Anatomy of the Reproductive Organs of the "Adnexa"
Cross Section of the Female Reproductive System
(Courtesy of Jones and Bartlett Publishers)
The uterus is a hollow, pear-shaped organ. It is located in a woman's pelvis between her bladder and rectum. It has fallopian tubes on both sides. The Fallopian tubes connect the uterus to the ovaries.
The uterus is made up of different sections. The bottom section of the uterus is called the cervix. It connects the uterus to the vagina. The middle section is called the corpus. The round top section is called the fundus. The walls of the uterus are made up of three layers:
- an inner layer, or endometrium
- a middle layer, or myometrium
- an outer layer, or serosa
The ovaries are best known for hormone and egg production in women. There are two ovaries in the pelvis. One is located on either side of the uterus. An ovary is small and looks like an almond. Every month during a woman's reproductive years, an ovary releases an egg. The egg travels to the uterus through a Fallopian tube. The ovaries also make hormones. That includes estrogen, progesterone, and testosterone. These hormones control the development of certain parts of a female, such as the breasts, body shape, and body hair. They also control the menstrual cycle and pregnancy.
Structure of the Ovary
(Courtesy of Jones and Bartlett Publishers)
Adnexal Mass Statistics
Some people use statistics to try to figure out their chances of getting cancer or of being cured. But statistics show what happens with large groups of people. Since no two people are alike, statistics cannot show what will happen to an individual.
These are some 2005 statistics on adnexal masses. They come from the American Cancer Society:
- Adnexal masses are found in women of all ages - from fetuses to the elderly. They are most likely to be malignant in girls younger than 15.
- Usually these masses are functional cysts. These disappear on their own and need no treatment.
- The chance you will develop an adnexal mass that's malignant is about 1.5 percent over the course of your life.
Adnexal Mass Symptoms
In many women, adnexal masses produce no symptoms at all. They may be found by the gynecologist during a routine exam. Depending on the cause of the adnexal mass, some women may experience pelvic pain or irregular menstrual periods. A large adnexal mass is one that is greater than about 6 centimeters; or 2 inches in diameter. When adnexal masses become large they may cause pressure on the bladder or rectum. They can also cause an increase in the frequency of urination or constipation. Sometimes a mass may twist, cutting off the blood supply to the ovary and causing sudden, severe pain. This is called ovarian torsion. It does not happen often. Most women with small adnexal masses will have no symptoms at all.
Adnexal Mass Diagnosis
Other, less serious things can cause symptoms of adnexal masses. So you should discuss them with your doctor. To determine the cause of any symptoms, the doctor will perform a physical exam. The doctor will also ask about your personal and family medical history. The doctor may also perform one or more of the following tests:
- Pelvic exam. The doctor usually finds adnexal masses during a pelvic exam. During a pelvic exam, the doctor feels the vagina, uterus, ovaries, bladder, and rectum. The doctor does this to check for lumps or anything unusual. An instrument called a speculum is used to make the vagina wider. That's so the doctor can see the top part of the vagina and the cervix.
- Ultrasonography. If the doctor feels an adnexal mass, the doctor will often order a pelvic sonogram (ultrasound). The doctor may also do this if you are having pelvic symptoms. In ultrasonography, sound waves are aimed at the ovaries. The echoes from the sound waves form a picture called a sonogram. A special computer transforms the echoes into images so that they can be viewed on a big screen. The echoes sound different for healthy tissues, fluid-filled cysts, and tumors. The uterus, tubes, and ovaries can generally be seen very well on a sonogram. A vaginal approach will give more accuracy. If an adnexal mass is present, its size, location, and appearance can be determined. If a woman has ovarian masses, the doctor will be very interested in whether the masses are cystic (fluid filled), solid, or both. If they are both cystic and solid they are called complex. Masses that are mostly composed of fluid-cysts-are less suspicious for cancer than are masses that contain solid areas.
When an adnexal mass is found, how it's managed depends on the following:
- the size and type of mass
- your age
- whether or not the mass causes any symptoms
For a woman of reproductive age with a small, non-suspicious, asymptomatic mass, the most likely cause is a functional cyst. It is also called a physiologic cyst. These cysts will almost always disappear on their own over four to six weeks. Usually, if you have this type of mass, the doctor will recommend that you have another sonogram in four to six weeks. Sometimes oral contraceptives will be prescribed. They may help the cysts go away more quickly or at least help prevent new cysts from growing. In about three out of every four cases, these masses will be gone by the second sonogram. The doctor can then be sure that the mass was a functional cyst that went away on its own. No further treatment is necessary. If the mass does not go away, sometimes surgery is recommended. In other cases, if the mass is purely cystic and does not grow, it can be followed by repeated sonograms and physical exams.
Women do not ovulate before their first menstrual period or after the menopause. So masses that occur in women in these age groups are not likely to be functional cysts. Generally, adnexal masses in young girls should be removed surgically. In postmenopausal women, small purely cystic adnexal masses may be watched for a period of time. These may also go away or remain stable over repeated evaluations.
