Lessons from a case report.
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Attitude of Health Personnel↗
Biomedical subjects
Jennifer Gunter
Publications and source records attributed to Jennifer Gunter.
Characteristics of women undergoing repeat induced abortion.
BACKGROUND: Although repeat induced abortion is common, data concerning characteristics of women undergoing this procedure are lacking. We conducted this study to identify the characteristics, including history of physical abuse by a male partner and history of sexual abuse, of women who present for repeat induced abortion. METHODS: We surveyed a consecutive series of women presenting for initial or repeat pregnancy termination to a regional provider of abortion services for a wide geographic area in southwestern Ontario between August 1998 and May 1999. Self-reported demographic characteristics, attitudes and practices regarding contraception, history of relationship violence, history of sexual abuse or coercion, and related variables were assessed as potential correlates of repeat induced abortion. We used chi2 tests for linear trend to examine characteristics of women undergoing a first, second, or third or subsequent abortion. We analyzed significant correlates of repeat abortion using stepwise multivariate multinomial logistic regression to identify factors uniquely associated with repeat abortion. RESULTS: Of the 1221 women approached, 1145 (93.8%) consented to participate. Data regarding first versus repeat abortion were available for 1127 women. A total of 68.2%, 23.1% and 8.7% of the women were seeking a first, second, or third or subsequent abortion respectively. Adjusted odds ratios for undergoing repeat versus a first abortion increased significantly with increased age (second abortion: 1.08, 95% confidence interval [CI] 1.04-1.09; third or subsequent abortion: 1.11, 95% CI 1.07-1.15), oral contraceptive use at the time of conception (second abortion: 2.17, 95% CI 1.52-3.09; third or subsequent abortion: 2.60, 95% CI 1.51-4.46), history of physical abuse by a male partner (second abortion: 2.04, 95% CI 1.39-3.01; third or subsequent abortion: 2.78, 95% CI 1.62-4.79), history of sexual abuse or violence (second abortion: 1.58, 95% CI 1.11-2.25; third or subsequent abortion: 2.53, 95% CI 1.50-4.28), history of sexually transmitted disease (second abortion: 1.50, 95% CI 0.98-2.29; third or subsequent abortion: 2.26, 95% CI 1.28-4.02) and being born outside Canada (second abortion: 1.83, 95% CI 1.19-2.79; third or subsequent abortion: 1.75, 95% CI 0.90-3.41). INTERPRETATION: Among other factors, a history of physical or sexual abuse was associated with repeat induced abortion. Presentation for repeat abortion may be an important indication to screen for a current or past history of relationship violence and sexual abuse.
Abortion Applicants↗
Topical misoprostol therapy for plasma cell vulvitis: a case series.
OBJECTIVE: To present the first reported case series of plasma cell vulvitis successfully treated with topical misoprostol. MATERIALS AND METHODS: Three women with vulvar pain and lesions secondary to plasma cell vulvitis refractory to conventional therapy were treated with topical misoprostol compounded in white petrolatum. RESULTS: All three patients had resolution of pain and lesions within 6 weeks of starting topical misoprostol. All patients tolerated the 0.01% concentration; however, local side effects were seen with the higher 0.02% concentration. CONCLUSIONS: Plasma cell vulvitis is a rare and painful vulvar disorder that is often refractory to therapy. All three patients in this case series were successfully treated with topical misoprostol. The immunosuppressive effects of misoprostol are hypothesized to be the mechanisms of action of this novel therapy for plasma cell vulvitis.
Administration, Intravaginal↗
Botulinum toxin a for vulvodynia: a case report.
UNLABELLED: Vulvodynia is a poorly understood chronic pain condition, and patients who are refractory to standard therapies often pose a therapeutic dilemma. Current treatment modalities include antidepressants, anticonvulsants, biofeedback, pelvic floor physical therapy, and surgery; however, the options are limited for patients who fail to respond to these treatments. We present a case of refractory vulvodynia with severe dyspareunia successfully managed with a novel therapeutic approach combining botulinum toxin A and surgery. PERSPECTIVE: The authors present a case of refractory vulvodynia that was successfully managed with a novel approach that combined botulinum toxin A and surgery.
Adult↗
Genital and perianal warts: new treatment opportunities for human papillomavirus infection.
Human papillomaviruses are among the most common sexually transmitted diseases in the United States. Genital warts are a common phenotypic expression of human papillomaviruses, affecting 1% of the population; therefore, the obstetrician/gynecologist will invariably be required to advise and treat patients with this clinical manifestation. Issues essential in the diagnosis, counseling, and management of patients with genital warts will be examined, including epidemiology, transmission, molecular biology, and host immune response. This review will also provide the health care professional with a thorough examination of the new patient-applied treatment opportunities for anogenital condyloma, in addition to an overview of current provider-administered therapies, to assist in patient management.
Adjuvants, Immunologic↗
Chronic pelvic pain: an integrated approach to diagnosis and treatment.
UNLABELLED: Chronic pelvic pain affects upward of 15% of women and is a frustrating condition for both patients and physicians. Chronic pelvic pain is not a disease, but a syndrome that results from a complex interaction between neurologic, musculoskeletal, and endocrine systems that is further influenced by behavioral and psychologic factors. Traditional approaches to this disorder have been surgical, although long-term success rates have been disappointing. Placebo response to surgery is common, and many conditions that contribute to the pain cannot be identified or treated with a surgical approach. Many patients will require a combination of both pharmacologic and nonpharmacologic treatments in addition to various types of invasive procedures. It is now recognized that many disorders contribute to the chronic pelvic pain symptom complex; thus, an integrated multidisciplinary approach to diagnosis and treatment is essential to achieve the greatest success. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to describe the pathophysiology of chronic pelvic pain, to outline the evaluation of a patient with chronic pelvic pain, and to explain the treatment options for patients with chronic pelvic pain.
Analgesics↗