tailieunhanh - Ebook ABC of medically unexplained symptoms: Part 2

(BQ) Part 2 book “ABC of medically unexplained symptoms” has contents: Pelvic and reproductive system symptoms, widespread musculoskeletal pain, managing medically unexplained symptoms in the consultation, cognitive approaches to treatment, behavioural approaches to treatment, pharmacological treatment, and other contents. | C H A P T E R 10 Pelvic and Reproductive System Symptoms Nur Amalina Che Bakri1 , Camille Busby-Earle2 , Robby Steel3 and Andrew W. Horne1 1 MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK 3 Department of Psychological Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK 2 Simpson OVERVIEW • >50% of patients with chronic pelvic pain (CPP) have no obvious underlying pathology • The diagnosis of functional CPP should be given as a positive statement not an expression of negative findings • Central sensitisation plays an important part in CPP and needs to be explained carefully • Vulvodynia and dyspareunia are commonly associated with CPP Introduction This chapter focuses on three common female pelvic symptoms: CPP, vulvodynia and dyspareunia. Although we categorise presentations as ‘organic’ or ‘functional’ it is important to recognise that these overlap: many women will have both organic pathology and functional symptoms. Chronic pelvic pain CPP is defined as an intermittent or constant pain in the lower abdomen or pelvis of at least 6 months’ duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy, that causes functional disability or limits daily activities A history of abuse (physical, sexual and/or psychological) is more common in women with CPP. GP assessment The aim of GP assessment in women with CPP is to exclude pathological causes of CPP and to recognise patients with functional CPP. This can usually be achieved by taking a history and performing an examination so that only selected patients are referred to secondary care. Typical features of organic symptoms Endometriosis is found in 35–50% women with CPP. Cyclical pelvic pain (often associated with dysmenorrhoea and dyspareunia) in women of reproductive age is the most common symptom associated with the condition and merits referral to secondary .