[Psychogenic amenorrhea]. / Aménorrhées psychogènes.

Any amenorrhoea noticed outside pregnancy, lactation and menopause periods might be of organic or functional origin. Today, non organic amenorrhoea are either called hypothalamic amenorrhoea, more exactly supra hypothalamic amenorrhoea; functional amenorrhoea--this definition being characterized by its lack of any anatomic substratum; or, psychogenic amenorrhoea--an etiologic definition. Like any amenorrhoea, functional or psychogenic amenorrhoea is the consequence of either anovulation or endometrial hypotrophy. Neuroendocrine sciences do open new exciting research perspectives but other ways all the more promising since hormonal mechanics would not be the explanation. Work on the unconscious is indeed the other road leading to these psychogenic amenorrhoea. The term "psychogenic"--of psychological origin--does not mean of unknown origin, provided we recognize the strong link between psyche and soma. Treatment for this kind of amenorrhoea is twofold: medical and psychotherapeutic. Even though psychological etiology is obvious, clinical examination must be rigorous and completed by complementary exams which will guide the therapeutics. This is reassuring to the patient for the gynaecologist she chose to consult is implied, and not the psychotherapist. This reassures us too, because what we care for, as doctors, is first of all the body. Psychotherapeutic support can be provided by the general practitioner or the gynaecologist, both with psychosomatics training, but a multidisciplinary approach must often be worked out.

[Sexual abuse: what gynaecologists hear]. / Abus sexuels : ce qu'en entendent les gynécologues.

For the last decade, it has become impossible for us to ignore the reality, frequency and psychopathological consequences of sexual abuses, even if those seldom constitute the official motive of patients' consultation. Many victims still hold to their secret. Hints such as behavior in our consultation rooms, way of expressing gynecological problems and certain sexual troubles should enable us to perceive their suffering. As for its cause, some patients, given enough time and empathy, will be able to open up and reveal it. It will take a long time as well as the help of other specialists to find the path towards repairing the damage.

[Sex and love]. / Sexe et sentiments.

Sex is established as soon as spermatozoid and ovule have met. Except for rare cases of ambiguity, you clearly see at birth whether the baby is a boy or a girl. This mere factual difference evolves into sexual identity through childhood and fully blossoms in teenagers. Is sexual maturity happily completed then? Not always. Unrational sexual pulsions and survival instincts belong to the whole animal species but for man's child, as soon as he is born and until he dies, feelings will be intimately involved with sexuality in all its various stages. Teenagers' sexuality is both the end stage of childhood sexuality, being as such full of psychological traps, and the beginning of a search for a balance between sex and love, which is perhaps our modern way of trying to achieve self-fulfilment and happiness.

[Breast cancer: the unspeakable]. / Cancer du sein: l'indicible.

The drama with the language is that "putting in words" creates an uncrossable chasm between the felt and the expressed. There are moments where the impossibility to communicate cuts the links between doctor and patient. And this often happens in a consultation after the breast cancer has been announced. The unspeakable then, stands between the two protagonists, as the spectral appearance of death. For the patients, the medical revelation then becomes an anathema. The doctor who says the word, becomes the one who overturns a destiny for ever. One knows from greek mythology that confronted to the tragic of his destiny, man hears the ineluctability of the oracle but cannot accepts it. It is the role of the psyche to divert the prophecy so as to have space for hope, for a project of live. To tell, not to tell, how to tell: there is no rule. The misunderstanding is inexorable: it sighs the discordance between the medical reality of the breast cancer, the subject desire and the implication of the doctor who is wedged between the one and the other.

[Contraception in adolescent girls: prevention]. / Contraception de l'adolescente: prevention.

PIP: Contraception for adolescents presents problems for physicians because the pediatricians and child psychologist with the greatest knowledge of adolescents are not the ones who prescribe contraception. Customary medical procedures may be inadequate for dealing with adolescents. Older women consulting for contraception usually themselves decide what method to choose, and their resistence to contraception and ambivalence to pregnancy can be explored. For adolescents, contraception may be a constraint rather than a choice. It may be imposed despite their conflicting desire for pregnancy and motherhood. Adolescents are usually accompanied by another person, who may make establishment of rapport difficult. If communication is not possible, it can be suggested that the examination be postponed. Attentive patience may eventually permit the examination to progress. The attitudes, preconceived notions, and emotions of the physician may prevent establishment of rapport with the adolescent patient. When contraception is imperative, there are usually no great risks in prescribing oral contraceptives even if the examination is refused. If the examination is done, the parts of the genital anatomy should be named and perhaps shown in a mirror to reassure the client that she is "normal", an important concern at this age. The examination should be used as an occasion to provide adolescents with the information they need to prevent gynecological and breast disorders, sexually transmitted diseases, cervical cancer, and other problems, and to seek prompt treatment if necessary. The immature reproductive systems and immune defenses of adolescent patients limit contraceptive choices for them, but lack of contraception brings its own serious risks of unwanted pregnancy, abortion, ectopic pregnancy, and even eventual sterility. Oral contraceptives (OCs) are completely effective, provide protection against some pelvic infections, and are safe when contraindications have been ruled out. OCs can be used before sexual activity commences, without risk to later fertility, and no interruption of the sexual act. OCs are generally well tolerated, but the daily discipline they require may be beyond the capabilities of some adolescents. The formulation should be changed if needed. Local methods provide some protection against sexually transmitted diseases but they are expensive and perhaps difficult for adolescents to obtain. Condoms can be useful if the male agrees to use them. Natural methods are unsuitable in very young girls with unstable cycles. IUDs are almost always contraindicated for adolescents because of the heightened risk of infection. Contraceptive methods should only be proposed for adolescents, never imposed. The physician should be readily available to answer questions. In the final analysis, a medical consultation is probably not the ideal approach to providing contraceptive information for adolescents, specialized centers or families might be better.^ieng

[Difficulties in female contraception resulting from sexual and emotional problems]. / Contraceptions difficiles pour la femme parce que sa vie sexuelle et affective est difficile.

PIP: Despite a wider choice and despite the progress made in the methods available, contraception remains an insoluble problem for some women. They find it difficult or impossible to select a suitable method. Adverse reactions or failure results in unwanted pregnancies or termination. It is important to try to determine what lies behind this refusal, these fears and failures, and to help the woman to escape from the damaging situation in which she finds herself trapped. (author's modified)^ieng

[A survey on the method of contraception employed by women gynecologists and by wives of gynecologists in France]. / Enquete sur la contraception des femmes gynecologues et des femmes de gynecologues en France.

PIP: A survey was conducted in France in 1978 to investigate contraceptive practices among 337 women gynecologists, and among 327 wives of gynecologists. Only 1/3 of questionnaires were returned. 80% of the women were married, over 30, with 2 children, and had never had an abortion. The IUD was found to be the most used method, with 36.6% of acceptors, against 23. 9% of pill users. Local mechanical methods were used by 17. 7% of couples, and coitus interuptus by 10.5%. Effectiveness and safety were the reasons most cited in choosing a method. 49.5% of women investigated had utilized the same method for at least 5 years. A similar survey conducted in the U.S. in previous years had yielded similar results.^ieng

[Contraception for nulliparas]. / La contraception chez la nullipare.

PIP: This panel discussion of contraception for nulliparae, in the form of questions and answers interspersed with general discussion, followed an introductory presentation by the first author (ibid: 1(1): 31-34. September 1973). The topics posed as questions were: how to judge a mature request for contraception; what are the causes of contraceptive failures and depressions; is a hypothalamic amenorrhea likely; are diaphragms, condoms, coitus interruptus, monthly pills, morning after pills, spermicides or deport injections recommended; how to prescribe contraception to a virgin; how to treat functional bleeding. There was much attention devoted to whether pills should be stopped at intervals to prevent amenorrhea. Several discussants contributed their results with IUDs and pills, and one summarized his results with 135 women under 25 years old.^ieng