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  1. Home
  2. Books
  3. Handbook of Women's Health
  • Cited by 5
  • 2nd edition
  • Edited by Jo Ann Rosenfeld, The Johns Hopkins University School of Medicine
Publisher:
Cambridge University Press
Online publication date:
December 2009
Print publication year:
2009
Online ISBN:
9780511642111
DOI:
https://doi.org/10.1017/CBO9780511642111
Subjects:
Medicine: General Interest, Obstetrics and Gynecology, Reproductive Medicine, Medicine
Information

Book description

This practical handbook provides a clear and comprehensive evidence-based guide to the care of women in primary care, intended for general and family practitioners, nurses, physician assistants, and all those who practise primary care of women. It emphasizes preventive and well-woman care throughout the life-cycle of a woman, including sexuality, contraception, medical care in pregnancy, and psychological and important medical concerns. This second edition, revised and updated throughout with several new contributing authors, incorporates the latest evidence and research-findings on a wide range of problems for which women seek medical guidance. There is an expanded section on menstrual problems and menopause-associated conditions, including clear guidance on the use of hormone replacement therapy.

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Contents

Page 2 of 2

Contents
  • Chapter 21 - Intimate partner violence against women
    pp 221-238
  • View abstract

    Summary

    This chapter presents etiology, symptoms, diagnostic difficulties, and the treatment of vaginitis. Inflammation of the vagina is the most common gynecological problem encountered by primary care physicians. The symptoms of vaginitis may include itching, irritation, purulent or other discharge, and foul odor. Bacterial vaginosis (BV) is the most common cause of vaginitis in the USA. During pregnancy, trichomoniasis is sometimes associated with preterm labor and premature rupture of membranes. Over-the-telephone diagnosis of vaginal infection is difficult and often wrong. Men physicians are more likely to treat vaginal infections over the phone than women physicians who usually require an office visit. Treatment for BV includes a variety of oral and topical treatments. Complementary treatment for single episodes and recurrent vaginitis are common. Treatment of recurrent BV may be achieved by twice-weekly treatment with metronidazole topical gel, although secondary infection with Candida can occur.
  • Chapter 22 - Depression
    pp 239-250
  • View abstract

    Summary

    This chapter presents the definition, risk factors, symptoms, diagnosis and treatment of chronic pelvic pain (CPP), dysmenorrhea, and dyspareunia. The most common causes of CPP are gastrointestinal. Irritable bowel syndrome (IBS), constipation, and diverticulitis, all can cause chronic pelvic pain. Women with high stress levels have two times the risk of dysmenorrhea. A higher risk of suffering dysmenorrhea occurs in women who are overweight. Women with dyspareunia had higher pain scores and higher levels of psychological distress, low levels of marital adjustment and more problems with sexual function. Treatment of dyspareunia is based on one of the three types: insertional dyspareunia, pain in a specific location, and pain with deep penetration. Pain associated with menopausal disorders and sexual relations is common and often the presenting complaint to the physician. The case of dyspareunia may be difficult to discover but an organized approach including psychological expectations may produce improvement.
  • Chapter 23 - Alcoholism, nicotine dependence and drug abuse
    pp 251-262
  • View abstract

    Summary

    This chapter describes the role of human papilloma virus (HPV), fundamentals about the Papanicolaou (Pap) smear, and the prevention of cervical cancer. The conventional Pap smear has been one of the most effective screening tests for cervical cancer prevention. Cervical cytological testing has been successful in preventing cervical cancer in women who present for screening with reductions of the cervical cancer rate by 70% in the last 100 years. Pap test screening should be initiated at the onset of sexual activity, within three years of onset of sexual activity, or at age 21. Prevention of diseases that come from infection with high risk HPV, such as precancerous cervical lesions, genital warts, vaginal and vulvar lesions, and cervical cancer is now possible by vaccination (Gardasil) against HPV types 6, 11, 15 and 18. With the use of the HPV vaccine, HPV infection is reduced and cervical cancer may be mostly prevented.
  • Chapter 24 - Coronary heart disease
    pp 263-282
  • View abstract

    Summary

    This chapter discusses the diagnosis, evaluation, staging and prognosis and treatment of postmenopausal bleeding and endometrial cancer. The primary symptom of endometrial cancer (ECa) is postmenopausal bleeding (PMB). A physical examination of PMB should look for vaginal and cervical abnormalities, polyps, masses, uterine size and symmetry, or ovarian masses. ECa (cancer of the body or corpus of the uterus) is the fourth most common malignancy in women in the USA, and seventh most common cause of cancer deaths in women. Prognostic factors are related to age, race, endocrine status, histological cell type, tumor grade, depth of myometrial invasion, extension beyond the uterus, adnexal metastases, and extrauterine and peritoneal spread. PMB has a variety of causes, one of which is endometrial cancer. Endometrial cancer is usually discovered at an early stage, is curable, and is usually a disease of postmenopausal women.
  • Chapter 25 - Diabetes in mid-life women
    pp 283-296
  • View abstract

    Summary

    This chapter discusses the risk factors, clinical signs, evaluation, prevention and screening, and treatment of ovarian cancer and ovarian masses. Ovarian cancer is the leading cause of death from gynecological malignancy and the fourth most common cause of cancer death in women. Advancing age is the greatest risk factor. Use of oral contraceptive pills reduces the risk of ovarian cancer by 30 to 60%. A review of women with ovarian cancer compared with women with breast cancer or no cancer found that most women with ovarian cancer complained of the four following groups of non-specific symptoms in the 1-3 months before diagnosis: abdominal pain (30%), abdominal swelling (16.5%), GI symptoms (8.4%), and pelvic pain (5.4%). Transvaginal sonography (TVS) is the examination of choice to establish the diagnosis. In menstruating women, pregnancy, pregnancy complications and functional cysts are the most common causes of ovarian masses.
  • Chapter 26 - Thyroid disorders
    pp 297-306
  • View abstract

    Summary

    This chapter discusses the risk factors, clinical definitions, diagnosis, and treatment of urinary incontinence (UI) and urinary tract infections (UTIs). In institutionalized women, UI is much more common. Approximately one-half of postmenopausal women develop UI while exercising. The four forms of urinary incontinence include: stress incontinence, urge incontinence, overflow bladder and functional incontinence. There are medical, behavioral, electrical, magnetic, and surgical treatments of UI. Every type of treatment has a success rate of 50% or greater. Family and general physicians can diagnose and treat UI in women with a great deal of efficacy using a history, physical examination and simple test in the office, using a variety of methods including behavioral therapy and medication. The risk factors for recurrent UTI include a personal history of UTI, incontinence, and presence of a cystocele. UTIs are common, and must be identified and treated.
  • Chapter 27 - Hypertension and stroke
    pp 307-318
  • View abstract

    Summary

    Benign breast disease includes mastalgia, fibrocystic breast disease (FBD), breast cellulites and abscesses, nipple discharges, and galactorrhea. FBD is the most common benign breast disease. FBD starts as microcysts and accompanying fibrosis in 65% of women. The cysts become larger as the woman ages, and can reach 3 to 4 cm. Breast infections can affect the skin, producing a primary cellulitis, or may be secondary to an infection of a sebaceous gland, axillary gland, or lymph node, such as in hidradenitis supparativa. Most mastitis occurs in breast-feeding women. Nipple discharges are the third most common complaint concerning 5% of women attending breast clinics. Discharges associated with a breast mass are more likely to be related to cancer. Diseases that affect the hypothalamic and pituitary areas such as sarcoidosis, tuberculosis, histocytosis, and multiple sclerosis can cause galactorrhea. Galactorrhea is often physiological or caused by medication or treatable hormonal disorders.
  • Chapter 29 - Arthritis
    pp 325-332
  • View abstract

    Summary

    Breast cancer is one of the most common cancers in women. The goal of the primary prevention of breast cancer is to avert the development of cancer in healthy women. Medications such as tamoxifen and raloxifene prevent development of breast cancer by interrupting the process of initiation and promotion of tumor. The antiestrogenic effects of these agents lead to growth inhibition of malignant cells. Screening for breast cancer can lead to the detection of preinvasive lesions such as ductal carcinoma in situ (DCIS) and early small node-negative cancers. Mammography reduces the mortality of breast cancer. Although the incidence of breast cancer increases with age, few studies have investigated the efficacy of mammography in women older than age 70. In women at high risk for breast cancer because of genetic syndromes, MRI of the breast is found to be more sensitive than mammography alone.

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