PARUL INSTITUTE OF AYURVEDA

Affiliated to

GUJARAT AYURVEDA UNIVERSITY, JAMNAGAR.

COMPILATION WORK ON:-

KARNINI YONIVYAPAD

COMPILED BY: THAKAR HITARTH SANJAYBHAI

ROLL NO : 28
3rd YEAR BAMS
ACADEMIC YEAR: 2016-17
 PARUL INSTITUTE OF AYURVEDA
Affiliated to
GUJARAT AYURVED UNIVERSITY,
JAMNAGAR

-:CERTIFICATE:-

This is to certify that Mr. THAKAR HITARTH SANJAYBHAI Student of

3rd Professional year has satisfactory written the Compilation of PRASUTI
TANTRA AVUM STREE ROGA subject in two academic Terms, from 2016
to 2017 under our supervision.

Date:
Place:

Sign of lecturer Sign of HOD

 Index

Sr. No. Topics Page No.

1 Introduction 1
2 Karnini yonivyapada Definition 7
3 Nidana 7
4 Samprati 8
5 Lakshana 8
6 Chikitsa 10
7 Cervical Erosion 11
8 Epidemiology 11
9 Etiology 12
10 Risk factors 13
11 Pathogenesis 14
12 Sign & Symptom 15
13 Types 15
14 Differential Diagnosis 17
15 Investigations 17
16 Complication 18
17 Treatment 18
18 References 19
19 Conclusion 20
 Mithyachara :-
The heading includes mithyaahara (abnormal diet) and
mithyavihar or achara (abnormal mode of life) both. Various
environmental factors operating either during embryonic life of the
girl (congenital abnormalities) or later life also come under this
heading.

 Abnormal diet :-
Abnormality in diet refers to excessive, mal or
inadequate diet along with non congenital, unwholesome,
unhygienic and incompatible food. Over eating may cause various
gynecologic disorders by producing over body weight, obesity and
diabetes etc. While inadequate or mal intake may cause nutritional
deficiency like weakness and emaciation resulting into arajaska or
lohitaksaya etc. The diet influences doshas and dushyas of body,
main causes of all the disorders.

 Abnormal mode of life :-

Coitus in abnormal body postures or with a weak
or young woman by a man possessing good size penis, use of
artificial organ for sexual orgasms etc. come under this group.
These may produce local ulceration, hyperemia and infection etc.
responsible for various gynecological disorders, besides, these also
reflect abnormalities are causes of gynecological disorders.

 Pradustaartava :-
 The word artava refers to ovarian hormones,
ovum and menstrual blood. Ovum is already described
separately, menstrual blood is a result of endometrial changes
brought about by hormones and reflects the status of
 reproductive system as well as hormones, it is never a cause of
diseases, thus here artava refers to hormones.

The following vata-harayogas should be used –

 Application of Lavanataila

 Swedana with pinda and kumbhikasweda

 Parisheka with sukoshnajala

 Bhojana with vataharaahara e.g. jaangala rasa.

 After shodhana karma, shamanachikitsa should bedone

according to doshic vitiation.

 Local treatment like uttarabasti should be employed after the

shodhanachikitsa according to nature of disease.

The drugs used for these procedures should be according to dosha

vitiated apart from the basic vata alleviating drugs and procedures.

 Vataja disorders - Sneha,sweda, basti etc. vata-harachikitsa

 Pittaja disorders - Raktapitta – hara, shrrt-kara chikista

 Sannipataja & - Mixed chikitsa according to doshic vitiation

Samsrishta dosha

Abnormalities

 Role of local treatment :-

After proper shodhana-karma, uttara vasti, vasti, abhayanga, pralepa,
pichu should be used.

 Stabdha & Karkasha yoni

 Application of veshavara (rice cooked with milk sweetened)

  Kumbhi swed with anupa mamsa

 Sudation with anupa, oudaka mamasa mixed with vata-hara

oushidhi kwatha

 Pichu with vata-hara taila or bala taila

 Dhavana and aapurana with vata-hara oushadhi

 Pichu with dhatakyadi taila

 Osha, chosha yukta yoni

 Sheetala and raktapitta hara chikitsa

 Durgadha, picchila yoni

 pancha kashaya churna aapurana

 prakshalana with rajavriksha kwatha

 Puya-srava-yukta yoni

 Prakshalana with lavana misnrita go-mutra

 Yonipurana with shodhana dravya pinda

 Sugandhita dravya purana, prakshalana

 Kandu-yukta yoni

 Yoni purana with dvi-haridra and briheti-phala kalka

 Varti with gopitta, matsya pitta

  Varti with madhu mishrita kinva

1. Varti-Dharana:

(A) Kushthadi Varti:

Varti prepared with kushtha, pippali, tender leaves of arka, saindhava
lavana pasted with the urine of goat should be applied at the site of erosion
for sometimes. After removing the varti,yoni should be cleaned with
lukewarm water.

(B) Pipplyadi varti: Pippali, marich, masha, shatahwa, kushtha,

saindhava lavana, pastedwith water and prepared a varti in shape of an index
finger. That varti can be used for yonivishodhana.

(C) Pitta varti: wick prepared with the pitta of pig is applied in yoni and
this varti acts as asamshodhana varti in kapha dushti yoni.

(D) Arkadi varti: This varti is prepared from arka ksheer, yavachurna,
saindhava lavana andshould be applied in yoni for short time. After
removing the varti, yoni should be cleaned with lukewarm water.

2. UTTAR BASTI:
(a) Uttar basti with oil treated with jivaniya group of drugs should be given
in karniniyonivyapad.
(b) Basti with urine of cow mixed with drugs having predominantly katu
properties should begiven.
(c) All measures for suppressing kapha should be used.

3. PICHU-DHARANA:
Oil which suppresses vata and kapha should be applied in the yoni.
Pichu dharana is an effective treatment in such a narrow passage for longer
duration.Sura manda pichu dharana is very effective in kaphaja yonivyapada
and cures vaginal discharge, itching, unctuousness and other symptoms of
kapha dosha.

4. YONI PRAKSHALANA:
 Yoni prakshalana should be done with kariradi kwath in vaginal
discharge. Yoni prakshalana should be done with nyagrodhadi kwath mixed
with ghrita, milk, and sugar. Aragwadhadi kashaya is also effective in
kaphaja yonivyapada for prakshalana. Kasisa, triphala, kankshi, amra, jambu
bija, dhataki with honey is useful in kaphaja yonivyapada asprakshalana.

5. YONI-PURANA:
Powder of palasha, dhataki, jambu, samanga, moch rasa and sarja rasa
in equal amount is used as yoni purana. This is very effective treatment in
vaginal discharge.Application of any kshar (eg snuhi kshar, apamarga kshar)
and then use of yoni pichu with medicated with jatyadi ghrita or jatyadi tail
is also clinically proved effective treatment in karnini yonivyapad.

As obstructed menstruation, infertility, cervical stenosis are clinical features

of karnini yonivyapad can be correlate with “Cervical erosion Disease”.

CERVICAL EROSION (ECTOPY) DISEASE :-

 Definition :-

Cervical erosion is a condition where the squamous

epithelium of the ectocervix is replaced by columnarepithelium, which is
continuous with the endocervix.

It is refers to denudation of superficial epithelium and can

describe as “ The interplay between two epithelia.”

Cervical erosion is the development of reddened area on the

protio-vaginal around the external os of the cevix. The squamous covering
of the cervix is replaced by columnar epithelium , Which is usually
continuous with that lining of the endocervix.
 Erosion is never ulcerated, unless and until it is malignant. The
indence of cervical erosion is between 50-85% in female of childbearing
age.

 Epidemiology:-
Women attending a family planning clinic were studied to
determine the relation between cervical erosion and clinical & social
characteristics.
The appearance of the cervix was recorded without knowledge
of women’s symptoms.
The prevalence of erosion increased with parity but, when the
effect of other factors were controlled , decreased in women aged 35 and
over.
Erosion is more common in women taking “pill”and less
common in women using barrier method of contraception than in
others.
No association was found between erosion and postcoital
bleeding , dysperunia , backache, or dysuria.
There was a significant but modest association between erosion
and vaginal discharge & suggestion that erosion may sometimes be
associated with nocturia and frequency of micturation.
Vaginal flora was similar in women with and without erosin.
Cervical erosion should not be regarded as pathological in asymptomatic
women, nor should it be assumed necessarily to be cause of symptoms in
women with genitourinary complaints.

o Etiology/ Cause :-
There are various types of cause are following as :

 Physiologycal :- These are common during pubery, first pregnancy,

puerperum, due to effect of sex hormone.

 Trauma though intercourse, tampon insertion, foreign objects

in the vagina , or speculum insertion.
 It can occur by certain diets habits , environmental factors ,
multiple sexual partners.

 Introduction of the foreign body into vagina for the sexual

gratification in unhygienic state may precipitate infection.

 The factors that may damage the defense mechanisum of the

cervix may predispose to cervical erosion. That includes infections ,
outflow of alkaline discharge, mucous, glycogen, menstrual flow
etc.

 Such type of chemical like vaginal use chemical agents ,

contraceptive creams or foams , douches.

 Congenital:-

At birth columnarepithelium of the endocervix extends beyond

the external os,This condition persist only for few days until the level
of estrogen derived from the mother falls, Thus, The congenital
ectopy heals spontaneously.

 Hormonal:-
The squamocolumnar junction (SCJ) is not static and its
movement, either inwards or outwards is dependent on estrogen.
When the estrogen level is high, it moves out so that the
columnar extends onto the vaginal portion of the cervix the
squamous epithelium.
This state is observed during pregnancy and amongst pill
users.The SCJ returns to normal position after 3 months following
delivery and little earlier following withdrawal of pill.

 Infection :-
The role of infection as the primary cause of ectopy has
been described. However , chronic cervicitis may be associated or
else the infection may supervene on erosion because of the delicate
 columnar epithelium which is more vulnerable to trauma and
infection.

 Risk factors:-
The cervical erosion is induce by high levels of Oestrogen.
Therefore, factors that increase the risk of ectropion are related to
those that increase levels of oestrogen :-
 Pregnancy
 Adolescence
 Menstruating age( it is uncommon in post-menopausal
women)
 Use of the combine oral contraceptive pill
 Pathogenesi :-
In the active phase of ectopy, the squamocolumnar junction moves
out from the os. The columnar epithelium of the endocervix maintains
its continuity while the ectocervix replacing the squamous epithelium.
The replaced epithelium is usually arranged in a single layer (flat
type) or may be so hyperplastic as to fold inwards to accommodate in
the increased area—a follicular ectopy. At times, it becomes heaped up
to fold inwards and outwards— a papillary ectopy .
Underneath the epithelium, there are evidences of round cell
infiltration and glandular proliferation. The features of infection are
probably secondary rather than primary.
The columnar epithelium is less resistant to infection than the
squamous epithelium.During the process of healing, squamocolumnar
junction gradually moves up towards the external os.
The squamous epithelium grows beneath the columnar epithelium
until it reaches at or near to its original position at the external os.
Alternatively, the replacement is probably by squamous metaplasia of
the columnar cells.
During the process,
The squamous epithelium may
obstruct the mouth of the underlying glands (normally
not present in ectocervix)

pent up secretion
 retention cyst

Nabothian follicle
Alternatively, the epithelium may burrow inside the gland lumina.
This process of replacement by the squamous epithelium is called
epidermidization.

 Sign & Symptoms :-

SYMPTOMS :-

The lesion may be asymptomatic. However, the following

symptoms may be present .
 Abnormal vaginal bleeding
- After sexual intercourse
- Between menstruation periodes
 Discharge ( clear or yellowish mucus)- may have an odor
if associated with a vaginal infection.
 Associated cervicitis may produce backache, pelvic pain
and at times , infertility.
 Contact bleeding specially during pregnancy and piils use
either following coitus may be associated.

SIGNS :-

 Internal exanination revels :-

 Per speculum :-
There is a bright red area surrounding and extending
beyond the external os in the ectocervix. The
Outer edge is clearly demarcated.
The lesion may be smooth or having small papillary
folds. It is neither tender or bleed to touch. But when rubbing with a
gauze piece, there may be multiple oozing spots.
 The Pelvic examination revels an area on the cervix
that looks raw, red, & inflamed .

 TYPES :-

There are mainly two types given below

1. Congenital
2. Acquired :- a. simple flat
b. papillary
c. Folliqular / cyast
1. Congenital :-
The congenital form of cervical erosion is consider as a physiolo
-gical variation. During intrauterine life the vagina & vaginal portion
of the cervix are lined by transitioned epithelium.
This epithelium extends into the cervical canal until sixth moth
of interauterine life. The columnar epithelium grows down from
cervical canal at the end of intrauterine life and in 1/3 of all newborn
females.
It extends to the same degree or to the vaginal part of cervix.
This condition persist for only a few days after birth until level of
estrogen from mother fall and congenital erosion heals spontaneously.

2. Acquired cervical erosion – Histopathological

classification:-

 A. Simple flat erosion:-

During the early stage of established cevicitis,
desquamation and shedding out of the epithelium around the
external os occurs due to looseing of the epithelium presenting
as red glistening area, which is simple flat erosion.
It is with smooth surface and very few glands open on its
surface. The tissue beneath raw area that are infiltrated with
round & plasma cells.
 B. Papillary erosion:-
In this type of cervical erosion due to proliferation of
columnar epithelium, it get folded and forms papillary
projection on a granulation tissue base of chronic cervicitis.
This way false glands are formed which penetrate into
the cervical stroma. The papillary effect is mainly the result of
local proliferation, which can be easily infected.

 C. Follicular/ cystic erosion:-

This type of cervical erosion during its healing stage, the
endo cervicitis and chronic discharge gets abdet, the squamous
epithelium re-grows towards the external os replacing the
columnar epithelium, which is made to atrophy and disappear.
As the month of the glands may be blocked may produce
retention cyst like elevation on the portio vaginalis and these
are called “ Nabothain Follicles”.

 Investigations :-
The Cytological examination of the cervical smear is
mandatory. This is essential to exclude malignancy or dysplasia.
If the Histopathological findings are doubtful colposcopy
and cervical biopsy should be carried out.
The other diagnosis are Pregnancy test , Triple swabs , &
Cervical smear.
The Triple swabs is done where any suggestion of
infection ( such as purulent discharge), endocervical and high
vaginal swabs should be taken.

 Differential Diagnosis :-
The diagnosis is confused with:

 Ectropin:-
The lips of the cervix back to exposure the endocevix.
This may be apparent when the lips of the cervix are stretched
by the bivalve speculum.
  Early carcinoma:-
It is indurated, frible and usually ulcerated which bleed.
Confirmation is by Biopsy.

 Primary Lesion :- In the Primary Lesion the ulcer has a

punched- out appearance.

 Tubercular Ulcer:- There is indurated ulcer with casetion at

the base. Biopsy confirms the Diagnosis.

 Complications:-
These surgical interventions may lead to following complications :-

 Sero-sanguineous discharge for about 2-3 weeks

 Secondary hemorrhage , Which occur between 10th and 14th
day and is due to either infection or sepration of sloughs or
bouth.
 Cervical stenosis

 Treatment:-
Cervical erosion is regarded as a normal variant, and dose
not require treatment . But in symptomatic cases following
approach treatment are advisable:-

 First line treatment to stop any estrogen containing medication

most commonly the combined oral contraceptive pill. This is
effective in the majority of cases.
 Active treatment is postponed until 12 months if the cervical
erosion is detected during pregnancy or early puerperal period.
 Persistence cervical erosion associated with disturbing vaginal
discharge should be treated surgically by
1. Thermal cauterization
2. Cryosurgery
3. Laser vaporization
  Medication to acidify the vaginal pH has been suggested, such as
boric acid pessaries.
 All these surgical interventios really upon the destruction of
columnar epithelium. Healing by squmous epithelium will follow
this treatment.
 In the procedure of thermal cauterization the lesion of the cervical
erosion is destroyed either by thermo coagulation or red-hot
cauterization.
 Following this procedure the sloughing of the brunt area occurs in
about 2 to 3 weeks and then epithelialization by squamous
epithelium occurs in about 6 to 8 weeks.

 Conclusion :-
In Ayurvedic classics, all gynecological disorders including
cervical erosion come under yonivyapada. Acharya Sushruta and
Maharshi Charak both have the slight difference about etiology of the
disease.Acharya Charaka & Vagbhatta described it as vata-kaphaja
and Acharya Sushruta mentioned it as Kaphaja.

Karniniyonivyapad is mainly due dominance of kapha or

vatakapha dosha. Therefore,yonivyapadas which are caused by Kapha
or Vatakaphaja doshas are main causative factors of swetapradara.
Treatment of Karnini yonivyapad is mainly based on the use of drugs
which are having predominance of kashaya rasa and kapha-shamaka
property and anti-inflammatory action also. Therefore, the drugs of
katu, tiksha & kashaya rasa dominance are mainly usedlocally as well
as internally.

Karnini Yonivyapad can be put parallel to Cervical Erosion in

modern medicine on the basis of different sighs & symptoms. By
improving the general health of women and increasing personal
hygiene, we can prevent the incidence of Cervical erosion. Treatment
of Karniniyonivyapad is mainly based on the use of drugs which are
having predominance of kashayarasa and kapha-shiamak property.
Balya chikitsa also play important role to prevent the incidence and to
treat the present disease. Anti-inflammatory drugs also have important
role in treatment of karnini yonivyapad.
 Cervical ectopy correlates with HPV infection. HPV 16 is
highly prevalent in cervical ectopy. sIgA antibodies against HPV16
capsids are generated in patients with cervical ectopy.

The present study allows the following conclusions:

• No data in the medical literature was found supporting routine

treatment for ectopy.

• Treatment can be used to relieve occasional symptoms associated

with ectopy. However, more symptoms are attributed to this condition
than can be confirmed in a controlled study.

• Further studies designed to test the hypothesis that protection against

cervical cancer is provided by treatment for ectopy are needed.

References :-
 Acharya Charaka, Charaka Samhita with Vidyotini Hindi Commentary
by Acharya Kasinath Shastri and Gorakhnath Chaturvedi, Chikitsa
Sthana 30/27.
 Streeroga-vijnan by Dr. V.N.K. Usha

 Textbook of Gynecology by D C Dutta 6th edition

 Acharya Vagbhata, Ashtanga Sangraha edited by S.P. Sharma, Uttara

Tantra 38/15.

 Acharya Sushruta, Sushruta Samhita (Poorvardh), Ayurveda Tatva

Sandipika, Hindi commentory by AmbikaDutta Shastri, Uttar Tantra
38/55.

 https://www.merriam-webster.com/dictionary/gynecology

 https://en.wikipedia.org/wiki/Cervical_ectropion