DYSTIENORRIBEA. — Gr., hc, diffi cult;ttnriaN, menses; and i)E11,, to flow.
Definition.—Dysmenorrhcea is not a disease, it is only a symptom. The term bas often been used in a very loose way to signify any or all the painful or other disagreeable sensations which may be as sociated with the abnormal performance of the function of menstruation. The headaches, the pains in the joints and muscles, the backaches, the nausea and vomiting which are of such frequent occurrence at the menstrual epoch do not constitute dysmenorrhcea, though they are doubtless influenced by the same cause which produces dysmenorrhcea. This symptom must be referred to the pelvic organs, to their nervous system, and to their vascular system; in other words, dysmenorrhoza is pain in the pel vic organs which is experienced in con nection with the function of menstrua tion. It is a symptom of a pathological condition. A woman who is in perfect physical condition menstruates without pain.
Dysmenorrhoea may, therefore, be de fined as a deviation from normal men struation, menstruation meaning essen tially a monthly congestion of the vascu lar system of the pelvis in obedience to a recurring impulse, with the shedding of more or less of the endometrium and the discharge of glandular secretions, the tension of the vascular system being re lieved by the discharge through the uter ine canal of a greater or smaller quantity of blood.
Symptoms.—The pain of dysmenor rhoea differs as to the time of its occur rence, its intensity, its duration, and the conditions which produce it. It occurs most frequently during the day or the two or three days which precede the menstrual flow.
ovarian dysmenorrhcea, usually within twenty-four to forty-eight hours before flow appears the patient is seized with sharp, darting pains in one or both ovarian regions, generally the left. This pain remains constant or increases, until finally a show of blood takes place. The pain is not in the median line, but on either side, and in this respect the pain differs from that due to a uterine cause. Munde (Med. Brief, May, '06).
Report of 20 cases of interraenstrual dysmenorrhcea, besides 25 collected from literature. The pain generally occurred from 12 to 16 days after the beginning of the previous menstruation and continued from 2 to 4 days, reached its maximum on the first or second day, was often dif ferent in character from the menstrual pain, and was rarely accompanied by dis charge. Attributed to awakening of
menstrual activity for the coming men strual period. :Malcolm Storer (Boston Med. and Surg. Jour., Apr. 19, 1000).
With many women the beginning of the flow means the relief of tension and the relief also of pain; with others it continues, sometimes diminishing, some times retaining its acuteness until the pelvic congestion has subsided.
There are two conditions present in anteflexion which are responsible for the pain. One is the swelling of the uterine mucosa which accompanies the flow, the other the condition of abnormal sensi tiveness at the internal OR. The tissues at the os internum are apt to be more rigid than normal and the nerves in an extremely-hypercesthetie state. The in creased congestion which accompanies the onset of menstruation and the ten sion of the tissites generally irritate the nerves and aggravate the pain. This is the ease dining the first few hours of the flow. Later the tissues become re laxed, and the canal, to a certain extent. straightened. and the pain disappears. After a time varying from twelve to twenty-four hours relaxation has oc- I curred, the flow is more profuse, and the pain has largely ceased. Davenport (Bos ton Med. and Surg. Jour., June 2, 'OS).
In intensity it raay be a simple ache, a feeling of distension within the pelvis, or it may be an acute, continuous, neuralgia like sensation. It is often spasmodic in character, with a feeling of contraction or bearing down in the uterus, and may be relieved when a clot or gush of blood is ejected from the uterine cavity. The acuteness of the pain is also governed by the temperament of the patient, a highly organized sensitive person -suffering more than a phlegraatic, insensitive one. It is more frequently experienced in . damp than in dry weather, at the sea shore rather than at the mountains, dur- ' ing an ocean-voy-age rather than on a journey inland. The more scar-tissue there is in and around the uterus, the greater the flexion of the organ, and the narrower the cervical canal, usually the more constant will be the occurrence of pain.