Current women's health reports最新文献

The topic of chronic pelvic pain (CPP) has long been a frustrating one for physicians and patients alike, with difficulties in diagnosis and management leading to delays in recovery. Recent insights into the neurobiology of chronic pain disorders and into mechanisms of visceral pain suggest that significant advances in treatment of CPP are likely to occur during coming years. These insights suggest that we consider directing our treatment efforts away from the visceral organ presumed to be primarily responsible for the CPP and toward treatment of the neurologic mechanisms that sustain chronic pain.

Female sexual dysfunction (FSD) is defined as a disorder of sexual desire, arousal, or orgasm, and/or sexual pain, which results in personal distress and has an impact on quality of life and interpersonal relationships. It is a compilation of problems that has both biologic and psychosocial components and is multifactorial in etiology. Improved understanding of the structures and substances involved in normal sexual function, as well as age-related changes, helps practitioners proactively evaluate and appropriately manage women with FSD. Addressing FSD in a clinical setting should begin with an open discussion about relational, situational, and psychological issues. Clinicians should emphasize nonpharmacologic and behavioral therapies with the goal of achieving satisfying and pleasurable experiences. The continued quest to understand female sexual function and dysfunction requires more education and research on treatment of underlying medical conditions and use of pharmacologic therapies.

In this paper, the current knowledge and recent literature on the epidemiology of urinary incontinence are examined. The populations discussed include community-dwelling women and institutionalized women. This review includes discussions of the prevalence of urinary incontinence with age, the prevalence of the types and severity of urinary incontinence, the variations with racial and ethnic differences, and the risk factors proposed for urinary incontinence. The theories behind the currently recognized risk factors and the recent literature supporting or refuting them are analyzed. Because of an abundance of studies, only a small fraction is represented in this paper, but we attempted to emphasize high-quality and larger population studies.

Women who are in a low socioeconomic status are most vulnerable to genital ulcer disease (GUD). GUD is recognized as an important co-factor for acquisition of HIV. GUD etiology has been elucidated in the past decade, with the availability of multiplex polymerase chain reaction. Worldwide, herpes simplex virus-2 (HSV-2) is the leading cause of GUD. However, mainly in women in developed countries, the incidence of GUD causation by HSV-1 is rising, owing to adolescents who are HSV-1 naïve and to increased oral sex practices. Especially in some African countries, the still high prevalence of chancroid should decrease in the next decade, because chancroid can easily be avoided and treated. Syphilitic ulcers seemed to be almost extinct, but recently there has been a resurgence of syphilis worldwide with the availability of effective HIV treatment. Development of herpes and chancroid vaccines, condom use, and the provision of education and accessible treatment facilities should help those women who now suffer from recurrent GUD infections.

Physical therapists are uniquely qualified to treat pelvic floor dysfunction with conservative management techniques. Techniques associated with incontinence and support functions of the pelvic floor include bladder training and pelvic floor rehabilitation: pelvic floor exercises, biofeedback therapy, and pelvic floor electrical stimulation. Pain associated with mechanical pelvic floor dysfunction can be treated by physical therapists utilizing various manual techniques and modalities. Research documents that conservative management is effective in treating many conditions associated with pelvic floor dysfunction. Research should be conducted to determine if addressing diastasis recti and contracture of the pelvic floor musculature should be a component of the standard physical therapy protocol.

Currently, most cases of active tuberculosis in the United States are a result of activation of latent tuberculosis infection. In this article, the history of the epidemiology of tuberculosis and latent tuberculosis infection is reviewed. Previous and current recommendations for screening and treatment for latent tuberculosis during pregnancy and the postpartum period are discussed. A review of the literature regarding postpartum and antepartum treatment is included. Finally, the question of whether antepartum or postpartum treatment is the most beneficial is discussed.

Osteoporosis is a serious public health concern. Skeletal fragility, leading to spine and hip fractures, is a major source of morbidity and mortality. Adequate calcium intake from childhood to the end of life is critical for the formation and retention of a healthy skeleton. It is important to prevent bone loss from occurring, to identify potential risk factors, and to correct them. Many genetic and lifestyle factors influence the risk for osteoporosis. Among these, diet is believed to be one of the most important, especially the roles of calcium and vitamin D. Deficiency in other dietary factors--eg, protein, vitamin K, vitamin A, phytoestrogens, and other nutrients--might also contribute to the risk for osteoporosis. In this article, the roles of diet and nutritional supplementation in preventing and treating osteoporosis are reviewed.