Chapter 7: Benign Disorders of the Female Reproductive Tract

Pelvic floor disorders result from structural weakening of the levator ani musculature and supportive pelvic fascia, causing abnormal descent and herniation of pelvic organs. This pathophysiology manifests clinically as various prolapse types including cystoceles involving bladder hernia, rectoceles from rectal wall descent, enteroceles of small bowel tissue, and uterine prolapse when the uterus descends into the vaginal canal. Urinary incontinence, a related consequence of pelvic floor insufficiency, is distinguished pathophysiologically between stress incontinence resulting from inadequate urethral sphincter closure during increased abdominal pressure and urgency incontinence driven by involuntary detrusor muscle contractions. Clinical management emphasizes conservative approaches including pelvic floor muscle training through targeted rehabilitation and mechanical support via vaginal pessaries, with surgical options such as colporrhaphy and hysterectomy reserved for severe cases unresponsive to conservative care. The chapter further examines benign neoplastic growths commonly encountered in the reproductive tract, including cervical and endometrial polyps, uterine leiomyomas that are estrogen-dependent fibroid tumors, and genital fistulas arising from ischemic tissue death following obstetric trauma. Cystic lesions such as Bartholin gland cysts and functional ovarian cysts represent additional benign pathologies requiring management. The chapter emphasizes polycystic ovary syndrome as a complex endocrine-metabolic disorder characterized by elevated androgen levels, peripheral insulin resistance, and anovulation disrupting both reproductive and metabolic function. Comprehensive PCOS management integrates hormonal therapy via oral contraceptives with insulin-sensitizing medications to address both reproductive abnormalities and reduce long-term metabolic complications including type 2 diabetes, metabolic syndrome, and increased cardiovascular risk.