For the Seventh Edition of this text, the title has been changed to Kistner's Gynecology
and Women's Health (from Kistner's Gynecology) to recognize the broad scope and
expanded interest in the field of women's health care. Although over the past 35 years,
previous editions of Kistner have appealed largely to students, trainees, and
practitioners in gynecology, this new edition should be useful not only for gynecologists
but for internists, family practitioners, and women's health specialists who are devoting
more of their time and effort to women's medical issues.
The reproductive tract in pediatric and adolescent patients differs from that of the adult, requiring special techniques and equipment for examination. The gynecologic problems addressed in children and adolescents may differ markedly from those of adult women but may be no less serious. Both the anatomy and physiology of the reproductive tract will change from the hormone-stimulated state of the newborn to the relatively estrogen-free state of the young child to the blossoming of womanhood during adolescence.
In this chapter the following common gyneco- logical problems of children and adolescents will be described: fusion of the labia, vulvovaginitis, lichen sclerosus, condylomata acuminata, sexual abuse, prepubertal bleeding, abnormal bleeding after menarche, trauma and genital tumors.
Temporal trends in unsafe abortion have been inconsistent internationally
(figure 2). Between 1995 and 2000, a decline of 5 or more percentage
points took place in the unsafe abortion rate in eastern, middle, and
western Africa, the Caribbean, and Central America. Other developing
areas had no appreciable change in the rate of unsafe abortion.
Unsafe abortions vary substantially by age across regions: adolescents
(15–19 years) account for 25% of all unsafe abortions in Africa, whereas
the percentage in Asia, Latin America, and the Caribbean is much lower
For over 70 years, the Association of Maternal & Child Health Programs
(AMCHP) has worked to protect the health and well-being of America’s
families, especially those that are low-income and underserved. A national,
non-profit association, AMCHP represents public health leaders serving at
the highest levels of state government, including directors of maternal and
child health (MCH) programs, directors of programs for children with special
health care needs, adolescent health coordinators and other government
The scope of practice of the gynecologist is broad and challenging. The
gynecologist is blessed with the longitudinal care of women from adolescence
through the end stages of life. In fact, many women consider their
gynecologist their primary care physician.
This edition of Obstetrics and Gynecology Clinics of North America
explores many of the daily challenges of office practice. Updates in new
contraceptive options and in management of dysfunctional uterine bleeding
The poor nutritional status of women in developing countries has been associated with
maternal mortality. Maternal deaths do not result from malnutrition alone, however, but
mainly from a lack of access to obstetric care and from previous conditions that may be
aggravated by poor nutrition.
Co–hosted by Realizing Rights: The Ethical Globalization Initiative, the
Council of Women World Leaders, and the Columbia University Mailman
School of Public Health, the meeting addressed the most fundamental chal-
lenges facing women’s health. Participants shared their experiences of what
policies have proven successful in providing access to health care, and com-
mitted themselves to develop and promote leadership in implementing health
care policies that effectively provide fundamental services to women.
During the transition to adulthood, lack of knowledge and awareness about reproductive organs,
physiological changes, or sexuality can promote psychosocial stress. This is particularly so for girls, who
also face gender discrimination. Adolescent girls and boys experience psychosocial stress. A study
conducted by the State Education Resource Centre (SERC) in Uttar Pradesh established that gender
equality was unknown and adolescent girls felt that they were a burden on their families and had poorer
self-image while their counterparts felt superior.
Women’s nutritional conditions differ widely among and within countries. Such conditions
are worst in the less-developed regions and countries of the world, where poverty, social
disparities, discrimination, and different kinds of malnutrition affect large populations.
Minimizing the frequency and consequences of iatrogenic infections depends on improving the
quality and accessibility of good medical services. Unlike STIs, which rely primarily on behavior
change for their prevention, avoiding iatrogenic infections centers on maximizing access to good
quality care, and in particular the technical competence of health care providers. It also requires
resources and supportive public policy measures and encouragement of prompt health care
seeking behavior by individuals.
Trachoma is first and foremost a disease of morbidity, reflecting
suffering and disability, in contrast with mortality, which reflects the
rate of death. The burden of disease is an effective framework for
discussing trachoma since it takes into account the effects of morbidity
and mortality on the ability to fulfill societal roles. The burden of
disease looks beyond the prevalence of a disease; that is, it attempts to
measure the impact of disease based on its distribution by sex and age....