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Transcript 
Managing Common
Gynecological Problems
Thomas Ross, D.O.
Negative
effects on
treatment efficacy and
tolerability induced or
driven by psychological
factors.
NOCEDO EFFECTS
A nocebo effect is a negative or ill effect
caused by the belief or suggestion that
something is harmful
 Both placebo and nocebo effects are
entirely psychogenic.
 Rather than being the result of the
biologically active compound, the effects
are the result of the patient’s perceptions,
expectations or prior experience.

Latin for “I shall harm”
The Effect of Treatment Expectation on
Drug Efficacy: Imaging the Analgesic
Benefit of the Opioid Remifentanil
Ulrike B, et al Science Translational
Medicine 3:70 Feb. 2011
MRI reveals objective as well as
subjective nacebo effects
We will utilize algorithms as a guideline or
starting point for each condition
discussion.
 These are reproduced from the excellent
and useful text, “GYNECOLOGIC
DECISION MAKING” by Roger P. Smith,
M.D.

Please provide your insight!
Diagnosis
Treatment
Referal
Amenorrhea
Dysmenorrhea
Dysuria
Hemorrhoids
Infertility
Mastalgia
Fibrocystic Disease
Nipple Discharge
Dyspareunia
Vaginismus
Thank you
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