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Ricucci N, Colonnello E, Limoncin E, Mollaioli D, Sansone A, Jannini EA, Ciocca G. Psychosexological correlates of 372 women with vulvodynia, overactive pelvic floor, postcoital cystitis, and interstitial cystitis. J Sex Med 2024; 21:471-478. [PMID: 38515245 DOI: 10.1093/jsxmed/qdae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/21/2024] [Accepted: 02/04/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Among the plethora of urogynecological conditions possibly affecting women, some of them, less explored, have significant impacts on sexological and psychological health, with a mutual influence. AIM The aim of this study was to investigate the sexological and psychological correlates of four urogynecological pathologies in a sample of women of childbearing age: overactive pelvic floor, vulvodynia, postcoital cystitis, and interstitial cystitis. Women cured of these conditions were also included, to assess the same aspects after the remission of physical symptoms. METHODS We recruited 372 women with an average age of 33.5 years through an online platform shared by a popular forum for women with urogynecological pathologies between March and May 2021. The participants filled out a socio-anamnestic questionnaire and a set of psychometric tests. OUTCOMES Participant data were collected by use of the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Toronto Alexithymia Scale-20, Female Sexual Function Index, and Orgasmometer-F, and the SPSS (Statistical Package for Social Sciences) v.26 was used for data analysis. RESULTS Overactive pelvic floor was reported by 66.4% of the women, vulvodynia by 55%, postcoital cystitis by 58.8%, and interstitial cystitis by 8.3%, and these conditions were often comorbid with each other, with 9.4% and 7% of women reporting having suffered psychological and sexual abuse, respectively. The presence of past abuse was correlated with overactive pelvic floor (P < .05), vulvodynia (P < .01), and major depression (P < .01). Significantly more depression occurred in women with vulvodynia than in the other subgroups (P < .05), except for women with only an overactive pelvic floor. There was no difference between the subgroups in the occurrence of alexithymia, sexual function, and orgasm (P < .05). Interestingly, the prevalence of sexual dysfunction increased in cured women. CLINICAL IMPLICATIONS The lack of significant differences, except for depression, between the pathological subgroups suggests a similar clinical and psychological relevance of the four pathologies studied. The persistence of sexual dysfunctions in cured women may be related to a residual dysfunctional relational modality with the partner. STRENGTHS AND LIMITATIONS The evaluation of both psychological and sexological variables in a group of less-explored urogynecological conditions represents a strength of this study, while a lack of a face-to-face assessment could represent a limitation. CONCLUSION The results of the present study should promote psychosexological interventions in women with these diseases, both during the pathological state and after remission.
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Affiliation(s)
- Noemi Ricucci
- Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome 00185, Italy
| | - Elena Colonnello
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome 00185, Italy
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Erika Limoncin
- Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome 00185, Italy
| | - Daniele Mollaioli
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Andrea Sansone
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Emmanuele A Jannini
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Giacomo Ciocca
- Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome 00185, Italy
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Lucas R, Talih M, Soares S, Fraga S. Bullying Involvement and Physical Pain Between Ages 10 and 13 Years: Reported History and Quantitative Sensory Testing in a Population-Based Cohort. THE JOURNAL OF PAIN 2024; 25:1012-1023. [PMID: 37914095 DOI: 10.1016/j.jpain.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/06/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023]
Abstract
We aimed to quantify the prospective association between bullying and physical pain in a population-based cohort of adolescents. We assessed 4,049 participants of the 10 and 13 years waves of the Generation XXI birth cohort study in Portugal. Pain history was collected using the Luebeck pain screening questionnaire. A subsample of 1,727 adolescents underwent computerized cuff pressure algometry to estimate pain detection/tolerance thresholds, temporal pain summation and conditioned pain modulation. Participants completed the Bully Scale Survey and were classified as "victim only", "both victim and aggressor", "aggressor only", or "not involved". Associations were quantified using Poisson or linear regression, adjusted for sex and adverse childhood experiences. When compared to adolescents "not involved", participants classified as "victim only" or "both victim and aggressor" at age 10 had higher risk of pain with psychosocial triggers, pain that led to skipping leisure activities, multisite pain, pain of higher intensity, and pain of longer duration, with relative risks between 1.21 (95% confidence interval: .99, 1.49) and 2.17 (1.57, 3.01). "Victims only" at age 10 had lower average pain detection and tolerance thresholds at 13 years (linear regression coefficients: -1.81 [-3.29, -.33] and -2.73 [-5.17, -.29] kPa, respectively), as well as higher pain intensity ratings (.37 [.07, .68] and .39 [.06, .72] mm), when compared with adolescents not involved. No differences were seen for the remaining bullying profiles or sensory measures. Our findings suggest that bullying may have long-term influence on the risk of chronic musculoskeletal pain and may interfere with responses to painful stimuli. PERSPECTIVE: We found prospective evidence that bullying victimization in youth: 1) is more likely to lead to negative reported pain experiences than the reverse, 2) may have long-term influence on adverse pain experiences, and 3) may contribute to pain phenotypes partly by interfering with somatosensory responses to painful stimuli.
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Affiliation(s)
- Raquel Lucas
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal; Department of Population Studies, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Makram Talih
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Sara Soares
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Sílvia Fraga
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Nicolson KP, Mills SE, Senaratne DN, Colvin LA, Smith BH. What is the association between childhood adversity and subsequent chronic pain in adulthood? A systematic review. BJA OPEN 2023; 6:100139. [PMID: 37588177 PMCID: PMC10430872 DOI: 10.1016/j.bjao.2023.100139] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/28/2023] [Indexed: 08/18/2023]
Abstract
Background Adverse childhood experiences and chronic pain are complex problems affecting millions of people worldwide, and result in significant healthcare utilisation. Our review aimed to determine known associations between adversity in childhood and chronic pain in adulthood. Methods We performed a prospectively registered systematic review (PROSPERO ID: 135625). Six electronic databases (Pubmed, Medline, Cochrane, Scopus, APA PsycNet, Web of Science) were searched from January 1, 2009 until May 30, 2022. Titles and abstracts were screened, and all original research studies examining associations between adverse childhood experiences and chronic pain in adulthood were considered for inclusion. Full texts were reviewed, and a narrative synthesis was used to identify themes from extracted data. Ten percent of studies were dual reviewed to assess inter-rater reliability. Quality assessment of study methodology was undertaken using recognised tools. Results Sixty-eight eligible studies describing 196 130 participants were included. Studies covered 15 different types of childhood adversity and 10 different chronic pain diagnoses. Dual reviewed papers had a Cohen's kappa reliability rating of 0.71. Most studies were of retrospective nature and of good quality. There were consistent associations between adverse childhood experiences and chronic pain in adulthood, with a 'dose'-dependent relationship. Poor mental health was found to mediate the detrimental connection between adverse childhood experiences and chronic pain. Conclusion A strong association was found between adverse childhood experiences and chronic pain in adulthood. Adverse childhood experiences should be considered in patient assessment, and early intervention to prevent adverse childhood experiences may help reduce the genesis of chronic pain. Further research into assessment and interventions to address adverse childhood experiences is needed.
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Affiliation(s)
- Karen P. Nicolson
- Division of Population Health & Genomics, University of Dundee, Dundee, UK
| | | | | | - Lesley A. Colvin
- Division of Population Health & Genomics, University of Dundee, Dundee, UK
| | - Blair H. Smith
- Division of Population Health & Genomics, University of Dundee, Dundee, UK
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Selai C, Elmalem MS, Chartier-Kastler E, Sassoon N, Hewitt S, Rocha MF, Klitsinari L, Panicker JN. Systematic review exploring the relationship between sexual abuse and lower urinary tract symptoms. Int Urogynecol J 2023; 34:635-653. [PMID: 35751671 PMCID: PMC9947020 DOI: 10.1007/s00192-022-05277-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patients presenting with lower urinary tract symptoms (LUTS) may report a history of sexual abuse (SA), and survivors of SA may report LUTS; however, the nature of the relationship is poorly understood. The aim of this review is to systematically evaluate studies that explore LUT dysfunction in survivors of SA. METHODS A systematic literature search of six databases, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, was performed. The last search date was June 2021 (PROSPERO CRD42019122080). Studies reporting the prevalence and symptoms of LUTS in patients who have experienced SA were included. The literature was appraised according to the PRISMA statement. The quality of the studies was assessed. RESULTS Out of 272 papers retrieved, 18 publications met the inclusion criteria: studies exploring LUTS in SA survivors (n=2), SA in patients attending clinics for their LUTs (n=8), and cross-sectional studies (n=8). SA prevalence ranged between 1.3% and 49.6%. A history of SA was associated with psychosocial stressors, depression, and anxiety. LUTS included urinary storage symptoms, voiding difficulties, voluntary holding of urine and urinary tract infections. Most studies were of moderate quality. Assessment of SA and LUTS lacked standardisation. CONCLUSIONS The review highlights the need for a holistic assessment of patients presenting with LUTS. Although most of the studies were rated as being of 'moderate' quality, the evidence suggests the need to provide a "safe space" in clinic for patients to share sensitive information about trauma. Any such disclosure should be followed up with further assessment.
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Affiliation(s)
- Caroline Selai
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Michael S Elmalem
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- UCL Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, Queen Square, London, UK
| | - Emmanuel Chartier-Kastler
- Department of Urology, Academic Hospital Pitié-Salpêtrière, Medical School, Sorbonne University, AP-HP, 47-83, Bd de l'Hôpital, 75651, Paris cedex 13, France
| | - Natalia Sassoon
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sam Hewitt
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Maria Francisca Rocha
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Larisa Klitsinari
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, Queen Square, London, UK
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Bullying Victimization and Sexual Wellbeing in Sexually Active Heterosexual, Cisgender and Sexual/Gender Minority Adolescents: The Mediating Role of Emotion Regulation. J Youth Adolesc 2021; 50:2136-2150. [PMID: 34228262 DOI: 10.1007/s10964-021-01471-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/22/2021] [Indexed: 12/28/2022]
Abstract
Bullying victimization is prevalent in adolescence and associated with adverse consequences on physical and psychological wellbeing, paricularly in sexual and gender minority youth. However, little is known about its associations with sexual wellbeing and the underlying mechanisms that could explain this association. The present study assessed the associations between bullying victimization and sexual wellbeing (sexual satisfaction, sexual desire/arousal and orgasmic function difficulties, sexual distress) via the mediating role of emotion regulation difficulties, considering potential sexual/gender minority status-based differences. Self-report online surveys were completed by 1036 sexually active (49.7% were girls) high school students (Mage = 14.6 years, SDage = 0.6). Bullying victimization was directly and negatively associated with sexual desire/arousal difficulties and positively with sexual distress. Higher emotion regulation difficulties mediated the associations between higher bullying victimization and higher orgasmic function difficulties, as well as higher bullying victimization and higher sexual distress. No significant association was observed between bullying victimization and sexual satisfaction. No significant differences were observed between heterosexual, cisgender and sexual and gender minority youth in any of the associations. The findings suggest that bullying victimization is associated with adolescents' sexual wellbeing. The cross-sectional design and small effect sizes support the need for further prospective cohort studies.
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Panicker JN, Selai C, Herve F, Rademakers K, Dmochowski R, Tarcan T, von Gontard A, Vrijens D. Psychological comorbidities and functional neurological disorders in women with idiopathic urinary retention: International Consultation on Incontinence Research Society (ICI-RS) 2019. Neurourol Urodyn 2019; 39 Suppl 3:S60-S69. [PMID: 31782982 DOI: 10.1002/nau.24233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022]
Abstract
AIMS Chronic urinary retention occurring in young women is poorly understood and a cause may not be found in a majority of cases. Different psychological comorbidities and functional neurological symptom disorders (FNDs) have been reported; however, these have been poorly explored. METHODS At the International Consultation on Incontinence Research Society meeting in 2019, a panel of clinicians generated a proposal to explore the relationship between psychological comorbidities, FNDs, and urinary retention in women with chronic idiopathic urinary retention. RESULTS Psychological comorbidities such as depression and anxiety, and FNDs such as leg weakness and loss of consciousness, have been reported in women with idiopathic urinary retention. Individuals react differently to physical and emotional stressors, and experimental models have demonstrated a relationship between the stress response and developing urinary retention. Trauma, particularly sexual trauma, may be a shared risk factor for developing psychological comorbidities and urinary retention. Children with voiding postponement often suffer from psychological comorbidities and behavioral disturbances; however, there is no evidence to suggest that this progresses to urinary retention in adulthood. "Psychogenic urinary retention" has been described in the urology and psychiatry literature in the past, and anecdotal cases of successful voiding following psychotherapy have been reported, though the true pathophysiology of this entity is uncertain. CONCLUSION Psychological and functional disorder comorbidities are reported in women with chronic urinary retention. The nature of the association between urinary retention and functional neurological disorder comorbidities needs to be further explored in terms of a disorder of bladder-brain interaction.
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Affiliation(s)
- Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Caroline Selai
- Department of Clinical and Movement Neurosciences and Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Francois Herve
- Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Kevin Rademakers
- Department of Urology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine and Koç University School of Medicine, Istanbul, Turkey
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Nygaard AS, Stedenfeldt M, Øian P, Haugstad GK. Characteristics of women with chronic pelvic pain referred to physiotherapy treatment after multidisciplinary assessment: a cross-sectional study. Scand J Pain 2019; 19:355-364. [DOI: 10.1515/sjpain-2018-0308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Chronic pelvic pain (CPP) in women is a complex condition that can seriously impact health and quality of life. Clinical guidelines for CPP place great demands on healthcare professionals, as they require both specialized knowledge about the pelvic area and knowledge of the mechanisms of chronic pain. To ensure best possible assessment and treatment of these women it is important to bring about more knowledge of the special CPP features. The purpose of this paper is to describe the characteristics of women with CPP evaluated at the University Hospital of North Norway, and further referred to physiotherapy. The frequency of having a history of abuse or previous pelvic surgery will also be reported, and analyses performed to investigate if subjective health status differs between women with and without these experiences.
Methods
We collected cross-sectional data from 62 women with CPP aged 20–65 (mean age 38.0), referred to physiotherapy after assessment by medical specialists. Data were collected by semi-structured interviews for demographic variables and medical history, and self-administered questionnaires on pain intensity, sexual function, urinary incontinence (UI), anal incontinence (AI), obstructed defecation syndrome (ODS), subjective health complaints (SHC) and symptoms of anxiety and depression.
Results
Pain duration of more than 10 years was reported by 42%, mean pain score was 4.7/10, and analgesics were used weekly by 48%. Previous pelvic or abdominal surgery was reported by 71%, and sick leave >12 weeks the last year by 34%. Reduced sexual desire was reported by 78%, dyspareunia by 73%, UI by 54%, AI by 23%, and obstructed defecation syndrome (ODS) by 34%. More than 90% reported musculoskeletal or pseudoneurologic complaints. Anxiety and depression scores defined as requiring treatment were reported by 40%. Abuse was reported by 50%, and associated with significantly more reports of ODS (p=0.02), more SHC (p=0.02) and higher anxiety scores (p=0.009). Analgesic use and sick leave were significantly higher both among women with a history of abuse (p=0.04 and p=0.005) and among those with previous surgery (p=0.04 and p=0.02). Women with previous surgery reported significantly lower pain intensity during intercourse than those without previous surgery (p=0.008).
Conclusions
Women with CPP have complex symptoms and high scores for both physical and psychological complaints. Women exposed to abuse have especially high scores related to analgesic use, sick leave, ODS, anxiety and SHC. Women with previous surgery report more analgesic use and sick leave, and lower pain intensity during intercourse, than those without previous surgery.
Implications
This study illustrates the complexity of CPP and highlights the need for health professionals to have specialized knowledge of the possible features of the condition. Previous abuse seems to be more associated with poor scores on several health outcomes than surgery, but this needs to be investigated further.
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Affiliation(s)
- Ane Sigrid Nygaard
- Norwegian National Advisory Unit on Incontinence and Pelvic Floor Health, University Hospital of North Norway , Pb. 96 , 9038 Tromsø , Norway
- Women’s Health and Perinatology Research Group, Institute of Clinical Medicine, University of Tromsø , Tromsø , Norway , Phone: 0047 – 92258582
| | - Mona Stedenfeldt
- Norwegian National Advisory Unit on Incontinence and Pelvic Floor Health, University Hospital of North Norway , Tromsø , Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
| | - Pål Øian
- Women’s Health and Perinatology Research Group, Institute of Clinical Medicine, University of Tromsø , Tromsø , Norway
- Department of Obstetrics and Gynecology , University Hospital of North Norway , Tromsø , Norway
| | - Gro Killi Haugstad
- Institute of Physiotherapy, OsloMet – Oslo Metropolitan University , Oslo , Norway
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Gazzuola Rocca L, Smith CY, Grossardt BR, Faubion SS, Shuster LT, Stewart EA, Rocca WA. Adverse childhood or adult experiences and risk of bilateral oophorectomy: a population-based case-control study. BMJ Open 2017; 7:e016045. [PMID: 28592582 PMCID: PMC5623400 DOI: 10.1136/bmjopen-2017-016045] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Bilateral oophorectomy has commonly been performed in conjunction with hysterectomy even in women without a clear ovarian indication; however, oophorectomy may have long-term deleterious consequences. To better understand this surgical practice from the woman's perspective, we studied the possible association of adverse childhood or adult experiences with the subsequent occurrence of bilateral oophorectomy. DESIGN Population-based case-control study. SETTING Olmsted County, Minnesota (USA). PARTICIPANTS From an established population-based cohort study, we sampled 128 women who underwent bilateral oophorectomy before age 46 years for a non-cancerous condition in 1988-2007 (cases) and 128 age-matched controls (±1 year). METHODS Information about adverse experiences was abstracted from the medical records dating back to age 15 years or earlier archived in the Rochester Epidemiology Project (REP) records-linkage system. Adverse childhood experiences were summarised using the Adverse Childhood Experience (ACE) score. RESULTS We observed an association of bilateral oophorectomy performed before age 46 years with verbal or emotional abuse, physical abuse, any abuse, substance abuse in the household, and with an ACE score ≥1 experienced before age 19 years (OR=3.23; 95% CI 1.73 to 6.02; p<0.001). In women who underwent the oophorectomy before age 40 years, we also observed a strong association with physical abuse experienced during adulthood (OR=4.33; 95% CI 1.23 to 15.21; p=0.02). Several of the associations were higher in women who underwent oophorectomy at a younger age (<40 years) and in women without an ovarian indication for the surgery. None of the psychosocial or medical variables explored as potential confounders or intervening variables changed the results noticeably. CONCLUSIONS Women who suffered adverse childhood experiences or adult abuse are at increased risk of undergoing bilateral oophorectomy before menopause. We suggest that the association may be explained by a series of biological, emotional, and psychodynamic mechanisms.
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Affiliation(s)
- Liliana Gazzuola Rocca
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandon R Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephanie S Faubion
- Women’s Health Research Center, Mayo Clinic, Rochester, Minnesota, USA
- Division of General Internal Medicine, Women’s Health Clinic, Mayo Clinic, Rochester, Minnesota, USA
| | - Lynne T Shuster
- Division of General Internal Medicine, Women’s Health Clinic, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth A Stewart
- Women’s Health Research Center, Mayo Clinic, Rochester, Minnesota, USA
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter A Rocca
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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