· 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