Multidisciplinary treatment of an unconsummated marriage with organic factors in both spouses.

Successful treatment of a case of unconsummated marriage involved the expertise of a urologist, gynecologist, and psychologist working together in an interdisciplinary clinic to treat sexual dysfunction. Total duration of treatment was 18 months, and components included surgical correction of congenital chordee, surgical excision of a hymenal remnant blocking the vaginal introitus, laser treatment of endometriosis, and sex therapy evaluation and follow-up totalling five sessions for both partners. At the end of treatment the couple was having pleasurable sexual intercourse.

Psychosexual aspects of the evaluation and management of vulvar vestibulitis.

OBJECTIVE: This article describes the structure and outcome of a collaboration between a gynecologist and a psychologist in evaluating and treating 45 consecutive women with vulvar vestibulitis. STUDY DESIGN: Women were interviewed by the psychologist in a structured format and also filled out questionnaires. Vulvar lesions were defined by clinical examination and colposcopy, and a conservative local excision was performed, without mobilization of the vagina. Postoperatively, women were offered sexual counseling including Kegel exercises, vaginal dilation, and couple therapy. Follow-up data were gathered a mean of 8 months after treatment. RESULTS: Of the 32 women who had both surgical excision of vulvar lesions and contact with the psychologist, 50% were much improved in perceived pain, 41% were somewhate improved, and 9% were unimproved. Factors predictive of an improved outcome included willingness to have psychologic treatment, higher socioeconomic status, and self-report of specific, localized areas of vulvar pain rather than vague, diffuse pain. Parous women were more likely to improve. Those who reported increased pain intensity premenstrually had poorer outcomes. CONCLUSIONS: Vulvar vestibulitis may be a syndrome that results from interacting pathophysiologic and psychologic factors, so that a comprehensive treatment approach is beneficial. Women who have diffuse genital pain or who refuse psychologic intervention may be poor candidates for surgery.

Circulating lipid and lipoprotein concentrations with oral estrogen-androgen hormone replacement therapy.

The goal of this study was to determine whether the administration of an oral combined estrogen-androgen preparation would influence the lipid and lipoprotein profile of postmenopausal women. There were no pretreatment to posttreatment differences in triglycerides, total cholesterol, or in low density lipoproteins and very low density lipoproteins. However, high density lipoprotein values decreased significantly after treatment. Although further study is warranted, these preliminary findings suggest that the potential beneficial effects of oral estrogen-androgen on sexual and psychological well-being may need to be weighed against the possible cardiovascular risks of adverse lipid changes in postmenopausal women.

Some misconceptions concerning the menopause.

Traditional assumptions about menopausal and postmenopausal women suggest that they are vulnerable to marked depression and deterioration in sexual interest and activity. A review of representative gynecologic and psychiatric publications dating back to the mid-nineteenth century tend to confirm these widely held beliefs. More contemporary epidemiologic and clinical studies fail to demonstrate a specific entity of menopausal depression and, in fact, show a decline in the prevalence of depression among women in this age group. Likewise, studies on sexual activity and interest among middle-aged women fail to demonstrate a consistent and predictable decline, but show rather wide variability. The presence of a suitable male partner appears to play a more important role than age per se.

Experience with an adolescent pregnancy program. A preliminary report.

A program has been designed to give comprehensive health care services to pregnant adolescents. The program components include community liason, patient education, counseling and social services, a nurse "on call" program for labor and delivery, and pediatric nurse-practitioner followup. In addition, a drug use identification component screens the patients by interview and urinalysis. Hypertensive disorders of pregnancy occurred in 10% of the first 202 patients. Forty-three percent had anemia (hematocrit less than 35%), and screening cervical cultures for gonorrhea were positive in 3.5%. Cigarettes, alcohol, and marijuana constituted the most common nonmedical drugs used, and aspirin the most common medical drug. Eighty-one percent of the patients attended 7 or more antenatal visits, one-half did not miss a single clinic appointment, and 95% completed a post-partum visit, indicating that the program was well accepted by the adolescents.

Patient acceptance of nurse-midwife in a private group practice.

Forty private obstetrical patients cared for by a group practice employing a nurse-midwife were interviewed. Half of the study group accepted the nurse-midwife for delivery. The other 20 were delivered by an obstetrician. Acceptance of prenatal care by the nurse-midwife was found to be favorable. Patients reported feeling more comfortable with the nurse-midwife and perceived her as more understanding, sympathetic and available to answer questions than the physicians. The initial encounter with the nurse-midwife differed significantly between those in the two delivery groups. Patients accepting the nurse-midwife for delivery were more likely to have first met her alone while those who chose to be delivered by an obstetrician-gynecologist were more likely to have been introduced to the nurse-midwife by the physician. The implications of this initial "imprinting experience" on the acceptance of the nurse-midwife for delivery are discussed.

Continuing education of obstetricians and gynecologists in fertility management.

One of the current fundamental problems in medicine is the massive quantity of new information that continues to develop and the requirement for the application of these data to good patient care. New techniques of merit need to be placed rapidly in the patient-care arena and the time lag between the steps from laboratory to clinic minimized. One approach to the achievement of the goal in fertility management is described in the following report; namely, a summary of the results of an education program in fertility management established in November, 1972, for the continued education of obstetricians and gynecologists from "developing countries". This report reviews the experience and data derived from the first 95 physicians completing a course in population dynamics. An estimate of the factual knowledge that these individual physicians possessed at the beginning of the course is compared with an estimate of the knowledge acquired within the 4 week training program. In a similar manner, an important part of this survey was a study of the attitudes of the clinical fellows in the areas of sex education, contraception, sterilization, and abortion. The results of this study suggest that newly developed techniques in clinical medicine may be taught to a specific and highly motivated group in an effective and efficient manner. The initial interest and response of physicians for admission to this program have demonstrated the need for the development of more similar educational programs.

Second thoughts on dementia. Evaluation and management of patients with mild dementia.

The early recognition of dementia along with consideration of differential diagnosis and elucidation of its underlying causes is of paramount importance because many of these conditions are remediable, given proper diagnosis and adequate treatment. The purpose of this article is to emphasize possible alternatives to the grim sentence of slowly progressive irreversible deterioration of personality and intellect when the verdict of dementia is pronounced.