Intracerebral hemorrhage

It is usually due to hypertension. The pathologic basis for hemorrhage is probably the presence of microaneurysms that develop on perforation vessel of 100 - 300 mcm in diameter in hypertensive patients. Most frequently in the basal ganglia and less commonly in the pons, thalamus, cerebellum, and cerebral white matter. Hemorrhage may extend into the ventricular system or subarachnoid space, and signs of meningeal irritation are then found.
Symptoms and signs
Consciousness is initially lost or impaired. Vomiting occurs very frequently at the onset of bleeding, and headache is sometimes present. There is generally a rapidly evolving neurologic deficit with hemiplegia or hemiparesis. Cerebellar hemorrhage may present with equilibrium.
Imaging : CT scan is important
Laboratory: blood count, platelet count, bleeding time, prothrombine and partial thromboplastin times and liver, Renal function test.
Treatment: it is generally conservative and supportive. Such therapy may include ventilatory support, blood pressure regulation, seizure prophylaxis, control of fever, osmotherapy and nutritional supplementation. Ventricular drainage may be required in patients with intrventicular hemorrhage and acute hydrocephalus. Cerebellar hemorrhage, prompt surgical evacuation of the hematoma is appropriate, because spontaneous unpredictable deterioration may otherwise lead to a fatal outcome and because operative treatment may lead to complete resolution of the clinical deficit.

Dyspareunia

Are you sexually active?
Are you having any sexual difficultis at this time?
During the pelvic examination, the patient should be placed in a half-sitting position and given a hand-held mirror and then asked to point out the site of pain and describe the type of pain.
Etiology:
A. Vulvovaginitis
B. Vaginismus
C. Remnants of the hymen
D. Insufficient lubrication of the vagina
E. Infection, endometriosis, tumors, or the other pathologic conditions
F. Vulvodynia

Infertility

Evaluation of male factors
A. Semen Analysis
-the Semen parameters in normal fertile males may vary significantly over time, and the first response to any abnormal result should be to wait an interval of several weeks to months and repeat the test. Keeping in mind that the cycle of spermatogenesis takes about 74 days. <5 million sperm /ml warrants an endrocrinologic evaluation including FSH, LH, and testosterone, or a karyotype in selected cases.
B. DNA assays
Several tests, including sperm chromatic structure assay (SCSA), comet, and terminal dUTP nick-end labeling (TUNEL) , have been developed to quantify the damage to DNA or chromatin.
C. Other tests: Postcoital test, antibody studies , a sperm penetration assay.

Evaluation of female factors
A. Ovulatory factor
Historical: onset of menarche, cycle length, premenstrual symptoms.
Confirmation of ovulation : history of mittelschmerz and / or regular menses with molimina and mild dysmenorrhea occur at intervals of 28-32 days, the likelihood of the patient having regular ovulatory cycles is very high. Progesterone levels of >3 ng/mL in the third week of the cycle.
Pelvic ultrasonography can provide evidence for ovulation. The disappearance of, or change in, the follicle and free fluid in the cul-de-sac can document ovulation.
B. The pelvic factor
Including abnormalities of the uterus , fallopian tubes, ovaries, and adjacent pelvic structureS. History: PID, appendicitis, intrauterine devices , endometritis, and septic abortion.
C. The cervical factor
Indicated by a history of abnormal pap smears, Postcoital bleeding, cryotherapy, conization, or DES exposure in utero.