Scholars Journal of Applied Medical Sciences Abbreviated Key Title: Sch J App Med Sci ISSN 2347-954X (Print) | ISSN 2320-6691 (Online) Journal homepage: https://saspublishers.com Obstetrics Gynecology Assessment of the Motivation for Consultation in the Gynecology Department at the University Teaching Hospital Gabriel Toure of Bamako Boubakary Guindo1*, Moctar Diaby1, Broulaye Diarra1, Diakaridia Maiga2, Sory Diawara3, Ibrahima Tekete2, Amadou Dolo2 1 Obstetrics Gynecology Department of Pr Bocar Sidy Sall University Hospital, Kati, Mali Obstetrics Gynecology Department of the Chu Gabriel Toure, Bamako, Mali 3 Malaria Research Training Center, Bamako, Mali 2 DOI: 10.36347/sjams.2022.v10i12.043 | Received: 15.10.2022 | Accepted: 29.11.2022 | Published: 10.12.2022 *Corresponding author: Dr. Boubakary Guindo Obstetrics Gynecology Department of Pr Bocar Sidy Sall University Hospital, Kati, Mali Abstract Original Research Article Symptoms due to their diversity and variability are the most common reasons for consultation. The grouping of these symptoms into entities could guide explorations and facilitate clinicians' diagnosis: leucorrhoea, pelvic pain, disorders of the cycle and genital hemorrhages, sexual disorders, urinary and rectal disorders, symptoms of breast fertility. To better target the diagnosis of common pathology, we have undertaken a study to determine the reasons for consultation in gynecology at CHU GABRIEL TOURE in Bamako. It consisted of a systematic collection of information on patients who had consulted the gynecology department from 1 January 2008 to 31 December 2009. It was found that women in periods of genital activity (15 to 49 years) constituted 86.3% 'sample. They were housewives in 58.5% of the cases and the average age of the consultants was 32.29 years with extremes of 1 to 96 years. Pregnancy desire was 16.3%; Pelvic pain 11.6% and vulvovaginal pruritus 8.9%. Vaginitis was the most commonly observed diagnosis with 15.9% followed by secondary infertility with 11.1% and uterine fibroids 8.1%. In (25%) one in four women under 15 years old, a recent hymenal perforation has been found. Elsewhere in the 15-49 age group, the diagnoses were vaginitis, secondary sterility, with 17.4% and 12.8%, respectively. After menopause cervix cancer was frequently observed with 37.0% of cases. The pathologies frequently observed were: primary sterility (21.1%) in nulligest; Secondary sterility (27.6%) in primiparae; Vaginitis (16.9%) in multigest and cervix cancer (26.4%) in large multigesta. Vaginitis has been the pathology frequently observed in all occupational categories. Keywords: Infectious and tumor pathologies, Infertility, Sexual aggression, Prolapse, Amenorrhea, Breast pathology, Menopause. Copyright © 2022 The Author(s): This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited. INTRODUCTION The medical examination is a capital time of the consultation. It should not be just a succession of precise answers to brief questions mirroring medical semiology. Nor is it a simple parlor conversation. It is an interactive instrument for the exchange of doctorpatient information that must be mastered because it is also a vector of emotions. The symptoms leading to consultation are numerous, of unequal frequency and importance. The main reasons for consultation in gynecology can be grouped under the following headings: leucorrhoea, pelvic pain, cycle disorders and genital bleeding, sexual disorders, urinary and rectal disorders, breast symptoms and fertility disorders. Leucorrhoea is a frequent reason for gynecological consultation of sexually active women [1]. Metrorrhagia is also a frequent reason for consultation in gynecology [2], the first sign of discovery of cancer of the cervix [3]. Pelvic pain represents about 10% of gynecological consultations, 20 to 40% of indications for laparoscopy and 10% of those for hysterectomy [49]. METHODOLOGY This is a retrospective cross-sectional study, data collection took place from January 1, 2008 to Citation: Boubakary Guindo, Moctar Diaby, Broulaye Diarra, Diakaridia Maiga, Sory Diawara, Ibrahima Tekete, Amadou Dolo. Assessment of the Motivation for Consultation in the Gynecology Department at the University Teaching Hospital Gabriel Toure of Bamako. Sch J App Med Sci, 2022 Dec 10(12): 2330-2335. 2330 Boubakary Guindo et al; Sch J App Med Sci, Dec, 2022; 10(12): 2330-2335 December 31, 2009 in the gynecology and obstetrics department of the CHU Gabriel Touré. The study covered all consultations in the gynecology and obstetrics department from January 2008 to December 31, 2009. We included in this study all the women who consulted in the gynecology and obstetrics department during the study period. The various information from the medical records were entered and analyzed with SPSS statistics 12.0 software and word processing in Word, Office 2007. RESULTS In two (2) years of study the total number of consultants was 3920 patients distributed as follows: 1810 patients in 2008 or 46.1% and 2110 women in 2009 (53.9%) (Table I). All women whose records were not completed were excluded from this study. The consultants' files served as a support for data collection. Table I: General description of the sample. General description Number % Sociodemographic characteristic Age groups < 15 years 127 3.2 15-49 years old 3379 86.3 > 49 years old 403 10.2 Unspecified 11 0.3 Occupation Household 2295 58.5 employee 544 13.8 Trader 508 13.0 Pupil/Student 555 14.2 Unspecified 18 0.5 Educational level Primary 312 8.0 Secondary 525 13.4 Superior 404 10, 3 Literate 13 0.3 No schooling 2666 68.0 Marital status Bride 3063 78.1 Single 686 17.5 Divorcee 46 1.2 Widow 125 3.2 Ethnic group Bambara 1139 29.1 Fulani 608 15.5 Soninke 684 17.4 Malinke 477 12.2 Other Malians 942 24.0 Foreign 70 1.8 Mode of admission Come by itself 2831 72.2 Referred 1089 27.8 Married, uneducated women whose main occupation is housework were the most represented in our sample. The majority of women came to consult on their own, ie 72.2%. The majority were between 15 and 49 years old, that is 86.3%, the average age was 32.29 years old. Among the professions encountered, housewives were the most represented with 58.5%. Unschooled women were in the majority in our study with a high proportion (68%). The status of married women was frequently observed in our study with 78.1% of consultants, single people were poorly represented with 17.5%. Bambara women consulted more with 29.1%. The majority of © 2022 Scholars Journal of Applied Medical Sciences | Published by SAS Publishers, India 2331 Boubakary Guindo et al; Sch J App Med Sci, Dec, 2022; 10(12): 2330-2335 women had come on their own to seek care in our service (72.2%). This observation would be due to a dysfunction of the reference system, it is the first and the second level which must refer to the third level of the health pyramid of Mali. Doctors were the most solicited in the referral of patients with 60.9% followed by the police authorities with 19.7%. Overall, the reasons for consultation most frequently reported by patients are the desire for pregnancy, pain pelvic and vulvo-vaginal pruritus with respectively 16.3%, 11.6% and 8.9% (Table II). Table II: Distribution of patients according to the reasons for consultation Reasons for consultation Number Percentage (%) Pelvic pain 456 11.6 Leucorrhoea 165 4.2 Abnormal bleeding 214 5.5 Urinary disorders 70 1.8 Pelvic mass 113 2.9 Desire for pregnancy 638 16.3 Sexual disorders 6 0.2 breast pain 90 2.3 breast lump 87 2.2 Breast discharge 27 0.7 Vulvovaginal pruritus 347 8.9 Contraception 4 0.1 Repeated abortion 77 2.0 Dyspareunia 224 5.7 Amenorrhea 188 4.8 Spaniomenorrhea 34 0.9 Other cycle disorders 78 2.0 Dysmenorrhea 224 5.7 Vulvar mass 110 2.8 sexual assault 219 5.6 Other gynecological reasons 258 6.6 Non-gynecological reasons 291 7.4 Total 3920 100.0 The six (6) main reasons for consultation in the gynecology and obstetrics department of the Center Hospitalier Universitaire Gabriel TOURE are as follows:  The desire for pregnancy (16.3%);  Pelvic pain (11.6%);  Vulvovaginal pruritus (8.9%);  Dyspareunia (5.7%);  Dysmenorrhea (5.7%);  Sexual assault (5.6%) pregnant with 16.4% respectively; 19.1% and 26.0%. One out of 5 students consulted for sexual assault. Girls under 15 mostly consulted for sexual assault with 89.0%. Patients aged 15 to 49 mainly consulted for desire for pregnancy (18.8%) and pelvic pain (12.0%). Abnormal bleeding (23.6%) and vulvovaginal pruritus (18.4%) were the main reasons for consultation in women over 49 years old. The vaginal examination revealed that 14.9% of the women had an enlarged uterus and in 7.8% the uterus was painful. There were painful adnexa in 7.8% and an adnexal mass in 2.9%. The main reasons for consultation were for nulligest the desire for pregnancy (19.6%) and sexual assault (18.4%) and for major multigestures abnormal bleeding (15.4%) and vulvo-pruritus. vagina (12.1%). Housewives, salaried employees and shopkeepers mainly consulted for the desire to become The breast nodule was found in 3.2% of the patients and an abdominal mass was observed in 4.7% of the patients. Vaginal speculum examination found: a healthy cervix in 74.2% and budding in 5.8% of women. We found 8.1% cervicitis. Among the abnormal vaginal samples, the most frequently found germs were Candida albicans (29.9%), Gardenerella vaginalis (22.5%); Candida albicans + Gardenerella vaginalis (15.2%); Ureaplasma urealyticum (5.2%). ECBU abnormalities highlighted germs such as Staphylococcus aureus (25.4%) Escherichia coli (22.9%); Klebsiella pneumoniae (15.9%). © 2022 Scholars Journal of Applied Medical Sciences | Published by SAS Publishers, India 2332 Boubakary Guindo et al; Sch J App Med Sci, Dec, 2022; 10(12): 2330-2335 The abnormal results of the spermogram mainly concerned Oligoasthenospermia (41.7%), Azoospermia (18.8%) and Asthenospermia (14.6%). hymenal perforation was found. Elsewhere among 1549 year olds, the diagnoses retained were vaginitis, secondary sterility, with 17.4% and 12.8% respectively. The investigations carried out made it possible to establish the following diagnoses: vaginitis with 15.9% followed by secondary sterility with 11.1%. In one in four women under the age of 15, a recent In patients over 49 years of age, cervical cancer was frequently observed with 37.0% of cases (Table III). Table III: Distribution of patients according to the diagnosis selected Diagnosis retained Number Percentage (%) Infectious diseases Vulvovaginitis 170 4.3 Vaginitis 624 15.9 Urinary tract infection 135 3.4 Cervicitis 85 2.2 Endometritis 25 0.6 Salpingitis/Adnexitis 79 2.1 Tumor pathologies Benign tumors breast lumps 74 1.9 Fibroma 319 8.1 Ovarian dystrophy 62 1.6 Ovarian Cyst 59 1.5 Malignant tumors Breast cancer 29 0.7 Vulvar cancer 1 0.0 Cervical cancer 267 6.8 endometrial cancer 13 0.3 Ovarian cancer 32 0.8 Sterility Primary sterility 230 5.9 Secondary sterility 436 11.1 Genital prolapse 113 2.9 Endometriosis 5 0.1 Gynecological malformations 6 0.2 Essential mastodynia 87 2.2 Dysmenorrhea 144 3.7 Primary amenorrhea (etiology not determined) 6 0.2 Secondary amenorrhea (etiology not determined) 49 1.3 Pregnancy 113 2.9 Recent perforation 46 1.2 Pre-menopause syndrome 30 0.8 Normal examination 334 8.5 Other gynecological pathologies 140 3.6 Other non-gynecological pathologies 118 3.0 Not examined 89 2.3 Vaginitis was the most frequently observed diagnosis with 15.9% followed by secondary infertility with 11.1%. The pathologies frequently observed were: primary sterility (21.1%) in nulliparous women; secondary sterility (27.6%) in primigravidae; vaginitis (16.9%) in multiparas and cervical cancer (26.4%) in grand multiparas. Considering parity, it was observed: primary sterility (17.1%) in nulliparous; secondary sterility (29.2%) in primiparae; vaginitis (17.0%) in multiparas and cervical cancer (32.2%) in grand multiparas. Vaginitis was the pathology frequently observed in all categories of professions. Systemic antibiotics were used in 27.9% of cases and analgesics in 20.2%. © 2022 Scholars Journal of Applied Medical Sciences | Published by SAS Publishers, India 2333 Boubakary Guindo et al; Sch J App Med Sci, Dec, 2022; 10(12): 2330-2335 DISCUSSION Overall, the reasons for consultation most frequently reported by patients were the desire for pregnancy, pelvic pain and vulvo-vaginal pruritus with respectively 16.3%, 11.6% and 8.9%. In the literature we have found the following results: 10 to 15% for the desire for pregnancy [10] and 20 to 30% for pelvic pain [11]. The under 15s mainly consulted for sexual assault with 89.0%. A study carried out in Finland [12] found 17% sexual abuse among children aged 4 months to 17 years. Patients aged 15 to 49 were consulted mainly for desire for pregnancy (18.8%) and pelvic pain (12.0%). Among the abnormal vaginal samples, the most frequently found germs were Candida albicans (29.9%), Gardenerella vaginalis (22.5%); Candida albicans + Gardenerella vaginalis (15.2%); Ureaplasma urealyticum (5.2%). Raphaël A et al., [13] found the following results: Gardenerella vaginalis (47.0%) and Candida albicans (29.4%). The investigations carried out made it possible to establish the following diagnoses: vaginitis with 15.9% followed by secondary sterility with 11.1%. In the literature Raphaël A. et al., [13] found a prevalence of Candida albicans vaginitis at 29.4%. In one in four women under the age of 15, a recent hymenal perforation was found. In the literature Piippo S. and Coll [14] found 29.0% of hymenal perforation in children under 17 years old. In patients over 49 years of age, cervical cancer was frequently observed with 37.0% of cases. TRAORE M. and Coll [15] reported that cervical cancer represents 50.0% of all gynecological cancers with an average age of 48.5 years. Systemic antibiotics were used in 27.9% of cases and analgesics in 20.2%. In the literature we found a rate of antibiotic use at 27.3% [16]. CONCLUSION It appears that women in the period of reproductive activity (15 to 49 years) constituted 86.3% of the sample. They were housewives in 58.5% of cases and the average age of the consultants was 32.29 years with extremes of 1 to 96 years. The desire for pregnancy represented 16.3% and pelvic pain 11.6%. 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