Acute abdominal pain in women at an emergency department: predictors of chronicity.

BACKGROUND: Persistence of pain after acute abdominal pain has been encountered but predictors of chronicity are insufficiently known. AIMS: To assess the course of acute abdominal pain and to explore whether chronicity is predicted by baseline demographic and clinical variables. METHODS: A follow-up study was conducted on all consecutive women who had visited an emergency department of a secondary care teaching hospital for acute abdominal pain. After a mean of 2.3years 115 women (58%) completed questionnaires. RESULTS: At follow-up 34 women (30%) still suffered from abdominal pain complaints for more than 3months the past year. Low education level (Exp(B)=4.21, p=0.017) and having experienced abuse before the age of 16 (Exp(B)=3.14, p=0.016) were significantly and independently associated with chronicity. No other socio-demographic or clinical factors predicted the outcome. CONCLUSION: At a 2.3year follow-up period nearly one third of all women with acute abdominal pain still suffered from pain. Low education level and abuse at younger age showed to be risk factors for pain persistence.

Predictors of outcome in a cohort of women with chronic pelvic pain - a follow-up study.

BACKGROUND: Chronic pelvic pain (CPP) in women is a long-lasting condition. AIMS: To explore changes in pain intensity, adjustment to pain, pain appraisal and coping strategies as well as to evaluate whether baseline pain appraisals and coping strategies and their changes were associated with outcome in the long term. METHODS: A follow-up study was conducted on all consecutive women who had visited a CPP-team of a university hospital. After an average period of 3.2 years 64% of them (N=84) completed questionnaires at baseline and follow-up. RESULTS: A reduction in pain intensity (p<.001, d=.6), improvement in adjustment to pain (SF-36 Physical Component Summary (p<.001, d=.4) and depressive symptoms (p<.01, d=.2)), as well as a reduction in catastrophizing pain (p<.01, d=.4) and an increase in perceived pain control (p<.01, d=.3) were observed. Neither biographic nor clinical variables were related with these changes. Pain appraisal and coping strategies at baseline did not predict changes from baseline in pain intensity. However, baseline levels of perceived pain control correlated with a change in depressive symptoms (r=-.27, p<.05), also after adjustment for pain intensity at baseline (r=-.28, p<.05). Changes from baseline in levels of catastrophizing pain were associated with changes in pain intensity (r=.44, p<.01), SF-36 Physical Component Summary (r=-.34, p<.01) and depressive symptoms (r=.71, p<.01). CONCLUSION: At a 3 year follow-up, improvement in pain intensity in women with CPP was not associated with baseline pain appraisals and coping strategies. A reduction in catastrophizing was related to better outcome in the long term.

Request for operative reduction of the labia minora; a proposal for a practical guideline for gynecologists.

The increase in women's request for labia reduction surgery raises medical and ethical dilemmas for the gynecological surgeon. A bio-psycho-social approach is suggested; the problem is put forward from the perspective of the medical ethical principles and a practical guideline is proposed.

A cognitive-behavioral group program for women with vulvar vestibulitis syndrome (VVS): factors associated with treatment success.

The results of this prospective open clinical trial (N = 76) indicate that a cognitive-behavioral group program for women with vulvar vestibulitis syndrome (VVS) affects sexuality, pain control, vaginal muscle control, and vestibular pain and that these changes may mediate changes in pain during intercourse. Improvements in sexual functioning and vestibular pain during treatment seem to be particularly important factors in determining short and longer term treatment outcome. These findings are consistent with a cognitive-behavioral conceptualization of VVS.

The effect of hysterectomy on sexual functioning.

The effect of hysterectomy on sexual function is an issue of debate. There are reasons to believe that removal of the uterus can have adverse effects on female sexual functioning by disrupting the anatomical relations in the pelvis. In this article, we review the literature on the impact of hysterectomy (without oophorectomy and for benign conditions) on the sexual functioning of premenopausal women. There is evidence that women for whom there is a clinical indication for hysterectomy are often experiencing a decreased quality of life. After successful treatment of dysfunctional uterine bleeding, either by hysterectomy or uterus-saving alternatives, the majority of women report experiencing improved sexual functioning. Nonetheless, the research on the effect of hysterectomy on female sexual functioning is not conclusive. Prehysterectomy sexual functioning and psychosocial state are significant predictors for posthysterectomy sexual dysfunction and depression. A minority of women report developing sexual dysfunctions as a result of hysterectomy. The nature and extent of these dysfunctions have not been adequately investigated. Many investigations in this area are flawed by methodological imperfections. For example, qualitative changes in sexual functioning and changes in the physiology of sexual function often were not adequately addressed. In the future, researchers should include both objective measures of physiological functioning and use standardized and validated self-report questionnaires. A critical attitude towards the indications of hysterectomy remains mandatory.