Justice also requires that preventive education and treatment referral should be Experts at the National Institute on Drug Abuse confirm that substance use Such laws may unwittingly result in pregnant women concealing substance use from . Any restrictions on the confidential nature of the relationship would involve. [EBOOKS] Learning Limits College Women Drugs And Relationships[FREE]. Book file PDF easily for everyone and every device. You can. In mybook Learning Limits (Williams, ), Idescribed the role of drugs ininterpersonal relationships among college women. I found the roleofdrugs among.
Obstetrician—gynecologists should function as patient advocates and oppose coercive screening, testing, and treatment interventions and prosecution of a particular population for substance use disorder. Obstetrician—gynecologists should protect patient autonomy, confidentiality, and the integrity of the patient—physician relationship to the extent allowable by laws regarding disclosure of substance use disorder.
Physicians should be aware that reporting mandates vary widely and be familiar with the legal requirements within their state or community. As previously noted, when a legal or medical obligation exists for physicians to test patients for substance use disorder, there is an ethical responsibility to notify patients of this testing and make a reasonable effort to obtain their informed consent.
In states that mandate reporting, policy makers, legislators, and physicians should work together to retract punitive legislation and identify and implement evidence-based strategies outside the legal system to address the needs of women with addictions Treatment Obstetrician—gynecologists should, when possible, advocate evidence-based and consensual interventions related to substance use disorder. Putting pregnant women in jail, where substances may be more available but treatment is not, jeopardizes the health of pregnant women and that of their existing and future children 33, 36 Work being done on a state level to make treatment of substance use disorder more readily available to pregnant women has been bolstered by federal regulations requiring that pregnant women be provided with priority access to programs Physicians are encouraged to continue to advocate the creation of treatment and rehabilitation centers that prioritize options for pregnant women, and it is hoped that policy makers, legislators, and physicians will work collaboratively to retract punitive legislation and identify evidence-based strategies outside of the legal system to improve treatment options and access for pregnant women with substance use disorder 26, Breastfeeding Breastfeeding is important for maternal and infant health and bonding and provides an inexpensive and safe alternative to formula.
For these reasons, a woman with a current or past history of substance use disorder should not be summarily excluded from or criminalized for nursing her infant. For women in well-supervised methadone-maintenance programs for treatment of opioid dependence, breastfeeding is encouraged and may be important to avoid neonatal abstinence syndrome Obstetrician—gynecologists must have accurate information, however, regarding the potential dangers of transmission of illicit substances and high concentrations of alcohol through breast milk so that they can accurately advise their patients on the relative benefits or harms of breastfeeding Parental Substance Use Disorder Obstetrician—gynecologists have an ethical responsibility to their pregnant and parenting patients with substance use disorder to discourage the separation of parents from their children solely based on substance use disorder, either suspected or confirmed.
Despite this, many physicians support efforts to separate women with substance use disorder from their children. More than one half of physicians surveyed supported a statute that would permit removal of children from any woman who abused alcohol or drugs This position is especially concerning because these responding physicians did not require evidence of physical or emotional neglect or physical or sexual abuse in providing this survey response.
Physician support of efforts to separate women with substance use disorder from their children most often reflects a desire to protect children, although some physicians also may feel that substance use disorder is a moral failing that deserves punishment.
However, threats and incarceration have proved ineffective in reducing the incidence of substance use disorder. Furthermore, removing children from the home not only violates child welfare goals of family integrity, but actually may subject children to greater risks in the foster care or child welfare systems Treatment of substance use disorder is more effective and less expensive than restrictive policies 43 and results in a net medical savings per mother—infant pair Women who have custody of their children during treatment of substance use disorder also complete treatment at a higher rate than women whose children are taken from them 45 Parental substance use disorder does not necessarily result in child harm or neglect.
Nevertheless, when there is strong evidence of harm to children that is due to parental substance use disorder, obstetrician—gynecologists have an ethical obligation, along with their pediatrician colleagues, to engage child protective services to more fully assess risk of child harm.
Each case should be evaluated independently and fairly, and available services should focus on maintaining or reunifying families rather than punishing and stigmatizing parents. Infertile Patients With Substance Use Disorder Obstetrician—gynecologists or other providers of infertility services may be faced with ethical dilemmas in which they must balance the interests of infertile patients with substance use disorder, the potential interests of future offspring, and their own conscientious practice interests Although substance use disorder in a parent does not necessarily result in child neglect or inadequate parenting capacity, every effort should be made to identify and treat this disorder before conception in order to optimize maternal health and the health of future offspring.
Any decision to decline to provide infertility treatment based on child safety concerns should be supported by clear evidence, made in conjunction with a multidisciplinary team of health care providers 47and applied equally regardless of age, race, ethnicity, and socioeconomic status. Adolescent Substance Use and Substance Use Disorder Confidentiality is as important to the patient—physician relationship with adolescents as with adults, and physicians must build a relationship of trust with their adolescent patients in order to facilitate candid discussions regarding health-related behaviors that include the use of alcohol and other substances.
Physicians should consider issues of informed consent, parental permission, and adolescent assent when dealing with detection and treatment of adolescent substance use disorder. Obstetrician—gynecologists should be aware of state laws that protect the confidentiality of minors regarding testing or treatment for substance use disorder.
Physicians may discuss issues of confidentiality with the parents or guardians of their adolescent patients to encourage parental involvement in health care decisions and, when appropriate, facilitate communication between these parties. In that discussion, parents and adolescents may be counseled that the information shared between each of them and the physician is treated as confidential.
Any restrictions on the confidential nature of the relationship would involve disclosure of risks to self or others Physician Personal Use of Medications and Illicit Substances If obstetrician—gynecologists identify substance use disorder in themselves or their colleagues, they have an ethical responsibility to safeguard patients by modifying their own practice and by seeking guidance from professional organizations to assist with resources for support and intervention.
Except in emergencies, it is never appropriate for physicians to write prescriptions for controlled substances for themselves or their family members It is unethical for obstetrician—gynecologists to practice medicine with diminished capacity resulting from the use of alcohol or licit or illicit substances because it may put patients at risk of harm 50 Physicians are obligated to assist with timely intervention and identification of a local treatment program for these colleagues felt to be at risk of impairment; appropriate intervention often is directed by state or national professional organizations 51, Hospitals and state medical societies have similarly been empowered to identify physicians who may be impaired and to refer them for rehabilitation, with the future goal to return to their professional roles Conclusion Incorporating the ethical frameworks presented in this Committee Opinion will help obstetrician—gynecologists navigate difficult professional situations involving substance use disorder.
These ethical frameworks support the routine screening of all patients for substance use disorder, and brief intervention and treatment referral for those patients with positive screening results. Obstetrician—gynecologists also have a responsibility to respond in a medically and ethically appropriate manner, within their local regulatory boundaries, to patient-care issues involving known or suspected substance use disorder. Maintenance of a therapeutic relationship will optimize care and advocacy for patients with substance use disorder who are parents, pregnant, or seeking pregnancy.
It also is important to advocate patient autonomy and confidentiality in the face of legally mandated drug testing and reporting. Finally, it is good medical practice and ethically appropriate for obstetrician—gynecologists to ensure their safe prescribing practices for legal therapeutic drugs and to be vigilant against licit or illicit substance use disorder in themselves or their medical colleagues in order to optimize personal and patient wellness and safety.
References American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Retrieved March 18, American College of Obstetricians and Gynecologists.
Alcohol screening and counseling: Retrieved October 24, Brief physician advice for high-risk drinking among young adults. Ann Fam Med ;2: Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic ReviewsIssue 2. Treatment of problem alcohol use in women of childbearing age: Alcohol Clin Exp Res ; A brief intervention for prenatal alcohol use: J Subst Abuse Treat ; Brief motivational intervention at a clinic visit reduces cocaine and heroin use.
Drug Alcohol Depend ; Screening, brief interventions, referral to treatment SBIRT for illicit drug and alcohol use at multiple healthcare sites: A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test ASSIST in clients recruited from primary health-care settings in four countries.
Women, their significant others, and crack cocaine. Am J Addict ;5: Unresolved feelings of guilt and shame in the maternal role with substance-dependent African American women. J Nurs Scholarsh ; The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida.
Learning Limits: College Women, Drugs, and Relationships - Kimberly M. Williams - Google Книги
N Engl J Med ; Ethical and legal analyses of three coercive policies aimed at substance abuse by pregnant women. Drugs, brains, and behavior: Retrieved January 21, Enhancing motivation for change in substance abuse treatment. Retrieved March 2, Punishing pregnant drug users: Toolkit on state legislation: American Academy of Pediatrics.
City of Charleston, U. Arrests of and forced interventions on pregnant women in the United States, — J Health Polit Policy Law ; Punishing women for their behavior during pregnancy: Drug addiction research and the health of women.
National Institute on Drug Abuse; Punishing pregnant drug-using women: J Addict Dis ; Substance abuse during pregnancy. State policies in brief. Arousal may be enhanced with stimulation of the clitoris. Use a vibrator to provide clitoral stimulation. Medical treatment for female sexual dysfunction Effective treatment for sexual dysfunction often requires addressing an underlying medical condition or hormonal change.
Your doctor may suggest changing a medication you're taking or prescribing a new one.
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Treating female sexual dysfunction linked to a hormonal cause might include: Localized estrogen therapy comes in the form of a vaginal ring, cream or tablet. This therapy benefits sexual function by improving vaginal tone and elasticity, increasing vaginal blood flow and enhancing lubrication. The risks of hormone therapy may vary depending on your age, your risk of other health issues such as heart and blood vessel disease and cancer, the dose and type of hormone and whether estrogen is given alone or with a progestin.
Talk with your doctor about benefits and risks. In some cases, hormonal therapy might require close monitoring by your doctor. This medication is a selective estrogen receptor modulator. It helps reduce pain during sex for women with vulvovaginal atrophy. Testosterone plays a role in healthy sexual function in women as well as men, although women have much lower levels of testosterone. Androgen therapy for sexual dysfunction is controversial.
Some studies show a benefit for women who have low testosterone levels and develop sexual dysfunction; other studies show little or no benefit. Originally developed as an antidepressant, flibanserin is approved by the Food and Drug Administration as a treatment for low sexual desire in premenopausal women.
A daily pill, Addyi may boost sex drive in women who experience low sexual desire and find it distressing. Potentially serious side effects include low blood pressure, sleepiness, nausea, fatigue, dizziness and fainting, particularly if the drug is mixed with alcohol.
Experts recommend that you stop taking the drug if you don't notice an improvement in your sex drive after eight weeks. Potential treatments that need more research More research is needed before these agents might be recommended for treatment of female sexual dysfunction: Tibolone is a synthetic steroid drug used in Europe and Australia for treatment of postmenopausal osteoporosis.
Due to concerns over increased risk of breast cancer and stroke in women taking tibolone, the drug isn't approved by the Food and Drug Administration for use in the U. This group of medications has proved successful in treating erectile dysfunction in men, but the drugs don't work nearly as well in treating female sexual dysfunction. Studies looking into the effectiveness of these drugs in women show inconsistent results. One drug, sildenafil Revatio, Viagramay prove beneficial for some women who have sexual dysfunction as a result of taking selective serotonin reuptake inhibitors SSRIsa class of drugs used to treat depression.
Don't take sildenafil if you use nitroglycerin for angina — a type of chest pain caused by reduced blood flow to the heart. Issues surrounding female sexual dysfunction are usually complex, so even the best medications aren't likely to work if other emotional or social factors remain unresolved. Request an Appointment at Mayo Clinic Clinical trials Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Lifestyle and home remedies To boost your sexual health, find ways to be comfortable with your sexuality, improve your self-esteem and accept your body. Try practicing these healthy lifestyle habits: Drinking too much blunts sexual responsiveness. Cigarette smoking restricts blood flow throughout your body. Less blood reaches your sexual organs, which means you could experience decreased sexual arousal and orgasmic response.
Regular aerobic exercise increases your stamina, improves your body image and elevates your mood. This can help you feel more romantic, more often.
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Make time for leisure and relaxation. Learn ways to decrease stress, and allow yourself to relax amid the stresses of your daily life. Being relaxed can enhance your ability to focus on your sexual experiences and may help you attain more satisfying arousal and orgasm. Alternative medicine More research is needed, but therapies that may help improve sexual satisfaction include: This type of meditation is based on having an increased awareness and acceptance of living in the present moment.
You focus on what you experience during meditation, such as the flow of your breath. You can observe your thoughts and emotions, but let them pass without judgment. Acupuncture involves the insertion of extremely thin needles into your skin at strategic points on your body. Acupuncture may have positive effects on low libido and lubrication difficulties, especially if these problems are related to the use of some antidepressant medications.
During yoga, you perform a series of postures and controlled breathing exercises to promote a flexible body and a calm mind. Certain subsets of yoga aim to channel the body's sexual energy and improve sexual functioning.
There are also some herbal supplements and topical oils marketed to increase libido and sexual pleasure. However, these products haven't been well-studied.
One product has estrogen-like properties and may encourage the growth of breast tumors that need estrogen to grow. Talk to your doctor before trying any herbal or topical oil formulations. Coping and support At each stage of your life, your level of sexual desire, arousal and satisfaction can change. Understand your body and what makes for a healthy sexual response.
The more you and your partner know about the physical aspects of your body and how it functions, the better able you'll be to find ways to ease sexual difficulties. Ask your doctor or look for educational materials to learn how issues such as aging, illnesses, pregnancy, menopause and medicines might affect your sex life. Communicate openly with your partner. Be flexible in your approach to intimacy with your partner. Continue to engage in the areas of intimacy that are working well for the two of you.
Accept changes that occur. Explore new aspects of your sexuality during times of transition to improve your sexual experiences. Sexual response often has as much to do with your feelings for your partner as it does with physical sexual stimuli.
Rediscover each other and reconnect. Preparing for your appointment If you have ongoing sexual difficulties that distress you, make an appointment with your doctor. You may feel embarrassed to talk about sex with your doctor, but this topic is perfectly appropriate. A satisfying sex life is important to a woman's well-being at every age.