Current women's health reports最新文献

All medical specialists struggle with problems that cannot be solved with medical knowledge alone. The field of gynecology is not unique in medicine for the presence of ethical dilemmas, but the nature of the dilemmas are unique. Gynecologists commonly confront complex ethical questions in their practices that can be answered only through thoughtful consideration of the values, interests, rights, goals, and obligations of those involved. In this paper, three ethical issues that commonly arise in the practice of gynecology are presented: adolescent confidentiality regarding reproductive health services, physician conscience and provision of abortion services, and the question of accommodating patient choice of provider gender. Each topic is introduced with a case vignette followed by an analysis of the issues involved and recommendations for resolution.

Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections (STI) in young women. Infection frequently is asymptomatic, but may lead to anogenital condylomata and cervical squamous cell carcinoma. This article provides an overview of the recent literature on HPV infection and its clinical sequelae with a focus on issues pertinent to adolescents.

The introduction of an intrauterine system that releases 20 mg of levonorgestrel (LNG-IUS) directly to the uterine lining has ushered in a new era for the intrauterine device. The LNG-IUS reduces menstrual bleeding and dysmenorrhea, and is an effective nonsurgical treatment for idiopathic menorrhagia in premenopausal women. Women using the device experience significant reductions in menstrual flow and increases in hemoglobin. Abnormal uterine bleeding has become a primary indication for the use of this intrauterine device in Europe, and it is an emerging off-label indication in the United States. Women randomized to the use of the device experience a reduction in bleeding similar to that obtained by hysteroscopic procedures, and satisfaction with the results is high. The device also provides endometrial protection in combination with estrogen as postmenopausal hormone replacement therapy. In this paper, the growing literature on the emerging noncontraceptive indications for the LNG-IUS is reviewed.

Eating disorders affect a minority of adolescents, but represent a significant source of chronic illness in this age group. Treatment requires a multidisciplinary team approach and family involvement. The prognosis for adolescents is better than that for adult patients with eating disorders, but requires prompt diagnosis and referral to experienced providers. In this article, updates on the latest developments in the diagnosis and treatment of anorexia nervosa and bulimia are presented.

It is important for healthcare providers to have a clear understanding of sexual orientation and other components of sexual identity (genetic gender, anatomic gender, gender identity, gender role, and sexual behavior). Knowledge of how a lesbian identity is formed will aide providers in guiding these girls through adolescence. Societal stigma often forces isolation that leads to many risky behaviors that affect health (alcohol and drug use; risky sexual behaviors; truancy and dropping out; running away and homelessness; and depression and suicide). Health providers need to ensure a safe and understanding environment for these girls, to enhance their physical, emotional, and social development to healthy adulthood.

Depression often coexists with sexual dysfunction, and the medical treatment of depression can further worsen sexual symptoms or cause de novo sexual dysfunction in a person who did not experience it prior to treatment. There are many drugs that can adversely affect sexual response. Among antidepressants, this effect is commonly observed with selective serotonin-reuptake inhibitors (SSRI). Various strategies for the treatment of SSRI-related sexual dysfunction have been studied, including: awaiting spontaneous remission of sexual dysfunction; reducing the dose of medication; taking a "drug holiday"; adding another drug to help reverse sexual symptoms; changing antidepressants; or initially starting with a different antidepressant that is known to have fewer or no sexual side effects. Overall, it is important to address sexual health when caring for a patient--to improve drug compliance and the patient's well being.

Polycystic ovary syndrome (PCOS) affects approximately 6% of women in their reproductive years. The symptoms of the syndrome are chronic anovulation and androgen excess. Infertility due to ovulatory dysfunction is a common problem for women with PCOS. Metformin, an antihyperglycemic agent, can correct the metabolic dysfunction that occurs with PCOS, and also stimulate folliculogenesis. The drug is effective alone and in combination with clomiphene citrate. An alternative option, ovarian diathermy, also promotes ovulation through changes in the intraovarian hormonal environment. Both techniques provide promising and effective alternatives for women with PCOS who do not respond to traditional oral ovulation induction agents.

Over the course of the 20th century, physicians had a variety of hormonal treatments to offer their menopausal patients. This paper traces the development and deployment of these therapies, which ranged from desiccated ewe ovary to the modern estrogen replacement therapy. In addition, this paper demonstrates that women often medicated themselves at menopause, turning perhaps to Lydia Pinkham's vegetable tonic or the more modern Change-O-Life elixir. Finally, this paper discusses the larger societal approaches to eliminating menopausal symptoms.