This case-based guide covers 100 gynecologic problems commonly encountered in office practice settings, from the simple to the complex. It encourages evidence-based care and incorporates up-to-date guidance on evaluation and management in office practice. Clinical problems are discussed in a clear, case-based format. The book integrates current guidelines and recommendations, supplemented with carefully-researched and vetted expert opinion for situations for which no guidelines exist. Each gynecologic problem is assessed through a brief case presentation followed by an in-depth discussion with visual aids. Question and answer sections feature teaching points. Cases and discussions are detailed enough to guide practice, yet remain focused and concise, with each case designed to be read in the time available when seeing a patient in clinical practice. An invaluable reference guide for gynecologists, family physicians, internal medicine providers, and other women's health care providers who offer office-based gynecologic care.
Section 1. Pelvic Pain: 1. A 27 year old with recurrent visits for severe pelvic pain Lee Learman; 2. A 25 year old with deep dyspareunia Kate McCracken; 3. A 16-year-old adolescent with ongoing dysmenorrhea despite oral contraceptive pill use Geri Hewitt; 4. A patient with pain at lateral aspect of prior Pfannenstiel incision Christopher Morosky; 5. A 26 year old with chronic pelvic pain and negative work-up Misa Perron-Burdic; 6. A 30 year old with endometriosis with worsening pelvic pain despite continuous oral contraceptives William Po; 7. A 47 year old P4 female with severe menstrual cramping and painful intercourse Ola Famuyide; Section 2. Vaginal Discharge and Sexually Transmitted Infections: 9. A 28 year old woman with metronidazole allergy and trichmonas infection Anita Tamirisa; 10. A 24 year old woman with mucopurulent cervicitis Jaime Alleyn; 11. A 27 year old woman with trichomonas requesting a prescription for her partner Rita Tsai; 12. A 33 year old woman with multiple visits for vaginal discharge and itching Shelly Holmstrom; 13. A 24 year old with trichomonas in the first trimester of pregnancy Mark Turrentine; 14. A 16 year old requesting confidential treatment for chlamydia exposure Kavita Arora; 15. A 75 year old female complaining of greenish discharge Amy R. Stagg; Section 3. Amenorrhea and Abnormal Vaginal Bleeding: 16. A 32 year old woman with friable cervix Julianna Schantz-Dunn; 17. A 28 year old with secondary amenorrhea and a family history of mental retardation Frederick Friedman, Jr.; 18. A 27 year old runner with secondary amenorrhea Janeen Arbuckle; 19. A 38 year old with secondary amenorrhea 6 months after gastric bypass Kyle Biggs; 20. A 25 year old with Mirena IUD, with new onset spotting and positive pregnancy test Jeffrey Rothenberg; 21. A 30 year old with irregular periods Scott Graziano; 22. A 25 year old female reports midcycle spotting Ann Chang and Tod Aeby; Section 4. Contraception and Abortion: 23. A 25 year old with no IUD string visible one year after placement Adrianne Dade; 24. An HIV positive woman requesting oral contraceptive pills Patricia Huguelet; 25. A 42 year old woman with IUD and actinomyces on cervical cytology Regan Theiler; 26. A 25 year old woman with a history of pulmonary embolism on OCPs who desires contraception Hedwige Saint Louis; 27. A pregnant 22 year old who desires long-acting postpartum birth control Stacey Holman; 28. A 19 year old with nonpalpable contraceptive implant desiring removal Michael Chinn; 29. A 24 year old with contraceptive implant placed 3 weeks ago presents with positive pregnancy test Roxanne Jamshidi; 30. An HIV positive woman requesting IUD Christy Boraas; 31. A 23 year old presents 2 hours after sexual assault Shandhini Raidoo; 32. A 35 year old woman BMI of 40 presents requesting oral contraceptive pills Sara Whetstone; Section 5. Breast Problems: 33. A 41 year old woman with bilateral clear nipple discharge Christine Isaacs; 34. A 38 year old woman with new onset unilateral bloody nipple discharge Esther Fuchs; 35. A 34 year old newly pregnant patient with a breast mass Asha Bhalwal; 36. A 29 year old woman with lacational mastitis and persistent fevers and erythema 48 hours after initiating antibiotic therapy Pamela Berens; 37. A 45 year old with unilateral green nipple discharge Tricia Yusaf; 38. A 35 year old with complaints of cyclic breast pain Dorota Kowalska; Section 6. Cancer Screening and Prevention: 39. A 22 year old with LSIL on initial cytology Mark Hiraoka; 40. A 25 year old woman who has received a letter from an aunt recommending Lynch testing Jessica Kingston; 41. A 30 year old woman with positive margins on LEEP for HSIL Jordan Hylton; 42. A 32 year old woman whose paternal aunt and grandmother had ovarian cancer Roopina Sangha; 43. A 23 year old with HSIL on cytology Florencia Greer Polite; 44. A 32 year ol