Vaginal bleeding

　　Vaginal bleeding refers to bleeding from any part of the reproductive tract, which can be divided into excessive menstrual bleeding, prolonged menstrual periods, irregular bleeding, or contact bleeding, etc. The amount of bleeding can vary. According to different causes, vaginal bleeding can be divided into the following types: bleeding related to endocrine disorders, neonatal vaginal bleeding, bleeding related to birth control pills, dysfunctional uterine bleeding, intermenstrual bleeding, postmenopausal uterine bleeding, etc. Bleeding related to pregnancy includes threatened abortion, incomplete abortion, ectopic pregnancy, placenta previa, placental abruption, hydatidiform mole, choriocarcinoma, etc.

　　Blood loss related to inflammation

　　11. Vulvar bleeding is seen in vulvar ulcers, urethral caruncle, etc.

　　10. Vaginal bleeding is seen in vaginal ulcers, vaginitis, especially senile vaginitis and trichomonal vaginitis, etc.

　　9. Cervical bleeding is seen in acute and chronic cervicitis, cervical erosion, cervical ulcer, cervical polyps, etc.

　　8. Uterine bleeding is seen in acute and chronic endometritis, chronic myometritis, acute and chronic pelvic inflammatory disease, etc.

　　Blood loss related to tumors

　　6. Irregular vaginal bleeding in young girls may be seen in grape-like sarcoma.

　　5. Vaginal bleeding in women over 40 is often seen in uterine fibroids.

　　4. Contact or irregular bleeding in middle-aged or postmenopausal women may be related to cervical cancer, endometrial cancer, functional ovarian tumors, etc.

　　Blood loss related to trauma

　　1. The first sexual intercourse or too rapid and forceful sexual movements can cause the vaginal wall to not fully expand, leading to vaginal wall tears. This situation is more common among girls who have 'stolen the forbidden fruit'. Generally speaking, the female vagina is elastic with many transverse and longitudinal wrinkles, which is easy to expand and less likely to tear. Young girls' vaginal development is not yet complete, and the first sexual intercourse can be too tense, causing muscle contractions and excessive force, which can easily lead to tears.

　　2. Elderly women often experience vaginal atrophy, reduced vaginal discharge, and may experience tears during sexual intercourse.

　　3.手淫：有的妇女用手或其他较坚硬的异物放入阴道，致使阴道破裂。

　　4.产伤：分娩时，胎头随子宫收缩而下降，如果产程进展过快，产道未及充分扩张，而胎儿又较大，也容易发生阴道壁撕裂。

　　5．外伤引起的出血。由于阴道壁含有丰富的血管，出血不止会产生严重的并发症，甚至危及生命。

　　与全身疾病有关的出血

　　见于肝脏病、再生障碍性贫血、血小板减少性紫癜白血病及妇产科疾病并发的弥散性血管内凝血。

　　月经时阴道出血

　　月经量明显增多，比平时的量增多一倍甚至更多，伴有大血块，突然站起时，大量经血涌出，严重时出现头晕、眼花、浑身无力等贫血表现。可能原因：放置节育环引出的出血、子宫肌腺症、排卵型功能失调性子宫出血。

　　生育年龄阴道出血

　　生育年龄的妇女在妊娠期间阴道出血。可能原因：流产、宫外孕、葡萄胎。

　　快要绝经时阴道出血

　　可能原因：无排卵型功能失调性子宫出血、恶性肿瘤。

　　月经前后点滴出血

　　持续数日，导致整个月经期持续十几天甚至更久。可能原因：放置节育环的副作用。

　　怀孕前期，出血可能是流产的征兆，但这并不意味着流产一定会发生。研究显示大约有20％-30％的女性在怀孕早期都会出现出血的现象。而有一半出现出血症状的孕妇并没有出现流产。而只有大约有15％-20％左右的出现流产，并且大部分都是出现在怀孕前四个月里。

　　流产的征兆：阴道出血，下腹剧痛，阴道有肌肉组织排出，大部分的流产都不能够预防的。这时人体中止并处理不健康的怀孕的方法。一次流产并不意味着你未来不能健康怀孕或者你的身体不健康。

　　宫外孕是指受精卵在子宫以外的地方着床。出现宫外孕的机率比流产更加低，通常每60个孕妇里面才会出现一个。宫外孕征兆：下腹剧痛（通常比经痛更加强烈），人绒毛膜促性腺激素水平较低，阴道出血。

　　葡萄胎，怀孕早期出血很少是由于葡萄胎引起的。葡萄胎是指胚胎并没有发育而是不正常的组织结构生长。葡萄胎的征兆：阴道出血，血液测试中反映人绒毛膜促性腺激素水平较高，胎儿心跳缺失，通过超声波能看到像葡萄样的组织。

　　怀孕后期，怀孕后期出血可能会对妈妈和胎儿的健康带来威胁，所以如果你在怀孕4-6个月期间有出血症状的话要尽快跟医生联系。

　　胎盘早剥。只有大约1％的孕妇会出现这种问题，而这种情况通常会出现在产前的12周内。胎盘早剥征兆：出血，腹痛，

　　Placenta previa, usually if the placenta is only partially located in the uterus, it may cause placenta previa. This is a very serious symptom and requires timely care and treatment. Women with the following conditions may be at greater risk: those who have given birth before, those who have had cesarean sections, other uterine surgery, carrying twins or multiples.

　　Premature delivery, bleeding may be a sign of premature delivery. In the weeks before childbirth, mucus and plug may be discharged, and some of it may contain a small amount of blood. Therefore, if bleeding occurs early, it may indicate premature labor, and you should communicate with a doctor as soon as possible.

　　The symptoms of vaginal bleeding can be roughly divided into the following types:

　　1. Increased menstrual flow and prolonged menstrual periods but normal cycle. It may be due to uterine fibroids, adenomyosis, FUB, or in women with intrauterine devices, there may also be an increased menstrual flow.

　　2. Irregular vaginal bleeding during the menstrual cycle. It is often due to FUB, but endometrial cancer should be ruled out first.

　　3. Long-term persistent vaginal bleeding. It is mostly due to malignant tumors of the reproductive organs, such as cervical cancer, endometrial cancer, etc.

　　4. Irregular bleeding after menopause. Childbearing-age women are more likely to consider diseases related to pregnancy, such as abortion, ectopic pregnancy, hydatidiform mole, etc.; postmenopausal women are more likely to have malignant tumors.

　　5. Postcoital bleeding. It is usually due to cervical erosion, cervical polyps, cervical cancer, or submucosal fibroids.

　　6. Vaginal bleeding accompanied by leukorrhea. It is often considered to be advanced cervical cancer, endometrial cancer with infection, or other conditions.

　　7. Paroxysmal vaginal blood and water. It may be possible to have primary fallopian tube cancer.

　　8. Intermenstrual bleeding. Occurs between two menstrual periods, lasting 3-4 days, and when the blood volume is extremely low, it is mostly due to ovulatory bleeding.

　　9. Menstrual spotting before and after. Small amounts of blood-stained discharge a few days before or after the onset of menstruation, usually due to abnormal ovarian function, or possibly endometriosis.

　　10. Not much bleeding, some people may only have small amounts of coffee-colored discharge, generally lasting half a day or 2 to 3 days, but not more than 7 days, and may be accompanied by mild ovulatory pain and low back pain. Western medicine calls this ovulatory bleeding, while traditional Chinese medicine refers to it as 'intermenstrual bleeding'. This is due to the temporary drop in estrogen levels, causing the endometrium to lose hormonal support and partially shed, resulting in regular vaginal bleeding. If someone is measuring their basal body temperature, they may find that this type of bleeding usually occurs during the transition from low to high body temperature. If the symptoms are mild, treatment may not be necessary, but if the symptoms are significant and may affect fertility, treatment should be considered.

　　11. Irregular menstrual cycle, excessive menstrual flow, prolonged menstrual periods, or irregular bleeding. Functional uterine bleeding is abbreviated as FUB. This disease is very common in clinical practice and is mainly caused by disorders in the neuroendocrine function regulating reproduction. The principle of treatment is to stop bleeding quickly, adjust and establish a normal menstrual cycle after stopping bleeding, prevent recurrence, and since there is prolonged bleeding, some people may also have varying degrees of anemia, so correcting anemia is also very important.

　　12, If there is bleeding 7 to 10 days after the menstrual period is delayed, do not think this is definitely delayed menstruation. Pay attention to observe whether the amount, color, and duration of the bleeding are the same as the usual menstruation. If there is irregular bleeding, intermittent bleeding, and accompanied by abdominal pain, pay attention to the possibility of ectopic pregnancy or threatened miscarriage; if the bleeding is more than usual, the duration is longer, and dysmenorrhea is obvious, it is more common in uterine fibroids or endometriosis. It is very necessary to seek medical attention in a timely manner.

　　13, Some women may experience vaginal bleeding after unprotected sexual intercourse due to the use of emergency contraception. The main impact of emergency contraception on the menstrual cycle is the change in the cycle, which may be early or delayed, especially for those who use it repeatedly, which may lead to menstrual irregularity, bleeding, and intermittent bleeding. Therefore, it can only be used as a remedial measure and cannot replace normal contraception methods. It should also be reminded that some women may experience menstrual irregularities due to the abuse of some hormone-containing 'health products', 'breast enhancement drugs', 'creams', and other products.

　　14, About 3 to 7 days after a general abortion or spontaneous abortion, vaginal bleeding will stop. Some individuals may experience a prolonged period due to weakness, fatigue, and other reasons, but this needs to be judged by a doctor. If there are no special circumstances, if the vaginal bleeding lasts longer, after excluding conditions such as intraoperative injury or cervical inflammation, it is very likely that there is a retained product in the uterus. At that time, the doctor will decide whether to use medication or to perform a curettage. Otherwise, the residual placental tissue may become choriocarcinoma after a period of time.

　　15, Women who have had a hydatid mole and have had intermittent vaginal bleeding again within two years after regular treatment may be early symptoms of malignant hydatid mole and should seek medical attention immediately. Most vaginal bleeding during non-menstrual periods is pathological. Since many people cannot distinguish between physiological and pathological bleeding, it is best to consult a doctor for safety reasons to avoid missing the opportunity for early diagnosis and treatment.

　　1, Diet adjustment: Eat more grains, fresh fruits, vegetables, and other high-protein and vitamin foods, and eat something light. Keep eating a certain amount of fruit every day, do not drink alcohol, and drink less coffee; choose vegetable oils, and eat less or no foods rich in cholesterol and saturated fatty acids. Eat more soy products, and you can eat some black rice, red dates, red beans, silver ear, and other foods that tonify Qi and blood.

　　2, Regular lifestyle: Ensure adequate nutrition and sleep, maintain a regular daily routine, pay attention to mental adjustment in daily life, maintain an optimistic and cheerful attitude, relax your mind, reduce psychological stress, and avoid negative emotions such as anxiety and tension.

　　3, Food therapy: Five white sweet cake (200 grams of flour, 100 grams of sugar, 50 grams each of white beans, white lotus seeds, white poria, white chrysanthemum flowers, and yam. Grind the beans, lotus seeds, poria, yam, and chrysanthemum flowers into fine powder, mix with flour, add water to make dough, and steam for consumption. This formula is effective if taken for a long time).

　　4. Regular sexual life: It can greatly increase the level of serotonin secretion in women's bodies, helping to prevent physiological rhythm disorder and endocrine disorders.

　　5. Regular health checks for female workers and female students in collective living, improve public health facilities in factories and schools, strengthen health education, pay attention to personal hygiene and menstrual hygiene. Female condoms also have a good preventive effect. In addition, the weak acidic environment of the vagina can maintain the self-cleaning function of the vagina. The normal value is 3.7-4.5, so the delicate acid formula of the female care liquid is suitable for daily cleaning and maintenance, and has an inhibitory effect on the growth and reproduction of fungi.

　　Physical examination

　　1. Pay attention to the overall condition, such as anemia, bleeding tendency, lymphadenopathy, and goiter.

　　2. During gynecological examination, pay close attention to the vagina and cervix, note the source of bleeding; during bimanual and three-hand examination, pay attention to the size, hardness, smoothness, and whether there is cervical tenderness, and whether there are masses and tenderness on both sides of the uterus.

　　3. For unmarried patients, a rectal examination is generally performed, but when a high degree of suspicion of tumor is present, a vaginal examination should also be performed.

　　Laboratory examination

　　Routine blood routine examination should be performed, and coagulation function test should be performed when necessary. Some special examinations should be performed according to the need.

　　1. Ovarian function examination:

　　(1) Basal body temperature measurement

　　(2) Cervical mucus examination

　　(3) Endometrial pathological examination

　　(4) Pituitary and ovarian hormone measurement

　　2. Pregnancy test: In addition to determining whether pregnant, it is also of great significance for the diagnosis of hydatidiform mole and choriocarcinoma.

　　3. Cervical smear cytology and cervical biopsy

　　4. Diagnostic curettage

　　Instrumental examination

　　1. Hysteroscopy

　　2. Laparoscopy

　　3. Colposcopy

　　4. Ultrasound examination

　　5. Hysterosalpingography with iodine oil

　　6. Pelvic CT examination

　　Postcoital vaginal bleeding is related to spleen, kidney, liver deficiency and damp-heat accumulation, which can be divided into three types. Diet therapy has a good effect.

　　The symptom of spleen and kidney deficiency: symptoms include sexual intercourse bleeding, fatigue and malaise, insomnia and dreams, lumbago and backache, pale complexion, abundant leukorrhea, thin white tongue coating. Treatment should be strengthening the spleen and tonifying the kidney, nourishing blood and stopping bleeding. The treatment formula is 'Shan Yao Li Zhen Zhou':山药 50 grams, Fructus Nelumbi 30 grams, powder of Panax notoginseng 6 grams, 20 red dates, 100 grams of millet. Grind the Shan Yao and Li Zhen into powder, mix with powder of Panax notoginseng, red dates, and millet, and cook into porridge with adequate water, to be eaten as breakfast.

　　The symptom of kidney and liver Yin deficiency: symptoms include sexual intercourse bleeding, accompanied by lumbago and knee weakness, dizziness and tinnitus, hot palms and soles, irritability and anger, dry mouth and thirst, red tongue with little coating. Treatment should be tonifying the kidney and nourishing the liver, and nourishing Yin and stopping bleeding. The treatment formula is 'Shu Di Huang Xian He Dan': Shu Di Huang, Fructus Lycii, each 30 grams, Xian He Cao 20 grams, eggs 3 pieces. Boil the above 3 herbs for 50 minutes, then add the eggs and cook until done. Eat the eggs and drink the soup, once a night.

　　Three, downward flowing damp-heat: symptoms include vaginal bleeding during sexual intercourse, burning pain in the genital area, distress, red face and eyes, bitter taste in the mouth and dry throat, dry and hard stool, yellow and red urine, yellow and greasy tongue fur. Treatment should be to clear the damp-heat in the lower jiao, cool the blood and stop bleeding. The treatment formula can be 'Mao Gen Chi Dou Porridge': 100 grams of fresh white mugwort, 10 grams of Gentiana scabra, decocted for 30 minutes, filtered to get the juice, then add adzuki beans and cook slowly until the beans are cooked into porridge, add appropriate amount of sugar and take it, once a day.

　　1. For slight bleeding, pay attention to the mental state of the patient, count the pulse, and let the patient rest in bed. For those with pale complexion and sweating, lower the head and raise the feet a little, drink some light salt water, keep warm, but not too hot. Take some tranquilizers or take hemostatic drugs at the same time. Go to the hospital after the condition is stable.

　　2. You can also place a cold pack or ice pack on the lower abdomen for cold compression hemostasis. When feeling nausea, turn your face to one side to prevent suffocation. Vaginal bleeding in women can be caused by many reasons, but if there are functional uterine bleeding or vaginal bleeding during pregnancy, it should be checked in the hospital as soon as possible.

　　3. Pay special attention to pregnancy! Because it may endanger the lives of both mother and child, no matter how much the amount of bleeding is, it should be treated as soon as possible. In addition, good rest is also necessary. The treatment method and risk level are different depending on whether or not pregnant. The most可怕 is pregnancy bleeding, as severe bleeding can endanger the lives of both mother and child. In addition, if there is severe abdominal pain with slight bleeding, it may be internal bleeding. Therefore, if there is bleeding during pregnancy, no matter how much the amount of bleeding is, it should be linked to an ambulance and sent to the hospital as soon as possible.

　　4. When bleeding occurs, first let the patient lie down and rest quietly. If the body temperature drops, you can use an electric blanket to warm the whole body. If there are symptoms such as pale complexion, sweating, and a rapid pulse, it is a sign of shock--at this time, the feet should be elevated and rest quietly.

　　5. In case of severe bleeding, place a non-fat cotton pad in the genital area and wrap it tightly with a girdle. For slight bleeding, a sanitary napkin pad is sufficient. If there is abnormal discharge (blood clots or meat clots, etc.) from the reproductive organs, it should be placed in a plastic bag for the doctor to examine. It is best not to let the patient see the discharged material to avoid frightening the patient.

　　6. In the case of no pregnancy, the genital area should be cleaned and sent to the obstetrics and gynecology department for examination to find out the cause as soon as possible.