Nadine Farag

Update: A 60-Year-Old Woman With Sexual Difficulties

Update: A 60-Year-Old Woman With Sexual Difficulties IN A CLINICAL CROSSROADS ARTICLE PUBLISHED IN FEBRUary 2007, Jennifer E. Potter, MD, discussed the impact of menopause on female sexuality, the pathophysiology of female sexual dysfunction, and the available treatment options. Ms B, a happily married 60-year-old postmenopausal woman, described the sexual relationship with her husband as an important part of her marriage. After reaching menopause at the age of 58 years, Ms B underwent bladder suspension surgery for incontinence and hysterectomy for uterine fibroids. Following these surgeries, she began experiencing vaginal dryness and noticed her desire for intimacy had decreased. She also found that it was more difficult for her to achieve an orgasm. At that time, Ms B was treated with esterified estrogen, 0.625 mg/d, and methyltestosterone, 1.25 mg/d. These hormones improved her symptoms but were discontinued because of concerns about adverse effects. She was later treated with an estradiol vaginal ring. While this helped her vaginal dryness, it did not increase her desire. Ms B wondered what she and her husband could do to revitalize their sexual relationship—whether there were medications she could take or lifestyle changes she could undergo to improve her sexual function. In her article, Dr Potter discussed that as women age and go through menopause, hormonal changes frequently cause a gradual decline in sexual desire, slower arousal, and difficulty achieving orgasm. Although there are few reliable tests for menopause-induced sexual dysfunction, Dr Potter thought that Ms B’s symptoms were consistent with the expected progression. There are no universal solutions, but Dr Potter recommended that Ms B try a number of simple measures to enhance her sexual desire. For example, she suggested that Ms B and her husband increase the adventure in their intimate life by experimenting with different sexual positions, new venues, and sex toys. She thought that Ms B would benefit from the use of a mechanical device such as a vibrator or a clitoral pump to increase the intensity of clitoral stimulation and from continued use of lubricants and topical estrogen.

Update: A 27-Year-Old Woman With a Diagnosis of Polycystic Ovary Syndrome

Update: A 27-Year-Old Woman With a Diagnosis of Polycystic Ovary Syndrome IN A CLINICAL CROSSROADS ARTICLE PUBLISHED IN FEBruary 2007, Richard S. Legro, MD, discussed the epidemiology, causes, diagnostic considerations of, and treatment options for polycystic ovary syndrome (PCOS). Ms R, an otherwise healthy 27-year-old woman, was diagnosed as having PCOS after experiencing weight gain, periods of amenorrhea lasting up to 4 months, and development of mild facial hair growth and acne. Although her blood work results were normal, her physician confirmed her diagnosis with an ultrasound that showed numerous small ovarian cysts. She subsequently began taking oral contraceptives, which regulated her menstrual cycle. Ms R continued to gain weight despite her healthy diet, active lifestyle, and regular exercise. Troubled by her inability to control her weight, she wondered if this weight gain was related either to PCOS or oral contraceptives. In addition, Ms R was balancing the risk of blood clots associated with oral contraceptives against the benefits of using such pills to manage her PCOS. Dr Legro suggested that Ms R continue taking oral contraceptives, particularly since she was at very low risk of developing blood clots. In addition, although Dr Legro did not attribute Ms R’s weight gain to either PCOS or oral contraceptives, he encouraged her to maintain her physical activity and to consider seeing a dietitian.

Update: A 35-Year-Old Physician With Opioid Dependence

Update: A 35-Year-Old Physician With Opioid Dependence IN A CLINICAL CROSSROADS ARTICLE PUBLISHED IN SEPtember 2004, John R. Knight, MD, discussed the epidemiology of physicians struggling with substance abuse, as well as risk factors, treatment options, and prospects for returning to practice. The patient, Dr L, was a 35-year-old specialist who began using hydrocodone after self-treating his symptoms for an upper respiratory tract infection with a codeine-containing cough suppressant. His use escalated, and Dr L was taking approximately 200 mg/d of hydrocodone during the course of his 18-month addiction. He sought no medical care during this period. After being confronted by his employer, Dr L was referred to a state physician health program, which required him to complete a 3-month inpatient stay at an addictions center if he wanted to retain his license. When we first interviewed Dr L, he was midway through his inpatient stay. In his article, Dr Knight recommended that Dr L complete treatment and enter into an agreement with the state health program. Dr Knight thought that frequent attendance at support meetings and ongoing therapy would be an essential element to Dr L’s recovery. Finally, Dr Knight believed Dr L would benefit from working through the 12 steps of recovery.

Update: A 76-Year-Old Man With Macular Degeneration

Jorge Arroyo, MD, discussed the epidemiology and pathophysiology of age-related macular degeneration (AMD). The discussion centered on Dr G, a 76-year-old semiretired surgeon devastated by the loss of depth perception in his right eye because it prevented him from continuing to practice surgery. Three years prior to the conference, Dr G noticed subtle vision changes, which progressed, resulting in a diagnosis of AMD. After the diagnosis, Dr G received photodynamic therapy to the right eye 5 times, twice with the experimental addition of intraocular triamcinolone. Despite these treatments, Dr G lost vision in his right eye. At the time of the conference, Dr G was primarily concerned with protecting the vision in his left eye, allowing him to maintain autonomy and function with general ease. Dr Arroyo suggested that Dr G meet with a visual rehabilitation specialist to discuss strategies to help him overcome the functional limitations of his vision loss. Dr Arroyo also advised Dr G to adhere to a diet high in fruits, vegetables, fish, and nuts and to take a daily Age-Related Eye Disease Study (AREDS)– recommended antioxidant and zinc formulation. Finally, Dr Arroyo recommended that Dr G’s depressive symptoms be addressed and treatment provided if necessary.