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1.
Obstet Gynecol Clin North Am ; 46(3): 501-514, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378291

RESUMO

Although American women spend approximately 30% to 40% of their lives in menopause, a state defined by the cessation of estrogen production by the ovaries, obstetricians and gynecologists in North America receive little formal education about menopausal health. Hormonal therapy has been available for more than 75 years; however, controversies surrounding its use have impacted training of care providers in all specialties. This article offers updates on care for menopausal women, focusing on symptomatology and health issues that arise related to the decline in all reproductive hormones. Lifestyle adaptations and nonmedical approaches, and nonhormonal and hormonal medications are discussed.


Assuntos
Terapia de Reposição de Estrogênios , Envelhecimento Saudável , Estilo de Vida , Menopausa/fisiologia , Adulto , Doenças Cardiovasculares , Feminino , Fogachos , Humanos , Libido , Menopausa/psicologia , Saúde Mental , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa , Saúde da Mulher
2.
Mayo Clin Proc ; 94(5): 842-856, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954288

RESUMO

Sexual problems are common in women of all ages. Despite their frequency and impact, female sexual dysfunctions (FSDs) are often unrecognized and untreated in clinical settings. In response, the International Society for the Study of Women's Sexual Health convened a multidisciplinary, international expert panel to develop a process of care (POC) that outlines recommendations for identification of sexual problems in women. This POC describes core and advanced competencies in FSD for clinicians who are not sexual medicine specialists and serve as caregivers of women and, therefore, is useful for clinicians with any level of competence in sexual medicine. The POC begins with the expectation of universal screening for sexual concerns, proceeds with a 4-step model (eliciting the story, naming/reframing attention to the problem, empathic witnessing of the patient's distress and the problem's impact, and referral or assessment and treatment) that accommodates all levels of engagement, and delineates a process for referral when patients' needs exceed clinician expertise. Distressing problems related to desire, arousal, and orgasm affect 12% of women across the lifespan. Low desire is the most common sexual problem, but sexual pain and other less common disorders of arousal and orgasm are also seen in clinical practice. Screening is best initiated by a ubiquity statement that assures the patient that sexual concerns are common and can be revealed. Patient-centered communication skills facilitate and optimize the discussion. The goal of the POC is to provide guidance to clinicians regarding screening, education, management, and referral for women with sexual problems.


Assuntos
Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Saúde Sexual/normas , Saúde da Mulher/normas , Competência Clínica , Empatia , Feminino , Humanos , Assistência Centrada no Paciente/métodos , Relações Médico-Paciente , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/normas , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/terapia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/terapia , Sociedades Médicas
3.
Maturitas ; 105: 46-51, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28602465

RESUMO

"Previvors", or "pre-survivors", are individuals who do not have cancer but have a genetic predisposition to cancer. One such example is women with BRCA mutations. As a result of their predisposition to cancer, many will undergo a bilateral salpingo-oophorectomy when they are premenopausal. For premenopausal women, the removal of ovaries results in the depletion of estrogen, immediate menopause, and, in many cases, resultant Sexuality, Intimacy, and Menopausal Symptoms (SIMS). Furthermore, they may undergo changes in body image. SIMS are underreported by patients and underdiagnosed by practitioners. At the time of diagnosis or at preoperative visits, women should be informed of the potential physiologic, hormonal, and psychosocial effects of their risk-reducing surgery. There are many modalities for management of these symptoms. Successful treatment requires the provider's awareness of the problem, ability to identify it, and willingness to treat it.


Assuntos
Menopausa , Neoplasias/prevenção & controle , Salpingo-Ooforectomia , Saúde Sexual , Sexualidade , Predisposição Genética para Doença , Terapia de Reposição Hormonal , Humanos , Neoplasias/genética
4.
Maturitas ; 83: 27-32, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26547237

RESUMO

A commonly used phrase describing aging is "60 is the new 40". Although in many aspects of life this may be correct, in discussing sexual health, challenges to maintaining excellent sexual health become more common around age 60. Biological aging challenges physical sexual activity and responsiveness. We commence by briefly surveying the extensive coverage of 'normal' physiological aging. We primarily focus on issues that arise in distinct disease and or pathophysiological states, including gynecological and breast cancer, as well as those associated with partners of men who are either prostate cancer survivors or who have taken therapy for erectile dysfunction (ED). Regrettably, there is a very modest literature on sexual health and associated possible interventions in older patients in these cohorts. We discuss a variety of interventions and approaches, including those that we have developed and applied in a clinic at our host university, which have generally produced successful outcomes. The extended focus to sexual relationship dynamics in partners of men with either prostate cancer or ED in particular is virtually unexplored, yet is especially timely given the large numbers of women who encounter this situation. Finally, we briefly discuss cross-cultural distinctions in older couples' expectations, which exhibit remarkable variation.


Assuntos
Envelhecimento/fisiologia , Neoplasias da Mama/psicologia , Disfunção Erétil/psicologia , Neoplasias dos Genitais Femininos/psicologia , Neoplasias da Próstata/complicações , Saúde Reprodutiva , Idoso , Neoplasias da Mama/fisiopatologia , Comparação Transcultural , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/fisiopatologia , Feminino , Neoplasias dos Genitais Femininos/fisiopatologia , Humanos , Relações Interpessoais , Masculino , Neoplasias da Próstata/terapia , Comportamento Sexual , Parceiros Sexuais/psicologia , Sexualidade , Sobreviventes/psicologia
5.
Menopause ; 22(11): 1231-8, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25944521

RESUMO

OBJECTIVE: This study aims to evaluate differences and similarities in the prevalence of postmenopausal symptoms and their impact on postmenopausal women and male partners of postmenopausal women in North America and Europe. METHODS: The Internet-based survey Clarifying Vaginal Atrophy's Impact on Sex and Relationships (CLOSER) was conducted in North America and Europe. The questionnaire included questions on symptoms experienced by women after menopause and the impact of these symptoms overall and specifically on emotional and physical relationships. This study included 8,200 respondents: 4,100 were postmenopausal women who had experienced vaginal discomfort and 4,100 were male partners of postmenopausal women with this symptom. Differences were significant at the 95% level of confidence. RESULTS: The survey identified vaginal dryness, hot flashes, night sweats, disrupted sleep, and weight gain as the top five symptoms experienced by postmenopausal women in North America and Europe. Overall, symptoms were found to be more prevalent in women from the United States, United Kingdom, and Canada (P < 0.05), and less prevalent in women from Sweden and Italy compared with other countries. In regards to the impact of symptoms overall and on emotional and physical relationships, the greatest number of women from the United States, United Kingdom, and Canada found the impact to be "worse than expected." CONCLUSIONS: The impact of postmenopausal symptoms on relationships is greater in women from countries where symptoms are more prevalent. Postmenopausal women and male partners of postmenopausal women may benefit from greater education about menopause and open discussions with their healthcare provider.


Assuntos
Coito , Dispareunia/epidemiologia , Pós-Menopausa , Índice de Gravidade de Doença , Comportamento Sexual/estatística & dados numéricos , Europa (Continente)/epidemiologia , Feminino , Fogachos/epidemiologia , Humanos , Pessoa de Meia-Idade , América do Norte/epidemiologia , Prevalência , Disfunções Sexuais Fisiológicas/epidemiologia , Parceiros Sexuais , Doenças Vaginais/epidemiologia
6.
Int J Womens Health ; 6: 281-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24648772

RESUMO

Postmenopausal vaginal atrophy, resulting from decreased estrogen production, frequently requires treatment. Estrogen preparations provide the most effective treatment; local application is preferred to systemic drugs when treating only vaginal symptoms. As local estrogen therapies have comparable efficacy, this study aimed to understand treatment practices, assess experiences with different forms of local estrogen-delivering applicators, and evaluate satisfaction. Women who were US residents aged ≥18 years, menopausal (no spontaneous menstrual period for ≥1 year or with a double oophorectomy), and receiving local estrogen therapy for 1-6 months (vaginal cream [supplied with a reusable applicator] or vaginal tablets [supplied with a single-use/disposable applicator]), completed an online questionnaire. Data from 200 women (100 cream users and 100 tablet users; mean therapy duration 3.48 months) showed that most stored medication in the room in which it was applied (88%) and applied it at bedtime (71%), a procedure for which cream users required, on average, more than twice the time of tablet users (5.08 minutes versus 2.48 minutes). Many cream users applied larger-than-prescribed amounts of cream, attempting to achieve greater efficacy (42%), or lower-than-recommended doses (45%), most frequently to avoid messiness (33%) or leakage (30%). More tablet users (69%) than cream users (14%) were "extremely satisfied" with their applicator. Postmenopausal women using local estrogen therapy were generally more satisfied with the application of vaginal tablets than cream. Patient satisfaction may help to facilitate accurate dosing. Positive perceptions of medication will help to optimize treatment, which, although not assessed in this study, is likely, in turn, to improve vaginal health.

7.
Int J Womens Health ; 5: 133-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23526171

RESUMO

Up to half of all postmenopausal women will experience changes in the genitourinary tract induced by the hypoestrogenic state, collectively known as vaginal atrophy. Vaginally administered local estrogen therapy (LET) is the standard of care for symptoms of vaginal atrophy that do not respond to nonhormonal interventions. Several LET formulations are available, and choice of therapy is based largely on patient needs and preferences. This online survey of postmenopausal LET users was conducted to investigate reasons for switching to vaginal estradiol tablets from other formulations and to evaluate factors associated with patient preference for and compliance with use of LET. Data was analyzed from 73 respondents currently using estradiol vaginal tablets who have previously used the estradiol vaginal ring, estradiol vaginal cream, and/or conjugated estrogen vaginal cream. Patients in this survey rated vaginal symptoms of vaginal atrophy as being more bothersome than urinary symptoms. Respondents preferred their current treatment with the vaginal tablet to their previous treatment with a cream or ring. The preference for tablets over creams was mainly related to formulation and application rather than to any perceived safety issues. Tablets were perceived as efficacious, convenient, and neat to apply. The study participants also reported a longer duration of tablet use compared with creams or rings, and greater compliance with vaginal tablets than with vaginal cream. This study provides new insights into reasons for patient noncompliance with estrogen cream or ring therapy that can be used to maximize patient adherence with LET.

8.
Maturitas ; 70(3): 210-5, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21943557

RESUMO

SEXUAL FUNCTION IN AGING WOMEN: Sexuality is an integral part of human expressions. Mental health plays a major role in sexuality. Several psychological interventions are proposed to increase the sexual quality of life in older women with diverse gynecologic pathology. A biopsychosocial approach utilizing brief strategies can be easily implemented in clinics to help women of all ages increase their sexual quality of life. THE IMPACT OF FEMALE PELVIC FLOOR DISORDERS ON SEXUAL FUNCTION IN OLDER WOMEN: Female pelvic floor disorders include urinary incontinence, pelvic organ prolapse, and fecal incontinence. These disorders increase dramatically with increasing age. Urinary incontinence has been demonstrated to have a negative impact on a woman's sexual function. Among sexually active older women with urinary incontinence, 22% report being moderately or extremely worried that sexual activity would cause urine loss. An increased prevalence of sexual distress [9% (6/76) vs. 1.3% (2/216), p=0.005] has been reported in sexually active women over 40 years old with urinary incontinence. Treatment of urinary incontinence can improve sexual function in older women. Among sexually active women (N=53) who underwent midurethral slings procedures for the correction of urinary incontinence, increased coital frequency, decrease fear of incontinence with coitus, decreased embarrassment due to incontinence was reported six months after surgery. Pelvic organ prolapse, a hernia of the vagina resulting in a visible vaginal bulge, has also been associated with a negative impact on sexual function. Women with advanced pelvic organ prolapse (POP-Q stage III or IV) have been demonstrated to have decreased body image reporting that they are more self-conscious about their appearance [adjusted odds ratio (AOR) 4.7; 95% confidence interval (CI) 2.9, 51], feel less feminine (AOR 4.0; 95% CI 1.2, 15) and less sexually attractive (AOR 4.6; 95% CI 1.4, 17) compared with women who have normal pelvic support. Both vaginal and abdominal approaches to surgical correction of pelvic organ prolapse have been demonstrated to improve sexual function. MENTAL HEALTH: Mental health plays a major role in older woman's sexuality. Sexual interest and satisfaction is tied to emotional expressivity, women's self-worth, feelings of depression and loneliness as well as cognitive function. Research has shown that both general practitioners and specialists lack training in sexual assessments. Behavioral health specialists, such as a psychologist, can play an integral role in helping to facilitate communication between the patient and the provider. A main focus of communication training is to facilitate open and genuine conversation between the provider and the patient. Providers are encouraged to ask open ended questions while patients are encouraged to discuss symptoms while coping with an internal state of anxiety. Despite the known prevalence of sexual dysfunction among older women, few studied empirically based interventions have been published with these women. This speaks to the general assumption among medical professionals that having the "sex talk" in older women with gynecological pathology is not important or relevant. A biopsychosocial approach utilizing some of the aforementioned brief strategies can be easily implemented in comprehensive gynecology clinics in order to help women of all ages increase their sexual quality of life.


Assuntos
Doenças Urogenitais Femininas/complicações , Disfunções Sexuais Psicogênicas/etiologia , Sexualidade , Estresse Psicológico/etiologia , Idoso , Feminino , Doenças Urogenitais Femininas/psicologia , Doenças Urogenitais Femininas/terapia , Humanos , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/terapia , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/terapia , Satisfação Pessoal , Disfunções Sexuais Psicogênicas/epidemiologia , Disfunções Sexuais Psicogênicas/prevenção & controle , Estresse Psicológico/prevenção & controle , Incontinência Urinária/complicações , Incontinência Urinária/terapia
9.
Menopause ; 18(4): 366-75, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21228727

RESUMO

OBJECTIVE: Black cohosh, a popular herbal treatment for menopausal symptoms, has been implicated in a number of hepatotoxicity case reports. The purpose of this investigation was to analyze data gained from clinical trials on the effect of black cohosh on liver function. METHODS: A meta-analysis of randomized, double-blind, and controlled clinical trials was conducted. These studies primarily evaluated the efficacy and safety of the isopropanolic black cohosh extract (iCR) in perimenopausal and postmenopausal women. Raw data on liver function values of aspartate aminotransferase, alanine aminotransferase, and γ-glutamyltranspeptidase were considered in this analysis, if these data at baseline and after 3 to 6 months of treatment were available. Standard methods of descriptive statistics were used in this analysis. RESULTS: Five studies involving a total of 1,117 women were included in the meta-analyses. A total of 1,020 women (test population=517 and reference population=503) completed the studies. Perimenopausal and postmenopausal women (40-60 y) were treated daily with iCR (corresponding to 40-128 mg drug) for 3 to 6 months. The meta-analyses of the standardized mean differences in the "test" versus "reference" showed no significant effects and no differences between double-blind, placebo-controlled and other trials. The overall fixed effect ± SEM was 0.055 ± 0.062 (P=0.37) for aspartate aminotransferase and 0.063 ± 0.062 (P=0.31) for alanine aminotransferase. The nonsignificant effects concerned the overall analyses of all included studies as well as the proportion of placebo-controlled studies. CONCLUSIONS: The results of this meta-analysis of five randomized, double-blind, and controlled clinical trials showed no evidence that iCR has any adverse effect on liver function.


Assuntos
Cimicifuga/química , Fogachos/tratamento farmacológico , Fígado/efeitos dos fármacos , Menopausa/efeitos dos fármacos , Fitoterapia , Extratos Vegetais/uso terapêutico , Adulto , Alanina Transaminase/metabolismo , Aspartato Aminotransferases/metabolismo , Doença Hepática Induzida por Substâncias e Drogas/enzimologia , Feminino , Fogachos/enzimologia , Humanos , Fígado/enzimologia , Testes de Função Hepática , Pessoa de Meia-Idade , Extratos Vegetais/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , gama-Glutamiltransferase/metabolismo
10.
Maturitas ; 67(2): 114-6, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20541880

RESUMO

Gynecological literature is replete with multiple papers on sexually transmitted infections (STIs) in young women. Although those past the reproductive prime may well be at lower risk for STIs than women in the peak reproductive years, STIs are regularly seen in the older cohort and are a cause for significant morbidity and distress. Care givers reluctantly approach or are outright amiss in assessing sexual health of their aging patients, nor is this population adequately counseled regarding practices of safe sex. Sexuality among the aging population, safe behaviors, and diagnostic challenges of STIs in an older cohort are herein discussed.


Assuntos
Doenças Sexualmente Transmissíveis/epidemiologia , Idoso , Envelhecimento/psicologia , Feminino , Humanos , Papel Profissional , Fatores de Risco , Sexualidade/psicologia , Doenças Sexualmente Transmissíveis/psicologia , Doenças Sexualmente Transmissíveis/transmissão
11.
Maturitas ; 66(1): 23-6, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20303222

RESUMO

Matters of sexuality and intimacy greatly impact quality of life of patients with gynecologic cancers. Vast amount of evidence exists showing that cancer dramatically impacts woman's sexuality, sexual functioning, intimate relationships and sense of self. Sexual functioning can be affected by illness, pain, anxiety, anger, stressful circumstances and medications. There is a growing acknowledgement that these needs are not being appropriately addressed by providers. With improvements in early detection, surgery and adjuvant therapy for gynecologic cancer, long term survival and cure are becoming possible. Quality of life is thus becoming a major issue for patients. Patients suffer from hot flashes, difficulty sleeping, loss of libido and intimacy, all resulting in significant morbidity and loss of quality of life. Using hormone replacement therapy in gynecologic cancer survivors is a topic a great debate. While limited studies are available to date, retrospective cohort reviews show no reported differences in overall or disease-free survival in patients using hormone replacements vs. controls in patients with ovarian cancer, endometrial cancer, cervical, vaginal or vulva cancer. Since safety of using HRT remains controversial and prospective studies are lacking, providers need to be able to provide alternatives to HRT. Centrally acting agents such as antiseizure agent gabapentin and selective serotonine re-uptake inhibitors, such as venlafaxine and fluoxitine have been demonstrated to show effectiveness in treating vasomotor symptoms and are easily tolerated. To address cardiovascular and osteoporosis risks of post-menopausal status, exercise, healthy diet, bisphosphonates, raloxifen and statins have been found to be effective. Psychotherapy plays an essential part in management of these issues. Review of the literature reveals recent trends among health psychologists to utilize psychoeducational interventions that include combined elements of cognitive and behavioral therapy with education and mindfulness training. Intervention studies have found positive effects from this approach, particularly within the areas of arousal, orgasm, satisfaction, overall well-being, and decreased depression. Many of patients' issues are easy to address with either hormonal, non-hormonal or psychotherapy modifications. The essential part of success is the providers appreciation of this serous problem and willingness and comfort in addressing it.


Assuntos
Neoplasias dos Genitais Femininos/terapia , Terapia de Reposição Hormonal , Neoplasias/terapia , Disfunções Sexuais Fisiológicas/terapia , Disfunções Sexuais Psicogênicas/terapia , Sexualidade , Feminino , Neoplasias dos Genitais Femininos/complicações , Humanos , Neoplasias/complicações , Psicoterapia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Parceiros Sexuais/psicologia , Sexualidade/psicologia
12.
Womens Health (Lond) ; 5(6): 659-67, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19863469

RESUMO

Embryogenesis research provides information on a time of heightened vulnerability in embryo development: the time from conception to the day a woman misses her menstrual period. During this period, it is vital for the woman to be aware of exposures, behaviors and nutritional factors that could negatively impact the developing embryo. This article discusses this critical, often-overlooked window of development and will review the various types of teratogens that affect pregnancy. Over-the-counter pregnancy tests are widely used to determine pregnancy status. Earlier test models detected only the pregnancy hormone human chorionic gonadotropin in the urine, but it is now known that there are other key forms of human chorionic gonadotropin that are relevant when determining pregnancy status. This article will explain why early knowledge of pregnancy status is important for both woman and embryo, and the role that patient education and pregnancy test choice can have on normal embryonic development.


Assuntos
Desenvolvimento Embrionário/efeitos dos fármacos , Testes de Gravidez , Doença Crônica , Aconselhamento , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Exposição Materna/prevenção & controle , Educação de Pacientes como Assunto , Gravidez , Complicações na Gravidez/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal , Sensibilidade e Especificidade , Transtornos Relacionados ao Uso de Substâncias , Teratogênios/toxicidade , Fatores de Tempo
13.
Pain ; 141(1-2): 31-40, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19022580

RESUMO

Many treatments used for women with vulvodynia are based solely upon expert opinion. This randomized trial aimed to test the relative efficacy of cognitive-behavioral therapy (CBT) and supportive psychotherapy (SPT) in women with vulvodynia. Of the 50 participants, 42 (84%) completed 10-week treatments and 47 (94%) completed one-year follow-up assessments. Mixed effects modeling was used to make use of all available data. Participants had statistically significant decreases in pain severity (p's<0.001) with 42% of the overall sample achieving clinical improvement. CBT, relative to SPT, resulted in significantly greater improvement in pain severity during physician examination (p=0.014), and greater improvement in sexual function (p=0.034), from pre- to post-treatment. Treatment effects were well maintained at one-year follow-up in both groups. Participants in the CBT condition reported significantly greater treatment improvement, satisfaction and credibility than participants in the SPT condition (p's<0.05). Findings from the present study suggest that psychosocial treatments for vulvodynia are effective. CBT, a directed treatment approach that involves learning and practice of specific pain-relevant coping and self-management skills, yielded better outcomes and greater patient satisfaction than a less directive approach.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Associação Livre , Dor Pélvica/psicologia , Dor Pélvica/terapia , Adulto , Análise de Variância , Distribuição de Qui-Quadrado , Método Duplo-Cego , Emoções/fisiologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Medição da Dor , Dor Pélvica/complicações , Estudos Retrospectivos , Comportamento Sexual , Resultado do Tratamento , Doenças Vaginais/complicações , Doenças Vaginais/terapia , Adulto Jovem
14.
J Reprod Med ; 52(2 Suppl): 165-8, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17477111

RESUMO

Increased awareness of the risk of cardiovascular disease (CVD) in postmenopausal women will aid clinicians in choosing the most appropriate hormone therapy (HT) for their patients. An antialdosterone-containing hormonal therapy offers postmenopausal women advantages beyond simply the relief of menopausal symptoms; drospirenone/estradiol therapy has a theoretical advantage for the modulation of postmenopausal cardiovascular target organ complications. Additionally, drospirenone/ estradiol therapy represents an attractive alternative to other forms of HT.


Assuntos
Androstenos/uso terapêutico , Terapia de Reposição Hormonal , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Pós-Menopausa/efeitos dos fármacos , Combinação de Medicamentos , Feminino , Humanos
15.
Pain Med ; 5(4): 349-58, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15563320

RESUMO

OBJECTIVE: This study aimed to test the reliability and validity of physician ratings in a broadly defined sample of women with vulvodynia and to examine the external validity of the vulvodynia subtypes. DESIGN: Participants were 50 women who were independently diagnosed with vulvodynia by two study gynecologists. Physician ratings corresponding to Friedrich's three criteria for vulvar vestibulitis were taken at the two examinations. Each participant's diagnosis was subtyped as vulvar vestibulitis (VV) or dysesthetic vulvodynia (DV) based upon the physician ratings. Participants completed standardized measures of pain, sexual function, psychological function, and quality of life to examine the discriminant validity of the subtypes. RESULTS: Test-retest reliability for the physician ratings of Friedrich's three criteria was stable for two of the three criteria (i.e., pain on attempted vaginal entry and tenderness to pressure localized within the vulvar vestibule). When these criteria were used to categorize participants as having VV or DV, the subtypes were not statistically different for measures used to examine the discriminant validity of the subtypes. While the distribution of patients changed when premenopausal state was added to the inclusion criteria for VV, the subtypes differed little on the outcome measures. CONCLUSIONS: Findings from the present study suggest that physician ratings for Friedrich's criteria can be operationalized and found to be reliable and valid in a wide range of women with vulvodynia. The absence of differences between subtypes on measures of pain, sexual function, psychological function, and quality of life challenge the clinical significance of these subtypes and support the theory that vulvodynia represents a continuum of chronic vulvar pain rather than two distinct entities.


Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico/estatística & dados numéricos , Ginecologia/normas , Medição da Dor/métodos , Dor/diagnóstico , Doenças da Vulva/diagnóstico , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Dor/etiologia , Dor/psicologia , Medição da Dor/estatística & dados numéricos , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e Questionários , Doenças da Vulva/classificação , Doenças da Vulva/fisiopatologia
16.
Fertil Steril ; 81 Suppl 2: 41-4; quiz 57-60, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15126097

RESUMO

There are many areas in the practice of gynecology that can lead to malpractice lawsuits for a practitioner who is not careful, even if he or she practices good medicine. Potential risks include failure to diagnose cancer, not following up with patients, failure to thoroughly check test results, and not keeping proper documentation. The cautious physician will attend to every problem that a patient presents, make sure that patients follow instructions, keep meticulous documentation, and always follow up to make sure his or her patient is progressing well.


Assuntos
Ginecologia/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Neoplasias da Mama/diagnóstico , Testes de Química Clínica/normas , Feminino , Humanos , Registros Médicos/normas , Cooperação do Paciente , Cuidados Pós-Operatórios/normas , Padrões de Prática Médica , Cuidados Pré-Operatórios/normas
17.
J Reprod Med ; 49(4): 311-20, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15134159

RESUMO

The benefit/risk profile of postmenopausal hormone therapy has been under greater scrutiny since Women's Health Initiative study data were published in July 2002. A nominal analysis showed the study drug, a combination of 0.625 mg conjugated equine estrogens (CEE) and 2.5 mg medroxyprogesterone acetate (MPA), to be associated with decreased risks of colorectal cancer and osteoporotic hip fractures but increased risks of coronary heart disease, stroke and venous thromboembolic events. This same profile was not seen in the estrogen-only arm of the study, and the trial investigators cautioned that the results observed with CEE/MPA might not apply to other dosages of combined hormone therapy, other types of estrogens and progestins, or other routes of administration. However, the unexpected results cast a long shadow of doubt over the safety of all hormone therapy, making it difficult for reproductive health care professionals to counsel women on the selection of appropriate treatment of vasomotor symptoms. A review of the literature suggests that not all estrogens and progestins are alike, and alternative drugs, doses and delivery systems may exhibit better safety profiles than CEE/MPA, with no loss of efficacy. Selection of therapy should be individualized, based on patients' specific needs and global health risks. When there is a compelling need for relief of climacteric symptoms, using the lowest effective dose of hormonal therapy remains a prudent recommendation.


Assuntos
Anticoncepcionais Femininos/administração & dosagem , Estradiol/administração & dosagem , Terapia de Reposição Hormonal/efeitos adversos , Acetato de Medroxiprogesterona/administração & dosagem , Administração Cutânea , Administração Oral , Doenças Cardiovasculares/etiologia , Química Farmacêutica , Anticoncepcionais Femininos/efeitos adversos , Estradiol/efeitos adversos , Feminino , Humanos , Acetato de Medroxiprogesterona/efeitos adversos , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Pós-Menopausa , Fatores de Risco
18.
J Sex Marital Ther ; 30(5): 315-24, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15672599

RESUMO

Using the Female Sexual Function Index (FSFI; Rosen et al., 2000), we assessed forty-two women with vulvodynia. Internal consistency was high (Cronbach's alphas = 0.90-0.97) for all scales. We compared scale scores to published healthy and patient sample data and found very large effect sizes (1.15-2.83), which indicated that women with vulvodynia reported significantly worse overall sexual function than women without sexual dysfunction and greater pain with sexual intercourse than women with female sexual arousal disorder. Results highlight difficulties experienced across all domains of sexual function, particularly with regard to dyspareunia, for women with vulvodynia. Findings also support the internal consistency and discriminant validity of the FSFI.


Assuntos
Coito , Dispareunia/complicações , Disfunções Sexuais Psicogênicas/complicações , Doenças da Vulva/complicações , Saúde da Mulher , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Dispareunia/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Reprodutibilidade dos Testes , Projetos de Pesquisa/normas , Autoavaliação , Índice de Gravidade de Doença , Disfunções Sexuais Psicogênicas/psicologia , Inquéritos e Questionários , Vulva/inervação , Doenças da Vulva/psicologia
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