Volume 101, Issue s122

Women account for almost one of four newly diagnosed cases of the human immunodeficiency virus (HIV) infection in the United States. It is believed that up to 20% of them are co-infected with hepatitis C virus (HCV). AIDS is now the third leading cause of death in women aged 25 to 44 years in the United States. The ability to better control the HIV infection and improve survival among the co-infected population will make managing chronic liver disease due to hepatitis C the next clinical challenge for these women. This article reviews the available data and summarizes the primary care approach to the female patient with HCV-HIV co-infection.

Colorectal cancer is the second leading cause of cancer-related deaths in developed countries. For women, it is the third leading cause of cancer-related deaths behind lung and breast cancers. Women have the same risk as men, and the lifetime risk of the development of colorectal cancer is 6%. One in 17 woman will have colorectal cancer diagnosed. There are risk factors unique to women, including gynecologic cancers, and treatment of gynecologic cancers, as well as delayed diagnosis in pregnancy. Fortunately, colorectal cancer is a preventable disease, as almost all colorectal cancers arise from premalignant polyps. Colorectal cancer screening is recommended in asymptomatic women aged 50 years and older who are at average risk. Screening and surveillance for colorectal cancer in women are important to improve the morbidity and mortality rates of this preventable disease.

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders seen by primary care physicians and specialists. The disorder affects approximately 15% to 20% of the world's population and is predominately found in women. Despite the high prevalence of IBS in the general population, our understanding of the disorder's diagnosis, etiology, and treatment options are limited. This deficiency in our understanding is the foundation to the distressed physician-patient relationships that are commonly found with this disorder. By becoming familiar with the diagnostic criteria for IBS and gaining a stronger understanding of the biopsychosocial factors of IBS symptomatology as well as the available treatment methods, the primary care physician or specialist can ensure greater confidence in making a correct diagnosis and in making other professional decisions with patients with IBS. Improvements in these areas will foster a supportive environment for a therapeutic relationship between physician and patient, thereby optimizing quality patient care and treatment outcome.

Medical practitioners caring for women with inflammatory bowel disease should recognize that gender may have a profound influence on patient perception of disease, body image, and clinical symptoms. These gender-related concerns as well as issues such as fertility and pregnancy increase the complexity of medical and surgical management of women with inflammatory bowel disease. This article reviews the important issues for practitioners to consider in taking care of women with ulcerative colitis and Crohn's disease, focusing especially on body image, fertility, management of disease during pregnancy, and osteoporosis.