Social problems of women patients in a private obstetrics and gynecology clinic.

Patients present or exhibit problems other than physical ones to their physicians and need access to some type of assistance for them. Over a 1 year period, women patients were referred to and seen by the medical social worker employed by a private obstetrics and gynecology clinic. Their social problems were studied by content analysis of patients' records, patients' social services cards, and monthly social services summaries. Results showed that 163 women exhibited 288 social problems consisting of three major types, financial, marital, and emotional. Various relationships were shown between the type of social problem and the primary reason the patient visited the clinic. It was also shown that if a patient has a financial problem, she is more likely to have a greater number of social problems than are other patients.     

Efficacy, acceptability, and metabolic effects of transdermal estradiol in the management of postmenopausal women

Systemic side effects that result from oral administration of estrogens to postmenopausal women may be minimized by use of the transdermal route. We administered transdermal estradiol, 0.05 mg/day, cyclically for 3 months to 12 postmenopausal and perimenopausal women to study the efficacy, acceptability, and metabolic effects of this dosage form. The results showed that transdermal estradiol significantly increased plasma levels of estradiol and estrone and urinary concentrations of estradiol conjugates, and produced significant improvement in menopausal symptoms and vaginal cytologic findings. The patches were well tolerated and no systemic side effects were reported. No clinically significant adverse biochemical changes were observed. Plasma renin substrate and renin activity were unchanged during therapy.     

Changes and challenges for women in academic obstetrics and gynecology

In obstetrics and gynecology, more than 60% of current residents and 36% of medical school faculty are women. However, fewer than 10% of professors and only a small number of department chairs and organizational leaders are women. This paper reviews the data on the growing number of women in obstetrics and gynecology, and in medicine in general, during the past 25 years. It reviews some of the challenges that women have faced and some strategies to enhance equitable opportunities.     

Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia.

OBJECTIVE: To evaluate the efficacy, acceptability, and possible side effects of a levonorgestrel-releasing intrauterine system for menorrhagia. METHODS: Sixty-three women with menorrhagia but without uterine enlargement, endometrial hyperplasia with atypia, or endometrial carcinoma were enrolled in this prospective, open, nonrandomized clinical trial. An intrauterine system releasing 20 microg/day of levonorgestrel (LNG-IUS; Mirena, Shering, Finland) was inserted in the postmenstrual phase. Menstrual pattern, number of bleeding days, and subjective and objective estimation of menstrual blood loss using a pictorial blood loss assessment chart (PBAC) were recorded before insertion and at specific intervals for 4 years. Hemoglobin levels and endometrial thickness were evaluated at baseline and at 12 months. Treatment continuation and hysterectomy rates were noted as well as side effects. RESULTS: The device was expelled spontaneously in 6 patients (9.52%) and removed prematurely in 9 patients (14.3%); 3 patients (4.8%) were lost to follow-up; and 45 patients (71.4%) continued with the LNG-IUS. Menorrhagia was cured in 35 (77.7%) of these 45 patients at 3 months and in all patients at 36 months. There was a significant decrease in the mean number of bleeding days (P=0.01) and PBAC score (P=0.00) at 1 month, and the decrease continued with treatment duration. The subjective blood loss reduction was considerable as well, and at 12 months the mean+/-SD rise in hemoglobin concentration was 1.06+/-1.7 g/dL (P=0.000). Endometrial thickness was decreased by 3.4+/-3.53 mm (P=0.0001) at 12 months. The most common side effect was intermenstrual spotting during the first 6 months, and 18 patients (28.57%) developed amenorrhea. CONCLUSION: Using the LNG-IUS is an effective and well-accepted option overall for the medical management of menorrhagia.     

Patterns of diagnosis and referral in women consulting for chronic pelvic pain in UK primary care.

OBJECTIVES: To describe duration of symptoms and patterns of diagnosis and referral in women with chronic pelvic pain. DESIGN: Retrospective cohort analysis of the MediPlus UK Primary Care Database. SETTING: One hundred and thirty-six general practices in the UK. STUDY GROUP: A cohort of 5051 incident cases of chronic pelvic pain. METHODS: The cohort was followed up from the start of their symptoms in 1992 until the end of the chronic pelvic pain episode or the end of 1995. MAIN OUTCOME MEASURES: Duration of symptoms, frequency of diagnoses and referral rates. RESULTS: A third of women had symptoms persisting for more than two years. Duration of symptoms increased significantly with age (P < 0.001) from a median of 13.7 months in 13-20 year olds to 20.2 months in women over the age of 60. Irritable bowel syndrome and cystitis were the most common diagnoses at all ages. Twenty-eight percent of women never received a diagnosis during three to four years of follow up after first consultation, and 60% of women had no evidence of a specialist referral. Women aged 21-50 and women whose final diagnosis was endometriosis received the largest number of diagnoses and had the highest referral rates. CONCLUSIONS: The numbers and types of diagnosis given to a woman with chronic pelvic pain and the likelihood of specialist referral depend on her age, as well as on the duration of symptoms. Women seen in secondary care for chronic pelvic pain are a highly selected group and are likely to represent only the tip of the iceberg.     

Recommendations for the use of cryotherapy in gynecology]

Bases on the experiences with the application of cryotherapy to 393 patients with 440 cryosurgical operations, special and general experiences concerning the cryotherapy in gynaecology are presented. Accordingly, the cryotherapy is suitable to increase the number of the conventional methods of medical attendance to the vulva, the vagina, and to the cervix uteri. The main possibilities of application are those to the sanitation indications of the portio, to the removal of acute condylomes, and to the pallative as well as to the curative therapy of the vulva carcinomes.     

Effect of hyperprolactinemia in male patients consulting for sexual dysfunction

IntroductionThe physiological role of prolactin (PRL) in male sexual function has not been completely clarified.AimThe aim of this study is the assessment of clinical features and of conditions associated with hyperprolactinemia in male patients consulting for sexual dysfunction.MethodsA consecutive series of 2,146 (mean age 52.2 ± 12.8 years) male patients with sexual dysfunction was studied.Main Outcome MeasuresSeveral hormonal and biochemical parameters were studied along with validated structured interviews (ANDROTEST and the Structured Interview on Erectile Dysfunction [SIEDY]). Mild hyperprolactinemia (MHPRL; PRL levels of 420–735 mU/L or 20–35 ng/mL) and severe hyperprolactinemia (SHPRL, PRL levels >735 mU/L, 35 ng/mL) were considered.ResultsMHPRL and SHPRL were found in 69 (3.3%) and in 32 (1.5%) patients, respectively. Mean age and the prevalence of gynecomastia were similar in the two groups and in subjects with normal prolactin values. MHPRL was not confirmed in almost one-half of the patients after repetitive venous sampling. Hyperprolactinemia was associated with the current use of antidepressants, antipsychotic drugs, and benzamides. SHPRL was also associated with hypoactive sexual desire (HSD), elevated thyrotropin (TSH), and hypogonadism. The association between HSD and SHPRL was confirmed after adjustment for testosterone and TSH levels, and use of psychotropic drugs (hazard ratio [HR] = 8.60[3.85–19.23]; P < 0.0001). In a 6-month follow-up of patients with SHPRL, testosterone levels and sexual desire were significantly improved by the treatment.ConclusionsOur data indicate that SHPRL, but not MHPRL, is a relevant determinant of HSD. Gynecomastia does not help in recognizing hyperprolactinemic subjects, while the use of psychotropic medications and HSD are possible markers of disease. In the case of MHPRL, repetitive venous sampling is strongly encouraged. Corona G, Mannucci E, Fisher AD, Lotti F, Ricca V, Balercia G, Petrone L, Forti G, and Maggi M. Effect of hyperprolactinemia in male patients consulting for sexual dysfunction.     

Patterns of diagnosis and referral in women consulting for chronic pelvic pain in UK primary care

Objectives To describe duration of symptoms and patterns of diagnosis and referral in women with chronic pelvic pain.
Design Retrospective cohort analysis of the MediPlus UK Primary Care Database.
Setting One hundred and thirty-six general practices in the UK.
Study group A cohort of 5051 incident cases of chronic pelvic pain.
Methods The cohort was followed up from the start of their symptoms in 1992 until the end of the chronic pelvic pain episode or the end of 1995.
Main outcome measures Duration of symptoms, frequency of diagnoses and referral rates.
Results A third of women had symptoms persisting for more than two years. Duration of symptoms increased significantly with age (   P < 0.001  ) from a median of 13.7 months in 13–20 year olds to 20.2 months in women over the age of 60. Irritable bowel syndrome and cystitis were the most common diagnoses at all ages. Twenty-eight percent of women never received a diagnosis during three to four years of follow up after first consultation, and 60% of women had no evidence of a specialist referral. Women aged 21–50 and women whose final diagnosis was endometriosis received the largest number of diagnoses and had the highest referral rates.
Conclusions The numbers and types of diagnosis given to a woman with chronic pelvic pain and the likelihood of specialist referral depend on her age, as well as on the duration of symptoms. Women seen in secondary care for chronic pelvic pain are a highly selected group and are likely to represent only the tip of the iceberg.