Somatization and CPP: Rosenthal Flashcards Preview

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What is somatization?

When the pt expresses emotional distress in terms of somatic complaints.
Very common in PC and Ob/Gyn.
Distress is out of proportion to physical findings.
Multiple, often shifting, somatic complaints at different times over the course of a pt's life.
Pain is the most common.


What is somatic symptom disorder?

Causes significant impairment with distress.
Pt is often (wrongly) suspected of drug seeking behavior or malingering. This brings about negative interactions.


Describe the Cognitive-Behavioral mode of somatic symptom disorder.

Pt not only experiences symptoms, but also, anxiety and panic about the meaning of the symptoms themselves.


Chronic pelvic pain

- pain in the pelvic/suprapubic region off and on every day, lasting for months
- potential causes: endometriosis, PID, leiomyomata, ovarian cysts, adhesions, others like GI/UG/MS
*fibroids won't cause pain unless they are large and pressing on another organ; ovarian cysts normally don't cause pain
- evaluation: H&P, pelvic US (this is often normal and enough to reassure the pt)
- there is an association between sexual abuse as a child and chronic pelvic pain (somatization); ask and she will talk


Treatment for chronic pelvic pain

- team sport btw gyn, urologist, PT, pain mngmt centers, psych
- counsel them about coping and offer non-narcotic drugs
- never prescribe narcotics for chronic pelvic pain, beware of drug seekers


What else can you do if there's still chronic pain and no explanation and failed medical treatment?

Diagnostic laparoscopy; may find things you can't find on imaging/exam like endometriosis or adhesions to bowel/pelvis.
Also, studies show that women get better when told their pelvis is "clean" following laparoscopy.
Avoid laparotomy at all costs! - this may cause adhesions, more pain, etc.



- disorder of endometrial glands/stroma/blood in the wall of the uterus (so it's like endometriosis but not ectopically)
- pts present with "boggy" enlarged, tender uterus, pelvic pain, pressure, dysmenorrhea, menorrhagia
- dx can only be made by pathology after hysterctomy


Treatment of adenomyosis

- prevent ovulation with OCPs, which prevents bleeding
- NSAIDs to block PG synthesis
- if failed, do hysterectomy



- pain with intercourse
- dx with H&P: how long (forever vs. recent), at what point/position, interfering with relationship
- potential causes:
1. if on insertion: vaginitis, vulvitis, vestibular adenitis
2. deep: cervicitis, endometriosis, adhesions, PID, mass effect of fibroids, bladder neck
3. after sex: seminal fluid can cause contractions of uterus (via PGs) which feels like menstral-type cramps
- if no dx can be made, need to consider deeper issue and consult specialist