A woman with moderate cystocele.
For this female patient seeking contraception, select the method that is medically contraindicated for her.
Mini pills are contraindicated in women with unexplained uterine bleeding or breast cancer. Both condoms and the diaphragm, used in conjunction with spermicides, are effective contraceptives. The diaphragm should carefully fit in the vagina and is therefore not applicable to women with anatomic distortion of the vagina. Latex condoms should not be used in women with a known latex allergy. Manufacturer’s contraindications to IUD use include history of acute PID, unexplained genital bleeding, suspected pregnancy, uterine cavity distortion, or recent postpartum endometritis. Wilson disease or a copper allergy are contraindications to the use of a coppercontaining IUD. Although tubal ligation may be considered in the patient with chronic obstructive lung disease, the risk of general anesthesia and surgical intervention in this patient is probably high enough to indicate a more conservative approach, such as the use of an IUD.
A woman with severely reduced functional capacity as a result of chronic obstructive pulmonary disease.
A woman with a known latex allergy.
A 35-year-old G2P2 states she just doesn’t want to have sex with her current partner. It is causing difficulties in the relationship. Upon further questioning, she reports an absence of sexual fantasies or dreams. She has no medical problems and takes no medications. Her physical examination is normal.
For the clinical scenario, select the most appropriate sexual dysfunction disorder.
Female sexual dysfunction disorders are characterized by painful intercourse or disturbances in desire, arousal, orgasm or resolution that causes marked distress or interpersonal difficulty. Sexual dysfunction is not better accounted for by another psychiatric disorder, and is not due exclusively to a substance or medical condition. Hypoactive sexual desire disorder is the persistent or recurrent absence of sexual fantasies or desire for sexual activity. Alcohol and drugs may interfere with sexual desire. Medications such as antihypertensives, anticholinergics, antidepressants, narcotics, sedatives, and others may decrease arousal and inhibit sexual interest. Sexual aversion disorder is a persistent or recurrent extreme aversion to or avoidance of sexual genital contact. Sexual prompts or advances by a partner are dismissed. It may be acquired following sexual or physical abuse or trauma, and may be life-long. When presented with a sexual opportunity, the individual may experience panic attacks or extreme anxiety. Sexual arousal disorder is the persistent inability to attain or maintain until completion of sexual activity an adequate lubrication-swelling response of sexual excitement. The inability to become aroused also may be related to anxiety or inadequate stimulation. Vaginismus is the recurrent involuntary spasm of the musculature of the lower third of the vagina that interferes with sexual intercourse and penetration. Usually at the root of vaginismus is a combination of physical or nonphysical triggers that cause the body to anticipate pain. Reacting to the anticipation of pain, the body automatically tightens the vaginal muscles, and sex becomes painful. Penile entry may be more difficult or impossible depending on the severity muscle contraction. Dyspareunia is recurrent or persistent genital/pelvic pain associated with sexual intercourse (not caused by vaginismus or lack of lubrication).
A 22-year-old G0 presents for sexual counseling. She has been dating the same 23-year-old man for 3 months. She really likes him and enjoys being with him; however, when sexual opportunity arises, she has intense anxiety and cannot continue the sexual encounter.
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