New Issue: Post-ICU Care, Dyspareunia, Hypothyroidism

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MAY 15, 2021

AFP Issue Frequency Change Coming Soon

Beginning with the July 2021 issue, AFP will publish 12 issues per year instead of 24, with twice the amount of editorial content and CME credit in each one. Look for the first “double issue” in mid-July. Additional information is available.


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Post-ICU Care in the Outpatient Setting

Because an increasing percentage of patients are surviving to intensive care unit (ICU) discharge and require follow-up in the outpatient setting, family physicians should be prepared to provide ongoing care and screening for common post-ICU complications. Patients should be screened for physical and psychological complications, such as weakness, cognitive impairment, depression, anxiety, and posttraumatic stress disorder, and treated when indicated.

SEE MORE IN AFP BY TOPIC ▶ COVID-19
Hypothyroidism: Diagnosis and Treatment

Clinical hypothyroidism is present in one in 300 people in the United States, with higher prevalence in female and older patients. Common symptoms are cold intolerance, fatigue, weight gain, dry skin, constipation, and voice changes. The signs and symptoms that suggest thyroid dysfunction are nonspecific and nondiagnostic. A diagnosis is based on blood levels of thyroid-stimulating hormone and free thyroxine. There is no evidence that population screening is beneficial.

SEE MORE IN AFP BY TOPIC ▶ THYROID AND PARATHYROID DISORDERS
 

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Dyspareunia in Women

Dyspareunia is recurrent or persistent pain with sexual intercourse that causes distress. Women with sexual pain are at increased risk of sexual dysfunction, relationship distress, and diminished quality of life. Clinicians should create a safe and welcoming environment when taking a sexual history, in which patients describe the characteristics of the pain. Physical examination of the external genitalia includes visual inspection and sequential pressure with a cotton swab. A single-digit vaginal examination may identify tender pelvic floor muscles; a bimanual examination can assess for uterine retroversion and pelvic masses. Common diagnoses include vulvodynia, inadequate lubrication, vaginal atrophy, and postpartum causes. Treatment may include lubricants, pelvic floor physical therapy, vaginal estrogen, and cognitive behavior therapy.

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Obstetric Lacerations: Prevention and Repair

Obstetric lacerations are a common complication of vaginal delivery and can lead to chronic pain and urinary and fecal incontinence. Perineal lacerations are defined by the depth of musculature involved. Late third-trimester perineal massage can reduce perineal lacerations in primiparous women. Lacerations involving the anal sphincter complex require additional expertise, exposure, and lighting. Postdelivery care should focus on pain control, preventing constipation, and monitoring for urinary retention. Acetaminophen and nonsteroidal anti-inflammatory drugs should be administered for pain as needed. Osmotic laxative use leads to earlier bowel movements and less pain during the first bowel movement.

CME credit for this article will be available when it is published in print.

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