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Women's Health and Education Center (WHEC)

Gynecology

List of Articles

  • Preanesthesia Care Recommendations For Gynecologic Patients
    There are a number of interventions that have been shown to optimize preanesthesia care for patients undergoing gynecologic surgery. One of the most important concepts championed in enhanced recovery after surgery (ERAS) pathways is that all staff involved in perioperative care must work together as a single team. Our goal should be to implement as many of these interventions as possible, to as many patients as possible. The use of common order sets are now commonplace in electronic health records and facilitate standardized implementation throughout surgical areas and even entire health systems. This strategy diminishes variation in perioperative management, reducing confusion among other members of the surgical team and decreasing variation in outcomes between surgeons. In particular, hospital systems should aim to adhere to antibiotic and thromboembolic prophylaxis for 100% of patients. This subject will continue to evolve as new data are collected.

  • Managing von Willebrand Disease in Women
    Bleeding disorders have serious implications for the practice of obstetrics and gynecology. The most common inherited bleeding disorder is von Willebrand disease (VWD), which is caused by a deficiency, dysfunction, or absence of von Willebrand factor (VWF). This disorder is caused by either a quantitative or qualitative defect in VWF. It is a common cause of heavy menstrual bleeding and other bleeding problems in women and adolescent girls. Obstetricians and gynecologists should include VWD and other bleeding disorders in the differential diagnosis when evaluating patients with heavy menstrual bleeding, regardless of age. Available treatment options for adolescents are similar to those for other women. Despite the therapeutic physiologic effect of pregnancy on patients with VWD, bleeding complications remain a significant risk to both mother and fetus. Because the risk of bleeding varies by subtype, accurate diagnosis of the disease is an essential step of care to provide recommendations regarding optimal therapy and genetic counseling. Overall, the preferred management for pregnancy that is complicated by VWD is anticipating complications by monitoring bleeding parameters. Therefore, with adequate monitoring, prophylaxis, and observation, patients with VWD can be expected to tolerate the course of pregnancy with minimal risk. Because of the importance of these guidelines for the practice of obstetrics and gynecology, the information relevant to women's health is summarized here.

  • Benign Vulvar Skin Disorders: Part 1
    Nearly one in six women will experience chronic vulvar symptoms at some point, from ongoing itching to sensations of rawness, burning, or dyspareunia. In many chronic cases, more than one entity is the cause. Specific skin diseases, sensations of rawness from various external and internal irritants, neuropathy, and psychological issues are all much more common causes of chronic vulvar symptoms than infections. Vulvar skin disorders can interfere with sexual function because of discomfort, pain, and embarrassment. Chronic vulvar conditions impact not only a womanís sexual well-being but also her overall quality of life. As women become more comfortable with vulvar health, they will seek the advice of their healthcare providers, especially about their sexual health. Gynecologist must be prepared to diagnose and treat vulvar conditions, including chronic vulvar skin disorders. A detailed history and physical examination, backed by a confident knowledge of the vulvar dermatoses, will aid in diagnosis and treatment. Focus of this review is on common benign conditions of vulvar skin: contact dermatitis; lichnoid vulvar dermatoses; extramammary Pagetís disease and squamous cell hyperplasia: their diagnosis and current management.

  • Benign Vulvar Skin Disorders: Part 2
    This review provides updated diagnosis and management of the common genital ulcers. Ulcers should be differentiated from erosions both clinically and histologically. The following non-infectious vulvar ulcers: vulvar aphthae in adult and pediatric patients, aphthae associated with Behҫhet's disease, vulvar ulcers resulting from Crohn's disease are discussed. Genital ulcers because of sexually transmitted diseases discussed are herpes simplex (HSV), syphilis, chancroid, lymphogranuloma venereum (LGV), granuloma inguinale (Donovanosis), vulvar ulcers associated with human immunodeficiency virus (HIV)-associated ulcers. Vulvovaginal symptoms often are chronic and can adversely affect sexual function and sense of well-being. The practicing obstetrician and gynecologist can play an important role in identifying skin diseases and initiating management. Additionally, the skin often reflects internal disease states. An astute healthcare provider can identify systemic conditions early, with the goal of improving management.

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