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Pain is among the foremost complaints of women seeking gynecological consultation, yet the diagnosis is often limited to endometriosis. Chronic Pelvic Pain discusses how to diagnose a broad scope of underlying conditions presenting in relation to pelvic pain in women and their treatment. Starting with an anatomical review from a pain point of view, several chapters continue to explore specific conditions such as vulvodynia, the often overlooked painful bladder syndrome and pelvic inflammatory disease. Also covered are topics such as sexual dysfunction, psychological aspects of chronic pelvic pain and alternative treatment methods. Practical treatment tips for specific conditions which are readily applicable in everyday practice are provided throughout. Special attention is given to the use of sonography and MRI in diagnostics. With its comprehensive approach, addressing both body and mind, this is essential reading for medical specialists and consultants and specialist medical trainees in gynecology, pain medicine, and family practice.
Earlier this century, Dr Robert L. Dickinson of New York City, during a symposium on infertility, described intrauterine insemination as follows: After the patient is positioned, ‘the tenaculum steadies the cervix and serves to draw open the canal, which should rarely need to be wiped and on which no antiseptic should be used. The pipette is now very gently filled. The tip touches first the interior of the cervical canal as high as may be and is passed to near the fundus. Gentle, steady pressure is made on the bulb until “unwell feelings” are produced and are continued till there is consciousness of slight distress in the sides of the abdomen low down, at which time the fallopian tubes are presumed to have fluid in them.’ (Dickinson, 1921). In his article, Dr Dickinson beautifully described all aspects of this procedure as a possible treatment of male factor infertility. Dr Edward Reynolds of Boston, in discussing Dr Dickinson's paper, commented that ‘Washing semen through the tubes impresses me as unphysiologic. I should want to see a large number of successes before I was ready to use it. The use of artificial insemination promiscuously without careful isolation of the cases which are due largely to cervical obstacles, I believe to be thoroughly unscientific and not free from danger. It comes down, in short, to the general principle that routine adoption of any procedure for a condition which is a result of multiple and varying causes is poor practice’ (Reynolds, 1921). Interestingly, this discussion took place at the Forty-fifth Annual Meeting of the American Gynecological Society in Chicago, Illinois, on 26 May 1920.
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