Book Review

Female Pelvic Floor Disorders: Investigation and Management

N Engl J Med 1993; 329:440-441August 5, 1993

Article

Female Pelvic Floor Disorders: Investigation and Management
Edited by J. Thomas Benson. 435 pp., illustrated. New York, W.W. Norton, 1992. $109. ISBN: 0-393-71013-0

In a 1991 article, “The Politics of Prolapse: A Revisionist Approach to Disorders of the Pelvic Floor in Women” (Perspectives in Biology and Medicine 34:486-496), Wall and DeLancey discussed the single musculofascial support structure of the pelvic floor, as well as the neuropathic cause common to the most frequent and troublesome pelvic-floor disorders of women. They summarized the neurophysiologic research of the colorectal surgeon Snooks and coworkers, as well as of the gynecologist David Warrell, who demonstrated that “rather than being problems located in isolated compartments, disorders of the pelvic floor have complex interrelations linked by denervation injury, which is present in pelvic and perineal prolapse as well as fecal and stress urinary incontinence.” Wall and DeLancey concluded that “the problem of the pelvic floor is therefore a problem with the structural integrity and neurologic `wiring' of the whole building, not just an isolated defect in some specialist's private apartment.” And yet the care of women with pelvic-floor disorders continues to be fragmented among urologists, gynecologists, gastroenterologists, colorectal surgeons, and gerontologists, with no one clinician seeing the whole syndrome or capable of treating the entire pelvis.

Dr. Benson's superb book is dedicated to improving communication among specialists, who must view the pelvic floor of women as an integrated system and recognize that a variety of symptoms can result from a common pathophysiologic mechanism. In this book, the anatomical and pathophysiologic features, diagnosis, and nonsurgical and surgical treatment of the entire spectrum of female pelvic-floor disorders are beautifully reviewed by international authorities in the various subspecialties. It is the only book I have seen that so fully includes the diverse perspectives of the many research subspecialists studying pelvic-floor dysfunction., and it manages to do so with such a common purpose and such clear language that the entire book holds together with a unified vision.

Several chapters are particularly fascinating and useful. The section on radiologic investigation of anorectal dysfunction contains an outstanding description of evacuation proctography (defecography) that is clearly written and contains excellent radiographs. Dr. Benson's chapter on pelvic-floor neurophysiology and electrodiagnosis with pudendal- and perineal-nerve motor terminal latency and evoked potentials brings a research tool to the clinically relevant level. The sections on vaginal physiology and postmenopausal sexual function are well done and are welcome inclusions. The graphics throughout the book are generally clear and appropriate, although there are a few minor labeling errors (e.g., the figure on page 190 has the wrong graph). Although this book may be too detailed for medical students, it would make a marvelous update for any clinician caring for women.

All of us who treat disorders of the female pelvic floor will perform more effectively with Dr. Benson's combined methods. Communicating with our colleagues and patients in this unified approach will allow us to make the progress in research that is necessary if women are to live productive, active lives into their 90s, with healthy bladder, bowel, coital, and pelvic-support functions.

Stephen B. Young, M.D.
University of Massachusetts Medical Center, Worcester, MA 01655

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