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Pierce J, Harte SE, Afari N, Bradley CS, Griffith JW, Kim J, Lutgendorf S, Naliboff BD, Rodriguez LV, Taple BJ, Williams D, Harris RE, Schrepf A. Mediators of the association between childhood trauma and pain sensitivity in adulthood: a Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network analysis. Pain 2023; 164:1995-2008. [PMID: 37144687 PMCID: PMC10440258 DOI: 10.1097/j.pain.0000000000002895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/13/2023] [Indexed: 05/06/2023]
Abstract
ABSTRACT Urologic chronic pelvic pain syndrome (UCPPS) is a complex, debilitating condition in which patients often report nonpelvic pain in addition to localized pelvic pain. Understanding differential predictors of pelvic pain only vs widespread pain may provide novel pathways for intervention. This study leveraged baseline data from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network's Symptom Pattern Study to investigate the impact of childhood sexual and nonsexual violent trauma on pelvic and nonpelvic pain sensitivity among adult patients with UCPPS, as well as potential mediators of this association. Study participants who met inclusion criteria for UCPPS completed questionnaires assessing childhood and recent trauma, affective distress, cognitive dysfunction, and generalized sensory sensitivity. Experimental pain sensitivity was also evaluated using standardized pressure pain applied to the pubic region and the arm. Bivariate analyses showed that childhood violent trauma was associated with more nonviolent childhood trauma, more recent trauma, poorer adult functioning, and greater pain sensitivity at the pubic region, but not pain sensitivity at the arm. Path analysis suggested that childhood violent trauma was indirectly associated with pain sensitivity at both sites and that this indirect association was primarily mediated by generalized sensory sensitivity. More experiences of recent trauma also contributed to these indirect effects. The findings suggest that, among participants with UCPPS, childhood violent trauma may be associated with heightened pain sensitivity to the extent that trauma history is associated with a subsequent increase in generalized sensory sensitivity.
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Affiliation(s)
- Jennifer Pierce
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Niloofar Afari
- VA Center for Excellence for Stress & Mental Health and Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Catherine S Bradley
- Departments of Obstetrics and Gynecology and Urology, Carver College of Medicine, and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jayoung Kim
- Departments of Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Susan Lutgendorf
- Department of Psychological and Brain Sciences, Department of Urology, and Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, United States
| | - Bruce D Naliboff
- Department of Medicine, Oppenheimer Center for Neurobiology of Stress and Resilience and Division of Digestive Diseases, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, United States
| | - Larissa V Rodriguez
- Institute of Urology, University of Southern California, Beverly Hills, CA, United States
| | - Bayley J Taple
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - David Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Richard E Harris
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
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Ross WT, Snyder B, Stuckey H, Ross IR, McCall-Hosenfeld J, Harkins GJ, Smith CP. Gynaecological care of women with chronic pelvic pain: Patient perspectives and care preferences. BJOG 2023; 130:476-484. [PMID: 36457127 DOI: 10.1111/1471-0528.17355] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/14/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To explore the experiences and care preferences of women with chronic pelvic pain, with or without a history of sexual trauma, seeking gynaecological care. DESIGN Qualitative study. SETTING Ambulatory endometriosis centre. POPULATION OR SAMPLE Women aged 18-55 years with chronic pelvic pain. METHODS Baseline demographics and sexual trauma history were obtained, and participants were assigned to focus groups according to a positive (four groups, 13 participants) or negative (two groups, nine participants) screen for a history of sexual trauma. The focus groups were led by a clinical psychologist and a gynaecological surgeon and consisted of semi-structured interviews. The interviews were audio-recorded and transcribed, and the transcripts were coded in NVivo 12. MAIN OUTCOME MEASURES Content analysis was used to derive themes according to the participants' own words. RESULTS Participants with chronic pelvic pain, with or without a history of sexual trauma, experienced delay in diagnosis and repetitive dismissals by clinicians. Participants' experiences of dismissals included: clinicians not listening, insufficient allocation of time to appointments and perceived redundant medical testing (i.e. sexually transmitted infection testing, urine cultures, ultrasounds). Participants identified clinician interactions as pivotal in coping with both pelvic pain and sexual abuse. Participants also provided feedback regarding trauma-informed practices and care delivery specific to patients with chronic pelvic pain. CONCLUSION Patients with chronic pelvic pain, with or without a history of sexual trauma, report negative experiences when interacting with the healthcare system. They have clear needs and preferences regarding gynaecological care and provide feasible suggestions for improving care delivery.
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Affiliation(s)
- Whitney Trotter Ross
- Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Bethany Snyder
- Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio, USA
| | - Heather Stuckey
- Department of Internal Medicine, Qualitative and Mixed Methods Core, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Ian R Ross
- Department of Internal Medicine, Division of Hospital Medicine, John Cochran Veterans Affairs Hospital and Washington University in St Louis, St Louis, Missouri, USA
| | - Jennifer McCall-Hosenfeld
- Department of Internal Medicine, Division of General Internal Medicine, Penn State Milton S Hershey College of Medicine, Hershey, Pennsylvania, USA
| | - Gerald J Harkins
- Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, UPMC, Mechanicsburg, Pennsylvania, USA
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Aboussouan AB, Mandell D, Johnson J, Thompson N, Huffman KL. An interdisciplinary chronic pain rehabilitation program effectively treats impairment in sexual function, depression, alexithymia, and pain in women with chronic pelvic pain. J Psychosom Obstet Gynaecol 2021; 42:261-271. [PMID: 32141387 DOI: 10.1080/0167482x.2020.1735341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Chronic pelvic pain (CPP) in women is often associated with marked emotional distress and disability, with particular impairments in sexual functioning. Research supports the efficacy of interdisciplinary chronic pain rehabilitation programs (ICPRPs) in treating chronic pain, however less is known about their utility in CPP. METHODS This retrospective study examined pain-related sexual impairment, emotional symptoms, and pain severity in CPP patients before and after completing a 3-4 week ICPRP. Predictors of post-treatment sexual impairment were also investigated. Participants included 58 female CPP patients and 58 age-matched females with non-pelvic chronic pain (NPCP). RESULTS All participants reported robust improvements across outcome measures. Women with CPP reported greater pre- and post-treatment impairment in sexual function than NPCP patients, despite significant treatment-related improvements. In contrast, CPP patients also reported higher levels of depression at baseline but showed greater treatment related-improvements. In participants with CPP, treatment-related improvements in depression, alexithymia, and pain severity significantly explained decreases in pain-related sexual impairment following treatment, whereas none of these variables explained sexual impairment outcomes in women with NPCP. CONCLUSION Results demonstrate that ICPRPs can effectively treat CPP, particularly through changes in depression and alexithymia. Future research should examine whether specific interventions can be added in ICPRPS to address CPP-related sexual impairment.
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Affiliation(s)
- Alix B Aboussouan
- Department of Clinical Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Darcy Mandell
- Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Johnson
- Center for Comprehensive Pain Recovery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
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Parsons BA, Baranowski AP, Berghmans B, Borovicka J, Cottrell AM, Dinis-Oliveira P, Elneil S, Hughes J, Messelink BEJ, de C Williams AC, Abreu-Mendes P, Zumstein V, Engeler DS. Management of chronic primary pelvic pain syndromes. BJU Int 2021; 129:572-581. [PMID: 34617386 DOI: 10.1111/bju.15609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Management of chronic pelvic pain (CPP) remains a huge challenge for care providers and a major burden for healthcare systems. Treating chronic pain that has no obvious cause warrants an understanding of the difficulties in managing these conditions. Chronic pain has recently been accepted as a disease in its own right by the World Health Organization, with chronic pain without obvious cause being classified as chronic primary pain. Despite innumerable treatments that have been proposed and tried to date for CPP, unimodal therapeutic options are mostly unsuccessful, especially in unselected individuals. In contrast, individualised multimodal management of CPP seems the most promising approach and may lead to an acceptable situation for a large proportion of patients. In the present review, the interdisciplinary and interprofessional European Association of Urology Chronic Pelvic Pain Guideline Group gives a contemporary overview of the most important concepts to successfully diagnose and treat this challenging disease.
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Affiliation(s)
| | - Andrew P Baranowski
- National Hospital for Neurology and Neurosurgery, University College London Hospitals Foundation Trust, University College London, London, UK
| | - Bary Berghmans
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan Borovicka
- Department of Gastroenterology/Hepatology, School of Medicine, Cantonal Hospital of St. Gallen, University of St. Gallen, St. Gallen, Switzerland
| | | | - Paulo Dinis-Oliveira
- Department of Urology, University of Porto Faculty of Medicine, Hospital de Sao Joao, Porto, Portugal
| | - Sohier Elneil
- National Hospital for Neurology and Neurosurgery, University College Hospital, London, UK
| | - John Hughes
- The James Cook University Hospital, Middlesbrough, UK
| | - Bert E J Messelink
- Department of Urology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Pedro Abreu-Mendes
- Department of Urology, University of Porto Faculty of Medicine, Hospital de Sao Joao, Porto, Portugal
| | - Valentin Zumstein
- Department of Urology, School of Medicine, Cantonal Hospital of St. Gallen, University of St. Gallen, St. Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, School of Medicine, Cantonal Hospital of St. Gallen, University of St. Gallen, St. Gallen, Switzerland
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Sexual assault as a risk factor for gynaecological morbidity: An exploratory systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 255:222-230. [DOI: 10.1016/j.ejogrb.2020.10.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022]
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Association between dysmenorrhea and chronic pain: a systematic review and meta-analysis of population-based studies. Am J Obstet Gynecol 2020; 223:350-371. [PMID: 32151612 DOI: 10.1016/j.ajog.2020.03.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of the study was to synthesize the epidemiological findings for the associations between dysmenorrhea, including primary dysmenorrhea and endometriosis-associated dysmenorrhea and any chronic pain conditions, including chronic pelvic pain, and chronic nonpelvic pain. DATA SOURCES The data sources included PubMed, Embase, and CINAHL from inception to December 2019. STUDY ELIGIBILITY CRITERIA The study criteria included observational population-based studies in which the relationship between dysmenorrhea and the presence or severity of chronic pain was examined. STUDY APPRAISAL AND SYNTHESIS METHODS Each study was double coded and evaluated for bias based on the modified Newcastle and Ottawa Scale. Random-effect meta-analyses were conducted to quantify the associations between dysmenorrhea and the presence of chronic pelvic and nonpelvic pain. RESULTS Out of 9452 records, 32 studies were included, with 14 reporting associations between dysmenorrhea and chronic pelvic pain, and 20 for dysmenorrhea and chronic nonpelvic pain. Primary dysmenorrhea and endometriosis-associated dysmenorrhea were examined in 7 studies, respectively. More than 30% of the studies were categorized as poor quality, 56% as moderate, and 12.5% as high. Dysmenorrhea was positively associated with both the presence and severity of chronic pelvic and nonpelvic pain conditions. Based on 6689 women from 8 studies, those with chronic pelvic pain had 2.43 (95% confidence interval, 1.98-2.99, I2, 42%) times the odds of having dysmenorrhea compared with those without. Based on 3750 women from 11 studies, those with chronic nonpelvic pain had 2.62 (95% confidence interval, 1.84-3.72, I2, 72%) times the odds of having dysmenorrhea compared with those without. Overall, dysmenorrhea was associated with 2.50 (95% confidence interval, 2.02-3.10) times the odds of chronic pain, which did not differ by chronic pelvic vs chronic nonpelvic pain, community vs clinical populations, or different geographical regions. CONCLUSIONS Dysmenorrhea may be a general risk factor for chronic pain, although whether primary dysmenorrhea increases the risk for chronic pain is unclear. Given that adolescence is a sensitive period for neurodevelopment, elucidating the role of primary dysmenorrhea in pain chronicity in future longitudinal studies is important for preventing both chronic pelvic and nonpelvic pain.
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Da Luz RA, de Deus JM, Valadares AL, Conde DM. Evaluation of sexual function in Brazilian women with and without chronic pelvic pain. J Pain Res 2018; 11:2761-2767. [PMID: 30519079 PMCID: PMC6235340 DOI: 10.2147/jpr.s176851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose The aim of this study was to evaluate sexual function in women with chronic pelvic pain (CPP) compared to a control group without CPP and to investigate the factors associated with sexual dysfunction in women with CPP. Methods This cross-sectional study included 100 women with CPP and 100 controls. Sexual function was evaluated using the Female Sexual Function Index (FSFI) and depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). A generalized linear model was used to compare the groups with respect to the overall FSFI score and the scores obtained for each FSFI domain. Multiple logistic regression analysis was used to identify the factors associated with sexual dysfunction in the study group. Results Anxiety was present in 66.0% of women with CPP in the study group compared to 49.0% of the controls (P=0.022). Depression was detected in 63.0% of women with CPP in the study group and in 38.0% of the controls (P=0.001). Sexual dysfunction was identified in 81.0% of the women with CPP in the study group compared to 58.0% of the controls (P=0.003). Following adjustment, the women with CPP had significantly lower mean scores compared to the controls in the FSFI domains of desire (3.0±1.3 vs 3.6±1.3; P=0.038), arousal (2.6±1.6 vs 3.4±1.9; P=0.002), lubrication (3.2±1.9 vs 3.7±2.3; P=0.011), orgasm (3.0±1.9 vs 3.6±2.2; P<0.002), and pain (2.5±1.7 vs 3.4±2.2; P<0.001). There was no difference between the groups for the satisfaction domain (P=0.337) or for the overall score (P=0.252). A positive and independent association was found between depression and sexual dysfunction in the women with CPP (P=0.012). Conclusion In the women with CPP, sexual dysfunction was more common, and the scores in most of the sexual function domains were poorer than in the control group. Concurrently, depression was found to be positively associated with sexual dysfunction in the women with CPP.
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Affiliation(s)
- Rosa Azevedo Da Luz
- Women's Health Unit, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - José Miguel de Deus
- Women's Health Unit, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil.,Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil,
| | - Ana Lr Valadares
- Department of Gynecology and Obstetrics, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Délio Marques Conde
- Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil,
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Champion JD, Piper J, Holden A, Korte J, Shain RN. Abused Women and Risk for Pelvic Inflammatory Disease1. West J Nurs Res 2016; 26:176-91; discussion 192-5. [PMID: 15005983 DOI: 10.1177/0193945903256402] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mexican and African American women with sexually transmitted diseases (STDs) underwent targeted physical exams and questioning regarding sexual or physical abuse, current genitourinarysymptomatology, and pelvic inflammatory disease (PID) risk behaviors to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms affecting diagnoses of STDs and risk for PID. Bivariate comparisons found abused women reported more PID risk behaviors including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found abused women were more likely to report pathologic genitourinary symptomatology than nonabused women. Clinicians made more presumptive diagnosesof PID for abused than for nonabused women upon physical examination. These findings indicate abused women are at high risk for PID. Its considerable impact on genitourinary symptomatology and risk for PID make assessment for abuse essential in clinical management of women with STDs and diagnosis of PID.
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Affiliation(s)
- Jane Dimmitt Champion
- Department of Family Nursing Care, University of Texas Health Science Center at San Antonio, USA
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Larsen ML, Hilden M, Skovlund CW, Lidegaard Ø. Somatic health of 2500 women examined at a sexual assault center over 10 years. Acta Obstet Gynecol Scand 2016; 95:872-8. [DOI: 10.1111/aogs.12903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 03/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Mie-Louise Larsen
- Centre for Victims of Sexual Assault; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
| | - Malene Hilden
- Centre for Victims of Sexual Assault; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
- Department of Obstetrics and Gynecology; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
| | - Charlotte W. Skovlund
- Department of Obstetrics and Gynecology; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
| | - Øjvind Lidegaard
- Department of Obstetrics and Gynecology; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
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10
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Abstract
Peripheral generators and the central nervous system have a role in the production of visceral and somatic hypersensivities and hyperalgesias.More generalised symptoms often exist and efferent activity from the CNS may also be responsible for abnormal visceral and muscular function.It is important to dissect out the symptoms and as well as treating peripheral generators to consider interventions of the central mechanisms aimed at the cognitive behavioural aspects of the patients' condition.
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11
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Gokyildiz S, Beji NK, Avcibay B, Ozgunen FT. Risk factors for chronic pelvic pain: hospital-based case-control study from Turkey. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2014. [DOI: 10.1111/ijun.12053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sule Gokyildiz
- Cukurova University; Adana Health High School; Balcali Kampusu; Yuregir Adana Turkey
| | - Nezihe K Beji
- Istanbul University; Florence Nightingale Faculty of Nursing; Department of Obstetrics and Gynecology Nursing; Abide-i Hurriyet cad. Sisli Istanbul Turkey
| | - Burcu Avcibay
- Cukurova University Adana Health High School; Balcali Kampusu; Yuregir Adana Turkey
| | - Fatma T Ozgunen
- Obstetrics and Gynecology Department; Cukurova University Faculty of Medicine; Balcali Kampusu; Yuregir Adana Turkey
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12
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Díaz-Mohedo E, Hita-Contreras F, Luque-Suárez A, Walker-Chao C, Zarza-Luciáñez D, Salinas-Casado J. Prevalence and risk factors of pelvic pain. Actas Urol Esp 2014; 38:298-303. [PMID: 24206627 DOI: 10.1016/j.acuro.2013.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the prevalence of Chronic Pelvic Pain (CPP) symptoms in Malaga and its province and to identify risk factors associated. METHOD a cross-sectional study was carried out in Malaga and its province, 18-65 years-old throughout a non-probability sampling by quotas (n = 887), stratified by sex, age and counties. All participants completed the QCPP-M, a self-administered questionnaire, validated tool due to its ability to discriminate patients with and without CPP. RESULTS prevalence of symptoms of CPP in subjects between 18-65 years-old was 22.8% in general population (30.9% women and 15.6% men) (RR = 1.974 for women versus men, 95% CI 1.53-2.55, P < .001). After correction by sex and age individuals who practice physical activity had a lower score in QCPP-M that others who do not not (mean difference -0.65 ± 0.27). They were significantly associated with higher scores in the following factors: lifting and/or moving weights in activities of daily life (1.34 ± 0.33), laxatives intake and/or high-fiber diet (2.09 ± 0.48), having suffered from urogenital infectious disease in the past: vulvovaginitis, cystitis and prostatitis (1.77 ± 0.55), hemorrhoids/anal fissure (1.31 ± 0.40) or pelvic trauma (1.21 ± 0, 61) respectively. Individuals who spend more time standing had a tendency to have higher scores on QCPP-M (coefficient of regression adjusted for sex and age of 0.078 points/hour, SE = 0.04, P < .068). CONCLUSIONS High prevalence of CPP symptoms in Málaga (22.8%), this is related with significantly several risk factors.
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13
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As-Sanie S, Clevenger LA, Geisser ME, Williams DA, Roth RS. History of abuse and its relationship to pain experience and depression in women with chronic pelvic pain. Am J Obstet Gynecol 2014; 210:317.e1-317.e8. [PMID: 24412745 DOI: 10.1016/j.ajog.2013.12.048] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 12/03/2013] [Accepted: 12/31/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We sought to determine the relationship among a history of physical or sexual abuse, pain experience, and depressive symptoms among women with chronic pelvic pain (CPP). STUDY DESIGN This was a cross-sectional study of women who presented to a tertiary referral center for evaluation of CPP (N = 273). All participants completed standardized questionnaires to assess a history of physical or sexual abuse, pain severity, pain disability, and depressive symptoms. Subjects were grouped by abuse category and compared to CPP participants without history of abuse. Multinomial logistic regression models were used to determine the association between adolescent or adult and childhood physical or sexual abuse with pain intensity, pain-related disability, and depressive symptoms. RESULTS Logistic regression analyses indicated that, after controlling for age and education, none of the abuse categories was associated with pain severity. However, adolescent or adult sexual abuse predicted greater pain-related disability (odds ratio, 2.39; 95% confidence interval, 1.05-5.40), while both adolescent or adult physical and sexual abuse were associated with higher levels of depression (both P < .05). Level of education was significantly associated with pain intensity, pain disability, and depression. CONCLUSION For our sample of women with CPP, a history of abuse during childhood or adulthood was not associated with differences in pain intensity, but adolescent or adult sexual abuse was associated with greater pain-related disability. A history of physical abuse or sexual abuse appears to hold a stronger relationship with current depressive symptoms than pain experience for women with CPP. Educational achievement holds a robust relationship with pain morbidity and depression for this population.
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Affiliation(s)
- Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI
| | - Lauren A Clevenger
- Department of Psychology, University of Michigan School of Medicine, Ann Arbor, MI
| | - Michael E Geisser
- Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI
| | - David A Williams
- Anesthesiology, University of Michigan Health System, Ann Arbor, MI; Chronic Fatigue and Research Center, University of Michigan Health System, Ann Arbor, MI
| | - Randy S Roth
- Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI; Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
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Dossa NI, Zunzunegui MV, Hatem M, Fraser W. Fistula and other adverse reproductive health outcomes among women victims of conflict-related sexual violence: a population-based cross-sectional study. Birth 2014; 41:5-13. [PMID: 24654632 DOI: 10.1111/birt.12085] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sexual violence (SV) is being used widely as a weapon of war. However, few studies have investigated its health effects. The objective of the present study is to investigate the relationship between sexual violence and several serious reproductive health conditions including fistula. METHODS We conducted a cross-sectional study among 320 women living in Goma, the Democratic Republic of Congo. We assessed the association of four outcomes: fistula, chronic pelvic pain, desire for sex, and desire for children, with SV in two contexts: conflict-related and nonconflict-related. Two groups of women: those who experienced conflict-related sexual violence (CRSV) and those who experienced nonconflict-related sexual violence (NCRSV), were compared with women who had not experienced SV. Data were collected by trained interviewers using a standard questionnaire. RESULTS Compared with women who did not experience SV, after adjustment for potential confounders, women who experienced CRSV were significantly more likely to have fistula (OR = 11.1, 95% CI [3.1-39.3]), chronic pelvic pain (OR = 5.1, 95% CI [2.4-10.9]), and absence of desire for sex (OR = 3.5, 95% CI [1.7-6.9]) and children (OR = 3.5, 95% CI [1.6-7.8]). Women who experienced NCRSV were more likely to report absence of desire for children (OR = 2.7, 95% CI [1.1-6.5]), and seemed more likely to report chronic pelvic pain (OR = 2.3, 95% CI [0.95-5.8]), although the difference was not statistically significant. Women who experienced NCRSV did not have higher odds for fistula and absence of sexual desire. CONCLUSION Conflict-related sexual violence can contribute to women's adverse reproductive health outcomes. Its impact is more devastating than that of NCRSV.
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Affiliation(s)
- Nissou Ines Dossa
- Département de médecine sociale et préventive, École de Santé Publique de l'Université de Montréal, Montreal, QC, Canada
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15
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Abstract
Chronic pelvic pain is pain lasting longer than 6 months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments.
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Affiliation(s)
- Sharon L Stein
- Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue Lakeside 5047, Cleveland, OH 44106, USA.
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Gordon A, Paneduro D, Pink L, Lawler V, Lay C. Evaluation of the frequency and the association of sexual pain and chronic headaches. Headache 2013; 54:109-15. [PMID: 24261411 DOI: 10.1111/head.12271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sexual pain and chronic headaches are both complex conditions with associated high disability. Little research has examined whether there is a relationship between the 2. The aim of this survey-based study was to explore the frequency of sexual pain in a population of women being treated for chronic headache. Peripheral aims included exploring the number of patients receiving treatment for sexual pain and the association between sexual pain and libido, and history of abuse. METHODS Patients presenting to an ambulatory chronic headache clinic were administered a short 10-item survey. RESULTS Forty-four percent of patients reported that they had pelvic region or genital pain brought on by sexual activity. Only half of these patients had ever discussed their pelvic pain with a health care provider, and 31% of these patients had not received treatment. Almost all patients would be interested in treatment if available. Seventy-five percent of patients indicated a change in libido. CONCLUSION Chronic headaches and sexual pain are both conditions that have a significant impact on patients and the health care system, and they do coexist. More research is needed to look at the relationship between these conditions in addition to epidemiology, symptomatology, evaluation, and treatments.
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Affiliation(s)
- Allan Gordon
- Wasser Pain Management Centre, Mount Sinai Hospital, Toronto, ON, Canada
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17
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Male chronic pelvic pain syndrome and the role of interdisciplinary pain management. World J Urol 2013; 31:779-84. [DOI: 10.1007/s00345-013-1083-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/15/2013] [Indexed: 11/26/2022] Open
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18
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Jina R, Thomas LS. Health consequences of sexual violence against women. Best Pract Res Clin Obstet Gynaecol 2013; 27:15-26. [DOI: 10.1016/j.bpobgyn.2012.08.012] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 08/09/2012] [Indexed: 11/26/2022]
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Howard HS. Sexual Adjustment Counseling for Women with Chronic Pelvic Pain. J Obstet Gynecol Neonatal Nurs 2012; 41:692-702. [DOI: 10.1111/j.1552-6909.2012.01405.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Gökyıldız Ş, Beji NK. Chronic pelvic pain: gynaecological and non-gynaecological causes and considerations for nursing care. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2012. [DOI: 10.1111/j.1749-771x.2011.01137.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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ter Kuile MM, Weijenborg PT, Spinhoven P. ORIGINAL RESEARCH—PAIN: Sexual Functioning in Women with Chronic Pelvic Pain: The Role of Anxiety and Depression. J Sex Med 2010; 7:1901-10. [DOI: 10.1111/j.1743-6109.2009.01414.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Haugstad GK, Haugstad TS, Kirste U, Leganger S, Hammel B, Klemmetsen I, Malt UF. Reliability and validity of a standardized Mensendieck physiotherapy test (SMT). Physiother Theory Pract 2009; 22:189-205. [PMID: 16920678 DOI: 10.1080/09593980600822834] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A standardized test was developed to evaluate posture, movement, gait, sitting posture, and respiration of patients with psychosomatic disorders, based on the Mensendieck principles of observation and analysis of motor function. To validate the test and to make a comprehensive body examination of a defined group of patients, it was applied in a study of women with chronic pelvic pain (CPP, ICD10 F45.4). Fifteen women with CPP and 15 matched, healthy controls were examined. Test subjects were video recorded and scored by three experienced Mensendieck physical therapists, blinded with respect to the selection of subjects. Scores from 0 (for least functional movement) to 7 (optimal function) were assigned to each test person according to a test manual. High intraclass correlations (ICC1.1 [corrected] ranging from 0.82 to 0.97) were found among the testers. The standardized Mensendieck test (SMT) discriminated well between women with CPP and the controls (sensitivity 0.9, specificity 0.7, mean values). The CPP patients scored significantly lower than the controls in all subtests (p < 0.01). The largest difference in scores were found for gait (patients 2.70 +/- 0.11, vs. control, 5.60 +/- 0.09) and respiration (patients 2.88 +/- 0.14, vs. control, 5.63 +/- 0.10). The results indicate that, in the hands of experienced Mensendieck therapists, the SMT is a reliable tool, demonstrating a good discriminative validity. Furthermore, it may turn out to be a useful instrument in the evaluation of patients with somatoform disorders. It may also point toward a possible therapeutic treatment approach to patients with CPP.
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Affiliation(s)
- Gro Killi Haugstad
- Oslo College, Faculty of Health Sciences, Mensendieck Physiotherapy, Oslo, Norway.
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23
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What is the significance of ovarian vein reflux detected by computed tomography in patients with pelvic pain? Clin Imaging 2009; 33:306-10. [DOI: 10.1016/j.clinimag.2008.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 09/29/2008] [Indexed: 11/20/2022]
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Abstract
This review aims to clarify the scope and clinical importance of psychosomatic approaches to obstetrics, gynaecology and andrology. This gradually expanding sub-specialty covers a wide domain of complex disease conditions that can be managed more effectively if the various biological, psychological and social aspects are recognised at the start and concurrent treatment initiated. The current need to practise biopsychosocial management of disease conditions is highlighted along with a description of what this would involve. The nine-field psychosomatic approach, which can be applied to everyday clinical encounters, has been illustrated. Clinical applications of the psychosomatic approach are discussed for various conditions including chronic pelvic pain, eating disorders, tokophobia, post-traumatic stress disorder, depression, menstrual disorders, infertility, bereavement and testicular cancer. Cultural considerations and the need for further research are also briefly discussed.
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Affiliation(s)
- Mira Lal
- Russells Hall Hospital, Women's & Children's Directorate, Dudley, UK.
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25
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Peterman A, Johnson K. Incontinence and trauma: sexual violence, female genital cutting and proxy measures of gynecological fistula. Soc Sci Med 2009; 68:971-9. [PMID: 19128867 DOI: 10.1016/j.socscimed.2008.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Indexed: 10/21/2022]
Abstract
Obstetric fistula, characterized by urinary or fecal incontinence via the vagina, has begun to receive attention on the international public health agenda, however less attention has been given to traumatic fistula. Field reports indicate that trauma contributes to the burden of vaginal fistula, especially in regions wrought by civil unrest, however evidence is largely anecdotal or facility-based. This paper specifically examines the co-occurrence of incontinence and two potential sources of trauma: sexual violence and female genital cutting using the most recent Demographic and Health Surveys in Malawi, Rwanda, Uganda and Ethiopia. Multivariate selection models are used to control for sampling differences by country. Results indicate that sexual violence is a significant determinant of incontinence in Rwanda and Malawi, however not in Uganda. Simulations predict that elimination of sexual violence would result in from a 7 to a 40% reduction of the total burden of incontinence. In contrast, no evidence is found that female genital cutting contributes to incontinence and this finding is robust for types of cutting and high risk samples. Results point to the importance of reinforcing prevention programs which seek to address prevention of sexual violence and for the integration of services to better serve women experiencing both sexual violence and incontinence.
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Affiliation(s)
- Amber Peterman
- University of North Carolina, Department of Public Policy, Chapel Hill, NC 27599-3435, USA.
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26
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Romans S, Cohen M. Unexplained and underpowered: the relationship between psychosomatic disorders and interpersonal abuse -- a critical review. Harv Rev Psychiatry 2008; 16:35-54. [PMID: 18306098 DOI: 10.1080/10673220801933788] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although it is commonly accepted that interpersonal violence (IntPV) leads to adverse health consequences, the available data are far from decisive. To test the hypothesized link, the authors devised an evidence-based strategy to determine the data quality in studies purporting to link IntPV and some medically unexplained disorders in women (irritable bowel syndrome, chronic pelvic pain, fibromyalgia/chronic fatigue, and other chronic pain syndromes). English language studies with control groups of unaffected women were assessed for the quality of their methodologies. The number of studies, together with the consistency of their findings in each domain, was collated to determine the overall weight of evidence regarding the link for each condition. The quantity and quality of research in each clinical area proved to be sparse. In general, most research was limited to small, convenience samples, with insufficient attention to the design of control groups and to sample size. The evidence currently available regarding irritable bowel syndrome, fibromyalgia/chronic fatigue, chronic pelvic pain, and other chronic pain syndromes does not allow for any firm conclusion regarding their link to IntPV. More research - paying particular regard to the methodological concerns identified here - is required in order to generate any definitive conclusions.
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Affiliation(s)
- Sarah Romans
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.
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27
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Leeners B, Stiller R, Block E, Görres G, Imthurn B, Rath W. Effect of Childhood Sexual Abuse on Gynecologic Care as an Adult. PSYCHOSOMATICS 2007; 48:385-93. [PMID: 17878496 DOI: 10.1176/appi.psy.48.5.385] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The study sought to evaluate whether childhood sexual abuse (CSA) experiences significantly affect the gynecologic care received as an adult. A self-administered questionnaire including eight questions on CSA was completed by 85 women exposed to CSA and 170 matched-control women. Women exposed to CSA experienced gynecologic examinations as anxiety-provoking significantly more often and sought more treatment for acute gynecologic problems; 43.5% of these women experienced memories of the original abuse situation during gynecologic consultations. Gynecologic care is particularly distressing for women exposed to CSA.
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Affiliation(s)
- Brigitte Leeners
- Department of Gynecology and Obstetrics, University Hospital, Clinic for Endocrinology, Frauenklinikstr. 10, CH 8091 Zürich, Switzerland.
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Roelofs K, Spinhoven P. Trauma and medically unexplained symptoms towards an integration of cognitive and neuro-biological accounts. Clin Psychol Rev 2007; 27:798-820. [PMID: 17728032 DOI: 10.1016/j.cpr.2007.07.004] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 03/06/2006] [Accepted: 03/06/2006] [Indexed: 12/29/2022]
Abstract
Medically unexplained symptoms (MUS) are frequently associated with a history of traumatization. The first purpose of the present review paper was to investigate systematically the evidence for such relation in a subset of clinical samples with MUS presenting with functional somatization: chronic pelvic pain, irritable bowel syndrome and conversion and somatization disorder. The second purpose was to critically review three dominant models explaining the relation between trauma and MUS (i.e. dissociation, conversion and hierarchical cognitive models). The latter model in particular adequately accounts for the non-volitional and non-intentional character of MUS and explains how traumata can affect the development of MUS without assuming that previous trauma is a necessary prerequisite of MUS. The cognitive model, however, lacks integration with current neurobiological findings, indicative of central stress-and central nervous system alterations in MUS. The final purpose of the present paper was, therefore, to review current neurobiological studies focused on trauma and MUS and to formulate a research agenda to integrate these neurobiological developments with cognitive models for MUS.
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Affiliation(s)
- Karin Roelofs
- Section of Clinical and Health Psychology, Leiden University, the Netherlands.
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Matheis A, Martens U, Kruse J, Enck P. Irritable bowel syndrome and chronic pelvic pain: a singular or two different clinical syndrome? World J Gastroenterol 2007; 13:3446-55. [PMID: 17659691 PMCID: PMC4146780 DOI: 10.3748/wjg.v13.i25.3446] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 02/12/2007] [Accepted: 03/12/2007] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) and chronic pelvic pain (CPP) are both somatoform disorders with a high prevalence within the population in general. The objective was to compare both entities, to find the differences and the similarities related to epidemiology and psychosocial aspects like stressful life events, physical and sexual abuse, illness behaviour and comorbidity. The technical literature was reviewed systematically from 1971 to 2006 and compared. According to literature, IBS and CPP seem to be one rather than two different entities with the same localisation of pain. Both syndromes also are similar concerning prevalence, the coexistence of mental and somatoform disorders, the common history of sexual and physical abuse in the past and their health care utilization. It could be shown that there were many similarities between IBS and CPP. Nevertheless both are traded as different clinical pictures as far. Therefore it seems to be reasonable and necessary to generate a common diagnosis algorithm and to bring gynaecologists and gastroenterologists into dialogue.
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Affiliation(s)
- Anna Matheis
- Department of Sychosomatic Medicine and Psychotherapy University Hospitals Tubingen, Frondsbergstrasse 23, Tubingen 72076, Germany
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Elzevier HW, Voorham-van der Zalm PJ, Pelger RCM. ORIGINAL RESERACH—OUTCOMES ASSESSMENT: How Reliable is a Self-administered Questionnaire in Detecting Sexual Abuse: A Retrospective Study in Patients with Pelvic-Floor Complaints and a Review of Literature. J Sex Med 2007; 4:956-63. [PMID: 17627742 DOI: 10.1111/j.1743-6109.2007.00523.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Sexual abuse and sexual functioning are topics that health professionals find difficult to discuss. Women who present with pelvic-floor complaints often experience sexual difficulties; therefore, questions regarding sexual function should be a routine part of screening. Furthermore, pelvic-floor complaints are correlated with sexual abuse and asking about abuse should be a routine part of screening as well. Considering the fact that many practitioners have difficulty enquiring about abuse, we have suggested that a questionnaire may be helpful in improving the recognition and management of patients who have a history of sexual abuse. AIM The efficiency of detecting sexual abuse by a self-administered questionnaire. METHODS Report of sexual abuse in a self-administered pelvic-floor questionnaire before visiting our outpatient pelvic-floor department was evaluated with the Pelvic Floor Leiden Inventories (PelFIs) administered by a pelvic- floor clinician in a later stage. MAIN OUTCOME MEASURES The percentage of sexual abuse detected by a taken questionnaire administered by a pelvic-floor clinician not confessed during a previous self-administered questionnaire. RESULTS Sexual abuse was reported in 20 patients with pelvic-floor dysfunction during administration of the PelFIs and were also evaluated on our pelvic-floor department. Only six of the patients (30%) did not note in the self-administered questionnaire that they had a history of sexual abuse. CONCLUSION A self-administered questionnaire for pelvic-floor complaints is reliable in detecting sexual abuse and can be helpful in daily practice.
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Affiliation(s)
- Henk W Elzevier
- Department of Urology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
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31
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Strzempko Butt F, Chesla C. Relational patterns of couples living with chronic pelvic pain from endometriosis. QUALITATIVE HEALTH RESEARCH 2007; 17:571-85. [PMID: 17478641 DOI: 10.1177/1049732307299907] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Chronic pelvic pain (CPP) is a disabling condition affecting 15 to 20% of U.S. women of reproductive age. Endometriosis, one of the most common causes of CPP, is associated with symptoms of pelvic pain, painful sexual intercourse, and infertility. In this qualitative study, the authors examined the relational impact of CPP from endometriosis on 13 couples through narrative interviews conducted individually and jointly. They describe five relational patterns that vary on degree of closeness, how care responsibilities are enacted, the degree to which couples are conjoined in their experiences, and how much their lives are overtaken with the disease. These patterns articulate couples' relational concerns as well as daily management of illness.
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Schei B, Guthrie JR, Dennerstein L, Alford S. Intimate partner violence and health outcomes in mid-life women: a population-based cohort study. Arch Womens Ment Health 2006; 9:317-24. [PMID: 17033738 DOI: 10.1007/s00737-006-0156-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2006] [Accepted: 09/10/2006] [Indexed: 11/24/2022]
Abstract
AIM To investigate the association between experience of intimate partner violence (IPV) and health outcomes measured prospectively. METHOD Eleven-year prospective study of a population-based cohort of 438 Australian-born women aged 45-55 years at baseline (in 1991). Annual face-to-face interviews measured health status and quality of life; questionnaires on intimate partner physical, emotional and sexual violence and on experiences of childhood abuse completed in year 6 of follow-up. RESULTS In year 11 of follow-up 233 women (mean age 59.9 SD 2.5 years) were interviewed of whom 62 (27%) reported experiencing physical and/or emotional and/or sexual IPV prior to the 6(th) year of follow-up. In bi-variate analysis a history of IPV was significantly associated with mental and sexual health variables and marital status at baseline and follow-up. Multivariate analysis found that at follow-up after allowing for baseline measures and other co-variates: Frequency of Sexual Activities was lower in women who had experienced IPV (p < 0.05); and negative mood was higher in women with the experience of IPV during the 12 months prior to completing the violence questionnaire (p < 0.05). CONCLUSION IPV was a significant contributor to mental and sexual health status measured prospectively in this cohort of mid-aged Australian-born women.
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Affiliation(s)
- B Schei
- Department of Community Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Cheong Y, William Stones R. Chronic pelvic pain: aetiology and therapy. Best Pract Res Clin Obstet Gynaecol 2006; 20:695-711. [PMID: 16765092 DOI: 10.1016/j.bpobgyn.2006.04.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Chronic pelvic pain (CPP) is a common condition in women and rates of consultation for CPP in general practice are similar to those for asthma and migraine. US and UK population-based studies, together with data from UK hospital settings demonstrate a substantial impact of CPP on health-related quality of life. In this review, we will examine the current evidence on the aetiology and management of CPP, focussing on the randomised controlled trials (RCTs) that are available to date. CPP is a heterogeneous condition and causation is often unclear. There are associations with specific pathological processes but a barrier to understanding is that many studies have data that are not comparable. In the community setting, as many as 60% of women with CPP have not received a specific diagnosis and up to 20% have not undergone any investigation. The factor most commonly associated with CPP in the community is irritable bowel syndrome, although in a tertiary setting with laparoscopy, pathology associated with CPP in ascending order of frequency is endometriosis (33%), adhesions (24%) and 'no pathology' (35%). Current RCT evidence provides some support for the use of ultrasound scanning as an aid to counselling and reassurance, progestogen (medroxyprogesterone acetate) or goserelin for pelvic congestion and a multidisciplinary approach to assessment and treatment. Adhesiolysis is not shown to be of benefit other than in women with extensive adhesions. While studied in relation to dysmenorrhoea rather than CPP, the short term results for presacral neurectomy (PSN) and laparoscopic utero-sacral nerve ablation (LUNA) seem to be similar, although PSN has better results in the long term. Selective serotonin reuptake inhibitor (SSRI) antidepressants have not been shown to be of benefit in CPP. Most of these conclusions are based on the outcome of single randomised trials and therefore need replication.
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Affiliation(s)
- Ying Cheong
- School of Medicine and Biomedical Sciences, Academic Unit of Reproductive and Developmental Medicine, Level 4, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK.
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Csorba R, Lampé L, Borsos A, Balla L, Póka R, Oláh E. Female Child Sexual Abuse within the Family in a Hungarian County. Gynecol Obstet Invest 2006; 61:188-93. [PMID: 16462143 DOI: 10.1159/000091274] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 12/11/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of the study was to analyze the characteristics of intrafamiliar female child sexual abuse and to explore common features that may be utilized as targets for possible methods of prevention. We also described the medical and legal approaches to handling child neglect. METHODS This was a descriptive, cross-sectional study on 52 sexually abused girls under the age of 18 at the Department of Obstetrics and Gynecology, Medical and Health Science Center of Debrecen. We prospectively recorded the data of all cases. Intrafamiliar events were defined if the victim and perpetrator belonged to the same family. Legal outcomes were also recorded. RESULTS During the 16-year period, 209 cases of sexual abuse were seen in our clinic, 52 of them had been involved in child sexual abuse within the family. This accounts for 25% of adolescent cases. Eighty-six percent of the victims were pupils, 50% of them were between 11 and 14 years of age. The perpetrator was the victim's father in 44%, and the stepfather in 40%. There was a slight difference between the type of abuse among the pre- and postpubertal group of victims, but statistically it was not significant. The abuse occurred on multiple occasions in 52%. The occurrence rate of assault was the highest in the summer season (58%), mostly in the afternoon (42%) and it took place almost exclusively at home (98%). The mother accompanied the victim in 38% of the cases and the police in 40%. Vaginal penetration was the type of abuse in 75%, and sexual perversion in 25%. Six victims were physically injured, the presence of sperm could be confirmed on vulvovaginal smears in 2 cases. One pregnancy conceived. Nine cases were reported to the police and as a result of legal proceedings, 5 perpetrators have been sentenced. CONCLUSION The majority of crimes take place within the family and are disclosed after multiple episodes. The small proportion of reported sexual assaults is the consequence of the lack of harmony between the Hungarian conditions of emergency care and the criminal law. Prevention calls for attention at all levels of child education, observation at off-school times, early involvement of health professionals, applying standardized medical guidelines and the modification of jurisdiction.
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Affiliation(s)
- Roland Csorba
- Department of Obstetrics and Gynecology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
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Kaya B, Unal S, Ozenli Y, Gursoy N, Tekiner S, Kafkasli A. Anxiety, depression and sexual dysfunction in women with chronic pelvic pain. SEXUAL AND RELATIONSHIP THERAPY 2006. [DOI: 10.1080/14681990500359897] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Gender-based violence is related to the power imbalance between men and women that is present, to a greater or lesser degree, in all societies. It was recognized as a human rights problem by the United Nations relatively recently. It includes emotional, physical and sexual violence. Sexual violence is the extreme form of gender-based violence, usually accompanied by the other types of violence. Its prevalence is difficult to determine, but it is likely to affect at least one-third of women at some time in their life. It has multiple effects on women's physical and gynaecological health, and these depend greatly on the quality of care that women receive immediately after the assault. Unfortunately, most emergency health services, including those in women's hospitals, are not prepared to provide the correct care for these women. Care should be multidisciplinary and should involve crisis treatment, meticulous clinical examination with complementary auxiliary methods, treatment of physical lesions, prevention of pregnancy and transmission of sexually transmitted infections, and follow-up for at least 6 months after the assault.
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Affiliation(s)
- Luis Tavara
- Latin American Federation of Obstetric and Gynecology Societies, Los Almendros 265-103, Residencial Monterrico, La Molina, Lima 12, Peru.
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Stones RW, Lawrence WT, Selfe SA. Lasting impressions: influence of the initial hospital consultation for chronic pelvic pain on dimensions of patient satisfaction at follow-up. J Psychosom Res 2006; 60:163-7. [PMID: 16439269 DOI: 10.1016/j.jpsychores.2005.06.077] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 06/21/2005] [Accepted: 06/28/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Chronic pelvic pain (CPP) is a common condition in women, and care experiences are distressing and unsatisfactory for many. Research suggests that elements of the initial hospital consultation influence clinical outcome. This study aimed to identify the dimensions through which initial consultations were subsequently recalled at follow-up. METHOD A questionnaire study of 100 women, 6 months following a hospital gynaecology consultation for CPP, was conducted. Measures of pain and ratings of the medical consultation were completed at initial consultation and at follow-up. RESULTS Follow-up questionnaire items loaded to constructs of "affect", "expectation", and "cognition", forming three subscales. Patients' initial ratings of the consultation and scores on all three subscales measured at follow-up were correlated, remaining significant for both affect and expectation after controlling for current pain status. CONCLUSION Doctor's affect and the appropriateness of information to meet expectations are important influences on experiences of care and contribute to the long-term therapeutic element of the consultation.
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Randolph ME, Reddy DM. Sexual functioning in women with chronic pelvic pain: the impact of depression, support, and abuse. JOURNAL OF SEX RESEARCH 2006; 43:38-45. [PMID: 16817066 DOI: 10.1080/00224490609552297] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Many studies have documented associations between sexual functioning, depression, experiences of childhood sexual abuse, relationship support, and chronic pelvic pain, but none have addressed the interrelationships among all of these variables in a unified model. The aim of this preliminary study was to construct an integrative model predicting sexual functioning for women with chronic pelvic pain. Sixty-three women with chronic pelvic pain completed measures of sexual functioning for use as the criterion variable, and measures of the impact of chronic pain, depression, experiences of sexual abuse, and relationship support as predictors. The primary finding was that depression mediated the effects of child sexual abuse and partially mediated the effects of relationship support on sexual behavior and satisfaction with the sexual relationship. In addition to its indirect relationship through depression, relationship support also independently predicted sexual function. Thus, in this nonclinical sample, the effects of child sexual abuse on sexual function depended on the extent of depressive symptoms, while the influence of relationship support depended in part on depression.
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Affiliation(s)
- Mary E Randolph
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI 53202, USA.
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Randolph ME, Reddy DM. Sexual abuse and sexual functioning in a chronic pelvic pain sample. JOURNAL OF CHILD SEXUAL ABUSE 2006; 15:61-78. [PMID: 16893819 DOI: 10.1300/j070v15n03_04] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Sexual abuse, particularly childhood sexual abuse, has been linked to chronic pelvic pain and to sexual dysfunction, though the sexual functioning of survivors of sexual abuse has not been studied in a chronic pain population. Sixty-three women with chronic pelvic pain completed measures of sexual function, sexual abuse, and pain. Using an index of the extent of sexual abuse experiences in childhood and adolescence/adulthood, higher scores were related to lower rates of sexual activity, less satisfaction with orgasm and feelings of closeness with sexual partners, and greater severity of and interference from pain. Findings point to the importance of controlling for relationship status in analyses of long-term effects of sexual abuse and of assessing chronic pelvic pain patients for histories of sexual abuse using measures that address the extent or severity of abuse.
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Affiliation(s)
- Mary E Randolph
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI 53202, USA.
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Abstract
Vulval varices and perivulval veins are common though often unrecognised, and pelvic pain is a common complaint, sometimes without an obvious cause, hence treatment is not always successful. An association between these two problems has long been established, and some cases of pelvic pain are clearly associated with venous pathology. Often, these patients present to the vein clinic with recurrent varicose veins, because the standard procedures have failed and the pelvic origin was not recognised. The understanding of the pathology has evolved and will be reviewed. To establish diagnosis, the communication from the atypical varicose veins in the legs to the ovarian veins must be shown and incompetence of one or both ovarian veins must be demonstrated. Treatment requires elimination of the retrograde flow in the ovarian veins. This can be by either surgical ligation and removal or obliteration with coils and sclerosant. Having removed the cause and relieved the pelvic symptoms, the leg veins can then be successfully treated.
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Csorba R, Aranyosi J, Borsos A, Balla L, Major T, Póka R. Characteristics of female child sexual abuse in Hungary between 1986 and 2001: a longitudinal, prospective study. Eur J Obstet Gynecol Reprod Biol 2005; 120:217-21. [PMID: 15925056 DOI: 10.1016/j.ejogrb.2004.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Revised: 07/16/2004] [Accepted: 08/23/2004] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To summarize the characteristics of female child sexual abuse and to explore common features that may be utilized as targets for possible methods of prevention. DESIGN Prospective, longitudinal study. SETTING A Hungarian county, University of Debrecen. PARTICIPANTS Between 1986 and 2001, 209 girls under the age of 18 who had been exposed to sexual abuse visited the Department of Adolescent Gynecology. METHODS We prospectively collected data illustrating the characteristics of all cases. Events in which victim and perpetrator were members of the same family were recorded as intrafamilial. Subsequent legal procedures were also evaluated. MAIN OUTCOME MEASURES We describe the medical and legal approaches to handling child neglect. RESULTS Seventy-five percent of the victims were students, and 47% of them were between 11 and 14 years of age. The perpetrator was familiar to the victim in 66% of the cases, and a stranger in 34%. Fifty-two (25%) perpetrators were members of the victims' families. In 11% of cases, the perpetrator was the victim's father and in 10%, her stepfather. The abuse had occurred on multiple occasions in 21%. The occurrence rate of assault was highest in the summer season (59%). Thirty-nine percent of victims were accompanied by their mothers when they attended the clinic and 43%, by police. officers. Vaginal penetration was the type of abuse in 80%, and sexual perversion in 20%. Sixty-six victims were physically injured, and in 38 cases the presence of sperm was confirmed in vulvo-vaginal smears. One pregnancy occurred as the result of the abuse. In all, 127 cases were reported to the police; 56 of the perpetrators were sentenced as a result of legal proceedings. CONCLUSION A high proportion of female child sexual abuse takes place within the family and is revealed only after multiple episodes. The low reported prevalence of sexual assault is the consequence of the lack of cooperation between the emergency services in Hungary and the Hungarian criminal law. Prevention requires vigilance in out-of-school times, child education, early involvement of healthcare professionals, and adjustment of the administration of justice.
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Affiliation(s)
- Roland Csorba
- Department of Obstetrics and Gynecology, Medical and Health Science Center Nagyerdei krt. 98, Debrecen, 4012 Hungary.
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Champion JD, Piper JM, Holden AEC, Shain RN, Perdue S, Korte JE. Relationship of abuse and pelvic inflammatory disease risk behavior in minority adolescents. ACTA ACUST UNITED AC 2005; 17:234-41. [PMID: 15924566 DOI: 10.1111/j.1041-2972.2005.00038.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Little is known about the relationship between minority adolescent's experiences of sexual or physical abuse and the pathology of gynecological symptoms that might have an impact on the diagnosis of sexually transmitted disease (STD) or risk for pelvic inflammatory disease (PID). The objective of this study was to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms that impact diagnoses of STD and risk for PID among Mexican American and African American adolescent women with a current STD. METHODS Mexican American and African American adolescent women (n = 373) with an STD underwent a targeted physical exam and questioning regarding sexual or physical abuse, current genitourinary symptomatology, and risk behaviors known to be associated with PID to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms that impact diagnoses of STD and risk for PID. RESULTS Bivariate comparisons found that abused adolescents (n = 232) reported more behaviors associated with increased risk for PID, including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found that abused adolescents were more likely to report pathologic genitourinary symptomatology than those who were not abused. Clinicians reported more abnormal physical exams but did not make any more presumptive diagnoses of PID for abused than nonabused adolescents. CONCLUSIONS Delayed treatment for PID dramatically worsens future fertility and chronic pelvic pain. These findings demonstrate that abused adolescent women are at high risk for PID. Because of its considerable impact on risk for PID, an assessment for abuse is essential in clinical management of adolescent women with STD and diagnosis of PID.
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Haggerty CL, Peipert JF, Weitzen S, Hendrix SL, Holley RL, Nelson DB, Randall H, Soper DE, Wiesenfeld HC, Ness RB. Predictors of Chronic Pelvic Pain in an Urban Population of Women With Symptoms and Signs of Pelvic Inflammatory Disease. Sex Transm Dis 2005; 32:293-9. [PMID: 15849530 DOI: 10.1097/01.olq.0000162361.69041.a5] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to assess the risk profile for chronic pelvic pain (CPP) after pelvic inflammatory disease (PID). STUDY Multivariate logistic regression was used to assess risk factors for CPP in a longitudinal study of 780 predominately black, urban women with clinically suspected PID: complaints of acute pain (<30 days); a clinical finding of pelvic tenderness; and leukorrhea, mucopurulent cervicitis, or untreated gonococcal or chlamydial cervicitis. CPP was defined as pain reported at >or=2 consecutive interviews conducted every 3 to 4 months for 2 to 5 years. RESULTS Nonblack race (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.31-3.58), being married (OR, 2.06; 95% CI, 1.02-4.18), a low SF-36 mental health composite score (OR, 2.71; 95% CI, 1.69-4.34), >or=2 prior PID episodes (OR, 2.84; 95% CI, 1.07-7.54), and smoking (OR, 1.65; 95% CI, 1.01-2.71) independently predicted CPP. Histologic endometritis or evidence of endometrial Neisseria gonorrhoeae or Chlamydia trachomatis infection was negatively associated with CPP (OR, 0.69; 95% CI, 0.44-1.10). CONCLUSIONS A range of demographic, clinical, historical, and behavioral factors predict CPP after PID.
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Affiliation(s)
- Catherine L Haggerty
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, Pennsylvania 15261, USA
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John R, Johnson JK, Kukreja S, Found M, Lindow SW. Domestic violence: prevalence and association with gynaecological symptoms. BJOG 2004; 111:1128-32. [PMID: 15383116 DOI: 10.1111/j.1471-0528.2004.00290.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the prevalence of domestic violence in a population of women attending a gynaecology outpatient clinic in the United Kingdom and also to investigate whether women who reported domestic violence were more likely to complain of certain gynaecological symptoms. DESIGN Questionnaire survey. SETTING A gynaecology outpatient clinic in a North of England Hospital. SAMPLE Nine hundred and twenty consecutive clinic attenders. METHODS Anonymous confidential questionnaire given to women. MAIN OUTCOME MEASURES Disclosure of a past history of domestic violence and gynaecological complaints. RESULTS Nine hundred and twenty consecutive women were included and 825 questionnaires were returned (90% response rate). The prevalence of physical abuse was 21% (171/825). Thirty-four (4%) had experienced violence in the past year. Domestic violence is three times less common in women over 50 years old. Ex-husbands (32%) and ex-boyfriends (29%) were the main perpetrators. Forty-eight percent women who had experienced physical violence also had forced sexual activity. Of the 15 presenting symptoms reported by the women, lower abdominal pain, dysmenorrhoea, dyspareunia, smear abnormalities, cancer worries and bowel symptoms were significantly more common complaints in the group who reported domestic violence. The women with domestic violence also had significantly more consultations; however, the duration of their symptoms was not significantly different. CONCLUSION The prevalence of domestic violence in a cohort of women who attended the gynaecology outpatient clinic in a North of England Hospital was 21%. Women who are subjected to domestic violence tend to have more consultations and are more likely to complain of certain symptoms.
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Affiliation(s)
- R John
- Women and Children's Hospital, Hull Royal Infirmary, UK
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Williams RE, Hartmann KE, Steege JF. Documenting the Current Definitions of Chronic Pelvic Pain: Implications for Research. Obstet Gynecol 2004; 103:686-91. [PMID: 15051560 DOI: 10.1097/01.aog.0000115513.92318.b7] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We examined chronic pelvic pain definitions used in published research, because the definition has direct implications for investigating causation and evaluating treatment. DATA SOURCES MEDLINE was searched for published articles in an Abridged Index Medicus journal from 1966 to 2001, restricted to humans, females, and English language. "Chronic pelvic pain" was used as a keyword. METHODS OF STUDY SELECTION We reviewed 101 abstracts of publications of chronic pelvic pain. Forty-three articles met the criteria of human, female, English language, chronic pelvic pain, and use of an experimental, cohort, case-control, or cross-sectional study design. TABULATION, INTEGRATION, AND RESULTS The following were not explicitly specified in the chronic pelvic pain definitions in these articles: duration of pain in 44%, restriction by pathology in 74%, location of pain in 93%, restriction by comorbidity in 95%, and additional inclusion/exclusion criteria in 65%. CONCLUSION We conclude that an explicit chronic pelvic pain definition is not used for research of this population. The use of a poor operational chronic pelvic pain research definition reduces the ability to investigate causation and improve treatment of this condition.
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Affiliation(s)
- Rachel E Williams
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Stenson K, Heimer G, Lundh C, Nordström ML, Saarinen H, Wenker A. Lifetime prevalence of sexual abuse in a Swedish pregnant population. Acta Obstet Gynecol Scand 2003; 82:529-36. [PMID: 12780423 DOI: 10.1034/j.1600-0412.2003.00111.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Our primary purpose was to determine the prevalence of sexual abuse in a non-selected pregnant population. We also endeavored to establish the age at which the abuse had occurred and the identity of the perpetrator and to analyze in sexually abused vis-à-vis non-abused women, various socio-economic and clinical variables. METHODS Over a period of 6 months, all women registered at antenatal clinics in Uppsala, Sweden, were questioned by their midwives regarding exposure to sexual abuse. Data from antenatal records were used to compare abused with non-abused women concerning socio-economic characteristics, previous ill health, reproductive history, pregnancy complications, and pregnancy outcome. Continuous variables were compared using the Student's t-test or the Mann-Whitney U-test and categorical variables using the chi-square test or Fisher's exact test. RESULTS Of 1038 women assessed, 84 (8.1%) reported that at some time in their life they had been forced to participate in or subjected to sexual activity against their will. In most cases the perpetrator was someone the woman knew. When compared with non-victims, those abused were more likely to report general health problems, especially gynecologic ill health and surgery, pulmonary disease/asthma, and/or psychiatric care. However, no differences were found regarding pregnancy outcome. CONCLUSIONS It was found that one pregnant woman in 12 had reported sexual abuse at some time in their life. To midwives and obstetricians who work closely both physically and emotionally with pregnant women, an awareness of the extent of the problem and of possible sequelae is essential.
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Affiliation(s)
- Kristina Stenson
- National Center for Battered and Raped Women, Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden.
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Peschers UM, Mont JD, Jundt K, Pfürtner M, Dugan E, Kindermann G. Prevalence of Sexual Abuse Among Women Seeking Gynecologic Care in Germany. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200301000-00021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gambone JC, Mittman BS, Munro MG, Scialli AR, Winkel CA. Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process. Fertil Steril 2002; 78:961-72. [PMID: 12413979 DOI: 10.1016/s0015-0282(02)04216-4] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop recommendations for the medical and surgical care of women who present with chronic pelvic pain (CPP) and are likely to have endometriosis as the underlying cause. DESIGN An expert panel comprised of practicing gynecologists from throughout the United States and experts in consensus guideline development was convened. After completion of a structured literature search and creation of draft algorithms by an executive committee, the expert panel of >50 practicing gynecologists met for a 2-day consensus conference during which the clinical recommendations and algorithms were reviewed, refined, and then ratified by unanimous or near-unanimous votes. PATIENT(S) Women presenting with CPP who are likely to have endometriosis as the underlying cause. MAIN OUTCOME MEASURE(S) None. CONCLUSION(S) Chronic pelvic pain frequently occurs secondary to nongynecologic conditions that must be considered in the evaluation of affected women. For women in whom endometriosis is the suspected cause of the pain, laparoscopic confirmation of the diagnosis is unnecessary, and a trial of medical therapy, including second-line therapies such as danazol, GnRH agonists, and progestins, is justified provided that there are no other indications for surgery such as the presence of a suspicious adnexal mass. When surgery is necessary, laparoscopic approaches seem to offer comparable clinical outcomes to those performed via laparotomy, but with reduced morbidity. The balance of evidence supports the use of adjuvant postoperative medical therapy after conservative surgery for CPP. There is some evidence that adjuvant presacral neurectomy adds benefit for midline pain, but currently, there is inadequate evidence to support the use of uterosacral nerve ablation or uterine suspension. Hysterectomy alone has undocumented value in the surgical management of women with endometriosis-associated CPP.
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Affiliation(s)
- Joseph C Gambone
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA.
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