Diane - Reproduction 1

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Background

Flan-ized version

Diane is a 30 year old female who has been married for five years and has been actively trying to conceive for three years. She reports extensive family pressure from her husband and mother-in-law primarily, but also from her own parents. Before trying to conceive, Diane used an IUD for contraception. Her periods have always been irregular, and her last period was 5 months ago. She reports that her husband was "not very happy" about the missed periods.

Diane reports that she is having sex twice a week, but isn't actively trying any other methods to assist insemination. She reports not enjoying sex as much now as three years ago, and is growing more frustrated with her inability to have children. At this point, she says that she and her husband don't talk about the issue very much, remarking that everything has already been said.

There is no previous history of infertility in the husband's family, and the only remarkable history in Diane's family is that her sister has a pelvic kidney.

Points

  • 30 year old female
  • married 5 years ago
  • Trying to conceive for 3 years
  • Frustrated about this
  • Husband laid off 3 months ago
  • Mother-in-law really wants kids
  • Some family pressure to have kids
  • Have sex twice a week
  • Doesn't enjoy sex as much now as three years ago
  • hasn't considered artificial insemination or other methods
  • Sister has pelvic kidney
  • No other investigations
  • Had IUD before she started trying to conceive
  • Hasn't had a period for 5 months; periods are sporadic
  • partner "not very happy" about the missed periods
  • Don't talk about it very much
  • No hospitalization, previous medical history, etc.
  • appeared remarkably uncomfortable
  • Works at Kwik-e-maid

What wasn't asked?

  • Do you have any STIs?
  • How many partners have you had?

Final session

  • Diane appeared to be abused
  • Claimed that she had fallen down in the tub
  • Corey plays hockey
  • He strongly opposed any testing for himself
  • Kept saying that the problem couldn't be him -- it's obviously Diane.


Objectives for week 1

  • What are some basic tests that should be carried out? (What are the next steps?)
  • What are the societal implications of infertility? Historically, have they always been this way?
  • Examine the following scenarios in discussing gender roles:
    1. Diane - 30 year old woman (this case)
    2. Diane - 15 year old girl with mullerian agenesis
    3. Diane - 42 year old man with vasectomy who is married but hasn't told his 28-year old wife
    4. Diane - 25 year old Somali woman married for 2 years; translator says that not conceiving for 2 years is culturally unacceptable
    5. Diane - 30 year old physician who has just setup practice, and hasn't conceived in 1 year.
  • What are some physician biases?
  • Discuss comfort level with some of these issues

Objectives for week 2

  • Why is it important to couples to have kids?
  • What is the psychology of cheatiing?
  • What is intraepithelial neoplasia (LSIL - Lowgrade squamous intraepithelial lesion)?
  • What would Diane have found if she net-searched for "abnormal pap smear"? What would one find on med-professional sites
  • What's the deal with premature-onset menopause and anovulation?

Objectives for week 3

Impotence

  • Discuss the difference between a male and female physician when the man has a "problem" and when the woman has a problem.

Relationship

  • What are the considerations in helping a couple conceive when the child will be raised in a toxic environment?
  • Something something about the power differential in the relationship

Abuse

  • What are the obligations of a physician who suspects abuse?
  • What if the abuse were reversed, and it was Diane who struck out against Corey?
  • Discuss a scenario in which the woman wants to have children, but the man doesn't (or vice versa).
  • Who is usually the first point of contact for an abused individual?
  • What are some shelters and resources for women who are abused in London? What about men?
  • What is the prevalence / incidence of abuse?
  • How do you conduct an interview that addresses abuse?
  • What are cultural differences in abuse, its reporting and its treatment?

Research

Intraepithelial neoplasia

  • Can be caused by STIs, namely HPV [1]
  • There are three types [2]
  • Can be prevented by yearly pap smears
  • There is a psychological stress component to risk of intraep. neoplasias [3]


Infidelity

  • The human penis as displacement vessel [4]

Googling for abnormal pap smears

Abuse

  • Source: [7]
    • The study of abuse is made difficult by selection biases and the like
    • battered samples and community samples are "largely non-overlapping"
    • Abuse can be dyadic, and the direction is not as clear as stipulated by feminist theory
    • There are equal equal rates of assault between the two sexes in domestic situations
    • "Jury's out" on directionality (man-to-woman vs. bidirectional)
  • Source: [8]
    • In the US, stats showed that 1.5 million women and 800k men were physically assaulted by an intimate partner in the previous 12 months.
    • Stets and Straus (1990): Women were more likely to go to the hospital, report depression, etc. as a result of physical abuse than men
  • Source: [9]
    • One response to the increasing domestic violence situation is that officers were encouraged to arrest, or begin with the inclination to arrest, persons involved in domestic violence situations.
    • Pro-arrest supporters were pissed off when police started arresting the woman or both parties involved int he violent situation.
    • The presumption that the pro-arresters were using was that females are predominantly or always the victims of domestic violence
    • It is possible that the increasing trend reflects instead the impartial application of the law.
    • There is still significant support for the (essentially) equal ratio of men to women when it comes to violence.
    • This study found that women arrestees didn't warrant as much concern as male arrestees

Resources

Abuse