Medically Unexplained Physical Symptoms

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Abstract
At a time when managed care is increasingly emphasizing the gatekeeper role, gynecologists are being recognized as the de facto primary care providers for many women. However, despite this prominent place in the medical care system, the training of most gynecologists has emphasized surgical and office-based procedures as well as the treatment of infectious and metabolic diseases. Students of gynecology have had little exposure to the management of common psychosocial distress, which accounts for a large amount of primary care clinician time. This distress is frequently expressed in the form of medically unexplained physical symptoms (such as abdominal pain or discomfort), a phenomenon known as somatization. This article examines the prevalence and phenomenology of medically unexplained physical symptoms and presents practical, balanced management strategies for the diagnosis and treatment of psychosocial distress "masquerading" as physical symptoms.

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