Download Williams Gynecology, Third Edition PDF

Williams Gynecology, Third Edition pdf

Williams Gynecology Third Edition is specifically designed as a practical quick-reference guide for practicing gynecologists and residents, but it will also appeal to clerkship medical students, nurse practitioners, and physician assistants. Williams Gynecology provides comprehensive coverage of the full spectrum of gynecologic healthcare and disease management, including benign general gynecology; reproductive endocrinology, infertility, and menopause; female pelvic medicine and reconstructive surgery; and gynecologic oncology.

The surgical management sections include Aspects of Gynecologic Surgery and Atlas of Gynecologic Surgery, which covers Surgeries of Benign Gynecologic Conditions, Minimally Invasive Surgery, Surgeries for Female Pelvic Reconstruction, and Surgeries for Gynecologic Malignancies.

Williams Gynecology, Third Edition is beautifully illustrated, with hundreds of original drawings for both the surgical atlas and medical reference portions. Each chapter follows a practical template for a consistent approach to diagnosis and treatment. With its extensive use of treatment algorithms, differential diagnosis boxes, and other elements, this book is also a reliable quick-reference. The third edition has been revised to keep up with new and expanded content on the latest topics, including minimally invasive procedures, benign gynecology, and the subspecialties of urogynecology, gynecologic oncology, and reproductive endocrinology. The authors are internationally known practitioners affiliated with Parkland Memorial Hospital/University of Texas Southwestern Medical Center at Dallas, Massachusetts General Hospital/Harvard Medical School, and the National Institutes for Health.

FeaturesWilliams Gynecology Third Edition

• Two resources in one—full-color medical text and surgical atlas—conveniently surveys the entire spectrum of gynecologic disease, including general gynecology, reproductive endocrinology and infertility, urogynecology, and gynecologic oncology

• Completely illustrated atlas of gynecologic surgery contains over 450 full color figures that illuminate operative techniques

• Unique templated text design ensures a consistent approach to diagnosis and treatment

• Strong procedure orientation covers a vast array of surgical operations, which are illustrated in detail

• Evidence-based discussion of disease evaluation reinforces and supports the clinical relevance of the book’s diagnostic and treatment methods

• Distinguished authorship team from the same Parkland Memorial Hospital ObGyn department responsible for Williams Obstetrics—the leading reference in obstetrics for more than a century

• Heavily illustrated gynecologic anatomy chapter created with the surgeon in mind to emphasize critical anatomy for successful surgery

• New artist drawings of minimally invasive procedures, urogynecology, and gynecologic oncology

• Numerous illustrations, photographs, tables, and treatment algorithms

Dedication – Williams Gynecology Third Edition

This edition of Williams Gynecology is dedicated to David L. Hemsell, MD, who served as Director of the Division of Gynecology at the University of Texas Southwestern Medical Center and Parkland Memorial Hospital for more than 20 years. During this tenure, his national awards have included a Meritorious Achievement award from the Infectious Diseases Society of America and an Outstanding Service award from the American College of Obstetricians and Gynecologists.

Early in his training, Dr. Hemsell joined the Air Force and served our country as a Flight Medical Officer. In these years, he pursued specialty training in reproductive endocrinology with Dr. Paul MacDonald. He joined our faculty as the Division Director of Gynecology in 1977. In addition to his Director role, Dr. Hemsell was the Chief of Gynecology at Parkland Memorial Hospital and Medical Director of the Parkland Obstetrics and Gynecology Emergency Room. In these roles, Dr. Hemsell created an environment in which evidence-based medicine was the standard for care. Accordingly, patients, residents, and junior faculty all benefitted from this scientific health care approach. He also served as Director of the Faculty Sexual Assault Examination and Testimony Program. In that role, he coordinated the examinations of many thousands of sexual assault victims and the collection of legal evidence. As a result of his efforts, Dallas County has a system regarded as among the best in medical and legal care for these victims. Williams Gynecology Third Edition

During his academic career, Dr. Hemsell added foundational knowledge regarding the etiology, pathogenesis, and treatment of female pelvic infections, especially those following gynecologic surgeries. With this expertise, he served as journal reviewer for multiple journals. He has added to academic knowledge through his nearly 50 book chapters and 100 peer-reviewed articles on multiple gynecologic topics.

For us in the Department of Obstetrics and Gynecology, Dr. Hemsell plays an important role of mentor and colleague. His experience and clinical expertise are invaluable and provide a valuable sounding board for challenging gynecology cases. On so many levels, we have benefitted greatly from his academic and clinical contributions.

Editors – Williams Gynecology Third Edition

Barbara L. Hoffman, MD

Associate Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

John O. Schorge, MD, FACOG, FACS

Chief of Gynecology and Gynecologic Oncology

Associate Professor, Department of Obstetrics and Gynecology

Massachusetts General Hospital–Harvard Medical School

Karen D. Bradshaw, MD

Holder, Helen J. and Robert S. Strauss and Diana K. and Richard C. Strauss Chair in Women’s Health

Director, Lowe Foundation Center for Women’s Preventative Health Care

Professor, Department of Obstetrics and Gynecology

Professor, Department of Surgery

University of Texas Southwestern Medical Center at Dallas

Lisa M. Halvorson, MD

Bethesda, Maryland

Joseph I. Schaffer, MD

Holder, Frank C. Erwin, Jr. Professorship in Obstetrics and Gynecology

Director, Division of Gynecology

Director, Division of Female Pelvic Medicine and Reconstructive Surgery

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chief of Gynecology, Parkland Memorial Hospital, Dallas

Marlene M. Corton, MD, MSCS

Director, Anatomical Education and Research

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Atlas Art Director

Lewis E. Calver, MS, CMI, FAMI

Associate Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Contributors – Williams Gynecology Third Edition

April A. Bailey, MD

Assistant Professor, Department of Radiology

Assistant Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 2: Techniques Used for Imaging in Gynecology

Co-Director of Radiologic Images for Williams Gynecology

Sunil Balgobin, MD

Assistant Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 40: Intraoperative Considerations

Karen D. Bradshaw, MD

Holder, Helen J. and Robert S. Strauss and Diana K. and Richard C. Strauss Chair in Women’s Health

Director, Lowe Foundation Center for Women’s Preventative Health Care

Professor, Department of Obstetrics and Gynecology

Professor, Department of Surgery

University of Texas Southwestern Medical Center at Dallas

Chapter 13: Psychosocial Issues and Female Sexuality

Chapter 18: Anatomic Disorders

Chapter 21: Menopausal Transition

Chapter 22: The Mature Woman

Anna R. Brandon, PhD, MCS, ABPP

Women’s Mood Disorders Center

Department of Psychiatry

University of North Carolina at Chapel Hill School of Medicine

Department of Psychiatry

University of Texas Southwestern Medical Center at Dallas

Chapter 13: Psychosocial Issues and Female Sexuality

Matthew J. Carlson, MD

Assistant Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 34: Uterine Sarcoma

Kelley S. Carrick, MD

Professor, Department of Pathology

University of Texas Southwestern Medical Center at Dallas

Director of Surgical Pathology Images for Williams Gynecology

Marlene M. Corton, MD, MSCS

Director, Anatomical Education and Research

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 25: Anal Incontinence and Functional Anorectal Disorders

Chapter 38: Anatomy

Chapter 43: Surgeries for Benign Gynecologic Disorders

Chapter 45: Surgeries for Pelvic Floor Disorders

Kevin J. Doody, MD

Director, Center for Assisted Reproduction, Bedford, TX

Clinical Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 20: Treatment of the Infertile Couple

David M. Euhus, MD

Professor, Department of Surgery

Johns Hopkins Hospital/University

Chapter 12: Breast Disease

Rajiv B. Gala, MD, FACOG

Vice-Chair, Department of Obstetrics and Gynecology

Residency Program Director, Department of Obstetrics and Gynecology

Ochsner Clinic Foundation

Associate Professor of Obstetrics and Gynecology

University of Queensland

Ochsner Clinical School

Chapter 7: Ectopic Pregnancy

Chapter 39: Preoperative Considerations

Chapter 42: Postoperative Considerations

William F. Griffith, MD

Medical Director, OB/GYN Emergency Services

Director, Vulvology Clinic

Co-Director, Dysplasia Services

Parkland Health and Hospital System, Dallas, Texas

Associate Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 4: Benign Disorders of the Lower Genital Tract

Chapter 29: Preinvasive Lesions of the Lower Genital Tract

Lisa M. Halvorson, MD

Bethesda, Maryland

Chapter 6: First-Trimester Abortion

Chapter 15: Reproductive Endocrinology

Chapter 16: Amenorrhea

Chapter 19: Evaluation of the Infertile Couple

Cherine A. Hamid, MD

Medical Director—Gynecology

Parkland Health and Hospital Systems, Dallas, Texas

Associate Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 40: Intraoperative Considerations

Barbara L. Hoffman, MD

Associate Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 1: Well Woman Care

Chapter 8: Abnormal Uterine Bleeding

Chapter 9: Pelvic Mass

Chapter 10: Endometriosis

Chapter 11: Pelvic Pain

Chapter 40: Intraoperative Considerations

Chapter 43: Surgeries for Benign Gynecologic Disorders

Chapter 45: Surgeries for Pelvic Floor Disorders

Siobhan M. Kehoe, MD

Assistant Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 33: Endometrial Cancer

Kimberly A. Kho, MD, MPH, MSCS, FACOG

Assistant Professor, Department of Obstetrics and Gynecology

Director of Gynecology, Southwestern Center for Minimally Invasive Surgery

University of Texas Southwestern Medical Center at Dallas

Chapter 41: Minimally Invasive Surgery Fundamentals

Chapter 44: Minimally Invasive Surgery

Jayanthi S. Lea, MD

Patricia Duniven Fletcher Distinguished Professor in Gynecologic Oncology

Director, Gynecologic Oncology Fellowship Program

Associate Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 31: Vulvar Cancer

Chapter 46: Surgeries for Gynecologic Malignancies

Eddie H. McCord, MD

Associate Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 3: Gynecologic Infection

David Scott Miller, MD, FACOG, FACS

Holder, Dallas Foundation Chair in Gynecologic Oncology

Medical Director of Gynecology Oncology

Parkland Health and Hospital System, Dallas, Texas

Director, Gynecologic Oncology Fellowship Program

Director of Gynecologic Oncology

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 33: Endometrial Cancer

Chapter 34: Uterine Sarcoma

Elysia Moschos, MD

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Administrative Director of Gynecologic Ultrasound

Parkland Health and Hospital System

Chapter 2: Techniques Used for Imaging in Gynecology

Co-Director of Radiologic Images for Williams Gynecology

David M. Owens, MD

Assistant Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 11: Pelvic Pain

Mary Jane Pearson, MD

Director, Third-year & Fourth-Year Medical Student Programs

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 1: Well Woman Care

David D. Rahn, MD

Associate Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 3: Gynecologic Infection

Chapter 23: Urinary Incontinence

Debra L. Richardson, MD, FACOG

Assistant Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 30: Cervical Cancer

Chapter 32: Vaginal Cancer

David E. Rogers, MD, MBA Williams Gynecology Third Edition

Associate Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 11: Pelvic Pain

Anthony H. Russell

Associate Professor

Department of Radiation Oncology

Massachusetts General Hospital—Harvard Medical School

Chapter 28: Principles of Radiation Therapy

Andrea L. Russo, MD

Assistant Professor

Department of Radiation Oncology

Massachusetts General Hospital—Harvard Medical School

Chapter 28: Principles of Radiation Therapy

John O. Schorge, MD, FACOG, FACS Williams Gynecology Third Edition

Chief of Gynecology and Gynecologic Oncology

Associate Professor, Department of Obstetrics and Gynecology

Massachusetts General Hospital—Harvard Medical School

Chapter 27: Principles of Chemotherapy

Chapter 33: Endometrial Cancer

Chapter 34: Uterine Sarcoma

Chapter 35: Epithelial Ovarian Cancer

Chapter 36: Ovarian Germ Cell and Sex Cord-Stromal Tumors

Chapter 37: Gestational Trophoblastic Disease

Chapter 46: Surgeries for Gynecologic Malignancies

Joseph I. Schaffer, MD

Holder, Frank C. Erwin, Jr. Professorship in Obstetrics and Gynecology

Chief of Gynecology

Parkland Health and Hospital System, Dallas, Texas

Director, Division of Gynecology

Director, Division of Female Pelvic Medicine and Reconstructive Surgery

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 24: Pelvic Organ Prolapse

Chapter 45: Surgeries for Pelvic Floor Disorders

Geetha Shivakumar, MD, MS Williams Gynecology Third Edition

Mental Health Trauma Services, Dallas VA Medical Center

Assistant Professor, Department of Psychiatry

University of Texas Southwestern Medical Center at Dallas

Chapter 13: Psychosocial Issues and Female Sexuality

Gretchen S. Stuart, MD, MPHTM

Director, Family Planning Program

Director, Fellowship in Family Planning

Assistant Professor, Department of Obstetrics and Gynecology

University of North Carolina at Chapel Hill

Chapter 5: Contraception and Sterilization

Mayra J. Thompson, MD, FACOG

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 41: Minimally Invasive Surgery Fundamentals

Chapter 44: Minimally Invasive Surgery

Clifford Y. Wai, MD Williams Gynecology Third Edition

Director, Fellowship Program in Female Pelvic Medicine and Reconstructive Surgery

Associate Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 23: Urinary Incontinence

Chapter 26: Genitourinary Fistula and Urethral Diverticulum

Claudia L. Werner, MD

Medical Director of Dysplasia Services

Co-Director Vulvology Clinic

Parkland Health and Hospital System, Dallas, Texas

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 4: Benign Disorders of the Lower Genital Tract

Chapter 29: Preinvasive Lesions of the Lower Genital Tract

Ellen E. Wilson, MD Williams Gynecology Third Edition

Director of Pediatric and Adolescent Gynecology Program

Children’s Medical Center, Dallas, Texas

Associate Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center at Dallas

Chapter 14: Pediatric Gynecology

Chapter 17: Polycystic Ovarian Syndrome and Hyperandrogenism

Preface – Williams Gynecology Third Edition

The first edition of Williams Obstetrics was published over a century ago. Since then, the editors of this seminal text have presented a comprehensive and evidenced-based discussion of obstetrics. Patterned after our patriarch, Williams Gynecology provides a thorough presentation of gynecology’s depth and breadth. In Section 1, general gynecology topics are covered. Sections 2 provides chapters covering reproductive endocrinology and infertility. The developing field of female pelvic medicine and reconstructive surgery is presented in Section 3. In Section 4, gynecologic oncology is discussed.

Traditionally, gynecologic information has been offered within the format of either a didactic text or a surgical atlas. However, because the day-to-day activities of a gynecologist blends these two, so too did we. The initial four sections of our book describe the evaluation and medical treatment of gynecologic problems. The remaining two sections focus on the surgical patient. Section 5 offers detailed anatomy and a discussion of perioperative considerations. Our final section presents an illustrated atlas for the surgical correction of conditions described in Sections 1 through 4. To interconnect this content, readers will find page references within one chapter that will direct them to complementary content in another.

Although discussions of disease evaluation and treatment are evidence based, our text strives to assist the practicing gynecologist and resident. Accordingly, chapters are extensively complemented by illustrations, photographs, diagnostic algorithms, and treatment tables.

Acknowledgment

During the creation and production of our textbook, we were lucky to have the assistance and support of countless talented professionals both within and outside our department.

First, a task of this size could not be completed without the unwavering support provided by our Department Chairman, Dr. Steven Bloom, and Vice-Chairman, Dr. Barry Schwarz. Their financial and academic endorsement of our efforts has been essential. Without their academic vision, this undertaking could not have flourished.

In constructing a compilation of this breadth, the expertise of physicians from several departments was needed to add vital, contemporaneous information. We were fortunate to have Dr. April Bailey, with joint appointments in the Department of Radiology and Department of Obstetrics and Gynecology, add her insight and knowledge as a specialist in radiology. Her many stunning images contribute to the academic richness of this edition. From the Department of Pathology, Dr. Kelley Carrick also shared generously from her cadre of outstanding images. She translated her extensive knowledge of gynecologic pathology into concepts relevant for the general gynecologist. From the Department of Surgery at Johns Hopkins University, Dr. David Euhus lent his considerable knowledge of breast disease to contribute both classic and state-of-the-art information to his truly comprehensive chapter, founded on his broad research and clinical expertise. From the Department of Psychiatry here at the University of Texas Southwestern Medical Center at Dallas and from the University of North Carolina at Chapel Hill School of Medicine, we were lucky to have Drs. Geetha Shivakumar and Anna Brandon provide an extensive discussion of psychosocial issues. They expertly distilled a broad topic into a logically organized, practical, and complete presentation. Williams Gynecology Third Edition

In addition, Dr. Gretchen Stuart, formerly of our department and now a faculty member at the Department of Obstetrics and Gynecology of the University of North Carolina at Chapel Hill, lent her considerable talents in summarizing contraceptive methods and sterilization techniques. Many warm thanks are extended to Dr. Rajiv Gala, also formerly of our department and now of the Ochsner Clinic. Rajiv masterfully organized and summarized chapters on ectopic pregnancy and perioperative practice. His extensive review of the literature and evidence-based writing shines through these chapters. In this edition, new contributors include Drs. Williams Gynecology Third Edition

Anthony Russell and Andrea Russo from the Department of Radiation Oncology at Massachusetts General Hospital—Harvard Medical School. In their chapter on radiation therapy, they adeptly provided clear explanations of this therapy’s fundamentals and offered extensive suggestions for clinical management of patient complications that may be encountered.

Within our own department, the list is too long and the words are too few to convey our heartfelt thanks to all of our department members for their generous contributions. From our Gynecology Division, many thanks are extended to Drs. Elysia Moschos and April Bailey, who sculpted a clear and detailed summary of traditional and new gynecologic imaging tools. In this edition, these two authors updated radiologic images as needed to present ultimate examples of normal anatomy and gynecologic pathology. We were also lucky to have experts in the field of preinvasive lesions of the lower genital tract, Drs. Claudia Werner and William Griffith. They crafted an information-packed discussion of this topic. In addition, Dr. Griffith has been a steadfast advocate of our project and has added extensive photographic content to many of our chapters. Drs. David Rahn and Eddie McCord teamed to update the chapter on gynecologic infection. Williams Gynecology Third Edition

Their extensive patient-care experience and rigorous literature review added greatly to the academic and clinical value of this chapter. We were also fortunate to have the expert writing talents of Drs. Mayra Thompson and Kimberly Kho, who provided a compelling and comprehensive discussion of minimally invasive surgery. Our textbook benefitted greatly from the clinical savvy and teaching-centric information that David Rogers and David Owens provided to their chapter. Also, Dr. Rogers has been a long-time supporter of our textbook. We are indebted to him for many of the classic surgical photographs in this edition. Williams Gynecology Third Edition

Intraoperative fundamentals were thoroughly and logically presented by Drs. Cherine Hamid and Sunil Balgobin. Their strengths in clinical practice and resident teaching are evident in their well-organized and essential chapter. Once again, blending experience and academic fundamentals, Dr. Mary Jane Pearson offered a comprehensive but concise primer on well care for the gynecologic patient.

Our Reproductive Endocrinology and Infertility Division provided other talented physicians and writers. Dr. Kevin Doody lent his considerable clinical and academic prowess in the treatment of infertility. He penned a chapter that clearly describes the state of the art in this field. Dr. Doody was also a kind benefactor with his spectacular clinical photographs on the topic and contributed these generously to numerous chapters. Williams Gynecology Third Edition

In addition, Dr. Ellen Wilson brought her wealth of clinical experience to chapters on pediatric gynecology and androgen excess. Drawing from her academic and clinical expertise, she crafted chapters that presented practical, prescriptive, and comprehensive discussions of these topics.

Dr. Marlene Corton is a skilled urogynecologist and has written extensively on pelvic anatomy. We were thrilled to have her create stunning chapters on anatomy and anal incontinence. Also from the Urogynecology and Female Pelvic Reconstruction Division, Drs. Clifford Wai and David Rahn added expanded content to their chapter on urinary incontinence. Dr. Wai also masterfully updated his chapter on vesicovaginal fistula and urethral diverticulum. Special thanks are extended to Dr. Ann Word and her contributions to our chapter on pelvic organ prolapse. Her expertise in extracellular matrix remodeling of the female reproductive tract added fundamental content to the discussion of prolapse physiology.

Dr. David Miller generously contributed his talents without hesitation, and we are indebted to him for his altruism toward our project. In addition, the Division of Gynecologic Oncology offered a deep bench of talented writers. The topic of vulvar cancer was thoroughly covered by Dr. Jayanthi Lea. Dr. Lea also assisted with updating our atlas and added essential steps for minimally invasive approaches. Her strengths in clinical practice and resident teaching are evident in her well-organized and evidence-based chapters. We also benefitted from Dr. Debra Richardson’s comprehensive presentation and clinical discussions of cervical and vaginal cancer in her two chapters. She has been a true advocate of both the text and study guide. Dr. Siobhan Kehoe described with clarity and clinical relevance the care and treatment of women with endometrial cancer. We were appreciative of Dr. Matthew Carlson, who teamed with David Miller to present the varied pathology and treatment of uterine sarcoma.

With this edition, several of our valued authors have turned their efforts to other promising pursuits. We are grateful to Drs. F. Gary Cunningham, Bruce Carr, David Hemsell, Larry Word, and Phuc Nguyen for their prior contributions to Williams Gynecology. All with well-known and well-established careers, they generously contributed their academic skills without hesitation. We are indebted to them for their altruism toward our project.

Of these academicians, Dr. F. Gary Cunningham provided the academic vision that led to the creation of this text. Dr. Cunningham has been the senior author for seven editions of Williams Obstetrics, spanning over 25 years. As such, we benefited greatly from his writing genius, his meticulous organization, and his tenacity to task. His dedication to evidence-based medicine established the foundation on which our textbook was built. We feel privileged to have learned the craft of clear, concise academic summary from a consummate master.

New beautiful and detailed artwork in our atlas this edition was drawn by Mr. Lewis Calver, here at the University of Texas Southwestern Medical Center at Dallas. Again for this edition, he paired his academic talents with Dr. Marlene Corton to create updated hysterectomy and urogynecologic images. Both of these anatomists committed countless hours in the cadaver laboratory and in the library to create academically new presentations. These renderings were crafted and tailored with the gynecologic surgeon in mind to depict important techniques and anatomy for these surgeries. Dr. Jayanthi Lea joined this gifted duo to add complementary and informative illustrations to her description of minimally invasive cancer surgeries.

We also acknowledge the efforts of our atlas artists from the first two editions: Marie Sena, Erin Frederikson, Jordan Pietz, Maya Shoemaker, SangEun Cha, Alexandra Gordon, Jennie Swensen, Amanda Tomasikiewicz, and Kristin Yang. Additionally, alumni from the Biomedical Communications Program at the University of Texas Southwestern Medical Center provided seminal pieces. These alumni include Katherine Brown, Thomas “T. J.” Fels, Belinda Klein, Anne Matuskowitz, Lindsay Oksenberg, Kimberly VanExel, and faculty member Richard P. Howdy, Jr. Also, Ms. Kimberly Hoggatt Krumwiede graciously provided several image series to help clarify the steps and missteps of reproductive tract development.

Within our text, images add powerful descriptive content to our words. Accordingly, many, many thanks are extended to those who donated surgical and clinical photographs. Of our contributors, many beautiful photographs within our book were taken by Mr. David Gresham, Chief Medical Photographer at the University of Texas Southwestern Medical Center. Dave’s eye for detail, shading, and composition allowed even simple objects to shine and be illustrated to their full potential. He has been an advocate and valued consultant. Our pathology images were presented at their best thanks to Mr. Mark Smith, a graphics designer here at the University of Texas Southwestern Medical Center. His expertise with micrographs improved the clarity and visual aesthetic of many our microscopic images. Williams Gynecology Third Edition

The providers in the Obstetrics and Gynecology Emergency Services (OGES) at Parkland Hospital were huge allies in our acquisition of images to illustrate normal and abnormal gynecologic findings. The skilled women’s health care nurse practitioners have been true supporters of our efforts, and we sincerely thank them.

We are truly indebted to our administrative staff. For this project, we were lucky to have Ms. Sandra Davis serve as our primary administrative assistant. We are greatly appreciative of her tremendous efforts, professionalism, and efficiency. Ms. Ellen Watkins was a valuable assistant in obtaining needed journal articles. She truly helped to keep our project evidence-based. None of our image and text production would have been possible without the brilliant information technology team in our department. Knowledgeable and responsive, Mr. Charles Richards and Mr. Thomas Ames have supported our project since the first edition. We could not do our job without their expertise.

Williams Gynecology was sculpted into its final form by the talented and dedicated group at McGraw-Hill Education. Once again, Ms. Alyssa Fried has brought her considerable intelligence, energetic work ethic, and creativity to our project. Her attention to detail and organizational talents have kept our project on track with efficiency and style. Our words fall well short in expressing our gratitude to her. Williams Gynecology Third Edition

Ms. Samantha Williams served as assistant to Ms. Fried, and we extend warm thanks for her tremendous support. Her efficiency, professionalism, hard work, accuracy, and positive attitude made coordination of this project a dream. Mr. Andrew Moyer joined our project during its final sculpting. He has taken our project under his care and has adeptly shepherded it to completion with a calm and efficient style. We happily look forward to many future collaborative editions together.

Without the thoughtful, creative efforts of many, our textbook would be a barren wasteland of words. Integral to this process are Armen Ovsepyan, at McGraw-Hill Education, and Alan Barnett of Alan Barnett Design. Mr. Richard Ruzycka served as production supervisor for this edition of our textbook. He adeptly kept our project on track through an array of potential hurdles. Special thanks are extended to Mr. Joseph Varghese and Dr. Shetoli Zhimomi at Thomson Digital. They and their artistic team assisted us in revising many of our text images. Their attention to detail and accurate renderings added important academic support to our words.

Our text took its final shape under the watchful care of our compositors at Aptara, Inc. Specifically, we thank Ms. Indu Jawwad for her talents in skillfully and expediently coordinating and overseeing composition. Her dedicated attention to detail and organization were vital to completion of our project. Her pleasant professionalism was appreciated daily. Also at Aptara, Mr. Shashi Lal Das served a crucial task of quality control and assisted in creating beautiful chapter layouts to highlight our content aesthetically and informatively. Special thanks go to Ms. Kristin Landon. As copyeditor for now several editions of both Williams Obstetrics and Williams Gynecology, Kristin has added precision and clarity to our efforts. Her pleasant and patient professionalism has made our text better.

We offer a sincere “thank you” to our residents in training. Their curiosity keeps us energized to find new and effective ways to convey age-old as well as cutting-edge concepts. Their logical questions lead us to holes in our text, and thereby, always help us to improve our work. Moreover, many of the photographs in this textbook were gathered with the help of our many residents.

In addition, the contributors to this text owe a significant debt to the women who have allowed us to participate in their care. The images and clinical expertise presented in this text would not have been possible without their collaborative spirit to help us move medical knowledge forward.

Last, we offer an enthusiastic and heartfelt “thank you” to our families and friends. Without their patience, generosity, and encouragement, this task would have been impossible. For them, too many hours with “the book” left them with new responsibilities. And importantly, time away from home left precious family memories and laughs unrealized. We sincerely thank you for your love and support.

Content – Williams Gynecology Third Edition

SECTION 1: BENIGN GENERAL GYNECOLOGY.

CHAPTER 1: Well Woman Care
CHAPTER 2: Techniques Used for Imaging in Gynecology
CHAPTER 3: Gynecologic Infection
CHAPTER 4: Benign Disorders of the Lower Genital Tract
CHAPTER 5: Contraception and Sterilization
CHAPTER 6: First-Trimester Abortion
CHAPTER 7: Ectopic Pregnancy
CHAPTER 8: Abnormal Uterine Bleeding
CHAPTER 9: Pelvic Mass
CHAPTER 10: Endometriosis
CHAPTER 11: Pelvic Pain
CHAPTER 12: Breast Disease
CHAPTER 13: Psychosocial Issues and Female Sexuality
CHAPTER 14: Pediatric Gynecology

SECTION 2: REPRODUCTIVE ENDOCRINOLOGY, INFERTILITY, AND THE MENOPAUSE.

CHAPTER 15: Reproductive Endocrinology
CHAPTER 16: Amenorrhea
CHAPTER 17: Polycystic Ovarian Syndrome and Hyperandrogenism
CHAPTER 18: Anatomic Disorders
CHAPTER 19: Evaluation of the Infertile Couple
CHAPTER 20: Treatment of the Infertile Couple
CHAPTER 21: Menopausal Transition
CHAPTER 22: The Mature Woman.

SECTION 3: FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY.

CHAPTER 23: Urinary Incontinence
CHAPTER 24: Pelvic Organ Prolapse
CHAPTER 25: Anal Incontinence and Functional Anorectal Disorders
CHAPTER 26: Genitourinary Fistula and Urethral Diverticulum.

SECTION 4: GYNECOLOGIC ONCOLOGY.

CHAPTER 27: Principles of Chemotherapy
CHAPTER 28: Principles of Radiation Therapy
CHAPTER 29: Preinvasive Lesions of the Lower Genital Tract
CHAPTER 30: Cervical Cancer
CHAPTER 31: Vulvar Cancer
CHAPTER 32: Vaginal Cancer
CHAPTER 33: Endometrial Cancer
CHAPTER 34: Uterine Sarcoma
CHAPTER 35: Epithelial Ovarian Cancer
CHAPTER 36: Ovarian Germ Cell and Sex Cord-Stromal Tumors
CHAPTER 37: Gestational Trophoblastic Disease.

SECTION 5: ASPECTS OF GYNECOLOGIC SURGERY.

CHAPTER 38: Anatomy
CHAPTER 39: Preoperative Considerations
CHAPTER 40: Intraoperative Considerations
CHAPTER 41: Minimally Invasive Surgery Fundamentals
CHAPTER 42: Postoperative Considerations.

SECTION 6: ATLAS OF GYNECOLOGIC SURGERY.

CHAPTER 43: Surgeries for Benign Gynecologic Disorders
CHAPTER 44: Minimally Invasive Surgery
CHAPTER 45: Surgeries for Pelvic Floor Disorders
CHAPTER 46: Surgeries for Gynecologic Malignancies.

About the Author


Director, Division of Gynecologic Oncology Fellowship Associate Professor, Department of Obstetrics and Gynecology Massachusetts General Hospital–Harvard Medical School

Professor, Department of Obstetrics and Gynecology University of Texas Southwestern Medical Center at Dallas

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F. Gary Cunningham, MD, Professor and Chairman, Department of Obstetrics & Gynecology, Jack A. Pritchard Professor of Obstetrics & Gynecology, Beatrice & Miguel Elias Distinguished Chair in Obstetrics & Gynecology, The University of Texas Southwestern Medical Center at Dallas, Chief of Obstetrics & Gynecology, Parkland Memorial Hospital, Dallas, Texas

Holder, Helen J. and Robert S. Strauss and Diana K. and Richard C. Strauss Distinguished Chairmanship in Women’s Health Director, Lowe Foundation Center for Women’s Preventative Health Care Associate Residency Program Director, Departm

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