The numbers are in! Deaths due to cardiovascular disease are declining in the United States.1 That is the good news. The bad news is that cardiovascular mortality in women exceeds that of men.1 One factor contributing to this disparity may be low socioeconomic status, which deters some women from seeking medical care. However, this disparity also reflects basic differences in normal physiology and pathophysiology between males and females that are not well understood and remain understudied.2 The lack of attention to sex differences in etiology of cardiovascular disease has resulted in inadequate methodologies and strategies to prevent, diagnose, and treat cardiovascular diseases in women compared with men. For example, physicians routinely order less stress testing and coronary angiography, and treat with less proven medications, in women they believe to have angina.3 This article provides a brief overview of cardiovascular diseases affecting women compared with men, how sex hormones affect vascular function, and illustrative scenarios applicable to reproductive medicine. In this discussion, “sex” is defined by the sex chromosomes and functioning reproductive organs; “gender,” or maleness and femaleness, is defined along a continuum of how an individual functions according to societal attributes or expectations.4
Background Fuller Albright first described a condition he termed primary ovarian insufficiency in 1942 when he reported a syndrome of amenorrhea, estrogen deficiency, and menopausal follicle-stimulating hormone (FSH) levels in young women. He used this term to make it clear that ovarian function was the primary defect, as evidenced by high FSH levels, rather than failure of gonadotropin secretion. Amenorrhea related to inadequate release of gonadotropins and low FSH levels would be categorized as secondary ovarian insufficiency, ie, inadequate ovarian function would be secondary to a pituitary or hypothalamic disorder. Albright reported on women with Turner syndrome as well as women with isolated POI who had none of the associated physical stigmata. In the latter case, subsequent investigators used the terms premature menopause or premature ovarian failure to herald complete depletion of potentially functional primordial follicles,
For couples desiring but having difficulty experiencing intercourse, great strides have been achieved to treat physical obstacles (such as erectile dysfunction); but a little blue pill to treat a loss of sexual desire does not yet exist. Neurosteroids, the steroids produced within the brain, may offer hope.
Recent epidemiological studies show the potential value of observing vaginal humidity for women wishing to get pregnant. When the couple/woman is concerned about a delay in conception, fertility-awareness methods not only maximize the chances for spontaneous conception, they also provide early stage information on reproductive function.
Astrology has been studied for millennia and practiced and accepted for as long. To understand astrology and its benefits for timing and even methods of conception, one must begin with a view of the zodiac and an examination of the couple's birth charts.
Treatments for urinary incontinence and overactive bladder often utilize a single approach. A new multitherapy method, comprehensive pelvic floor rehabilitation with stimulation therapy, involves behavioral interventions, patient-specific pelvic floor exercise prescription, patient- and diagnosis-specific pelvic floor stimulation, and perhaps medication. Although in its early stages of assessment, this comprehensive treatment shows immense promise.
Among women of reproductive age, having children and careers often collide. As many men and women pursue careers, many have doubts as to when and whether they want to have children. At issue is combining childrearing with educational-professional development and accepting the loss of personal freedom that comes with building a family. These men and women are falsely reassured by popular beliefs that steroid contraception delays reproductive aging and that advances in new reproductive technologies can compensate for the age-related decline in fertility. As a result, women and their partners postpone childbearing without fully understanding the possible consequences. Yet age is the single most important determinant of male and female fertility—natural or treated.
Gynecologists are faced with an increasing number of questions from patients regarding the latest in cosmetic treatments—from energy-based ones that are used to treat spider veins, acne, acne scarring, and wrinkles to foam sclerotherapy. Each treatment type carries inherent risks and benefits.
Sexual activity is one of the most common and simplest of human functions. The sexual mindset for men and women, once they have consented, is to have sex unencumbered and free. However, given the realities of unwanted pregnancies and sexually transmitted diseases (including the AIDS virus), couples—especially non-monogamous ones—need protection.
With pregnancy coming later and later in a woman's life, breast cancer during gestation or postpartum may be seen more often. In this context, the imaging techniques commonly used to diagnose and treat cancer offer unique challenges.
