Antisperm antibodies are usually present in:
For a woman who has been operated for chocolate cyst with normal menstrual cycle, any of the following may be prescribed except:
A 30-year-old female has severe dysmenorrhoea and dyspareunia. On examination, uterus is 8-week size, uniformly enlarged and there is tenderness in posterior fornix. What is the most probable diagnosis?
UPSC-CMS 2016 - Obstetrics and Gynecology UPSC-CMS Practice Questions and MCQs
Question 31: Antisperm antibodies are usually present in:
- A. Vagina
- B. Fallopian tube
- C. Uterus
- D. Cervix (Correct Answer)
Explanation: ***Cervix*** - The **cervical mucus** is the most clinically significant site in the **female reproductive tract** where **antisperm antibodies** interfere with fertility. - These antibodies can **agglutinate sperm**, **immobilize sperm**, or reduce their ability to penetrate through cervical mucus and reach the ovum, contributing to **immunological infertility**. - In the context of local immune responses affecting fertilization, the **cervix** acts as a critical immunological barrier where ASAs are detected and clinically relevant. - Note: Antisperm antibodies can also be detected in **serum** (blood) and are commonly found in **seminal plasma** in males, but among reproductive tract sites in females, the **cervix** is the primary location of clinical significance. *Vagina* - The **acidic environment** (pH 3.8-4.5) of the vagina is generally hostile to sperm, but it is not a primary site for antisperm antibody formation or action. - While some immune cells exist, the vagina's protective function relies more on acidic pH and normal flora rather than specific antisperm antibodies. *Fallopian tube* - The fallopian tubes are primarily involved in **sperm transport**, **fertilization**, and **embryo transport**, but are not a primary site where antisperm antibodies cause clinical infertility problems. - Although sperm encounter the tubal environment, the **cervical mucus** at the cervix acts as a more significant and earlier immunological barrier. *Uterus* - The uterine cavity is generally more accommodating to sperm after they pass through the cervical barrier, and is not the primary site for antisperm antibody-mediated infertility. - The **cervix** serves as the critical immunological checkpoint before sperm reach the uterine environment.
Question 32: For a woman who has been operated for chocolate cyst with normal menstrual cycle, any of the following may be prescribed except:
- A. Oral progestogens
- B. Injection leuprolide
- C. Tablet dienogest
- D. Tranexamic acid (Correct Answer)
Explanation: ***Tranexamic acid*** - **Tranexamic acid** is an antifibrinolytic agent used to reduce **heavy menstrual bleeding** by inhibiting plasminogen activation. - In a woman with a **normal menstrual cycle** who has undergone surgery for a chocolate cyst, heavy bleeding is not an issue, so tranexamic acid would be **unnecessary** and not indicated for endometriosis management. *Oral progestogens* - **Oral progestogens** are commonly prescribed for endometriosis to **suppress ovarian activity** and induce decidualization and atrophy of endometrial implants. - They help manage symptoms like **pain** and prevent recurrence of chocolate cysts by creating a **progestin-dominant environment**. *Injection leuprolide* - **Leuprolide** is a **GnRH agonist** that creates a **hypoestrogenic state** by downregulating pituitary GnRH receptors, thereby suppressing ovarian hormone production. - This effectively reduces the growth of **endometrial implants** and manages endometriosis symptoms, often used post-operatively to prevent recurrence. *Tablet dienogest* - **Dienogest** is a **fourth-generation progestin** specifically approved for the treatment of endometriosis. - It works by suppressing ovarian estrogen production and inhibiting the growth of **endometrial lesions**, making it a suitable long-term post-operative therapy.
Question 33: A 30-year-old female has severe dysmenorrhoea and dyspareunia. On examination, uterus is 8-week size, uniformly enlarged and there is tenderness in posterior fornix. What is the most probable diagnosis?
- A. Fibroid uterus
- B. Endometrial carcinoma
- C. Dysfunctional uterine bleeding
- D. Adenomyosis (Correct Answer)
Explanation: ***Adenomyosis*** - **Adenomyosis** is characterized by the presence of **endometrial glands and stroma within the myometrium**, leading to a diffusely enlarged uterus and often presenting with **severe dysmenorrhoea** and **dyspareunia**. - A **uniformly enlarged, tender uterus** (described as 8 weeks size) in a patient with these symptoms is highly suggestive of adenomyosis, as the ectopic endometrial tissue causes pain and uterine enlargement. *Fibroid uterus* - **Fibroids (leiomyomas)** typically cause an **irregularly enlarged uterus** and can lead to heavy menstrual bleeding (menorrhagia) and pelvic pressure, but severe dyspareunia is less common. - While fibroids can cause an enlarged uterus and dysmenorrhoea, the **uniform enlargement** and prominent **tenderness of the posterior fornix** (suggesting broad involvement) are more aligned with adenomyosis. *Endometrial carcinoma* - **Endometrial carcinoma** typically presents with **postmenopausal bleeding** or abnormal uterine bleeding, often in older women, and usually does not cause a uniformly enlarged and tender uterus. - While it can cause pelvic pain, the specific presentation of **severe dysmenorrhoea and dyspareunia** with a diffusely enlarged and tender uterus is not characteristic of endometrial cancer. *Dysfunctional uterine bleeding* - **Dysfunctional uterine bleeding (DUB)** refers to abnormal bleeding that is not due to structural or systemic causes, often associated with **anovulation** and hormonal imbalances, primarily characterized by irregular or heavy periods. - DUB usually does not cause a **uniformly enlarged or tender uterus** and is less directly associated with the severe dysmenorrhoea and dyspareunia seen in this case.