Prasuti p2 Part A

प्रसूति िन्त्र
&
स्त्रीरोग
Paper II
PART A
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CHAPTER I: Artava vyapad
 Shuddha Artava
मासातिष्पिच्छदाहातिि पञ्चरात्रानुबष्पि च ।
नैवातिबहु नात्यल्पमािि वं शुद्धमातदशेि् ॥ २२५ ॥
गुञ्जाफलसवर्णं च पद्मालक्तकसतिभम् ।
इन्द्रगोपकसङ्काशमािि वं शुद्धमातदशेि् ॥ २२६ ॥ (च - तच - ३०)
The menstruation which appears every month, which is free from sliminess, burning
sensation and pain, which continues for five nights and which is neither excessive nor
scanty is normal / pure.
The menstruation which resembles in colour the Gunja Phala, Lotus, Lac or Indragupta is
normal / pure.
 Artava Dusti / Asta-Artava Dusti

The vitiated Artava is devoid of Beeja and therefore incapable of producing Garbha.
The Lakshana of Artava Dusti are the same as for Shukra Dusti.
 Bheda:
Doshapradhanya Artava Dusti Lakshanapradhanya Artava Dusti

(Acharya Sushruta) (Acharya Vagbhata)
1) Vataja 1) Vataja
2) Pittaja 2) Pittaja
3) Shleshmaja 3) Kaphaja
4) Raktaja 4) Kunapagandhi
5) Vata-Pittaja 5) Ksheena
6) Vata-Kaphaja 6) Granthibhuta
7) Pitta-Kaphaja 7) Putipuya / Puti
8) Tridoshaja 8) Mutra-pureesha-sagandhi
 Sadhya-Asadhyata:
Acharya Sadhya Kricchrasadhya Asadhya
Sushruta Vataja, Pittaja, --- Raktaja, VP, VK, PK, VPK
Kaphaja
Vagbhata I Ekadoshaja, --- Kunapagandhi,

Ksheena Granthibhuta, Putipuya,
Mutra-pureesha-sagandhi
Vagbhata II --- Ekadoshaja, Kunapagandhi, Mutra-pureesha-sagandhi

Granthbhuta, Putipuya,
Ksheena
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 Lakshana & Chikitsa:
Artava Dusti Lakshana Chikitsa

- Snigdha, Ushna, Amla, Lavana Dravya
- Aruna, Krishna Varna - Niruha Basti
- Vedana, Toda, Bheda - Ksheerapaka with Kashmarya & Kshudra saha
1) Vataja - Tanu, Ruksha, Phenila, Alpa - Ksheera / Ghrita processed with Madhuka &
- Chira saruja srava Shringalavinna Kalka
(delayed flow with pain) - Yoni Dharana with Priyangu & Tila Kalka
- Yoni Prakshalana with Sarala & Mudgaparni
- Madhura, Sheeta, Kashaya Dravya

- Peeta, Neela Varna - Virechana with Shamyaka & Gavakshi Ksheera
- Ushna, Putigandha, Apicchila - Kakoli & Viadari moola Kvatha
2) Pittaja - Daha srava - Shveta Chandana with Madhu
(flow with burning sensation) - Yoni Dharana with Chandana & Payasya Kalka
- Yoni Prakshalana with Gairika Kvatha; Arista
- Katu, Ruksha, Kashaya Dravya

- Shukla, Pandu Varna - Vamana with Madana phala Kvatha
3) Shleshmaja - Snigdha, Picchila, Guru - Kutaja Katuka Ashvagandha Kvatha
Kaphaja - Kandu, Glani, Mutrasanga - Ksheerivriksha patra Kvatha with Madhu
- Ksheerivriksha patra Churna with Madhu & Ghrita
- Yonipurana with Lodhra & Tinduka Kvatha
- Rakta Varna - Shveta / Rakta Chandana Kvatha

4) Raktaja - Ushna, Daha - Yonipurana or Dharana with Triphala Kalka
Kunapagandhi - Kunapagandhi (putrid smell like - Yoniprakshalana with Triphala Kvatha
dead body)
5) Vata-Pittaja - Vata & Pitta lakshana - Raktavardhaka Chikitsa

Ksheena - Ksheena (delayed / scanty)
6) Vata-Kaphaja - Vata & Kapha lakshana - Patha Tryushana Vrikshaka Kvatha

Granthibhuta - Granthi (clotted appearance) - Patha Trikantaka Vrikshaka Kvatha
7) Pitta-Kaphaja - Pitta & Kapha lakshana

Putipuya / Puti - Putigandha (putrid smell) Same as Kunapagandhi Chikitsa
8) Tridoshaja - VPK lakshana

Mutra- - Mutra-pureesha-sagandhi Asadhya
pureesha- (smell of urine & faeces)
sagandhi
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 Samanya Chikitsa:
- Snehna Svedana -> Vamanadi Shodhana Karma -> Uttarabasti
- Snehana Svedana -> Shodhana Karma -> Rasayana Vajikarana Dravya
- Snehana Svedana -> Yoni Kalka, Pichu, etc.
- Yoni Prakshalana with Vatadi Doshara Kvatha
 Aushadhi Prayoga:
- Shatapuspa & Shatavari Kalpa
- Yolgaraj Guggulu
- Chandraprabha Vati
- Pugapaka
- Jeevantyadi Anuvasana Yamaka
- Mustadi Yapana Basti
- Sahacharadi Yapana Basti
 Correlation of Artavadusti with Modern Medicine:
Artava Dusti Modern

1) Vataja Oligomenorrhoea / Hypomenorrhoea associated with
Dysmenorrhoea
2) Pittaja Inflammatory condition associated with infection
3) Shleshmaja / Kaphaja Cervicitis, Endometritis associated with oligomenorrhoea
4) Raktaja / Kunapagandhi Carcinoma of pelvic organs
5) Vata-Pittaja / Ksheena Hypo-oestrogenic oligomenorrhoea due to TB or severe

autoimmune conditions
6) Vata-Kaphaja / Granthibhuta Malignant lesions of pelvic organs
7) Pitta-Kaphaja /Putipuya / Puti Acute infections like pelvic abcess, pyometra
8) Tridoshaja / Mutra-pureesha-sagandhi Vesico or recto vaginal fistula
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 Asrigdara / Pradara
(Menorrhagia / Polymenorrhagia / Menometrorrhagia)
This condition is known as Asrigdara because the normal Artava gets increased by
vitiated Asrika (Rakta Dhatu).
It is also known as Pradara due to augmentation or expansion of Artava.
 Nidana, Samprapti & Samanya Lakshana:

If a woman takes excess of Lavana, Amla, Guru, Katu, Vidahi and Snigdha Ahara;
Gramya & Audaka Mamsa; Krishara, Payasa, Dadhi, Sukta, Mastu, Sura, etc.; then
Vayu in her body gets aggravated. This vitiated Vayu causes increase in the
quantity of blood which gets lodged in the Srotas that go towards the
Garbhashaya. By directing the Rakta from Raktavasrota to Artavavaha Srotas, the
quantity of Artava increased immediately causing Asrigdara.
 Bheda: - 4
Bheda Lakshana
01) Vataja Artava -> Phenila, Tanu, Ruksha, Shyava-Aruna, Saruja / Niruja
Deha -> Kati Vankshana Hrit Parshva Pristha Shroni Vedana
02) Pittaja Artava -> Saneela, Peeta, Ati-ushna, Asita, Rakta, Srava, Arti
Deha -> Daha, Raga, Trishna, Moha, Jvara, Bhrama
03) Kaphaja Artava -> Picchila, Pandu, Guru, Snigdha, Sheeta, Ghana, Mandaruja
Deha -> Chardi, Arochaka, Hrillasa, Shvasa, Kasa
04) Sannipatika Tridoshaja Lakshana
 Chikitsa:
- Tanduliyaka-moola Kalka with Madhu & Tanbulambu.
- Rasanjana & Laksha with Aja Ksheera.
- Rajadana & Kapittha-patra Kalka fried with Ghee. (Vata-Pitta shamaka)
- Pittaja Asrigdara -> Kalka from Madhuka, Haritaki, Bibhitaka, Amalaki, Lodhra,
Musta, Saurastrika and Madhu.
- Pittaja Asridgara -> Virechana with Trivrit, Aragvadha, etc; Mahatiktaka Ghrita
- Kaphaja Asrigdara -> Nimba & Guduchi with Madya
- Garbhasrava Chikitsa
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 Artava Vriddhi
(Menorrhagia / Polymetrorrhagia / Menometrorrhagia / Acute AUB)
Artava Virddhi is the excessive flow/increased amount of menstrual fluid.
 Lakshana:
- Ati-Raktasrava / Ati-pravritti
- Angamarda (due to obstruction of Vayu)
- Daurgandhya (due to similarity to Pitta)
 Upadrava:
- Daurbalya
- Rakta Gulma
 Chikitsa:
As all the increased Dhatus are managed, likewise Artava Vriddhi should be
treated by Shodhana and Shamana karma to alleviate the vitiated Doshas without
affecting the other Dhatus or Doshas. In excessive Dosha vitiation, Shodhana is
given; in minor Dosha vitiation, Shamana is given.
 Artava Kshaya
(Hypomenorrhoea / Oligomenorrhoea)
In Artava Kshaya, menstruation fails to occur at the proper time i.e. regular monthly
cycles do not occur or cycles are delayed or scanty; or is associated with pain.
Menstruation lasts less than 2 days or menstrual cycle lasts longer than 35 days.
i) Yathochita Kale Adarshana (menstruation at improper time/not seen at the right time)
ii) Alpata (decreased amount of menstruation)
iii) Yonivedana (associated with pain; it occurs because of vitiated Vayu filling up the
Yoni pradesha due to decreased amount of Artava.)
Chikitsa:
In general, a person desires substances in accordance to the Vriddhi Kshaya of the Dhatu
and Upadhatu; likewise, in Artavakshaya, the woman desires:
- Katu, Amla, Lavana, Ushna, Vidahi and Guru Ahara
- Fruits, vegetables and beverages
- Samshodhana Karma & Agneya Dravya
- Vamana, Virechana
- Tila, Masha, Shukta, Kulattha, etc.
- Sheetakalyana Ghrita
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 Amenorrhoea
 Introduction:
- Amenorrhoea is the absence of menstruation.
- Menstruation is mainly controlled by the hypothalamus, pituitary gland, ovaries
and uterus. Amenorrhoea may occure due to disturbance of any of these four
structures.
 Types: - 2
1) Primary
2) Secondary
1) Primary Amenorrhoea
- It is the absence of menses by 16 years of age while normal secondary
sexual characteristics have developed. (Anatomical)
OR
- It is the absence of menses by 14 years of age while normal secondary
sexual characteristics have not developed. (Physiological)
- It has congenital or anatomical causative factors.
2) Secondary Amenorrhoea
- It is the absence of menses for 3 individual normal menstrual cycles or for 6
months.
- It has pathological causative factors.
 False Amenorrhoea / Cryptomenorrhoea / Hidden Menstruation:

- It is a sub-type of primary amenorrhoea which is caused due to an anatomical
defect which leads to blockage of normal menstrual flow, resulting in
accumulation of menstrual fluid in the uterine cavity.
- It may be caused due to blockage in the lower reproductive passage.
Signs & Symptoms:

- Lower abdominal pain & heaviness
- Amenorrhoea although secondary sexual characteristics are present.
Diagnosis: USG - pelvis
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 True Amenorrhoea:
1) Physiological
2) Pathological
1) Physiological True Amenorrhoea

a) Before puberty -> Undeveloped reproductive organs; lack of hormones
b) Adolescence -> 2 years after menarche, the menstruation is irregular;

It may not occur for several months.
c) Pregnancy -> High level of oestrogen & progesterone;

menstruation start when progesterone level is low.
d) Lactation -> Hypothalamus & pituitary gland are concerned with

production of prolactin hormone; 80% of women have
amenorrheoa during lactation.
e) Menopause -> Decreased functioning of ovaries; absence of graafian

follicle; Age 45-55 years
2) Pathological True Amenorrhoea

a) Amenorrhoea with secondary sexual characteristics and
genital/congenital causes.
b) Amenorrhoea with secondary sexual characteristics and non-anatomic
causes.
c) Amenorrhoea with secondary sexual characteristics and anatomical
causes.
 Hypothalamic Amenorrhoea:
Dysfunction of hypothalamus due to:
Tumor, brain trauma, thrombosis, obesity, overeating, encephalitis, meningitis,
depression, mental stress, PCOD, anorexia
 Pituitary Amenorrhoea:
Dysfunction of pituitary gland due to:
- Sheehan’s syndrome -> Postpartum hypo-pituitarism
-> Pituitary gland is damages during childbirth due to
excessive blood loss or low BP; or due to excessive PPH.
- Simmond’s syndrome -> Destruction of anterior lobe of pituitary gland.
- Placenta previa, Abruptio placentae

- Assisted vaginal delivery
- Multiple pregnancy
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 Ovarian Amenorrhoea:
- Underproduction of oestrogen and progesterone due to primary ovarian failure.
- Continuous production of osetrogen and progesterone; may be due to follicular
cyst, persisting gluteal cyst or granulosa cyst.
- Overproduction of androgens -> oestrogen increase -> inhibition of other
endometrial and follicular activities, low level of luteinizing hormone.
- PCOS -> Poly-cystic ovarian syndrome may cause ovarian metabolic error or
overproduction of androgens -> oestrogen increase
 Uterine Amenorrhoea:
- Congenital absence of uterus
- Deformity of uterus
- Removal of uterus
- Damage to the uterus due to radiotherapy / chemotherapy
- Heavy curettage (excessive scrapping of endometrium)
- Asherman’s syndrome -> Endometrium is completely destroyed by curettage.
- Post-abortal infection -> adhesion of internal organs -> secondary amenorrhoea.
- TB of endometrium
 Endocrine Amenorrhoea:
- Hypo- or hyperthyroidism (leading to hormonal imbalance)
- Diabetes mellitus
-> Amenorrhoea may also occur due to an acute illness, chronic disease, excessive
exercise, environmental factors, starvation, anorexia nervosa, bulimia nervosa,
obesity.
 Diagnosis of Amenorrhoea:
1) Subjective -> Physical examination and proper history taking
2) Objective -> Investigations
Investigations:
- UPT (Urine pregnancy test) -> if female is sexually active
- USG uterus & adnexa -> to check for any congenital deformity or disease
- Blood sugar -> to check for DM
- Hormonal assay -> FSH, LH, TSH, T3, T4, Prolactin
GnRh increased = Primary ovarian failure (POF)
GnRh decreased = Hypothalamic & pituitary lesions
(Gonadotropin-releasing hormone)
- CT-scan, MRI, Laparoscopy
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 Treatment of Amenorrhoea:
- Hormonal pills (oestrogen & progesterone) to regulate the menstrual cycle
- Wholesome diet
- Surgical treatment in case of cryptomenorrhoea
- तवरे चन, बष्पि (अस्थापन, अनुवासन, उत्तर), नस्य (शिपुिा िैल)

- वािशामक, वािानुलोमन, स्रोिोशोधन, रजःपरवतिि क
- दशमू ल क्वाथ, वरुर्णतशग्रु क्वाथ
- रजःप्रवतिि नी वटी
- काञ्चनार गुग्गुलु
- शिावरी, शिपुिा
 Correlation of Amenorrhoea in Ayurveda:

वन्ध्या नष्टािि वा तवद्याि् ।
According to A. Sushruta, Vandhya is the condition in which there is absence of
Artava.
Only A. Sushruta has mentioned Vandhya as one of the Yonivyapad.
Absence of Artava is the cardinal sign of Vandhya. Other symptoms are same as
Vataja Yonivyapad.
Nastartava can be correlated with either no ovum, no hormones or no menses.

The last one may be Primary or Secondary Amenorrhoea.
A. Vagbhata mentioned the term Anartava which can be correlated with

amenorrhoea. Anartava occurs due to obstruction of Raktamarga by Vata and
Kapha Dosha.
Rajonasha and Rajo-anupasthiti are the terms used by A. Bhavamishra and

A. Bhela respectively.
-> Primary Amenorrhoea as per Ayurveda:

Excessive aggravation of Vata in Garbhini may cause disturbance and damage the
development of reproductive organs of the foetus which results in Vandhya of the
child (primary amenorrhoea).
-> Pathological amenorrhoea can be observed in:

- Vandhya Yonivyapad
- Shandhi Yonivyapad
- Arajaska / Lohitakshaya Yonivyapad (secondary amenorrhoea)
- Pandu
- Raktagulma
- Rajayakshma
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 Dysmenorrhoea
Dysmenorrhoea is defined as painful cramps that occur with menstruation incapacitating
enough to interfere with routine activities. It is the most common gynecological problem
in women of various age and race, and it is the most common cause of pelvic pain
leading to absenteeism as school and work.
 Protective factors:
- Regular exercise
- Oral contraceptives
- Early childbirth
 Risk factors:
- Age < 20 years
- Attempts to lose weight
- Depression, Anxiety
- Disruption of social network
- Heavy menses
- Nulliparity
- Smoking
 Types: - 3
1) Primary
2) Secondary
3) Membraneous
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1) Primary Dysmenorrhoea
- Menstrual pain appears on the first day
- Age 18-24 years
- 50% of females have primary dysmenorrhoea
- 5-10% have severe pain
Causes:
a) Incoordination of uterine muscles -> Hypertonus of Isthmus fibre &
external os -> Spasm & pain
b) High level of prostaglandin in uterus
c) High level of progesterone
d) High level of vasopressin
Symptoms:
a) 90% of cases -> Pain for a few hours before onset of menstruation. The
pain normally subsides ~6 hours after onset of menstruation.
Site of pain = Hypogastrium, inner & front aspects of the thighs, lower
backache
b) 5-10% of cases -> Severe attack of primary dysmenorrhoea.

Paleness, sweating, nausea, vomiting, diarrhoea, rectal & bladder
tenesmus (constant or frequently recurring urge for defecation &
micturition).
Treatment:
- तनदान पररवजिन (psychological & physical factors)
- पथ्याहार
- तवश्राम
- स्वे दन (abdomen & back)
- वािानुलोमन
- रजःप्रवतिि नी वटी
- दशमू ल क्वाथ, तिलगुड क्वाथ
- After menstruation:
पञ्चकमि , especially बष्पि - अस्थापन & अनुवासन
Basti is to be done for 7 days after 3 successive menstrual cycles; with Tila
Taila, Eranda Taila or Bala Taila.
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2) Secondary Dysmenorrhoea
- Menstrual pain throughout
- Age 30 years
- Generally develops in elder age if the woman always had painless
menstruation.
Causes:
a) Pelvi pathologies: PID, Endometriosis, Pelvic congestion, Uterine fibroid,
Uterine colic, Adenomyosis, Leiomyoma, IUCD (Intra-uterine
contraceptive device)
b) Congenital abnormalities of the uterus: Unicornuate uterus, cervical
stenosis, Septate vagina
Symptoms:
- Pain starts 2-3 days prior to onset of menstruation and persists throughout
the whole period.
- Backache (mild – severe)
- Pelvic pain
- Pre-menstrual engorgement in the pelvis due to congestion of blood in intra-
uterine cavity.
Investigations:
- USG pelvis
- HSG (Hystero-salpyngo-graphy)
- Microbial cultures (investigation for bacterial or fungal infections)
- MRI
3) Membraneous Dysmenorrhoea
- Very rare condition
- Severe menstrual pain because the complete cast of uterine cavity is
expelled.
- Severe colic pain
- Clotted menstruation
 Correlation of Dysmenorrhoea in Ayurveda:

Dysmenorrhoea can be compared with Udavarta / Udavartini / Udavritta
Yonivyapad.
A. Charaka says that in Udavartini, pain is relieved once menstruation started. So,
it can be compared with primary dysmenorrhoea.
A. Sushruta says that in Udavarta, pain may be present throughout the menstrua
period. So, it can be compared with all types of dysmenorrhoea.
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 Abnormal Uterine Bleeding (AUB)
Any uterine bleeding beyond the normal volume, duration and frequency is considered
as abnormal uterine bleeding.
 Normal menstruation:
1) Menstrual blood loss = 35 ml (20-80 ml)
2) Menstrual flow = 2-6 days
3) Interval = 21-35 days
 Terminology to describe AUB:

1) Oligomenorrhoea: Bleeding occurs at intervals of > 35 days; it may vary
between 6 weeks – 6 months.
2) Polymenorrhoea: Bleeding occur at intervals of < 21 days but normal in

amount.
3) Menorrhagia: Bleeding occurs at normal intervals (21-35 days) but with heavy
flow (> 80 ml) or prolonged duration (> 7 days).
4) Polymenorrhagia: Bleeding is excessive and frequent.
5) Menometrorrhagia: Bleeding occurs at irregular, non-cyclic intervals with

heavy flow (> 80 ml) or prolonged duration (> 7 days).
6) Metrorrhagia: Bleeding is irregular in any amount; it occurs between normal

ovulatory cycles.
7) Mid-cycle spotting: Spotting occurs just before ovulation, usually due to

decline of oestrogen level.
8) Acute AUB: Bleeding is characterized by significant blood loss resulting in

hypovolemia or shock.
9) DUB: Dysfunctional uterine bleeding – ovulatory or anovulatory bleeding.
10) Postmenopausal bleeding: Bleeding recurs in a menopausal woman, at least

1 year after cessation.
 Causes of AUB:
Structural Causes Systemic Causes
Polyp Coagulopathy
Adenomyosis Ovulatory dysfunction
Leiomyoma Endometrial
Malignancy Iatrogenic
Hyperplasia Idiopathic
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Dysfunctional Uterine Bleeding (DUB)
AUB with no organic cause is termed as DUB; there is no clinically detectable organic,
systemic or iatrogenic cause. This condition is a diagnosis of exclusion. It usually occurs at
the extremes of reproductive age i.e. adolescence and above the age of 40 years.
 Classification:
1) Anovulatory Bleeding
2) Ovulatory Bleeding
1) Anovulatory Bleeding
Anovulation is the most common cause of AUB when there is no organic
cause. Absence of active corpus luteum in ovary is the characteristic feature
(follicle ripens and fails to rupture, ovum dies and cysts are formed).
Bleeding is non-cyclical and continuous for 2-8 weeks; at times it is heavy and
may be life threatening. In 50% of cases, it is preceded by short period of
amenorrhoea.
2) Ovulatory Bleeding
Polymenorrhoea, Polymenorrhagia, Oligomenorrhoea
Polymenorrhoea and Polymenorrhagia

The normal ovarian cycle quickens, accelerating the follicular rather than luteal phase;
the endometrial proliferation increases and menses takes place every 2-3 weeks.
Polymenorrhoea may follow the menarche or precede menopause.
This condition resolves by itself within a few months to 2 years.
Polymenorrhoea may persist for a few months after pregnancy due to failure of pituitary
gland where the ovary is abnormally or excessively stimulated.
Oligomenorrhoea
Oligomenorrhoea is the condition in which the menstrual cycle lasts longer than 35 days.
Menstruation may be regular / irregular / infrequent. It is usually caused by a prolonged
follicular phase.
 Causes:
1) Physological oligomenorrhoea -> Normal
2) Pathological oligomenorrhoea -> Ovarian causes e.g.: Hormonal imbalance,
Dysfunction of ovaries, Ovarian cysts
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Hypomenorrhoea
Hypomenorrhoea is the condition in which menstrual bleeding is less or short in duration
(≤ 2 days) or both. It is not categorized under AUB.
 Causes:
1) Physiological hypomenorrhoea -> Normal
2) Pathological hypomenorrhoea -> Uterine causes e.g.: Bleeding surface of
endometrium is smaller than normal, Uterine adhesion, Uterine synechiae
(Asherman syndrome), TB of endometrium, Chronic endometritis, Chronic
pelvic infection, Reconstructive uterine surgery
 Complications: Ectopic pregnancy, Abortion
-> Diagnosis for Oligomenorrhoea and Hypomenorrhoea are the same as for
Amenorrhoea.
 Diagnosis:
1) Subjective -> Physical examination and proper history taking
2) Objective -> Investigations
Investigations:
- UPT (Urine pregnancy test) -> if female is sexually active
- USG uterus & adnexa -> to check for any congenital deformity or disease
- Blood sugar -> to check for DM
- Hormonal assay -> FSH, LH, TSH, T3, T4, Prolactin
GnRh increased = Primary ovarian failure (POF)
GnRh decreased = Hypothalamic & pituitary lesions
(Gonadotropin-releasing hormone)
- CT-scan, MRI, Laparoscopy
Menorrhagia
Menorrhagia is defined as excessive cyclic uterine bleeding which occurs at regular
intervals over several cycles, or prolonged bleeding that lasts for more than seven days.
AUB includes both, non-cyclic and cyclic bleeding. Although ABU and menorrhagia are
grouped together, they do not have the same etiology.
 Risk factors: Increased age, Premenopausal leiomyoma, Endometrial polyp

 Causes:
1) Uterine causes = Fibroid uterus, Adenomyosis
2) Adnexal causes = Endometriosis, PID
3) Higher centers = DUB, Hypothyroidism
4) Miscellaneous = Bleeding disorders, IUCD
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 Management of AUB:
Choice of treatment for acute AUB depends on clinical stability, overall acuity,
suspected etiology of the bleeding, desire for future fertility, and underlying
medical problems. The two main objectives of managing acute AUB are:
1) To control the current episode of heavy bleeding.
2) To reduce menstrual blood loss in subsequent cycles.
Medical therapy is considered the preferred initial treatment. However, certain

situations may call for prompt surgical management.
Medical Treatment:
A) Anovulatory Bleeding:
- Combination of OCP (oral contraceptives - ≤ mcg of triphasic pills)
- Medroxyprogesterone acetate (10 mg per day for 10-14 days per month)
B) Ovulatory Bleeding:
- Medroxyprogesterone acetate (10mg per day for 21 days per month)
- Ibuprofen (600-1,100 mg per day, five days per month)
- Naproxen sodium (550-1,100 mg per day, five days per month)
- Mefenamic acid (1,500 mg per day, five days per months)
- Tranexamic acid (650 mg; two tables three times per day, five days per month)
Surgical Treatment:
- Operative hysteroscopy (Intracavitary structural abnormalities)
- Myomectomy (Leiomyoma)
- Trans-cervical endometrial resection (Resistant menorrhagia or

menometrorrhagia)
- Endometrial ablation (Resistant menorrhagia or menometrorrhagia; secondarily

for management of resistant acute uterine haemorrhage)
- Uterine artery embolization (Leiomyoma)
- Hysterectomy (Atypical hyperplasia, Endometrial cancer, Bleeding that does not

respond to less invasive uterus-sparing surgeries)
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CHAPTER II: yonivyapad
Paryaya: Yonivyapad, Yonigada, Yonidosha, Yoniroga, Guhyaroga
Yonivyapad Bheda: - 20
 According to Acharya Sushruta:
उदाविाि िथा वन्ध्या तवप्लु िा च पररप्लु िा ॥ ६ ॥
वािला चे ति वािोत्था तपत्तोत्था रुतधरक्षरा ।
वातमनी स्रंतसनी चातप पुत्रघ्नी तपत्तला च या ॥ ७ ॥
अत्यानन्दा च या योतनः कतर्णिनी चरर्णाद्वयम् ।
श्लेष्मला च कफाज्ज्ञे या षण्डाख्या फतलनी िथा ॥ ८ ॥
महिी सूतचवक्त्रा च सविजेति तत्रदोषजा । (सु - उ - ३८)
 According to Acharya Charaka:

1) वातज 11 = वातिक, अचरर्णा, अतिचरर्णा, प्राक्चरर्णा, उदावतिि नी, पुत्रघ्नी,
अन्तमुि खी, सूचीमु खी, शुष्का, षण्ढी, महायोतन
2) पित्तज 3 = पैतत्तक, रक्तयोतन, अरजस्का
3) कफज 1 = श्लैष्पष्मक
4) वातपित्तज 2 = पररप्लु िा, वातमनी
5) वातकफज 2 = उपप्लु िा, कतर्णिनी
6) पिदोषज 1 = सतिपातिक
 According to Acharya Vagbhata:

1) वातज 11 = वातिकी, वातमनी, अतिचरर्णा, प्राक्चरर्णा, उदावृत्ता, जािघ्नी,
अन्तमुि खी, सूचीमु खी, शुष्का, षण्ढा, महयोतन
2) पित्तज 2 = पैतत्तकी, रक्तयोतन
3) कफज 1 = श्लैष्पष्मकी
4) वातपित्तज 2 = पररप्लु िा, लोतहिक्षया
5) वातकफज 2 = उपप्लु िा, कतर्णिनी
6) कृपिज 1 = तवप्लु िा
7) पिदोषज 1 = सतिपातिकी
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Yonivyapad Nidana:
 According to Acharya Sushruta:
प्रवृद्धतलङ्गं पुरुषं याऽत्यथि मुपसेविे ॥
रूक्षदु बिलबाला या िस्या वायुः प्रकुप्यति ॥ ३ ॥ (सु - उ - ३८)
1) प्रवृद्धतलङ्गं पुरुषं -> Coitus with a man who has a large penis
2) अत्यथि मुपसेविे -> Excessive sexual intercourse
3) रूक्ष -> Dryness
4) दु बिल -> Weakness
5) बाला -> Sexual intercourse during Bala-avastha (< 16 years)
Due to these causative factors, Vata Dosha gets aggravated and localizes at Yoni
(genital organs) which are already in Khavaigunya avastha.
Generally, Vata Dosha is responsible for Yonivyapad. Pitta & Kapha only get
involved additionally in some cases.
 According to Acharya Charaka:

तमथ्याचारे र्ण िाः स्त्रीर्णां प्रदु ष्टेनािि वेन च ।
जायन्ते बीजदोषाच्च दै वाच्च शृर्णु िाः पृथक् ॥ ८ ॥ (च - तच - ३०)
1) तमथ्याचर -> Improper conduct, behaviour, manner, activities, etc.
a) तमथ्याहार (प्रतमिाशन, समाशन, तवषमाशन, अध्याशन)
b) तमथ्यातवहार (प्रवृद्धतलङ्गं पुरुषं, अत्यथि मुपसेविे , बाला, वेदधारर्ण, अपद्रव्य सेवन)
c) पापकमि (तहं सा, िे य, अन्यथाकाम, पैशून्य, परुष, अनृि, सष्पििालापा, व्यापाद,
अतभध्या, दृष्पिपयिय)
2) प्रदु ष्टािि व -> Vitiated ovarian hormones
3) बीजदोष -> शुक्रशोतर्णि दोष - Vitiated sperm & ovum; it may cause
Yonivyapad in the woman or congenital Yonivyapad in
a female progeny.
4) दै व -> ईश्वर - God’s will; idiopathic.
 According to Acharya Vagbhata:

तवषमस्थाङ्गशयनभृ शमै थुनसेवनैः ।
दु ष्टािि वादपद्रव्यै बीजदोषेर्ण दै विः ॥ २८ ॥ (अ.हृ. - उ - ३३)
1) तवषमस्थाङ्गशयन -> Inappropriate sleeping posture
2) भृ शमै थुनसेवन -> Excessive sexual intercourse
3) दु ष्टािि व -> Vitiated ovarian hormones
4) अपद्रव्य सेवन -> Use of improper/artificial substances for sexual pleasure
5) बीजदोष -> शुक्रशोतर्णि दोष - Vitiated sperm & ovum
6) दै व -> ईश्वर - God’s will; idiopathic
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पिदाि योपिव्यािद्
1) पिथ्याहार
a) वातिकाहार a) वातिक, सूचीमु खी, पुत्रघ्नी / जािघ्नी
b) पैतत्तकाहार b) पैतत्तक, रक्तयोतन
c) श्लैष्पष्मकाहार c) श्लैष्पष्मक, उपप्लु िा
d) सतिपातिकाहार d) सतिपातिक
(तवरुद्धाहार मधु रातद रस)
2) पिथ्यापवहार अन्तमुि खी, सूचीमु खी, महायोतन, तवप्लु िा, कतर्णिनी

a) अतिमै थुन a) अतिचरर्णा, अत्यानन्दा
b) बाला b) प्राक्चरर्णा
c) प्रवृद्धतलङ्गं पुरुष c) फतलनी
d) वेदधारर्ण d) अचरर्णा, पररप्लु िा, उपप्लु िा, उदावतिि नी, शुष्का
e) अपद्रव्य सेवन e) सवि योतनव्यापद्
3) प्रदु ष्टातत व लोतहिक्षया, अरजस्का, उदावतिि नी, कतर्णिनी, वातमनी,

पुत्रघ्नी, शुष्का, वन्ध्या, रक्तयोतन
4) बीजदोष वातमनी, पुत्रघ्नी, सूचीमु खी, षण्ढी, वन्ध्या
5) दै व पुत्रघ्नी, षण्ढी
Yonivyapad Upadrava:
The female is considered the root cause of progeny, and Yonivyapad leads to
destruction of that root; hence it leads to infertility.
When Yoni is vitiated, the woman is unable to conceive as she cannot retain the Shukra,
and she gets afflicted with Asrigdara, Gulma, Arsha, and Vatadi Roga.
Samanya Lakshana:
 Vataja Yonivyapad:
- Karkasha, Stabdha, Shula, Toda
- Artava prasava: Phenila, Aruna, Krishna, Alpa, Tanu, Ruksha
 Pittaja Yonivyapad:
- Daha, Paka, Jvara, Putigandha
- Artava prasava: Ushna, Bahu, Puti, Neela, Peeta, Krishna
 Kaphaja Yonivyapad:
- Picchila, Kandu, Atisheetala, Avedana
- Artava prasava: Pandu, Picchila
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Samanya Chikitsa:
 According to Acharya Sushruta: Snehadi Karma followed by Uttarabasti with
Dravya according to Dosha predominance.
 According to Acharya Charaka: Snehana, Svedana, Panchkarma (Mridushodhana)

is required to be done in all Yonivyapad. After the body is cleaned, specific
treatment for each Yonivyapad should be followed.
 According to Acharya Vagbhata: Snehana, Svedana, Vamanadi Karma

(Mridushodhana) followed by Basti, Abhyanga, Parisheka, Pralepa and
Pichudharana. Yonivyapad cannot occur without involvement of Vata, so it should
be treated first.
 Abhyantara Aushadhi Prayoga:

Pushyanuga Churna, Brihat Shatavari Ghrita, Phala Ghrita/Phala Sarpi, Laghuphala
Ghrita/Triphaladi Ghrita, Nyagrodhadi Kvatha, Maharsnadi Kvatha, Jeerakadi
Modaka
Phala Ghrita:
Ingredients: Manjistha, Kustha, Tagara, Triphala, Sharkara, Vacha, Dvinisha,
Madhua, Meda, Deepyaka, Katurohini, Payasya, Hingu, Kakoli, Vajigandha,
Shatavari (1 karsha each)
Ghrita (1 prastha)
Ksheera (4 prastha)
Effect: When taken during Puspa-avastha (ovulation), Phala Ghrita ensures

conception. It improves normal pregnancy and is useful in recurrent miscarriage.
Ayushya, Paustika, Medhya, Pumsavana; it is helpful in all Yonidosha.
 Bahya Aushadhi Prayoga:

- In diseases of Yoni and Garbhashaya, 2-3 Asthapana Basti should be given
followed by Uttarabasti. Uttarabsti is given during Artava Kala (Ritukala) because
Yoni and Garbhashaya are free from coverings and Aushadha can enter easily.
- Palasha Niruha Basti, Shatavaryadi Anuvasana Basti, Shtavaryadi Rasayana Basti
Guduchyadi Rasayana Basti, Baladi Yamaka Anuvasana Basti
 Pathya:
- Sura, Asava, Arista, Lashuna svarasa in the morning in accordance to
predominant Dosha along with Ksheera.
- Yava, Abhaya-arista, Sidhu, Taila, Pippali Churna, Pathya, Lauhabhasma with
Makshika, Bala Taila, Mishraka Sneha, Sukaumaraka Sneha
- Lashuna Rasayana
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 Doshaja Pradhana Chikitsa:
1) Vataja Yonivyapad:
- Snehana, Svedana, Basti and other procedures which alleviate Vata Dosha.
- Pichudharana, Siddha Taila, Ushna & Snigdha Dravya
- Parisheka: Guduchi Triphala Danti Kvatha
- Himsra Kalkadharana
2) Pittaja Yonivyapad:
- Sheeta Kriya, Raktapitta Chikitsa
- Snehana with Ghrita or Siddha Ghrita prepared with Pittahara Dravya.
- Parisheka, Abhyanga, Pichudharana is done with Sheeta Dravya.
- Panchavalkala Kalkadharana
3) Kaphaja Yonivyapad:
- Ruksha & Ushna Dravya
- Basti with Gomutra mixed with Katu Dravya, Varti prayoga
- Shyama Kalkadharana
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Vatika Yonivyapad
Nidana: Vatakara Ahara & Vihara
 According to Acharya Charaka: Vatika Yonivyapad

1) Dosha: Vata
2) Lakshana:
- Yoni Toda, Vedana, Stambha, Pipeelika, Karkasha, Supti, Ayasa
- Artava srava: Sashabda, Saruja, Phena, Tanu, Ruksha
3) Chikitsa:
- Abhyanga with Taila & Saindhava Lavana
- Svedana: Nadi, Kumbhi, Ashma, Prastara, Sankara Svedana with
Vatashamaka Dravya
- Snehapana: Bala Ghrita, Kashmaryadi Ghrita
- Pichudharana: Saindhavadi Taila (Ruja-apaha), Guduchyadi Taila
- Pippalyadi Yoga, Vrishakadi Churna, Rasnadi Ksheerapaka
 According to Acharya Sushruta: Vatala Yonivyapad

1) Dosha: Vata
2) Lakshana: Karkasha, Stabdha, Shula, Toda
 According to Acharya Vagbhata: Vatiki Yonivyapad

1) Dosha: Vata
2) Lakshana:
- Ruk, Toda, Ayama, Supti, Pipeelika, Stambha, Karkasha
- Artava srava: Phenila, Aruna, Krishna, Alpa, Tanu, Ruksha
- Vankshana & Parshva Vyatha, Gulma kramena
 Correlation with Modern Medicine:

In Vataja Yonivyapad, pain is an important clinical feature along with stiffness,
rougness, hyperaesthesia, displacement, etc.
This condition can be correlated to vaginal neuralgia associated with hypo-
oestrogenism, and laxity of perineum.
Atrophic vaginitis occurring in menopausal women who are hypo-oestrogenic
resembles Vatika Yonivyapad.
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Paittika Yonivyapad
Nidana: Pittakara Ahara & Vihara
 According to Acharya Charaka: Paittika Yonivyapad

1) Dosha: Pitta
2) Lakshana:
- Daha, Paka, Jvara, Ushna
- Artava srava: Neela, Peeta, Asita, Bahu, Ushna, Kunapagandha
3) Chikitsa:
- Sheeta Kriya, Raktapitta Chikitsa
- Snehana with Ghrita or Siddha Ghrita prepared with Pittahara Dravya.
- Parisheka, Abhyanga, Pichudharana is done with Sheeta Dravya.
- Panchavalkala Kalkadharana
 According to Acharya Sushruta: Pittala Yonivyapad

1) Dosha: Pitta
2) Lakshana: Daha, Paka, Jvara
 According to Acharya Vagbhata: Paittiki Yonivyapad

1) Dosha: Pitta
2) Lakshana:
- Daha, Paka, Ushna, Putigandha, Jvara
- Artava srava: Ushna, Bahu, Puti, Neela, Peeta, Krishna

All the clinical features like burning sensation, fever, suppuration, etc. are
suggestive of an acutve infection such as Vaginits, Bacterial Vaginosis,
Trichomoniasis, Vulvovaginal Candidiasis.
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Shlaishmika Yonivyapad
Nidana: Kaphakara Ahara & Vihara, Abhishyandi Ahara
 According to Acharya Charaka: Shlaishmika Yonivyapad

1) Dosha: Kapha
2) Lakshana:
- Picchila, Sheeta, Kandu, Alpavedana, Pandu varna
- Artava srava: Pandu, Picchila
3) Chikitsa:
- Ruksha & Ushna Dravya
- Basti with Gomutra mixed with Katu Dravya, Varti prayoga
- Udumbara Taila, Udumbara Dugdha, Dhatakyadi Taila
- Yoniprakshalana: Takra, Gomutra, Shukta, Triphala Kvatha
- Pippali, Lohabhasma, Haritaki with Madhu
- Shyama Kalkadharana
 According to Acharya Sushruta: Shleshmala Yonivyapad

1) Dosha: Kapha
2) Lakshana: Picchila Yoni, Kandu yukta, Sheetala
 According to Acharya Vagbhata: Shlaishmiki Yonivyapad

1) Dosha: Kapha
2) Lakshana:
- Avedana, Sheetala, Kandu
- Aratava srava: Pandu, Picchila

The clinical features like itching, unctuous discharge with mild pain or without pain
are suggestive of Trichonomas or Monilial infection.
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Sannipatika Yonivyapad
Nidana: Samashana (Viruddha-ahara) with all 6 Rasa
 According to Acharya Charaka: Sannipatika Yonivyapad

1) Dosha: Vata, Pitta, Kapha
2) Lakshana: Vatika Paittika Shlaishmika Lakshana;
- Daha, Shula
- Artava srava: Shveta, Picchila
3) Chikitsa: Vatika Paittika Shlaishmika Chikitsa
 According to Acharya Sushruta: Sarvaja Yonivyapad

1) Dosha: Tridosha
2) Lakshana: Vatala Pittala Shleshmala Lakshana
 According to Acharya Vagbhata: Sannipatiki Yonivyapad

1) Dosha: Vata, Pitta, Kapha
2) Lakshana: Symptoms of all other Yonivyapad may occur.

Sannipatika Yonivyapad is suggestive of a chronic condition associated with
infection and inflammation. It may include Pelvic pain (acute or chronic) which can
result from a number of different conditions such as:
PID, Endometriosis, Uterine fibroid, UTI, Kidney stones, Mid-cycle pain, Ovarian
torsion, Ruptured ovarian cyst, Corpus luteum cyst, Follicular cyst, Ectopic
pregnancy, Adhesions, Dysmenorrheoa, Malignancies, etc.
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Rakta Yoni
Nidana: Pittakara Ahara & Vihara, Pradusta-artava
 According to Acharya Charaka: Rakta Yoni / Asrija / Apraja Yonivyapad

1) Dosha: Pitta
2) Lakshana: Rakta atipravartate (excessive flow of blood). The bleeding does
not stop even when the woman becomes pregnant.
- It is named as Asrija because bleeding does not stop even when the woman
becomes pregnant.
- It is named as Apraja because miscarriage occurs due to excessive continued
bleeding and the woman remains without a progeny.
- It is named as Rakta Yoni because there is excessive bleeding.
3) Chikitsa:
- Involvement of other Dosha should be checked by examining the discharged
blood. Accordingly, Aushadhi should be given to alleviate the Dosha.
- Vata -> Dadhi mixed with Sharkara, Madhu, Yastimadhu & Nagara.
- Pitta -> Musta mixed with Ksheera, Sharkara & Madhu
- Kapha -> Ruksha & Ushna Dravya
- Pushyanuga Churna for gynecic and menstrual disorders associated with
white, blue, yellow, brownish, black and pinkish discharge.
- Uttarabasti with Ghrita processed with Kashmari and Kutaja Kvatha.
- Asrigdara Chikitsa
 According to Acharya Sushruta: Rudhirakshara / Lohitakshara Yonivyapad

1) Dosha: Pitta
2) Lakshana: Pittala Lakshana; Ati-asrika prakshara, Sadaha
 According to Acharya Vagbhata: Rakta Yoni

1) Dosha: Pitta
2) Lakshana: Asrika ati-srute

Asrija, Rudhirakshara and Rakta Yoni can be correlated with ovulatory or non-
ovulatory dysfunctional uterine bleeding or luteal phase defect which leads to
early abortion; Luteal insufficiency, Dysfunctional Uterine Bleeding (DUB).
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Lohitakshaya Yonivyapad
Nidana: Pradusta-artava
 According to Acharya Charaka: Not mentioned
 According to Acharya Sushruta: Not mentioned
 According to Acharya Vagbhata: Lohitakshaya Yonivyapad

1) Dosha: Vata, Pitta
2) Lakshana: Ksheena Rajah, Sadaha, Karshya, Vaivarnya

In Lohitakshaya, there is scanty bleeding which can be correlated with
Oligomenorrhoea due to anemia. Women are generally prone to develop anemia
due to monthly menstrual bleeding.
Arajaska Yonivyapad
Nidana: Pradusta-artava
 According to Acharya Charaka: Arajaska Yonivyapad

1) Dosha: Pitta
2) Lakshana: Anartava, Karshya, Vaivarnya
3) Chikitsa:
- Ksheerapaka prepared with Jeevaniya Dravya (Jeevaka, Rishabhaka, Meda,
Mahameda, Kakoli, Ksheera kakoli, Mudgaparni, Mashaparni, Jeevanti,
Madhuka)
- Uttarabasti with Ghrita processed with Kashmari and Kutaja Kvatha.
 According to Acharya Vagbhata: Not mentioned

Arajaska (A. Charaka) and Lohitakshaya (A. Vagbhata) Yonivyapad are similar
conditions. However, in Arajaska there is no menstrual flow at all. The underlying
cause may be the same as for Lohitakshaya i.e. Anemia.
Anemia can lead to amenorrhoea, emaciation and discolouration (paleness)
which are the symptoms described for Arajaska Yonivyapad.
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Acharana Yonivyapad
Nidana: Adhavana, Vega dharana
 According to Acharya Charaka: Acharana Yonivyapad

1) Dosha: Vata (Jantu)
2) Lakshana: Kandu, Atiratipriya (excessive desire for copulation)
3) Chikitsa:
- Yoniprakshalana or Uttarabasti with Siddha Taila prepared by boiling Tila
Taila with Jeevaniya Dravya (Jeevaka, Rishabhaka, Meda, Mahameda, Kakoli,
Ksheera kakoli, Mudgaparni, Mashaparni, Jeevanti, Madhuka).
- Kalkadharana: Powder of yeast mixed with honey; it cleanses the genital
tracts, relieves Kandu, Kleda and Shopha of Yoni.
 According to Acharya Sushruta: Acharana Yonivyapad

1) Dosha: Kapha
2) Lakshana: Shleshmala Lakshana; During copulation, the woman releases
(orgasm) before the man. Dalhana explans that the woman has excessive
libido, she cannot conceive and there is excessive itching and unctuousness
due to Kapha Dosha.
 According to Acharya Vagbhata: Vipluta Yonivyapad

1) Dosha: Krimi / Jantu
2) Lakshana: Kandu, Atiratipriya (excessive desire for copulation)

The clinical features of Acharana (Charaka & Sushruta) and Vipluta (Vagbhata) are
the same. The disease is due to unhygienic practice and owing to excessive libido
the woman gets agitated. Krimi may be taken as pathogenic micro-organisms. This
condition may be correlated to Female Sexual Dysfunction and local pathology.
Female sexual dysfunction can be subdivided into sexual desire, arousal, orgasmic
and sexual pain disorders which may be due to hormonal/endocrine dysfunction,
or musculo-, neuro-, psycho- or vasulogenic.
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Aticharana Yonivyapad
Nidana: Atimaithuna
 According to Acharya Charaka: Aticharana Yonivyapad

1) Dosha: Vata
2) Lakshana: Shopha, Supti, Ruja
3) Chikitsa:
- Yoniprakshalana with Siddha Taila prepared by boiling Tila Taila with
Jeevaniya Dravya (Jeevaka, Rishabhaka, Meda, Mahameda, Kakoli, Ksheera
kakoli, Mudgaparni, Mashaparni, Jeevanti, Madhuka).
- Asthapana & Anuvasana Basti with Siddha Taila cooked with Vatahara
Dravya for 100 times. After that, Svedana should be done with Sneha Drayva.
Additionally, Vatashamaka Ahara and Upanaha should be used.
 According to Acharya Sushruta: Aticharana Yonivyapad

1) Dosha: Kapha
2) Lakshana: Shleshmala Lakshana; Even though the woman has frequent sexual
intercourse, the Beeja does not remain inside; she does not conceive.
 According to Acharya Vagbhata: Aticharana Yonivyapad

1) Dosha: Vata
2) Lakshana: Vatiki Lakshana & Shopha Samyukta

Aticharana Yonivyapad can be correlated with Vaginal Inflammation due to
excessive coitus associated with Infertility.
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Prakcharana Yonivyapad
Nidana: Coitus during Bala-avastha
 According to Acharya Charaka: Prakcharana Yonivyapad

1) Dosha: Vata
2) Lakshana: Vatika Lakshana; Pristha, Kati, Uru, Vankshana Ruja
3) Chikitsa:
- Asthapana & Anuvasana Basti with Siddha Taila cooked with Vatahara
Dravya for 100 times. After that, Svedana should be done with Sneha Drayva.
Additionally, Vatashamaka Ahara and Upanaha should be used.
 According to Acharya Vagbhata: Prakcharana Yonivyapad

1) Dosha: Vata
2) Lakshana: Vatiki Lakshana & Pristha, Jangha, Uru, Vankshana Ruja

Prakcharana Yonivyapad can be correlated to Lower Backache of gynaecological
origin. Since its causative factor is mentioned as having sexual intercourse as a
young child, it can be correlated with Sexual Abuse which may lead to various pain
related symptoms and disturbance of normal development of the child; especially
psychologically, which beside the sexual act itself, is suggestive for the aggravation
of Vata Dosha.
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Upapluta Yonivyapad
Nidana: Kaphakara Ahara & Vihara, Chardi Shvasa Vega dharana
 According to Acharya Charaka: Upapluta Yonivyapad

1) Dosha: Vata, Kapha
2) Lakshana: Aggravated Vayu vitiates Yoni, carries Kapha towards Yoni and
vitiates the Kapha Dosha.
Srava: Pandu Shveta, Satoda
3) Chikitsa:
- Snehana, Svedana, Vamanadi Mridushodhana followed by Pichudharana
with Santarpana Taila.
 According to Acharya Vagbhata: Upapluta Yonivyapad

2) Lakshana: Vatiki Shlaishmiki Lakshana & Shveta, Picchila Rakta prasrava

Upapluta Yonivyapad can be correlated with Moniliasis.
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Paripluta Yonivyapad
Nidana: Kshavathu & Udgara Veda dharana during copulation
 According to Acharya Charaka: Paripluta / Vipluta Yonivyapad

2) Lakshana:
- Shopha, Sparsha-akshama (tenderness)
- Rakta srava: Sa-arti, Neela, Peeta
- Srhoni, Vankshana, Pristha Arti, Jvara
3) Chikitsa: Pichudharana: Taila processed with Kvatha of Shallaki, Jingini,

Jambu, Dhava, Nyagrodha, Udumbara, Ashvattha, Parisha and Plaksha.
 According to Acharya Sushruta: Paripluta Yonivyapad

1) Dosha: Vata
2) Lakshana: Vatala Lakshana & Severe pain during copulation
 According to Acharya Vagbhata: Paripluta Yonivyapad

2) Lakshana: Neela, Peeta Rakta srava; Basti, Kukshi Gurutva; Atisara; Arochaka;
Shroni, Vankshana Ruk; Toda; Jvara

Paripluta Yonivyapad is suggestive of Dypareunia as per A. Sushruta.
A. Charaka’s description indicates an Acute Gonococcal Infection and which can
develop into PID.
Vipluta Yonivyapad
Nidana: Mithyavihara
 According to Acharya Charaka: Mentioned only under Chikitsa instead of Paripluta
 According to Acharya Sushruta: Vipluta Yonivyapad

1) Dosha: Vata
2) Lakshana: Vatala Lakshana & Nitya vedana (daily or continuous vaginal pain)
 According to Acharya Vagbhata: Vipluta Yonivyapad -> Refer to Acharana

Yonivyapad

Vipluta (Sushruta) Yonivyapad is suggestive of Vaginal Neuralgia of psychogenic
origin, Chronic pelvic pain or Dyspareunia.
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Udavartini Yonivyapad
Nidana: Vega dharana (Vata, Vit, Mutra), Pradusta-artava
 According to Acharya Charaka: Udavartini Yonivyapad

1) Dosha: Vata
2) Lakshana: Ruja, Kricchra Rajah srava (pain gets relieved after discharge of
menstrual blood)
3) Chikitsa:
- Snehapana with Traivrita (Ghrita, Taila & Vasa).
- Svedana
- Basti with Ksheera boiled by adding Dashamula (Bila, Shyonaka, Gambhari,
Patala, Agnimantha, Shalaparni, Prishniparni, Brihati, Kantakari, Gokshura)
- Anuvasana Basti & Yoniprakshalana with Traivrita (Ghee, Taila & Vasa).
 According to Acharya Sushruta: Udavarta Yonivyapad

1) Dosha: Vata
2) Lakshana: Vatala Lakshana; Rajah Saphena, Kricchra srava
 According to Acharya Vagbhata: Udavritta Yonivyapad

1) Dosha: Vata
2) Lakshana: Phenila Rajah, Kricchra srava

The typical clinical description of relief of pain at the onset of menstrual flow is
suggestive of Primary Dysmenorrhoea. It can also be correlated to Pre-menstrual
Syndrome (PMS).
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Karnini Yonivyapad
Nidana: Mithyavihara, Pradusta-artava
 According to Acharya Charaka: Karnini Yonivyapad

2) Nidana: Pregnant woman strains prematurely to expel the foetus.
3) Lakshana: Vata and Kapha vitiated Rakta; aggravated Vayu gives rise to
Karnika (sprouts of muscles / nodular growth). This obstructs the blood flow.
4) Chikitsa:
- Yoni Varti: Kustha, Pippali, Arka, Saindhava Lavana and Aja-mutra.
- Kaphahara Chikitsa
 According to Acharya Sushruta: Karnini Yonivyapad

1) Dosha: Kapha
2) Lakshana: Shleshmala Lakshana; Karnika, Yonau asrigbhyam prajayate (blood
in the vagina)
 According to Acharya Vagbhata: Karnini Yonivyapad

2) Lakshana: Karnika, Rajo-marga Nirodhana

In Karnini Yonivyapad there is a characteristic development of Karnika (rounded
protuberance) in cervix uteri. It can be correlated with Cervical Erosion.
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Putraghni Yonivyapad
Nidana: Vatakara Ahara & Vihara, Pradusta-artava, Beeja Dosha, Daiva
 According to Acharya Charaka: Putraghni Yonivyapad

1) Dosha: Vata
2) Lakshana: Aggravated Vayu due to its dryness destroys each and every
Garbha produced by a vitiated Beeja.
3) Chikitsa:
- Uttarabasti with Ghrite processed with Kashmari and Kutaja Kvatha.
- Upanaha with Kalka of Yava, Godhuma, Kinva, Kustha, Shatapuspa,
Shrayahva, Priyangu, Bala and Akhukarni should be applied locally.
 According to Acharya Sushruta: Putraghni Yonivyapad

1) Dosha: Pitta
2) Lakshana: Pittala Lakshana; the woman retains the Beeja (Garbha) for some
time and expels it along with excessive bleeding.
 According to Acharya Vagbhata: Jataghni Yonivyapad

1) Dosha: Vata
2) Lakshana: Vatiki Lakshana & Ati-raukshya Dusta-artava, Jata-jata suta hanti
(repeated death of the newborn child)

- Putraghni (A. Charaka) = Miscarriage (Recurrent)
- Putraghni (A. Sushruta) = Still birth
- Jataghni (A. Vagbhata) = Neonatal death
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Antarmukhi Yonivyapad
Nidana: Mithyavihara (Copulation after a heavy meal or in abnormal postures)
 According to Acharya Charaka: Antarmukhi Yonivyapad

1) Dosha: Vata
2) Lakshana: Distortion of Yonimukha; Asthi, Mamsa Arti; due to excessive pain,
sexual intercourse becomes intolerable.
3) Chikitsa: Upanaha with Kalka of Yava, Godhuma, Kinva, Kustha, Shatapuspa,

 According to Acharya Vagbhata: Antarmukhi Yonivyapad

1) Dosha: Vata
2) Lakshana: Asthi, Mamsa, Yoni mukha Vakrayet (distortion), Tivra Ruja

Antarmukhi Yonivyapad can be correlated with Retroflexion and Retroversion
where the uterus is fixed; with severe pain in lower abdomen, etc.
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Suchimukhi Yonivyapad
Nidana: Vatakara Ahara & Vihara, Mithyavihara, Beeja Dosha
 According to Acharya Charaka: Suchimukchi Yonivyapad

1) Dosha: Vata
2) Lakshana: Due to dryness of aggravated Vata, the genital organs of the
female foetus in the womb become narrow and remain narrow even when
the girl is grown up.
3) Chikitsa: Upanaha with Kalka of Yava, Godhuma, Kinva, Kustha, Shatapuspa,

 According to Acharya Sushruta: Suchivaktra Yonivyapad

1) Dosha: Tridosha
2) Lakshana: Sarvaja Lakshana; Atisamvritti (vagina is very constricted)
 According to Acharya Vagbhata: Suchimukchi Yonivyapad

1) Dosha: Vata
2) Lakshana: Yoni Mandu-Dvara (narrow opening / passage)

Suchimukhi Yonivyapad can be correlated with Pinhole Os or Vaginal Stenosis.
-> Pinhole Os: It is a rare congenital deformity where the os is very narrow as the
size of a pin head. It is also known as Stenosis of Uterine Cervix. In some cases,
the endocervical canal may be completely closed.
A stenosis is any passage in the body that is narrower than it should typically be.
-> Vaginal Stenosis: Vaginal stenosis is defined as a narrowing and shortening of

the vagina. Vaginal stenosis can cause the vagina to become less flexible, drier and
more fragile, which can result in dyspareunia (painful sex) and discomfort during
pelvic exams. Vaginal stenosis can be the result of chemotherapy or radiation
therapy side effects in the pelvis or surgery around the pelvic area. It can also be
made worse by chemotherapy.
Management:
- Vaginal dilation therapy is an option for preventing and treating vaginal stenosis.
Vaginal dilation therapy aims to gently stretch the vaginal walls over an extended
period of time, usually weeks or even months.
- Vaginal stenosis often results in increased dryness in the vagina, so using a
dedicated vaginal moisturiser could help to increase hydration.
- Using a heat pack can reduce discomfort.
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Shuska Yoni
Nidana: Vega dharana during Ritukala or Maithuna, Pradusta-artava
 According to Acharya Charaka: Shuska Yoni

1) Dosha: Vata
2) Lakshana: Arti, Vit Mutra sanga, Yoni shosha
3) Chikitsa:
- Yoniprakshalana or Uttarabasti with Siddha Taila prepared by boiling Tila
Taila with Jeevaniya Dravya (Jeevaka, Rishabhaka, Meda, Mahameda, Kakoli,
Ksheera kakoli, Mudgaparni, Mashaparni, Jeevanti, Madhuka).
- Upanaha with Kalka of Yava, Godhuma, Kinva, Kustha, Shatapuspa,
 According to Acharya Vagbhata: Shuska Yoni

1) Dosha: Vata
2) Lakshana: Vit Mura sangraha, Yoni shosha, Ativedana

Shuska Yonivyapad can be correlated to a hypo-oestrogenic state in a woman.
During menopause or post-menopause, women often suffer from vaginal dryness
and pain due to lack of oestrogen; however, Shuska Yonivyapad is a condition of
women in their reproductive age, so a menopausal or post-menopausal woman
cannot be considered; but the underlying cause i.e. Hypo-oestrogenism, can be
comapared to Shuska Yonivyapad.
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Vamini Yonivyapad
Nidana: Pradusta-artava, Beeja Dosha
 According to Acharya Charaka: Vamini Yonivyapad

2) Lakshana: The Shukra which is deposited in the Yoni is excreted with or
without pain after 6 or 7 days.
3) Chikitsa: Snehana, Svedana, Vamanadi Mridushodhana followed by

Pichudharana with Santarpana Taila.
 According to Acharya Sushruta: Vamini Yonivyapad

1) Dosha: Pitta
2) Lakshana: Pittala Lakshana; the woman expels the Beeja along with Rajah and
Vata.
 According to Acharya Vagbhata: Vamini Yonivyapad

1) Dosha: Vata
2) Lakshana: Either on 6th or 7th day after copulation, the received Shukra is
expelled; with or without pain.

Vamini Yonivyapad can be correlated with various conditions such as Implantation
Defect, Early abortion, Effluvium Seminis, Ovulation Cascade, Luteal Phase
Defect.
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Shandhi Yonivyapad
Nidana: Beeja Dosha, Daiva
 According to Acharya Charaka: Shandhi Yonivyapad

1) Dosha: Vata
2) Lakshana: The aggravated Vata destroys the female reproductive organs of
the foetus inside the womb. Later in her life, the progeny develops aversion
for men and her breastst do not grow.
3) Chikitsa: Asadhya
 According to Acharya Sushruta: Shandhi Yonivyapad

1) Dosha: Tridosha
2) Lakshana: Sarvaja Lakshana; Anartava-stana (no menstration and breasts),
Roughness / friction during copulation
 According to Acharya Vagbhata: Shandha Yonivyapad

1) Dosha: Vata
2) Lakshana: Vatiki Lakshana, the woman has a hateful dispostition towards men
and her breasts do not develop.

Shandhi Yonivyapad is mainly caused due to Beeja Dosha, hence it can be
correlated with a congenital defect. There is congenital absence of
gonadotropins/ovarian hormones and occurs specifically in females. All these are
suggestive of Turner’s Syndrome.
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Maha Yoni
Nidana: Mithyavihara
 According to Acharya Charaka: Maha Yoni

1) Dosha: Vata
2) Lakshana: Aggravated Vata causes dilatation of the openings of Garbhashaya
and Yoni. Since they do not close again, she suffers from pain and bloody
discharge which is dry and frothy. There will be protuberance of Mamsa and
she suffers from pricking pain in Parva & Vankshana.
3) Chikitsa:
- Snehapana with Traivrita (Ghrita, Taila & Vasa)
- Svedana
- Basti with Ksheera boiled by adding Dashamula (Bila, Shyonaka, Gambhari,
Patala, Agnimantha, Shalaparni, Prishniparni, Brihati, Kantakari, Gokshura)
- Anuvasana Basti & Yoniprakshalana with Traivrita (Ghee, Taila & Vasa)
 According to Acharya Sushruta: Mahati / Maha Yoni

1) Dosha: Tridosha
2) Lakshana: Sarvaja Lakshana; Vivritta (vagina is very wide)
 According to Acharya Vagbhata: Maha Yoni

1) Dosha: Vata
2) Lakshana: Vata obstructs Yoniasya (vaginal opening) and Garbhakostha
(uterus). It leads to dilation and causes protrusion of Mamsa. It is associated
with severe pain.

- Phalini = Vaginal prolapse
- Sramsini = 1st & 2nd degree uterine prolapse
- Mahayoni = 3rd degree / complete uterine prolapse
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Sramsini / Prasramsini Yonivyapad
 According to Acharya Sushruta: Sramsini Yonivyapad

1) Dosha: Pitta
2) Lakshana: Pittala Lakshana; the woman eliminates more blood, is weak and
has difficulty in delivery.
-> Sramsini or Prasramsini is the descent of an organ.

Acharya Madhava says there is displacement, excessive discharge and difficutl
labour along with Pitta Lakshana.
Madhukosha has interpetred Samsrana as being displaced from its own place,
prolapse or as being compressed.
Chikitsa:
- Traivrita Sneha (Ghrita, Taila, Vasa) as Panartha & Anuvasana Basti.
- Abhyanga with Ghrita, Svedana with Dugdha, followed by replacing the
prolapsed Yoni by hand to its own site. Yoni purana with Veshavara pinda is done
and it should be bandaged.
- Laghuphala Ghrita, Repeated use of Basti and Svedana

Phalini / Andini Yonivyapad
Nidana: Pravriddhalingam purusha
 According to Acharya Sushruta: Phalini Yonivyapad

1) Dosha: Tridosha
2) Lakshana: Sarvaja Lakshana; the woman is unable to conceive.

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Vandhya Yonivyapad
Nidana: Pradusta-artava, Beeja Dosha
 According to Acharya Sushruta: Vandhya Yonivyapad

1) Dosha: Vata
2) Lakshana: वन्ध्यां नष्टािि वं तवद्याि् ... ।
Vatala Lakshana; the woman has no or damaged Artava (no menstruation /
ovum; damaged ovum).
-> The aggravated Vata Dosha causes destruction and disturbance in the
developing female foetus inside the womb. This may lead to Vandhya
Yonivyapad in the progeny.

Vandhya Yonivyapad can be considered as a state of absolute Sterility where a
female is unable to conceive. Various vaginal congenital conditions due to
chromosomal abnormalities like MRKHS, AIS, etc. can be correlated.
Atyananda Yonivyapad
Nidana: Atimaithuna
 According to Acharya Sushruta: Atyananda Yonivyapad

1) Dosha: Kapha
2) Lakshana: Shleshmala Lakshana; the woman does not obtain
pleasure/contentment (na santosha) from copulation.

Atyananda Yonivyapad can be correlated with Nymphomania due to
neurosis/psychosis/menopause.
AYURVEDA LIBRARY
 Vandhyatva
Acharya Sushruta says that a woman with destructed or absent Artava is called Vandhya;
causing the condition termed as Vandhyatva (infertility).
Acharya Vagbhata explains that the congenital deformity of due to Beeja Dosha of Yoni
(female genital tract) is the cause of Vandhyatva.
 Garbha Sambhava Samagri: Essential factors for conception

1) According to Acharya Charaka:
Conception of Garbha is only successful in the presence of unimpaired Shukra,
Artava, Garbhashaya and by following Garbhadhana Purvakarma.
While observing the advised diet and regimen, when a female & male of
physical & mental maturity & health copulate, the unvitiated Shukra is
ejaculated into a healthy Yonimarga. It then reaches the Garbhashaya and
unites with Shuddha Artava resulting in conception.
2) According to Acharya Sushruta:

a) Ritu (Ritukala)
b) Kshetra (Garbhashaya)
c) Ambu (Poshana / Rasa)
d) Beeja (Shukra & Artava)
When these four factors come together, conception is bound to occur

just like a seed germinates when it is planted in the appropriate season,
inside the proper ground and required water is supplied.
3) According to Acharya Vagbhata:

a) Garbhashaya (Uterus)
b) Marga (Vaginal passage & fallopian tube)
c) Rakta (Ovum)
d) Shukra (Sperm)
e) Anila (Vata Dosha)
f) Hridi / Mana (Mental state)
All these factors in a pure & healthy (Shuddha) state are necessary for
conception.
-> Any disruption or abnormality in Garbha Sambhava Samagri leads to infertility.
 Nidana:
1) Samanya: Ahara & Vihara Dosha; Akala Yoga (Vaya, Ritukala); Atma Dosha;
Balakshaya, Daiva Prakopa (idiopathic); Durmanasya (psychological); etc.
2) Vishista:
Beeja Dosha; Artava Dusti; Yonivyapad; Jataharini; Yoni-arsha;
Garbhakoshabhanga; Panchakarma Ayoga / Mithyayoga / Atiyoga; Arbuda;
Rakta Gulma; Srotovedha (injury to Artavavaha srotas); etc.
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 Bheda: According to Madhava Nidana
1) Based on Etiology: - 9
i) Adivandhya -> Due to misdeeds of previous life; primary infertility
ii-vi) Doshaja -> Vataja, Pittaja, Kaphaja, Sannipatika, Raktaja
vii) Bhutaja -> Negative psychic forces, infections, etc.
viii) Daiva -> Due to will of God, Idiopathic
ix) Abhicharaja -> Harmful rituals, black magic, curse, etc.
2) Based on Outcome / Presentation: - 4

i) Garbhasravi -> Recurrent miscarriage
ii) Mritputrika -> Still birth
iii) Kanyaprasu -> Only female child
iv) Kakavandhya -> Secondary infertility
 Samanya Chikitsa:
1) Shodhana Karma: Vamanadi Karma; especially Basti
- Shodhana karma regulates and restores the normal physiological functions
and relives obstructions.
- It should always be followed by Samsarjama Krama and adopting Pathya
Ahara & Vihara. Rasayana & Vajikarana Dravya after Shodhana also help in
improving conception by providing nourishment to all the Dhatus and
specifically enhancing Shukra Dhatu.
2) Shamana Karma: Shamana karma for Vandhyatva mainly focuses on

Pittashamaka Chikitsa to regulate Ritukala.
3) Sthanika Chikitsa: It restores a healthy state of Yoni and provides functional

capacity of Kshetra (Garbhashaya); especially Uttarabasti is useful.
4) Bheshaja Prayoga:
a) Bahya: Narayana Taila, Shatapuspa Taila (Nasya, Abhyanga, Basti), Lashuna
Taila, Shatavari Taila, Bala Taila Basti, Traivritta Sneha Basti
b) Abhyantara: Palasha patra, Lakshmana moola, Ashvagandha Kvatha, Phala

Ghrita, Phalakalyana Ghrita, Soma Ghrita, Lakshmanadi Ghrita, Kalyanaka
Ghrita, Lashuna Ghrita, Dashamoola Arista
5) Rasaushadhi Prayoga: Khandakadya Lauha, Pugapaka
6) Daivyavyapashraya Chikitsa
- Worship of family deity
- Worship Lord Ganehsa
- Chanting Durga Mantra
AYURVEDA LIBRARY
 Infertility
Infertility is defined as the inability of a couple to conceive in spite of one year of
frequent unprotected intercourse where the woman is < 35 years of age; 6 months if the
woman is > 35 years of age.
Sterility is an absolute state of inability to conceive.
Fecundability is the probability of a woman conceiving within a given period of time,
especially during a specific month or menstrual cycle.
Fecundity is the natural capability to produce an offspring, measured by the number of
gametes, seed set, or asexual propagules. A lack of fertility is infertility while a lack of
fecundity would be called sterility.
 Causes of Infertility:
1) Physiological
a) Pre-menarche
b) Post-menopause
c) Lactation period
2) Pathological
a) Male factors (30-40%)
b) Female factors (40-50%)
c) Both (10%)
d) Unknown (10%)
 Male factors:
1) Defective spermatogenesis
2) Obstruction of efferent duct system
3) Failure to deposit sperm high in the vagina
4) Errors in the seminal fluid
 Female factors:
1) Ovulation factors (40%)
Aging, Anovulation, Luteal phase defect, Luteinized unruptured follicle,
Diminished ovarian reserve, PCOS, POF, Endocrine disorder, Tobacco use
2) Tubal factors (35%)

Obstruction / Blockage, Endometriosis, Others
3) Uterine / Cervical factors (> 3%)

Congenital uterine-anomaly, Fibroids, Polyps, Poor cervical mucous quality,
Uterine synechiae, Pinhole os
4) Peritoneal factors (10%)

Peritubal adhesions, Endometriosis
5) Unexplained or Psychological factors (15%)
AYURVEDA LIBRARY
 Investigation of Infertility:
- Clinical assessment of both partners: Age, occupation, previous marriages,
history of any illness and operations, appendicitis, peritonitis, tuberculosis,
chlamydia, severe head injury, meningitis, encephalitis, alcohol, etc.
- All the systems are covered, especially the reproductive system.

Abnormalities of penis, cryptorchidism, size and consistency of testes, epididymis,
presence of vas, varicocele and prostrate abnormality in men.
In women, assess vagina, size, position, mobility of uterus, enlargement or fixation
of adnexa. Rule out galactorrhoea, acne, hirsutism, thyroid disorders, etc.
 Assessment of Male Infertility:

1) Semen analysis
2) Hormonal assessment
3) Testicular biopsy
 Assessment of Female Infertility:

1) Body Mass Index (BMI)
2) Basal hormone evaluation
3) Ultrasonography
4) Hormone assays
5) Endometrial biopsy/curettage
 Management of Infertility:
The couple should be aware that the chance of conception is most likely between
10th and 18th day of 28 day cycle during which the coitus is timed at 48 hour
interval. After coitus, the woman should rest quietly for 10 minutes to ensure that
some semen remain in contact with the cervix.
1) Management of Ovulatory Dysfunction

- The underlying cause of ovulatory dysfunction should be treated; e.g.
thyroid dysfunction.
- Hyperprolactinemia is treated with dopaminergic agents.
- An insulin-sensitizing agent like metformin induces ovulation in PCOS
patients.
- Laparoscopic ovarian drilling for ovulation induction is considered when
conservative management fails.
- In ovulatory dysfunction without an evident or uncorrectable cause, oral
ovulation-inducing agent clomiphene citrate can be given.
- Hypothalamic amenorrhoea may respond to gonadotropin therapy.
- Women with limited reserve are unlikely to benefit from ovulation
induction; oocyte donation is the only choice.
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2) Management of Tubal, Uterine, and Pelvic Disease
Tubal block may be treated with reparative surgery, but it has increased risk
of ectopic pregnancy. IVF is an alternative especially in cases marked by
damaged tubes.
Patients with endometriosis may benefit from laparoscopic ablation or
laparotomy.
Ovulation induction with or without IUI and IVF is advised.
3) Management of Unexplained / Persistent Infertility

Treatment options include IUI, clomiphene citrate therapy, and IUI with
clomiphene citrate or gonadotropin therapy.
IVF may be useful in patients with persistent infertility in whom treatment for
a specific diagnosis has not been successful.
4) Natural Boosters of Fertility

- Multigrain diet: Ragi, oats, millets, etc.
- Protein: Pulses, soy beans, legumes, milk, etc.
- Fruits: Pomegranate, papaya, watermelon, guava, etc.
- Vegetables: Carrots, beetroots, pumpkin, moringa leaves, etc.
- Nuts & Seeds: Almonds, dill seeds, etc.
- Water: 3-4 liters / day
- Exercise: 30 min / day, 5 days / week; e.g. Brisk walking, Yoga
AYURVEDA LIBRARY
-> Assisted Reproductive Technology (ART)
Assisted reproductive technology refers to a variety of procedures involving
manipulation of gametes and embryos to treat infertility.
1) Intrauterine Insemination (IUI)

Intrauterine insemination is a fertility treatment where sperm are placed directly into a
woman’s uterus.
During natural conception, sperm have to travel from the vagina through the cervix, into
the uterus, and to the fallopian tubes. With IUI, sperm are “washed” and concentrated,
and placed directly into the uterus, which puts them closer to the egg.
IUI is a relatively non-invasive and a less expensive fertility treatment compared to in

vitro fertilization (IVF). In some cases, couples may begin with IUI before progressing to
IVF if needed. IUI may be the only treatment needed to achieve pregnancy.
IUI can be performed using a male partner’s sperm or donor sperm.
IUI is most commonly used in following scenarios:

Unexplained infertility; Mild endometriosis; Issues with the cervix or cervical mucus; Low
sperm count; Decreased sperm motility; Issues with ejaculation or erection; Same-sex
couples wishing to conceive; A single woman wishing to conceive; A couple wanting to
avoid passing on a genetic defect from the male partner to the child.
IUI is not effective in following scenarios:

Women with moderate to severe endometriosis; Women who have had both fallopian
tubes removed or have both fallopian tubes blocked;
Women with severe fallopian tube disease; Women who have had multiple pelvic
infections; Men who produce no sperm (unless the couple wishes to use donor sperm).
Procedure:
IUI is a relatively painless and non-invasive procedure. IUI is sometimes done in what is
called the “natural cycle,” which means no medications are given. A woman ovulates
naturally and has the sperm placed at around the time of ovulation.
IUI can also be combined with ovarian stimulation. Medications such as clomiphene
citrate (Clomid), hCG (human Chorionic Gonadotropin), and FSH (follicle stimulating
hormone) may be used to prompt the ovaries to mature and release an egg or multiple
eggs. Ovulation with more than one egg usually increases chance of pregnancy.
The sperm which is used for IUI is collected from the man on the day of the procedure
and is “washed.” This is a process where the seminal fluid and other debris are removed
so that the sperm is very concentrated and unlikely to irritate the uterus.
Or the donor sperm will be thawed.
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- The patient is made to lie on an exam table, use a speculum to gently open the vagina
and visualize the cervix.
- The sperm will be passed through the cervix and placed into the uterus using a long,
thin tube.
- Patient shall remain reclined on the exam table for 10 to 30 minutes following the
insemination.
- Most women experience little to no discomfort, although some women may experience
mild uterine cramping or vaginal bleeding following the procedure.
- Some practices perform a second insemination the following day.
- Some practices also prescribe progesterone to take after the procedure and through
the early stages of pregnancy if pregnancy is achieved.
2) In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is a type of assistive reproductive technology (ART).
It involves retrieving eggs from a woman’s ovaries and fertilizing them with sperm. This
fertilized egg is known as an embryo. The embryo can then be frozen for storage or
transferred to a woman’s uterus.
Depending on the situation, IVF can use:

- The eggs and the sperm of the concerned couple.
- Eggs of the woman and donor sperm.
- Donor eggs and sperm of the man.
- Donor eggs and donor sperm.
- Donated embryos.
Embryos may also be implanted in a surrogate, or gestational carrier. This is a woman

who carries your baby for someone who is unable to.
Infertility issues for which IVF may be necessary include:

Reduced fertility in women over the age of 40; Blocked or damaged fallopian tubes;
Reduced ovarian function; Endometriosis; Uterine fibroids; Male infertility, such as low
sperm count or abnormalities in sperm shape; Unexplained infertility.
Parents may also choose IVF if they run the risk of passing a genetic disorder on to their
offspring. A medical lab can test the embryos for genetic abnormalities. Then, only
embryos without genetic defects are implanted.
Preparation for IVF:

- Women will first undergo ovarian reserve testing. This involves taking a blood sample
and testing it for the level of follicle stimulating hormone (FSH). The results will give
information about the size and quality of the eggs.
- Uterus examination (ultrasound or scope)
- Sperm testing. This involves giving a semen sample, which a lab will analyze for the
number, size, and shape of the sperm. If the sperm are weak or damaged, a procedure
called intracytoplasmic sperm injection (ICSI) may be necessary.
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Procedure:
There are five steps involved in IVF:
i) Ovarian stimulation
ii) Follicular aspiration
iii) Insemination
iv) Embryo culture
v) Embyro transfer
i) Ovarian stimulation
A woman normally produces one egg during each menstrual cycle. However, IVF requires
multiple eggs. Using multiple eggs increases the chances of developing a viable embryo;
therefore, fertility drugs are given.
ii) Follicular aspiration

Follicular aspiration is the process of egg retrieval. It is a surgical procedure performed
with anesthesia. The doctor will use an ultrasound wand to guide a needle through the
vagina, into the ovary, and into an egg-containing follicle. The needle will suction eggs
and fluid out of each follicle.
iii) Insemination
The male partner will now need to give a semen sample. A technician will mix the sperm
with the eggs in a petri dish. If that does not produce embryos, the doctor may decide to
use ICSI.
iv) Embryo culture

Your doctor will monitor the fertilized eggs to ensure that they are dividing and
developing. The embryos may undergo testing for genetic conditions at this time.
v) Embyro transfer
When the embryos are big enough, they can be implanted. This normally occurs three to
five days after fertilization. Implantation involves inserting a catheter into the vagina,
past the cervix, and into the uterus. There the embryo will be released.
Pregnancy occurs when the embryo implants itself in the uterine wall. This can take 6 to
10 days. A blood test will determine positive pregnancy.
Complications of IVF:
- Multiple pregnancies, which increases the risk of low birth weight and premature birth
- Miscarriage
- Ectopic pregnancy
- Ovarian hyperstimulation syndrome (OHSS)
- Bleeding, infection, or damage to the bowels or bladder
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3) Gamete Intrafallopian Transfer (GIFT)
Aspiration of oocytes following ovulation induction either laparoscopically or under
TVUS. This procedure is different form IVF in the sense that in IVF, the embryo is
transferred inside the endometrial cavity while in case of GIFT, the gametes are
transferred into the fallopian tube.
The semen is prepared and washed. The oocytes (2 per tube) are mixed with 50,000
sperms and transferred to each ampullary portion of fallopian tube by laparoscopy.
Indications: Unexplained fertility; Failed IUI; Male infertility; Immunological factors in

male or in the cervix.
4) Zygote Intrafallopian Transfer (ZIFT)

ZIFT is a combination of IVF and GIFT. Fertilization occurs in the IVF laboratory.
Fertilized oocytes in the pronuclear stage are transferred to fallopian tubes 18-24 hours
after insemination.
5) Intracytoplasmic Semen Insemination (ICSI)

ICSI revolutionized management of male infertility.
A single live sperm is injected into the cytoplasm of the oocyte which is then incubated
overnight. ICSI is nowadays used as a part of IVF cycle.
Indications:
- Sperm count < 5 million / ml
- Immotile sperms
- Abnormal sperm morphology
- Obstructive or non-obstructive azoospermia
- Previous failed IVF
- Unexplained infertility
Procedure:
The sperm (obtained through masturbation, epididymal aspiration, testicular biopsy, or
needle puncture of the testes) is paralyzed by stroking the distal portion of its tail. The
oocyte is stripped from the cumulus using a solution of hyaluronidase, the membrane of
the oocyte is pierced and the oolemma is entered with the microneedle which is loaded
with sperm. The spermatozoan is released inside the oolemma, and the microinjected
oocyte is kept in the incubator.
The success rate is 30-40%.
AYURVEDA LIBRARY
 Anovulation / Anovulatory Cycle
In an optimal scenario, a woman’s reproductive system will ovulate every month. But
there can be situations that cause anovulation, or the lack of ovulation in a menstrual
cycle. In that case, the woman becomes infertile.
An anovulatory cycle occurs when a women skips ovulation. During ovulation, the ovary
releases an oocyte.
It is not uncommon for a woman in her prime conception years to experience an
anovulatory cycle occasionally.
In a normal cycle, the production of progesterone is stimulated by the release of an egg.
Progesterone helps a woman’s body maintain regular periods. But during an anovulatory
cycle, an insufficient level of progesterone can lead to heavy bleeding. A woman may
mistake this bleeding for a real period.
This kind of bleeding may also be caused by a buildup in the lining of the uterus, known
as the endometrium, which can no longer sustain itself. It can be caused by a drop in
oestrogen as well.
A menstrual cycle without ovulation is most common in two distinct age groups:
- Girls who have recently begun menstruating: In the year following the menarche, the
female is more likely to experience anovulatory cycles.
- Women who are close to menopause: A woman between the ages of 40 and 50 is at a
greater risk of hormonal changes. This may lead to anovulatory cycles.
Sudden changes to hormone levels can trigger anovulatory cycles.

Other causes include:
- Body weight that is too high or too low
- Extreme exercise habits
- Eating habits
- High levels of stress
Diagnosis of anovulation includes examination of progesterone levels, endometrium,

blood or use of USG.
Treatment for anovulation depends on the causative factor.

- If anovulatory cycles are related to an outside influence like nutrition or lifestyle,
effective treatments will include regulating eating habits and moderating physical
activities. Making changes to the body weight (gaining or losing weight) may also be
sufficient to restart stalled ovulation.
- Sometimes internal imbalances are the reason and certain medications can stimulate
the fertility. These medications are designed to combat the cause of a woman’s
infertility. There are drugs designed to ripen the follicles, increase oestrogen, and help
the ovaries release an oocyte.
- Surgery is an option in the event of a serious complication, such as a tumor.
AYURVEDA LIBRARY
 Tubal Blockage / Blocked Fallopian Tubes
If a fallopian tube is blocked, the passage for the sperm to get to the ovum, as well as the
path back to the uterus for the fertilized oocyte, is blocked.
Causes of blocked fallopian tubes:

Fallopian tubes are usually blocked by scar tissue or pelvic adhesions.
- Pelvic inflammatory disease. This disease can cause scarring or hydrosalpinx.
- Endometriosis. Endometrial tissue can build up in the fallopian tubes and cause a
blockage. Endometrial tissue on the outside of other organs can also cause adhesions
that block the fallopian tubes.
- Certain sexually transmitted infections (STIs). Chlamydia and gonorrhea can cause
scarring and lead to pelvic inflammatory disease.
- Past ectopic pregnancy. This can scar the fallopian tubes.
- Fibroids. These growths can block the fallopian tube, particularly where they attach to
the uterus.
- Past abdominal surgery. Past surgery, especially on the fallopian tubes themselves, can
lead to pelvic adhesions that block the tubes.
Symptoms of blocked fallopian tubes:

- Blocked fallopian tubes do not often cause symptoms. Many women are not aware that
their tubes are blocked and encounter fertility problems.
- In some cases, blocked fallopian tubes can lead to mild, regular pain on one side of the
abdomen. This usually happens in a type of blockage called hydrosalpinx. This is when
fluid fills and enlarges a fallopian tube.
- Conditions that can lead to a blocked fallopian tube can cause their own symptoms.
Effect on fertility:
- Blocked fallopian tubes are a common cause of infertility. Sperm and an egg meet in the
fallopian tube for fertilization. A blocked tube can prevent them from joining.
- If both tubes are fully blocked, pregnancy without treatment will be impossible. If the
fallopian tubes are partially blocked, pregnancy may still occur. However, the risk of an
ectopic pregnancy increases.
- If only one fallopian tube is blocked, the blockage most likely will not affect fertility.
Fertility drugs can help increase the chance of ovulating on the open side.
Diagnosis of a blocked fallopian tube: Hysterosalpingography (HSG), Laparoscopy
Treatment of blocked fallopian tubes:

- Laparoscopic surgery can be used to remove small amounts of scar tissue or adhesions.
- If the fallopian tubes are blocked by large amounts of scar tissue or adhesions,
treatment to remove the blockages may not be possible.
- Surgery to repair tubes damaged by ectopic pregnancy or infection may be an option. If
a blockage is caused because part of the fallopian tube is damaged, a surgeon can
remove the damaged part and connect the two healthy parts.
AYURVEDA LIBRARY
 Dyspareunia
Dyspareunia is genital pain experience just before, during or after sexual intercourse.
According to ‘The Diagnostic and Statistical Manual of Mental Disorders’ (DSM-IV), it is a
subcategory of sexual dysfunction.
Most commonly pain is felt during coitus.
Dyspareunia can be divided into three types:
i) Superficial Dyspareunia: Local lesion on vulva or vagina. Pain occurs with attempted
penetration. It is usually secondary to anatomic or irritative conditions, or vaginismus.
ii) Vaginal Dyspareunia: Vaginal pain is related to friction (i.e. lubrication problems),
including arousal disorders.
iii) Deep Dyspareunia: Deep pain is due to pathology or paravaginal tissues or pelvic
organs and is related to thrusting, often associated with pelvic disease or relaxation.
 Turner Syndrome (TS)

Turner’s Syndrome is a chromosomal disorder that affects only females.
It occurs when one of the X chromosomes (sex chromosomes) is partially or completely
missing.
 Types:
1) Classical Turner Syndrome:
- One X chromosome is completely missing.
- It affects about half of all people with TS.
2) Mosaic Turner Syndrome:

- Also known as Mosaicism or Turner Mosaicism
- Abnormalities occur only in the X chromosomes of some of the body cells.
 Clinical Features & Complications:

During intra-uterine period: Thick neck tissue, Cystic hyagroma, Low weight
During infancy: Short stature / Delayed growth, Lack of ovarian development,
Broad chest with widely spread nipple, Low set ears, Dropping eyelids, Cubitus
valgus, Reduced birthweight
 Diagnosis: Ultrasound, Amniocentesis, Chorionic Villus Sampling (CVS)

 Treatment:
- There is no cure for turner syndrome.
- Treatment focuses to reduce symptoms & complications.
- Short stature: administration Growth hormone, alone or with androgen
- Lack of ovarian development: Estrogen replacement therapy to help with
development
- Psychological counseling
AYURVEDA LIBRARY
 Endometriosis
Endometriosis is a condition in which the layer of tissue that normally covers the inside
of the uterus grows outside of it.
Most often this occurs on the ovaries, fallopian tubes, and tissue around the uterus and
ovaries; however, in rare cases it may also occur in other parts of the body.
 Causes: Unknown
 Risk factors: Family history
 Onset: 30-40 years
 Duration: Long term
 Symptoms:
- Pelvic pain & Infertility (main symptoms)
- Dysmenorrhoea (progressive pain)
- Dyspareunia
- Dysuria (urinary urgency, frequency, and sometimes painful voiding)
- Asymptomatic in 20% of cases
- The pain can range from mild to severe cramping or stabbing pain that occurs on
both sides of the pelvis, in the lower back and rectal area, and even down the legs.
Chronic pelvic pain - lower back pain or abdominal pain.
 Complications:
Internal scarring, Adhesions, Pelvic cysts, Chocolate cysts of ovaries, Ruptured
cysts, Bowel and ureter obstruction resulting from pelvic adhesions
A chocolate cyst is an ovarian cyst filled with old blood. These cysts, which doctors
call endometriomas, are not cancerous, though they usually mean that a person's
endometriosis is severe enough to complicate their fertility. Between 20 and 40
percent of people with endometriosis develop chocolate cysts.
Treatment –> Laparoscopic cystectomy
 Stages:
1) Stage I (Minimal): Findings restricted to only superficial lesions and possibly a
few filmy adhesions.
2) Stage II (Mild): In addition, some deep lesions are present in the cul-de-sac;
the space behind the uterus.
3) Stage III (Moderate): As above, plus the presence of endometriomas on the
ovary, and more adhesions.
4) Stage IV (Severe): As above, plus large endometriomas, extensive adhesions.
 Diagnosis: Symptomatic, USG, Tissue biopsy

 Differential Diagnosis: PID, IBS, Interstitial cystitis, Fibromyalgia
 Prevention: Combined oral contraceptives, Exercise
 Treatment: NSAIDs, Continuous birth control pills, Intra-uterine device with
progestogen, Surgery, In vitro fertilization (IVF)
AYURVEDA LIBRARY
 Adenomyosis
Adenomyosis is a condition in which the lining of the uterus (endometrium) penetrates
the muscular wall of the uterus (myometrium).
Adenomyosis is completely limited to the inside of the uterus. It is sometimes referred to
as internal endometriosis. Adenomyosis is internal, while endometriosis is external in
relation to the uterus.
 Cause: Adenomyosis develops when there is an imbalance in the levels of estrogen

and progesterone in the body. This causes excessive growth on the inner surface
of the uterus.
 Classification: - 3
1) Focal: As the name indicates, focal adenomyosis is adenomyosis in one
particular site of the uterus.
2) Adenomyoma: Adenomyoma is a form of focal adenomyosis, but it is more
extensive, as it results in a uterine mass or benign tumor, similar to uterine
fibroma.
3) Diffuse: Unlike the other two classifications, diffuse adenomyosis is spread
throughout the uterus.
 Symptoms: Dysmenorrhea, Menorrhagia (may include clots), Dyschezia, Dysuria,

Hematuria, Neuropathy, Dyspareunia, Anemia, Endometritis, Asymptomatic
 Diagnosis: USG
 Treatment:
- Laparoscopic deep excision surgery within the uterus in focal or adenomyoma
- Hysterectomy or partial hysterectomy
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 Fibroid Uterus
Fibroids are abnormal growths that develop in or on a woman’s uterus. Sometimes these
tumors become quite large and cause severe abdominal pain and heavy periods. In other
cases, they cause no signs or symptoms at all. The growths are typically benign, or
noncancerous.
According to the Office on Women’s Health, up to 80 percent of women develop fibroids
by the age of 50. However, most women do not have any symptoms.
 Synonyms: Uterine fibroid, Uterine fibroma, Leiomyoma, Myoma
 Cause: Unknown
 Risk factors:
- Hormones: Oestrogen and progesterone cause the uterine lining to regenerate
during each menstrual cycle and may stimulate the growth of fibroids.
- Family history
- Pregnancy
- Nulliparity
- Obesity
- Age > 40
 Types: - 4
1) Intramural / Interstitial fibroids: Intramural fibroids are the most common
type of fibroid. These types appear within the muscular wall of the uterus.
Intramural fibroids may grow larger and can stretch the womb.
2) Subserosal fibroids: Subserosal fibroids form on the outside of the uterus,

which is called the serosa. They may grow large enough to make the womb
appear bigger on one side.
3) Pedunculated fibroids: Subserosal tumors can develop a stem, a slender base

that supports the tumor. When they do, they are known as pedunculated
fibroids.
4) Submucosal fibroids: These types of tumors develop in the myometrium.

Submucosal tumors are not as common as the other types.
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 Symptoms:
The symptoms usually depend on the number of tumors as well as their location
and size.
- Metrorrhagia (may include clots)
- Menorrhagia
- Polyuria
- Dyspareunia
- Abdominal distension
- Pain in the pelvis or lower back
- Increased menstrual cramping
 Diagnosis: USG, MRI pelvis
 Management:
1) Home remedies and natural treatments
- Yoga, Massage
- Heat application to relieve cramps
- Avoid meat and high-calorie foods.
- Foods high in flavonoids, green vegetables, green tea, and cold-water.
- Reducing stress & overweight
2) Medications
- Gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide
(Lupron), will cause the oestrogen and progesterone levels to drop. This will
eventually stop menstruation and shrink fibroids.
- GnRH antagonists also help to shrink fibroids. They work by stopping the
body from producing follicle-stimulating hormone (FSH) and luteinizing
hormone (LH).
Other options that can help control bleeding and pain, but do not shrink or
eliminate fibroids, include:
- Intrauterine device (IUD) that releases progestin
- Over-the-counter (OTC) anti-inflammatory pain relievers, such as ibuprofen
- Birth control pills
3) Surgery
- Myomectomy
- Hysterectomy
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 Genital Prolapse
Genital prolapse occurs when pelvic organs slip down from their normal anatomical
position and either protrude into the vagina or press against the wall of the vagina. The
pelvic organs are usually supported by ligaments and the muscles, connective tissue and
fascia which are collectively known as the pelvic floor. Weakening of or damage to these
supportive structures allows the pelvic organs to slip down.
The condition is most common in postmenopausal women who have had children, but
can also occur in younger women and women who have not had children. It is estimated
that at least half the women who have had more than one child have some degree of
genital prolapse (although only 10-20% complain of symptoms).
 Types:
There are a number of different types of prolapse. The prolapse of a pelvic organ
may occur independently or along with other pelvic organ prolapses. Prolapses are
graded according to their severity:
First-degree prolapse: The structure protrudes a short way into the vagina or wall.
Second-degree prolapse: The structure drops to the opening of the vagina.
Third-degree prolapse: The structure bulges through the opening of the vagina.
1) Uterine prolapse: A uterine prolapse involves the descent of the uterus and
cervix down the vaginal canal due to weak or damaged pelvic support
structures.
2) Cystocele: A cystocele occurs when the tissues supporting the wall between
the bladder and vagina weaken, allowing a portion of the bladder to descend
and press into the wall of the vagina.
3) Urethrocele: A urethrocele occurs when the urethra descends and presses

into the wall of the vagina. A urethrocele rarely occurs alone, instead usually
accompanying a cystocele. The term cystourethrocele is used to refer to the
prolapse of both part of the bladder and the urethra.
4) Rectocele: A rectocele occurs when the tissues supporting the wall between
the vagina and rectum weaken allowing the rectum to descend and press into
the wall of the vagina.
5) Enterocele: An enterocele is similar to a rectocele, but instead involves the

Pouch of Douglas (area between the uterus and the rectum) descending and
pressing into the wall of the vagina.
6) Vaginal vault prolapse: A vaginal vault prolapse occurs when the top of the
vagina descends in women who have had a hysterectomy.
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 Symptoms:
Some women who develop a vaginal prolapse do not experience symptoms.
Symptoms most commonly associated with a vaginal prolapse depend on the type
of vaginal prolapse present. The most common symptom of all types of vaginal
prolapse is the sensation that tissues or structures in the vagina are out of place.
Some women describe the feeling as "something coming down" or as a dragging
sensation. This may involve a protrusion or pressure in the area of the sensation.
Generally, the more advanced the prolapse, the more severe the symptoms.
General symptoms that may be seen with of all types of vaginal prolapse include
pressure in the vagina or pelvis, painful intercourse (dyspareunia), a mass at the
opening of the vagina, a decrease in pain or pressure when the woman lies down,
and recurrent urinary tract infections.
Symptoms specific to certain types of vaginal prolapse include:

- Difficulty emptying bowel: This may be indicative of an enterocele, vaginal vault
prolapse or rectocele. A woman with difficulty emptying her bowel may find that
she needs to place her fingers on the back wall of the vagina to help evacuate her
bowel completely. This is referred to as splinting.
- Difficulty emptying bladder: This may be secondary to a cystocele, urethrocele,

enterocele, vaginal vault prolapse, or prolapsed uterus.
- Constipation: This is the most common symptom of a rectocele.
- Urinary stress incontinence: This is a common symptom often seen in

combination with a cystocele.
- Pain that increases during long periods of standing: This may be indicative of an
enterocele, vaginal vault prolapse, or prolapsed uterus.
- Protrusion of tissue at the back wall of the vagina: This is a common symptom of
a rectocele.
- Protrusion of tissue at the front wall of the vagina: This is a common symptom of
a cystocele or urethrocele.
- Enlarged, wide, and gaping vaginal opening: This is a physical finding frequently
seen in combination with a vaginal vault prolapse.
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 Treament:
1) Conservative treatment options
Pelvic floor exercises, also called Kegels, strengthen the muscles that support
the vagina, bladder, and other pelvic organs.
- Weight loss may help to reduce the pressure on the pelvic organs.
- Pessary - this device, which is made from plastic or rubber, is placed inside
the vagina and holds the bulging tissues in place.
2) Surgery
A piece of the person’s own tissue, tissue from a donor, or a man-made
material will be used to support the weakened pelvic floor muscles.
Manchester repair / Fothergill operation:

The Manchester operation, Manchester repair or simply Fothergill operation
is a technique used in gynecologic surgeries. It is an operation for uterine
prolapse by fixation of the cardinal ligaments. Its purpose is to reduce the
cystourethrocele and to reposition the uterus within the pelvis.
 Correlation of Genital Prolapse with Yonivyapad:

Phalini, Sramsini and Mahayoni can be correlated to different genital prolapse.
 Cervical Erosion
 Medical term: Cervical Ectopy / Cervical Ectropion
 Definition:
Cervical erosion is a condition in which cells that normally line the inside of the
cervical canal extend to the surface of the cervix.
- Columnar epithelium may extend further downwards and protrude on the

surface of the cervical os and onto the vaginal portion of cervix.
- It may also undergo squamous metaplasia and transform to stratified squamous
epithelium.
 Types:
1) Physiological
2) Pathological
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 Causes:
1) Physiological: ▪ Hyper-estrogen level, Pregnancy, Birth control pills
▪ Birth may lead to cervical erosion in female child due to
response to maternal estrogen.
▪ Hormone Replacement Therapy (HRT)
2) Pathological: ▪ Infections (bacteria, yeasts)

▪ Chronic vaginal infection
▪ Chemical contraception, e.g. anti-sperm gel can change the
normal level of vaginal acidity and cause cervical erosion.
 Symptoms:
1) Physiological: ▪ Asymptomatic
2) Pathological: ▪ Vaginal itching / irritation, Pain and bleeding during or after
coitus, Abnormal vaginal discharge
 Diagnosis:
1) Physiological: ▪ As it is asymptomatic and resolves by itself, patients usually
do not go to a physician.
2) Pathological: ▪ Symptoms, PS- & PV- examination, Pap smear, Cervical biopsy
 Treatment:
1) Physiological: ▪ Resolves by itself
2) Pathological: ▪ Cervical cauterization - the aim of the treatment is to destroy
columnar cells so that normal squamous cells can grow in their
place again.
a) Modern = Electrocautery, Cryocautery, Diathermy,
Antibiotics
b) Ayurveda = Agnikarma, Yoniprakshalana, Yonipichu
 Precautions & Advice for the patient:

- After cervical cauterization, for 15 days increased vaginal discharge is normal as
the waste tissue is excreted.
- Cervical erosion requires 6-8 weeks to heal.
- Avoid coitus, tampons (pichu) & douches (prakshalana) to protect the recovering
area to prevent injury and infection.
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 Cervical Intraepithelial Neoplasma (CIN) / Cervical Dysplasia
Cervical dysplasia is a condition in which healthy cells on the cervix undergo abnormal
changes. In cervical dysplasia, the abnormal cells are not cancerous, but can develop into
cancer if not detected early and treated.
 Cause:
- Human papillomavirus (HPV). HPV is a sexually transmitted virus, and there are
hundreds of strains. Some are low-risk and cause genital warts. Others are high-
risk and cause cell changes that can turn into cervical dysplasia and cancer.
 Risk factors:
- Suppressed immune system (disease, immonuosuppressant drugs, etc.)
- Multiple sexual partners
- Giving birth before the age of 16
- Sexual intercourse before the age of 18
- Smoking cigarettes
 Classification:
1) CIN 1, mild dysplasia
2) CIN 2, moderate dysplasia
3) CIN 3, severe dysplasia, or carcinoma in situ
Carcinoma in situ (CIS) is a group of abnormal cells that are found only in the
place where they are first formed in the body. These abnormal cells may
become cancerous and spread to nearby normal tissue.
 Diagnosis:
There are typically no symptoms of cervical dysplasia. Occasionally, abnormal
bleeding may occur. However, in the absence of symptoms, the cell changes are
invisible to the naked eye and are usually found during a regular Pap smear
examination. Pap test results will indicate a squamous intraepithelial lesion (SIL).
There are different categories of SIL, including:
i) Low-grade SIL (LSIL)
ii) High-grade SIL (HSIL)
Many times, LSIL resolves on its own. A follow-up should be done.

In case of HSIL a colposcopy & cervical biopsy may be done.
 Treatment:
Treatment of cervical dysplasia depends on the severity of the condition. Mild
dysplasia might not be treated immediately since it can resolve without treatment.
Repeated Pap smears may be done every three to six months.
For CIN 2 or 3, treatment can include: Cryosurgery, Laser therapy, Cone biopsy,
Loop electrosurgical excision procedure (LEEP)
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 Retroverted Uterus
A retroverted uterus is a uterus that curves in a backward position at the cervix instead
of a forward position.
A retroverted uterus is one form of “tilted uterus,” a category that also includes
anteverted uterus, which is a uterus that is tilted forward rather than backward.
 Synonyms: Tipped uterus, Retroflexed uterus, Uterine retroversion,

Backward uterus, Uterine retro displacement
 Causes:
A retroverted uterus is a standard variation of pelvic anatomy that many women
are either born with or acquire as they mature. Actually about a quarter of women
have a retroverted uterus. Genetics may be the cause.
In other instances, the condition may have an underlying cause that is often
associated with pelvic scarring or adhesions. These include:
- Endometriosis. Endometrial scar tissue or adhesions can cause the uterus to stick
in a backward position, almost like gluing it in place.
- Fibroids. Uterine fibroids can cause the uterus to become stuck or misshapen, or
to tilt backward.
- Pelvic inflammatory disease (PID). When left untreated, PID can cause scarring,
which may have a similar effect to endometriosis.
- History of pelvic surgery. Pelvic surgery can also cause scarring.
- History of prior pregnancy. In some instances, the ligaments holding the uterus
in place become overly stretched during pregnancy and stay that way. This may
allow the uterus to tip backward.
 Symptoms:
Some women are asymptomatic. If symptoms occur, they may include:
- Dyspareunia
- Dysmenorrhoea
- Urinary tract infections (UTI)
- Mild incontinence
- Increased urinary frequency or feeling of pressure in the bladder
- Trouble inserting tampons
- Protrusion of lower abdomen
 Retroverted uterus and sex:

A retroverted uterus does not usually interfere with sexual sensation.
It can, however, make sexual intercourse painful (dyspareunia) in some instances.
This discomfort may be more pronounced in certain positions. Changing sexual
positions may reduce the discomfort.
AYURVEDA LIBRARY
 Retroverted uterus and fertility:
A retroverted uterus does not typically affect a woman’s ability to conceive. This
condition is sometimes associated with other diagnoses that may affect fertility
potential such as: Endometriosis, Uterine fibroids, PID
 Retroverted uterus and pregnancy:

A retroverted uterus does not typically affect the viability of a pregnancy.
It may create more pressure on the bladder during the first trimester. That may
cause either increased incontinence or difficulty urinating. It can also cause back
pain for some women.
The uterus may also be harder to see via ultrasound until it begins to enlarge with
pregnancy. Transvaginal ultrasounds during the first trimester may be necessary to
see the progression of pregnancy.
The uterus should expand and straighten toward the end of the first trimester,
typically between weeks 10 and 12. This will cause your uterus to lift out of the
pelvis and no longer tip backward.
On occasion, the uterus is not able to not make this shift. Sometimes this is caused
by adhesions that keep the uterus anchored into the pelvis.
If the uterus does not shift forward, the risk for miscarriage may increase. This is
known as an incarcerated uterus; it is uncommon.
 Treatment:
- Exercises. Certain types of exercises designed to strengthen the ligaments and
tendons that hold the uterus in an upright position may be beneficial; such as
Kegel exercises:
1) Tighten and hold the pelvic floor muscles for five seconds (count 1 one
thousand, 2 one thousand, 3 one thousand, 4 one thousand, 5 one thousand).
2) Relax the pelvic muscles.
3) It is suggested to do 10 to 20 Kegel exercises three to four times each day.
However, these will not provide relieve if the uterus is stuck in place because of
scarring or adhesion.
- Pessary device. Pessaries are made from silicone or plastic. They are small
devices that can be inserted into the vagina to prop the uterus into an upright
position. Pessaries can be used on either a temporary or permanent basis. They
have been associated with infection if left in long-term.
- Surgical techniques. Uterine suspension procedure, Uplift procedure
AYURVEDA LIBRARY
 Pelvic Inflammatory Diseases (PID)
PID is an infection of a woman's reproductive organs. The reproductive organs include
the uterus, fallopian tubes, ovaries, and cervix.
 Cause: A woman can get PID if bacteria move up from her vagina or cervix and into
her reproductive organs. Many different types of bacteria can cause PID. Most
often, PID is caused by infection from two common STIs; gonorrhoea and
chlamydia.
 Risk factors:
- History of PID or STI
- < 25 years and sexually active. PID is most common in women 15 to 24 years old.
- Multiple sex partners or having a partner who has.
- Douche. Douching can push bacteria into the reproductive organs and cause PID.
Douching can also hide the signs of PID.
- Recent insertion of intrauterine device (IUD). The risk of PID is higher for the first
few weeks only after insertion of an IUD, but it is rare after that.
 Symptoms:
Many women are asymptomatic. When symptoms do happen, they can range
from mild to serious. Signs and symptoms include:
- Lower abdominal pain (most common symptom)
- Fever (40°C or higher)
- Abnormal vaginal discharge (foul smell)
- Dyspareunia, Dysuria, Oligomenorrhoea
 Diagnosis: Symptomatic diagnosis, Pelvic exam, Cervical culture, Urine test, USG
 Treatment:
- Antibiotics
- Hospitalization may be necessary if the patient is heavily affected, pregnant or
unable to swallow pills.
- PID may require surgery. This is rare and only necessary if an abscess in the pelvis
ruptures or there is an indication that an abscess will rupture. It can also be
necessary if the infection does not respond to antibiotic treatment.
- Without treatment, PID can lead to serious problems like infertility, ectopic
pregnancy, and chronic pelvic pain.
 Prevention:
- Safe & protected sexual intercourse
- STI tests
- Avoiding douches
- Wiping from front to back after using the bathroom to stop bacteria from
entering the vagina.
AYURVEDA LIBRARY
Pelvic Infections & Sexually Transmitted Infections
Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) are also
called venereal diseases; named after Venus, the Greek Goddess of love.
STIs are infections transmitted predominantly from an infected partner through sexual
contact; other modes of transmission include placenta, blood transfusion, infected
needles, etc.
 Chlamydia Trachomatis Infections

Chlamydia is the commonest among STIs. Many chlamydial infections produce only a few
or no symptoms in women and are never detected.
It is recognized as the main causative factor for pelvic inflammatory disease (PID).
 Clinical Features: Often it is asymptomatic. Following symptoms may occur:

- Muco-purulent vaginal discharge
- Hypertrophic ectopy of the cervix which bleeds on touch
- Dysuria and increased frequency of micturition
- Acute Bartholinitis may occur in combination with gonococcal infection
- Menorrhagia / Metrorrhagia / Post-coital bleeding
- Silent salpingitis -> tubal scarring -> infertility or ectopic pregnancies
 Diagnosis: Cell culture, Direct fluorescent antibody (DFA), ELISA, PCR & LCR
 Treatment: Azithromycin, Doxycycline, Erythromycin, Ofloxacin, Levofloxacin
 Trichomonas Vaginitis / Trichomoniasis

It is caused by the protozoa trichomonas vaginalis, a motile flagellated parasite.
It is usually associated with bacterial vaginosis. It may lead to PROM or preterm labour.
 Risk factors: IUCD, Smoking, Multiple sex partners, etc.
 Clinical Features:
- Profuse greenish-yellow muco-purulent vaginal discharge
- Dysuria
- Vulval soreness
- Pruritus vulvae
- Strawberry spots on the vaginal vault and cervix
- pH > 5
 Diagnosis: Wet mount microscopy of vaginal discharge, Rule out coexisting

chlamydia, gonorrhoea, syphilis and HIV.
 Treatment: Metronidazole, Tinidazole
AYURVEDA LIBRARY
 Vaginal Candidiasis / Moniliasis
A vaginal yeast infection, also known as candidiasis or moniliasis, is a common condition.
A healthy vagina contains bacteria and some yeast cells. But when the balance of
bacteria and yeast changes, the yeast cells can multiply.
Vaginal yeast infections are not categorized under sexually transmitted infections (STIs).
Sexual contact can spread it, but women who are not sexually active may also get
infected.
Once affected a yeast infection, it is more likely for it to recur.
 Causes:
The fungus Candida is a naturally occurring microorganism in the vaginal area.
Lactobacillus bacteria keep its growth in check. If there is an imbalance, these
bacteria will not work effectively. This leads to an overgrowth of yeast, which
causes the symptoms of vaginal yeast infections.
Several factors can cause a yeast infection, including:
- Antibiotics which decrease the amount of Lactobacillus
- Pregnancy
- Uncontrolled diabetes
- Weak immune system
- Poor eating habits; including a lot of sugary foods
- Hormonal imbalance near the menstrual cycle
- Stress, lack of sleep
A specific kind of yeast called Candida albicans causes most yeast infections. These
infections are easily treatable.
 Symptoms:
- Vaginal itching
- Swelling around the vagina
- Burning sensation during micturition or sexual intercourse
- Dyspareunia
- Soreness, Redness, Rash
- Whitish-gray and clumpy vaginal discharge (may be watery)
 Diagnosis:
- Medical history to check about previous infections; candidiasis or STI.
- Pelvic exam; external signs of infection
- Microscopic examination of vaginal discharge
AYURVEDA LIBRARY
 Treatment:
Treating a vaginal yeast infection can relieve symptoms within a few days. In more
severe cases, it may take up to 2 weeks.
Treatments are generally determined based on the severity of symptoms.
Simple infections:
1-to-3-day regimen of an antifungal cream, ointment, tablet, or suppository.
Common medications include:
- Butoconazole (Gynazole)
- Clotrimazole (Lotrimin)
- Miconazole (Monistat)
- Terconazole (Terazol)
- Fluconazole (Diflucan)
Complicated infections:
14-day antifungal cream, ointment, tablet, or suppository.
Two or three doses of fluconazole (Diflucan).
Long-term prescription of fluconazole taken once a week for 6 weeks or long-term
use of a topical antifungal medication.
 Prevention:
Take up:
- Well-balanced diet
- Eating yogurt or taking supplements with lactobacillus
- Wearing natural fibers such as cotton, linen or silk
- Washing underwear in hot water
- Replacing feminine products frequently
Avoid:
- Wearing tight pants, pantyhose, tights or leggings
- Using feminine deodorant or scented tampons or pads
- Sitting in wet clothing, especially bathing suits
- Sitting in hot tubs or taking frequent hot baths
- Douching
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 Bacterial Vaginosis (BV)
Bacterial vaginosis is the commonest type of vaginal infection in the reproductive age
group. Its primary causes are bacterial imbalances due to douching and frequent sexual
intercourse.
 Causative Organism: Gardnerella vaginalis
 Clinical features: 50% of cases are asymptomatic. Following symptoms may occur:
- A fishy odorous vaginal discharge, especially following coitus
- Presence of milky, non-viscous discharge which is adherent to the vaginal wall.
- No or minimal vaginal irritation.
- pH > 4.5
 Complications: PID, Fertility issues; PROM / Premature delivery, Chorioamnionitis,

Post-caesarean endometritis if infection occurs during pregnancy.
 Diagnosis: Microscopic examination of vaginal discharge reveals an increased

number of clue cells and absence of leucocytes.
Demonstration of clue cells on a saline smear is the most specific criterion for
diagnosing BV. Clue cells are vaginal epithelial cells that have bacteria adherent to
their surfaces. The edges of the squamous epithelial cells, which normally have a
sharply defined cell border, become studded with bacteria.
 Treatment: Metronidazole, Tinidazole, Clindamycin
 Chancroid (Soft Core)

Chancroid is a very rare STI. Syphilis must be ruled out. The combination of a painful
ulcer with tender or suppurative lymphadenopathy is pathognomonic of chancroid.
 Causative Organism: Haemophilus ducreyi
 Clinical features:
- Multiple small papules or vesicles break down forming acute painful shallow
ulcers which discharge offensive pus.
- Bright red oedematous congestion which bleeds easily around the ulcers.
- Unilateral painful and tender lymphadenopathy
 Diagnosis: Polymerase chain reaction (PCR), Specialized cultures
 Treatment: Azithromycin, Erythromycin, Ceftriaxone
AYURVEDA LIBRARY
 Syphilis
 Causative Organism: Treponema pallidum
 Mode of transmission: Abrasion in skin, mucous membrane, blood transfusion,
tattooing, kissing, etc.
 Incubation period: 9-90 days
 Classification:
1) Primary Syphilis
Incubation period: 10-20 days
The primary lesion begins with single small pink macule, later on it ulcerates
at the site of infection, usually on genitalia.
The ulcer is painless and does not bleed easily on touch. The regional lymph
nodes are enlarged and are painless.
The usual sites of ulcer in males are cornal sulcus of penis and the glans penis.
In females, the labia majora, labia minora, cervix, urethral orifice and clitoris.
Extra genital ulcers are seen in 10% cases. It may be found on fingers, tongue,
lips, nipples, rectum, anus.
2) Secondary Syphilis
The primary chancre heals spontaneously. After 6 weeks to 6 months from
the onset of primary lesion, the secondary stage of syphilis sets in. It starts
with mild fever, headache and vomiting.
Four important signs in secondary syphilis:
a) Skin rashes
b) Generalized lymphadenopathy
c) Condylomata lata
d) Mucus patches
3) Tertiary Syphilis / Late Syphilis

It affects the skin, mucosa and bones. Teritary syphilis is characterized by the
formation of localized granulomas called gumma’s. This takes more than 10
years to appear. Gumma’s of critical organs like the heart, brain and liver can
be fatal.
-> Congenital Syphilis

Transmission of syphilis to foetus from mother through placenta may occur at
any stage of pregnancy; usually 16th week of pregnancy.
 Diagnosis: Dark ground illumination microscopy of serum, Serological tests,

Wasserman (WR) test, Venereal Disease Research Laboratory (VDRL), Treponema
pallidum haemagglutination (TPHA) test, ELISA
 Treatment: Benzathine penicillin, Ceftriaxone, Doxycycline
AYURVEDA LIBRARY
 Gonorrhoea
Gonorrhoea is derived from the Greek words “gonos” (seed) and “rhoia” (flow).
Both gonorrhoea and chlamydia affect the same organs and have similar clinical
presentation.
60% of women with proven gonorrhoea also suffer from Trichomonas vaginalis and / or
Chlamydia trachomatis. Candida albicans, HSV (herpes simplex virus), etc. are also
associated. So, gonorrhoea should be suspected whenever there is a complaint of vaginal
discharge.
 Causative Organism: Neisseria gonorrhoeae
- Non-pruritic purulent vaginal discharge
- Dysuria and frequency
- Soreness
- Vulval erythema and swelling
- Inguinal adenitis in acute cases
- Cystitis, Proctitis, Bartholinitis
In women, the primary site of infection is the endocervix and the infection
commonly extends to the urethra and vagina. The infection may spread to
Bartholin’s glands, endometrium and fallopian tubes. The infections ascends to the
fallopian tubes at the time of menstruation or after instrumentation giving rise to
acute salpingitis which may be followd by PID resulting in sterility if not treated.
 Diagnosis:
- Gram staining of urethral, cervical or rectal swabs
- Culture
 Treatment: Ceftriaxone, Cefixime, Ciprofloxacin, Ofloxacin, Levofloxacin
AYURVEDA LIBRARY
 Genital Herpes
Genital herpes is the commonest cause of genital ulcers.
 Causative Organism: Large DNA viruses, Herpes simplex virus type 1 & 2
- The first clinical manifestation is very severe in women causing painful ulcers at
the perineum, introitus, vagina and labia majora.
- It is associated with dysuria, abnormal vaginal discharge, fever and malaise.
Lymph nodes are enlarged
- The primary episode may last for 3-4 weeks.
 Complications: Severe bacterial infection, sacral radiculomyelopathy, actue

urinary retention, meningitis, encephalitis, neonatal herpes during labour
 Recurrence:
- Almost 50% of the patients have recurrent episodes which are less severe,
unilateral and of short duration which lasts about 1 week and is often preceded by
pain or hyperaesthesia of the site.
- Stress, menstruation, intercourse may predispose recurring episodes.
 Diagnosis:
- Tissue culture
- Immunofluorescent ELISA
- PCR
 Treatment:
- General symptomatic treatment
- Frequent saline and soothing baths
- Acyclovir (not advisable in recurrent cases where the infection is self-limiting)
AYURVEDA LIBRARY
 Human Immunodeficiency Virus (HIV) &
Acquired Immune Deficiency Syndrome (AIDS)
AIDS is a disease of the immune system caused by the Human Immunodeficiency Virus;
HIV 1 and HIV 2.
The virus destroys or impairs cells of the immune system and progressively destroys the
body's ability to fight infections and certain cancers.
 Mode of transmission:
- In adults and adolescents, HIV is most commonly spread by sexual contact with
an infected partner.
- Nearly all HIV infections in children under the age of 13 are from vertical
transmission, which means the virus is passed to the child when they are in their
mother's womb or as they pass through the birth canal, or through breastfeeding.
Seroconversion illness: (2-3 weeks duration)
- Flu like symptoms; fatigue, fever, sore throat, weight loss, diarrhoea, myalgia
- Some may develop cervical lymphadenopathy, diffuse skin rash or ulcerations of
the mouth or genitalia.
Clinical latency:
- Patients may remain asymptomatic for many years.
- Appearance of infection may be the first manifestation of HIV.
- Persistent lymphadenopathy is also a feature of early symptomatic disease.
Oral manifestations: Oral hairy leukoplakia, Candidiasis, HSV infection, Gingivitis
Cutaneous manifestations: Herpes zoster, HSV infection, Scabies, Folliculitis
GI manifestations: Oesophagitis, Diarrhoea, Malabsorption -> weight loss
Respiratory manifestations: Tuberculosis, Pneumocystis carinii pneumonia (PCP)
CNS manifestations: Perihperal neuropathy, Aseptic meningitis, AIDS -> dementia

complex, seizures; HIV -> Encephalopathy
Endocrine manifestations: Adrenal insufficiency, Hypogonadism
Cardiac manifestations: Myocarditis, Dilated cardiomyopathy
Gynaecological manifestations: Vulvo-vaginal candidiasis, Cervical dysplasia,

Cervical Carcinoma, PID
AYURVEDA LIBRARY
 Diagnosis: ELISA (Enzyme-Linked Immunosorbent Assay), HIV RNA by PCR,
Western blot / immunoblot test
 Management:
1) Preventive measures:
- Wide spread voluntary counselling and testing
- Counselling regarding safe sex practice and health education, barrier
methods reduce transmission by 80%.
- Male circumcision reduces transmission by 50%.
- Screening of blood, semen donors.
- Post exposure prophylaxis – Zidovudine + Lamivudine
- MTP in HIV positive cases
- Avoid breast feeding
2) Definitive treatment:
Anti-retroviral therapy (ART)
- Nucleoside reverse transcriptase inhibitors (NRTIs): Zidovudine, Zalcitabine,
Lamivudine, Stavudine
- Non-Nucleoside reverse transcriptase inhibitors (NNRTIs): Delaviridine,

Nevirapine, Efavirenz
- Protease inhibitor (PI): Indinavir, Saquinavir, Ritonavir
- Fusion inhibitor: Enfuviritide
- Integrase inhibitor: Raltegravir
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Benign and Malignant Tumors of the Female Genital Tract
 Yonikanda
- Yonikanda is mentioned in Madhava Nidana, Bhavaprakasha Nighantu, Sharngadhara
Samhita and Yogaratnakara.
- Yonikanda is a disease of the vulva or lower vaginal canal having a round shape.
 Nidana:
तदवास्वप्नादतिक्रोधाि् व्यायामादतिमौथु नाि् ।
क्षिाच्च नखदन्ताधै वािादद्याः कुतपिा यदा ॥
- Divasvapna
- Atikrodha
- Vyayama
- Atimaithuna
- Injury by Nakha & Danta
 Samanya Lakshana:
- Rounded structure having shape of Nikucha phala
- Infected with pus or blood
 Bheda: - 4
1) Vataja = Ruksha, Vivarna, Sphutita
2) Pittaja = Daha, Raga, Jvara
3) Kaphaja = Kandu, Neelapuspa / Tila Puspa
4) Sannipatika = VPK lakshana
 Chikitsa:
- Yonipurana with Gairika, Amra-asthi, Jantughna, Rajani, Anjana & Katphala mixed
with Kshaudra.
- Yoniprakshalana with Triphala Kashaya & Kshaudra.
- Yonipichu with Mooshika Taila.
- Vataja Yonikanda = Svedana

- Pittaja Yonikanda = Virechana
- Kaphaja Yonikanda = Vamana
- Sannipatika Yonikanda = VPK chikitsa

Yonikanda can be correlated with Bartholin’s abscess.
Vataja = Early stage of Bartholin’s abscess
Pittaja = Acute suppurative stage
Kaphaja = Acute suppuration in chronic stage
AYURVEDA LIBRARY
 Bartholin’s Gland
- Situated in superficial perineal pouch
- Close to the posterior end of vestibule
- 4’o clock and 8’ o clock position
- Pea sized, 0.5 cm, yellowish-white
 Acute Bartholinitis
- Causative Organism: Gonococci, E.colli,
Staphylococcus, Streptococcus, Chlamydia trachomatis
- Pathology: Epithelium of the gland and duct get swollen. Lumen of the duct may
get blocked or remains open through which exudate escapes.
Clinical features: Local pain and discomfort even to the extent of difficulty in
walking or sitting. On examination, tenderness and induration of posterior half of
labia when palpated between thumb outside and index finger inside the vagina.
Treatment: Hot compress, Antibiotics
Fate: Complete resolution, Abscess, Recurrence, Cyst formation
 Bartholin’s Abscess
- Cause & Pathology: Developed from acute bartholinitis. The duct gets blocked by
fibrosis and exudates pent up inside to form an abscess.
- Clinical Features: Intense local pain and discomfort; unable to walk or sit; fever.
On examination, unilateral tender swelling beneath posterior half of labium majus
expanding medially to posterior part of labium minus.
- Treatment: Rest, Analgesics, Sitz baths, Marsupialization -> Surgery by which an

elliptical opening is made on the inner aspect of labium minus to drain the pus.
 Bartholin’s Cyst
- Cause: Infection or trauma followed by fibrosis and occlusion of lumen. Trauma
by lateral or ill-directed mediolateral episiotomy.
- Clinical features: Local pain, dyspareunia. On examination, unilateral swelling on

posterior half of labium majora which opens up into posterior end of labium
minus. It makes the vulval cleft S-shaped. Fluctuant and non-tender.
- Treatment: Sitz baths, Antibiotics, Surgical drainage, Marsupialization
AYURVEDA LIBRARY
 Yoni-Arsha
Yoni-arsha is mentioned by Acharya Charaka, Sushruta, Vagbhata and Harita.
The aggravated Doshas reach the Yoni and form an umbrella-shaped muscular sprout.
It is foul smelling, unctuous and has blood mucoid discharge.
If ignored, it causes destruction of Yoni and Artava.
Chikitsa:
- Prakshalana with Triphala Ksheerivriksha tvak Kashaya
- Hayamaradi Taila or Taila processed with Goji, Vidanga, Madhuka, Sarvagandha.
- Lepana with Tutha, Gairika, Lodhra, Rasanjana, Saindhava mixed with Kshaudra
-> Yoni-arsha can be correlated with condyloma acuminata (papilloma) or cervical polyp.
 Condyloma Acuminata / Genital Warts

Condyloma acuminata are benign lesions caused by HPV (human papillomavirus);
transmitted sexually.
They grow in clusters along a narrow stalk giving it a cauliflower-shaped appearance.
- Treatment: Podophyllin liquid and cream, Interferon injection
Destructive Methods: Cryotherapy, Electrodiathermy, Laser therapy, Surgical removal
 Cervical Polyp
Cervical polyps are localized proliferations of the endocervical mucosa which may
protrude through the external os. These are usually benign, but may rarely be malignant.
They are found in 2-5% of adult women and produce irregular vaginal spotting/bleeding.
Treatment usually includes polypectomy.
 Types:
1) Mucous polyp: Most common; ≤ 5 cm, bright red, often pedunculated.
2) Fibroid polyp: Can arise from uterus or cervix; pedunculated; intermenstrual

bleeding, colicky pain, sensation of mass coming down.
3) Placental polyp: Retained placental tissue gets adhered to the uterine wall.
Patient may present with offensive vaginal discharge and irregular bleeding.
4) Malignant polyp: Primary or secondary conversion of a benign polyp.
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 Cervical Cancer
Cervical cancer is a cancer arising from the cervix.
It is due to the proliferation and abnormal growth of cells that have the ability to invade
or spread to other parts of the body.
It is the most common cancer in women under the age of 35.
Cervical cancer can take several years to become established. In general, it takes about
15-30 years for the cancer to develop in an individual with a robust immune system. If
the immune status is compromised, as in a person with HIV infection, for example, this
time may be as short as 5-10 years.
 Risk factors:
- Cervical cancer is not a hereditary disease. The cancer develops as a
consequence of HPV infection, following the transmission of oncogenic strains of
the virus. This may occur through skin-to-skin contact in the genital areas of the
vagina, anus or through the mouth or throat.
- Weakened immunity, Smoking
- Early age at first sexual intercourse, Long-term use of oral contraceptives
- Multiple sexual partners, Higher number of children
- Chronic cervical inflammation
 Symptoms:
In the early stages there are no real signs of the disease. As the disease progresses,
symptoms appear, such as:
- Vaginal bleeding at unusual times. This refers to bleeding outside the period of
menstruation for women of child-bearing age, and at any time after women have
been through the menopause.
- Dyspareunia, Unusual-smelling vaginal discharge
- Constipation, Fatigue, Weight loss, Loss of appetite
- Blood in urine, Incontinence
- Swelling of one leg, Kidney pains in the side or back, Bone pain
 Location:
The meeting point between the ectocervical and endocervical cells is called the
transformation zone.
Cells in the transformation zone are most likely to become cancerous
AYURVEDA LIBRARY
 Staging: FIGO staging system
Stage I: Confined to the organ of origin.
IA1 = Cancerous cells are divided. IA2 = Cancerous cells join.
IB1 = Cervical cancer is ≤ 4 cm large. IB2 = 4 ≤
Stage II: Invasion of surrounding organs or tissue.

IIA = Cervical cancer has grown into the top part of the vagina.
IIB = Cervical cancer has grown into the adnexal tissues.
Stage III: Spread to distant nodes or tissue within the pelvis.

Cervical cancer blocks the ureter and travels to the kidney.
Stage IV: Distant metastasis(es).

IVA = Cervical cancer has invaded the womb & rectum.
IVB = Cervical cancer has spread to the lungs.
 Diagnosis:
- HPV testing of cervical cell samples to identify the presence of DNA or RNA from
high-risk strains of virus, even without visible or microscopic cell changes.
- Conventional testing (Pap/smear tests) and liquid-based cytology
- Visual inspection
 Prevention: Regular cervical screening, HPV vaccines, Condoms
 Treatment:
- Surgery, Chemotherapy, Radiation therapy
- Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy
with removal of the lymph nodes or radiation therapy. Radiation therapy is given
as external beam radiotherapy to the pelvis and brachytherapy.
-> Radiation therapy is a type of cancer treatment that uses beams of intense
energy to kill cancer cells. Radiation therapy most often uses X-rays, but protons
or other types of energy can also be used.
The term radiation therapy most often refers to external beam radiation therapy.
During this type of radiation, the high-energy beams come from a machine outside
of the body that aims the beams at a precise point. During a different type of
radiation treatment called brachytherapy, radiation is placed internally.
AYURVEDA LIBRARY
 Endometrial Cancer
(Garbhashaya-ashrita Arbuda)
Endometrial cancer is a cancer that arises from the endometrium (the lining of the
uterus).
It is the result of the proliferation and abnormal growth of cells that have the ability to
invade or spread to other parts of the body.
It is the 3rd most common cancer in women.
Endometrial cancer is also called corpus cancer.
 Risk factors:
- Obesity, Diabetes mellitus
- Breast cancer
- Use of tamoxifen
- Nulliparity, High levels of estrogen
- Late menopause, Increasing age
 Symptoms:
- Usual onset after menopause
- Vaginal bleeding not related to menstrual period; it is most often the first sign
- Dysuria, Dyspareunia, Pelvic pain
 Classification:
1) Carcinoma (94%)
2) Sarcoma (6%)

Stage I:
IA Tumor is confined to the uterus with less than half myometrial invasion.
IB Tumor is confined to the uterus with more than half myometrial invasion.
Stage II:
II Tumor involves the uterus and the cervical stroma.
Stage III:
IIIA Tumor invades serosa or adnexa.
IIIB Vaginal and/or parametrial involvement.
IIIC1 Pelvic lymph node involvement.
IIIC2 Para-aortic lymph node involvement, with or without pelvic node
involvement.
Stage IV:
IVA Tumor invades bladder mucosa and/or bowel mucosa.
IVB Distant metastases including abdominal metastases and/or inguinal lymph
nodes.
AYURVEDA LIBRARY
 Diagnosis:
- Dilation and curettage (D&C; removal of endometrial tissue)
This tissue is then examined histologically for characteristics of cancer. If cancer is
found, medical imaging may be done to see whether the cancer has spread or
invaded other tissues.
- Examinations: EB, PAP smear, Pelvic examinations, TVS, MRI, CT scan,
Hysteroscopy, CA – 125, Tumor marker
 Treatment:
- Surgical treatment typically consists of hysterectomy including a bilateral
salpingo-oophorectomy, which is the removal of the uterus, and both ovaries and
fallopian tubes.
- Lymphadenectomy
- Surgery can be followed by radiation therapy and/or chemotherapy in cases of
high-risk or high-grade cancers. This is known as adjuvant therapy.
- Hormonal therapy (progestin)
AYURVEDA LIBRARY
Ovarian Tumor
Ovarian tumors or ovarian neoplasms, are tumors arising from the ovary.
They can be benign or malignant. Benign tumors of the ovary include ovarian cysts;
malignant tumor is known as ovarian cancer.
 Benign Ovarian Tumors / Ovarian Cysts

An ovarian cyst is a fluid-filled sac within the ovary.
 Symptoms:
- None
- Bloating, lower abdominal pain, lower back pain, abnormal uterine bleeding
 Complications: Rupture, twisting of the ovary

 Diagnosis: USG
 Treatment: Conservative management, Analgesics, Surgery
 Types:
1) Functional
a) Follicular cyst
b) Corpus luteum cysts
c) Theca lutein cysts
2) Non-Functional
a) Polycystic ovary syndrome (PCOS)
b) Chocolate cysts (caused by endometriosis)
c) Hemorrhagic ovarian cyst
d) Dermoid cyst
e) Ovarian serous cystadenoma
f) Ovarian mucinous cystadenoma
g) Paraovarian cyst
h) Borderline tumor cysts
Functional Ovarian Cysts

a) Follicular cyst, the most common type of ovarian cyst. In menstruating women, a follicle
containing the ovum, an unfertilized egg, will rupture during ovulation. If this does not occur,
a follicular cyst of more than 2.5 cm diameter may result.
b) Corpus luteum cysts appear after ovulation. The corpus luteum is the remnant of the
follicle after the ovum has moved to the fallopian tubes. This normally degrades within 5 to 9
days. A corpus luteum that is more than 3 cm is defined as cystic.
c) Theca lutein cysts occur within the thecal layer of cells surrounding the developing
oocytes. Under the influence of excessive hCG, thecal cells may proliferate and become
cystic. This usually occurs on both ovaries.
AYURVEDA LIBRARY
Polycystic Ovary Syndrome (PCOS)
Synonyms: Stein Leventhal Syndrome, Functional Ovarian Hyperandrogenism, Ovarian

Hyperthecosis, Sclerocystic Ovary Syndrome
Polycystic ovary syndrome is a condition in which the women’s hormones are disturbed; it
affects women during their childbearing years (ages 15 to 44). Many women have PCOS but
do not know it.
PCOS affects a woman’s ovaries, the reproductive organs that produce oestrogen and
progesterone; hormones that regulate the menstrual cycle. The ovaries also produce a small
amount of male hormones called androgens.
The ovaries release ova to be fertilized by a man’s sperm. The release of an egg each month
is called ovulation. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) control
ovulation. FSH stimulates the ovary to produce a follicle - a sac that contains an egg - and
then LH triggers the ovary to release a mature ovum.
In PCOS, many small, fluid-filled sacs grow inside the ovaries. These sacs are actually follicles,
each one containing an immature egg. The eggs never mature enough to trigger ovulation.
The lack of ovulation alters levels of estrogen, progesterone, FSH, and LH. Estrogen and
progesterone levels are lower than usual, while androgen levels are higher than usual.
Extra male hormones disrupt the menstrual cycle, so women with PCOS get fewer periods
than usual.
The three main features of PCOS are:

i) Cysts in the ovaries
ii) High levels of male hormones
iii) Irregular or skipped periods
 Cause: Unknown
 Risk factors:
Genes, insulin resistance, and inflammation have all been linked to excess
androgen production.
- Genes; studies show that PCOS runs in families.
- Insulin resistance; up to 70 percent of women with PCOS have insulin resistance.

When cells cannot 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.
- Inflammation; women with PCOS often have increased levels of inflammation.

Being overweight can also contribute to inflammation.
AYURVEDA LIBRARY
 Symptoms:
- Irregular periods. A lack of ovulation prevents the uterine lining from shedding
every month. Some women with PCOS get fewer than eight periods a year.
- Heavy bleeding. The uterine lining builds up for a longer period of time, so the
menstrual bleeding is stronger.
- Hair growth. More than 70% of women with PCOS grow more hair on their face
and body; including on their back, belly, and chest.
- 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% 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.
 Complications:
- Infertility or fertility problems due to disturbed horomones, menstrual cycle and
ovulation. Miscarriage, PIH & GDM.
- Metabolic syndrome, Heart disease, Diabetes, Stroke, Sleep apnea, Endometrial
cancer, Depression
 Diagnosis:
- Presence of the 3 main features: i) Cysts in the ovaries
ii) High levels of male hormones
iii) Irregular or skipped periods
- Symptomatic examination
- Pelvic examination, USG
- Blood tests for androgen level, cholesterol, insulin, triglyceride levels, etc.
 Management:
- Lifestyle modification (diet & regular exercise)
- Maintain healthy body weight
- Insulin sensitizers (metformin) to restore menstrual cycle and induce ovulation.
It reduces glucose production in the liver, insulin resistance, androgens and LH.
- Steroid hormones; OCPs are most efficient means of androgen suppression. Birth
control pills can help regulate the menstrual cycle and treat PCOS symptoms like
hair growth and acne. A permanent method of hair removal by electrolysis or laser
ablation after suppression of hyperandrogenism is also possible.
- Antiandrogens therapy with spironolactone along with OCPs.
- Assisted fertility; clomiphene or gonadotropins can be used to induce ovulation
and is advised for use in patients who wish to become pregnant.
- Surgery can be an option to improve fertility if other treatments do not work.
Laparoscopic ovarian drilling is a procedure in which several punctures are made
with a laser or thin heated needle in one or both of the polycystic ovaries to
restore normal ovulation.
AYURVEDA LIBRARY
 Ovarian Cancer
Ovarian cancer is a cancer that forms in or on an ovary.
It is the result of proliferation and abnormal growth of cells that have the ability to
invade or spread to other parts of the body.
 Risk factors:
- Nulliparity, Post-menopause
- Hormone therapy, Fertility medication
- Genetics
- Obesity, Smoking
- Low levels of vitamin D in the blood
- HPV
- Environmental: talc, pesticides, herbicides, chemical in the environment, or in
the human diet.
 Symptoms:
- Early: Bloating, abdominal or pelvic pain or discomfort, back pain, irregular
menstruation or postmenopausal vaginal bleeding, pain or bleeding after or during
sexual intercourse, loss of appetite, fatigue, diarrhoea, indigestion, heartburn,
constipation, nausea, feeling satiated, and possibly urinary symptoms (including
frequent urination and urgent urination).
- Late: Bloating, pelvic pain, abdominal swelling, loss of appetite with metastasis
 Types:
1) Ovarian carcinoma
2) Germ cell tumor
3) Sex cord stromal tumor
 Diagnosis: Tissue biopsy, CA 125, USG transvaginal
 Treatment: Surgery, Chemotherapy, Radiation therapy
AYURVEDA LIBRARY
Stage I: Cancer is completely limited to the ovary.
IA Tumor in one ovary.
IB Tumor in both ovaries.
IC Tumor in the ovaries and on the surface.
Stage II: Pelvic extension of the tumor (must be confined to the pelvis) or primary
peritoneal tumor, involves one or both ovaries.
IIA Tumor has invaded the fallopian tube.
IIB Tumor has invaded the bowl or bladder.
IIC Tumor cells are present in the abdominal fluid.
Stage III: Cancer is found outside the pelvis or in the retroperitoneal lymph nodes,
involves one or both ovaries.
IIIA Tumor cells are in the lining of the abdomen.
IIIB Tumor in the lining of abdomen are ≤ 2 cm large.
IIIC Tumor invaded the lymph nodes.
Stage IV: Distant metastasis.

Tumor has spread to other organs such as lungs, liver, etc.
AYURVEDA LIBRARY
Congenital Malformations of the Female Genital Tract
Congenital anomalies of the female genital tract are developmental issues that form in
the embryo. These formations can occur in the vagina, ovaries, uterus or cervix.
 Causes: While the exact cause is unknown, issues in development may be related
to genetic defects, or even the use of certain drugs during pregnancy. Some of
these anomalies can affect fertility and contribute to pregnancy complications.
 Symptoms:
While some congenital anomalies of the female genital tract could be
asymptomatic, common symptoms include:
- Inability to empty the bladder
- Breasts do not grow
- Menstrual flow that occurs despite the use of a tampon
- Repeated preterm birth, or miscarriages
- Monthly cramping or pain without menstruation
- Dyspareunia
 Types:
1) Congenital malformations of the uterus
a) Septate uterus: A common congenital uterine abnormality, this condition
occurs when a band of muscle or tissue divides a uterus into two
sections. This condition can cause miscarriages and preterm birth.
b) Bicornuate uterus: This condition deals with a heart-shaped uterus with

two horns. It can increase the risk of preterm labour.
c) Arcuate uterus: This condition is described as a uterine surface that has a

slight indentation. This condition is not much associated with the loss of
pregnancy.
d) Unicornuate uterus: A unicornuate describes a uterus that is only half-

developed.
e) Didelphys uterus: This condition occurs when a woman has two uterine
bodies. Each uterus has a cervix.
AYURVEDA LIBRARY
2) Congenital malformations of the vulva
a) Labial hypoplasia: Labial hypoplasia occurs when one or both of the labia
do not develop normally. The labia act as fat pads that protect from
trauma. This irregularity can surface either during childhood, or through
puberty.
b) Labial hypertrophy: Labial hypertrophy describes the enlargement of the
labia. This can lead to irritation, chronic infections, interference with
intercourse and pain.
3) Congenital anomalies of the hymen

a) Imperforate hymen: A hymen is a membrane that surrounds or covers
the opening of the vagina. The hymenal tissue is a circular form of tissue,
which has a hole within the center. When there is no opening in the
hymen, a membrane covers the area called an imperforate hymen. This
requires surgical correction and is usually diagnosed in newborns, or
during the first menstrual period. If it is not surgically corrected, the
patient may experience irregular menstrual periods due to blockage. This
blockage can cause back pain, abdominal pain or difficulty with urination.
b) Microperforate hymen: A microperforate hymen is similar to an

imperforate hymen, but with the presence of a very small hole within.
This hole makes it difficult for blood and mucus to come through the
hymenal opening. Instead of a regular period lasting four to seven days,
longer periods could occur due to the fact that blood cannot drain at a
normal rate. This can also make wearing tampons painful. The hymenal
tissue could tear during intercourse. A microperforate hymen could go
away with age, or it could tear away due to tampons and intercourse. A
surgical correction can be performed to remove extra tissue and create a
normal opening.
c) Septate hymen: A septate hymen is when the hymenal membrane has

extra tissue in the middle, causing two small vaginal openings as opposed
to one. This could interfere with the ability to wear a tampon, or to take
a tampon out after it has filled with blood. A septate hymen does not
need to be surgically removed, but is typically torn during sexual
intercourse. Possible side effects include pain, discomfort or bleeding.
This can be corrected via a simple surgical approach that removes the
septate hymen.
AYURVEDA LIBRARY
4) Congenital anomalies of the vagina
a) Transverse vaginal septum: A transverse vaginal septum is a horizontal
collection of tissue that forms in the embryo. It essentially creates a
blockage of the vagina. This can occur at different levels of the vagina.
Some women have a small hole in the septum called a fenestration.
During a menstrual period, blood could take longer to flow, causing
periods to last longer. If there is no hole and the septum is blocking the
upper vagina from the lower vagina, menstrual blood can pool and may
cause abdominal pain. This will most likely require surgical correction.
b) Vertical or complete vaginal septum: A vertical or complete vaginal

septum is a condition where a wall of tissue runs vertically up and down
the length of the vagina, dividing it into two cavities. While this condition
may cause no symptoms, it may lead to pain when removing or inserting
a tampon, or dyspareunia.
c) Vaginal agenesis: Vaginal agenesis is a condition that develops before

birth where the vagina fails to fully develop. The most common form of
this condition is Mayer-von Rokitansky–Küster-Hauser’s syndrome
(MRKH), in which the vagina does not develop in the embryo. Women
with MRKH have functional ovaries. There are several variations of
MRKH, such as the lack of a vagina and a uterus, or no vagina, a single
midline uterus and no cervix. Symptoms include a small pouch where the
vagina should be, absence of a menstrual cycle and lower abdominal
pain. Vaginal agenesis requires surgical correction, or having intercourse
and a baby may be impossible. Some women may have kidney
abnormalities.
5) Congenital anomalies of the cervix

a) Cervical agenesis: Cervical agenesis occurs when a woman is born
without a cervix. This means there could be the absence of a uterus and a
vagina.
b) Cervical duplication: Cervical duplication occurs when a woman is born

with two cervixes. Symptoms can include abnormal pain before a period,
abnormal bleeding and infertility issues.
 Diagnosis: Medical history, Physical examination, HSG, USG, MRI
AYURVEDA LIBRARY
CHAPTER iII: menopause / rajonivritti
Menopause is the permanent cessation of menstruation resulting from the loss of

ovarian and follicular activity.
The mean age of menopause is 50 years and is mainly determined genetically.
Menopausal age is not related to menarche, socioeconomic status, number of
pregnancies, lactation or use of OCP. Smoking induces premature menopause.
Menopause occurs at the age between 45-55; the menstrual cycle usually becomes
irregular and ovulation often fails to occur. After a few months to a few years, the cycle
ceases altogether due to diminished ovarian activity; reduced production of oestrogen
and progesterone. This period during which the menstrual cycle ceases is called
menopause.
Menopause itself is a normal physiological change for women and should not be
regarded as a disease.
Perimenopause / Climacteric = A transitional phase lasting 1-5 years; during this phase
the genital organs involute in response to the cessation of gonadal activity. Climacteric
can be considered as the counterpart of puberty whereas menopause as the counterpart
of menarche.
Early post-menopause = First five years since last menstrual period.
Late post-menopause = More than five years since last menstrual period.
 Changes during Menopause

 Genital organs: They undergo atrophy and retrogression.
- The ovaries shrink in size and the tunica albugenia thickens.
- The endometrium is represented only by a basal layer with deeply compact
stroma and few simple tubular glands. These endometrial glands may dilate just
before menopause where cystic glandular hyperplasia sets in causing metropathia
haemorrhagica.
- The cervix shrinks, vaginal fornices disappear, vaginal epithelium becomes pale,
yellow, dry and is prone to infection (senile vaginitis).
 Breast changes: Involution changes occur around the age of 35, with regression of
glandular tissue and its replacement by fat and fibrosis. Before the age of 50, this
process is characterized by loss of some lobular tissue; in older women, its
progression results in almost complete replacement of lobular tissue by collagen
and fat.
AYURVEDA LIBRARY
 Thyroid & Adrenals: Initially, T4 metabolism slows down and there is a
compensatory decrease in T4 secretion. Later, conversion of T4 to T3 decreases and
TSH levels increase (latent hypothyroidism). Hence the incidence of
hypothyroidism increases with age and is more common in women than men.
As a result of the hormonal changes, the woman becomes coarser in built and
appearance, and develops features suggestive of a mild degree of acromegaly.
The shoulders become fat, the waistline is lost, slight growth of facial hair.
Axillary and pubic hair is not shed because these depend on the adrenals rather
than the ovary. Body hair becomes sparse only later.
Increase in weight is common due to increased appetite or eating in the face of
emotional stress, or alteration in metabolism which lower the nutritional
requirements.
 Menopausal Syndrome
Menopausal syndrome occurs in women around 50 years of age; before, during, or after
menopause.
- Irregular periods with scanty or excessive bleeding
- Hot flushes, Night sweats
- Vaginal dryness and itching
- Arthralgia, Oedema, Anaemia
- Mood swings, Stress incontinence, Sleeplessness, Lassitude, Weakness, Excessive
hair fall, Wrinkling of skin, Loss of sexual desire
 Complications:
Cardiovascular problems
Osteoporosis, Fractures
-> Vasomotor Symptoms

Hot flushes and night sweats are seen in 75% of cases. Hot flush or heat wave spreads all
over the body; mainly upper half, especially the face.
It usually lasts for 5 min and skin temperature rises due to peripheral vasodilation,
especially in the fingers and toes. There is increased sweating, palpitation and anxiety.
It is considered to be due to dysfunction of thermoregulatory centers in the
hypothalamus and hyp-oestrogenism.
-> Urogenital Symptoms

Vaginal dryness, pruritus, dyspareunia, dysuria and urgency due to urogenital atrophy
owing to oestrogen deficiency. The thin dry vagina is prone to bleeding. Vaginal pH
becomes alkaline and is prone to infection. Urinary incontinence and pelvic organ
prolapse can also occur.
AYURVEDA LIBRARY
 Management & Use of Rasayana
 Prevention:
In general, if Rasayana karma is done in a proper manner by firstly purifying the
body through Vamanadi Karma, then taking Rasayana Dravya and following Pathya
Ahara & Vihara, aging of a woman can be slowed down and menopause may be
delayed. Furthermore, the general health of the woman is increased and she is
less prone to experience symptoms or complications.
Vatahara Rasayana such as Anuvasana Basti, Matra Basti, Ksheera Basti & Yapana
Basti, Balya & Vayasthapana Dravya, Abhyanga & Shirodhara, etc. are useful to
prevent aging as well as to treat complications of Vriddha-Avastha; whether
physical or mental.
Menopause sets in when the woman enters Vriddha-Avastha. Vata Dosha is

naturally strong during that period, so Rasayana karma should aim to pacify Vata.
Pathya:
- Godhuma, Purana Shali, Mudga, Phala, Ghrita, Ksheera, etc.
- Dinacharya, Ritucharya, Ritushodhana, Sadvritta
- Atapa sevana, Yoga abhyasa
- Maintain a healthy body weight
- Control of BP and cholesterol levels
- Use of calcium supplements
- Wholesome diet rich in calcium & antioxidants; avoid excessive pungent, salty
and sour food items.
- Avoid extreme physical exertion
 Medicines:
General Dravya:
- Amalaki, Yastimadhu, Shatavari, Ashoka, Ashvagandha, Gokshura, Bala, etc.
- Pravala, Mukta, Shankha, Kukkuta-anda tvak Bhasma and Asthishrinkala are
beneficial in relieving complications related to Asthi & Meda Dhatu.
- Mahanarayana Taila, Ksheerabala Taila, Bala Taila, Dhanvantara Taila
Dravya according to Dosha dominance during Rajonivritti:

Vata -> Kumari, Ashvagandha, Kumkum, Arjuna, Ela, Guggulu, Lashuna, Madhuka
Pitta -> Arjua, Kumari, Brahmi, Shatavari, Yastimadhu, Chandana
Kapha -> Shunthi, Maricha, Pippali, Haridra, Tvak, Guggulu
Aushadhi Prayoga:
Bleeding -> Chandraprabha Vati, Lodhra-asava, Ashoka-arishta, Dadimadi Ghrita
Vasomotor symptoms -> Pravala or Mukta Pisti, Chandana-asava, Usheera-asava
Anemia -> Loha-asava, Shatavari Guda, Ashvagandha-arishta
Insomnia / Mood swings -> Mana Mitra Vataka, Brahmi Vati, Brahma Rasayana
Fragile bones -> Lakshadi Taila, Dhanvantara Taila (Basti prayoga)
AYURVEDA LIBRARY
 Abnormal Menopause
 Premature Menopause / Premature Ovarian Failure (POF) /
Premature Ovarian Insufficiency (POI)
When ovaries cease to function after the age of 40, it is termed as menopause and
is considered physiological. If it occurs before the age of 40, it is termed as
premature menopause / POF / POI.
It is rare for the menopause to occur before the age of 40, and the diagnosis of
premature menopause should never be made until all other causes for
amenorrhoea have been excluded; often there may be a family history of a similar
condition.
Clinically, premature menopause is defined as secondary amenorrhoea for at least
3 months with raised FSH, raised FSH/LH ratio and low E2 level in woman below
the age of 40 years.
Causes:
- Genetic: Turner’s syndrome, Gonadal dysgenesis, Trisomy 18 & 13
- Autoimmune: Auto-antibodies against ovarian follicle, polyglandular
autoimmune syndrome
- Infections: Mumps, TB
- Iatrogenic: Chemotherapy, Radiation therapy
- Metabolic: Galactosaemia, 17α hydroxylase deficiency, Addison’s disease, DM
- FSH receptor absent / defect (Savage syndrome)
- Toxin: Tobacco, etc.
Symptoms:
The first sign of POI is usually irregular or missed periods. Later symptoms may be
similar to those of natural menopause:
- Hot flashes
- Night sweats
- Irritability
- Poor concentration
- Decreased sex drive
- Dyspareunia
- Vaginal dryness
Complications:
Anxiety and depression, Dry eye syndrome and eye surface disease, Heart disease,
Infertility, Low thyroid function, Osteoporosis
Classification:
There are two kinds of POF; in one where there are no follicles and in the other
where there are primordial follicles left behind in which the autoimmune ovarian
disease damages only the maturing follicles.
AYURVEDA LIBRARY
Diagnosis:
- H/O amenorrhoea < 35 years of age
- Serum FSH > 40 mlU/ml
- Serum E2 level < 20 pg/ml
- Ovarian biopsy is not essential for diagnosis.
Management:
- HRT (hormone replacement therapy)
- In case of autoimmune disorders: corticosteroids
- IVF with donor’s oocyte if pregnancy is wanted.
- Gonadectomy to avoid malignancy.
- Spontaneous recovery from POF, though a possibility, is very rare.
 Delayed / Late Menopause:

If menopause fails to occur even beyond 55 years of age, it is called delayed
menopause. Common causes are constitutional, leiomyoma, diabetes, oestrogenic
tumor of ovary. There is an increased tendency to develop carcinoma of the
uterine body.
Unless there is a strong family history, a delayed menopause may be an indication
for hysteroscopy, endometrial sampling. In the absence of any pelvic pathology,
diagnostic curettage is done and hysterectomy should be done in high risk cases of
endometrial carcinoma.
 Surgical Menopause
Surgical menopause is caused due to bilateral oophorectomy in women < 40 years
of age. In about 25-50% if women, ovarian function declines within 2-5 years after
a hysterectomy; it is assumed that it may be caused by interruption of blood
supply from the uterine artery.
Surgical menopause is said to be more troublesome than the natural one because
the ovarian influence is withdrawn suddenly.
The rate of bone loss is greater in the first year after hysterectomy than in
subsequent years or after a natural menopause.
 Radiation Menopause:
Radiation menopause is less intense than surgical menopause. Ovarian function is
suppressed by exposure to intense gamma radiation. In a woman less than 40
years of age, X-ray ‘castration’ may not be permanent; the effect lasting only for a
few years. Thereafter she may conceive, but there is a theoretical risk of the
fertilized ovum being abnormal.
Menopause can also be induced by inserting radium and other isotopes into the
uterus. These act by destroying the endometrium or depressing ovarian function.
AYURVEDA LIBRARY
CHAPTER iV: shukra vijnana
Shukra is derived from the root “Shucha kleda”; pure discharge.

Shukra Dhatu is the purest among the 7 Dhatus. It is formed from Majja Dhatu and
therefore it is also known as Majja Rasa.
 Paryaya: Majja Rasa, Veerya, Retas, Beeja, Pumsatva, Paurusha, Teja, Indriya,
Rohana, Bala, Nirmala
 Sthana:
1) Shukravaha Srota
a) Moola Sthana -> Vrishana & Shepha (A. Charaka)
b) Moola Sthana -> Vrishana & Stana (A. Sushruta)
2) Shukradhara Kala -> Sarva Shareera

- Just as Ghee is present in milk, Shukra is also present all over the body.
- As Ghee comes out after processing of milk, Shukra also comes out of the
body during ejaculation.
- As Ghee is the purest form of milk, Shukra is also the purest Dhatu.
 Pramana: ½ Anjali
 Shukrajanana Dravya:
- Madhura, Sheeta, Guru, Snigdha Dravya
- Ksheera, Ghrita, etc.
- Ksheerapaka with Dravya described in Shukrajanana, Jeevaniya, Brimhaniya,
Balya and Stanyajanana Mahakashaya Varga.
Shukrajanana: Jeevaka, Rishabhaka, Kakoli, Ksheera Kakoli, Mudgaparni,

Mashamaparni, Meda, Shatavari, Jatamamsi, Kulinga
Jeevaniya: Jeevaka, Rishabhaka, Meda, Mahameda, Kakoli, Ksheera Kakoli,
Mudgaparni, Mashaparni, Jeevanti, Madhuka
Brimanhiya: Ksheerini, Dugdhika, Ashvagandha, Kakoli, Ksheera Kakoli, Bala, etc.
Balya: Bala, Atibala, Ashvagandha, Sthira, Shatavari, Mashaparni, Payasya, etc.
Stanyajanana: Kusha, Kasha, Darbha, Shali, Shastika, etc.
 Shukrashodhana Dravya:
Kustha, Elavaluka, Katphala, Samudraphena, Bahhu Phala, Ikshu, Kandekshu,
Kokilaksha, Vasuka, Usheera
AYURVEDA LIBRARY
 Shuddha Shukra:
1) A. Charaka:
तिग्धं घनं तपष्पच्छलं च मधु रं चातवदातह च ॥ १४५ ॥
रे िः शुद्धं तवजानीयाच्छ्वेिं स्फतटकसतिभम् । (च - तच -३०)
बहलं मधु रं तिग्धमतवस्रं गुरु तपष्पच्छलम् ।

शुक्लं बहु च यच्छु क्रं फलवत्तदसंशयम् ॥ ५० ॥ (च - तच - २)
2) A. Sushruta:
स्फतटकाभं द्रवं तिग्धं मधु रं मधु गष्पि च ।
शुक्रतमच्छष्पन्त केतचत्तु िै ल क्षौद्रतनभं िथा ॥ (सु - शा - २)
 Shukra Kshaya:
- Karana: जरया तचन्तया शुक्रं व्यातधतभः कमि कषिर्णाि् ।
क्षयं गच्छत्यनशनाि् स्त्रीर्णां चातितनषेवर्णाि् ॥ ४३ ॥ (च - तच - २)
- Lakshana: शुक्रेतचराि् प्रतसच्ये ि शुक्रं शोतर्णिमे व वा ।

िोदोऽत्यथं वृषर्णयोमे ढ्रं धू मायिीव च ॥ २० ॥ (अ.हृ. - सू - ११)
 Shukra Vriddhi:
- Lakshana: अतिस्त्रीकामिां वृद्धं शुक्रं शुक्राश्मरीमतप । (अ.हृ. - सू - ११)
 Shukra Dusti: - 8
A) According to A. Vagbhata: (Same as Artava Dusti)

1) Vataja Vata -> Tanu, Ruksha, Phenila, Aruna, Saruja, Chirasrava
2) Pittaja Pitta -> Peeta, Neela, Apicchila, Dahasrava
3) Kaphaja Kapha -> Majja-samsrishta, Bahu, Vibaddha, Avasadi
4) Kunapagandhi Rakta -> Cadaveric smell, large quantity
5) Ksheena VP -> Scanty / low quantity
6) Granthi VK -> Knotty / soldified
7) Puya PK -> Putrid smell
8) Mutra-pureesha-sagandhi VPK -> Smell of urine & faeces
AYURVEDA LIBRARY
B) According to A. Charaka:
Nidana:
- Ativyavaya, Ativyayama, Akale Maithuna
- Asatmya Ahara; Ruksha, Tikta, Kashaya, Lavana, Amla, Ushna Ahara
- Jara, Chinta, Shoka, Bhaya, Krodha, Abhichara, Karshya, Vega Sandharana
- Kshata, Shastra, Kshara, Agnikarma
- Sexual intercourse through tracks other than the female genital organ; sexual
intercourse with a woman who is not passionate.
Bheda:
फेतनलं िनु रूक्षं च तववर्णं पूतिष्पच्छलम् ॥ १३९ ॥
अन्यधािू पसंसृष्टमवसातद िथाऽष्टमम् । (च - तच - ३०)
1) Phenila (frothy)
2) Tanu (thin)
3) Ruksha (dry)
4) Vivarna (discoloured)
5) Puti (putrid smell)
6) Picchila (slimy)
7) Anya-dhatu-
samsrishta (mixed with other tissue elements)
8) Avasadi (skinning to the bottom of water)
1-3) Phenila, Tanu & Ruksha Shukra Dusti are due to Vata Dosha. It gets ejaculated
with pain and in small quantity.
4-5) Vivarna & Puti Shukra Dusti are due to Pitta Dosha. It is blue or yellow in
colour, excessively hot and causes burning sensation during ejaculation.
6) Picchila Shukra Dusti is due to Kapha Dosha.
7) Anya-dhatu-samsrishta Shukra Dusti is due excessive sexual intercourse, injury

or ulceration. It generally gets ejaculated along with Rakta.
8) Avasadi Shukra Dusti is due to suppression of manifested urge; Vayu gets

aggravated. Since Shukra is Ashraya for Kapha Dosha, Vayu dries up the Kapha
Dosha which leads to Grathita (knotty) appearance. It gets ejaculated with
difficulty and sinks in water.
AYURVEDA LIBRARY
Chikitsa:
- Vajikarana Dravya, Jeevaniya Ghrita, Chyavanaprasha, Shilajatu Rasayana
- Niruha & Anuvasa Basti for Vataja Dusti
- Abhaya-amalikya Rasayana for Pittaja Dusti
- Pippali Rasayana, Amalaki Rasayana, Bhallataka Rasayana for Kaphaja Dusti
- Raktapitta Chikitsa for Rakta Dusti
- सतपिः पयो रसाः शातलयिवगोधू मषतष्टकाः ।

प्रशिाः शुक्रदोषेषु बष्पिकमि तवशेषिः ॥ १५२ ॥
इत्यष्टशुक्रदोषार्णां मु तननोक्तं तचतकष्पििम् । (च - तच - ३०)
Ghrita, Ksheera, Rasa, Shali, Yava, Godhuma, Sastika, and especially Bastikarma
are useful for treating all eight types of Shukra Dusti.
 Concept of Stree Shukra:

- Shukra is present throughout the Shareera just as Ghrita in Ksheera, Taila in Tila
beeja, Ikshurasa in Guda, but the specific location/seat of Shukra is Majja, Mushka
(scrotum/vagina) and Stana.
- Acharya Vagbhata says that the woman secretes Shukra during coitus with men,
but it does not play any role in conception.
Acharya Arundatta clarifies that during coitus, woman secretes Retas, but this
secretion may occur even without coitus by mere memory, touch or sight of the
desired man. This Retas has no role in conception.
- Acharya Sushruta says that if two hypersexual women indulge in coitus, they
secret Shukra which results in a boneless foetus.
 Semen:
Semen consists of sperm and seminal fluid which is a secretion of seminiferous
tubules, seminal vesicles, prostate and bulbourethral glands.
The volume of semen in ejaculation is 2.5-5 ml, with 50-150 million sperm per ml.
It is slightly alkaline; pH 7.2-7.7.
The prostate secretion contributes to the milky appearance whereas seminal
vesicles and bulbourethral secretion gives it a sticky consistency.
Seminal fluid is a transportation medium with nutrients offering protection from
hostile acidic male urethra or female vagina.
The semen coagulates within 5 minutes of ejaculation and liquefies after 10-20
minutes.
AYURVEDA LIBRARY

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प्रसूति िन्त्र

 Artava Dusti / Asta-Artava Dusti

Doshapradhanya Artava Dusti Lakshanapradhanya Artava Dusti

Vagbhata I Ekadoshaja, --- Kunapagandhi,

Vagbhata II --- Ekadoshaja, Kunapagandhi, Mutra-pureesha-sagandhi

Artava Dusti Lakshana Chikitsa

- Madhura, Sheeta, Kashaya Dravya

- Katu, Ruksha, Kashaya Dravya

- Rakta Varna - Shveta / Rakta Chandana Kvatha

5) Vata-Pittaja - Vata & Pitta lakshana - Raktavardhaka Chikitsa

6) Vata-Kaphaja - Vata & Kapha lakshana - Patha Tryushana Vrikshaka Kvatha

7) Pitta-Kaphaja - Pitta & Kapha lakshana

8) Tridoshaja - VPK lakshana

 Correlation of Artavadusti with Modern Medicine:

Artava Dusti Modern

2) Pittaja Inflammatory condition associated with infection

3) Shleshmaja / Kaphaja Cervicitis, Endometritis associated with oligomenorrhoea

4) Raktaja / Kunapagandhi Carcinoma of pelvic organs

5) Vata-Pittaja / Ksheena Hypo-oestrogenic oligomenorrhoea due to TB or severe

6) Vata-Kaphaja / Granthibhuta Malignant lesions of pelvic organs

7) Pitta-Kaphaja /Putipuya / Puti Acute infections like pelvic abcess, pyometra

8) Tridoshaja / Mutra-pureesha-sagandhi Vesico or recto vaginal fistula

 Nidana, Samprapti & Samanya Lakshana:

04) Sannipatika Tridoshaja Lakshana

Artava Virddhi is the excessive flow/increased amount of menstrual fluid.

 False Amenorrhoea / Cryptomenorrhoea / Hidden Menstruation:

Signs & Symptoms:

Diagnosis: USG - pelvis

1) Physiological True Amenorrhoea

b) Adolescence -> 2 years after menarche, the menstruation is irregular;

c) Pregnancy -> High level of oestrogen & progesterone;

d) Lactation -> Hypothalamus & pituitary gland are concerned with

e) Menopause -> Decreased functioning of ovaries; absence of graafian

2) Pathological True Amenorrhoea

- Simmond’s syndrome -> Destruction of anterior lobe of pituitary gland.

- Placenta previa, Abruptio placentae

- तवरे चन, बष्पि (अस्थापन, अनुवासन, उत्तर), नस्य (शिपुिा िैल)

 Correlation of Amenorrhoea in Ayurveda:

Nastartava can be correlated with either no ovum, no hormones or no menses.

A. Vagbhata mentioned the term Anartava which can be correlated with

Rajonasha and Rajo-anupasthiti are the terms used by A. Bhavamishra and

-> Primary Amenorrhoea as per Ayurveda:

-> Pathological amenorrhoea can be observed in:

b) 5-10% of cases -> Severe attack of primary dysmenorrhoea.

 Correlation of Dysmenorrhoea in Ayurveda:

 Terminology to describe AUB:

2) Polymenorrhoea: Bleeding occur at intervals of < 21 days but normal in

4) Polymenorrhagia: Bleeding is excessive and frequent.

5) Menometrorrhagia: Bleeding occurs at irregular, non-cyclic intervals with

6) Metrorrhagia: Bleeding is irregular in any amount; it occurs between normal

7) Mid-cycle spotting: Spotting occurs just before ovulation, usually due to

8) Acute AUB: Bleeding is characterized by significant blood loss resulting in

9) DUB: Dysfunctional uterine bleeding – ovulatory or anovulatory bleeding.

10) Postmenopausal bleeding: Bleeding recurs in a menopausal woman, at least

Polymenorrhoea and Polymenorrhagia

 Complications: Ectopic pregnancy, Abortion

 Risk factors: Increased age, Premenopausal leiomyoma, Endometrial polyp

Medical therapy is considered the preferred initial treatment. However, certain