1,721,118 research outputs found
Doctors and the chronic pelvic pain patient
No full textMany women with chronic pelvic pain (CPP) turn out not to have any identifiable pathology despite having undergone multiple investigations. There is no consensus as to the best management for women in this group. Although a multidisciplinary approach to diagnosis and care has been advocated as best practice, it is costly and not practical in most units in the United Kingdom, and many other countries. Clinicians need to be aware of the importance of attitude and medical consultation as factors influencing patients' outcome from investigation and treatment. While consulting styles reflect the individual personality of the doctor, we need to be aware of our own underlying attitudes and how these might enter into the dynamics of the consultation. Some patients may want to have open, non-directive consultations, some more directive consultation styles. It is, therefore, essential for the physicians to identify patients' expectations or preferences and then try to meet them, in order to attain "concordance" in communication. In this chapter, we will examine some studies that relate to the doctor-patient relationship in women with CP
The enigma of chronic pelvic pain
No full textChronic pelvic pain (CPP) remains a difficult gynaecological ‘headache’. Despite its prevalence in 15% of women in the general population,there have been limited advances made in the last decade in terms of its clinical management. In this article, we review the currentevidence available in the treatment of patients with CPP and also discuss some of the important management strategies that may provevaluable. It is important to individualise treatment based on each patient’s history, signs and symptoms. The currently available informationabout the treatment of women with CPP provides some support for the use of ultrasound scanning as an aid to counselling andreassurance, the use of progestogen (medroxyprogesterone acetate) or goserelin for pelvic congestion and (with the aim of improvedfunction and self-rating) the use of a multidisciplinary approach to assessment and treatment. Adhesiolysis has not been shown to be ofbenefit other than in women with severe adhesions. Ablation of endometriosis may provide benefit when this is the cause of CPP. Selectiveserotonin re-uptake inhibitor (SSRI) antidepressants have not been shown to be of benefit. The management of CPP remains an enigmaand much needs to be done in terms of basic science and clinical research to address this problem
Symposium: Tubal disease and fertility outcome. Controversies in the management of ectopic pregnancy
No full textEctopic pregnancy is a common clinical problem, but there appears to be much controversy surrounding the surgical management of its occurence. This paper reviews the available evidence on the management of ectopic pregnancy. The discussion focuses initially around the choice of medical versus surgical treatment. Next, the question is addressed that if surgical management is deemed necessary, whether the approach should be laparoscopic or via open laparotomy. Lastly, if surgery is undertaken, should salpingectomy or salpingotomy be performed? Laparoscopy will remain the main method of treatment for women with ectopic pregnancy, as it provides obvious advantages over open surgery. On balance, salpingotomy should be the surgical treatment of choice for the majority of women with ectopic pregnancy, as it results in a higher subsequent pregnancy rate, although there is a slightly higher recurrent ectopic pregnancy rate and persistent trophoblastic disease rate when compared with women treated with salpingectomy. There is also a place for medical treatment of women with low concentrations of human chorionic gonadotrophin. A variable dosing methotrexate regimen is more effective compared with single dose regimen, and the fixed multiple regimen is associated with a high rate of side effects
Reproductive ageing
No full textThe rate of attrition of a woman’s lifetime stock of oocytes is inexorable. Despite controversial research suggesting that under certain circumstances the ovary might repopulate itself by differentiation of stem cells into follicles and oocytes, the picture in clinical practice now, and in the foreseeable future, is one of managing the decline in fertility and increase in rates of miscarriage and chromosomal abnormalities in offspring that result from reproductive ageing in the female. ‘Unexplained infertility’ is a rare diagnosis for a couple where the woman is in her 20s, but becomes the most common cause of infertility in women over 35 years of age. This increase follows from the decline in oocyte ‘quality’ seen as the consequence of ageing in women. Quality in this context refers to a complex series of age-related changes in nuclear and cytoplasmic competence, affecting such fundamental processes as spindle formation and chromosome segregation, mitochondrial function and the integrity of the cytoskeleton. A poor-quality oocyte is less likely to fertilise and, if fertilised, will produce an embryo which is generally slow to divide and unlikely to implant. This paper will assess current methods for measuring ovarian reserve, discuss the complications of reproductive ageing and their consequences and describe available strategies to ameliorate their impact on fertility, and will also touch on reproductive ageing in the male
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