Primary Care in Obstetrics and Gynecology Second Edition Primary Care in Obstetrics and Gynecology A Handbook for Clinicians Second Edition Joseph S. Sanfi lippo, MD, MBA Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Vice Chairman, Reproductive Sciences, Magee-Women’s Hospital, Pittsburgh, Pennsylvania, USA Roger P. Smith, MD Professor, Vice Chair and Program Director, Department of Obstetrics and Gynecology, University of Missouri, Truman Medical Center, Kansas City, Missouri, USA Joseph S. Sanfi lippo, MD, MBA Roger P. Smith, MD Professor Professor Department of Obstetrics, Gynecology, and Vice Chair and Reproductive Sciences Program Director University of Pittsburgh School Department of Obstetrics of Medicine and Gynecology Vice Chairman University of Missouri Reproductive Sciences Truman Medical Center Magee-Women’s Hospital Kansas City, MO 64108 Pittsburgh, PA 15213 USA USA Drug Dosage Notice: The authors and editors of this book have checked carefully to ensure that drug dosage recommendations are precise and in agreement with accepted standards at the time of publication. Nevertheless, dosage schedules are changed periodi- cally as research and clinical experience reveal new data. Therefore, you should check the manufacturer’s recommendation for dosages of all medications, especially in instances when the drug is one which you use infrequently or with which you otherwise lack familiarity. Library of Congress Control Number: 2006920204 ISBN: 978-0387-32327-5 e-ISBN: 978-0387-32328-2 Printed on acid-free paper. © 2007, © 1998 Springer Science+Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar meth- odology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identifi ed as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The pub- lisher makes no warranty, express or implied, with respect to the material contained herein. 9 8 7 6 5 4 3 2 1 springer.com Preface “The obligation to promote the good of the patients is a basic presump- tion of medical care giving a defi ning feature of the physician’s ethical responsibility. To promote the patient’s good is to provide care in which benefi ts outweigh burdens or harms” [American College of Obstetri- cians & Gynecologists (ACOG) Committee Opinion #156, 1995]. How does the busy clinician balance this with the confl icting pressures of time, regulation, paperwork, increased costs, declining reimbursements, burnout, and ever-changing knowledge? These issues have affected us at all levels: the medical student, the resident, and the established practitioner. This second edition of this book has been designed to address the issue of changing knowledge and to touch on some of the other issues as well. Let us begin with medical student training. More informa- tion, clinical application, problem-based learning (PBLs), and often- times short but succinct obstetrics and gynecology rotations are the current name of the game. How can we train our future physicians to think multisystem? The ability to collate all information and apply it to the specifi c clinical problem at hand remains a challenge. One objec- tive of this book is to tie the gynecologic and the medical knowledge clinical application together and to apply them to the patient who is currently in front of us. Residency training continues to stress exposure to primary and preventive ambulatory health care, i.e., internal medicine, critical care, geriatrics, and the emergency department. The book is designed to provide information that can integrate these disparate callings. Primary care, as obstetricians and gynecologists are asked to provide, covers the spectrum from the pediatric-adolescent, to the reproductive-aged woman, to menopause and beyond. Adolescent and sexual development and awareness, along with psychological and cog- nitive development, all begin early and proceed rapidly into adulthood. When should the fi rst pelvic examination be performed? How do we provide health guidance and counseling based on age? We attempt to provide guidelines to these questions in this second edition. vi Preface Periodic health assessment is important in our day-to-day clinical activities. How do we as clinicians provide primary and preven- tive care? How does a busy clinician identify the high-risk patient? For example, when is a lipid profi le or colorectal screening indicated? What is the gynecologist’s role in preconception counseling and genetic testing, hepatitis vaccination, human immunodefi ciency (HIV) assess- ment, mammography, infl uenza, and human papilloma virus vaccina- tions? The list goes on. The second edition of this book is designed to provide a suc- cinct, immediately clinically applicable source of information. It is our sincere hope that everyone who has this new revised edition at his or her disposal can provide excellence in clinical care. Joseph S. Sanfi lippo, MD, MBA Roger P. Smith, MD Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Section I Primary Care and the Obstetrician-Gynecologist 1 Primary Care in Obstetrics and Gynecology: Health Maintenance and Screening . . . . . . . . . . . . . . . . . . . . . . . 3 Douglas W. Laube 2 Pediatric and Adolescent Patients . . . . . . . . . . . . . . . . . . 33 Mary Anne Jamieson and Joseph S. Sanfi lippo 3 Elderly Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Hugh R.K. Barber† and Roger P. Smith 4 Lesbian Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Joseph S. Sanfi lippo and Ruth Schwarz† 5 The Role of Genomic and Applied Molecular Biology. . . 89 Randall S. Hines 6 Emergencies in the Offi ce Setting . . . . . . . . . . . . . . . . . . 105 Mary Nan Mallory Section II C linical Management Principles for the Offi ce Setting 7 Abnormal Pap Smear: Gynecologic Pathology and Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Richard S. Guido 8 Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 G. Randolph Schrodt, Jr. †Deceased. viii Contents 9 Breast Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 William H. Hindle 10 Cardiovascular Hypertension . . . . . . . . . . . . . . . . . . . . . . 195 Dayton W. Daberkow II and Thomas E. Nolan 11 Chronic Pelvic Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 Arnold P. Advincula and Arleen Song 12 Contraception Update. . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Amitasrigowri S. Murthy and Bryna Harwood 13 Coronary Heart Disease in Women: Diagnosis, Evaluation, and Preventive Therapy. . . . . . . . . . . . . . . . . 265 Nanette K. Wenger 14 Dermatologic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . 283 Jeffrey P. Callen 15 Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 Sri Prakash L. Mokshagundam and Vasti L. Broadstone 16 Gastrointestinal Disorders . . . . . . . . . . . . . . . . . . . . . . . . 327 Roger P. Smith 17 Headaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345 Douglas W. Laube 18 Nutrition, Obesity, and Eating Disorders . . . . . . . . . . . . 357 Bernadette McIntire and Joseph A. Lacy 19 Respiratory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 379 Roger P. Smith 20 Sexual Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397 Jean D. Koehler 21 Sports Medicine and Injuries in the Athletic Woman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433 Tanya J. Hagen and Freddie H. Fu Contents ix 22 Thyroid Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449 Mary Korytkowski and Haruko Akatsu Kuffner Appendix Ready Reference Tables for Preventive Health Care and Health Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467 Joseph S. Sanfi lippo Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511 Contributors Arnold P. Advincula, MD Clinical Assistant Professor, Department of Obstetrics and Gynecology, Division of Gynecology, University of Michigan, Ann Arbor, MI 48109, USA Hugh R.K. Barber, MD† Emeritus Professor, New York University School of Medicine, Depart- ment of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY 10021, USA Vasti L. Broadstone, MD Southern Indiana Diabetes and Endocrinology Specialties, Joslin Dia- betes Center, New Albany, IN 47150, USA Jeffrey P. Callen, MD Professor, Department of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville, Louisville, KY 40292, USA Dayton W. Daberkow II, MD Associate Professor, Department of Clinical Medicine, Internal Medi- cine Residency Program Director, Department of Internal Medicine, Louisiana State Health Sciences Center, New Orleans, LA 70112, USA Freddie H. Fu, MD Professor and Chairman, Department of Orthopedics, Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15203, USA Richard S. Guido, MD Associate Professor, Department of Obstetrics, Gynecology, and Repro- ductive Sciences, Division of Gynecology Specialties, Magee-Women’s Hospital, Pittsburgh, PA 15213, USA †Deceased.