Linda French

Dysmenorrhea in adolescents: diagnosis and treatment.

Dysmenorrhea occurs in the majority of adolescent girls and is the leading cause of recurrent short-term school absence in this group. In the vast majority of cases, a presumptive diagnosis of primary dysmenorrhea can be made based on a typical history of low anterior pelvic pain coinciding with the onset of menses and lasting 1–3 days with a negative physical examination. Risk factors for primary dysmenorrhea include nulliparity, heavy menstrual flow, and smoking. Poor mental health and social supports are other associations. Empiric therapy for primary dysmenorrhea can be initiated without diagnostic testing. Effective therapies include NSAIDs, oral contraceptives, and pharmacologic suppression of menstrual cycles. In atypical, severe, or refractory cases, imaging and/or laparoscopy should be performed to investigate secondary causes of dysmenorrhea. The most common cause of secondary dysmenorrhea is endometriosis, the treatment of which may include medical and surgical approaches. Pharmacologic treatment of young women with pain related to endometriosis is similar to treatment of primary dysmenorrhea but may infrequently include gonadotropin-releasing hormone agonists in severe refractory cases.

Periodic Abstinence From Pap (PAP) Smear Study: Women’s Perceptions of Pap Smear Screening

BACKGROUND The purpose of this study was to explore attitudes, beliefs, and perceived barriers to risk-based cervical cancer screening through focus group interviews of patients. METHODS We conducted 8 focus group interviews of women using semistructured interviews. The investigators independently reviewed the focus group transcripts and identified the overall themes and themes unique to each question using an immersion and crystallization approach. RESULTS Women are in agreement that cervical cancer screening is important and that women should get Pap smears regularly as an important way of protecting their health. They are not open to the idea of reducing the frequency of Papanicolaou (Pap) smears, however, because they perceive annual screening to be successful in reducing cervical cancer mortality. Additionally, they have concerns about test accuracy. Women are distrustful of the rationale for reducing the frequency of Pap smears. Women’s previous bad experiences have reinforced their need for self-advocacy. CONCLUSION Women are reluctant to engage in risk-based cervical cancer screening. In this environment, risk-based cervical cancer screening recommendations are likely to be met with resistance.

Urinary Problems in Women

Women who have symptoms related to the genitourinary system present daily in a typical family medicine practice. The most common complaints are dysuria, increased urinary frequency, and incontinence. In the vast majority of cases the underlying problem is either urinary tract infection, urinary incontinence without infection, or bladder pain without infection that may be termed painful bladder syndrome/interstitial cystitis. This article discusses epidemiology, pathophysiology, risk factors, diagnosis, and treatment of these conditions.

HEALTH SYSTEM CHANGE AND ACADEMIC DEPARTMENTS

Health system change is a now a reality in the United States and presents opportunities for family medicine to contribute rational solutions to the twin problems of high cost and variable quality confronting American health care. Academic health centers in particular will need to change if they are