Post on 02-Feb-2023
· Commonly used AppendlX abbreviations in
A gyn(Ccology
AID Artificial insemination using donor semen. As opposed to AIH which is artificial insemination using husband's or partner's semen. The latter is usually specially prepared and injected high into the uterine cavity (HIUI or high intrauterine insemination).
AIS
BSO
BTB
CIN
COC
D&C
Adenocarcinoma-in-situ. A glandular preinvasive condition of the cervix, less common than its squamous counterpart, CIN (vide below).
Bilateral salpingo-oophorectomy. A surgical procedure removing both ovaries and fallopian tubes.
Breakthrough bleeding. A term usually applied to the bleeding occasionally noticed by some women using combined oral contraception. The bleeding occurs while the pill is being taken and not in the pill-free week. Bleeding in the pill-free week is normal and is termed withdrawal bleeding.
Cervical intra-epithelial neoplasia. A premalignant condition of the cervix.
Combined oral contraceptive. This refers to steroid oral contraceptives containing an oestrogen, usually ethinyloestradiol and a progestogen. POP refers to progesterone only pills. The term OCP means oral contraceptive pills and is a generic term for both combined and progesterone only preparations.
Dilatation and curettage. An operative procedure, usually performed under a general anaesthetic. The cervix is
ApPENDIX A 281 ..................................................................................................................
DUB
ERPOC
FIGO
GIFT
HPV
HRT
gradually dilated using a graduated set of dilators to a level where a curette can be introduced into the uterine cavity. This is then used to scrape endometrial or other tissue from the endometrium for histological analysis. The procedure is diagnostic. It is not a treatment for menstrual dysfunction.
Dysfunctional uterine bleeding. Excessive (>80 ml) or erratic menstruation where no recognizable pathology can be found . Pathologies to exclude that might account for menorrhagia or irregular cycles include fibroids, endometriosis, pelvic inflammatory disease or endometrial hyperplasia or neoplasia.
Evacuation of retained products of conception. Also referred to as an 'Evac' . This is an operative procedure performed under general, regional or local anaesthetic whereby residual placental and fetal tissue are scraped off the uterine walls following an incomplete abortion.
International Federation of Obstetrics and Gynrecology. An international body that provides standards for classification such as staging procedures for gynrecological malignancies.
Gamete intra-fallopian transfer. A method of assisted conception. Ova and sperm are inserted into the distal end of the fallopian tube under laparoscopic guidance to allow fertilization to occur in the ampullary portion of the tube.
Human papillomavirus. A group of DNA viruses. Many subtypes have been identified some of which may be oncogenic. Of particular interest in preinvasive and invasive disease of the cervix where they may be implicated in the neoplastic process (esp Types 16 and 18).
Hormone replacement therapy. Replacement of oestrogen alone or with progesterone in naturally menopausal women or in women who have had their ovaries removed. HRT is also given in situations of absent or low oestrogen production such as Turner's syndrome. In cases where the uterus remains in situ, i.e. not hysterectomized,
282 ApPENDIX A .....................................................................................................................
HSG
HSV
1MB
IUCD
IVF
K
Lap Dye
a progestogen should also be given to minimize the risk of hyperplasia and neoplasia.
Hysterosalpingogram. An imaging technique whereby radio-opaque dye is infused through a specially designed applicator through the endocervical canal. Its purpose is to highlight the endometrial cavity for abnormalities of shape and contour and also to outline the fallopian tubes. This will determine any blockage, the level and to some extent the nature of the blockage. It is usually performed as an adjunct to fertility investigations especially prior to planned tubal surgery.
Herpes simplex virus. Two subtypes, Type I and Type II. Both may cause genital herpes.
Intermenstrual bleeding. Any vaginal bleeding occurring between what a woman regards as normal menses. This may be mid-cycle as can occur at ovulation (although usually quite light) or premenstrual spotting.
Intra-uterine contraceptive device. Often referred to as a coil by women. This is a plastic device, usually containing a copper c~mponent, that is inserted into the uterine cavity as a form of contraception.
In vitro fertilization. Ova are collected from either natural or more usually stimulated cycles under ultrasound guidance. The collected ova are then mixed with sperm and fertilization and early embryogenesis supported in artificial media outside the body. The early embryo is transferred back to the endometrial cavity by the transcervical route. This was the first type of popularized assisted conception and is appropriate for women with either nonfunctional or absent fallopian tubes where GIFT and ZIFT would be inappropriate.
Koilocytosis. A short term used to describe the cytological and histological fearures associated with human papillomavirus infection (see HPV).
Laparoscopy and tubal patency test. An endoscopic procedure using a laparoscope to visualize the pelvic organs. By injecting a coloured dye into the endometrial cavity
via the cervix the patency of the fallopian tubes can be assessed. Also referred to as TPT (Tubal patency test).
LAVH Laparoscopically assisted vaginal hysterectomy.
LLETZ Large loop excision of the transformation zone. A diathermy excision technique for the treatment of women with cervical intraepithelial neoplasia.
LMP Last menstrual period. This refers to the first day of the woman's last period, i.e. the day that menstruation began. An average cycle lasts 28 days of which 3-7 days will be days of menstruation. The least consistent part of the cycle is the follicular phase whereas the luteal phase usually lasts about 14 days. Ovulation therefore occurs about 14 days prior to menstruation.
PCB Post coital bleeding. Vaginal bleeding occurring either during or after penetrative intercourse. Although carcinoma of the cervix may c-ause this, benign conditions such as a cervical ectropion can as well. Some bleeding is not unusual following the first time a woman has intercourse.
PCT Post coital test. Examination of a sample of cervical mucus shortly after sexual intercourse. This is done to assess the number and forward motility of sperms. It also shows if intercourse has taken place properly.
PID Pelvic inflammatory disease. Refers to infection of the uterus, tubes or ovaries. Most likely pathogens are gonococci, chlamydia or anaerobes.
PMB Post menopausal bleeding. This describes any episode of vaginal bleeding occurring after the menopause. The latter is usually defined as a period of 12 months' amenorrhoea which mayor may not be associated with other climacteric symptoms such as hot flushes, vaginal dryness etc.
PMS/PMT Premenstrual syndrome or premenstrual tension. A cyclical disorder seen classically in the week prior to normal menstruation. Characterized by both physical (bloating, breast tenderness, oedema) and emotional (mood swings, irritability, depression and tearfulness) symptoms.
ApPENDIX A 283
284 ApPENDIX A .......................................................................................................................................... .. .......................................................................
POD
RaFEA
STD
TAH
TCRE
TZ
Vag Hyst
Pouch of Douglas. A peritoneum-lined space lying between the posterior aspect of the cervix and upper vagina and the anterior aspect of the rectum. If this prolapses down into the vagina an enterocele forms. May contain loops of small bowel.
Radiofrequency endometrial ablation. A means of destroying the endometrium yet leaving the uterus intact. This technique employs a microwave principle ro generate heat in the endometrium.
Sexually transmitted disease. An infection contracted by sexual contact. Also GUM, genitourinary medicine.
Total abdominal hysterecromy. A surgical procedure to remove the urerus and cervix.
Transcervical resection of the endometrium. A technique where the endometrium is resected hysteroscopically using a fine diathermy loop. This is a treatment for menorrhagia that conserves the uterus.
Transformation zone. An area on the cervix between squamous epithelium and glandular epithelium where dysplasia and metaplasia occur.
Vaginal hysterectomy. A surgical procedure to remove the uterus and cervix but the approach is through the vagina. Usually combined with a repair procedure at the same time.
VE or PV Vaginal examination. A standard part of the basic gynaecological examination. The procedure is often called a BIMANUAL examination as the fingers of one examining hand are placed in the vagina while the other hand is used to palpate the lower abdomen.
ZIFT Zygote intrafallopian transfer. Similar to GIFT but fertilization and thus zygote formation occurs outside the body. The zygote is transferred back to the distal end of the fallopian tube to allow the early part of embryogenesis to occur in its natural environment .
Index
Note: page numbers in italics refer to tables, those in bold refer to figures.
Abdominal examination 20-1 Abdominal pain
ectopic pregnancy 40 ovarian cyst 51,52,53
Abortifacients 128 Abortion
missed 38, 124, 125 septic 38-9, 149 see also Miscarriage
Abortion Act (1967, revised 1991) 149
Actinomycin D 43 Acupuncture 234, 235 Acyclovir 45 Adenocarcinoma-in-situ 173 Adenomyosis 86
dysmenorrhoea 75 menstrual conditions 75-6
Adhesions endometriosis 88, 120 pelvic inflammatory disease 85
Adnexae adhesions 88 gynaecological emergencies 49-56 see also Fallopian tubes; Ovary
Adoption 122-3 Age
fertility 131 reproductive 78 see also Elderly women
Amenorrhoea 63, 64-8 ectopic pregnancy 40 infertility 116 primary 64-5 secondary 65 treatment 68
Androgen insensitivity 269 Androgens 116 Androstenedione 116 Angry patients 10-11 Anorexia nervosa 115 Anovulation 73
lactation 130 Anti-D immunoprophylaxis 37,
125 Antibiotics 134 Anticonvulsants 134 Antiprogestin 149,151 Antisperm antibodies 119 Anxiety, gynaecological cancers
189-90 Arias Stella reaction 38 Artificial insemination with
husband's sperm 119 Asherman's syndrome 67 Azoospermia 119
Backache 82 Bacterial vaginosis 100, 101, 102 Bacteroides 83 Bad news, breaking 10 Barrier contraceptive methods 13 5,
140-1, 142-3, 144-6 Bartholin's abscess 44, 278 Bartholin's gland 14, 15
cyst 44, 278 Behc;et's disease 103 Bicollis 269 Bicornis unicollis 269 Billings method 146-7 Bimanual examination 21,23,24-5 Biofeedback 234, 235
Bladder drill 234, 235 Bladder neck
endoscopically guided suspension 232-3
primary surgery 236 Blighted ovum 35, 38, 125 Blood supply
uterus 18 vagina 16
Blood vessels external genitalia 15 fallopian tubes 19 ovaries 19
Body image 260 Body temperature
charts 118 infertility investigation 115 rhythm method 146
Bowel function, pelvic pain 93, 94, 95
Breakthrough bleeding 63 Breast cancer
hormone replacement therapy 248, 249
oral contraceptives 134 sterilization 147-8
Breasts , examination 20 Bromocriptine 118
Candida 102 genital warts 106 recurrent 101-2
Candida spp. 100, 101 menopause 239
Caps 140-1, 144-5 Cervical 129
286 INDEX
Carcinogens 178 Cardinal ligaments 196 Cardiovascular disease
hormone replacement therapy 248,251
postmenopause 241 Catheterization 236 Cerebrovascular accident 241, 248 Cervical cancer
adenocarcinoma-in-situ 173 CIN 155 detection 182 geni tal warts 106 HRT 251 postmenopause 172-3 screening 154 sexual activity 179 staging 168-9, 188 symptoms 183
Cervical dilatation 70-1 anaesthesia 29
Cervical ectropion 74, 270-1 Cervical epithelium hyperkeratosis
204 Cervical excitation 84 Cervical glandular intraepithelial
neoplasia (CGIN) 154, 173
Cervical incompetence 274 miscarriage 124
Cervical intraepithelial neoplasia (CIN) 154
contraception 170-1 follow up 168 grades 161 high grade 164 human papillomavitus 155 hysterectomy 169-70 progression risk 156-7 sexual transmission 155 transformation zone 156
Cervical mucus 18 changes 146
Cervical polyps 74, 272 Cervical precancer 178 Cervical screening 182
Cervical shock 124 Cervical smear 23, 26
abnormal 154 cervical transformation zone
155-7 counselling 167-8 follow up 168 further investigation 163-4,
165, 166, 167 HRT 251 postmenopause 171-3 pregnancy 171
dyskaryosis 161, 162 explaining to women 159 results 159-61 taking 158-9
Cervical stenosis 75, 273 secondary amenorrhoea 67
Cervical transformation zone 155-7, 166
CIN 167 extension to vaginal vault 170
Cervix 17-18 bimanual examination 24-5 cautery 19 colposcopy 27-8 cone biopsy 164, 166-7 dilatation 19 double 269 gynaecological emergencies
45-6 haemorrhage 45-6 normal 162 trauma 36, 38, 46 tumours 176
Chemotherapy gynaecological cancers 191-2 ovarian function 66 palliation 192
Childbirth pelvic organ support weakening
197 psychosexual counselling 261
Chlamydia 49, 50 pelvic inflammatory disease
106-7
Chlamydia trachomatis 83, 84, 99, 100,102
specimen taking 109 Chocolate cysts 87, 90-1, 274 Cholesterol 241
progestogen effects 132 Choriocarcinoma 124, 125
trophoblastic disease 275, 276, 277
Chromosomal defect, miscarriage 123
Clean intermittent self catheterization (CISC) 236
Climacteric 63 definition 238 symptoms 239
Clitoral hypertrophy 270 Clitoris 14 Clomiphene 118 Clostridium spp. 83, 84 Coitus
pain 82 see also Dyspareunia
Coitus interruptus 128, 146 Collagen
pelvic organ support weakening 197-8
weakness 203 Colle's fracture of wrist 241, 242 Colporrhaphy
anterior 232 see also Uterovaginal prolapse,
repair Colposacropexy 208 Colposcopy 27-9
abnormal cervical smear 163 dysplastic epithelium 165 hysterectomy for CIN 170 microinvasion 168-9 postmenopause 172 pregnancy 171
Colposuspension 198,231-2 Communication 1
anxiety 10 non-verbal 4, 5-6 verbal 4-5, 6
Conception assisted 40, 119, 120-1 conditions for 113
Condom 128, 145-6 female 141 with oral contraceptives 133
Cone biopsy 75, 164, 166-7 cervical stenosis 273 secondary amenorrhoea 67
Confidentiality 3 Congenital abnormalities of female
genital tract 268 Congenital adrenal hyperplasia 65 Constipation, pelvic pain 93, 94 Consumers 1 Contact tracing II O-ll Continence
advisors 236 mechanism in women 212-13
Contraception barrier methods 135 CIN 170-1 counselling 152 effectiveness 131 emergency 134-5, 140 history 8 hormonal 131-7 non-hormonal 137-41, 142-3,
144-6 oligomenorrhoea 73-4 sexually transmitted disease 108 see also Caps; Condom; Diaphragm
Contraceptives barrier methods 140-1, 142-3,
144-6 early society 128 see also Oral contraceptives
Corpus luteum 59, 60 cyst 274
Cough, chronic 198 Counselling
abnormal cervical smear 167-8 adoption 122-3 contraception 152 gynaecological cancers 178, 187,
189, 190
infertility 121-2 microinvasion 169 miscarriage 38, 125-6 rape 264-5 sterilization 147 tubal occlusion 148-9
Crisis intervention techniques 264 Crohn's disease 103 Cryptomenorrhoea 64 Curettage 70-1
miscarriage 37 Cusco's speculum 23, 24, 26 Cystic teratoma, benign 52 Cystocele 199, 200, 201
menopausal symptom 240 repair 206
Cystometry 222-4 Cystoplasty, augmentation (CLAM)
234, 236
Dalkon shield 13 7 Danazol 71, 76, 77
endometriosis 90, 120 I-Deamino, 8-arginine vasopressin
234, 235 Depression, libido suppression 256 Detrusor contractions 227
prevention 234 Detrusor instability 214-15,217,
223 behavioural therapy 234, 235 drug therapy 234, 235 treatment 234-6 with urethral sphincter
incompetence 236 Detrusor/sphincter mechanism 213 Diabetes mellitus 251 Diagnosis 8 Diaphragm 140-1, 142-3, 144-5 Diathermy
cervical intraepithelial neoplasia (CIN) 163, 166
cone biopsy 166 Diet, candida 101 Dilatation and curettage for
menorrhagia 70-1
INDEX 287
Disseminated intravascular coagulation 124-5
Diverticular disease 93 Doctor-patient relationship 1 Dopamine 130 Double-Dutch contraceptive
method 133 Drugs 7 Dyskaryotic cells 161, 164 Dysmenorrhoea 7, 36,47-8, 63,
75 endometriosis 69, 89 management 48-9
Dyspareunia 8, 43, 82 endometriosis 69, 89 lichen sclerosus 277 sexual dysfunction 262 sexual function 260 uterovaginal prolapse repair 208 vulvitis 102
Dysuria 105
Ectopic pregnancy 34, 35, 38, 39-43
after sterilization 35 causes 40 diagnosis 40-1 HCG assay 41 IUCD 140 loss 124 management 42-3 mortality 43 pain 85 pelvic inflammatory disease 50 progesterone only pill 135 recurrence risk 42 ruptured 125 silent 40 tubal conservation 42-3 tuberculosis 86 unruptured 125
Ectropion, cervical 74, 270-1 Ehlers-Danlos syndrome 198 Elderly women, sexuality 265-6 Electrical stimulation 230 Electromyography 226
288 INDEX ............................................................................................................. .. . .....
Endocervical canal 172 Endometrial ablation for
menorrhagia 71 Endometrial cancer
endometrial hyperplasia precursor 180
hormone replacement therapy 248
oral contraceptives 134 postmenopause 173 risk factors 178 symptoms 183
Endometrial hyperplasia 180 Endometrial polyps 74 Endometrial resection 65
menorrhagia 71 ovarian function 66
Endometriosis 62, 86-8 adnexal adhesion 88 cyst formation 87, 88 dysmenorrhoea 48, 75 infertility 120 menstrual conditions 75-6 ovarian cysts 274 symptoms 69,89 treatment 90-1
Endometrium 17 endoscopic visualization 70 hormone changes 57 hysteroscopy of lining 29 proliferative phase 59 sampling 29-30, 70
Enterocele 199, 200 repair 207-8
Enuresis, nocturnal 211, 235 Environmental factors,
gynaecological cancers 179-80
Episiotomy scar 259 Escherichia coli 83 Ethinyloestradiol 131-2,134 Explanation to patients 9-10 External genitalia 12-15
Faecal incontinence 202, 203 Fallopian rubes 19
disease treatment 119-20 endometriosis 75 fimbriae 119 hydrorubation with dye 116 infection 83 occlusion 147, 148-9 pain 81-2 patency 116-17 pelvic pain 86
Family history 7 Family planning
development 129 natural 146-7
Faradism 230 Female genital tract
congenital abnormalities 268 external genitalia 12-15 infection of lower 43-5 internal genitalia 16-19
Femidom 141 Femur neck fracture 241, 242 Fertility
age 131 human 112 physiological variations 130-1 selected 57
Fertility control 128-9 early society 128 natural family planning 146-7 sterilization 147-9 technological innovations 129-30
Fertilization assisted 40
ovarian hyperstimulation 54 HCG 60
Fetus, abnormal 38 Fibroids
bleeding 47 degeneration 36, 48 dysmenorrhoea 75 infertility 115 malignant polyp 93 menorrhagia 72 pelvic pain 92 raised intra-abdominal pressure
198
red degeneration 34, 92 submucous 272
Follicle stimulating hormone (FSH)
59 infertility 116
Follicles, primordial 19 Forceps, sponge-holding 22 Fornix 16 Fothergill operation see Manchester
repair Fundus 17
Galactorrhoea 65 infertility 115
Gamete intrafallopian tube transfer (GIFT) 40, 120
Gartner's duct cysts 268 remnants 279
Genetic defects 123 Genital warts 105-6 Glutaraldehyde crosslinked bovine
collagen 233 Glycogen 16
ovarian cycle 60 Gonadotrophin releasing hormone
(GnRH) 59 agonist analogues 76 agonists 151 analogues 77, 90 antagonists 151 deficiency 64
Gonadotrophin treatment for ovulation failure 118
Gonococcus pelvic inflammatory disease 50 specimen taking 109 see also Neisseria gonorrhoeae
Gonorrhoea 99, 100 pelvic inflammatory
disease 106-7 see also Neisseria gonorrhoeae
Griseofulvin 134 Gynaecological cancers 176
age 178 anxiety 189-90
causes 177-81 chemotherapy 191-2 counselling 179, 187, 189,
190 curative treatment 190 diagnosis 185-6, 187, 189 environmental factors 179 hereditary factors 179, 178 hormonal therapy 192 incidence 176-7, 179 investigations 185-7 management 191-2 mortality 177, 177 neoadjuvant therapy 191 operative risk 187 palliative treatment 190, 192 patient support 189-90 presentation 182-3, 184-5 prognosis 181-2 radiotherapy 191, 192 risk factors 178 sexual function 260 spread 186-7,191-2 staging 187, 188 surgery 191, 192 survival 181-2 symptoms 183 treatment objectives 190-1
Gynaecological emergencies 33 adnexae 49-56 cervix 45-6 non-pregnancy related 43-56 pregnancy 33, 34, 35-43 symptoms/signs 34 uterus 46-9 vaginal 43-5 vulval 43-5
Gynaecological examination 12, 19-25
anatomy 12-19 bimanual 21, 23, 24-5 patient positioning 20-1 vulva 21-2
Health surveillance 1 Herpes genitalis 104-5
Herpes simplex virus 103, 104-5 Herpes vulvovaginitis 44-5 Hirsutism 115,116,270 History taking 2-4
content 6-8 infertili ty 114-15 sexual problems 255
HIV infection 99 Home ovulation kits 118, 147 Hormone replacement therapy
243-4 administration route choice
247 benefits 247-8 cardiovascular disease 248 cerebrovascular accident 248 duration 248-9 history 244 implants 244, 246 medical conditions 250-1 oral 244, 245 percutaneous 244, 246 risks 248, 249 side-effects 249-50 tibolone 247 transdermal 244, 245-6 types 244-7 vaginal controlled-release
tablets 244, 247 vaginal creams 244, 247
Hot flushes 239, 249 B Human chorionic gonadotrophin
(BHCG) 41 serum levels 276, 277
Human chorionic gonadotrophin (HCG) 33
assay for ectopic pregnancy 41 assay Supra-regional Centres
125 B subunit assay 41 contraceptive vaccine 151 fertilization 60 luteal cysts 52 ovulation failure 118 trophoblastic disease 276 urinary assay 36-7
INDEX 289
Human immunodeficiency virus see HIV infection
Human papillomavirus 106 cervical cancer 155 vulval cancer 180
Huntington's chorea 147 Hydatids of Morgagni 268 Hydatiform mole 276
miscarriage 123, 124, 125 Hydrosalpinx, tubal 86 Hymen 14
imperforate 68, 268 rigid 259
Hyperkeratosis of cervical epithelium 204
Hyperprolactinaemia 64 amenorrhoea 68 infertility 116,118 ovarian hyperstimulation 54 secondary amenorrhoea 65
Hypnotherapy 234, 235 Hypogonadotrophic gonadism 116 Hypospadias 115 Hypothalamic dysfunction 119 Hypothalamic-pituitary failure 66 Hypothalamus 59
secondary amenorrhoea 65 Hypothyroidism 54 Hysterectomy
amenorrhoea 65 cervical polyps 272 CIN 169-70 endometriosis 91 fibroids 49, 72 gynaecological cancers 182 menorrhagia 71 microinvasion 169 ovarian function 66 pelvic abscess rupture 51 psychosexual problems 260, 261 radical 191 uterine bleeding 47 vaginal uterine prolapse repair 207
Hysterosalpingography 117 Hysteroscope 28, 29 Hysteroscopy 29, 30, 71
290 INDEX .....................................................................................................................
Immunosuppression candida 101 gynaecological cancers 177-8
Implantation emergency contraception 134-5 non-tubal 39 prevention 134-5, 141
in vitro fertilization 40, 119, 120 sperm dysfunction 119 tubal disease 120
Incisional hernia 203 Incontinence aids 236 Infection
cervical 106-8 dysmenorrhoea 48 fallopian tubes 83 IUCD 140 lower genital tract 43-5 miscarriage 124 pelvic pain 83-6 septic abortion 38-9 urinary tract 240 uterine haemorrhage 47 uterus 83
Infertility 112 causes 113-14 counselling 121-2 endometriosis 120 gynaecological cancer 180 incidence 113 investigation 114-18 male 117-18 PID 50 treatment 118-20 unexplained 120
Information giving 8-11 Inguinal hernia 203 Injectables for stress incontinence
231, 233 Intercourse, uterovaginal prolapse
202 Interferential therapy 230 Intermenstrual bleeding 7, 63, 74 Internal genitalia 16-19 Interview, patient-centred 4-6 Intra-abdominal pressure, raised 198
Intrauterine contraceptive device (IUCD) 137-40
bacterial vaginosis 101 CIN treatment 171 contraindications 139 copper-bearing 137, 138 development 129 dysmenorrhoea 75 ectopic pregnancy 40 emergency contraception 135, 140 insertion 138, 139 levonorgestrel-releasing 137 pelvic inflammatory disease
(PID) 50 problems 140 progestogen containing 71 , 250
Intrauterine insemination (IVI) 120 Irritable bowel syndrome
clinical signs 95 pelvic pain 94-6 treatment 95-6
Isthmus 17
Kissing ulcers 13 Koilocyte 161
Labia majora 13 ulcerating squamous carcinoma
13 Labia minora 13, 14 Lactation 65
fertility 130-1 Lactic acid 16 Laparoscopy, tubal occlusion 148 Laser
cone biopsy 166 therapy for CIN 163
Le Fort procedure 208 Levator ani 14 Levator spasm 108 Levonorgestrel 132, 134 Levonorgestrel-releasing IVCD 137 Libido
determinants 256 factors affecting 257-8 loss 255, 256
menopause 257-8 menstrual cycle 257 mood 260 sex therapy 264 sexual dysfunction 262 suppression 256
Lichen sclerosus 277, 278 Life-table analysis 131 Lippes Loop 137,138 Listening 4-5 Lower genital tract infection 43-5 Luteal cysts 52 Luteal phase insufficiency 74 Luteinizing hormone (LH) 59
home ovulation kits 147 infertility investigation 116 miscarriage 123 suppression in miscarriage
prevention 126 surge 59
Luteinizing hormone releasing hormone (LHRH)
endometriosis 120 pulsatile 119
Luteolysis 60 Lymphatic drainage
external genitalia 15 fallopian tubes 19 ovaries 19 uterus 18-19 vagina 17
Magnetic resonance imaging 226-7 Malignant melanoma 147-8 Management plans 3 Manchester repair 207 Marshall-Marchetti-Krantz
operation 231, 232 Maximal electrical stimulation 234,
235 Medroxyprogesterone acetate 136 Mefenamic acid 71, 75 Menarche 58, 61, 63
age 7 failure to establish 64-5 fertility 130
Menopausal problems 238 Menopause 63
abnormal cervical smear after 171-3
age 7 definition 238 fertility decline 130 late and gynaecological cancer
180 libido 257-8 management 243 oestrogen loss 172 premature 68 prolapse 198 squamocolumnar junction 172 symptoms 238-42 woman's view 242-3
Menorrhagia 7,36,63,69-72 causes 69-71 fibroids 72 IUCD 140 levonorgestrel-releasing IUCD
137 management 71-2
Menstrual cycle 57 anovulatory 180 libido 257 model 60,61
Menstrual history 7 Menstrual problems
age 77-8 patient concerns 77
Menstruation abnormalities 62, 63, 183 associated conditions 75-7 frequent 74 loss 61 normal 58-61 painful see Dysmenorrhoea retrograde 64
endometriosis 76, 87 uterine bleeding disorders
62-3 Mental handicap, sterilization 148 Mestranol 132 Metastases, vaginal 17
Methotrexate 43 Methylene blue dye 116 Metropathic bleeding 73 Microinvasion 168-9 Micturition 210-12 Miscarriage 34, 35, 112
cervical incompetence 274 complete 37-8 counselling 125-6 diagnosis 36-9, 124-5 histological evaluation 38 history 6 incidence 36 incomplete 37-8 inevi table 37 investigations 125 management 125-6 reasons 123-4 recurrent 126 threatened 36-7,124,125 see also Pregnancy, loss
Mole, invasive 276 Mons pubis 12, 13 Mosaicism 65 MUllerian ducts
failure to develop 269 fusion disorders 65, 268
MUllerian system suppression 269-70
Myocardial infarction 241 Myomectomy 72
cervical polyps 272 fibroids 49
Nabothian follicles 272 Neisseria gonorrhoeae 83, 99, 102
see also Gonococcus; Gonorrhoea Neoadjuvant therapy 191 Neonates, herpes simplex infection
104-5 Nerves
external genitalia 15 fallopian tubes 19 ovaries 19 uterus 19 vagina 17
INDEX 291
Night sweats 239, 249 Nocturia, intractable 235 Norethisterone 132
enanthate 136
Obesity infertility 115, 116 oestrogens 180 raised intra-abdominal pressure
198 uterovaginal prolapse recurrence
208 Oestradiol implants 246 Oestrogen
cardiovascular disease protection 241
combined oral contraceptives 131,132
deficiency bone loss 241 states 238 vaginal lubrication 265
detrusor instability 234, 235 endometrial hyperplasia 180 endometriosis 90 hormone replacement therapy
243 libido restoration 258 obesity 180 ovarian cycle 59 premenstrual syndrome 77 sexual desire 256 side effects 132 stress incontinence
postmenopausal 213 replacement therapy 230
vaginal levels in elderly 266 Oestrogen-dependent malignancy
250 Oligomenorrhoea 73-4
infertili ty 116 Oligospermia 119 Oophorectomy
bilateral 66 pelvic congestion 92
Ophthalmia neonatorum 107
292 INDEX
Oral contraceptives amenorrhoea 67 cancer 134 candida 101 combined 131-4
cervical ectropion 271 contraindications 133 development 129 drug interactions 134 dysmenorrhoea 75 ectopic pregnancy 40 premenstrual syndrome 77 progesterone only pill 135-6 taking 133
Orgasm sexual dysfunction 262 uterine contractions 260, 265
Orgasmic ability after childbirth 261 elderly women 265
Osteitis pubis 232 Osteoporosis 241-2
hormone replacement therapy 248
Outpatient examination 26-30 colposcopy 27-9 patient selection 26
Ovarian cancer 92, 177, 185 disease spread 186-7 HRT 251 mortality 177 oestrogen-secreting 180 oral contraceptives 134 ovulation 180 presentation 182 raised intra-abdominal pressure
198 risk 178, 182 survival 181 symptoms 183 treatment 190
Ovarian cysts 34,36,51-6,274-5 dermoid 275 endometriosis 75-6,89, 120 germ cell tumours 275 haemorrhage 53-4
malignant 274-5 pelvic pain 92 rupture 53-4 torsion 52, 53-4,92 types 52
Ovarian failure, premature 63, 116
Ovarian hormone cycle 57, 59 changes 59-61 proliferative phase 59 secretory phase 60
Ovarian vein thrombosis 50-1 Ovary 19
bimanual examination 25 dermoid tumour 52,53 endometriosis 75, 87 hyperstimulation 54-5 pain 81-2 secondary amenorrhoea 66 stimulation failure 64 tumours 176
Overflow incontinence 216 Ovulation
failure treatment 118-20 induction 54-5 infertility investigation 115-16 inhibition for emergency
contraception 134-5 ovarian cancer 180 postpartum 130 predictor kits 118, 147
Pad testing 220 Pain
organic 81 ovarian 81-2 psychogenic 81 tubal 81-2 uterine 81 see also Dysmenorrhoea;
Dyspareunia Parity, gynaecological cancer 180 Patient position, dorsal 20, 23 Patient support for gynaecological
cancers 189-90 Pearl index 131
Pelvic abscess management 5 1 rupture 50-1
Pelvic congestion 91-2 Pelvic floor 14-15, 194
exercises 228, 229, 230 ligaments 196 muscles 195-6 oedema 108 weakness 214
Pelvic infection acute 83-4 differential diagnosis 84-5 investigation 84 management 84
Pelvic inflammatory disease 36, 49-50
adhesions 85 chlamydia 106-7 chronic 85 dysmenorrhoea 75 gonorrhoea 106-7 investigation 49 management 49-50 psychological effects 107-8 sequelae 50-1 sexual function 260 symptoms 107 treatment 110 tubal hydrosalpinx 86 tuberculosis 85-6
Pelvic mass 51 Pelvic organ support 195-6
weakening 197-8 Pelvic organs 16, 17 Pelvic pain 81
backache 82 characteristics 81-2 diverticular disease 93 emergency 33 endometriosis 86-8 Fallopian tubes 86 fibroids 92 infection 83-6 irritable bowel syndrome 94-6 IUCD 140
medical causes 96 ovarian cancer 92 ovarian cysts 92 pelvic congestion 91-2 sexually transmitted disease
106-8 surgical 93-4 uterine origin 47-8
Pelvic surgery, prolapse 198 Pelvis, endometriosis 87 Perimenopausal bleeding 73 Perineometer 228, 229 Perineum 14 Peritonism 51 Peri toni tis 84 Pictorial blood loss assessment
chart 69, 70 Pi pelle endometrial sampler 29,
30 Pituitary
dysfunction 119 secondary amenorrhoea 65
Placentation, abnormal 38 PLISSIT 261 Pneumococci 83 Polycystic ovarian syndrome
amenorrhoea 66 infertility 116 oestrogen levels 180 ovarian hyperstimulation 54 ovulation 73
Polycystic ovaries amenorrhoea 68 oligomenorrhoea 73
Polymenorrhoea 74 Population control 129 Porphyria 96 Post pill oligomenorrhoea 74 Postcoital bleeding 7,63,74,
183 Postcoital test 117-18 Postmenopausal bleeding 63 Postreproductive menstrual
problems 78 Pouch of Douglas 16,25
endometriosis 75, 87, 89
Pregnancy abnormal cervical smear 171 amenorrhoea 65, 67 cervical ectropion 271 colposcopy 171 complications and vaginal
bleeding 58 diagnosis 33, 35-6 emergencies 33, 34, 35-6 loss 112, 123-6 psychosexual counselling 261-2 termination 149,150,151
history 6 wedge biopsy 171 see also Abortion; Ectopic
pregnancy; Miscarriage Premenstrual syndrome 62, 76-7 Privacy 3 Procidentia 199, 202 Products of conception
cervical shock 124 histology 125 retained 37, 125
Progesterone infertility investigation 115 ovarian cycle 59-61 premenstrual syndrome 77
Progesterone only pill 135-6 Progestogen
combined oral contraceptives 131,132
depot injections 74 endometriosis 90 hormone replacement therapy
244 HRT withdrawal bleeds 249 injectable 136 pelvic congestion 91-2 premenstrual symptoms 249-
50 premenstrual syndrome 77 uterine haemorrhage 46
Progestogen-releasing silicone implants 136-7
Prolactin inhibiting factor 130 Prostaglandin E 151
INDEX 293
Prostaglandin synthetase inhibitors 48,71
Prostaglandins menstruation 57 ovarian cycle 60-1
Pseudopregnancy 90 Psychosexual counselling 260-4 Psychosexual development 256 Puberty 59
delayed 67 menstrual problems 78 sexual drive 256
Pubococcygeus muscle 259
Radiotherapy gynaecological cancers 191, 192 ovarian function 66 palliation 192 vaginal stenosis 260
Rape counselling 264-5 Rectocele 199, 200, 201-2
repair 207 Reproductive age, menstrual
problems 78 Rhesus isoimmunization 37, 125 Rhythm method 146 Rifampicin 134 Ring pessary 205-6
Salpingectomy, ectopic pregnancy 42
Salpingitis, acute abdomen 83, 84
Salpingo-oophorectomy, bilateral pelvic abscess rupture 51 uterine bleeding 47
Secondary sexual characteristics
59 Seminal fluid analysis 117, 118 Sex steroids, libido effects 257 Sex therapy 262-4 Sexual abuse, trauma 45 Sexual activity, gynaecological
cancers 179 Sexual behaviour 254 Sexual desire, control 255-6
294 INDEX
Sexual dysfunction 253-4, 262 general 256 therapy 262-4
Sexual experience, enjoyment 256 Sexual function, disease impact 260 Sexual history 2, 8
sexually transmitted disease 108-9
Sexual inhibition, general 257 Sexual intercourse
physical problems 258-9 urinary incontinence 211-12
Sexual response desire phase 255 impairment 256-7
Sexuality changes 255-8 elderly women 265-6
Sexuality problems 253 gynaecologist role 254-5 scale 254 sexual dysfunction 253-4
Sexually transmitted disease 98-9 cervical infection 106-8 contact tracing 110-11 Double-Dutch contraceptive
method 133 fear 99 genital warts 105-6 investigation 108-11 lumps 105-6 partner 108-9 pelvic pain 106-8 sexual function 260 sexual history 108-9 specimen taking 109 symptoms 99-108 treatment 109-11 vaginal discharge 99-102 vulval ulcers 103-5
Sheath see Condom Shock
bacteraemic 84 cervical 124
Sick role 1 Sickle cell disease 96
Silicone implants, progestogen-releasing 136-7
Sim's speculum 21 Sling procedures 231,233 Smoking
CIN 155 gynaecological cancers 180 progesterone only pill 135 raised intra-abdominal pressure
198 uterovaginal prolapse recurrence
208 Social environment 3 Social history 7 Speculum 21
bivalve 23, 24, 26 examination 23-4 insertion 23-4
Sperm count 112 Sperm dysfunction
assisted conception 121 treatment 119
Sperm-mucus interaction 117-18 Spermicide 145
caps 141 condoms 145 cream 129 diaphragms 141
Spironolactone 134 Sponge, contraceptive 145 Spotting, intermenstrual 62 Squamocolumnar junction 27-8
postmenopause 172 Staphylococci 83 Stein-Leventhal syndrome 66 Sterilization 147-9
indications 147 pregnancy 35-6
Streptococci 83 Stress 9 Stress incontinence 202, 214
genuine 214,215,217 complex surgical procedures
231, 233 conservative management
228-30
surgical management 228, 231-4
menopause 240 postmenopausal 213
Stress profile, urethral 224 Sweating 239, 249 Syphilis 103
Tachyphylaxis 246 Tampon, retained 101,102 Tay-Sachs'disease 147 Testicular feminization 65, 68 Testosterone
infertili ty 116 sexual desire 256 subcutaneous implants for libido
258 testicular feminization 65
Tetanus toxin 45 Thromboembolic disease, HRT
2-50-1 Thrombophlebitis, pelvic 50-1 Thrush see Candida spp. Tibolone 247, 249 Tranexamic acid 71 Trauma
cervical 46 rape 264, 265 secondary amenorrhoea 67 sexual abuse 45 vaginal 45 vulval 45, 103
Treatment plans 8 Trichomonas vagina/is 100, 101, 102,
107 Trophoblastic disease 43, 275-7 Tubal occlusion see Fallopian tubes,
occlusion Tuberculosis
culture 117 pelvic 85-6 secondary amenorrhoea 67
Turner's syndrome 64-5, 68, 269
Ultrasound ectopic pregnancy 41-2
hydatiform mole 276 infertility investigation 115-16 pelvic 48 urodynamic investigations
226-7 Underwear 101 Ureteric calculi 96 Urethra 212
closure 213 hypermobility 214 sphincter mechanism 213
Urethral mucosa prolapse 240 Urethral plugs 230 Urethral pressure profilometry
224-6 Urethral sphincter incompetence
215 Urinary bladder 212
filling phase 222-3 function investigations 218-27 mechanoreceptors 213 retrograde filling 222 sphincter mechanism 213
Urinary frequency/volume charts 219-20
Urinary incontinence 202, 210-12 age 211 causes 213-16 continence advisors 236 frequency/volume charts 219-20 investigations 217-18 management 227-34 overflow 216 pad testing 220 preoperative assessment 218 prevalence 210 urodynamic investigations 217-
18 Urinary tract
infection 96, 240 menopausal symptoms 240
Urodynamic investigations ambulatory 227 basic 220-4 complex 224-7 cystometry 222-3
electromyography 226 magnetic resonance imaging
226-7 ultrasound scanning 226-7 urethral pressure profilometry
224-6 uroflowmetry 220-1 videocystourethrography 224,225
Uroflowmetry 220-1 Uterine abnormalities, miscarriage
124 Uterine bleeding
disorders 62-3 frequency 73-4 volume 64-72
dysfunctional 46 haemorrhage 46-7 menorrhagia 69-72
Uterine cancer 36, 47, 176, 184 Uterine evacuation 37, 38 Uterine fundus, hysteroscopy 30 Uterine fusion abnormalities 268-9 Uterine prolapse 199, 202
repair 207 Uterosacral ligaments 196
endometriosis 75,87 Uterovaginal prolapse 194
collagen weakness 203 conservative treatment 205-6 degrees 201 examination of patient 203-4 explaining to women 203 incontinence association 202 pelvic organ support 195-8 postoperative complications 208 recovery 208 recurrent 208 repair 206-8, 232 surgery 205 symptoms 201-2 treatment 205-8 types 198-9, 200 vaginal pessary 205-6
Uterus 17-19 bicornuate 269 bimanual examination 25, 29
INDEX 295
gynaecological emergencies 46-9 infection 83 pain 81 retroverted 18, 24
endometriosis 89 secondary amenorrhoea 66-7 supports 18, 196
Vagina 16 absent 259, 269-70 adenocarcinoma 273 gynaecological emergencies 43-5 menopausal symptoms 240 metastases 17 pessary 205-6 pH 156 size 23, 24 trauma 36 tumours 176, 273
Vaginal adenosis 272-3 Vaginal bleeding
abnormal 57-8 ectopic pregnancy 40 emergency 33 frequent menstruation 74 intermenstrual 7, 63, 74 menopause 240 postcoital 74 threatened miscarriage 124
Vaginal cones 228-30 Vaginal cysts 278-9
Vaginal infection, dyspareunia 260 Vaginal intraepithelial neoplasia
(VaIN) 170, 173-4 Vaginal lubrication 265
radiotherapy 260 Vaginal ring, progestogen-releasing
137 Vaginal septum 269 Vaginal vault
cytology 170 prolapse 199
repair 208 Vaginismus 102, 259
sex therapy 264 sexual dysfunction 262
296 INDEX .....................................................................................................................
Vaginosis, bacterial 100, 101, 102 Vasectomy 147, 148 Vertebrae, crush fracture 241, 242 Videocystourethrography 224, 225 Virilism 270 Virilizing tumour 270 Voiding difficulties, menopause
240 Voiding phase 223-4 Volsellum forceps 22, 29 Vulva 12-14
benign conditions 277, 278 cancer 184
aetiology 180-1 symptoms 183
dysuria 105 examination 21-2 gynaecological emergencies 43-5 infection and dyspareunia 102,
260 itching 100 lichen sclerosus 277, 278 menopausal symptoms 240 muscles 195 sores 100, 103-5 tumours 176 ulcers 103-5
Vulval dystrophy 180 Vulval intraepithelial neoplasia
(VIN) 173-4
cancer risk 182 Vulvectomy, radical 191 Vulvitis, dyspareunia i02, 260 Vulvovaginitis, herpetic 44-5
Warts, genital 105-6 Wedge biopsy, cervical during
pregnancy 171 Wertheims' hysterectomy 191 Withdrawal bleeds, hormone
replacement therapy 249 Wolffian system 268, 270, 278
Zygote intrafallopian tube transfer (ZIFT) 120