A method of diagnosing and treating functional pelvic disease

Abstract

I NTEREST in the problem of functional pelvic disease has increased in recent years. It is recognized that any of the symptoms which usually result from organic disease may appear as a result of emotional and psychological disturbances. Every disease has a somatic and a psychic component. Fordyce Barker,’ in his presidential address before the Second Annual Meeting of the American Gynecological Society, discussed the frequency with which the correction of emotional problems relieved symptoms in patients with apparent organic pelvic disease. Be also urged a revival of conservative management in gynecologic treatment. Cooke* has stated, “Ninety-five per cent of the severity of human suffering is mental; a great deal of the symptomatology encountered in the practice of gynecics is of purely mental origin.” The recent gynecologic literature contains an increasing number of references to the psychosomatic origin of some specific gynecologie complaints.“~ 4. B The use of hypnotism and suggestion in the treatment of obstetric and gynecologic diseases is receiving attention.6j 7, * In the majority of our patients predominance of the somatic or the psychic factor in a patient’s illness is obvious, and little difficulty is encountered in making a diagnosis. Rowever, in a large group of patients the psychic and somatic conditions overlap, making accurate differentiation extremely difficult. A previous study” of the private gynecologic patients referred to our clinic revealed that 32.5 per cent of them suffered primarily from functional disease. Thirteen per cent of the patients had pat,hologic changes in the pelvis in addition to a functional complaint. Many patients were referred for various operative procedures which were unnecessary after a fundamental emotional problem had been solved. Others had a pathologic lesion treated elsewhere, but had failed to respond because an unsolved psychological problem was present. The purpose of this paper is to evaluate the methods we use for diagnosing and treating functional pelvic disease. Such an evaluation must be based upon the accuracy of the diagnosis, and the patient’s response to treatment. A summary of the results obtained in the treatment of this series of pat,ients is therefore included in the data.