Intimate partner violence (IPV) is a global public health problem, linked to long-term health, social, and economic consequences. IPV is a preventable public health problem that includes physical and sexual violence, stalking, and psychological aggression directed at a woman by a person with whom she has, or has had, an intimate relationship. Violence against women interferes with the health of the woman and also affects the relationship with the primary care provider. This chapter explains in detail the assessment and health consequences of IPV. Most states have laws to protect women from their abusers. The courts in most states try to prosecute perpetrators. IPV continues to be a threat to the health of women and their families in the United States, at a cost $10 billion annually. The chapter’s goal is to provide sensitive, kind, well-informed, universal screening with appropriate referrals for all women who suffer from IPV.
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The Intrauterine contraception (IUC) is a plastic contraceptive device that is inserted into the uterine cavity through the cervical canal. The IUC is for contraceptive use only. No IUC is intended to offer any protection against sexually transmitted infection transmission. There are five IUCs available in the United States, which includes copper IUC with white strings, levonorgestrel (LNG)-containing IUC with brown strings, LNG-containing IUC with blue strings. All types have a two-strand, polyethylene monofilament string that protrudes from the cervical os. Intrauterine contraception has been expanded to include not only the levonorgestrel containing Mirena, but also the new, smaller Kyleena device. Kyleena is an LNG-IUC system and provides continuous contraceptive protection for 5 years. A silver ring visible on ultrasound distinguishes Kyleena from other IUCs. The chapter also presents contraindications and management of side effects of IUC.
Spontaneous or natural menopause is marked by the end of the reproductive stage of women’s life. It is a period of transition, and for most women is a normal, physiological, and developmental life event often perceived differently across various cultures. Menopause is the permanent cessation of menses after 12 consecutive months of amenorrhea, or when follicle- stimulating hormone levels are consistently elevated in the absence of other obvious pathologic causes. This chapter explains the physiology of menopause. The menopause transition, also referred to as perimenopause, is associated with fluctuating hormone secretion causing irregular menstrual cycles and ultimately, permanent cessation of menses. Only two major early symptoms are directly attributed to menopause: change in menstrual cycles and vasomotor symptoms (VMS). VMS is a global term referring to hot flashes, hot flushes, and night sweating. VMS are experienced by up to 75% of all perimenopausal women in the United States.
In females, the urinary and reproductive systems are completely separate, unlike in males. The internal female reproductive organs are located in the lower pelvis and are safely tucked inside the bony pelvis, behind the pubic bone. External genitalia collectively include the mons pubis, the labia majora, the labia minora, the vestibule, the clitoris, and the vaginal orifice. This chapter presents the structure, functions, and purposes of the organs of female reproduction. It explains the anatomy and physiology of the following: ovaries; fallopian tubes; uterus; vagina; pelvic support; uterine ligaments; and associated pelvic organs. The lower urinary tract system consists of the bladder and urethra. The bladder has three layers: outer layer—an adventitious layer of connective tissue that is covered by the peritoneum of the anterior wall of the pelvis; middle layer—consists of the detrusor muscle, which facilitates bladder emptying; and inner layer— lined with mucous membrane.
Polycystic ovarian syndrome (PCOS) is an endocrine disorder and one of the most commonly occurring endocrine disorders in women. PCOS is the most common cause of female subfertility. This chapter describes Rotterdam criteria for classification of PCOS. It then provides clinical screening for PCOS. The screening process includes physical examination such as hair distribution; breast examination; peripheral exam; laboratory analysis such as free testosterone; estradiol; serum prolactin; clinical intervention such as patient education; pharmacotherapy and pregnancy-related risks. The chapter describes the goals for management of PCOS. The goals are to lower insulin levels; restore/preserve fertility; treat hirsutism and/or acne; regulate menstruation; prevent endometrial hyperplasia and hence prevent development of endometrial cancer. The decision is driven by whether the woman is younger or older, as well as her desire for future conception.
Obesity is recognized as a complex, multifactorial, chronic disease whereby excess body fat is accumulated through complex interactions involving the environment, genetic predisposition, human metabolism, as well as neuroendocrine and behavioral factors. Adiposity-based chronic disease disproportionally and differentially affects women’s health across a spectrum of physical, psychological, and social conditions. In the clinical setting, ranges for normal weight, overweight, and obesity are determined using weight and height to calculate a surrogate measure of percentage of body fat called the body mass index (BMI). BMI is used in the clinical setting to assess risk for the development of adiposity-related diseases and as a metric for determining treatment interventions. This chapter explains gender differences in obesity, genetic causes of obesity, medical causes of obesity and risk factors associated with exogenous obesity. It tabulates body mass index measurements, medical complications of obesity, and reproductive complications of severe obesity.
Polyps are the most common benign tumors of the cervix and are found most often during the menstruating years. They are soft, pear-shaped (finger-like), red to purple lesions, and are usually pedunculated growths from the surface of the cervical canal. Typically, polyps are not cancerous (benign) and are easy to remove. They are often removed during a routine pelvic examination. Polyps do not usually grow back. However, women who have polyps once are at risk of growing more polyps. During a pelvic examination, the healthcare provider will see smooth, red, or purple finger-like growths on the cervix. A cervical biopsy will most often show cells that are consistent with a benign polyp. Rarely, there may be abnormal, precancerous, or cancer cells in a polyp. Polyps are easy to remove in the office at the time of the visit. There is no need for special follow-up as polyps seldom recur after removal.
Percutaneous tibial nerve stimulation (PTNS) is an office based neuromodulation system designed to deliver retrograde access to the sacral nerve through percutaneous electrical stimulation of the tibial nerve. It is a minimally invasive procedure that acts indirectly (mechanism is not exactly known) via a central afferent impulse from the tibial nerve that targets the sacral nerve plexus in the spinal cord, influencing reflexes via the pudendal nerve among the bladder, urethral sphincter, and pelvic floor, and is designed to alter aberrant bladder signals. Hence, it controls overactive bladder (OAB). This chapter presents the indications and contraindications of OAB. PTNS is a proven effective noninvasive therapy for OAB symptoms. The chapter discusses in detail the treatment efficacy, treatment frequency and risks of treatment of OAB. It presents a sample worksheet to use to evaluate a woman for PTNS.
This chapter provides a review of basic cutaneous anatomy for dermatology assessment. The epidermis and the dermis rest on the subcutaneous layer. These layers form the integumentary system. The skin is the largest organ of the body. Epidermis is the outer layer of the skin. It is composed of the following layers stratum germinatum, stratum spinosum, stratum granulosum, stratum corneum. In the cutaneous assessment, the color of the skin can add valuable clues to the patient’s state of health; it is the largest organ of the body and as such it may give valuable clues regarding systemic disease. To examine the skin, one must listen to the patient’s history and current concerns; look at all of the skin; touch the skin being examined; and smell for any unusual odors. It discusses dermatologic issues related to pregnancy and contraception. The chapter describes briefly general dermatology, cosmesis, and photoaging.
Urinary incontinence (UI) is a common condition defined as an involuntary leakage of urine. Women is twice as likely to be affected as men, and prevalence increases with age. Nonsurgical treatment options may include pharmacological treatment, pelvic muscle exercises (PMEs), bladder training exercises, and electrical stimulation. Pelvic floor stimulation is proposed as a nonsurgical treatment option for women with pelvic floor dysfunction. This chapter describes in detail the pelvic floor electrical stimulation (PFES). PFES involves the electrical stimulation of pelvic floor muscles (PFM) through a battery-powered control unit that initiates and regulates the output of electrical stimulation to the electrodes. PFES is thought to improve partially denervated urethral and pelvic floor musculature by enhancing the process of reinnervation. The chapter presents indications and contraindications to pelvic floor electrical stimulation. PFES is indicated for patients with: stress incontinence, urge incontinence. PFES is contraindicated for patients with dementia, absent or diminished sensation.