What does a young girl experience in her first gynecological examination? Study on the relationship between anxiety and pain.

STUDY OBJECTIVE: The purpose of the two-part study was to determine how the initial gynecological examination was experienced, examining the relationship between anxiety and pain. DESIGN AND PARTICIPANTS: A total of 669 patients who had attended the special gynecological outpatient clinic for female children and adolescents, and 800 female pupils of either high schools (H) or vocational schools (V), were retrospectively asked to complete a standardized questionnaire (30 questions). The statistical instruments used were Chi-square test, loglinear models, and Spearman correlation coefficients. RESULTS: A total of 169 completed questionnaires could be evaluated in the case of children who attended the special outpatient clinic and 210 in the case of the pupils. (1) There was a significantly positive correlation between anxiety and pain; however, the sex of the examiner had no influence on how the examination was experienced. The accompanying persons underestimated the anxiety of the patients prior to the examination and overestimated the pain experienced. (2) Loglinear models showed that there is no relationship between the type of school attended and the pain score, a significant relationship between the type of school and the anxiety (P <.01), and a significant relationship between the anxiety and pain score irrespective of the type of school attended. CONCLUSIONS: The studies showed a surprisingly high frequency of pain, anxiety, and their correlation during the initial gynecological examination. Further studies of influencing factors and interventions are needed.

[Chronic pelvic pain and chronic vulvodynia as multifactorial psychosomatic disease syndromes: results of a psychometric and clinical study taking into account musculoskeletal diseases]. / Chronische Unterbauchschmerzen und chronische Vulvodynie als multifaktorielle psychosomatische Krankheitsbilder: Ergebnisse einer psychometrischen und klinischen Studie unter besonderer Berücksichtigung der muskuloskeletalen Erkrankungen.

OBJECTIVE: Chronic Pelvic Pain Syndrome (CPPS) and vulvodynia (CVPS) are two gynecological syndromes with psychosomatic implications. The purpose of the study was to examine multifactorial psychosomatic syndromes taking into account musculoskeletal diseases. PATIENTS AND METHODS: The psychosomatic data acquired in respect of 106 CPPS and 36 CVPS patients was evaluated. In addition, these patients were subject to orthopedic clinical examinations and the results compared with a control group without pain (n = 35). 68 CPPS and 24 CVPS patients took part in psychological tests, the results of which were compared with those of a control group of healthy women (n = 34). RESULTS: There was a significantly higher incidence of sexual abuse among the CPPS group. Sexual abuse and somatization were found to be significantly predictive factors. The CPPS and CVPS patients were significantly more depressive than the healthy group. The two clinical groups differ in that the CPP syndrome is significantly more frequently linked with a so-called early disturbance. The incidence of musculoskeletal diseases was higher in the case of the CPPS patients. CONCLUSIONS: Interdisciplinary psychosomatic treatment, which also includes nongynecological disorders, especially musculoskeletal diseases, is necessary in the case of both these syndromes.

Chronic pelvic pain syndrome (CPPS) and chronic vulvar pain syndrome (CVPS): evaluation of psychosomatic aspects.

The purpose of our study was to examine the chronic pelvic pain syndrome (CPPS) and the chronic vulvar pain syndrome (CVPS) as two psychosomatic gynecological syndromes. Sociodemographic data were collected from 106 CPPS and 36 CVPS in-patients (under internal and external supervision). Sixty-eight CPPS and 24 CVPS patients were examined using psychological tests (Freiburg Personality Inventory (FBI) and Giessen Test (GT)) and compared with a control group of 34 healthy women. Descriptive statistics, the chi-square test, multi-variant analyses, and regression analyses were used for statistical evaluation. There was a significantly higher incidence of sexual abuse and severe psychological disturbances in the CPPS group (p < 0.03). Sexual abuse was found to be a significant predictor of the CPP syndrome. The CPPS and CVPS patients were significantly more depressed than the control group (p < 0.03). CPPS and CVPS are two distinct psychosomatic gynecological syndromes accompanied by different psychological disturbances.

Psychosomatic aspects of vulvodynia. Comparison with the chronic pelvic pain syndrome.

OBJECTIVE: To examine psychosomatic aspects of vulvodynia (VD) in comparison with the chronic pelvic pain syndrome (CPPS). STUDY DESIGN: Sixty-seven VD patients and 97 CPPS patients were examined with psychological tests (Freiburg Personality Inventory, Giessen Test) and compared with a control group of 34 healthy women. Sociodemographic data and psychoanalytic diagnoses were collected for 36 VD patients and 106 CPPS patients (inpatients). Descriptive statistics, chi 2 test and multivariant analyses were used. RESULTS: CPPS patients had significantly higher somatization than VD patients (P < .004). Both CPPS and VD patients, as inpatients, were significantly more depressive than the control group. In milder forms of VD, the patients (outpatients) exhibited no depression. The incidences of sexual abuse and severe psychological disturbances were significantly higher in the CPPS group (P < .01). CONCLUSION: VD and CPPS are two, distinct psychosomatic gynecologic syndromes and indicate psychosomatically oriented therapy.

Psychosomatic aspects of urinary incontinence.

Psychosomatic aspects of urogynecological disorders may play an important role in their clinical presentation. 72 patients presenting to the urogynecological clinics and a control group of 34 healthy women were included in this study. After informed consent had been obtained, all patients were subjected to (1) a detailed enquiry about personal- and medical history (2) psychological tests (Freiburg's personality inventory, a questionnaire focused on anxiety and anger, and Beck's depression inventory) and (3) routine urodynamic measurement. Patients with stress incontinence had a mean duration of symptoms of 59 months. In 67% there was a combination with clinical urge symptoms. 53% of the patients did not have regular sexual intercourse. Of those who had regular intercourse 23% had incontinence during intercourse and 25% were anorgasmic. 59% of the patients had dysmenorrhea and a negative attitude to their menarche. Urodynamic evaluation showed stress, urge or no incontinence in 39%, 12% and 39%, respectively. Analysis of the psychosomatic tests did not show a specific psychosomatic influence. Negative sexual life correlated with depressive mood, which was not based on the urogynecological problem. There was no causal relationship between personality traits and urogynecological problems. The individual perception of incontinence, however, may depend on or influence personality structure.

[Not Available]. / Qualitativ-inhaltsanalytische Studie zu pychosomatischen Aspekten der Endometriose/ Qualitative Research on Psychosomatic Aspects of Endometriosis.

Endometriosis is one of the most frequent gynecological disorders in the reproductive age. Discrepancies between clinical findings and subjective Symptoms cause the question of the determing factors for the subjective experience. In the present study an hermeneutic, sense-orientated approach was employed by using qualitative methods of research. Eleven interviews with endometriosis patients were recorded on tape and transcribed, followed by an individual-case and a comparative analysis in partly deductively and inductively defined categories. The psychosexual development has been found as negatively influenced. Endometriosis patients show conflicting concepts of their sex-specific role. A found aggression conflict manifests itself in the pain Sensation, at an intrapsychic land an interpersonnel level: it influences the relations with other persons, in particular, the doctor-patient relationship. Changes of sense in the doctor-patient-relationship and recent concepts of psychosomatic disorders are discussed.

[Pruritus as a psychic phenomenon (author's transl)]. / Juckreiz als mentales Phänomen.

Pruritus is a psychosomatic phenomenon which may be triggered physically and has psychic consequences. Pruritus may, however, also be triggered psychically and have a physical substrate as a consequence. The present study attempts to contribute to the understanding of the psychic origin of itching. Itching is considered as an affect and an analogy with behaviour patterns from the animal kingdom is pointed out. If the doctor perceives his patient's affects he can by interpretation help the patient to perceive unconscious affects and thus to recognize the cause of the itch. The symptom may then disappear.

[Psychosomatics of acne]. / Psychosomatik der Akne.

Psychopathology occurs much more frequently in cases of persisting than in juvenile acne. Moreover, a neurotic personality structure is much more common in cases of persisting than juvenile acne. When a neurotic structure is present, the juvenile acne patient maladjusts to the acne and develops neurotic symptoms. Such psychological consequences represent further stress and cause exacerbations, thus transforming the juvenile into persisting acne. The increased psychopathology in persisting acne is thus both a result as well as a partial cause. It is a link in a vicious circle. The typical pathological patterns of reaction in acne are described.

[Psychological and physical reactions following cosmetic breast surgery]. / Psychische und körperliche Reaktionen nach kosmetischen Brustoperationen

Women with only minor anatomical deviations may request plastic surgery in an attempt to compensate a feeling of inadequacy or humiliation. Psychological evaluation may be warranted to preclude a number of possible sequels: feeling of cold, shivering and shaking, lasting for days, with or without conjunctivitis and rhinitis vasomotorica; hypochondriacal and paranoid tendencies, mistrustfulness and misunderstandings in regard to the doctor. The doctor's assent to the operation and performing of the operation may increase the feeling of humiliation instead of alleviating it.