Dysmenorrhoea and Sterility: Personality Studies

Psychopathic Personality

The discussion of any topic is handicapped so long as there are doubts and disagreement as to what is being discussed.

The experience of dysmenorrhea and its relationship to personality variables

The aims of this study were: to relate women's subjective experience of primary dysmenorrhea to psychogenic needs assessed longitudinally at the age of 15 and at the age of 25 in a nonclinical sample; to compare the psychogenic needs of women with severe primary dysmenorrhea with those of other women who never have experienced dysmenorrhea; and to examine whether women with severe dysmenorrhea were less conventionally feminine than women who never have experienced dysmenorrhea. At 25 years, 42% of the women experienced dysmenorrhea and 15% experienced pain that limited their daily activity. Differences in psychogenic needs according to the Cesarec Marke Personality Schedule and in psychological masculinity and femininity according to the Attitude Interest Schedule were found in women with severe primary dysmenorrhea compared with women who never experienced dysmenorrhea. The results indicate that women with severe dysmenorrhea have less self-esteem at 15 years, but compensate for this at 25 years by being more achievement-oriented and aggressive than women who never experienced dysmenorrhea. Further, women with severe dysmenorrhea are more conventionally feminine than women who never have experienced dysmenorrhea.

Treatment of dysmenorrhoea and premenstrual syndrome with non-steroidal anti-inflammatory drugs

The menstrual cycle is associated with 2 potentially incapacitating events: dysmenorrhoea and premenstrual syndrome. Although substantial evidence has accumulated to indicate that excessive endometrial production of prostaglandin F2 alpha is the major underlying cause of painful menstruation, correspondingly little is currently known about the basic aetiology of the premenstrual syndrome. Non-steroidal anti-inflammatory drugs have been used to alleviate the discomfort of both entities, and while these agents have come to assume a primary role in the treatment of dysmenorrhoea, a body of evidence substantiating their efficacy in premenstrual syndrome has yet to be developed.

New concepts in dysmenorrhea

The etiology of primary dysmenorrhea, which is the most common gynecologic complaint and cause of lost working hours, remains obscure but merits careful scientific investigation. Recent studies suggest that increased endometrial prostaglandin production and release may be responsible for dysmenorrhea. Prostaglandins cause myometrial contractility that, if excessive, leads to uterine ischemia and pain. This hypothesis has led to clinical trials of antiprostaglandin agents such as indomethacin and fenamates, which inhibit the synthesis of prostaglandin through the prostaglandin synthetase system as well as antagonize their action at the cell receptor level. The good response of dysmenorrhea to other conventional forms of therapy such as oral contraceptives and dilatation of the cervix can be partly explained on the basis of a reduced level of prostaglandins in the menstrual fluid with such therapy. There is a definite need for further evaluation of the antiprostaglandin compounds in the treatment of dysmenorrhea so that sound formulations can be evolved for the elimination of this incapacitating disorder.

Fertility and psychiatric morbidity

This paper reviews the literature concerning the fertility of those with psychological illness. Conflicting views have been presented over the last hundred years, but more recent and better designed surveys show more consistent results. These demonstrate with reference to psychotics that schizophrenics, but not manic-depressives, have fewer children than control population groups. There is no consistent evidence yet that those with neurosis and personality disorder have reduced fertility, although there is a suggestion that infertile women are more likely to have a personality disturbance than fertile controls. Further well-controlled population surveys are needed in this neglected field.

MENSTRUATION AND PERSONALITY

This investigation is concerned with the prevalence of dysmenorrhoea and premenstrual symptoms in the general population and with their relationship to personality.

Many authors have expressed the opinion that such relationships exist, but we will confine our review here to those studies which have presented supporting data. Wittkower and Wilson (1940) studied 57 patients with primary dysmenorrhoea and found there was a history of childhood maladjustment four times as often in these patients as in a control group. They considered that patients with dysmenorrhoea could be classified into two main personality types: the first, “characterized by deep resentment of their feminine role”; the second, “obviously immature physically and either shy or shut-in or chronically anxious and complaintive”. Sainsbury (1960) observed a significantly raised neuroticism score on the Maudsley Personality Inventory for patients attending hospital for dysmenorrhoea. Such views as these are not universally held, and would certainly not be shared by many gynaecologists. Nor are they supported by the little evidence forthcoming from population studies.