Obstetrics and Gynecology Clinics of North America

Hysteroscopy and hysterography approach the uterine cavity in different ways and each has advantages and limitations. Hysteroscopy is more accurate for the diagnosis of abnormalities that project into the uterine cavity such as polyps, subm…

While uterotubal chromopertubations were performed early in the 1970s with the introduction of hysteroscopy, cornual cannulation was extended and adapted to fluoroscopy. The disadvantages of fluoroscopy include the difficulty in ruling out …

This article reviews the major reasons for hysterectomies and critiques some of the alternative practices, such as medical therapy to shrink fibroids, and new surgical techniques, such as laparoscopic-assisted hysterectomies. Perhaps in res…

The most important factors in the evaluation and treatment of breast pain consist of a thorough history, physical, and radiologic evaluation. These can be used to reassure the patient that she does not have breast cancer. In the 15% of mast…

Primary dysmenorrhea, secondary dysmenorrhea, and cyclic pelvic pain syndromes represent a special subset of CPP. Although more common and no less debilitating, these conditions are better understood, more easily diagnosed, and more success…

Although epidemiology can suggest populations at risk for endometriosis, a single form of therapy with consistent results for all patients is lacking. It is without question that the advancement of conservative therapy for endometriosis-ass…

Endometriosis in women older than 40 years of age presents unique therapeutic challenges to the practicing physician. Management requires the evaluation of reproductive goals and a determination of the objectives of therapy, including sympt…

The approach to the patient with CPP with a history of PID remains a diagnostic challenge even for the experienced clinician. From the initial diagnosis of presumed PID to managing the pain that may result, using an approach that looks at a…

The surgical procedures used for the treatment of chronic pelvic pain, their indications, and success rates are reviewed. A thorough preoperative evaluation is presented that will enable the physician to detect patients at high risk for sur…

Despite a lack of formal evidence for the efficacy of antidepressants in the treatment of CPP, several lines of evidence suggest that they may play an increasingly important role in the treatment of this disorder. Although best combined as …

In conclusion, the CO2 laser has been useful for the vaporization and excision of endometriosis through the laparoscope. Removal through the laparoscope, however, requires recognition of the lesion. Microscopic lesions may not be seen throu…

Although it is true that the clinical results of surgery performed with lasers through the laparoscope are no better than those achieved with laparotomy, the laser has had a significant impact on the treatment of pelvic abnormalities in inf…

Because most laser procedures use the heating effect of the light and given the number of parameters that may be varied--such as power density, power, pulsing, and heating of fiber tips and probes--significant overlap in applications of the…

The YAG laser with the contact sapphire probe has definite advantages over other laser systems. Compared with CO2 lasers, its flexible fiber delivery system can be more easily used. Moreover, the laser can be used within a liquid environmen…

Vaginal epithelial lesions including endometriosis, cysts, septae, human papillomavirus (HPV) disease, and vaginal intraepithelial neoplasia (VaIN) can be successfully treated by laser surgery. The carbon dioxide laser with a wavelength of …

Cyclic pelvic pain is a common gynecologic problem caused by relatively few diseases, which usually can be diagnosed and remedied quickly. Some complaints reflect normal physiologic aspects of the menstrual cycle (mittelschmerz, menstrual a…

Excessive vaginal bleeding, or menorrhagia, is one of the most common presenting symptoms for gynecologic patients. Although this disorder has many possible etiologies, it is generally possible to approach its diagnosis and management in an…

Vaginal bleeding in early childhood, regardless of its duration and quantity, is always of clinical importance. This article discusses the examination of the child and adolescent and reviews the various causes of vaginal bleeding in these p…

Adenomyosis frequently involves gravid and nongravid uteri, remaining asymptomatic in up to one half of all cases. The symptoms of adenomyosis, particularly menorrhagia and dysmenorrhea, correlated with the depth of myometrial involvement, …

The serum CA-125 level is elevated in most women with endometriosis. Although tests are readily available to measure the marker, simple modifications of the present assays are required to improve and standardize the quality of the measureme…

The classification of endometriosis has evolved during this century under the influence of many factors. Although classifications initially paralleled the staging of pelvic malignancies, more modern systems follow the natural progression of…

Evidence from clinical epidemiologic research is reviewed in relation to the prevalence of endometriosis, characteristics associated with its development, the association between endometriosis and infertility, and the efficacy of treatment.

Endometriosis is one of the most common conditions encountered in gynecology and the field of infertility. The clinical presentation depends on the location and the extent of disease, but the severity of symptoms does not correlate directly…

Endometriosis is a difficult problem for practicing gynecologists and is commonly associated with infertility. The diagnosis of endometriosis should only be made at the time of laparoscopy or laparotomy and should be confirmed with biopsy i…