THROUGHOUT most of recorded history, literary and clinical descriptions of depression have adhered to a rigid separation between mental processes and their physical substrates. This impediment to scientific inquiry held sway until Spinoza argued forcefully against the dualism of mind and body and Darwin helped to explain the purposefulness of the living organism in terms of natural selection rather than divine intention.1 In this century, Freud's deromanticizing of the psyche2 and Kraepelin's accurate descriptions of the major psychoses3 set the stage for contemporary efforts to understand mental disorders.We now know that major depression is a heritable, recurrent, syndromal illness. . . .
From ancient times up to the present, there have been anecdotal observations of an association between "personality," health and disease. Today, we are confronted with the apparent reality of the association as evidenced by classical Pavlovian conditioning of immune responses as well as immunomodulatory effects of stress and central nervous system lesioning (for review, see [1]). However, a molecular basis for these phenomena has only recently emerged.
Primary care physicians are frequently faced with the challenge of evaluating primary amenorrhea in adolescent girls. Approximately 15% of these women have abnormal genital examination, with Müllerian agenesis being the second most frequent cause. We report two cases of adolescents with Müllerian agenesis that presented to a tertiary adolescent medicine center with primary amenorrhea and the very rare sexual phenomenon of urethral coitus. The aim of this report is to emphasize the importance of performing a genital examination in girls who present with amenorrhea in the primary care setting, even if 'normal' vaginal sexual activity is assumed.A 19-year-old Caucasian and a 16-year-old Filipino girl presented to a tertiary adolescent medicine center with primary amenorrhea and a history of 'normal' vaginal coitus. Investigation revealed Müllerian agenesis in association with urethral coitus in both cases; neither patient suffered significant urethral damage to require urethra reconstruction. However, the first adolescent had recurrent pyelonephritis and renal scarring and the second had dysuria.To the best of our knowledge, Case 1 also represents the second reported case of pituitary prolactinoma in association with Müllerian agenesis. The first adolescent underwent a hernia repair and vaginoplasty, whereas the second had vaginal dilatations.Our cases highlight the need for careful assessment of the external genitalia and vagina patency in all girls with amenorrhea, even if they report 'normal' vaginal sexual activity. Early identification of anatomic disorders such as Müllerian agenesis, will allow provision of proper care according to the patient's needs and the existing abnormalities, and prevention of rare, unintentional but potentially physically and emotionally harmful, patterns of sexual intercourse.
