Dyspareunia - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

DYSPAREUNIA A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Dyspareunia: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00386-4 1. Dyspareunia-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on dyspareunia. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON DYSPAREUNIA........................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Dyspareunia.................................................................................. 8 E-Journals: PubMed Central ....................................................................................................... 14 The National Library of Medicine: PubMed ................................................................................ 14 CHAPTER 2. ALTERNATIVE MEDICINE AND DYSPAREUNIA .......................................................... 29 Overview...................................................................................................................................... 29 National Center for Complementary and Alternative Medicine.................................................. 29 Additional Web Resources ........................................................................................................... 35 General References ....................................................................................................................... 35 CHAPTER 3. PATENTS ON DYSPAREUNIA ....................................................................................... 37 Overview...................................................................................................................................... 37 Patent Applications on Dyspareunia ........................................................................................... 37 Keeping Current .......................................................................................................................... 39 CHAPTER 4. BOOKS ON DYSPAREUNIA ........................................................................................... 41 Overview...................................................................................................................................... 41 Chapters on Dyspareunia............................................................................................................. 41 CHAPTER 5. MULTIMEDIA ON DYSPAREUNIA ................................................................................ 47 Overview...................................................................................................................................... 47 Video Recordings ......................................................................................................................... 47 CHAPTER 6. PERIODICALS AND NEWS ON DYSPAREUNIA ............................................................. 49 Overview...................................................................................................................................... 49 News Services and Press Releases................................................................................................ 49 Newsletter Articles ...................................................................................................................... 50 Academic Periodicals covering Dyspareunia ............................................................................... 52 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 55 Overview...................................................................................................................................... 55 NIH Guidelines............................................................................................................................ 55 NIH Databases............................................................................................................................. 57 Other Commercial Databases....................................................................................................... 59 APPENDIX B. PATIENT RESOURCES ................................................................................................. 61 Overview...................................................................................................................................... 61 Patient Guideline Sources............................................................................................................ 61 Finding Associations.................................................................................................................... 64 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 67 Overview...................................................................................................................................... 67 Preparation................................................................................................................................... 67 Finding a Local Medical Library.................................................................................................. 67 Medical Libraries in the U.S. and Canada ................................................................................... 67 ONLINE GLOSSARIES.................................................................................................................. 73 Online Dictionary Directories ..................................................................................................... 74 DYSPAREUNIA DICTIONARY ................................................................................................... 75 INDEX .............................................................................................................................................. 107

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with dyspareunia is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about dyspareunia, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to dyspareunia, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on dyspareunia. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to dyspareunia, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on dyspareunia. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON DYSPAREUNIA Overview In this chapter, we will show you how to locate peer-reviewed references and studies on dyspareunia.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and dyspareunia, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “dyspareunia” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Treatments for Patients with Pelvic Pain Source: Urologic Nursing. 19(1): 33-35. March 1999. Contact: Available from Society of Urologic Nurses and Associates, Inc. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (609) 256-2335. E-mail: [email protected]. Summary: Chronic pelvic pain (CPP) is a vague and confusing term that generally refers to noncyclic pain in the abdominal or pelvic area, that has been present for 6 months or longer, and that may have a negative impact on activities of daily living and quality of life. This article presents an overview of the incidence and types of pelvic pain, followed by some practical information concerning the presentation of patients with pelvic pain. The author explains to nurses simple physical therapy techniques that are used in treating patients with pelvic pain. Symptoms associated with CPP include low back

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pain, heavy feeling in the pelvis, radiating leg pain, pain with urination or defecation, constipation, diarrhea, coccyx pain, suprapubic pain, abdominal pain, bloating, cramping, irregular menstrual cycles, pain with menstruation, and dyspareunia (painful intercourse). An initial evaluation should include a thorough musculoskeletal assessment; referral to a physical therapist should also be considered. Biofeedback can be useful for monitoring the pelvic floor muscles and accessory muscles for patients with CPP. Transcutaneous electrical nerve stimulation (TENS) may be effective for treating patients with CPP. Manual therapy is another essential component of the treatment plan for patients with CPP. Manual therapy may include visceral mobilization of the pelvic organs and supporting structures, soft tissue massage or myofascial techniques to pelvic girdle musculature, scar tissue massage, internal vaginal or anal work to muscles and tissues, and joint mobilization to spine and extremities. 2 tables. 9 references. •

Patients with Sexual Dysfunction: Your Guidance Makes a Difference Source: Patient Care. 33(7): 99-100, 102-103, 110, 115-118, 123. April 15, 1999. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: Impairment of sexual function can be a distressing aspect of vascular, neurologic, endocrinologic disorders, and other conditions. Sexual dysfunction also may be psychogenic, and the patient may benefit from counseling. For some patients, rectifying a few simple misconceptions or explaining anatomy often brings a great improvement in sexual function. This article helps primary care providers understand how they can make a difference for their patients in this area by applying good listening skills, offering commonsense advice, and especially by remaining alert for physiologic problems manifesting themselves as sexual difficulties. The authors stress that, without prompting, patients may fail to mention their sexual concerns. Topics covered include when to talk about sex, clues to sexual problems (such as evidence of sexually transmitted diseases), the role of information (particularly for patients with other health concerns, including menopause, cardiovascular disease, or post childbirth), sexual history, the physical examination and laboratory tests, common problems (erectile dysfunction and lack of interest in sex), the use of sildenafil (Viagra), premature ejaculation, priapism (painful, sustained erection), pain during intercourse (dyspareunia), vaginismus (involuntary vagina muscle contraction), drugs that can inhibit sexual function, and when to refer patients to a specialist. One sidebar lists books and resource organizations (including websites) to recommend to patients who want additional information. 4 tables. 22 references.

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Interstitial Cystitis: An Overlooked Cause of Pelvic Pain Source: Postgraduate Medicine. 88(1): 101-109. Summary: In this article, the author discusses the manifestations of interstitial cystitis, appropriate diagnostic methods, and available treatment options. Interstitial cystitis is a disease primarily affecting young and middle-aged women which is characterized by pelvic pain, urinary frequency, and dyspareunia. Of the available treatments, the most common are intermittent hydrodilation of the bladder and intermittent intravesical instillation of dimethyl sulfoxide. The author stresses that although interstitial cystitis is uncommon, its potentially devastating effects may be modified or even averted if primary care physicians are familiar with its presentation and maintain a high index of suspicion. 2 figures. 2 talbes. 16 references. (AA-M).

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Sex and Interstitial Cystitis: Explaining the Pain and Planning Self-Care Source: Urologic Nursing. 13(1): 4-11. March 1993. Summary: Interstitial cystitis (IC) is a disease that can disrupt many aspects of a person's life, with increased urinary frequency and urgency, along with intermittent or constant pain. This article addresses the phenomenon of added pain with sexual activity in people with IC. Topics include dyspareunia, other sexual problems, medications and their possible effects on sexual response, the phases of female sexual response, and identifying the problems and finding solutions. The author focuses on the importance of self-care in dealing with the chronic nature of IC. 1 figure. 11 tables. 31 references.

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ABCs of Interstitial Cystitis: A Primer for Midlevel Providers Source: Physician Assistant. 24(12): 22, 25-28, 37. December 2000. Contact: Available from Springhouse Corporation. Physician Assistant, P.O. Box 908, Springhouse, PA 19477. (215) 646-8700. Fax (215) 646-4399. Summary: Interstitial cystitis is a relatively uncommon cause of chronic and severe pelvic pain in women aged 40 to 60 years. This article offers an overview of interstitial cystitis (IC) for physician assistants. While predominantly a female disorder (90 percent), IC does occur in men. IC is a noninfectious, inflammatory disease of the bladder characterized by urgency, frequency, suprapubic pain, dyspareunia (painful sexual intercourse), and nocturia (getting up at night to urinate). Making a correct diagnosis requires a high index of suspicion within the primary care setting because there are few physical examination findings. The author cautions that IC often has a profound impact on a patient's quality of life, especially when the diagnosis is missed or delayed. The author discusses demographics, etiology (autoimmune hypothesis, leaky epithelium hypothesis, and mast cell hypothesis), clinical manifestations of IC, physical findings, differential diagnosis, diagnosis (urinalysis, cystoscopy), and treatment options, including therapeutic hydrodistension, intravesicular instillation, oral medications, and surgical treatments. The author also reviews the course of the disorder, including the incidence of remission, the psychological impact of IC, and the great need for social support mechanisms to help patients cope with IC. One sidebar offers the contact information for the Interstitial Cystitis Association (ICA), an organization that provides a network of current information and education and a national registry and support system for people with IC. The author concludes that although all treatments are palliative, not curative, it is important for the patient with IC to know that the symptoms can be effectively managed in most cases. 1 table. 32 references.

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Remote Controlled Intraurethral Insert for Artificial Voiding: A New Concept for Treating Women with Voiding Dysfunction Source: Journal of Urology. 161(3): 895-898. March 1999. Summary: Many patients with voiding dysfunction (usually urinary incontinence) find clean intermittent catheterization unsatisfactory. This article reports on a study that evaluated the efficacy of the new remote controlled intraurethral In Flow Catheter insert for treating women with voiding dysfunction. The authors evaluated the intraurethral insert in 92 women (mean age 56 years). The insert is available in various sizes to adapt to individual urethras. It comprises a valve and pump assembly. A remote control unit is operated to open the valve and activate the pump, generating active urine flow. In 45 patients (49 percent), the device was removed after a mean of 7.1 days due to local discomfort or urinary leakage around the insert. At a mean followup of 7.6 months

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(range 2 to 26) 47 women (51 percent) continued to use the device, and all are dry with complete bladder emptying. The insert was replaced periodically (mean 38 days) to prevent salt deposits in and around it, which lead to urine leakage. Asymptomatic bacteriuria developed in 22 patients (46.8 percent). No dyspareunia (pain during sexual intercourse) was reported. All patients were satisfied with the insert and preferred it to previous treatment modalities. The authors conclude that this new remote controlled intraurethral insert is safe and effective in women with voiding difficulties. 2 figures. 15 references. (AA-M). •

Interstitial Cystitis: Urgency and Frequency Syndrome Source: American Family Physician. 63(7): 1199-1206. October 1, 2001. Contact: Available from American Academy of Family Physicians. 8880 Ward Parkway, Kansas City, MO 64114-2797. (800) 274-2237. Summary: This article familiarizes family physicians with the latest thinking on interstitial cystitis (IC), a chronic, severely debilitating disease of the urinary bladder. Excessive urgency and frequency of urination, suprapubic pain, dyspareunia (painful sexual intercourse), chronic pelvic pain, and negative urine cultures are characteristic of IC. The course of the disease is usually marked by flare-ups and remissions. Other conditions that should be ruled out include bacterial cystitis, urethritis, neoplasia, vaginitis, and vulva vestibulitis. Glomerulations or Hunner's ulcers found at cystoscopy confirm the diagnosis. Oral treatments for IC include pentosan polysulfate, tricyclic antidepressants, and antihistamines. Intravesicular (in the bladder) therapies include hydrodistention, dimethyl sulfoxide (DMSO), and heparin, or a combination of agents. The author stresses that referral to a support group should be offered to all patients with IC. A patient information handout on IC, written by the author of this article, is provided in the same issue. 5 figures. 2 tables. 35 references.

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Bladder Endometriosis: Conservative Management Source: Journal of Urology. 163(6): 1814-1817. June 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a study undertaken to evaluate the characteristics of women with bladder endometriosis who are successfully treated with hormonal therapy. Endometriosis is the deposition of endometrial glands and uterine tissue outside the uterine cavity; in approximately 1 to 2 percent the urinary tract (notably the bladder) is a site for endometrial implantation. The records of 14 patients (mean age of 48.6 years, range 26 to 71 years) diagnosed with bladder endometriosis were reviewed for presenting complaints, findings and response to therapy. The most frequent presenting complaints were urgency (78 percent), frequency (71 percent), suprapubic pain (43 percent), urge incontinence (21 percent), and dyspareunia (painful intercourse, in 21 percent). Of the patients, 86 percent did not have a history of recurrent urinary tract infections, 6 (42 percent) had a history of endometriosis, including 3 who were previously treated with hysterectomy or oophorectomy (removal of the uterus or ovaries), and 8 (57 percent) were on some form of therapy for estrogen deficiency. In all patients, endometrial implants were identified on cystoscopic examination. Of the patients, 13 were treated either with low dose oral contraceptives, decrease or elimination of the estrogen component of the present regimen, or addition of progesterone to therapy; and 12 (92 percent) reported sustained improvement of symptoms at a mean of 18.6 months (range 8 to 24 months). The authors conclude that in

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more than 70 percent of cases the presenting symptoms of bladder endometriosis are identical to those of interstitial cystitis. Therefore, endometriosis should always be considered in the patient referred for frequency, urgency, and pain with no documented infection. Hormonal therapy is reasonable and effective management for bladder endometriosis. This option preserves fertility, making it especially attractive to younger women. 2 figures. 1 table. 25 references. •

Complications of Incontinence Surgery Source: International Urogynecology Journal. 5(6): 353-360. 1994. Contact: Available from Springer-Verlag New York, Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6372. Summary: This article reviews the complications of incontinence surgery. The authors stress that knowledge of the complications that may result from surgical procedures for stress urinary incontinence is important for appropriate preoperative counseling. Complications addressed in the article include failure to cure incontinence; bleeding; infection; intraoperative damage to viscera; voiding dysfunction; osteitis pubis; nerve injuries; sling erosion; genital prolapse; and dyspareunia. 4 tables. 65 references.

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Interstitial Cystitis Update Source: Infections in Urology. 10(3): 75-79, 82. May-June 1997. Contact: Available from SCP Communications, Inc. 134 West 29th Street, New York, NY 10001-5399. Summary: This article updates readers on interstitial cystitis (IC). The author notes that the primary symptoms of IC are chronic urinary frequency associated with urethral, pelvic, or bladder pain, and often dyspareunia. The etiology of IC is likely from a variety of causes, and the syndrome may represent a common pathologic endpoint for several disease processes. Recent evidence makes a strong case for an autoimmune cause. Bacteria undetected by routine urine culture may also contribute to the pathogenesis of IC. Although treatment remains empiric, a variety of oral and intravesical therapies are available. The author describes hydrodistention, oral drugs, intravesical therapy, other agents, narcotics, surgery, and investigational therapies being used to treat IC. Patients with a bladder capacity of less than 250cc may benefit from surgery. The author concludes with a description of current research efforts under way through initiatives by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in conjunction with the Interstitial Cystitis Association. Areas of interest include the role of the bladder epithelium in IC. Bladder epithelial cells can respond to immune stimulation by the production of cytokines and the expression of an activated cell-surface phenotype. Another advancement in the study of this condition is the establishment of an IC database; information is being collected on people with IC in an attempt to better classify and understand the disease. 3 figures. 34 references. (AAM).

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Interstitial Cystitis: A Bladder Problem Source: American Family Physician. 63(7): 1212-1214. October 1, 2001. Contact: Available from American Academy of Family Physicians. 8880 Ward Parkway, Kansas City, MO 64114-2797. (800) 274-2237.

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Summary: This patient education handout helps readers understand interstitial cystitis (IC), a chronic, severely debilitating disease of the urinary bladder. People with IC may have many of the following symptoms: an urgent need to urinate, both in the daytime and during the night; pressure, pain, and tenderness around the bladder, pelvis and perineum; a bladder that will not hold as much urine as it did before the IC; pain during sexual intercourse (dyspareunia); and, in men, discomfort or pain in the penis or scrotum. In many women, the symptoms get worse before their menstrual period. Stress may also make the symptoms worse, but stress does not cause the condition. The fact sheet discusses the causes of IC, the diagnostic tests that may be used to confirm a diagnosis, treatment options, and lifestyle changes that may contribute to a reduction in symptoms. Treatment options can include dietary changes, bladder distention (with fluid and medications, done under anesthesia), medications, and bladder instillation. Other treatment strategies can include quitting smoking, bladder training, physical therapy, biofeedback, and transcutaneous electrical nerve stimulation (TENS). The fact sheet concludes with the contact information for the Interstitial Cystitis Association (www.ichelp.org) and the National Kidney Foundation (www.kidney.org). A professional education article, written by the author of this handout, is provided in the same issue. •

Sex Hormones and Diabetes Source: Diabetes Reviews. 6(1): 6-13. 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This review article determines the changes in sex hormones and the mechanisms by which they occur in animals and humans with diabetes and then examines the effects of sex hormones on diabetes and the putative relationship these hormones might have to leptin levels. Several studies have indicated that men with diabetes have a decline in levels of total and free testosterone. This is caused by a failure of hypothalamic-pituitary function to adequately drive testosterone secretion, as well as a defect in testicular steroidogenesis. The possibility that testosterone would have salutary effects in men with diabetes is raised. In particular, testosterone appears to inhibit leptin production and thus may decrease insulin resistance. In women, the major effect of diabetes appears to be on the ovary. In rodents, diabetes results in a decrease in ovulation. In humans, rodents, and swine, diabetes in females is associated with hyperandrogenicity and a decline in levels of estradiol. Diabetes also appears to produce resistance to some of the effects of estradiol. Hyperandrogenicity in females, in contrast to males, is associated with insulin resistance. Oral contraceptives and postmenopausal estrogen replacement do not appear to have any major positive or negative effects on carbohydrate metabolism. Hormonal changes in both men and women with diabetes may lead to a decline in libido, a loss of the quality of the erection in men, and vaginal dryness that may be associated with dyspareunia in women. 2 figures. 2 tables. 70 references. (AA-M).

Federally Funded Research on Dyspareunia The U.S. Government supports a variety of research studies relating to dyspareunia. These studies are tracked by the Office of Extramural Research at the National Institutes of

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Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to dyspareunia. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore dyspareunia. The following is typical of the type of information found when searching the CRISP database for dyspareunia: •

Project Title: CLINICAL EVALUATION OF BOTANICAL DIETARY SUPPLEMENT Principal Investigator & Institution: Derman, Richard J.; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2003 Summary: The overall objectives of this project are to conduct Phase I and II clinical trials of black cohosh (Cimicifuga racemosa) and red clover (Trifolium pratense), to be used for women's health problems-for menopausal hot flashes (primarily) and other somatic symptoms. Observational and epidemiological studies demonstrated that black cohosh is effective for menopausal women, and safe (at least in short-term). Phase I: The aims of this study is to determine safe doses (acute toxicity) of extracts of both botanicals, to be used in the subsequent Phase II clinical trial. Three doses will be tested over a one-week period in an attempt to determine symptoms of acute toxicity. There will be 5 subjects for each of 3 dosages (1X, 2X, 3X) of the 2 botanicals. (N=30) The goal is a sample size large enough to estimate unknown parameters Also studied will be pharmacokinetics (hourly bloods) absorption, distribution, metabolism, elimination, and pharmacological mode of action and side effects in healthy menopausal women. Phase II: This is a one year, randomized, controlled, double-blind efficacy study, the primary aim of which is to evaluate the efficacy of black cohosh and red clover, over a "safe dose range," for menopausal hot flashes. Additional goals are to assess these botanicals for other menopausal symptoms such as insomnia, joint pain, vaginal dryness, and dyspareunia (using Kupperman Index, bleeding scales and index of sexual function). They will also assess longer-term risks and safety issues and to determine changes in biomarkers (such as bone turnover and lipids) associated with use of these botanicals. Most previous studies of black cohosh lasted at most 6 months. Longer-term (1-year) safety data will be evaluated. In particular, incidence of endometrial hyperplasia, breakthrough bleeding, and other side effects will be determined. Subjects (n=112) will be randomized into one of 4 treatment groups (28/gr): placebo, Prempro 0.625/2.5, black cohosh and red clover. Also they will take blood samples to measure DNA oxidation products for measurements of DNA strand breaks using the comet assay to determine if DNA in peripheral blood leukocytes is being protected from damage through the antioxidant properties of the 'active' compounds or whether DNA damage is being produced (indicator of toxicity). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Project Title: LIVING WITH CHRONIC PELVIC PAIN: PERSONAL/SOCIAL IMPACT Principal Investigator & Institution: Strzempko, Fran M.; Dean's Office; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 15-MAR-2003; Project End 30-NOV-2004 Summary: (provided by applicant): Chronic pelvic pain (CPP) is an ambiguous and disabling condition, affecting 10-15% of U.S. women of reproductive age. Endometriosis, a condition for which there is no effective treatment, is the most common diagnosis of CPP. Common symptoms include pelvic pain, and dyspareunia. Relationship and role disruptions in endometriosis are reported, but the woman and couple's symptom experiences and responses have not been documented. The purpose of this study is to articulate the woman and her partner's illness understanding, symptom experience, and relationship responses to living with CPP. The larger aim is to develop knowledge to support the holistic care for women with CPP, so we may provide humanistic and effective nursing interventions for women and their partners. The proposed study is a mixed-method design, with qualitative methodology as primary. Interpretive phenomenology guides the design and conduct of the study. A measurement of distress and affective response is the adjunct quantitative method. Specific aims are: 1) articulate the commonalities and differences of the lived experience of women who have CPP with a diagnosis of endometriosis, and their partners; 2) describe the symptom experience from the woman and her intimate partner's perspective; 3) compare dyadic versus individual constructions of living with endometriosis; and 4) describe the relationship between the woman and her partner's symptom experience. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEURAL MECHANISMS OF GYNECOLOGICAL PAIN Principal Investigator & Institution: Berkley, Karen J.; Mckenzie Professor; Psychology; Florida State University 97 South Woodward Avenue Tallahassee, Fl 323064166 Timing: Fiscal Year 2004; Project Start 14-SEP-1977; Project End 30-JUN-2008 Summary: (provided by applicant): The long-term goal of this program is to advance understanding of neural mechanisms of pelvic pain in females. The studies here focus on endometriosis, a disease in which endometrial growths occur abnormally outside the uterus and synthesize many substances such as cytokines and prostaglandins. Symptoms include reduced fertility and several pelvic pains, including dyspareunia (vaginal hyperagesia). A rat model of endometriosis, in which uterine tissue is autotransplanted into the abdomen and forms cysts, has been used to study reduced fertility. The autotransplants also induce vaginal hyperalgesia. Four studies in rats are proposed to test hypotheses concerning mechanisms underlying this hyperalgesia. Studies 1 and 2 will test the hypotheses that the hyperalgesia depends on estrogen and requires continued presence of the cysts. The studies will be done by determining how manipulating hormone levels or excising the cysts affects the hyperalgesia, which will be assessed using behavioral measures of vaginal nociception. Study 3 will test the hypothesis that the cysts contribute to vaginal hyperalgesia by sending nociceptive information to the central nervous system via their own induced nerve supply. The study will be done using selective markers for afferent and autonomic efferent nerve fibers to characterize the cysts' sensory and sympathetic innervation under different experimental conditions (time after surgery; estrous stage). Study 4 will test the hypothesis that cannabinoids contribute to the hyperalgesia by regulating, via CB1 receptors, the cysts' production of }ro- and anti-inflammatory cytokines and

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prostaglandins. The study will be done using enzyme-linked mmunosorbent assays to compare the cysts' production of cytokines and prostaglandins after treatments with cannabinoid agonist, antagonist, and control agents at different times after surgery and in different estrous stages. It is hoped that the results will contribute to our knowledge of the etiology of endometriosis and to improving treatment strategies for pelvic and other visceral pains in both women and men. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REPRODUCTIVE/CONTRACEPTIVE ENDOMETRIOSIS

RISK

FACTORS

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Principal Investigator & Institution: Holt, Victoria L.; Professor; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, Wa 98109 Timing: Fiscal Year 2003; Project Start 01-MAY-1997; Project End 30-APR-2006 Summary: (provided by applicant): Endometriosis affects 5-10% of reproductive-age women with chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. Medical treatment with 6 months of danazol or a GnRH agonist and surgical treatment are effective in alleviating symptoms in the short term, but the side effects of medical and surgical intervention preclude indefinite continuation or repeated treatment, and symptoms reoccur in 40-50% of women after treatment cessation. Knowledge of risk or protective factors for recurrence is of great importance, therefore, yet the effect of patient characteristics and behaviors on symptom recurrence likelihood has largely been unexamined. The main objectives of this competing continuation application are to determine the 48-84 month symptom recurrence rate in a cohort of 18-49 year old women with a first-time diagnosis of endometriosis, according to disease severity and treatment, and to assess relationships between symptom recurrence and estrogenrelated subject characteristics and behaviors. The study hypothesis is that factors associated with higher estrogen levels, including lack of regular exercise, peripheral body fat distribution, alcohol use, dietary phytoestrogen ingestion, presence of low activity alleles in genes involving estrogen metabolism, and use of hormone replacement therapy, may increase long-term risk of endometriosis symptom recurrence after treatment cessation. The proposed retrospective cohort study will utilize cases (n=337) from the principal investigator's current case-control study of endometriosis risk factors (Reproductive/Contraceptive Risk Factors & Endometriosis, R01 HD33792) conducted within a large health maintenance organization in Washington State. Information available from the cases in that study, including in-person interviews with pre-diagnosis details of medical, reproductive, menstrual, contraceptive, behavioral, and other characteristics; dietary and anthropometric measurements; and values of 4 genetic polymorphisms (GSTM1, COMT, CYP1A1, CYP1A2) will be combined with additional interview information to be collected between 48-84 months after initial diagnosis on treatment details, timing and extent of any recurrence of symptoms, and post-diagnosis estrogen-related characteristics and behaviors. Medical records and pharmacy records will be used as to supplement subject-provided diagnosis, treatment and recurrence information. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RISK FACTORS FOR ENDOMETRIOSIS Principal Investigator & Institution: Hunter, David J.; Director; Epidemiology; Harvard University (Sch of Public Hlth) Public Health Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 03-AUG-2001; Project End 31-JUL-2003

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Dyspareunia

Summary: (provided by applicant): Endometriosis, the third leading cause of gynecologic hospitalization in the United States, remains one of the most enigmatic gynecologic pathologies. Endometriosis is defined as the presence of endometrial tissue outside of the uterine cavity. These implants respond to the hormonal cues of the menstrual cycle and "bleed" as they would in the uterus. The consequence is the development of adhesions, scarring, and painful inflammation. Signs and symptoms include dysmenorrhea, dyspareunia, infertility, dysuria, and irritable bowel syndrome.The effects of the disease can be physically and mentally debilitating with frequent misdiagnoses and poor treatment options. Its prevalence among U.S. women has been estimated to be approximately 10%, [the] time from onset of symptoms to laparoscopically confirmed diagnosis is estimated to average between 6 and 11 years. To date, the etiology of endometriosis remains unknown and few epidemiologic studies exist. Using data on 2,690 laparoscopically confirmed incident cases of endometriosis collected from the Nurses' Health Study II, an ongoing, prospective cohort study that began in 1989, the applicant proposes a study to assess the following hypotheses: a) Women with menstrual characteristics of younger age at menarche, longer time to menstrual regularity, or shorter menstrual cycle length are at higher risk of endometriosis. b) Women with a low waist-to-hip ratio are a higher risk of endometriosis. c) Women with a higher body mass index at age 18 are at lower risk of endometriosis. d)Women who were born with a greater birthweight are at higher risk of endometriosis. All analyses will control for other known and suggested risk factors for endometriosis such as oral contraceptive use and cigarette smoking. The applicant will have more than 90% power to evaluate the above hypotheses. These analyses will be the first prospective data with adequate power to evaluate this important and understudied cause of morbidity among premenopausal women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SEXUAL FUNCTIONING AND QOL IN WOMEN WITH CERVICAL CANCER Principal Investigator & Institution: Bodurka, Diane C.; Gynecologic Oncology; University of Texas Md Anderson Can Ctr Cancer Center Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 16-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Sex and sexuality are issues central to women's health. Despite the important nature of this topic, sexual concerns have often been overlooked by health care providers during the treatment and post-treatment surveillance of women with gynecologic cancer. Although it has been demonstrated at least since the early 1980s that sexual dysfunction is perhaps the most significant morbidity of treatment for cervical cancer, little progress has been made in specifying the impact of surgery vs. radiotherapy, or in studying the broader impact of sexual dysfunction on the quality of life (QOL) of cervical cancer survivors. Virtually all studies have excluded non-English speaking patients. This study will evaluate the sexual outcomes of therapy for cervical cancer and the relationship of these issues to QOL. We will prospectively study 144 women receiving treatment and follow-up surveillance for cervical cancer. The aims of the study are: 1.) To assess the entire range of sexual functioning (desire, arousal, orgasmic capacity, dyspareunia, and sexual satisfaction) over the course of treatment and early follow-up in patients with local and locally advanced cervical cancer; 2.) To assess general cancer-related QOL over the course of treatment and early follow-up in patients with local and locally advanced cervical cancer; 3.) To characterize the relationship between sexual dysfunction and overall cancer-related QOL over time; and 4.) To identify factors that may predict better sexual

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function outcomes in patients treated for cervical cancer. At baseline, and at 1, 2, and 4 months post-treatment, women will fill out standardized questionnaires measuring sexual function and satisfaction, relationship happiness, health-related QOL, and cancer-related QOL. At each assessment, a clinician will use a vaginal probe to assess length and caliber of the vaginal canal. Through completion of questionnaires and measurement of vaginal length and compliance, we plan to develop culturally sensitive, short-term interventions to improve sexual functioning and QOL of cervix cancer survivors. Our long-term goal is to evaluate the effectiveness of such interventions in randomized trials. Ultimately, we hope to integrate our findings into daily clinical practice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VULVODYNIA INTERVENTIONS

PREVALENCE

AND

EFFICACY

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Principal Investigator & Institution: Bachmann, Gloria A.; Associate Dean for Women's Health; Obstetrics, Gynecology & Reproductive Sciences; Univ of Med/Dent Nj-R W Johnson Med Sch Robert Wood Johnson Medical Sch Piscataway, Nj 088545635 Timing: Fiscal Year 2002; Project Start 29-SEP-2000; Project End 31-AUG-2005 Summary: Vulvodynia is a complex, multi-factorial chronic pain syndrome which is associated with significant distress and interpersonal. Vulvar vestibulitis and dyspareunia are two common, although not well-understood clinical components or sub-types of vulvodynia. Chronic vulvar pain is experienced by, according to recent surveys, about 10-15% of the female population between 18 and 80. Pathophysiologic findings have not been convincing for the role of any specific antibody or etiological mechanism, although several have been proposed including aberrant somatosensory processing in the peripheral or central inflammatory process. The epidemiology and predictors of vulvodynia have similarly not been well- articulated in the literature. One study suggested that the disorder may be largely limited to white, middle-aged women, although sampling and data gathering limitations cloud the assessment of these findings. Thirdly, many centers have begun emphasizing surgical treatments for vulvar vestibulitis, although these approach is rejected by about 1/3 of women at the outset. The vestibulectomy procedure also leads to definite worsening of the condition in about 10% of cases. This grant will propose to examine efficacy, outcomes and costeffectiveness associated with four non-surgical interventions for vulvodynia. In general, the women's Health Research Section of RWJMS is committed to offering minimallyinvasive services and treatments to a broad diversity of women in the central northeast region. Our previous experience and that of our Co-PI's make our site uniquely wellprepared to offer a broad range of dissemination and educational experiences, both locally and nationally, in the final years of the grant cycle. We plan to arrange and host an international consensus conference (something we have done twice recently in other areas of relevance), and to disseminate findings obtained from this and similar conferences broadly. We will also disseminate any questionnaires and treatment manuals developed in the context of this grant via website or other appropriate electronic or non-electronic form. We will develop patient education and public information materials, which will also be distributed in the most accessible and least costly form. Our ultimate goal is to share findings from this and related research with the broadest cross-spectrum of women that we can. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Dyspareunia

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “dyspareunia” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for dyspareunia in the PubMed Central database: •

Achieving sustainable quality in maternity services -- using audit of incontinence and dyspareunia to identify shortfalls in meeting standards. by Clarkson J, Newton C, Bick D, Gyte G, Kettle C, Newburn M, Radford J, Johanson R.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=59837

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with dyspareunia, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “dyspareunia” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for dyspareunia (hyperlinks lead to article summaries): •

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A large cyst of Skene's duct -- a rare cause of superficial dyspareunia. Author(s): James ST. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1979 February; 19(1): 61-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=292423

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A modified cystourethropexy in management of incontinence and dyspareunia. Author(s): Graham JM. Source: J S C Med Assoc. 1998 January; 94(1): 33. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9473868

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A modified cystourethropexy in the management of incontinence and dyspareunia. Author(s): Graham JM, Stresing HA. Source: J S C Med Assoc. 1990 November; 86(11): 578-82. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2270049

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A psychosexual approach to managing dyspareunia. Author(s): Butcher J. Source: The Practitioner. 2003 June; 247(1647): 484-9, 493-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12822317

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A unique cause of male dyspareunia. Author(s): Agrawal V, Raghavan L, Dargan P. Source: J Indian Med Assoc. 1999 December; 97(12): 526. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10638136

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Biopsychosocial profile of women with dyspareunia. Author(s): Meana M, Binik YM, Khalife S, Cohen DR. Source: Obstetrics and Gynecology. 1997 October; 90(4 Pt 1): 583-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9380320

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Brittle nails and dyspareunia as first clues to recurrences of malignant glucagonoma. Author(s): Chao SC, Lee JY. Source: The British Journal of Dermatology. 2002 June; 146(6): 1071-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12072081

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Causes and treatment options for women with dyspareunia. Author(s): Sarazin SK, Seymour SF. Source: The Nurse Practitioner. 1991 October; 16(10): 30, 35-8, 41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1758656

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Celiac disease as a cause of chronic pelvic pain, dysmenorrhea, and deep dyspareunia. Author(s): Porpora MG, Picarelli A, Prosperi Porta R, Di Tola M, D'Elia C, Cosmi EV. Source: Obstetrics and Gynecology. 2002 May; 99(5 Pt 2): 937-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11975966

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Chemotherapy-induced dyspareunia: a case study of vaginal mucositis and pegylated liposomal doxorubicin injection in advanced stage ovarian carcinoma. Author(s): Krychman ML, Carter J, Aghajanian CA, Dizon DS, Castiel M. Source: Gynecologic Oncology. 2004 May; 93(2): 561-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15099982

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Clinical approach to dyspareunia. Author(s): Graziottin A. Source: Journal of Sex & Marital Therapy. 2001 October-December; 27(5): 489-501. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11554211

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Crohn's disease: an unusual cause of dyspareunia. Author(s): Hamilton PA, Brown P, Davies JD, Salmon PR, Crow KD. Source: British Medical Journal. 1977 July 9; 2(6079): 101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=871767

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Deep dyspareunia. Author(s): Teoh G. Source: Aust Fam Physician. 1980 May; 9(5): 345-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6447498

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Difficulties in the differential diagnosis of vaginismus, dyspareunia and mixed sexual pain disorder. Author(s): van Lankveld JJ, Brewaeys AM, Ter Kuile MM, Weijenborg PT. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 1995 December; 16(4): 201-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8748995

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Dyspareunia and recurrent stress urinary incontinence after laparoscopic colposuspension with mesh and staples. A case report. Author(s): Sharp HT, Doucette RC, Norton PA. Source: J Reprod Med. 2000 November; 45(11): 947-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11127111

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Dyspareunia and vaginismus. Author(s): Steege JF. Source: Clinical Obstetrics and Gynecology. 1984 September; 27(3): 750-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6488616

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Dyspareunia and vaginismus. Author(s): Fordney DS. Source: Clinical Obstetrics and Gynecology. 1978 March; 21(1): 205-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=630754

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Dyspareunia and vulvar disease. Author(s): Marin MG, King R, Dennerstein GJ, Sfameni S. Source: J Reprod Med. 1998 November; 43(11): 952-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9839263

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Dyspareunia and vulvodynia are probably common manifestations of factitious urticaria. Author(s): Lambiris A, Greaves MW. Source: The British Journal of Dermatology. 1997 January; 136(1): 140-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9039322

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Dyspareunia and vulvodynia: unrecognised manifestations of symptomatic dermographism. Author(s): Lambiris A, Greaves MW. Source: Lancet. 1997 January 4; 349(9044): 28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8988122

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Dyspareunia associated with the use of glycerol-impregnated catgut to repair perineal trauma. Report of a 3-year follow-up study. Author(s): Grant A, Sleep J, Ashurst H, Spencer D. Source: British Journal of Obstetrics and Gynaecology. 1989 June; 96(6): 741-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2803998

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Dyspareunia due to exostosis formation after pelvic fracture. Author(s): Wilkes RA, Seymour N. Source: British Journal of Obstetrics and Gynaecology. 1993 November; 100(11): 1050-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8251453

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Dyspareunia from auto suture staples. A report of two cases. Author(s): Messitt JJ. Source: Obstetrics and Gynecology. 1977 March; 49(3): 369-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=840468

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Dyspareunia in undiagnosed Sjogren's syndrome. Author(s): Tayal SC, Watson PG. Source: Br J Clin Pract. 1996 January-February; 50(1): 57-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8729607

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Dyspareunia in women. Breaking the silence is the first step toward treatment. Author(s): Canavan TP, Heckman CD. Source: Postgraduate Medicine. 2000 August; 108(2): 149-52, 157-60, 164-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10951754

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Dyspareunia, an increasing symptom in gynecology. Author(s): Schellen TM. Source: Int J Fertil. 1983; 28(2): 116-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6136475

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Dyspareunia, back pain and chronic pelvic pain: the importance of this pain complex in gynecological practice and its relation with grandmultiparity and pelvic relaxation. Author(s): Gurel H, Atar Gurel S. Source: Gynecologic and Obstetric Investigation. 1999; 48(2): 119-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10461003

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Dyspareunia. Author(s): Rhodes P. Source: British Medical Journal (Clinical Research Ed.). 1984 June 23; 288(6434): 1916-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6234048

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Dyspareunia. Author(s): Jarvis GJ. Source: British Medical Journal (Clinical Research Ed.). 1984 May 26; 288(6430): 1555-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6426641

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Dyspareunia. Author(s): Setchell ME. Source: Br J Hosp Med. 1981 November; 26(5): 538, 540-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7326523

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Dyspareunia. Author(s): Wabrek AJ, Wabrek CJ. Source: Journal of Sex & Marital Therapy. 1975 Spring; 1(3): 234-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1225983

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Dyspareunia. Author(s): Elstein M. Source: British Medical Journal. 1971 May 1; 2(756): 277. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5572399

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Dyspareunia. Author(s): Fullerton WT. Source: British Medical Journal. 1971 April 3; 2(752): 31-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5573192

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Dyspareunia. Author(s): Harlow RA. Source: The Practitioner. 1969 March; 202(209): 393-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5767368

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Dyspareunia. A special type of chronic pelvic pain. Author(s): Steege JF, Ling FW. Source: Obstetrics and Gynecology Clinics of North America. 1993 December; 20(4): 77993. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8115091

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Dyspareunia. Report of a case secondary to vaginal adenosis. Author(s): Kotz HL, Dodek OI, Levin R. Source: Med Ann Dist Columbia. 1967 February; 36(2): 105-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5231708

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Dyspareunia. Tracing the cause. Author(s): DeWitt DE. Source: Postgraduate Medicine. 1991 April; 89(5): 67-8, 70, 73. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2008404

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Dyspareunia: A significant symptom in Crohn's disease. Author(s): Brooke BN. Source: Lancet. 1979 June 2; 1(8127): 1199. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=86929

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Dyspareunia: a symptom of female sexual dysfunction. Author(s): Spano L, Lamont JA. Source: Can Nurse. 1975 August; 71(8): 22-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1139541

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Dyspareunia: an integrated approach to assessment and diagnosis. Author(s): Sandberg G, Quevillon RP. Source: The Journal of Family Practice. 1987 January; 24(1): 66-70. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3540180

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Dyspareunia: more than bad sex. Author(s): Meana M, Binik YM, Khalife S, Bergeron S, Pagidas K, Berkley KJ. Source: Pain. 1997 July; 71(3): 211-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9231863

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Dyspareunia: sexual dysfunction or pain syndrome? Author(s): Meana M, Binik YM, Khalife S, Cohen D. Source: The Journal of Nervous and Mental Disease. 1997 September; 185(9): 561-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9307618

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Dyspareunia: three case reports. Author(s): Jones KD, Lehr ST, Hewell SW. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1997 January-February; 26(1): 19-23. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9017543

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Dyspareunia; a symptom of sexual disorder in the female. Author(s): Spano L, Lamont JA. Source: Infirm Can. 1976 January; 18(1): 16-21. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1043847

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Equestrian dyspareunia. Author(s): Greiss FC Jr. Source: American Journal of Obstetrics and Gynecology. 1984 September 15; 150(2): 168. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6476038

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Evaluation and differential diagnosis of dyspareunia. Author(s): Heim LJ. Source: American Family Physician. 2001 April 15; 63(8): 1535-44. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11327429

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Factors influencing spontaneous abortion, dyspareunia, dysmenorrhea, and pelvic pain. Author(s): Heisterberg L. Source: Obstetrics and Gynecology. 1993 April; 81(4): 594-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8459974

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Female dyspareunia. Author(s): Ryan L, Hawton K. Source: Bmj (Clinical Research Ed.). 2004 June 5; 328(7452): 1357. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15178614

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Female dyspareunia. Author(s): Lamont JA. Source: American Journal of Obstetrics and Gynecology. 1980 February 1; 136(3): 282-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7352518

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Flat condyloma of the hymenal ring: an unusual cause of dyspareunia. Author(s): Miles PA, Reamy K. Source: Acta Cytol. 1983 March-April; 27(2): 212-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6301186

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Focal vulvitis and localised dyspareunia. Author(s): Nadarajah R, Haye KR. Source: Genitourinary Medicine. 1990 December; 66(6): 463. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2265849

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Focal vulvitis and localised dyspareunia. Author(s): Oates JK. Source: Genitourinary Medicine. 1990 February; 66(1): 28-30. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2179114

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Focal vulvitis: a characteristic syndrome and cause of dyspareunia. Features, natural history, and management. Author(s): Peckham BM, Maki DG, Patterson JJ, Hafez GR. Source: American Journal of Obstetrics and Gynecology. 1986 April; 154(4): 855-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3963075

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Functional male dyspareunia: a case study. Author(s): Gruver GG. Source: American Journal of Psychotherapy. 1977 July; 31(3): 450-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=19979

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Herpetic adhesions causing dyspareunia. Author(s): Parker JD, Bullough J. Source: International Journal of Std & Aids. 1992 January-February; 3(1): 58-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1543772

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Heterotopic ossification of the adductor longus muscle presenting as dyspareunia. Author(s): Russell GV Jr, Perry MD, Pearsall AW 4th. Source: Am J Orthop. 2000 November; 29(11): 879-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11079107

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Introital operations for dyspareunia. Author(s): Munsick RA. Source: Clinical Obstetrics and Gynecology. 1980 March; 23(1): 243-71. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6988129

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Kegel dyspareunia: levator ani myalgia caused by overexertion. Author(s): DeLancey JO, Sampselle CM, Punch MR. Source: Obstetrics and Gynecology. 1993 October; 82(4 Pt 2 Suppl): 658-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8378003

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Laparoscopic plication and suspension of the round ligament for chronic pelvic pain and dyspareunia. Author(s): Batioglu S, Zeyneloglu HB. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2000 November; 7(4): 547-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11044511

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Late complications of total hip replacement from bone cement within the pelvis. A review of the literature and a case report involving dyspareunia. Author(s): Awbrey BJ, Wright PH, Ekbladh LE, Doering MC. Source: The Journal of Bone and Joint Surgery. British Volume. 1984 January; 66(1): 41-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6693475

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Longstanding vulval problems and entry dyspareunia among STD-clinic visitors in Oslo-results from a cross-sectional study. Author(s): Edgardh K, Abdelnoor M. Source: International Journal of Std & Aids. 2003 December; 14(12): 796-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14678585

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Long-term follow-up (5-20 years) after uterine ventrosuspension for chronic pelvic pain and deep dyspareunia. Author(s): Halperin R, Padoa A, Schneider D, Bukovsky I, Pansky M. Source: Gynecologic and Obstetric Investigation. 2003; 55(4): 216-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12904695

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Male dyspareunia due to short frenulum: an indication for adult circumcision. Author(s): Whelan P. Source: British Medical Journal. 1977 December 24-31; 2(6103): 1633-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=563279

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Male dyspareunia in the uncircumcised patient. Author(s): Shechet J, Tanenbaum B, Fried SM. Source: American Family Physician. 1999 July; 60(1): 54, 56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10414629

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Management of dyspareunia in postmenopausal women. Author(s): Wallis LA. Source: J Am Med Womens Assoc. 1987 May-June; 42(3): 82-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3584783

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Mangement of dyspareunia secondary to hymenal remnants. Author(s): Grillo L, Grillo D. Source: Obstetrics and Gynecology. 1980 October; 56(4): 510-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7422198

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Membranous hypertrophy of the posterior fourchette as a cause of dyspareunia and vulvodynia. Author(s): Barbero M, Micheletti L, Valentino MC, Preti M, Nicolaci P, Ghiringhello B, Borgno G. Source: J Reprod Med. 1994 December; 39(12): 949-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7884750

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Office gynecology. Relieving dyspareunia. Author(s): Huffman JW. Source: Postgraduate Medicine. 1976 January; 59(1): 223-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1246539

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Old and new causes of superficial dyspareunia. Author(s): Harrington CI. Source: British Medical Journal (Clinical Research Ed.). 1987 October 3; 295(6602): 854. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3119075

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Old and new causes of superficial dyspareunia. Author(s): Riley AJ, Bromwich P. Source: British Medical Journal (Clinical Research Ed.). 1987 August 29; 295(6597): 513-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3117201

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Outcome of surgical treatment for superficial dyspareunia from vulvar vestibulitis. Author(s): Schneider D, Yaron M, Bukovsky I, Soffer Y, Halperin R. Source: J Reprod Med. 2001 March; 46(3): 227-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11304863

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Painful coitus: a review of female dyspareunia. Author(s): Meana M, Binik YM. Source: The Journal of Nervous and Mental Disease. 1994 May; 182(5): 264-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10678307

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Penetration disorder: dyspareunia exists on the extension of vaginismus. Author(s): Kaneko K. Source: Journal of Sex & Marital Therapy. 2001 March-April; 27(2): 153-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11247214

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Perineal management during childbirth and subsequent dyspareunia. Author(s): Bex PJ, Hofmeyr GJ. Source: Clin Exp Obstet Gynecol. 1987; 14(2): 97-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3568401

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Postpartum dyspareunia. Author(s): Dennerstein G. Source: J Reprod Med. 2000 November; 45(11): 964. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11127116

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Postpartum dyspareunia. An unexplored problem. Author(s): Goetsch MF. Source: J Reprod Med. 1999 November; 44(11): 963-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10589408

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Prevalence and incidence of prolonged and severe dyspareunia in women: results from a population study. Author(s): Danielsson I, Sjoberg I, Stenlund H, Wikman M. Source: Scandinavian Journal of Public Health. 2003; 31(2): 113-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12745761

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Psychosocial correlates of pain attributions in women with dyspareunia. Author(s): Meana M, Binik YM, Khalife S, Cohen D. Source: Psychosomatics. 1999 November-December; 40(6): 497-502. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10581978

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Quiz case of the month. A 26-year-old woman presented to her gynecologist with dyspareunia. Author(s): Paraira M, Ubeda B, Alert E, Alegret X. Source: European Radiology. 2000; 10(8): 1361-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10939512

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Re: Vaginal dilation in the treatment of dyspareunia. Author(s): Barnes J, Harrison RF, O'Sullivan K. Source: Ir Med J. 1984 June; 77(6): 186. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6746262

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Reflux dyspareunia. Author(s): Kirk AJ. Source: Thorax. 1986 March; 41(3): 215-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3715779

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Rotated hypoplastic hemipelvis: a cause of obstructive dyspareunia. Author(s): Kucera PR, Field T, Widell E, Banchi MT, DiSaia P. Source: Obstetrics and Gynecology. 1987 September; 70(3 Pt 2): 509-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3627615

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Sjogren's syndrome in women presenting with chronic dyspareunia. Author(s): Mulherin DM, Sheeran TP, Kumararatne DS, Speculand B, Luesley D, Situnayake RD. Source: British Journal of Obstetrics and Gynaecology. 1997 September; 104(9): 1019-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9307528

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Supravaginal uterine amputation vs. hysterectomy. Effects on coital frequency and dyspareunia. Author(s): Kilkku P. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1983; 62(2): 141-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6868962

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The clinical evaluation of dyspareunia. Author(s): Phillips NA. Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 1998 May; 10 Suppl 2: S117-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9647973

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The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Author(s): Jamieson DJ, Steege JF. Source: Obstetrics and Gynecology. 1996 January; 87(1): 55-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8532266

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The prevalence of dyspareunia. Author(s): Glatt AE, Zinner SH, McCormack WM. Source: Obstetrics and Gynecology. 1990 March; 75(3 Pt 1): 433-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2304713

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The role of vaginal apex excision in the management of persistent posthysterectomy dyspareunia. Author(s): Sharp HT, Dodson MK, Langer KM, Doucette RC, Norton PA. Source: American Journal of Obstetrics and Gynecology. 2000 December; 183(6): 1385-8; Discussion 1388-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11120501

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Therapeutic ultrasound for postpartum perineal pain and dyspareunia. Author(s): Hay-Smith EJ. Source: Cochrane Database Syst Rev. 2000; (2): Cd000495. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10796210

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Treatment of dyspareunia and vaginal outlet distortions by perineoplasty. Author(s): Woodruff JD, Genadry R, Poliakoff S. Source: Obstetrics and Gynecology. 1981 June; 57(6): 750-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7231828

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Treatment of dyspareunia following medical illness. Author(s): Leventhal JL, Taylor M, Sadock V. Source: The Western Journal of Medicine. 1992 February; 156(2): 196-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1536080

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Unusual complications following abdominal hysterectomy: dyspareunia and consort glans laceration after vaginal cuff stapling. Author(s): Zerner J, Miller BA, Nelson BD. Source: J Maine Med Assoc. 1980 June; 71(6): 169-70, 73. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6993594

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Urticaria: increasingly recognised but not adequately highlighted cause of dyspareunia and vulvodynia. Author(s): Lambiris A, Greaves MW. Source: Acta Dermato-Venereologica. 1997 March; 77(2): 160-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9111835

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Vaginal dilation in the treatment of dyspareunia. Author(s): Boylan P, Turner M, MacDonald D. Source: Ir Med J. 1984 April; 77(4): 104-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6735665

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Vaginismus and dyspareunia: is there a difference in clinical presentation? Author(s): de Kruiff ME, ter Kuile MM, Weijenborg PT, van Lankveld JJ. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 2000 September; 21(3): 149-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11076336

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Vulvar pain and dyspareunia due to glomus tumor. Author(s): Kohorn EI, Merino MJ, Goldenhersh M. Source: Obstetrics and Gynecology. 1986 March; 67(3 Suppl): 41S-42S. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3003638

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Vulvar vestibulitis syndrome: an often unrecognized cause of dyspareunia. Author(s): Pagano R. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1999 February; 39(1): 79-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10099756

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CHAPTER 2. ALTERNATIVE MEDICINE AND DYSPAREUNIA Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to dyspareunia. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to dyspareunia and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “dyspareunia” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to dyspareunia: •

A randomized comparison of group cognitive--behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Author(s): Bergeron S, Binik YM, Khalife S, Pagidas K, Glazer HI, Meana M, Amsel R. Source: Pain. 2001 April; 91(3): 297-306. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11275387

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Botulinum toxin a for vulvodynia: a case report. Author(s): Gunter J, Brewer A, Tawfik O. Source: The Journal of Pain : Official Journal of the American Pain Society. 2004 May; 5(4): 238-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15162347

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Characteristics of women with vulvar pain disorders: responses to a Web-based survey. Author(s): Gordon AS, Panahian-Jand M, Mccomb F, Melegari C, Sharp S. Source: Journal of Sex & Marital Therapy. 2003; 29 Suppl 1: 45-58. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12735088

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Dyspareunia of vulvo-vaginal origin. Causes and management. Author(s): Huffman JW. Source: Postgraduate Medicine. 1983 February; 73(2): 287-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6823460

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Effectiveness of psychological treatment of human sexual dysfunction. Author(s): O'Connor JF. Source: Clinical Obstetrics and Gynecology. 1976 June; 19(2): 449-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1277615

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Effects of hormone replacement therapy on sexual psychophysiology and behavior in postmenopause. Author(s): Sarrel PM. Source: Journal of Women's Health & Gender-Based Medicine. 2000; 9 Suppl 1: S25-32. Review. Erratum In: J Womens Health Gend Based Med 2001 January-February; 10(1): 91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10695871

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Electrochemical therapy of pelvic pain: effects of pulsed electromagnetic fields (PEMF) on tissue trauma. Author(s): Jorgensen WA, Frome BM, Wallach C. Source: Eur J Surg Suppl. 1994; (574): 83-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7531030

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Endometriosis and pain. Author(s): Martin DC, Ling FW. Source: Clinical Obstetrics and Gynecology. 1999 September; 42(3): 664-86. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10451777

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Endometriosis presenting as a urethral diverticulum: a case report. Author(s): Chowdhry AA, Miller FH, Hammer RA. Source: J Reprod Med. 2004 April; 49(4): 321-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15134160

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Endometriosis treated by the method of resolving blood stasis to eliminate obstruction in the lower-jiao. Author(s): Wang D, Wang Z, Yu C.

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Source: J Tradit Chin Med. 1998 March; 18(1): 7-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10437253 •

Epidemiological determinants of vesicovaginal fistulas. Author(s): Tahzib F. Source: British Journal of Obstetrics and Gynaecology. 1983 May; 90(5): 387-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6849845

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Female sexual dysfunction. Author(s): Walton B, Thorton T. Source: Curr Womens Health Rep. 2003 August; 3(4): 319-26. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12844457

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Female sexual function and response. Author(s): Arcos B. Source: J Am Osteopath Assoc. 2004 January; 104(1 Suppl 1): S16-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14992322

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Functional gynaecological disorders. Author(s): Adam GS. Source: The Medical Journal of Australia. 1966 July 9; 2(2): 82-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5945873

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Health-seeking behavior of Karachi women with reproductive tract infections. Author(s): Bhatti LI, Fikree FF. Source: Social Science & Medicine (1982). 2002 January; 54(1): 105-17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11820674

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Hormone replacement therapy: I. A pharmacoeconomic appraisal of its therapeutic use in menopausal symptoms and urogenital estrogen deficiency. Author(s): Whittington R, Faulds D. Source: Pharmacoeconomics. 1994 May; 5(5): 419-45. Review. Erratum In: Pharmacoeconomics 1995 September; 8(3): 244. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10147233

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How can second-stage management prevent perineal trauma? Critical review. Author(s): Flynn P, Franiek J, Janssen P, Hannah WJ, Klein MC. Source: Can Fam Physician. 1997 January; 43: 73-84. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9626426

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Hypno-desensitization therapy of vaginismus. I. “In vitro” method. II. “In vivo” method.

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Author(s): Fuchs K, Hoch Z, Paldi E, Abramovici H, Brandes JM, Timor-Tritsch I, Kleinhaus M. Source: Int J Clin Exp Hypn. 1973 July; 21(3): 144-56. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4735670 •

Hypnotherapy as a treatment for vulvar vestibulitis syndrome: a case report. Author(s): Kandyba K, Binik YM. Source: Journal of Sex & Marital Therapy. 2003 May-June; 29(3): 237-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12851128

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Hypnotherapy for vaginismus. Author(s): Schneck JM. Source: Int J Clin Exp Hypn. 1965 April; 13(2): 92-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5877348

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Hypnotherapy in gynecological disorders. Author(s): LECKIE FH. Source: Int J Clin Exp Hypn. 1964 July; 12: 121-46. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14213277

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Mechanically induced pelvic pain and organic dysfunction in a patient without low back pain. Author(s): Browning JE. Source: Journal of Manipulative and Physiological Therapeutics. 1990 September; 13(7): 406-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2212886

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New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial. Author(s): Boccasanta P, Venturi M, Salamina G, Cesana BM, Bernasconi F, Roviaro G. Source: International Journal of Colorectal Disease. 2004 July; 19(4): 359-69. Epub 2004 March 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15024596

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Perineal massage in labour and prevention of perineal trauma: randomised controlled trial. Author(s): Stamp G, Kruzins G, Crowther C. Source: Bmj (Clinical Research Ed.). 2001 May 26; 322(7297): 1277-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11375230

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Persistent vulvar vestibulitis: the continuing challenge. Author(s): Bornstein J, Goldik Z, Alter Z, Zarfati D, Abramovici H.

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Source: Obstetrical & Gynecological Survey. 1998 January; 53(1): 39-44. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9440128 •

Psycho-sexual disorders and their treatment: part I. Author(s): Haslam MT. Source: Current Medical Research and Opinion. 1974; 2(8): 488-99. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4614955

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Randomized trial of perineal massage during pregnancy: perineal symptoms three months after delivery. Author(s): Labrecque M, Eason E, Marcoux S. Source: American Journal of Obstetrics and Gynecology. 2000 January; 182(1 Pt 1): 76-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10649159

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Recontextualizing sexuality in chronic illness: women and interstitial cystitis. Author(s): Webster DC. Source: Health Care for Women International. 1997 November-December; 18(6): 575-89. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9416041

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Reproductive performance after the repair of obstetric vesico-vaginal fistulae. Author(s): Evoh NJ, Akinla O. Source: Ann Clin Res. 1978 December; 10(6): 303-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=742828

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Selection criteria and long-term results of surgery in symptomatic rectocele. Author(s): Boccasanta P, Venturi M, Cioffi U, De Simone M, Strinna M, Salamina G, Raimondi A, Contessini-Avesani E. Source: Minerva Chir. 2002 April; 57(2): 157-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11941291

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Sexual dysfunction, Part II: Diagnosis, management, and prognosis. Author(s): Halvorsen JG, Metz ME. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1992 March-April; 5(2): 177-92. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1575070

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Surgical treatment for chronic pelvic pain. Author(s): Carter JE. Source: Jsls. 1998 April-June; 2(2): 129-39. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9876726

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Surgical treatment of traumatic cloaca. Author(s): Venkatesh KS, Ramanujam P. Source: Diseases of the Colon and Rectum. 1996 July; 39(7): 811-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8674376

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Symptomatology, quality of life and economic features of irritable bowel syndrome-the effect of hypnotherapy. Author(s): Houghton LA, Heyman DJ, Whorwell PJ. Source: Alimentary Pharmacology & Therapeutics. 1996 February; 10(1): 91-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8871448

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The behavioural treatment of sexual inadequacy. Author(s): Asirdas S, Beech HR. Source: Journal of Psychosomatic Research. 1975; 19(5-6): 345-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2774

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The problem of pelvic disease. Author(s): RUTHERFORD RN. Source: J Am Med Womens Assoc. 1965 February; 20: 155-60. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14256944

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The problem of pelvic dis-ease. Author(s): RUTHERFORD RN. Source: J Am Med Womens Assoc. 1965 February; 20: 155-60. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14253356

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Treating vulvar vestibulitis with electromyographic biofeedback of pelvic floor musculature. Author(s): McKay E, Kaufman RH, Doctor U, Berkova Z, Glazer H, Redko V. Source: J Reprod Med. 2001 April; 46(4): 337-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11354833

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Treatment of vulvar vestibulitis syndrome with electromyographic biofeedback of pelvic floor musculature. Author(s): Glazer HI, Rodke G, Swencionis C, Hertz R, Young AW. Source: J Reprod Med. 1995 April; 40(4): 283-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7623358

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to dyspareunia; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Dyspareunia Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 3. PATENTS ON DYSPAREUNIA Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.7 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “dyspareunia” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on dyspareunia, we have not necessarily excluded nonmedical patents in this bibliography.

Patent Applications on Dyspareunia As of December 2000, U.S. patent applications are open to public viewing.8 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to dyspareunia:

7Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm. 8 This has been a common practice outside the United States prior to December 2000.

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Treatment of dyspareunia with topically administered nitroglycerin formulations Inventor(s): Bennett, Sean R.; (Denver, CO), Doherty, Jane K.; (Cupertino, CA), Doherty, Paul C. JR.; (Cupertino, CA), Gesundheit, Neil; (Los Altos, CA), Hanamoto, Mark S.; (Belmont, CA), Place, Virgil A.; (Kawaihae, HI), Spivack, Alfred P.; (Menlo Park, CA), Wilson, Leland F.; (Menlo Park, CA) Correspondence: Reed & Eberle Llp; 800 Menlo Avenue, Suite 210; Menlo Park; CA; 94025; US Patent Application Number: 20040044080 Date filed: April 4, 2003 Abstract: Methods and formulations for treating dyspareunia are provided. A pharmaceutical composition formulated so as to contain a therapeutically effective amount of nitroglycerin is administered to the vagina or vulvar area of the individual undergoing treatment. Preferred formulations are immediate release formulations in which at least 80% of the nitroglycerin in the formulation is released therefrom within 4 hours following administration. The formulations may contain one or more additional active agents, e.g., agents that are also useful to treat dyspareunia and/or potentiate the action of nitroglycerin. Such additional agents include vasoactive agents such as prostaglandins, phosphodiesterase inhibitors, androgens such as testosterone, estrogens such as estradiol, and selective modulators of estrogen and androgen receptors. A kit for a patient to use in the self-administration of the formulation is also provided. Excerpt(s): This application is a continuation-in-part of U.S. Ser. No. 09/905,458, filed Jul. 13, 2001; which was a continuation of U.S. Ser. No. 09/539,484, filed Mar. 30, 2000, now U.S. Pat. No. 6,306,841; which was a continuation of U.S. Ser. No. 09/181,316, filed Oct. 27, 1998, now abandoned; which was a continuation-in-part of both U.S. Ser. No. 08/959,064, filed Oct. 28, 1997, now U.S. Pat. No. 5,877,216, and U.S. Ser. No. 08/959,057, filed Oct. 28, 1997, now abandoned; the disclosures of which are hereby incorporated by reference. This invention relates generally to methods and pharmaceutical formulations for treating women suffering from dyspareunia. More particularly, the invention pertains to the topical administration of a nitroglycerin-containing pharmaceutical formulation in the treatment of dyspareunia. Sexual response in women is generally classified into four stages: excitement, plateau, orgasm, and resolution. Masters and Johnson, Human Sexual Response (Boston, Mass.: Little, Brown & Co., 1966). With sexual arousal and excitement, vasocongestion and muscular tension increase progressively, primarily in the genitals, and is manifested by increased blood flow, elevated luminal oxygen tension, and vaginal surface lubrication as a result of plasma transudation that saturates the fluid reabsorptive capacity of the vaginal epithelium. Vasoactive intestinal polypeptide ("VIP") release may induce the physiological changes of sexual arousal and excitement, and may be the major neurotransmitter that participates in the innervation of the vaginal blood supply. Peptide histidine methionine has been co-located with VIP within nerve fibers that innervate small blood vessels, smooth muscle and epithelial cells in the vaginal tract. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with dyspareunia, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “dyspareunia” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on dyspareunia. You can also use this procedure to view pending patent applications concerning dyspareunia. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 4. BOOKS ON DYSPAREUNIA Overview This chapter provides bibliographic book references relating to dyspareunia. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on dyspareunia include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Chapters on Dyspareunia In order to find chapters that specifically relate to dyspareunia, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and dyspareunia using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “dyspareunia” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on dyspareunia: •

Cystocele Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 361-371. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: A cystoscele is herniation of the urinary bladder through the weakened supportive fascia of the anterior vaginal compartment. Cystocele is one of the manifestations of pelvic floor relaxation and prolapse. This chapter on cystocele and its surgical correction is from an exhaustive textbook on urologic surgery. The authors stress it is important to ascertain the level of sphincteric competence preoperatively in any patient undergoing cystocele repair. The repair of cystocele is based on several factors: the presence or absence of urinary incontinence, the grade of the cystocele, the inherent pathophysiological fascial weakness (central or lateral), the bladder's emptying

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ability, and the associated vaginal or abdominal pathology to be repaired. The authors describe the surgical techniques used, including combined repair of lateral and central defects with mesh and vaginal wall sling, repair of lateral defect (six corner bladder suspension), and repair of a central defect. Complications associated with cystocele repair can be avoided by careful attention to detail during dissection of the cystocele and passage of the ligature carrier. Careful cystoscopic evaluation intraoperatively should alert the surgeon to many other potential complications. Postoperative bladder instability is a well documented complication of cystocele repair. Other potential complications are persistent pain, infection, bleeding, recurrent incontinence, vaginal stenosis or shortening, vesicovaginal fistula, ureterovaginal fistula, and dyspareunia (pain during sexual intercourse). 5 figures. 8 references. •

Female Urethral Diverticula Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 397-406. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: Female urethral diverticula (pouches) arise from the wall of urethra and consist mainly of fibrous tissue lined with epithelium. In many cases, the epithelial lining may be absent because of the chronic inflammation, and the diverticulum may be adherent to the neighboring structures including the periurethral fascia and anterior vaginal wall. This chapter on female urethral diverticula is from an exhaustive textbook on urologic surgery. The authors caution that, because of the complexity and variability of diverticula, thorough evaluation is required to completely assess important pretreatment factors and plan appropriate management. With proper pretreatment evaluation, surgical treatment is generally associated with an excellent outcome. The presenting symptoms of urethral diverticulum vary considerably and include the three Ds (dysuria, postvoid dribbling, and dyspareunia or painful sexual intercourse), urinary frequency or urgency, recurrent infection, urinary incontinence, hematuria (blood in the urine), anterior vaginal pain, and swelling. The authors recommend urethral diverticulectomy (removal of the diverticulum) if the patient is symptomatic and or the diverticulum is of significant size (more than 0.5 cm in diameter). The authors first briefly review alternative treatments, including endoscopy, marsupialization, and miscellaneous techniques, and then detail the recommended surgical techniques, including preparation, diverticulectomy, bladder neck suspension, and postoperative care. The urethral diverticulum may recur as a result of incomplete excision of the diverticulum and its urethral communication site. Urethrovaginal fistula (an opening between the urethra and vagina) is also a possible complication of urethral diverticulectomy. The authors conclude that female urethral diverticula are more common than previously thought, and the suspicion should always be high in the clinician's mind. The three layer vaginal flap technique of diverticulectomy has an excellent success rate and minimal complications. 6 figures. 3 tables. 10 references.

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Interstitial Cystitis Source: in Landau, L.; Kogan, B.A. 20 Common Problems in Urology. New York, NY: McGraw-Hill, Inc. 2001. p. 119-132.

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Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgraw-hill.com. PRICE: $45.00;plus shipping and handling. ISBN: 0070634130. Summary: Interstitial cystitis (IC) is a clinical syndrome of urinary frequency, urgency, and pelvic pain in the absence of any other definable pathology (disease), such as urinary infection, carcinoma (cancer), or cystitis (bladder inflammation) induced by radiation or medication. This chapter on IC is from a text on common problems in urology (written for the primary care provider). The author notes that traditionally patients received the diagnosis of IC only if their symptoms were severe and persistent, and perhaps only if destructive changes in bladder tissue were seen on cystoscopy or biopsy. The patient with mild or intermittent symptoms was likely to receive the diagnosis of recurrent urinary tract infection (UTI) or urethral syndrome in women or prostatitis or BPH (benign prostatic hyperplasia or overgrowth) in men. In reality, the patient most likely had an early form of IC. This chapter covers principal diagnoses, pathophysiology, risk factors, why IC is important to diagnose, the typical presentation of IC, key elements to the history (location of pain, nocturia and frequency, dyspareunia or painful intercourse, and duration), physical examination, ancillary tests (analysis of catheterization urine specimen, voiding log, urodynamics, potassium test, and cystoscopy), principles of treatment and recommendations, and patient education approaches. The author also notes common errors in managing IC, controversies, and emerging concepts. A patient evaluation and care algorithm is also provided. The author concludes that the majority of patients can now be successfully treated for IC. The best results are obtained when IC is diagnosed early and treatment is initiated before severe bladder damage has occurred. 3 figures. 6 tables. 17 references. •

Ileoanal Pouch Anastomosis Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 197-202. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email: [email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This chapter on ileoanal pouch anastomosis is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). The authors report that long term follow-up of pouch function and quality of life indicates a very high degree of acceptance and happiness level of the patients undergoing restorative proctocolectomy (RP). In ileoanal pouch anastomosis (IPAA), the entire diseased colon and rectum are removed, but the anal sphincters are preserved. A new rectum is formed from the terminal ileum (ileal pouch); attaching the pouch to the anal canal restores defecation to the standard transanal route with satisfactory fecal continence. Bowel movement frequency ranges from four to nine movements every 24 hours, averaging six times per day. This, however, is not a good indication of success as many patients will evacuate their pouches when it is convenient to do so, rather than defer defecation. Urgency, defined as inability to defer defecation for 15 minutes, is a major concern for many patients preoperatively. Invariably, this is negated by the pouch procedure; the exception is when patients develop pouchitis. Pad use, either due to need or for a sense of security, increases with age, episodes of pouchitis, and the patients with mucosal stripping of the anal canal as well as decreasing sphincter function. Operative mortality (deaths from the surgery) remains

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under 0.5 percent and reported impotence rates are less than 1 percent. Although dyspareunia (painful sexual intercourse) may occur post-pouch construction, overall, there is an improvement in female sexual function post-pouch compared to pre-pouch. Perhaps the most singled out problem of the pelvic pouch procedure is that of pouchitis; by eliminating one disease, the patient is set up for another. Yet this has to be viewed with the perspective that 90 percent of pouchitis cases are transient and easily treated, and that fewer than three-quarters of patients are subject to repeated episodes. Patients, in their quest for preservation of their anal function, understand and generally are satisfied with the trade-off of RP. 1 figure. 15 references. •

Chronic Bladder Disorders and Chronic Dysuria Source: in Carlson, K.J. et al. Primary Care of Women. St. Louis, MO: Mosby-Year Book, Inc. 1995. p. 133-135. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177 or (314) 872-8370. Fax (314) 432-1380. PRICE: $69.95 (as of 1995). ISBN: 0801676770. Summary: This chapter, from a medical reference for clinicians engaged in the primary care of women, discusses chronic bladder disorders and chronic dysuria. The authors consider the primarily sensory disorders: those associated with chronic irritative symptoms of dysuria, frequency, urgency, and, occasionally, pelvic pain and dyspareunia. Topics covered include the causes of chronic irritative symptoms, including interstitial cystitis, bacterial cystitis, urethritis, urethral syndrome, urethral diverticulum, postmenopausal atrophy, and trauma; evaluation considerations, including patient history, physical evaluation, and diagnostic tests; and management considerations for interstitial cystitis and urethral diverticula. 1 figure. 8 references.

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Abdominal Approaches to Surgery for Female Incontinence Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 319-327. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: Urinary incontinence in women is common. This chapter on abdominal approaches to surgery for female incontinence is from an exhaustive textbook on urologic surgery. The incidence of urinary incontinence rises after vaginal delivery, apparently as a result of nerve stretch, which can also occur after prolonged straining from constipation. The second major cause of urinary incontinence is detrusor instability, characterized by the occurrence of detrusor contractions during the filling phase or provoked by coughing or posture change. Detrusor instability is often associated with symptoms of frequency, nocturia, urgency, and urge incontinence. Urinary incontinence can be classified on the basis of radiologic findings and the degree of bladder base descent. If conservative measures have not succeeded, patients who have genuine stress incontinence, who are bothered by the symptom, and who are appropriate candidates should be offered surgery. The authors detail the surgical techniques used, including Burch colposuspension, the Marshall Marchetti Krantz procedure, suburethral slings, laparoscopic Burch colposuspension, and anticipated outcomes. Urethral obstruction after successful surgery occurs in about 10 percent of cases. Postoperative voiding difficulties may be predicted by preoperative voiding problems. Dyspareunia (pain during sexual intercourse) following pelvic floor surgery

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is not uncommon. The authors caution that obtaining information about the true results of this surgery can be difficult. Patients with persistent or recurrent urinary incontinence should be thoroughly reassessed. 5 figures. 3 tables. 12 references.

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CHAPTER 5. MULTIMEDIA ON DYSPAREUNIA Overview In this chapter, we show you how to keep current on multimedia sources of information on dyspareunia. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on dyspareunia is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “dyspareunia” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “dyspareunia” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on dyspareunia: •

Electrical Stimulation as a Treatment Option for Incontinence Source: Costa Mesa, CA: Wound Ostomy and Continence Nurses Society. 199x. (videocassette). Contact: Available from Wound Ostomy and Continence Nurses Society. 2755 Bristol Street, Suite 110, Costa Mesa, CA 92626. (888) 224-9629 or (714) 476-0268. Fax (714) 5453643. Website: www.wocn.org. PRICE: $15.00 for members; $20.00 for nonmembers. Summary: Electrical stimulation is a useful adjunctive treatment for selected patients with stress urinary incontinence, urge incontinence (detrusor instability), fecal incontinence, and other pelvic floor dysfunctions, including dyspareunia (painful sexual intercourse). Little systematic research evaluating the optimum parameters or concomitant therapies has been conducted, however. Consequently, there is no single recommended electrical stimulation method. This videotape program presents the method of electrical stimulation as used by Katherine N. Moore for the treatment of stress and urge incontinence. Practical tips concerning patient position, therapist

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position, sensor position, and closure technique are provided. Electrical stimulation features the application of electrical current to the pelvic viscera or nerve supplies. The program discusses the importance of individual pre-treatment assessment and the contraindications to electrical stimulation, including the presence of metal implants, IUD, or pacemaker; pregnancy; hemorrhoids; or urinary tract infection. The program also emphasizes the need for evaluation of the efficacy of the treatment through such measures as a voiding diary, pad test, quality of life assessment, and assessment of muscle strength. The video then walks the viewer through the procedure itself, noting that the stimulation should be felt by the patient but should not be uncomfortable. A medical model is used to show the positioning for vaginal electrical stimulation; a live patient is used to demonstrate the muscle contractions that can be seen and felt during the electrical stimulation. The narrator then outlines some typical programs of muscle stimulation for each type of urinary incontinence, stressing the importance of the workrest cycle and the need to adjust intensity to patient tolerance. The best results are obtained with this method when the patient has mild incontinence, the patient can inhibit detrusor contractions voluntarily, and the electrical stimulation is combined with other behavior modification techniques. The program concludes by cautioning viewers that the therapist can be at risk for back and wrist strain; methods to avoid these problems are depicted. The program encourages therapists to employ gentleness and tact while performing this low risk, minimally invasive technique.

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CHAPTER 6. PERIODICALS AND NEWS ON DYSPAREUNIA Overview In this chapter, we suggest a number of news sources and present various periodicals that cover dyspareunia.

News Services and Press Releases One of the simplest ways of tracking press releases on dyspareunia is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “dyspareunia” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to dyspareunia. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “dyspareunia” (or synonyms). The following was recently listed in this archive for dyspareunia: •

Tamoxifen Causes Dyspareunia In Half Of Women Source: Reuters Medical News Date: February 17, 1995

•

Causes of dyspareunia often overlooked by clinicians Source: Reuters Medical News Date: September 07, 1999

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “dyspareunia” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “dyspareunia” (or synonyms). If you know the name of a company that is relevant to dyspareunia, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “dyspareunia” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly

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51

to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “dyspareunia” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on dyspareunia: •

IC and Sexuality: Communication Breakdown Source: ICA Update. 14(4): 1-4. 2000. Contact: Available from Interstitial Cystitis Association. 51 Monroe Street, Suite 1402, Rockville, MD 20850. (301) 610-5300. Website: www.ichelp.org. Summary: This article explores the issue of sexuality for people with interstitial cystitis (IC), focusing on the importance of communication for coping with any sexual difficulties. With IC, painful sexual intercourse (dyspareunia) can occur for a number of reasons, many of which are still undefined. Theories about the causes of dyspareunia in IC include increased pelvic vascularity (blood flow to the pelvic region); increased nerve activation; pelvic floor dysfunction; sympathetic reflux dystrophy (which can cause diminished blood flow to the pelvic region and heighten pain); trauma to the bladder and surrounding areas during intercourse; irritating neurotransmitters; and related diseases, such as vulvodynia and or endometriosis. Regardless of cause, the pain is real and it can occur before, during, and after sexual activity. The author cautions that it may be difficult to find a physician or other health care provider who understands both the physical and emotional sides of sexual problems that are frequently associated with IC or who is comfortable discussing them with the patient. Having to contend with such a difficult disease as IC can amplify the difficulties that may develop within any intimate relationship. The key ingredient to better sexual expression and understanding, despite having IC, is communication. The author recommends talking openly, educating one's partner about IC, taking care of oneself, and experimenting with sexual alternatives. The author reports on information gleaned from a small group of patients with IC who discussed how they were working through their sexual intimacy issues.

•

Fibro and Interstitial Cystitis Source: Fibromyalgia Wellness Letter. 2(2): 3. April 1999. Contact: Available from Fibromyalgia Wellness Letter. P.O. Box 921907, Norcross, GA 30010-1907. (877) 775-0343. Summary: This brief article, from a newsletter for people with fibromyalgia, reviews the condition of interstitial cystitis (IC). IC is a chronic inflammatory condition affecting the bladder wall; about 10 percent of people with fibromyalgia also have IC. The symptoms of IC can include pain in the bladder and pelvic region, often accompanied by urinary urgency and frequency. People with IC may also experience nocturia (urinating at night), dysuria (painful urination), and dyspareunia (painful sexual intercourse). There is no definitive test to diagnose IC, so physicians must rule out other conditions, such as urinary tract infections. Cystoscopy (visualization of the bladder with a cystoscope) may be used to confirm the diagnosis. The article briefly discusses treatment options, which include bladder distension, oral medications (including pentosan polysulfate sodium, brand name Elmiron), bladder instillation with DMSO, experimental medications (still under study), transcutaneous electrical nerve stimulation (TENS), diet modification, and surgery. The article concludes with the contact information of the Interstitial Cystitis Association (ICA, 800-HELP-ICA or www.ichelp.org).

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What Else Can We Attribute to GERD? Source: Digestive Health Matters. 3(4): 1-2. Fall 2001. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. Website: www.iffgd.org. Summary: This health newsletter article reviews some seldom discussed complications of gastroesophageal reflux disease (GERD). GERD is characterized by the return (reflux) of gastric (stomach) acid backwards into the esophagus. The common symptoms of GERD include heartburn, unexplained chest pain, and inflammation and scarring of the lower esophagus (esophageal stricture) leading to swallowing difficulty. In this article, the author discusses other symptoms associated with GERD which may be common and can cause great distress. These symptoms are sore throat and cough, nocturnal choking, aspiration pneumonia, asthma, acid laryngitis, dental erosions, and reflux dyspareunia (heartburn during sexual intercourse). The author also considers problems with misdiagnosis and treatment options for these lesser-known complications of GERD. Treatment is focused on the rigorous prevention of reflux (drug therapy, lifestyle and dietary changes). 3 references.

Academic Periodicals covering Dyspareunia Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to dyspareunia. In addition to these sources, you can search for articles covering dyspareunia that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute9: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

9

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.10 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:11 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

10

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 11 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway12 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “dyspareunia” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 1449 48 912 5 2 2416

HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.16 Simply search by “dyspareunia” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

12

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

13

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 14 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 15 16

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists17 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.18 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.19 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

17 Adapted 18

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 19 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on dyspareunia can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to dyspareunia. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to dyspareunia. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “dyspareunia”:

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Female Sexual Dysfunction http://www.nlm.nih.gov/medlineplus/femalesexualdysfunction.html Male Genital Disorders http://www.nlm.nih.gov/medlineplus/malegenitaldisorders.html Pelvic Inflammatory Disease http://www.nlm.nih.gov/medlineplus/pelvicinflammatorydisease.html Sexual Health Issues http://www.nlm.nih.gov/medlineplus/sexualhealthissues.html Sexually Transmitted Diseases http://www.nlm.nih.gov/medlineplus/sexuallytransmitteddiseases.html Vaginal Diseases http://www.nlm.nih.gov/medlineplus/vaginaldiseases.html

Within the health topic page dedicated to dyspareunia, the following was listed: •

Diagnosis/Symptoms About Vulvodynia: Diagnosis Source: National Vulvodynia Association http://www.nva.org/about_vulvodynia/diagnosis.html

•

Treatment About Vulvodynia: Treatment Source: National Vulvodynia Association http://www.nva.org/about_vulvodynia/treatment.html FDA Clears New Female Sexual Therapy Device Source: Food and Drug Administration http://www.fda.gov/bbs/topics/ANSWERS/ANS01012.html

•

Coping Female Sexuality after Cancer Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=SA00071

•

Organizations American College of Obstetricians and Gynecologists http://www.acog.org/ National Vulvodynia Association http://www.nva.org National Women's Health Information Center Source: Dept. of Health and Human Services http://www.4woman.gov/

Patient Resources

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63

Prevention/Screening Vulvar Problems Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZQX9DQA7C &sub_cat=9

•

Statistics JAMA Patient Page: Sexual Dysfunction -- Silence about Sexual Problems Can Hurt Relationships Source: American Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZSAC20NAC &sub_cat=2

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on dyspareunia. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Q and A. Crohn's Disease and Ulcerative Colitis: Women's Issues Source: New York, NY: Crohn's and Colitis Foundation of America. 2002. 6 p. Contact: Available from Crohn's and Colitis Foundation of America (CCFA). 386 Park Avenue South, 17th Floor, New York, NY 10016-8804. (800) 932-2423. E-mail: [email protected]. Website: www.ccfa.org. PRICE: Single copy free. Summary: Crohn's disease and ulcerative colitis are chronic digestive diseases of the small and large intestines, collectively known as inflammatory bowel disease (IBD). This brochure answers common questions that women with these diseases may have. Symptoms of IBD can include diarrhea, abdominal pain, rectal bleeding, and fever; loss of appetite and weight loss are also common. If medications fail to control the symptoms of the disease, or if certain complications occur, surgery may be required. Yet, in spite of the physical and emotional demands of coping with IBD, most patients are able to lead full, satisfying lives. The brochure covers specific topics including the impact of IBD on menstruation, birth control and conception, dyspareunia (painful sexual intercourse), iron deficiency, pregnancy, drug therapy for IBD during pregnancy and breastfeeding, diagnostic procedures and surgery during pregnancy, pregnancy in women who have had prior bowel surgery, the genetic risks of IBD (passing along the disease to one's

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child), dietary recommendations for pregnant women with IBD, osteoporosis, and menopause. The brochure includes a brief description of the goals and activities of the Crohn's and Colitis Foundation of American (www.ccfa.org). The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to dyspareunia. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to dyspareunia. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with dyspareunia. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about dyspareunia. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

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Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “dyspareunia” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “dyspareunia”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “dyspareunia” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “dyspareunia” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.20

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

20

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)21: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

21

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

73

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on dyspareunia: •

Basic Guidelines for Dyspareunia PID Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000888.htm

•

Signs & Symptoms for Dyspareunia Dyspareunia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm

•

Diagnostics and Tests for Dyspareunia ANA Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003535.htm Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm

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Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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DYSPAREUNIA DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Actin: Essential component of the cell skeleton. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adipocytes: Fat-storing cells found mostly in the abdominal cavity and subcutaneous tissue. Fat is usually stored in the form of tryglycerides. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU]

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Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Alpha Cell: A type of cell in the pancreas (in areas called the islets of Langerhans). Alpha cells make and release a hormone called glucagon, which raises the level of glucose (sugar) in the blood. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Androgenic: Producing masculine characteristics. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Angina: Chest pain that originates in the heart. [NIH] Anthropometric measurements: Measurements of human body height, weight, and size of component parts, including skinfold measurement. Used to study and compare the relative proportions under normal and abnormal conditions. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Dictionary 77

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH]

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Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH]

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Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Broad Ligament: A broad fold of peritoneum that extends from the side of the uterus to the wall of the pelvis. [NIH] Cannabidiol: Compound isolated from Cannabis sativa extract. [NIH] Cannabinoids: Compounds extracted from Cannabis sativa L. and metabolites having the cannabinoid structure. The most active constituents are tetrahydrocannabinol, cannabinol, and cannabidiol. [NIH] Cannabinol: A physiologically inactive constituent of Cannabis sativa L. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Catgut: Sterile collagen strands obtained from healthy mammals. They are used as absorbable surgical ligatures and are frequently impregnated with chromium or silver for increased strength. They tend to cause tissue reaction. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]

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Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chromium: A trace element that plays a role in glucose metabolism. It has the atomic symbol Cr, atomic number 24, and atomic weight 52. According to the Fourth Annual Report on Carcinogens (NTP85-002,1985), chromium and some of its compounds have been listed as known carcinogens. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Circumcision: Excision of the prepuce or part of it. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloaca: The common chamber into which the intestinal, urinary, and genital tracts discharge in birds, reptiles, amphibians and many fishes; also a phylogenetically related embryonic structure in mammals. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Codons: Any triplet of nucleotides (coding unit) in DNA or RNA (if RNA is the carrier of primary genetic information as in some viruses) that codes for particular amino acid or signals the beginning or end of the message. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Coitus: Sexual intercourse. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Comet Assay: A genotoxicological technique for measuring DNA damage in an individual cell using single-cell gel electrophoresis. Cell DNA fragments assume a "comet with tail" formation on electrophoresis and are detected with an image analysis system. Alkaline assay conditions facilitate sensitive detection of single-strand damage. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes

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immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Condyloma: C. acuminatum; a papilloma with a central core of connective tissue in a treelike structure covered with epithelium, usually occurring on the mucous membrane or skin of the external genitals or in the perianal region. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH]

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Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Continence: The ability to hold in a bowel movement or urine. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Cryopreservation: Preservation of cells, tissues, organs, or embryos by freezing. In histological preparations, cryopreservation or cryofixation is used to maintain the existing form, structure, and chemical composition of all the constituent elements of the specimens. [NIH]

Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cystocele: Fallen bladder. When the bladder falls or sags from its normal position down to the pelvic floor, it can cause either urinary leakage or urinary retention. [NIH] Cystoscope: A thin, lighted instrument used to look inside the bladder and remove tissue samples or small tumors. [NIH] Cystoscopy: Endoscopic examination, therapy or surgery of the urinary bladder. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytotoxic: Cell-killing. [NIH]

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Danazol: A synthetic steroid with antigonadotropic and anti-estrogenic activities that acts as an anterior pituitary suppressant by inhibiting the pituitary output of gonadotropins. It possesses some androgenic properties. Danazol has been used in the treatment of endometriosis and some benign breast disorders. [NIH] Daunorubicin: Very toxic anthracycline aminoglycoside antibiotic isolated from Streptomyces peucetius and others, used in treatment of leukemias and other neoplasms. [NIH]

Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilator: A device used to stretch or enlarge an opening. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Dimethyl Sulfoxide: A highly polar organic liquid, that is used widely as a chemical solvent. Because of its ability to penetrate biological membranes, it is used as a vehicle for topical application of pharmaceuticals. It is also used to protect tissue during cryopreservation. Dimethyl sulfoxide shows a range of pharmacological activity including analgesia and anti-inflammation. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Dissection: Cutting up of an organism for study. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU]

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Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Doxorubicin: Antineoplastic antibiotic obtained from Streptomyces peucetics. It is a hydroxy derivative of daunorubicin and is used in treatment of both leukemia and solid tumors. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Dysuria: Painful or difficult urination. [EU] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromagnetic Fields: Fields representing the joint interplay of electric and magnetic forces. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]

Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU]

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Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH]

Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endorphins: One of the three major groups of endogenous opioid peptides. They are large peptides derived from the pro-opiomelanocortin precursor. The known members of this group are alpha-, beta-, and gamma-endorphin. The term endorphin is also sometimes used to refer to all opioid peptides, but the narrower sense is used here; opioid peptides is used for the broader group. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Energy balance: Energy is the capacity of a body or a physical system for doing work. Energy balance is the state in which the total energy intake equals total energy needs. [NIH] Enkephalins: One of the three major families of endogenous opioid peptides. The enkephalins are pentapeptides that are widespread in the central and peripheral nervous systems and in the adrenal medulla. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH]

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Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Stricture: A narrowing of the esophagus often caused by acid flowing back from the stomach. This condition may require surgery. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Evacuation: An emptying, as of the bowels. [EU] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Fallopian tube: The oviduct, a muscular tube about 10 cm long, lying in the upper border of the broad ligament. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body

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through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastroesophageal Reflux Disease: Flow of the stomach's contents back up into the esophagus. Happens when the muscle between the esophagus and the stomach (the lower esophageal sphincter) is weak or relaxes when it shouldn't. May cause esophagitis. Also called esophageal reflux or reflux esophagitis. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glossitis: Inflammation of the tongue. [NIH] Glucagonoma: Glucagon-secreting tumor of the pancreatic alpha cells characterized by a distinctive rash, weight loss, stomatitis, glossitis, diabetes, hypoaminoacidemia, and normochromic normocytic anemia. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Governing Board: The group in which legal authority is vested for the control of health-

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related institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gynaecological: Pertaining to gynaecology. [EU] Gynecologic cancer: Cancer of the female reproductive tract, including the cervix, endometrium, fallopian tubes, ovaries, uterus, and vagina. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Happiness: Highly pleasant emotion characterized by outward manifestations of gratification; joy. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Hoarseness: An unnaturally deep or rough quality of voice. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless,

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odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotherapy: Sleeping-cure. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hysterectomy: Excision of the uterus. [NIH] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileum: The lower end of the small intestine. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local

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infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Ingestion: Taking into the body by mouth [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Instillation: . [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intravesical: Within the bladder. [NIH] Introns: Non-coding, intervening sequences of DNA that are transcribed, but are removed from within the primary gene transcript and rapidly degraded during maturation of messenger RNA. Most genes in the nuclei of eukaryotes contain introns, as do mitochondrial and chloroplast genes. [NIH] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques.

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[EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kinetic: Pertaining to or producing motion. [EU] Laceration: 1. The act of tearing. 2. A torn, ragged, mangled wound. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngitis: Inflammation of the larynx. This condition presents itself with dryness and soreness of the throat, difficulty in swallowing, cough, and hoarseness. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Leptin: A 16-kD peptide hormone secreted from white adipocytes and implicated in the regulation of food intake and energy balance. Leptin provides the key afferent signal from fat cells in the feedback system that controls body fat stores. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Lipid: Fat. [NIH] Liposomal: A drug preparation that contains the active drug in very tiny fat particles. This fat-encapsulated drug is absorbed better, and its distribution to the tumor site is improved. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It

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stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lubricants: Oily or slippery substances. [NIH] Lubrication: The application of a substance to diminish friction between two surfaces. It may refer to oils, greases, and similar substances for the lubrication of medical equipment but it can be used for the application of substances to tissue to reduce friction, such as lotions for skin and vaginal lubricants. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Menarche: The establishment or beginning of the menstrual function. [EU] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired

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from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Mucositis: A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Myalgia: Pain in a muscle or muscles. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH]

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Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Oophorectomy: Surgery to remove one or both ovaries. [NIH] Orgasm: The crisis of sexual excitement in either humans or animals. [NIH] Ossification: The formation of bone or of a bony substance; the conversion of fibrous tissue or of cartilage into bone or a bony substance. [EU] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH]

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Papilloma: A benign epithelial neoplasm which may arise from the skin, mucous membranes or glandular ducts. [NIH] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pentosan polysulfate: A drug used to relieve pain or discomfort associated with chronic inflammation of the bladder. It is also being evaluated for its protective effects on the gastrointestinal tract in people undergoing radiation therapy. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perianal: Located around the anus. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Phosphodiesterase Inhibitors: Compounds which inhibit or antagonize the biosynthesis or actions of phosphodiesterases. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine

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(sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physician Assistants: Persons academically trained, licensed, or credentialed to provide medical care under the supervision of a physician. The concept does not include nurses, but does include orthopedic assistants, surgeon's assistants, and assistants to other specialists. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH]

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Preoperative: Preceding an operation. [EU] Prepuce: A covering fold of skin; often used alone to designate the preputium penis. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Priapism: Persistent abnormal erection of the penis, usually without sexual desire, and accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis. [EU] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Proctocolectomy: An operation to remove the colon and rectum. Also called coloproctectomy. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostaglandins D: Physiologically active prostaglandins found in many tissues and organs. They show pressor activity, are mediators of inflammation, and have potential antithrombotic effects. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Prostatitis: Inflammation of the prostate. [EU] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH]

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Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychophysiology: The study of the physiological basis of human and animal behavior. [NIH]

Psychosexual: Pertaining to the mental aspects of sex. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH]

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Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Round Ligament: A fibromuscular band that attaches to the uterus and then passes along the broad ligament, out through the inguinal ring, and into the labium majus. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the

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broad physiological actions and distribution of this biochemical mediator. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in

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spastic paralysis or in cerebral palsy. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Stenosis: Narrowing or stricture of a duct or canal. [EU] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU]

Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal pressure is increased, such as with laughing, sneezing, coughing, or physical activity. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH]

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Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Systemic: Affecting the entire body. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetrahydrocannabinol: A psychoactive compound extracted from the resin of Cannabis sativa (marihuana, hashish). The isomer delta-9-tetrahydrocannabinol (THC) is considered the most active form, producing characteristic mood and perceptual changes associated with this compound. Dronabinol is a synthetic form of delta-9-THC. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thoracic: Having to do with the chest. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic

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microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Transcutaneous: Transdermal. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urethritis: Inflammation of the urethra. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urinary urgency: Inability to delay urination. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamics: The mechanical laws of fluid dynamics as they apply to urine transport. [NIH]

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Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginal Fistula: An abnormal passage communicating with the vagina. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Veins: The vessels carrying blood toward the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vesicovaginal Fistula: An abnormal communication between the bladder and the vagina. [NIH]

Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Vulva: The external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

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Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zygote: The fertilized ovum. [NIH]

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INDEX A Abdomen, 10, 75, 78, 79, 90, 91, 95, 101, 104 Abdominal, 3, 26, 42, 44, 63, 75, 91, 94, 101, 103 Abdominal Pain, 4, 63, 75, 91, 103 Aberrant, 13, 75 Acceptor, 75, 94 Acetylcholine, 75, 93 Actin, 75, 93 Activities of Daily Living, 3, 75 Adhesions, 12, 21, 75 Adipocytes, 75, 91 Adrenal Cortex, 75, 86, 97 Adverse Effect, 75, 100 Afferent, 10, 75, 91 Affinity, 75, 100 Agonist, 11, 75, 83 Algorithms, 76, 78 Alleles, 11, 76 Allergen, 76, 83 Alpha Cell, 76, 87 Alpha Particles, 76, 98 Alternative medicine, 50, 76 Amino Acids, 76, 95, 96, 97 Amputation, 25, 76 Anal, 4, 43, 76, 85, 86 Anastomosis, 43, 76 Androgenic, 76, 83 Androgens, 38, 75, 76 Anemia, 76, 87 Anesthesia, 8, 76 Angina, 76, 94 Anthropometric measurements, 11, 76 Antibacterial, 76, 101 Antibiotic, 76, 83, 84, 101 Antibodies, 77, 98 Antibody, 13, 75, 77, 81, 82, 88, 89, 98 Antigen, 75, 77, 81, 88, 89 Anti-inflammatory, 10, 77 Antioxidant, 9, 77 Anus, 76, 77, 79, 80, 95, 98 Aqueous, 77, 78 Arachidonic Acid, 77, 97 Arterial, 77, 89, 94, 97 Arteries, 77, 78, 82 Arterioles, 77, 78 Aspiration, 52, 77

Assay, 77, 80 Atrophy, 44, 77 Axons, 77, 93 B Back Pain, 18, 77 Bacteria, 7, 76, 77, 86, 92, 101, 103 Bacteriuria, 6, 77, 103 Base, 44, 78, 91 Benign, 43, 78, 83, 93, 95, 98 Benign prostatic hyperplasia, 43, 78 Bile, 78, 86, 87, 91, 101 Bile Acids, 78, 87, 101 Biochemical, 76, 78, 99 Biomarkers, 9, 78 Biopsy, 43, 73, 78 Biosynthesis, 77, 78, 95 Biotechnology, 14, 50, 57, 78 Biotransformation, 78 Bladder, 4, 5, 6, 7, 8, 41, 42, 43, 44, 51, 78, 81, 82, 89, 90, 95, 97, 101, 103, 104 Blastocyst, 78, 81, 96 Bloating, 4, 78, 91 Blood pressure, 78, 79, 89, 100 Blood vessel, 38, 78, 79, 91, 100, 102, 104 Body Fluids, 78, 84, 100, 103 Body Mass Index, 12, 79 Bowel, 43, 63, 76, 79, 82, 83, 90, 101, 103 Bowel Movement, 79, 82, 83, 101 Broad Ligament, 79, 86, 99 C Cannabidiol, 79 Cannabinoids, 10, 79 Cannabinol, 79 Carbohydrate, 8, 79, 87 Carcinoma, 16, 43, 79 Cardiac, 79, 85, 94, 101 Cardiovascular, 4, 79, 99 Cardiovascular disease, 4, 79 Case report, 16, 20, 22, 29, 30, 32, 79 Catgut, 17, 79 Catheterization, 5, 43, 79, 90 Caudal, 79, 89, 96 Causal, 79, 85 Cecum, 79, 91 Cell, 5, 7, 75, 76, 77, 78, 79, 80, 81, 82, 86, 90, 93, 94, 96, 99, 102, 104 Central Nervous System, 10, 75, 79, 84, 87, 99

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Cerebrovascular, 79 Cervical, 12, 80 Cervix, 13, 80, 88 Chest Pain, 52, 80 Chromium, 79, 80 Circumcision, 22, 80 Clinical trial, 9, 57, 80, 84, 98 Cloaca, 34, 80 Cloning, 78, 80 Codons, 80 Cohort Studies, 80, 85 Coitus, 24, 80 Colitis, 63, 64, 80, 91 Collagen, 79, 80 Colon, 34, 43, 80, 90, 91, 97, 103 Comet Assay, 9, 80 Complement, 80, 81 Complementary and alternative medicine, 29, 35, 81 Complementary medicine, 29, 81 Complete remission, 81, 99 Compliance, 13, 81 Computational Biology, 57, 81 Conception, 63, 81, 82, 86, 101 Concomitant, 47, 81 Condyloma, 21, 81 Connective Tissue, 80, 81, 82, 92 Constipation, 4, 44, 82, 91 Continence, 43, 47, 82 Contraceptive, 11, 12, 82 Contraindications, ii, 48, 82 Coronary, 79, 82, 94 Coronary heart disease, 79, 82 Corpus, 82, 95, 97 Corpus Luteum, 82, 97 Cortex, 82 Cross-Sectional Studies, 82, 85 Cryopreservation, 82, 83 Cues, 12, 82 Curative, 5, 82, 102 Cyclic, 82, 95 Cyst, 14, 82 Cystitis, 4, 5, 6, 7, 8, 33, 42, 43, 44, 51, 82 Cystocele, 41, 82 Cystoscope, 51, 82 Cystoscopy, 5, 6, 43, 51, 82 Cytokines, 7, 10, 82 Cytotoxic, 82, 98 D Danazol, 11, 83 Daunorubicin, 83, 84 Defecation, 4, 43, 83

Desensitization, 31, 83 Diagnostic procedure, 37, 50, 63, 83 Diarrhea, 4, 63, 83, 91 Digestion, 78, 79, 83, 90, 91, 101 Digestive system, 83, 93 Dilation, 25, 27, 83 Dilator, 83, 94 Dimethyl, 4, 6, 83 Dimethyl Sulfoxide, 4, 6, 83 Direct, iii, 83, 99 Dissection, 42, 83 Distal, 83, 87 Distention, 8, 83 Diverticula, 42, 44, 83 Diverticulum, 30, 42, 44, 83 Dopamine, 83, 93 Dorsal, 83, 96 Double-blind, 9, 84 Doxorubicin, 16, 84 Drive, ii, vi, 4, 8, 44, 84, 91 Drug Interactions, 84 Drug Tolerance, 84, 102 Duct, 14, 79, 84, 101 Duodenum, 78, 84, 94, 101 Dysmenorrhea, 11, 12, 15, 20, 25, 84 Dystrophy, 51, 84 Dysuria, 12, 42, 44, 51, 84 E Efferent, 10, 84 Efficacy, 5, 9, 13, 48, 84 Ejaculation, 4, 84, 99 Electrolyte, 84, 96, 100 Electromagnetic Fields, 30, 84 Electrons, 77, 78, 84, 91, 94, 98 Electrophoresis, 80, 84 Embryo, 78, 84, 89, 101 Emollient, 84, 87 Empiric, 7, 84 Encapsulated, 85, 91 Endocrinology, 85, 88 Endometrial, 6, 9, 10, 12, 85 Endometriosis, 6, 10, 11, 12, 30, 51, 83, 85 Endometrium, 85, 88, 92 Endorphins, 85, 93 Endoscopy, 42, 85 Energy balance, 85, 91 Enkephalins, 85, 93 Environmental Health, 56, 58, 85 Enzyme, 11, 85, 95, 104 Epidemiologic Studies, 12, 85 Epidemiological, 9, 31, 85 Epinephrine, 83, 85, 93, 94

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Epithelial, 7, 38, 42, 85, 95 Epithelial Cells, 7, 38, 85 Epithelium, 5, 7, 38, 42, 81, 85 Erectile, 4, 85, 95 Erection, 4, 8, 85, 97 Erythema, 85, 104 Esophageal, 52, 86, 87 Esophageal Stricture, 52, 86 Esophagitis, 86, 87 Esophagus, 52, 83, 86, 87, 88, 91, 95, 99, 101 Estradiol, 8, 38, 86 Estrogen, 6, 8, 10, 11, 31, 38, 86 Evacuation, 82, 86 Excitation, 86, 93 Exogenous, 78, 86 Extracellular, 81, 82, 86, 100 F Fallopian tube, 86, 88 Family Planning, 57, 86 Fat, 11, 75, 77, 82, 86, 91, 100 Fatty acids, 86, 97 Fecal Incontinence, 47, 86, 89 Feces, 82, 86, 101 Fetus, 86, 96, 101, 104 Fistula, 42, 86 Flatus, 86, 87 Free Radicals, 77, 86 Friction, 86, 92 G Gallbladder, 75, 83, 86 Gamma Rays, 86, 98 Gas, 86, 89, 91, 94 Gastric, 52, 87, 88 Gastrin, 87, 88 Gastroesophageal Reflux, 52, 87 Gastroesophageal Reflux Disease, 52, 87 Gastrointestinal, 52, 85, 87, 95, 99, 102, 103 Gastrointestinal tract, 87, 95, 99, 103 Gene, 76, 78, 87, 90, 99 Genital, 7, 62, 80, 87, 88, 104 Genitourinary, 21, 87, 104 Genotype, 87, 95 Germ Cells, 87, 94, 100, 102 Gestation, 87, 96, 101 Gland, 75, 87, 92, 94, 97, 99, 101 Glossitis, 87 Glucagonoma, 15, 87 Glucose, 76, 80, 87, 90 Glucuronic Acid, 87, 88 Glutamic Acid, 87, 93 Glycerol, 17, 87, 95

Glycine, 87, 93 Governing Board, 87, 96 Grade, 41, 88 Grafting, 88, 89 Gynaecological, 31, 88 Gynecologic cancer, 12, 88 Gynecology, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23, 25, 26, 27, 30, 33, 88 H Happiness, 13, 43, 88 Heart attack, 79, 88 Heartburn, 52, 88 Hematuria, 42, 88 Hemorrhoids, 48, 88 Heparin, 6, 88 Heredity, 87, 88 Histamine, 88 Histidine, 38, 88 Hoarseness, 88, 91 Homologous, 76, 88, 99, 102 Hormonal, 6, 8, 12, 77, 88 Hormonal therapy, 6, 88 Hormone, 10, 11, 30, 31, 76, 85, 86, 87, 88, 90, 91, 97, 102 Hormone Replacement Therapy, 11, 30, 88 Hormone therapy, 88 Hydrogen, 75, 78, 79, 88, 93, 94, 97 Hydrolysis, 78, 89, 96 Hyperalgesia, 10, 89 Hyperplasia, 9, 89 Hypersensitivity, 76, 83, 89 Hypertension, 79, 89 Hypertrophy, 23, 78, 89 Hypnotherapy, 32, 34, 89 Hypothalamic, 8, 89 Hypothalamus, 89 Hysterectomy, 6, 25, 26, 89 I Ileal, 43, 89 Ileum, 43, 79, 89 Immunologic, 89, 98 Immunotherapy, 83, 89 Implantation, 6, 81, 89 Impotence, 25, 44, 85, 89 In vivo, 31, 88, 89 Incision, 89, 90 Incompetence, 87, 89 Incontinence, 5, 6, 7, 14, 15, 16, 41, 42, 44, 47, 89, 101 Induction, 76, 89 Infection, 7, 42, 43, 89, 92, 102, 104

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Infertility, 11, 12, 90 Inflammation, 12, 42, 43, 52, 77, 80, 82, 83, 86, 87, 90, 91, 95, 96, 97, 101, 103, 104 Inflammatory bowel disease, 43, 63, 90 Ingestion, 11, 90 Inguinal, 90, 99 Innervation, 10, 38, 90 Insomnia, 9, 90 Instillation, 4, 5, 8, 51, 90 Insulin, 8, 90 Insulin-dependent diabetes mellitus, 90 Intermittent, 4, 5, 43, 90 Interstitial, 4, 5, 6, 7, 8, 33, 42, 43, 44, 51, 90 Intervertebral, 90, 91 Intervertebral Disk Displacement, 90, 91 Intestinal, 38, 80, 90 Intestine, 79, 90, 91 Intracellular, 89, 90, 96 Intravesical, 4, 7, 90 Introns, 90 Intubation, 79, 90 Invasive, 13, 48, 90 Involuntary, 4, 86, 91, 100, 101 Ionizing, 76, 91, 98 Ions, 78, 84, 89, 91, 93 Irritable Bowel Syndrome, 12, 25, 34, 91 Ischemia, 77, 91 K Kb, 56, 91 Kinetic, 91 L Laceration, 26, 91 Large Intestine, 63, 79, 83, 90, 91, 98, 100 Laryngitis, 52, 91 Larynx, 91 Leptin, 8, 91 Leukemia, 84, 91 Libido, 8, 76, 91 Lipid, 87, 90, 91 Liposomal, 16, 91 Liver, 75, 77, 78, 83, 86, 87, 88, 91 Localized, 85, 89, 91, 96, 104 Low Back Pain, 4, 32, 91 Lower Esophageal Sphincter, 87, 91 Lubricants, 92 Lubrication, 38, 92 Lumbar, 77, 90, 91, 92 Lymph, 80, 92 Lymph node, 80, 92 Lymphatic, 90, 92, 100 M Malignant, 15, 92, 93, 98

Malnutrition, 77, 92 MEDLINE, 57, 92 Membrane, 81, 85, 91, 92, 96 Menarche, 12, 92 Meninges, 79, 92 Menopause, 4, 64, 92, 96 Menstrual Cycle, 4, 12, 92, 97 Menstruation, 4, 63, 84, 92 Mental, iv, 9, 20, 24, 56, 58, 89, 92, 98 Metabolite, 78, 83, 92 Microbe, 92, 103 Microbiology, 77, 92 Microorganism, 92, 104 Mobilization, 4, 92 Modification, 48, 51, 92, 98 Molecular, 57, 59, 78, 81, 88, 93, 103 Molecular Structure, 93, 103 Molecule, 77, 78, 81, 86, 89, 93, 94, 98 Mucositis, 16, 93 Mucus, 93, 103 Muscle Contraction, 4, 48, 93 Musculature, 4, 34, 93, 101 Myalgia, 22, 93 Mydriatic, 83, 93 Myosin, 93 N Neoplasia, 6, 93 Neoplasms, 83, 93, 98 Nerve Fibers, 10, 38, 93 Nervous System, 75, 79, 93, 95 Neural, 10, 75, 93 Neurologic, 4, 93 Neurons, 93, 102 Neurotransmitter, 38, 75, 83, 87, 88, 93, 94, 102 Neutrons, 76, 93, 98 Nitrogen, 76, 94 Nitroglycerin, 38, 94 Norepinephrine, 83, 93, 94 Nucleus, 82, 86, 90, 93, 94, 97, 101 O Oophorectomy, 6, 94 Orgasm, 38, 84, 94 Ossification, 21, 94 Osteoporosis, 64, 94 Ovaries, 6, 88, 94, 100 Ovary, 8, 82, 86, 94 Ovulation, 8, 94 Ovum, 82, 87, 94, 97, 104, 105 Oxidation, 9, 75, 77, 78, 94 P Pacemaker, 48, 94

111

Palliative, 5, 94, 102 Pancreas, 75, 76, 78, 83, 90, 94, 103 Pancreatic, 87, 94 Pancreatic Juice, 87, 94 Papilloma, 81, 95 Partial remission, 95, 99 Pathologic, 7, 78, 82, 89, 95 Pathologies, 12, 95 Pathophysiology, 43, 95 Patient Education, 8, 13, 43, 63, 68, 70, 74, 95 Pelvis, 4, 8, 22, 75, 79, 92, 94, 95, 104 Penis, 8, 84, 95, 97 Pentosan polysulfate, 6, 51, 95 Peptide, 38, 91, 95, 96, 97 Perianal, 81, 95 Perineal, 17, 24, 26, 31, 32, 33, 95 Perineum, 8, 95 Peripheral blood, 9, 95 Peripheral Nervous System, 85, 93, 95, 102 Pharmacokinetic, 95 Pharmacologic, 76, 95, 103 Pharynx, 87, 95 Phenotype, 7, 95 Phosphodiesterase, 38, 95 Phosphodiesterase Inhibitors, 38, 95 Phospholipids, 86, 95 Physical Examination, 4, 5, 43, 96 Physical Therapy, 3, 8, 96 Physician Assistants, 5, 96 Physiologic, 4, 75, 78, 92, 96 Physiology, 85, 88, 96 Placenta, 86, 96, 97 Plants, 87, 94, 96, 103 Plasma, 38, 77, 96, 99 Pneumonia, 52, 82, 96 Polypeptide, 38, 80, 96 Posterior, 23, 76, 77, 83, 94, 96 Postmenopausal, 8, 23, 44, 94, 96 Postoperative, 42, 44, 96 Potassium, 43, 96 Practice Guidelines, 58, 96 Premenopausal, 12, 96 Preoperative, 7, 44, 97 Prepuce, 80, 97 Presynaptic, 93, 97 Prevalence, 12, 24, 25, 26, 97 Priapism, 4, 97 Probe, 13, 97 Proctocolectomy, 43, 97 Progesterone, 6, 97, 101 Prolapse, 7, 41, 97

Prostaglandins, 10, 38, 77, 97 Prostaglandins A, 11, 97 Prostaglandins D, 97 Prostate, 78, 97, 103 Prostatic Hyperplasia, 97 Prostatitis, 43, 97 Protein S, 78, 97 Proteins, 76, 77, 80, 81, 82, 93, 94, 95, 96, 97 Protons, 76, 89, 91, 97, 98 Psychic, 91, 92, 98 Psychogenic, 4, 98, 103 Psychophysiology, 30, 98 Psychosexual, 15, 98 Public Policy, 57, 98 Publishing, 14, 98 Pupil, 83, 93, 98 Purulent, 98, 104 Q Quality of Life, 3, 5, 12, 34, 43, 48, 98 R Radiation, 43, 86, 91, 95, 98, 104 Radiation therapy, 95, 98 Radioactive, 89, 98 Radioimmunotherapy, 98 Radiotherapy, 12, 98 Randomized, 9, 13, 29, 33, 84, 98 Rectal, 63, 98 Rectum, 34, 43, 77, 79, 80, 83, 86, 87, 89, 90, 91, 97, 98 Recur, 42, 98 Recurrence, 11, 98, 99 Refer, 1, 4, 80, 85, 92, 93, 98, 99, 103 Reflux, 25, 51, 52, 87, 99 Refraction, 99, 101 Regimen, 6, 84, 99 Regurgitation, 87, 88, 99 Remission, 5, 99 Retrospective, 11, 99 Risk factor, 11, 12, 43, 85, 99 Round Ligament, 22, 99 S Screening, 63, 80, 99, 103 Scrotum, 8, 99, 102 Secretion, 8, 88, 90, 93, 99 Sediment, 99, 103 Segregation, 77, 99 Self Care, 75, 99 Semen, 84, 97, 99 Senile, 94, 99 Sensibility, 89, 99 Sensor, 48, 99 Serotonin, 93, 99

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Sex Characteristics, 76, 100, 102 Sexually Transmitted Diseases, 4, 62, 100 Shock, 100, 103 Side effect, 9, 11, 75, 100, 102 Signs and Symptoms, 99, 100 Skeletal, 76, 100 Small intestine, 79, 84, 88, 89, 90, 100 Smooth muscle, 38, 88, 94, 100, 102 Sneezing, 100, 101 Social Environment, 98, 100 Social Support, 5, 100 Sodium, 51, 100 Soft tissue, 4, 100 Solid tumor, 84, 100 Solvent, 83, 87, 100 Soma, 100 Somatic, 9, 95, 100 Spastic, 91, 100 Specialist, 4, 64, 83, 101 Spectrum, 13, 101 Sperm, 76, 101, 102 Sphincter, 43, 91, 101 Spinal cord, 79, 92, 93, 95, 97, 101 Spontaneous Abortion, 20, 101 Sprains and Strains, 91, 101 Stasis, 30, 101 Stenosis, 42, 101, 102 Sterility, 90, 101 Steroid, 83, 101 Stimulus, 84, 86, 90, 101 Stomach, 52, 75, 83, 86, 87, 88, 91, 95, 99, 100, 101 Stomatitis, 87, 101 Stool, 80, 89, 91, 101 Strand, 9, 80, 101 Stress, 4, 7, 8, 16, 41, 44, 47, 91, 101, 104 Stress incontinence, 44, 101 Stress urinary, 7, 16, 47, 101 Stricture, 101, 102 Stroke, 56, 79, 102 Stromal, 85, 102 Subacute, 90, 102 Subclinical, 89, 102 Substance P, 92, 99, 102 Support group, 6, 102 Symptomatic, 17, 33, 42, 102 Synaptic, 93, 102 Systemic, 78, 85, 90, 98, 101, 102 T Testicles, 99, 102 Testicular, 8, 102 Testis, 86, 102

Testosterone, 8, 38, 102 Tetrahydrocannabinol, 79, 102 Therapeutics, 32, 34, 102 Thoracic, 77, 102 Tolerance, 48, 102 Topical, 38, 83, 102 Toxic, iv, 83, 102, 103 Toxicity, 9, 84, 102 Toxicokinetics, 103 Toxicology, 58, 103 Toxin, 29, 102, 103 Transcutaneous, 4, 8, 51, 103 Transfection, 78, 103 Trauma, 17, 30, 31, 32, 44, 51, 86, 103 Tricyclic, 6, 103 Tumor marker, 78, 103 U Ulcerative colitis, 43, 63, 90, 103 Ureters, 103 Urethra, 42, 78, 95, 97, 103 Urethritis, 6, 44, 103 Urinalysis, 5, 103 Urinary, 4, 5, 6, 7, 8, 41, 42, 43, 44, 48, 51, 77, 80, 82, 87, 89, 101, 103, 104 Urinary Retention, 82, 103 Urinary tract, 6, 43, 48, 51, 77, 103 Urinary tract infection, 6, 43, 48, 51, 77, 103 Urinary urgency, 51, 103 Urinate, 5, 8, 103 Urine, 5, 6, 7, 8, 42, 43, 77, 78, 82, 88, 89, 101, 103 Urodynamics, 43, 103 Urogenital, 31, 87, 104 Urticaria, 17, 26, 104 Uterus, 6, 10, 12, 79, 80, 82, 85, 88, 89, 92, 94, 97, 99, 104 V Vagina, 4, 38, 42, 80, 88, 92, 104 Vaginal, 4, 8, 9, 10, 13, 16, 19, 25, 26, 27, 30, 33, 38, 41, 42, 44, 48, 62, 92, 104 Vaginal Fistula, 33, 104 Vaginitis, 6, 104 Vascular, 4, 90, 96, 104 Vasoactive, 38, 104 Veins, 78, 104 Venous, 88, 94, 97, 104 Venules, 78, 104 Vesicovaginal Fistula, 31, 42, 104 Veterinary Medicine, 57, 104 Virulence, 102, 104 Viruses, 80, 92, 104

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Viscera, 7, 48, 100, 104 Visceral, 4, 11, 104 Vitro, 31, 88, 89, 104 Vivo, 104 Volition, 91, 104 Vulva, 6, 104 W White blood cell, 77, 93, 104

Womb, 104 X X-ray, 86, 98, 104 Y Yeasts, 95, 105 Z Zygote, 81, 105

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