This disease occurs more frequently associated with chronic inflammation of the pelvic peritoneum and connective tissues than as an affection of the ovaries alone. Both organs may be involved, but when the disease is unilateral the left ovary is more frequently affected. This is because of its proneness to congestion, the left ovarian vein not only being without valves, but it opens into the renal vein at right angles, and because of its location it is subject to pressure from fecal accumulation in the lower bowel.

The disease is most common in married women and during the age of sexual activity.

Causes

(1) Deranged spinal innervation.

(2). Pelvic inflammation, especially gonorrhoeal or puerperal. Endometritis, salpingitis, cellulitis or peritonitis may cause ovaritis by extension, the two former by extension through the tubes, the latter by continuity of tissue.

(3). Uterine Displacements by causing congestion. Retroversion especially as it not only greatly distorts the course of the blood vessels, but also displaces the ovaries.

(4). Prolapse of the ovary by producing congestion and irritation.

(5). Repeated attacks of acute ovaritis.

(6). Continued congestion. This may be from intemperate coitus, masturbation, unsatisfied sexual desire or severe exertion, heavy lifting, alcoholism, heart, lung or kidney disease.

Pathology

The disease may occur primarily as a disease of the ovary or a disease of the peritoneal covering of the ovary, or what is in fact, a peri-ovaritis. In the early stages of the disease the ovaries are congested and may be enlarged to two or three times their natural size. This enlargement may be permanent or the contraction of new inflammatory tissue within the organs themselves, together with the contraction of adhesions surrounding them, may cause them to atrophy and become smaller than normal. When enlarged the ovary is often prolapsed into the recto-uterine excavation or by the side of the rectum. It may be fixed here or in its normal position by adhesions.

Cystic degeneration is not uncommon. (Fig. 10.) The cysts may be small and Multiple, or one large cyst may form and by pressure, cause atrophy of the ovarian tissue, a true ovarian cyst being formed. The cysts originate from the corpora lutea or from Graffian follicles, which are prevented from rupture because they are deeply seated or covered with inflammatory exudate, or because of insufficient menstrual congestion to cause their normal rupture. Waxy degeneration of the ovary sometimes occurs.

Symptoms

These are frequently vague and may be masked by the accompanying conditions.

Pain is rather constant. It is usually located in the groin, most frequently on the left, and radiates to the sacrum, the rectum, the bladder or down the thigh to the knee. It is increased by jolting or jarring, often by defecation or micturition and by coition, if the ovary is prolapsed. Standing or walking for even a short while is painful and difficult. The pain is always more severe preceding menstruation, sometimes several days before, and is relieved if the flow is profuse, but continues when the flow is scanty.

Sympathetic pains are often felt in the breasts.

Leucorrhoea is sometimes present as a result of the general pelvic congestion.

Menstruation may be irregular or profuse, in the early stages, but later if the ovarian tissue is destroyed amenorrhoea will result.

Reflex nervous symptoms are sometimes pronounced. Irritability, mental depression, hysteria, or even epilepsy may result.

Diagnosis

This is made from the history of some previous pelvic inflammation or the operation of some of the less frequent causes, together with the tenderness and spherical enlargement of the ovary, (which increases before menstruation), the premenstrual pain, and the presence of adhesions about the ovary.

Treatment

In addition to the treatment as outlined under Adhesions, to free the ovary, it should be manipulated directly. This is done by making circular movements limited, if not to the painful area, at least to the ovary itself. These motions can be made by either the external or internal hand. The hand not employed in these manipulations is used to make counter pressure and to immobilize the ovary while the motions are made. When prolapsed the ovary can sometimes be more easily reached by recto-abdominal manipulation.

Efforts should be made with each treatment to replace the ovary.