Dyspareunia

<bold>FIGURE 2.17 A, B:</bold> Close-up view of adenomyosis of the uterine fundus. This is diverticulosis of the uterine wall (<italic>arrows</bold> point to diverticular holes). <italic>V</bold> points to enlarged vessels. <bold>C:</bold> Associated with diverticular adenomyosis are enlarged, thin-walled surface vessels that account for increased uterine bleeding at the time of menses.

<bold>FIGURE 5.3</bold> Adenomyosis, foci of endometrial glands and stroma deep within the myometrium, distort the uterine wall. (10×, hematoxylin and eosin.)

<bold>FIGURE 5.4</bold> This gross photograph of a bisected supracervical hysterectomy specimen exhibits irregular thickening of the myometrium, characteristic of adenomyosis. Multiple deep myometrial foci of dark blue discoloration mark the sites of adenomyosis (<italic>long white arrows</bold>). The short black arrow indicates a small leiomyoma.

<bold>FIGURE 18.27</bold><bold>A</bold> and <bold>B:</bold> Hysterograms show direct signs of adenomyosis. The contrast medium has injected numerous diverticula.

<bold>FIGURE 22.40</bold> A: Endometrial atrophy with adhesions at the fundus of the uterus and old adenomyosis. B: Large diverticulum of adenomyosis just below the uterine fundus.

Vaginal Gram stain showing a true clue cell and abnormal bacteria characteristic of bacterial vaginosis.

Wet mount showing characteristic clue cells. Note that the epithelial cells are so heavily covered by bacteria as to obscure the margins.

Homogeneous discharge of bacterial vaginosis.

Laparoscopic view of acute pelvic inflammatory disease (PID).

Pyosalpinx and blunted fimbria associated with acute PID.

Adenomyosis. A microscopic view shows an endometrial gland and stroma in the myometrium.

FIG. 3.81. Diffuse adenomyosis. Sagittal T2-weighted image through uterus demonstrates thickened, indistinct junctional zone (<italic>arrows</bold>).

<bold>FIG. 28.8.</bold>Pelvic pain. A: Composite transvaginal sonogram showing enlarged left ovary (top right and bottom left) without flow and associated with a paraovarian cyst in left adnexa (lower right). The right ovary (top left) was normal, showing intraparenchymal flow. The left adnexa was found to be twisted three times and was surgically untwisted with good result. See color figure 28.8A. B: Doppler sonogram of enlarged left ovary containing venous flow. This finding suggest...

<bold>Fig GU 41-4. Diffuse uterine adenomyosis.</bold> Sagittal T2-weighted image demonstrates an enlarged uterus with thickening of the myometrium and diffuse low signal intensity throughout. The junctional zone is obliterated.⁴⁴

Figure 16.2. Wet mount of normal vaginal secretion and secretion from patient with bacterial vaginosis.

FIG. 9.2. This uncircumcised boy developed a moderately severe case of balanoposthitis.

FIG. 9.16. A: Trichomonad in the vaginal discharge of a 17-year-old patient with gonococcal pelvic inflammatory disease. The flagellated protozoan is elliptical and somewhat larger than the adjacent polymorphonuclear leukocytes (2253 magnification). B: After suspension in saline solution for microscopy, trichomonads gradually become swollen and immobile. This balloon-shaped trichomonad is barely recognizable (2253 magnification).

FIGURE 25.6 Candidal balanitis. This diabetic patient has erythematous erosions. The KOH examination revealed pseudohyphae (see Figures 26.8 and 26.9).