My Catastrophizing and Your Catastrophizing: Dyadic Associations of Pain Catastrophizing and the Physical, Psychological, and Relational Well-being of Persons With Endometriosis and Their Partners.

OBJECTIVES: Endometriosis, a painful chronic gynecologic condition, contributes to disruptions in multiple areas of life for both those affected and their partner. Pain catastrophizing has been associated with worse pain outcomes and quality of life for women with endometriosis and with more cognitive load for partners. Examining both partners' pain catastrophizing dyadically with our variables of interest will enhance understanding of its associations with the distressing nature of experiencing and responding to pain during sex for couples with endometriosis. METHODS: Persons with endometriosis experiencing pain during sex and their partners (n=52 couples; 104 individuals) completed online self-report measures of pain catastrophizing, depressive symptoms, sexual satisfaction, and partner responses to pain. Persons with endometriosis reported on pain during sexual activity. Analyses were guided by the Actor-Partner Interdependence Model. RESULTS: Persons with endometriosis' pain catastrophizing was associated with their higher pain intensity and unpleasantness during sex. When persons with endometriosis reported more pain catastrophizing, they were less sexually satisfied and reported their partners responded more negatively to their pain. When partners reported higher catastrophizing, they were more depressed and responded more negatively to the pain. DISCUSSION: Consistent with the Communal Coping Model of pain catastrophizing, although meant to elicit support from the environment, the often-deleterious cognitive process of magnifying, ruminating, and feeling helpless about one's pain (or one's partner's pain) is associated with poorer outcomes for the individual with pain and their romantic partner. Implications for pain management include the relevance of involving the partner and attending to the pain cognitions of both members of the couple.

"Just relax": physicians' experiences with women who are difficult or impossible to examine gynecologically.

INTRODUCTION: The internal pelvic exam is a critical component of women's reproductive health care; however, it can be perceived as uncomfortable, embarrassing, and painful, which may lead some women to avoid this procedure. AIMS: The purpose of this study was to survey physicians with respect to their experiences with female patients who are difficult or impossible to examine gynecologically. METHODS: Six hundred and fifty-eight obstetrician-gynecologist and family physicians were sent a 15-item questionnaire by mail and 424 participants responded (64% response rate). The survey consisted of questions pertaining to demographic variables, professional training and practice information, the frequency with which they encounter female patients who are difficult or impossible to examine, and the strategies employed with and beliefs surrounding such patients. MAIN OUTCOME MEASURES: The main outcome measures were the frequency of patients who are difficult or impossible to examine, strategies used to manage such patients, and beliefs as to why these patients are difficult or impossible to examine. RESULTS: The results, based on a final sample size of 401, indicated that most respondents have had some experience with patients who are difficult or impossible to examine. In such cases, most physicians (87%) reported attempting to address their patients' lack of relaxation. The majority of physicians in this study believed that a previous negative experience with (87%), and heightened anxiety about (79%), the exam were to blame. Twelve percent of respondents specifically reported that a previous history of sexual abuse was an important factor. CONCLUSIONS: This study reinforces the importance of being aware of patient discomfort during pelvic exams and of developing strategies that fit the individual patient and her needs. Future research should examine women's perceptions of their reproductive care, particularly correlates of pain and anxiety during pelvic exams, prevalence of negative experiences, and doctor-patient interactions in this context.

The Relationship Between the Sexual Self and the Experience of Pregnancy.

Studies reveal that prenatal health-care providers and educators often refrain from discussing sexuality with their patients. The present study explored the relationship between sexuality and pregnancy by considering whether the way in which women view themselves sexually is associated with their experience of pregnancy. Findings revealed that a positive sexual self was significantly related to a positive experience of pregnancy and that particular experiences of pregnancy were more significantly related to how women viewed themselves sexually than others. The findings encourage further discussion regarding the role that comprehensive sex education and training of prenatal health-care providers might play in ultimately establishing open, honest, and nonjudgmental discussions about sexuality between providers and their pregnant patients and partners.

Sexual orientation identification of men who have sex with men in public settings in Canada.

The present study attempts to determine how men who have sex with men (MSM) identify in terms of their sexual orientation. The sexual identity of MSM has important implications for the spread of HIV. The literature suggests that gay or bisexual identifying MSM are more likely to practice safer sex than heterosexually-identified MSM. A significant number of the MSM in public settings, such as parks, are believed to be heterosexual identifying. MSM in bathhouses are presumed to be gay or bisexual identifying. Parks have been the focus of safer sex outreach efforts targeted towards heterosexually-identified MSM. Sexual orientation self-identification was ascertained from park and bathhouse users via one-on-one interactions with outreach workers from 1996 to 1998. Chi-square analysis revealed no significant difference in the expressed sexual orientation of bath and park users, with both populations consisting mostly of gay-identified men. Heterosexually-identified MSM are not found in significant numbers in public settings. The current micro educational approach used to target these men may not be cost-effective. Alternative strategies are discussed.