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Gynaecology, Obstetrics and Sexual Function
"...Topics relating to genital tract functions, even menstruation, are
still distasteful to many people. Discussion of the problem in a relaxed interview,
dragging the subject from shameful darkness into the light of unembarrassed conversation,
may in itself be recognisably beneficial, while inappropriate levity or
embarrassment can bury the matter even deeper..."
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Menstrual Disorders
"...It is difficult to identify those environmental circumstances which induce menorrhagia
as opposed to amenorrhoea, and equally difficult to define what particular psychodynamic
aberrations are conducive to one response as opposed to the other. There
are no specific personality profiles or underlying psychodynamics that appear to be
determinant in this matter..."
Vaginal Discharge
"...A patient from a rigidly Presbyterian background was engaged to the only son of a widow who
suffered a lengthy, predominantly neurotic, chronic illness. The widow was very possessive of
her son, and his fiancée was not made welcome in the house. Their courtship was carried out
mostly in cinema seats and parked cars. The woman complained of excessive mucoid discharge,
giving her a sore vulva. She had acquired temporary relief when a gynaecologist had cauterised
the cervical canal, but the trouble had returned. She suffered considerable premenstrual pelvic
pain, and her periods were heavy, though not incapacitating. She had never had intercourse, so
she did not know whether she had dyspareunia. She was advised that when she got married and
led a full, uninhibited sexual life, her symptoms would resolve. In due course her fiancé broke
loose from his dominating mother, and the couple were able to marry. There were some initial
coital difficulties, including deep dyspareunia, but the woman accepted explanation and reassurance,
and before long the dyspareunia and the leucorrhoea disappeared...."
Irritable Colon, Colon Spasm, Spastic Colon
"...No consideration of psychosomatic gynaecological complaints would be complete
without attention to the confusion caused by, and the misdiagnoses resulting from,
colon spasm. The psychodynamics and aetiology of this condition are dealt with
elsewhere in this book..."
Infertility
"...to attribute childlessness to psychological
causes needs more than a process of exclusion, and strong positive indications should
be evident; techniques for investigating infertility are still being developed which
may ultimately reveal pathology..."
Pregnancy and Labour
"...It would be surprising if the prospect of the experiences of pregnancy and labour,
being of such magnitude, did not exercise considerable psychosomatic influences on
the patient. She will never be the same again, nor will the relationship with her
mother or her husband, her anatomy or her appearance. The very need to attend
antenatal clinics will impress upon her that her course is fraught with hazards.
Regarding labour she must wonder how so large a thing can come through so small
a hole without inevitable pain and suffering, being cut open or torn, split apart and
bleeding, possibly even dying. As men speak of their experiences at war, so she will
have heard women speak of their labours. Those that have proceeded normally will
have little to say; those to whom the bizarre has occurred, will speak endlessly..."
Breast Feeding
"...Every herdsman knows that a locum milker, however skilled, will usually record less
than the full expected yield, and that such distractions as children playing around in
the hayloft overhead will reduce the let-down and consequently the volume recovered.
The effect of stress is well recognised..."
Disorders of Sexual Function
"...Mrs. A. brought an urgent referral letter from her GP. She was over 50, mousy, drably dressed
and scuttled into the room like a frightened rabbit. The letter said that her GP had tried to take
a smear but had found it too difficult. She had been married 20 years, but intercourse had been
erratic for 2 years and was always painful so she and her husband had stopped bothering. She
said they would have liked to have had children but thought her husband never really wanted
any, and now it was too late. None the less she had heard about sexual problem clinics but she
had been too shy to talk to her husband about it. Then she mentioned how she and her husband
both had jobs they really enjoyed and shared hobbies, and that they were very lucky. Although
nervous, the patient did not have vaginismus, and a decision was made not to disturb the accommodation
the couple had made with each other...."