Introduction Description: Infection by Haemophilus ducreyi results in chancroid, a group of infrequently encountered sexually transmitted infections (STIs). Chancroid is more common than syphilis in some areas of Africa and Southeast Asia, but it is uncommon in the United States. Prevalence: In the United States, 10–15 cases per year are reported (8 cases in 2019), generally in small, sporadic outbreaks (underreporting and lack of testing may…

Introduction Description: Sexual dysfunction/anorgasmia is the lack of interest in sexual expression or sexual contact or the inability to achieve orgasm. Most studies indicate that only 30%–40% of women are able to experience orgasm during intercourse, and up to 15% of sexually active women have never experienced sexual release. Some limit the appellation of “dysfunction” to only those cases involving personal distress. (Dyspareunia is discussed separately…

Introduction Description: Rape and sexual assault encompass manual, oral, and genital contact by one person without the consent of the other in a way that would be considered sexual in a consensual situation. It does not require penetration, ejaculation, force, or evidence of resistance—only the lack of consent. The legal definition varies slightly by location, but it often includes elements of fear, fraud, coercion, or threat.…

Introduction Description: Pyelonephritis is an infection of the kidney or upper urinary tract. Prevalence: More than 200,000 cases per year in the United States. Acute pyelonephritis during pregnancy: 0.5%–2%. Predominant Age: Any. Genetics: No genetic predisposition known. Etiology and Pathogenesis Causes: Pyelonephritis generally develops when pathogens associated with a bladder infection (most commonly Escherichia coli ) ascend to the kidneys via the ureters. Seeding of the…

Introduction Description: Pruritus ani is the acute or chronic itching (generally intense) of the anal and perianal skin. Patients also may have complaints of vulvar itching or of a vaginal infection that has not responded to therapy. Prevalence: Common; 1%–5% of the population. Predominant Age: All ages. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Anal disease—fissures, fistulae, infection (bacterial, fungal, pinworms, scabies), neoplasia, hemorrhoids, leakage…

Introduction Description: Premenstrual syndrome (PMS) and the more severe variant of premenstrual dysphoric disorder (PMDD) involve physical and emotional symptoms that are characterized by their relationship to menses. Symptoms are confined to a period of not more than 5 days before the onset of menstrual flow with complete resolution at or soon after the end of menstrual flow. Symptoms must persist over three or more consecutive…

Introduction Description: Postcoital bleeding is vaginal bleeding that occurs following sexual intercourse. Prevalence: Common (5%–10% women per year, up to 13% of women 20–34 years old). Predominant Age: Reproductive age and beyond. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Uterine (pregnancy, endometrial polyps, endometrial hyperplasia, endometrial carcinoma, leiomyomata, intrauterine contraceptive device [malpositioned]), cervical (polyps [5%–18% of cases], cervicitis [ Chlamydia cervicitis 2%], cervical erosion [ectropion,…

The Challenge The challenge is to identify patients who may benefit from pessary therapy and to effectively select, fit, and monitor pessary use. Scope of the Problem: As the population ages, the prevalence of pelvic relaxation disorders will increase. Pessary therapy offers an attractive, effective, nonsurgical therapy for many of these patients. Patients with symptomatic pelvic relaxation, uterine retroversion, cervical incompetence, or urinary incontinence may benefit…

The Challenge Description: A palpable or otherwise discernible mass or swelling in the abdomen or pelvis. Scope of the Problem: The finding of a mass can be disconcerting to both the patient and the provider. For women from adolescence to senescence, the finding of a mass conjures concerns about reproductive tract pathologies, ranging from the benign to malignant. Objectives of Management: Identify the type and origin…

Introduction Description: Osteoporosis is characterized by the loss of bone mass (calcium) and microarchitectural disruptions that puts the patient at risk for fracture with minimal trauma or during activities of daily living. This process disproportionately affects older women, resulting in significant morbidity and mortality. Estimates of medical costs are as high as $10 billion each year in the United States. Prevalence: Of women older than 75…

Introduction Description: Obesity is a state of increased fat and lean body mass (>20% higher than ideal weight; body mass index [BMI] ≥30 kg/m 2 ) that is associated with increased health risks. Obesity affects more women than men and is of special concern in adolescents and older women. Weight gained during pregnancy (in excess of that related to the pregnancy) is often not lost. Prevalence:…

Introduction Description: Myofascial syndrome is characterized by muscular and fascial pain and is associated with localized tenderness and pain referred to sites that are often remote. Myofascial pain syndromes and fibromyalgia frequently demonstrate trigger-point involvement. These syndromes may present as chronic lower abdominal or pelvic pain that is easily confused with gynecologic causes. Prevalence: 3% of the population. Approximately 15% of women with chronic pain syndromes.…

Introduction Description: Benign proliferations of melanocytes (junctional nevi) are often referred to as melanomas. Malignant melanoma is the malignant degeneration of cells from the melanocytic (pigment) system. Although generally a skin lesion, malignant melanomas may arise in any pigmented tissue (eg, the eye). The vulva accounts for 5%–10% of all malignant melanomas in women, despite containing only 1% of the skin surface. Prevalence: 4.5/100,000 people; an…

Introduction Description: Pain located in the lower portion of the back (generally between the level of the iliac spines and the lower ribs) with radiation to the abdomen, pelvis, legs, or trunk. In women, gynecologic processes are often implicated (correctly or incorrectly) in this complaint. Low back pain is especially common during pregnancy. Prevalence: Common (>80% suffer some form of low back pain during their lifetime,…

Introduction Description: A functional syndrome of intermittent abdominal pain, constipation, and diarrhea related to hypermotility of the gut in the absence of any organic cause. Prevalence: 15% of the population. First described in 1818 and accounts for 50% of all visits to gastroenterologists; 2.4–3.5 million physician visits per year and an estimated 2.2 million prescriptions. Despite the prevalence of irritable bowel syndrome (IBS), only approximately 25%…

The Challenge The challenge is to assist couples who experience difficulty conceiving through normal means. Scope of the Problem: The inability to conceive and bear children affects 6%–12% of the American population. Under ordinary circumstances, 80%–90% of normal couples conceive during 1 year of attempting pregnancy. Infertility is generally defined as failure to conceive after 1 year of regular, unprotected intercourse (or after 6 months for…

Introduction Description: Reduced or inadequate circulating levels of thyroid hormone. Women are 5–10 times more likely to suffer from hypothyroidism than men. Menstrual disturbances may be the first indication of this abnormality. Some women develop a transient (3–4 months) hypothyroid state (painless subacute thyroiditis) after giving birth. Prevalence: 5–10/1000 general population; 6%–10% of women older than 65 years. Predominant Age: Older than 40 years. Genetics: No…

Introduction Description: Hyperthyroidism is the excess production of thyroid hormone. It is three times more common in women than in men and may result in menstrual irregularity or fertility disturbances or may complicate pregnancy. It may occur because of Graves autoimmune disease (most common) or toxic single or multinodular goiters. Trophoblastic tumors or dermoid cysts may rarely be the cause. Prevalence: 1/1000 women; 0.1%–0.4% of all…

Introduction Description: A hemorrhoid is a symptomatic dilation of the hemorrhoidal venous plexus that results in perianal swelling, itching, pain, hematochezia, and fecal soiling. The dentate line demarcates internal and external hemorrhoids. Prevalence: Present in 50%–80% of all Americans. Predominant Age: Adult (peak age 45–65); more common after pregnancy. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Dilated rectal venous plexus with varying degrees of inflammation.…

Introduction Description: Hematuria is the presence of blood, either microscopically or macroscopically, in the urine. Hematuria is only a symptom and requires further evaluation to establish a cause. Hematuria should be considered an indication of malignancy until proven otherwise for those over the age of 35 years. Prevalence: Common in women. Predominant Age: Any age, most common in reproductive years in association with urinary tract infections.…