Psychological Aspects of Women's Health Care

Book excerpt: In the decade since the first edition of this work was published, an incredible array of reproductive technologies and associated issues has emerged. Obstetricians and gynecologists are hard-pressed to deal with the startling breadth and depth of these issues, which require mastery over a daunting combination of ever-increasing scientific knowledge, technical skills, long hours, legal liability, and exposure to clinical situations of overwhelming emotional intensity. Psychiatrists have a vital role to play in helping obstetricians and gynecologists cope with a host of problems whose resolutions require not just technical skill, but also knowledge of biology, psychology, sociology, anthropology, ethics, and law. For example, to design and implement strategies to reduce the transmission of HIV, psychiatrists could work with public health workers to incorporate the psychology, sociology, and anthropology of female reproductive behavior. Psychiatrists could likewise improve the diagnosis and treatment of breast and pelvic malignancies by elucidating the factors that deter women from self-examination and regular medical screening and enhance treatment compliance. Divided into three sections, this clinical and theoretical sourcebook addresses every major area of contemporary concern. Pregnancy covers topics from the psychology of normal gestation to physical and psychiatric complications during and after pregnancy, including new prenatal diagnostic techniques and the dynamic issues that emerge when abnormalities are detected, and the use of psychotropic drugs and electroconvulsive therapy in pregnant and lactating patients. Gynecology discusses not only common gynecologic problems but also more controversial issues such as induced abortion and the new reproductive technologies, including the role of the menstrual cycle in exacerbating and precipitating psychologic symptoms, the psychiatric aspects of menopause, the assessment and management of chronic pelvic pain, the psychosocial concomitants of gynecologic malignancies and the emotional demands on the oncology team, and the special implications of HIV/AIDS. General Issues offers a broad, balanced view of topics rarely found in the literature, such as men's reactions to women's reproductive events, substance abuse and eating disorders, sexual and physical abuse (often part of the histories of patients with personality disorders and posttraumatic stress disorders), ethical and legal issues, and health care for lesbian patients. Of special significance is Dr. Stotland's chapter on how consultation-liaison services are provided to obstetrics and gynecology services. This practical and scholarly volume is exceptionally useful as a teaching reference for medical and other health care students and residents in psychiatry and obstetrics and gynecology. It also provides a valuable resource for the clinician working to improve the psychological well-being of women patients.