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Biomedical subjects

D Winaver

Publications and source records attributed to D Winaver.

13 recordsLinked to original sources

[Psychogenic amenorrhea].

Any amenorrhoea noticed outside pregnancy, lactation and menopause periods might be of organic or functional origin. Today, non organic amenorrhoea are either called hypothalamic amenorrhoea, more exactly supra hypothalamic amenorrhoea; functional amenorrhoea--this definition being characterized by its lack of any anatomic substratum; or, psychogenic amenorrhoea--an etiologic definition. Like any amenorrhoea, functional or psychogenic amenorrhoea is the consequence of either anovulation or endometrial hypotrophy. Neuroendocrine sciences do open new exciting research perspectives but other ways all the more promising since hormonal mechanics would not be the explanation. Work on the unconscious is indeed the other road leading to these psychogenic amenorrhoea. The term "psychogenic"--of psychological origin--does not mean of unknown origin, provided we recognize the strong link between psyche and soma. Treatment for this kind of amenorrhoea is twofold: medical and psychotherapeutic. Even though psychological etiology is obvious, clinical examination must be rigorous and completed by complementary exams which will guide the therapeutics. This is reassuring to the patient for the gynaecologist she chose to consult is implied, and not the psychotherapist. This reassures us too, because what we care for, as doctors, is first of all the body. Psychotherapeutic support can be provided by the general practitioner or the gynaecologist, both with psychosomatics training, but a multidisciplinary approach must often be worked out.

Amenorrhea↗

[Sexual abuse: what gynaecologists hear].

For the last decade, it has become impossible for us to ignore the reality, frequency and psychopathological consequences of sexual abuses, even if those seldom constitute the official motive of patients' consultation. Many victims still hold to their secret. Hints such as behavior in our consultation rooms, way of expressing gynecological problems and certain sexual troubles should enable us to perceive their suffering. As for its cause, some patients, given enough time and empathy, will be able to open up and reveal it. It will take a long time as well as the help of other specialists to find the path towards repairing the damage.

Attitude of Health Personnel↗

[Sex and love].

Sex is established as soon as spermatozoid and ovule have met. Except for rare cases of ambiguity, you clearly see at birth whether the baby is a boy or a girl. This mere factual difference evolves into sexual identity through childhood and fully blossoms in teenagers. Is sexual maturity happily completed then? Not always. Unrational sexual pulsions and survival instincts belong to the whole animal species but for man's child, as soon as he is born and until he dies, feelings will be intimately involved with sexuality in all its various stages. Teenagers' sexuality is both the end stage of childhood sexuality, being as such full of psychological traps, and the beginning of a search for a balance between sex and love, which is perhaps our modern way of trying to achieve self-fulfilment and happiness.

Adolescent↗

[Breast cancer: the unspeakable].

The drama with the language is that "putting in words" creates an uncrossable chasm between the felt and the expressed. There are moments where the impossibility to communicate cuts the links between doctor and patient. And this often happens in a consultation after the breast cancer has been announced. The unspeakable then, stands between the two protagonists, as the spectral appearance of death. For the patients, the medical revelation then becomes an anathema. The doctor who says the word, becomes the one who overturns a destiny for ever. One knows from greek mythology that confronted to the tragic of his destiny, man hears the ineluctability of the oracle but cannot accepts it. It is the role of the psyche to divert the prophecy so as to have space for hope, for a project of live. To tell, not to tell, how to tell: there is no rule. The misunderstanding is inexorable: it sighs the discordance between the medical reality of the breast cancer, the subject desire and the implication of the doctor who is wedged between the one and the other.

Breast Neoplasms↗