Q 1. 1 For whom has this e-book been written?

This e-book has been written for those who may have a gynaecological problem, for those who know someone who has, and for those who wish to learn more about women’s health. It is for discerning people who wish to appreciate the background to treatment options. Nurses, medical students, trainee gynaecologists and general practitioners looking for a text that discusses the issues rather than just the essential clinical facts may find this book helpful not only for gynaecology and women’s health, but as a framework for the caring aspects in the art of medicine.

Q 1. 2 Why has this book on women’s health been written?

Research has shown that most of the information given to patients by their doctors is forgotten within a short time. Explanatory leaflets enhance understanding and increase patient compliance leading to increased treatment success. For several years, the author has provided information leaflets for patients. These take the format of questions and answers. The questions are those most frequently asked by our patients and the answers are those provided in our clinic setting. Many patients have commented on how helpful they find these leaflets and medical students and junior doctors often request a full set.

It was at the recommendation of many of my patients and trainees that I embarked on writing this book. Extensive cross-referencing has been utilised to assist understanding.


References:

Physicians in health care management: 7. The patient-physician partnership: Changing roles and the desire for information (1994) 01-02-1198

Q 1. 3 What are the objectives of this book?

A modern woman wishes to understand her treatment and to be treated with understanding. She requires sufficient knowledge to assist her in making an informed choice whenever there are treatment options. Successful gynaecological treatment relies on a partnership between the patient and her chosen doctor. In writing “Frequently Asked Questions on Women’s Health,” the author has attempted to explain:-

• most aspects of women’s health in simple terms.

• essential medical words and expressions.

• the structure (anatomy) and function (physiology) of the female reproductive organs.

• the disorders (pathology) that may occur with the structure or function of the female genital organs.

• the medical and surgical treatment options.

• the potential advantages and disadvantages of each treatment.

It has been estimated that every ten years mankind doubles scientific knowledge. In other words, we accumulate as much new understanding about the universe in ten years as had been learned by all previous generations. There can be little doubt that medicine in general, and obstetrics and gynaecology in particular, have more than kept pace. This would mean that since the author first attended medical school thirty years ago there would have been an eight-fold increase. It follows that medical knowledge will increase sixteen-fold during the clinical careers of doctors currently qualifying.

Knowledge can be compared to an iceberg. From a distance it appears tiny but as we get closer we see, learn and understand more although we also appreciate how much more is still to be revealed. We must ensure a diligent balance between early utilisation of medical advances and safety, for knowledge, like an iceberg, should be treated with a combination of respect and caution to avoid potential hidden dangers of titanic proportions. Many patients, as well as doctors, are understandably bewildered by this. Examples of these issues are addressed in this book whenever opportunity has arisen.

Case histories, the medical stories, of some of my patients, with their kind consent, have been integrated to illustrate real-life gynaecological problems and how they have been cared for.

It is impossible to include a detailed discussion of all the drugs (medicines) that could be used in gynaecological practice. A brief synopsis of those more frequently used has been included.

Q 1. 4 What is gynaecology?

Gynaecology is the clinical speciality caring for problems associated with the female genital tract (Figure 2.1). Obstetrics, the management of pregnancy and childbirth by doctors, and gynaecology was initially a branch of surgery becoming a speciality in its own right in the 1920’s. A significant change in philosophy with regard to training for the aspiring obstetrician and gynaecologist arose in the 1970s. Until then, most gynaecologists underwent a general surgical training before specialising. A shift towards medical treatment and an ever increasing breadth to the subject have encouraged direct entry into obstetrics and gynaecology.

Q 1. 5 What is reproductive medicine?

The arrival of refined technologies including ultrasound assessment of the pelvic organs (Q4.9), hormone tests, laser, embryology, and sophisticated hormonal treatment have changed the direction of the speciality from its surgical origins ever towards a more medical approach. Just as obstetrics and gynaecology became too large a discipline to remain within general surgery, so in turn there has been a need for sub-specialisation. Reproductive medicine focuses on medical, as opposed to surgical, treatment of gynaecological problems. Hormones are the major, but by no means the only, component of treatment.

Reproductive medicine includes the medical treatment of menstrual (period) problems (Chapters 6, 7, 8 and 24), infertility (Chapters 9-11), premenstrual tension (Chapter 25) and the menopause (Chapters 26-8). The other sub-specialities include feto-maternal medicine (high-risk obstetrics), oncology (malignancy – Chapter 32) and uro-gynaecology (bladder problems amenable to gynaecological intervention Chapters 29 & 30).

Q 1. 6 How common are gynaecological problems?

Gynaecological problems are extremely common. The following are just a few of the more frequent gynaecological questions that women often ask themselves and their professional advisors.

• Is my body working normally?

• When should I seek professional advice?

• Will I require tests and if so what will these involve for me?

• Do I require treatment?

• What will be my treatment options?

• How can I tell which will be the best treatment for me?

• How will I benefit from a particular treatment?

• Could a proposed treatment cause problems (side-effects) for me?

• Could I change my treatment if I am not happy with it?

• What is the best way for me to avoid an unplanned pregnancy?

• Will we be able to have children when we wish?

• What will happen to me at the menopause?

There are seldom simple answers to these questions. Every woman is an individual, with her own particular set of circumstances. Every clinical problem requires evaluation and the potential benefits and risks of investigations and treatments demand careful explanation and consideration. If you have a recurring pain that does not require even a paracetamol tablet it is unlikely that you would require an operation to determine the cause or remove the source of the pain – the risks of surgery are likely to be greater than the potential benefits.

A woman’s body is continually reminding her about her femininity. First there are the changes in body shape during puberty. This is followed by the menarche (first period) and then monthly periods. The majority of women have some symptoms associated with their menstrual cycles such as breast or pelvic discomfort, premenstrual tension or heavy periods. Most women have a little discharge from the vagina. Four out of five women will develop menopausal symptoms. These are all very personal and intimate matters that are rarely discussed with others. Gynaecological problems range in severity from a minor disruption of the menstrual cycle to life threatening malignancy. They may be of a physical origin such as an ovarian cyst leading to abdominal pain or distension. They may arise from hormonal changes leading to menstrual cycle disturbance or psychological (affecting the mind) symptoms such as anxiety, tension or depression. Female contraception, infertility and problems in early pregnancy are within the province of gynaecology. The range of investigations and treatments available to us is increasing rapidly. Frequently the relationship with a partner may be affected sometimes leading to marital disharmony. The media appear to thrive on women’s health issues, harping on anxieties, particularly when there is no other newsworthy story.

Q 1. 7 How much information do patients want to know about their condition?

It is apparent to all doctors that patients are seeking ever more detailed explanations for their symptoms and information to assist them with treatment options. There is a particular interest in women’s health. Many will have found a book or article in a magazine. Although few patients would wish to reach into the very depths of current research, some go as far as a computer search on the internet. These sites can provide a useful source of information although caution is required (Q4.28). At the end of most chapters of this book, a few selected Web sites have been included, which may set you on the road to some fascinating surfing. Details of support groups have also been provided.

In gynaecology, and particularly in reproductive medicine, there are quite complex issues to be addressed. It is relatively simple for a patient to understand that a “joint is wearing out” or that a “heart-valve is leaking” but hormones are an enigma to the majority. The interplay of the various hormones that are involved in the menstrual cycle, fertility, general health and the psyche are not yet fully understood even by specialists.

References:

The provision of information leaflets before colposcopy beneficial? A prospective randomised study. (1999) 01-07-2702

Patient-based evaluation of a colposcopy information leaflet (1997) 01-07-1838

Informed choice for users of health services: Views on ultrasonography leaflets of women in early pregnancy, midwives, and ultrasonographers (1996) 01-07-1584

The write stuff. Simple guidelines can help you write and design effective patient education materials (1995) 01-07-1190

Recall, retention, utilisation and acceptability of written health education materials (1995) 01-07-1189

Strategies for teaching patients: a meta-analysis (1995) 01-07-1191

Patient education: An example of one-to-one communication (1995) 01-07-1197

Exploring information-exchange in consultation: The patients’ view of performance and outcomes (1995) 01-07-1196

The effect of educational brochures on follow-up compliance in women with abnormal Papanicolaou smears (1994) 01-07-1193

Approaches to the measurement of explanation and information-giving in medical consultations: a review of empirical studies (1984) 01-07-637

A method for better physician-patient communication (1977) 01-07-462

Q 1. 1 For whom has this e-book been written?
Q 1. 2 Why has this book been written?
Q 1. 3 What are the objectives of this book?
Q 1. 4 What is gynaecology?
Q 1. 5 What is reproductive medicine?
Q 1. 6 How common are gynaecological problems?
Q 1. 7 How much information do patients want to know about their condition?
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