ABSTRACT
Current follow-up strategy for women after large loop excision of the transformation zone (LLETZ) for cervical intra-epithelial neoplasia (CIN) is burdened by a low compliance. We evaluated the performance of home-based Human Papillomavirus (HPV) self-sampling (Self-HPV) after treatment for CIN with the aim to assess the (i) feasibility and (ii) follow-up compliance. This study took place at the Geneva University Hospitals between May 2016 and September 2020. Women aged 18 years or older, undergoing LLETZ for a biopsy-proven cervical intraepithelial neoplasia grade 1 or worse (CIN1 + ) were invited to participate. Agreement statistics, interpreted according to the scale of κ values, were calculated for Self-HPV and HPV performed by the physician (Dr-HPV). The samples were analyzed using GeneXpert and Cobas. Sample size was calculated to provide a 10% precision to estimate the kappa coefficient. A total of 127 women were included, with a median age of 35 years (interquartile range 30-41 years). There was a substantial agreement between Self-HPV and Dr-HPV using GeneXpert at 6 and 12 months, with a κ value of 0.63 (95%CI: 0.47-0.79) and 0.66 (95%CI: 0.50-0.82), respectively. Up to 9/10 (90%) women who did not come to their follow-up visit did not send their Self-HPV, either. In the follow-up after LLETZ treatment, home-based self-HPV is feasible, with substantial agreement between the two groups, however, concern remains regarding adherence to Self-HPV performance at home and loss to follow-up. The trial was registered on clinicaltrials.gov with the identifier NCT02780960.
ABSTRACT
Endometriosis can negatively affects many aspects of womens'life, including their sexuality. Deep or superficial dyspareunia is reported by nearly half of women with endometriosis. The pain has chronic inflammatory, neuropathic or muscular components. Repetition of painful experiences, but also treatments for endometriosis can lead to other sexual disorders such as lack of desire and arousal. We present a narrative review exploring the causes of sexual pain in endometriosis patients and how they could deteriorate quality of sexual life if unrecognized.
L'endométriose touche les femmes en âge de procréer et affecte de nombreux aspects de leur vie, notamment leur sexualité. Des dyspareunies profondes ou superficielles sont rapportées par près de la moitié des femmes souffrant de cette affection. Les douleurs ont pour origine notamment une réaction inflammatoire chronique au niveau des lésions et ont une composante neuropathique. La répétition d'expériences douloureuses, mais aussi les traitements de l'endométriose peuvent entraîner d'autres troubles sexuels tels que l'absence de désir et d'excitation. Nous présentons ici une revue narrative de la littérature explorant les causes de ces troubles et les mécanismes qui mènent à leur chronicisation.
Subject(s)
Dyspareunia/complications , Endometriosis/complications , Health Surveys , Female , Humans , Sexual BehaviorABSTRACT
Sexual dysfunctions, particularly sexual pain, are common in adult women of all ages. In patients with endometriosis, a chronic gynecological pain condition affecting women of reproductive age, sexual pain is the third most common symptom. Multiple biological factors are involved in endometriosis-related sexual pain including tissue damage, inflammation, hormonal changes, alterations within the peripheral and central nervous system and pelvic floor muscle dysfunctions. Conceptual models of sexual pain espouse a multifactorial view, with empirical evidence suggesting the implication of psychosexual and relationship difficulties in the development and persistence of sexual pain and associated distress. We review literature on the biological, psychological, sexual and interpersonal factors associated with development and persistence of sexual pain in women with endometriosis. In addition, we discuss chronic pain conditions frequently associated with endometriosis (vulvodynia, bladder pain syndrome and inflammatory bowel syndrome) and how they are linked with sexual pain. Finally we discuss the clinical implications and provided suggestions for future research and medical care, focusing on a multidisciplinary and biopsychosocial approach.
Subject(s)
Dyspareunia/etiology , Endometriosis/complications , Genital Diseases, Female/complications , Biomedical Research/trends , Dyspareunia/psychology , Female , Forecasting , HumansABSTRACT
Endometriosis-associated pelvic pain is a major health concern in women of childbearing age. Controlled studies have shown that endometriosis can adversely affect women and their partners' general psychological well-being, relationship adjustment and overall quality of life. Furthermore, women with endometriosis report significantly more sexual dysfunctions compared to healthy women. Empirical studies indicate that specific psychosocial factors may modulate pain experience, pain-related distress and treatment outcome. Research on psychosexual interventions in endometriosis treatment is limited but shows to be effective in reducing endometriosis-related pain and associated psychosexual outcomes. An individualized, couple-centered, multimodal approach to care, integrating psychosexual and medical management for endometriosis, is thought to be optimal.
Subject(s)
Endometriosis/psychology , Pelvic Pain/psychology , Sexual Dysfunction, Physiological/psychology , Comorbidity , Cost of Illness , Endometriosis/complications , Female , Humans , Pelvic Pain/etiology , Quality of Life , Sexual Dysfunction, Physiological/etiology , Sexual Partners/psychologyABSTRACT
Every day, 5 women are diagnosed with gynecological cancer in Switzerland. Prognosis of ovarian, endometrial and cervical cancer is dependent on early diagnosis. Cervical cancer mortality has decreased since the introduction of screening. Unfortunately, screening in ovarian and endometrial cancer has not shown the same results. On the contrary, patients screened for these cancers have an increased morbidity without any additional benefit of survival. This article presents a review of the clinical benefits and harms of gynecological cancer screening.
Parmi les femmes en Suisse, on découvre chaque jour cinq cas de cancer gynécologique. le diagnostic précoce d'un cancer du col de l'utérus, de l'endomètre et de l'ovaire est associé à un pronostic favorable. La réduction de la mortalité due au cancer du col de l'utérus est un exemple de l'effet, sur une population, d'une prévention par le dépistage. Par contre, malgré des recherches dans ce sens, il n'existe actuellement aucun test de dépistage du cancer de l'endomètre ou de l'ovaire permettant un tel impact. Au contraire, les effets négatifs dus à ces examens semblent être plus importants que leurs bénéfices. Cet article présente un résumé des bénéfices et dommages du dépistage des cancers gynécologiques.
