Psychosomatic Gynecology
Dr. Nelson Soucasaux, Brazilian gynecologist
In the daily practice of a gynecology office, it is very easy to perceive
that highly intricate emotional problems often lie behind a great number
of the complaints, symptoms and disturbances that patients bring to the
consultations. To a great extent, these emotional problems are related to
several aspects of the female nature and constitution. Menstrual disorders,
hormonal dysfunctions, premenstrual and menstrual symptoms, pelvic pains,
recurrent vulvo-vaginitis, sexual problems, some of the symptoms attributed
to the use of the hormonal contraceptives - to mention only some of the
most frequent examples -, are often somatizations of several emotional problems.
Additional reasons for consultation are the search for information and orientation
about basic aspects of the female life: puberty, events related to the menstrual
cycle, sexuality, contraceptive methods, pregnancy, menopause, etc. Thus,
the importance of an essentially psychosomatic approach to gynecologic practice
is enormous.
Women are inclined to project many of their emotional problems on the
parts of their organism more related to the female nature, as their sexual
organs and their intricate endocrine physiology. The interrelation between
mind, cerebral cortex and limbic system, with its influence on the function
of the hypothalamus-hypophysis-ovaries axis, is widely known. The ovarian
function is commanded by the hypophyseal gonadotropins (FSH and LH), the
release of which is controlled by the hypothalamus, part of the brain which
the hypophysis is attached to. The ovarian hormones, in turn, act upon the
hypothalamus and, by means of feedback mechanisms, contribute to the self-regulation
of the system. In this way, starting from disturbances in the hypothalamus-hypophysis-ovaries
axis, the most diverse hormonal dysfunctions can occur.
On the other hand, through the sympathetic and parasympathetic systems,
many other projections of tensions can arrive at the woman's pelvic organs
by the neurovegetative pathways. Alterations in the immunologic system -
also susceptible to suffer influences of psychological factors - can also
affect the genital apparatus, creating a predisposition to infections, and,
together with other factors, have some participation in the development
of cancer. As a result, emotional conflicts and neurosis can act by means
of several neuroendocrine, neurovegetative and immunologic pathways, contributing
to generate the most varied disturbances and pathological manifestations
in women.
The neuroendocrine pathway has been the most researched one, and concerns
the control of the ovarian function by the hypothalamus-hypophyseal system.
As the hypothalamus is always receiving nervous stimuli from other parts
of the brain, it is very easy to understand how the central nervous system
has an enormous influence on the ovarian cycle and on the sexual steroids
synthesis. The ovarian hormones produce a multiplicity of effects in the
woman's sexual organs and in other parts of the female body. Considering
that most of the gynecologic physiology is endocrine, the neuroendocrine
system seems to be the most important pathway for the psychosomatic projections
in gynecology. In this pathway, the actions of the mind and the central
nervous system over the woman's body become apparent by means of the hormones.
The neurovegetative pathway has been less researched, but we should
remember that it might also be very important. Through it, the nervous stimuli
originating in the central nervous system arrive at the woman's sexual organs
in a direct way, conducted by the vegetative innervation of these organs.
Even considering that in normal conditions the neurovegetative influences
over the female genitals can be small, in pathological situations a nervous
hyperstimulation transmitted to these organs through their autonomic innervation
must certainly assume a great importance, causing several disturbances and
dysfunctions. On this subject, see my article "Fundamentos para o Estudo
das Influências Neurovegetativas em Ginecologia" ("Basis
for the Study of the Neurovegetative Influences in Gynecology").*
From the holistic point of view, there are several very important features
of the female nature and constitution that, unfortunately, have been almost
entirely forgotten by current gynecology. The study of this subject acquires
great importance because the problems related to these features of the female
nature, acting through the psychosomatic pathways, can be projected on the
woman's body, generating many disturbances and pathological manifestations,
depending on the mechanisms or parts of the organism "selected"
for the somatizations. As we know, the "target" areas for the
psychosomatic projections, as well as their patterns, seem to follow extremely
individual determinisms.
One woman can suffer from amenorrhea or oligomenorrhea (absence of menstruation
or long-lasting cycles), another from menorrhagia (menstrual hemorrhages);
one other can present polymenorrhea (very short cycles) or intermenstrual
bleedings, still another can exhibit aggravation of the premenstrual and
menstrual symptoms, painful breasts, dysmenorrhea, etc. The same is valid
for vulvo-vaginal pruritus, recurrent vaginitis, pelvic pains, dyspareunia
(pain at sexual intercourse), various other sexual problems, etc. All of
this depends on the individual predisposition for specific disturbances,
as well as on the meaning of the psychosomatic projection which comprehends
the whole personality and life of a specific woman.
What remains a mystery is why the somatization of a conflict manifests
itself in a specific manner, creating a determined symptom or pathological
manifestation. This happens because the "logic" of the projection
does not always emerge clearly. Therefore, it is fundamental that gynecology
pay attention to all of these mechanisms and to their complex and often
obscure dynamics, and that women also become aware of the importance of
psychosomatics.
*Soucasaux, Nelson - "Fundamentos para o Estudo das Influências
Neurovegetativas em Ginecologia" ("Basis for the Study of the
Neurovegetative Influences in Gynecology") - in: Jornal Brasileiro
de Medicina, vol 57, nº 4, October 1989, Rio de Janeiro.
The text above is an excerpt from my book "Novas Perspectivas
em Ginecologia" ("New Perspectives in Gynecology"). For more
information on the book, see page http://www.nelsonginecologia.med.br/novas.htm,
from my Website www.nelsonginecologia.med.br.
Copyright Nelson Soucasaux 1990, 2001
________________________________________________________________________
Nelson Soucasaux is a gynecologist especially dedicated to clinical,
preventive and psychosomatic gynecology. Graduated in 1974 by Faculdade
de Medicina da Universidade Federal do Rio de Janeiro, Brazil, he is the
author of several articles published in medical journals and of the books
"Novas Perspectivas em Ginecologia" ("New Perspectives in
Gynecology") and "Os Órgãos Sexuais Femininos: Forma,
Função, Símbolo e Arquétipo" ("The
Female Sexual Organs: Shape, Function, Symbol and Archetype"), published
by Imago Editora, Rio de Janeiro, 1990, 1993.
© 2001 Harry Finley. It is illegal
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