Aspects of mental health care in a gynecological setting

Psychological disorders are commonly associated with gynecological conditions, but are frequently undetected and untreated, and may influence the presentation and treatment outcomes of the physical condition. Some of the gynecologic conditions such as menopause, premenstrual syndrome, premenstrual dysphoric disorder, chronic pelvic pain, polycystic ovarian syndrome etc can be associated with an increased risk of psychological symptoms and disorders.

Anxiety and depression are common psychiatric conditions and are associated with significant morbidity. Gynecological conditions, by their nature, are likely to be accompanied by impairments in social, occupational and personal functioning. Greater emphasis should be placed on the mental health aspects of gynecological conditions.

Women present to gynecological clinics with a wide variety of physical conditions, ranging from bothersome premenstrual and menopausal symptoms, to incontinence and pelvic pain. It is well established that depression and anxiety occur more commonly in those with physical illness compared with healthy populations. 

Moreover, many gynecological conditions, by their nature, affect personal and intimate relationships, as well as social and professional roles, thus giving rise to a range of psychological issues, which, may in turn influence the presentation and outcomes of coexisting physical conditions. These relationships are complex, and involve the interplay of hormonal, social, cultural and individual psychological factors.

The gynecological setting provides an important opportunity for the detection and treatment of psychological issues. These can range from transient concerns to more serious symptoms of depression and anxiety, and depressive and anxiety disorders that meet specific diagnostic criteria. Yet, the psychological aspects of conditions presenting in the gynecological setting are somewhat neglected, resulting in relatively few studies that have examined the consequent mental health care needs of women attending gynecological clinics.