturbances that are supposed to be normal to menstruation; they are: — a certain amount of pain in the pelvis extending through the back and thighs, also nervous depression, resulting in lassitude, headache, nervous instability, and derangement of the function of different organs. Some of the last are: eye strain, skin eruptions — such as urticaria and acne, — pains in the joints, and loosening of the sacro-iliac joint in the case of sacro-iliac disease, and various sorts of "neu- ralgias." They are often spoken of as "reflex symptoms."
Exaggeration of the menstrual molimina constitutes dysmenorrhea, although the term is more often applied to the actual pain which is referred to the pelvis than to the more distant manifestations.
Dysmenorrhea may be classified as of two sorts, (1) that associated with definite discoverable lesions of the uterine organs, and (2) that in which no abnormality of those organs can be determined. 1. Dysmenorrhea Associated with Pelvic Lesioxs This includes dysmenorrhea occurring in the case of (1) Con- genital malformations of the uterine organs, (2) retroposition with anteflexion, (3) pelvic inflammation, and (4) fibroids.
<Callout type="risk" title="Risk">Retroposition with anteflexion can cause frequent and painful micturition.</Callout>
- Dysmenorrhea Where no Pelvic Lesion Can be Found Dysmenorrhea often exists in women who, apparently, have perfectly normal uterine organs. In this event the painful menstruation is (1) neurotic, or (2) due to poor general health.
<Callout type="tip" title="Tip">Neurotic dysmenorrhea may be alleviated by addressing underlying mental health issues.</Callout>
Membranous dysmenorrhea is characterized by severe cramp-like pains in the lower abdomen and back, resembling labor pains, occurring at the time of menstruation and followed by the expulsion of a more or less incomplete cast of the cavity of the corpus uteri in the shape of a sac, triangular in form, gray in color, and having a rough surface. When floated MEMBRANOUS DYSMENORRHEA 131 in water and laid open, the interior of the sac is smooth. With the aid of a magnifying glass this smooth surface is seen to be studded with minute openings which represent the mouths of the utricular glands.
<Callout type="warning" title="Warning">Exfoliative vaginitis may accompany membranous dysmenorrhea, complicating diagnosis.</Callout>
Intermenstrual pain, or "Mittelschmerz," is the name given to pain similar to the pain of dysmenorrhea, occurring on a definite date between two menstrual periods, often midway between, but not always. This affection is by no means uncommon and every gynecologist of wide experience has met with several cases.
<Callout type="important" title="Important">Intermenstrual pain may be associated with sterility or pregnancy.</Callout>
Menorrhagia (monthly bleeding, from nve?} menses, and pjjrvuvaij to burst forth) an excessive loss of blood at the menstrual periods, and metrorrhagia (uterine bleeding, from ^rpa} womb, and fayvuvatj to burst forth) a loss of blood independent of menstruation, are two terms which frequently can not be used with discrimination because the two conditions so often coexist. That is to say, a metrorrhagia becomes a menorrhagia when the menstrual period arrives, and menorrhagia, as in the case of a submucous fibroid, in the course of time becomes a metrorrhagia.
<Callout type="gear" title="Gear">A magnifying glass is essential for examining membranous dysmenorrhea.</Callout>
Menorrhagia is a relative term, for what is a moderate flow for one woman would be rated as excessive by another. Therefore, before pronouncing that menorrhagia exists in any given case, the physician must inquire minutely as to the patient's normal habit of menstruation, getting the number
Key Takeaways
- Dysmenorrhea can be caused by pelvic lesions or non-pelvic factors.
- Membranous dysmenorrhea involves the expulsion of a sac-like structure during menstruation.
- Intermenstrual pain may indicate underlying issues and is not always associated with regular menstrual cycles.
Practical Tips
- Identify the cause of dysmenorrhea to determine appropriate treatment options, whether it's pelvic lesions or neurotic factors.
- Use a magnifying glass for accurate diagnosis of membranous dysmenorrhea.
- Consider underlying mental health issues when treating neurotic dysmenorrhea.
Warnings & Risks
- Retroposition with anteflexion can cause frequent and painful micturition, which may be mistaken for other conditions.
- Exfoliative vaginitis may accompany membranous dysmenorrhea, complicating diagnosis.
- Intermenstrual pain is not always associated with regular menstrual cycles and may indicate underlying issues.
Modern Application
While the historical techniques in this chapter are rooted in early 20th-century medical practices, the core concepts of recognizing and managing dysmenorrhea remain relevant. Modern readers can apply these principles by seeking professional medical advice for accurate diagnosis and treatment, using updated diagnostic tools like ultrasound, and considering holistic approaches to address underlying causes such as pelvic inflammatory disease or endometriosis.
Frequently Asked Questions
Q: What are the common causes of dysmenorrhea?
Dysmenorrhea can be caused by pelvic lesions such as congenital malformations, retroposition with anteflexion, pelvic inflammation, and fibroids. It can also occur due to non-pelvic factors like poor general health or neurotic conditions.
Q: How is membranous dysmenorrhea diagnosed?
Membranous dysmenorrhea is diagnosed by examining the expulsion of a sac-like structure during menstruation, which can be observed with the aid of a magnifying glass. The interior of this sac is smooth and studded with minute openings representing utricular glands.
Q: What should I do if I experience intermenstrual pain?
Intermenstrual pain may indicate underlying issues such as sterility or pregnancy. It's important to consult a gynecologist for an accurate diagnosis, especially if the pain is severe or persistent.