1MEN’S AND WOMEN’S HEALTH – SEPTEMBER 6TH, 2007

INTRODUCTION TO WOMEN’S HEALTH

Required texts:
• Manual of Gynecologic Examination and Relevant Lab Tests, C. Proctor, University of Toronto Press, Toronto, 2006.
• Woman Abuse Proctocol, Beverly Huang and Cory Webb, University of Toronto Press, Toronto, 2004.
• Note: the OB/GYN book that was listed as REQUIRED in the book store IS NOT required.

Research Assignment:
• To develop research skills
• Can work alone or in groups of up to 4.
• Choose question, set out to answer question.
• Synthesize information from research to answer question
• Example paper will be posted
• 3-4 recent articles, and 1 relevant article. Supplement with textbook information
• 1500 word paper, Vancouver style references (see outline for link to Vancouver style site). APA is also okay.

LECTURE 1: CURRENT ISSUES IN WOMEN’S HEALTH

• We will be getting note package, but what she says is important too.
• Discussing what makes women’s health unique
• We are seeing health effects that were more present in men (lung cancer, heart disease) become more prevalent in
women with changing roles, working.
• Other reasons for differences:
o Genitalia! Women see their doctors more than men due to issues around reproduction, menstruation.
o Different hormonal patterns
o Body image, weight loss
o Different cultural/social pressures
o Birth control
o Women socialized to communicate more: talk to their doctors more, more proactive about their health and
their family’s health.
o Exposures to risks: illness from children, household toxins (true for men who are actively involved in
parenting too)

Slide: re: Lifestyle – Comparison of men and women re: health. This list is how women differ from men.
• More likely to be underweight: may lead to amenorrhea

SELF CARE:
• Women more likely to take medication. Women experience pain differently than men

STRESS AND WELL-BEING

• Women: decreased mortality, but increased morbidity
• Do women perceive stress more than men, or are their lives more stressful? More experience of pain.
• More likely to suffer from depression, but as seen in previous slide, more likely to seek help for psych issues.

Common diseases among women:

• Auto-immune disease
• Thyroid problems
• Osteoporosis, arthritis
• Fibromyalgia
• MS
• Some cancers (breast, colon, lung)

CAUSES OF DEATH
• Same as men, although psychosis is not on list for men.
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OUR ROLE? Specific ways we can intervene and work with women
• Counselling: we have time for this in our practice!
• Education (eg. Breast cancer, cervical cancer)
• Diet/Lifestyle
• Prevention
• Screening: physical exams, asking good questions
• Promoting physical activity
• Managing the chronic illnesses that women suffer from (eg. Pain, chronic fatigue, fibromyalgia)

WELL-WOMAN SCREENING
• Universal screening for women that seem healthy. To make sure that you are not missing something that has not
come up yet.
• What makes a good screening test? Efficacy, expense, availability, safety
• See list of exams in notes
• Evidence of height and weight relevance to health: mixed reviews
• Breast exams: Medical associations discourage this: women go to doctor too often having found lump that is benign!
Proper training in doctor’s office is important. Still taught at this school: empowering to women to know their bodies.
• Pelvic exams: begin when females become sexually active (HPV). Might start at 18-21 even if they say they haven’t
had sex: they may be having sex and not telling you. Also there are pathologies of female genitalia that are not
related to sex.
• Changing sexual partners: more risk.
• 3 clear Paps: can have pelvic exams less often
• HPV vaccine… controversy!

• Hemoglobin: Anemia more common in women than men d/t menstruation

• Bone mineral density: good to get baseline at 50 years of age (or earlier)
• Predicting when woman goes through menopause: look at her mother
• Hemoccult: colon cancer one of most fatal cancers in women.
• Mammograms: more debate on this: density of breast tissue may make test ineffective
• Thyroid panel

GYNECOLOGIC HISTORY TAKING – ASSIGNMENT #1 (done in class)

Purpose: see notes

Can be therapeutic: many women have never been asked about their sexual history, menstrual experience
Sensitivity: very important

Menstrual history
• Age of first period (12-14 is normal)
• Date of last menstrual period
• Interval between periods (28 is textbook: Normal is 21-35 days)
• Duration of bleeding (3-7 days)
• Date of last gyne exam, Pap, and results of Pap (indication of self care, make sure of appropriate follow up)

Menses:
• Colour? (Esp. for TCM and Homeopathy assessment)
• Clots (size, colour)
• Consistency (thin, heavy)
• Amount (cause of iron def?)
• Pain? (LODRFICARA) (Improved/worsened by: Heat, pressure, cold, medication, activity)
• Associated symptoms (systemic: n/v chills, cravings, water retention)
• PMS?

Obstetric history

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• Number of previous pregnancies (-gravida means pregnancy)
• Number of live births
• Number of miscarriages/abortions
• Complications of prg/birth
• Method of delivery (vaginal, caesarian)
• Recovery after childbirth

Vaginal discharge
• Any unusual discharge? (abnormal: bad odour, green/yellow/grey, clotting
• Colour?
• Odour?
• Timing? (different organisms cause flare-ups at different times)
• Associated symptoms? (itching, burning, rashes, redness)
• Medications or other conditions (diabetes)? (may affect vaginal discharge)

Sexual history
• Any concerns about sexuality or sexual relationships?
• Are you currently sexually active?
• Do you have more than one sexual partner?
• Are you currently planning or avoiding pregnancy? (leads to other topics)
• Do you use contraception? What method? Do you have any questions about contraception?
• How do you define your sexuality?
• Is your sexual relationship satisfying to you?

Assignment:
Practice going through the female menstrual history

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