Genital tuberculosis (TB) in females is by no means uncommon, particularly in communities where pulmonary or other forms of extragenital TB are common. TB can affect any organ in the body, can exist without any clinical manifestation, and can recur.
A review of the literature reveals that the highest incidence of TB is still in India, followed by Scandinavia and Scotland. It is estimated that almost one half of the population of India has TB and that one person dies every minute from TB. The true incidence of genital TB is not known given that, owing to its subtle presentation, many cases remain undiagnosed. It has been estimated that approximately 5% of females presenting to infertility clinics worldwide have genital TB. Female genital TB is typically understood as a disease of young women, with 80% to 90% of cases diagnosed in patients 20–40 years old, often during workup for infertility.
Genital TB is almost always secondary to TB elsewhere in the body—usually pulmonary and sometimes renal, gastrointestinal, bone, or joint; occasionally it is part of a generalized miliary disease process.
Grossly, the size and shape of the uterus may appear normal. The tuberculous process generally is localized to the endometrium, is most extensive in the fundus, and decreases toward the cervix. The myometrium is not usually involved. In premenopausal patients, much of the infected tissue is shed during the menstruation, only to have the endometrium reinfected from the tubes with each cycle. In genital TB, there is a high incidence of involvement of the endometrium.
Tuberculosis can be correlated with Yakshma or Rajyakshma in Ayurveda .In Rajyakshma , dhatukshaya ( loss of essence of tissues ) is the main reason of pathogenesis and can affect any organ .
Ayurvedacharya Harita has described six types of Bandhyatva(infertility)(1) Kakabandhya (secondary infertility) — a woman who does not conceive after giving birth to one child; (2) Anapatya (primary infertility) — a woman, who never conceives; (3) Garbhasravi – a lady, who suffers from habitual abortions; (4) Mritavatsa — a woman, who repeatedly gives birth to stillborn babies; (5) Dhatukshaya — a woman, who does not conceive because of losing the Bala or strength, and (6) Infertility due to Garbhasamkocha caused by coitus with a girl before menarche (Ajatarajasa).
The fifth type of infertility, Dhatukshaya can be considered either as tuberculosis affecting the reproductive organs or may indicate a condition of emaciation along with lowered immunity, making her susceptible for recurrent infections
Types Of TB (Tuberculosis)
Tuberculous osteomyelitis– affect the skeleton.
Tuberculous salpingitis – effects genital tract.
CNS Tuberculosis – affects brain and nervous tissue.
Gastrointestinal Tuberculosis – affects the GIT tract.
Renal tuberculosis – affects kidney and Urinary tract.
Scrofula or Tuberculous lymphadenitis – affects the lymph nodes especially of lower jaw.
Signs and symptoms of genital tuberculosis(uterus)
There are no evident symptoms for TB in uterus as the bacteria of TB remains hidden for nearly 10 to 20 years in body of infected person. You can find some sign to identify the TB of uterus such as
- disturbance in menstrual cycle,
- abrupt loss in weight,
- pelvic pain, fever for a long time,
- vaginal discharge.
Diagnosis of genital tuberculosis becomes difficult as there are no clear symptoms initially. Your doctor can advise you further test if required.
How does it spread?
Contrary to what is believed, TB does not spread by sharing of utensils or clothes or through touch. It spreads when an infected person coughs, spits or sneezes and you come in contact with the bacteria. If the bacterium enters a woman’s lungs, it may affect the woman’s genitals overtime if left untreated. The infection usually starts in the fallopian tubes and later spreads to the uterus.
In such a case, going through a number of tests should help. Of all the aforementioned symptoms, tuberculosis and infertility is closely related.
How can genital TB affect my fertility?
Female genital tuberculosis is fast emerging as a major health issue that affects fertility levels in women. Doctors say tuberculosis is a major cause of infection leading to infertility among 25-30% of women in India. There is an increasing trend of genital tuberculosis among women. Genital or pelvic TB usually affects the fallopian tubes causing tubal obstruction, which cannot be reversed. If the TB is diagnosed at an early stage and the infection is treated, the damage to the uterus or fallopian tubes may heal. If left untreated for long, TB in the fallopian tubes, ovaries and uterus may not heal and lead to scarring. Scarring of the uterus usually results in scanty periods. In some, the menstrual periods may completely stop because the uterine lining may be badly affected. Unfortunately, in these cases women may not be able to conceive.
How is genital TB diagnosed?
A tuberculin skin test can be performed to detect the presence of TB anywhere in the body. Also, depending upon the site of infection, chest X-ray, pelvic ultrasound scan, endometrial curettage, cervical smear examination, menstrual blood analysis and laparoscopic or endoscopic examination of the genital organs may also have to be done to diagnose the condition.
Ayurvedic Management :
Panchakarma ( Purification measures ) should be done according to condition of the patient.
- Mix a pinch of salt in a glass of Orange Juice combined with 1 tsp of Honey will help in giving Vitamin C to the body and helps increasing immunity in the body of Tuberculosis patient.
- Make a fine paste of handful of drumstick leaves and pour to 1 glass of hot water, add 1 tsp. black pepper powder, salt, and lemon juice. Take the mixture in the morning.
- Including bottle gourd (lauki) into the diet builds immunity and sustains health. Include in form of juice or cooked vegetable.
- Green tea is rich in antioxidants and helps to improve the immunity of the body. The polyphenol present in the green tea fight against the bacteria causing tuberculosis.
- A Garlic is a very ancient Indian Ayurvedic remedy for Tuberculosis. Boil 20-30 grains of garlic with 150 ml. of milk and 50ml of water, and make a thick concentrate out of it, filter it and consume it twice daily for relief
- Consume 1/2 tsp of amla powder before and after a meal. Fresh Amla or Gooseberry Juice with honey in morning also helps in treating Tuberculosis.
- Rice ,wheat ,barley ,green gram, horse gram, pomegranate , raisins , tamarind , long pepper , dry ginger , coriander , cinnamon , small cardamom , bishop’s weed , freshly prepared butter , goat’s milk , honey , candy sugar ( mishri) can be taken .
Ashwagandha ( Withania somnifera ) , Giloy ( Tinospora cordifolia ) , Shatavari ( Asparagus racemosus ) , Arjun (Terminalia arjuna ) , Bala ( Sida cordifolia ) , Dashmoola , Vasa ( Adhatoda vasika ) , Amalaki ( Phyllanthus emblica) , Haritaki ( Terminalia chebula ) etc.
Compound preparations : Chyavanaprasha , Sitopaladi powder , Talasadi powder , Chagalayadi ghrita , Vardhaman pippali rasayan , Drakshadi avaleha , Phalaghrita etc .
Chandanadi oil , Shatdhauta ghrita for external application
Food to be Avoided by Tuberculosis Patients:
- Strong Tea/ Coffee
- White Bread
- Pickles / Sauce
- Tinned food
- Reduce excess refined flour
- cold, sweet and salty foods
The information mentioned is for general purpose, please do contact your medical practitioner before taking any remedy.