Women’s psychosomatic health promotion and the biopsychosociocultural nexus

Abstract

Chapter 8 discusses the promotion of women's psychosomatic health by prevention or early treatment of cancer and obesity. Health providers have to consider the biological, psychological, social, and cultural factors that alter psychosomatic interactions to generate these health conditions. Primary/secondary prevention need more emphasis than tertiary prevention or treatment. The transition of normal cervical epithelium to cervical-intraepithelial neoplasia (CIN), and the progression of CIN 2/3 to cancer is preventable. Two-thirds of patients with CIN have HPV infection. Cervical screening allows astute clinical decision-making as CIN could revert back to normal epithelium. Colposcopically-directed early treatment of CIN 2/3 is a secondary preventive measure. Cervical screening has reduced cervical cancer in the West but organised screening is unavailable in low-middle income countries where cervical cancer is common. Sociocultural practices promote unsafe sex, such as when minors in these countries acquire HPV infection through marriage to an older infected male or when women/adolescents are war victims. Inebriated party-goers may acquire HPV infection through unsafe sex. HPV vaccines protect against 70% of carcinogenic HPV strains only. Serious adverse effects after vaccination are uncommon. Barrier contraception prevents HPV, and other sexually transmitted diseases. Obesity increases the risk of endometrial cancer. Type-1 endometrial cancer relates to obesity and starts at a younger age, unlike type-2. Obesity also affects fertility. Transgenerational changes in the fetus of the obese gravida can promote obese offspring. Bariatric surgery for obesity is however expensive, with a potential for complications. WHO directives thus advise on prevention of obesity, and the overweight habitus. Primary prevention of obesity through lifestyle changes should start in childhood.