John Parks

Emotional reactions to pregnancy

0 BSTETRICIANS and gynecologists have unusual opportunities to direct patients in healthy attitudes regarding sex, childbirth, and parenthood. A number of physicians in our specialty1-7 have recently recorded the adva.ntages of evaluating the emotional along with the physiologic and pathologic processes in pregnancy. During the past fifty years motherhood has gained a great scientific margin of safety. As we progress into the second half of this century, we find physicians with an increasing interest in the emotional factors which contribute to the good health of their patients. The purpose of this presentation is to direct attention to certain emotional reactions to pregnancy which form an important part of everyday obstetric practice. We all understand the influence of medical terminology on the lives of our patients. Obstetricians are particularly aware of the interest patients have in the words applied to pregnancy. Practically all women have some apprehension about pregnancy and, as physicians, we sometimes contribute our share to their fears. Historically, women (and men) have been indoctrinated with the impression that childbirth is an ordeal, unshapely, painful, and dif

Premarital Gynecologic Examination

ult. The background of parenthood is based on this unpleasant premise. While science has made childbirth a relatively safe experience, obstetrics is stil1 handicapped by a fright-provoking terminology which includes such words as labor pains, lacerations, forceps, dry labor, rupture of the bag of waters, hemorrhage, abortion, stitches, shots, cesarean section, and mortality. As we physicia.ns work and think in these terms, it is little wonder that our patients grasp an eerie sense of the abnormal about pregnancy. It is a common experience for a young girl, about to have her first infant, to have a middle-ofthe-night conversation with her obstetrician regarding the frequency and duration of her ‘(labor pains,” the presence or absence of “bleeding,” and a question of whether or not the “bag of waters has ruptured.” Final instructions frequently are, “Go into the hospital when your pains are five to ten minutes apart. ” Following such a conversation the stage is set for a tough time. The husband is convinced that something quite traumatic is going to happen to his wife, and she begins to wonder if the weird stories she has heard about delivery are really true. A physician can rarely contribute as much to the self-confidence of a couple as at the time of childbirth. “Nothing in the life of a man or woman is going to be as important to themselves or to society as their parenthood.“* Parenthood starts with the

Genetics and gynecologic practice

Young persons who consult physicians for premarital examination and counsel should leave our offices with a healthy knowledge of their anatomy, a feeling of adequacy and self-confidence, and a wholesome approach to marriage and parenthood. The wise couple seeks guidance and information from a professional counselor or physician and avoids discussing intimate features of family life with anyone else. The young woman who gains confidence in her physician through the premarital examination will return after marriage for the follow-up and prenatal care so essential to her gynecologic health.

Reactions of the vulva to systemic diseases.

T H E obstetrician-gynecologist in his daily responsibilities has a fundamental interest in human development. Few clinicians and scientists have a better opportunity than he to practice preventive and early corrective medicine. Applied research which leads to an understanding of the early development of human life should bring dividends in better health throughout all of life.17 The purpose -of this presentation is to demonstrate how the gynecologist may apply recent advances in genetics to his daily practice. When Barr and Bertram discovered a “nucleolar satellite” associated with the nucleolus in the neurons of adult female cats and postulated that this chromatin product was derived from the heterochromatin of the sex chromosomes, a new avenue of investigation and clinical application of genetic sex differences was established. Cytogenetics measure for hydramnios or as a diagnostic procedure in erythroblastosis, examination of the cellular content for female chromatin bodies should be done as an added informative test. ParkI has further demonstrated that sex chromatin is first seen in approximately the twelfth day in the trophoblast and at about 16 days in the human embryo. Genetic sex can be determined early in life. Advances in our knowledge of hereditary blood types and acquired antigen-antibody reactions have prepared us to anticipate potential fetal and maternal hazards among incompatible Rh and ABO blood systerns.l’ G, lo, 18, 22 Mutual responsibility for the well-being of the newborn in these conditions is shared with the pediatrician, hematologist, and pathologist.

Stricture-forming lesions of the female genitals and rectum

Abstract Regional reactions of the vulva to a number of noninfectious systemic diseases may be explained by anatomic and metabolic factors peculiar to this area of the body surface. Because of its vascularity, abundant nerve supply, frequent trauma, constant contamination, warmth, moisture, and variable histologic structure, the vulva frequently reflects deficiency diseases, metabolic disorders, and allergic reactions. The gynecologist is often consulted concerning lesions of this area which are, in reality, indications of internal disease. Some clinical points in identification of vulval lesions associated with such diseases as diabetes mellitus, pernicious anemia, aplastic anemia, uremia, vitamin deficiency, chronic atrophic dermatitis, certain common dermatologic conditions, and allergic reactions have been described and illustrated with colored slides.

Care of the Postmenopausal Patient

Abstract 1. 1. Attempts have been made in the District of Columbia, at Gallinger Municapal Hospital, to develop facilities for the diagnosis and treatment of lesions of the female genitals. 2. 2. The use of sodium salt of sulfanilic acid in the treatment of lymphopathia venereum has been discussed. 3. 3. Corrective surgical procedures can be utilized in lymphopathia venereum of the vulva, the healing phase of granuloma inguinale and in the papillomatous growth of condyloma acuminatum. 4. 4. We have not necessarily explored new fields but have applied established diagnostic procedures. Only in this way can a higher percentage of correct diagnoses be made and proper therapy instituted.

Median episiotomies and complete perineal lacerations

The physician has a responsibility to the growing number of postmenopausal women in our society. With proper treatment these women can stay youthful, useful, healthy and happy. Properly administered estrogen replacement therapy will provide a feeling of well-being and eliminate many postmenopausal problems. Postmenopausal attention also may consist of guidance and possibly treatment to improve marital relations, prescribing a course of self-improvement, activity or a change of scenery, and “just listening.”