Multiple prolapsing mullerian vaginal cysts mimicking cystocele and enterocele

Multiple vaginal cysts are rare. Large cysts may present as vaginal wall prolapse. Proper assessment by clinical examination (under anaesthesia if necessary) and by USG and/or MRI should be done before surgical planning. Complete excision of cyst wall is necessary to prevent recurrence. A 40 years old P1L1 presented with mass per vaginum associated with pain and dyspareunia. On examination third degree cystocoele and a large posterior vaginal wall cyst with enterocoele was seen. Ultrasonography revealed no remarkable finding. Examination under anaesthesia followed by cyst excision was planned. Preoperatively three cysts were found, one on anterior wall mimicking as cystocoele, two cysts over prolapsed posterior vaginal wall, of which one had already ruptured. All the three cysts were excised completely. Histopathology revealed Mullerian cyst. This was an unusual case of multiple Mullerian vaginal cysts

Effect of intrauterine copper device on cervical cytology and its comparison with other contraceptive methods

Background: The intrauterine device (IUD) is the most commonly used reversible family planning method all over the world .The risk of cervical neoplasia associated with use of an intrauterine device (IUD), specially the copper releasing one, has been an important concern. The aim and objectives of the study was to determine safety of copper IUCD with regard to changes in cervical cytology and to compare the changes with other methods of temporary contraception.Methods: This was a prospective study carried out at a tertiary care institute for a period of 3 years. A total of 200 women of age group 18-40 years were included. 100 subjects who opted Cu-T 380A IUD were compared with 100 controls that had either opted other mode of temporary contraception like barrier, injectable, oral or did not use any method. Detailed history and examination of all subjects were done. All the women were subjected to conventional Pap smear and were followed at 6 months of interval for 1 year and then yearly up to 3 years. In each visit thorough pelvic examination was done and PAP smears were taken.Results: Among women using IUCD, 67.7% showed normal cytology as compared to 72.0% of the controls. On follow up, the incidence of normal cytology decreased (40%) with increased duration of use (up to 3 years). Incidence of inflammatory smear though first decreased up to 1 year (21.8%) but then gradually increased up to 2 years (37.0%) of use and then again decreased to 20.0% up to 3 years of use. ASCUS was found in only one case that used the device up to 2 years of use. LSIL was detected in 2 cases (20%) using IUD up to 3 years. No case of high grade intraepithelial lesion (HSIL) or invasive cancer was seen.Conclusions: There was no significant risk of cervical dysplasia or invasive carcinoma in IUCD users up to 2 years of use while other contraceptives (except barrier one) showed increased incidence of mild dysplasia (LSIL) after 1 year of use. Though risk of cervical malignancy is less with intrauterine copper devices, regular follow up should be done in long term users

Caesarean scar endometriosis: a rare site of extrapelvic endometriosis

Scar endometriosis is a rare presentation of extrapelvic endometriosis. A caesarean section scar is the most common site. The typical clinical presentation is that of a palpable firm subcutaneous nodule near surgical scars associated with cyclic pain and swelling during menses. It is often misdiagnosed with other abdominal wall and scar related pathological conditions. Diagnosis is mainly based upon a high index of suspicion. USG with color Doppler can clinch the diagnosis in patients with typical clinical features. FNAC may be inconclusive. MRI is the most sensitive but expensive modality to make the diagnosis. Wide local excision is the treatment of choice. We report a case of caesarean scar endometriosis and discuss about incidence, pathophysiology, diagnosis and treatment of this condition