Female sexual dysfunction (FSD) can cause acute emotional and physical distress for women impacting their quality of life. Affecting approximately 12% of women in the United States, FSD is a generalized term that encompasses a number of sexual health problems including hypoactive sexual desire disorder (HSDD) and genitopelvic pain/penetration disorders. FSD can affect women across the life span, however it is increasingly common as women age due to hormonal factors and biological changes associated with declining estrogen levels. HSDD includes female sexual arousal disorder and female orgasmic disorder. The cause of FSD is multifactorial including biological, psychological, relational, and sociocultural aspects. Both HSDD and genitopelvic pain/penetration disorders are classified in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. This chapter discusses etiology, history, physical examination, laboratory testing, differential diagnosis, complications, consultation and referral, treatment, and follow-up for sexual dysfunction.

Increasingly, clinicians practicing in primary care and gynecologic settings are finding themselves in the position of needing to prescribe and provide follow-up monitoring for women needing psychotropic medication management. Issues associated with mental and emotional health encompass a broad range of conditions in which alteration in mood or behavior results in discomfort or decreased functioning for a woman. These changes result in chronic or acute distress. Attempting to cope with this distress may alter the woman’s ability to work, attend school, and care for children and others. This can place a strain on family, social, professional, or workplace relationships, as well as cause somatic manifestations that may contribute to morbidity and mortality. This chapter discusses psychiatric conditions commonly seen in women’s health care settings, responsibilities of clinicians, history, physical examination, differential diagnosis, laboratory testing, treatment, complications, consultation, and follow-up.

One important goal of Healthy People 2020 is to improve the health, safety, and well-being of persons who are sexual or gender minorities. This chapter reviews basic concepts for clinicians to support delivery of culturally competent and affirming health care to foster health for all individuals, no matter how they identify their sexual orientation or gender identity. It also reviews language, development of affirming environments, and clinical care considerations. Receipt of culturally competent affirming care is directly associated with increased mental and physical well-being, reductions in disease transmission and progression, reduction of health care costs, and increased longevity. Understanding and using correct and clearly defined language and terminology helps clinicians: understand the unique needs and experiences of varied subgroups of minority individuals, measure health disparities in the practice, locally, and nationally, and provides a foundation to foster understanding, build trusting relationships, and provide affirming and culturally competent care.

Abuse and/or violence in a relationship occurs when one person physically, sexually, verbally, emotionally, or economically abuses or controls another person. Experiencing fear of a partner in a relationship is characteristic of an abusive situation, regardless of whether there is physical violence. Fearing physical harm is enough to consider the relationship abusive. Constant degradation damages ego, self-esteem, and confidence. Intimate partner violence (IPV) affects an estimated one in five adolescents, and IPV affects approximately one in four women. IPV and control may also negatively affect obstetrical and reproductive health. All women should be screening for current and past physical and sexual violence at health care visits. This chapter discusses screening, history, physical examination, laboratory testing, interviewing procedure, evidence documentation, treatment, referrals/consultation, and follow-up for women who have experienced abuse and violence.

Infertility is the inability to conceive after 1 year or more of unprotected intercourse for women less than age 35 and the inability to conceive after 6 months for women over the age of 35. Infertility also affects the ability to successfully carry a pregnancy to term, this includes women who repeatedly experience spontaneous pregnancy loss. Earlier evaluation is not limited by this definition and may be warranted for women who do not have menses or who do not ovulate, have suspected tubal disease, uterine abnormalities, endocrine disorders, or a known male/sperm factor. This chapter provides factors related to male infertility, female infertility, and couple infertility. It discusses some history related to infertility such as history of previously treated infertility with assisted reproductive technology, complete medical and surgical history, and complete menstrual history. The chapter also discusses physical examination, differential diagnosis, laboratory testing, treatment and intervention, complications, consultation/referral, and follow-up for infertility.

Women may seek care for a range of common gynecologic concerns, including menstrual disorders, sexually transmitted infections, vaginosis and vaginitis, sexual dysfunction, contraception, preconception, perimenopause and menopause, and breast or cervical abnormalities. Women also seek care and assistance when they are faced with sex- and gender-specific primary health care issues, such as substance abuse, physical or sexual violence, weight management, osteoporosis, and genitourinary tract conditions. This chapter focuses on the following substance abuse: opioids, alcohol, and tobacco. It reflects specific issues faced by women with addiction. The chapter then discusses definition, etiology, barriers to treatment, history, physical examination, laboratory testing to consider, differential diagnoses, treatment, complications, consulation/referral, and follow-up.

The initial visit to a gynecologic clinician encompasses preventive health care that includes a discussion of health topics relevant to a woman’s age and risk factors, a full comprehensive health history, an exam, screening tests, and immunizations as appropriate. This chapter provides a comprehensive guide to a well-woman exam and can be adapted for specific practice settings and time constraints. It discusses history such as medical history, recent changes in immediate family history, gynecologic history, urinary tract history, pap smear history, sexual history, and social history. The chapter discusses physical exams, such as vital signs, weight/height/body mass index, general exam, gynecologic exam, and internal pelvic exam. It also provides the laboratory testing to consider and treatment/intervention. The Woman’s Preventative Services Initiative, the American College of Obstetricians and Gynecologists, and the Health Resources and Services Administration provide guidance on recommended age-related health topics, exams, screening tests, and immunizations.

This chapter discusses breast conditions such as breast cancer screening guidelines, abnormal breast discharge, breast mass, and mastalgia/breast pain. Evidence-based guidelines for breast cancer screening continue to evolve with research findings. National organizations publish their own guidelines that can vary slightly. Practicing clinicians must decide which organizational recommendation they will adhere to and stay updated on any published changes and the rationale for the change. The chapter discusses etiology, history, physical examination, laboratory/radiologic testing, differential diagnosis, treatment, complications, consultation/referral, and follow-up for abnormal breast discharge, breast mass, and mastalgia/breast pain.

Increasingly, women are using complementary and alternative medicine (CAM) therapies for preventive and palliative care as alternative or adjunct therapies to their traditional medical care. This chapter discusses the most commonly used therapies for a variety of conditions that affect women. Women may not perceive vitamins, minerals, herbs, and supplements as medications. Because drug interactions exist with both prescription and over the counter products, it is important for the clinician to ask each woman about the use of CAM therapies at every visit. Women who are pregnant and/or breastfeeding should not use any CAM therapies without consulting their health care provider. Alternative therapies refer to treatment approaches that, though used for many years, have not been evaluated and tested by conventional methods and rigorous research. The chapter provides the general categories of CAM, reasons for selection/use of CAM, concerns regarding CAM, considerations, and frequently used/recommended CAM therapies.