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Resumen Antecedentes: En México los embarazos adolescentes son 77 por cada 1,000. De los nacimientos anuales, el 17% son de madres adolescentes, con casi 350,000. Objetivo: Explicar por qué las adolescentes se embarazan a pesar del conocimiento de métodos anticonceptivos. Métodos: Con un estudio exploratorio y observacional, se evaluaron a 300 adolescentes embarazadas de 15 a 19 años, que no tenían antecedentes de consumo de sustancias adictivas y cuyos embarazos no fueron resultado de una violación.. Se aplicó el cuestionario de funcionamiento familiar y una entrevista de los antecedentes sociodemográficos. Resultados: El inicio de vida sexual fue a los 12 años para el 1.7%, de las participantes, a los 13 para el 7.3%, a los 14 para el 18.7%, a los 15 para el 36%, a los 16 para el 19.3% y las restantes (17%) tuvieron un inicio a los 19 años. El 100% manifestó que conocía métodos anticonceptivos, incluyendo la píldora del día siguiente. Conclusiones: El embarazo a temprana edad viene acompañado de mitos sociales e individuales sobre el conocimiento de la sexualidad humana, la anticoncepción y la vida amorosa. El embarazo representa para las jóvenes tener un objeto de amor y obtener un lugar en el mundo y dentro sus familias.
Abstract Background: In Mexico, teenage pregnancy is 77 for every 1,000. In terms of annual births, 17% are from teenage mothers, which are almost 350,000. Objective: To explain why teenage girls get pregnant in spite of knowing about contraceptives. Method: An observational and exploratory study by which 300 pregnant teenage girls between 15 and 19 years old were evaluated, with no history of substance abuse and whose pregnancies were not the result of rape. A questionnaire on family dynamics and an interview about their sociodemographic background were applied. Results: The first sexual intercourse for 1.7% of the participants was at 12 years old; for 7.3%, at 13; for 18.7%, at 14; for 36%, at 15; for 19.3%, at 16, and for the remaining 17%, near 19 years old. All of them (100%) stated they knew about contraceptives, including the morning-after pill. Conclusions: Pregnancies at an early age come with individual and social myths about the knowledge of human sexuality, contraception, and love life. For these young women, a pregnancy represents an object of love and obtaining a place in the world and within their families.
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Marital problems have multiple causes. One factor leading to marital dissatisfaction is communication, both the inability to communicate in certain areas and the way in which communication is made. One hundred four Mexican couples who attend a reproductive health care institution in Mexico City took part in this study. The relationship between the amount and style of communication was studied in order to develop profiles with explanatory indicators. A study was carried out with two samples (men and women) that were classified in terms of marital satisfaction or dissatisfaction. Indicators related to marital satisfaction are talking about the marital relationship, discussing work (women and men), communicating about sexuality (women). Indicators of marital dissatisfaction are talking about children, having and perceiving a reserved and negative style of communication (men), having and perceiving a negative and violent style of communication (women).
Assuntos
Casamento/psicologia , Satisfação Pessoal , Autoimagem , Cônjuges/psicologia , Adulto , Comunicação , Feminino , Humanos , Relações Interpessoais , Masculino , México , Pessoa de Meia-IdadeRESUMO
Es conocido que en el terreno de la salud, el adecuado establecimiento de la relación médico-paciente favorece la intervención profesional oportuna, mejorando la evolución en el proceso de la enfermedad que da motivo al establecimiento de tal vínculo. Esta relación también ha cambiado, favoreciendo la participación activa del paciente en la toma de decisiones sobre su cuidado y salud, así como el compromiso ético en los profesionales de la salud con relación a la actualización de sus conocimientos, remarcando la importancia de la comunicación entre ambas partes. El paciente con cáncer y su familia cursan por un proceso peculiar, debido a la representación social y mental de esta enfermedad, así como por la toma de decisiones, y se hace evidente en ellos una especial vulnerabilidad durante el curso del padecimiento. El médico debe desarrollar su habilidad para la comunicación de malas noticias, asumiendo un rol ético, profesional y humanitario.
It is a well known fact in the health circle that establishing an adequate rapport with the patient facilitates timely interventions, which in turn can improve the course of the disease. The physician-patient relationship has evolved in order to favor an active participation of the patient in the decision-making process concerning his health and self-care, as well as promoting a more ethical commitment of the health professional through motivating knowledge updating and emphazising the importance of developing communication skills. Cancer patients and their families are particularly vulnerable, since they experience a difficult process due to the social and mental representations of cancer, and the tough decisions they have to make in relation to the disease. The health professional has to develop communication skills to deliver bad news from an ethical, professional and human point of view.
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A mediados de la pasada década se publicó un trabajo en el que se analizaba por qué, a pesar del desarrollo experimentado por la psicología y salud en México, en ese entonces se hadan evidentes dos problemas: la falta de reconocimiento profesional de la psicología y los psicólogos en los marcos normativos sobre la materia, por un lado, así como las dificultades que enfrentaban para su integración en los equipos interdisciplinarios de salud, por el otro. Casi una década después nos encontramos que en general la situación no ha cambiado de manera sustancial, lo que a final de cuentas se traduce en un ejercicio profesional que dista mucho de estar impactando positivamente al diseño, instrumentación y evaluación de programas de investigación e intervención en el seno mismo de las instituciones de salud. Con base en el sentido común y la experiencia de los autores, en este trabajo se discute sobre tres asuntos que consideramos pudieran ayudar a revertir dicha situación, en beneficio de la psicología y los psicólogos que se desempeñan en el ámbito de la salud.
In the middle of the last decade was published a work in which analyzed why, despite the development experienced by the psychology and health in Mexico, then became evident two problems: the lack of professional recognition of psychology and psychologists in the normative frameworks on the subject, on the one hand, as well as the difficulties faced by these for their integration into the interdisciplinary teams of health, on the other. Almost a decade later we find that overall the situation has not changed substantially, which ultimately translates into a professional practice that is far be positively impacting the design, implementation and evaluation of research and intervention programs in the context of health institutions. Based on common sense and the experience of the authors, in this work is discussed on three issues that we believe could help to reverse this situation, for the benefit of psychology and psychologists working in the health field.
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At the National Institute of Perinatology, a line of clinical psychological research is the study and treatment of patients with couple problems to generate strategies of intervention based on clinical research. Objective To identify risk indicators in a psychotherapy institutional group process. Material and method The qualitative-interpretative method was used. The sessions, in an open group form, were once a week during two hours. Attendance ranged between eight and 12 participants. 35 sessions were analyzed with the content analysis method. Results The mean age was 32.3 years for women and 35.1 for men. The information was systematized with the most significant stories. The indicators found in women were: impotence and trapping feelings, affective distancing from their couple, confusion of the origin of the relationship conflicts between external and/or internal origins, violent or confused communication, submissive or explosive character, resentment due to a perceived indifference from their couple, history of sexual abuse which difficults a satisfactory development of couple relationships, guilt, and resentment or anger feelings at their parents. The indicators in men were: trapping and impotence feelings due to the control exercised by their couples, violent behaviors on domestic environments, over-exigent and persecutory conducts, difficulty on the individuation process and unsolved conflicts with their primary figures which prevent a satisfactory relationship. Conclusions Marital problems deeply disturb the affective life of people and have familiar and social consequences. This paper is an incursion to understand a small part of the important facts regarding this universe, aiming to be more specific in the treatment plans for people suffering marital conflicts.
Una línea de investigación clínica de Psicología en el Instituto Nacional de Perinatología, es el estudio y atención a las pacientes con problema de pareja, para generar estrategias de intervención basadas en la investigación clínica. Objetivo Detectar indicadores de riesgo en un proceso de psicoterapia de grupo institucional. Material y método Se utilizó el método cualitativo-interpretativo. Las sesiones se llevan a cabo una vez a la semana, con dos horas de duración, en grupo abierto, con una fluctuación de entre ocho y 12 participantes. Se analizaron 35 sesiones con análisis de contenido. Resultados La edad promedio fue de 32.3 años para las mujeres y de 35.1 para los hombres, la sistematización de la información obtenida se realizó con las partes de los relatos más significativos. Algunos indicadores encontrados en las mujeres fueron: sensación de impotencia y atrapamiento, distanciamiento afectivo de su pareja, confusión al no ubicar si los conflictos en la relación son externos o internos, la comunicación es violenta o confusa, o son sumisas o son explosivas, hay resentimiento por percibir indiferencia de su pareja, hay relatos de abuso sexual que dificulta un desarrollo satisfactorio de la vida en pareja, culpa, resentimientos e ira hacia sus padres. En los hombres hay atrapamiento e impotencia por un control desmedido que ejerce su pareja hacia ellos, ejercen actos violentos en el ámbito doméstico, son muy exigentes y persecutorios, con dificultad en el proceso de individuación, conflictos no resueltos con sus figuras primarias, imposibilitan una relación satisfactoria. Conclusiones Los problemas maritales afectan profundamente la vida afectiva de las personas con consecuencias familiares y sociales. Este trabajo es una incursión para entender una pequeña parte de lo que incluye este universo y poder ser más específicos en los planes de tratamiento de las personas que sufren conflictos maritales.
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En el campo de la salud se sabe que la intervención oportuna conlleva un mejor resultado y pronóstico respecto de aquello que se atiende y la intervención a la salud mental no es una excepción. Por una parte, la psicología, dentro de las instituciones, centra su atención en pacientes que acuden a ella por encontrarse médicamente enfermos, o bien porque experimentan un proceso que debe ser médicamente atendido. Ambas circunstancias tienen un efecto en la esfera psíquica y emocional del individuo, cuya respuesta no puede ser considerada como psicopatológica por tratarse de una reacción esperada frente a los hechos que se enfrentan. Por otra parte, la especialización ha llevado a que la intervención concentre a diferentes disciplinas en la atención integral del paciente. La interdisciplinariedad tiene un efecto en la relación costo-beneficio dada la necesidad de establecer acciones que posibiliten la prevención de padecimientos mentales, así como la optimización de recursos mediante una derivación y atención selectiva de pacientes. Sin embargo, cuando se trata la salud mental el equipo de salud no siempre tiene bien delimitados los criterios de derivación para atención psicológica. Es por ello que en el presente escrito pretendemos describir algunas pautas que permitan al personal de salud tomar la decisión de solicitar apoyo al personal de psicología para la atención de los pacientes; en particular se harán algunas consideraciones hacia la paciente diabética que cursa con un embarazo de riesgo.
On the healthcare field it is well known that a timely intervention leads to better results and prognosis in regard of what is being taking care of and a timely intervention in the mental healthcare is no exception to such affirmation. Psychology inside the healthcare institutions focuses its attention towards patients because they are sick or they are undergoing a process that needs medical attention. It is clear that in both circumstances there is an effect in the emotional and psychic sphere of the person and specialization has led medical intervention to concentrate different disciplines for the comprehensive and integral care of the patient. The interdisciplinary has an effect in the relation between costs-benefits due to the importance of establishing actions tending to prevent mental disorder as to the optimization of the resources through the reference and selective attention of patients. Nevertheless, when we have an issue of metal health, the healthcare professionals don't always have well specified criteria for referring the patient to psychological treatment. If we recognize the necessity of referring the patient to a specialist, we can speed up and make easier the resolution of the patient's problem in the institution. This is why in the present document our intention is to describe certain guidelines to help the healthcare staff make the timely decision for referring the patient to the psychological staff for. We will emphasize towards the patient diagnosed with diabetes with a risky pregnancy.
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One target of psychology of health is the quest for specificity when detecting factors related to psychological disorders, among which there are female sexual dysfunctions showing associated pain: dyspareunia and vaginismus (not caused by medical disease). Dyspareunia is the presence of genital pain during sexual intercourse and is related to psychological or relational factors. Vaginismus is characterized by spasms in the muscles of the vaginal entrance, making it difficult or impossible to perform coitus; the woman can be sexually aroused, responsive and enjoying sexual games, she can even reach her orgasm, as long as there is no penetration. Of all the causes mentioned, the following are recognized: incapacity to let go to the erotic experience, fear to failure, cultural influence predisposing sexual conflict, anxiety and shame, as well as couple problems. However, specificity is lacking in the factors related to each one of these sexual dysfunctions in order to provide elements generating intervention strategies. Objective The objective is to detect new indicators with the purpose of having a better understanding of why an individual exercises sexuality in such a way that it makes her have a proper sexual response and why, in other situations, the sexual response shows alterations leading to dyspareunia or vaginismus. Four are the specific objectives: 1. Identification of current indicators that have an influence in sexual dysfunctions of the participants. 2. Identification of indicators that have had an influence in the unsatisfactory development of sexuality of the participants. 3. Identification of elements of perception of the participants in the couple life of their parents that may have had an impact on their sexuality. 4. Identification of indicators that, within the sexual management provided by the family, had an impact in the sexual life of the participants. Material and methods The qualitative-interpretative method was used, in the form of an exploratory case-study. The institution where the study took place was the Department of Psychology of the National Institute of Perinatology (INPerlER). The sample was constituted by three participants, all of them patients from the institution; they had to comply with certain inclusion criteria of the study. Any physical problem that could have caused the sexual dysfunction was discarded. The first participant did not show any sexual dysfunction (NSD), the second one showed dyspareunia (D) and the third one showed vaginismus (V). We used a semi-structured, focalized, in-depth interview. Interviews took place after having signed a letter of informed consent, accordingly to the ethical institutional requirements, and we also got an approval of recording the interview. We used the analysis of content with an empiric, exploratory orientation. Categories were organized accordingly with the specific objectives. Results The three participants were: NSD: 32 years old, five years of marriage. No sexual dysfunction. V: 36 years old, six years of marriage. Diagnosis: vaginismus. D: 33 years old, one year in free union. Diagnosis: dyspareunia. Data systematization was performed dividing the units of analysis by every participant and the parts of the most significative stories of every specific objective within its respective categories. In the analysis of categories we detected two conditions: internal and relational, as well as two types of indicators: risk indicators and protective indicators. What marked the difference was the dominium of the protective indicators overthe risk indicators in the NSD participant. Among the more important risk indicators, we found feelings of disadvantage, uselessness and devaluating feelings, linked to a tendency to submissive behavior, as a consequence of remote causes such as having faced a double moral in the family: on the one hand erotized family bonds during infancy and, on the other hand, prohibitions and stiffness towards any sexual curiosity or manifestation, apart from a poor socialization. The conflict between desire and sexual prohibition generates confusion in the identification of sensations, setting a painful, fearful association to sexuality, even moreso if this landscape is complicated with other elements such as violence and carelessness. Other elements found as a consequence of the aforementioned include self-inflicted violence, annulment of desire, lack of self-care and interacting problems with the opposite sex in everyday life. All of this leads to an incapacity of exerting a satisfactory sexual life, drifting towards secondary fears when feeling disadvantageous while interacting with the couple; this, in great extent, determines the conflicts, which maybe either a cause or a consequence of the sexual problem. Confusion also arises when trying to identify whether problems are internal or external, thence conductual responses tend to complicate the relationship. In both sexual dysfunctions we find a specific type of frustration, since desire, excitement and orgasm are present, but coitus cannot be performed in a satisfactory way. The following are the more important protective indicators: conductual assertive responses, clarity in the affections, situation of the problems, search for sexual information, openness to family communication and with the couple, a couple's differential place, plus the search of satisfaction of sexuality and self care. Among the indicators shared we found: limited or null sexual education, poor communication in the family nucleus, and gender stereotypes highly polarized between parents, among others. Conclusions We corroborate in this study that it is the combination of specific elements which contributes to the presence of these two sexual dysfunctions, since the psychological world has many intertwined streams, intervention models cannot be centered only in sexual techniques, but they should also consider the indicators related to such alterations. Finally, it must be pointed out that the results of this phase are the product of an exploratory study, opening the gates to new lines of research.
Una de las metas de la psicología de la salud es la búsqueda de especificidad en la detección de factores relacionados con los trastornos psicológicos, entre los que se encuentran las disfunciones sexuales femeninas por dolor: la dispareunia y el vaginismo (no debidas a enfermedad médica). La dispareunia es la presencia de dolor genital en la relación sexual. El vaginismo se caracteriza por espasmos de la musculatura de la entrada vaginal que dificultan o hacen imposible la realización del coito. Entre las causas se mencionan la incapacidad de abandonarse a la experiencia erótica, temor al fracaso, etc. Sin embargo, hace falta especificar los factores relacionados con éstas disfunciones sexuales para obtener elementos generadores de estrategias de intervención. Objetivo de la segunda fase Detectar indicadores para tener una mayor comprensión de por qué una mujer tiene un ejercicio de la sexualidad que la lleva a tener una respuesta sexual adecuada y por qué en otra la respuesta sexual presenta alteraciones que dan como resultado la presencia de dispareunia o vaginismo. Los objetivos específicos son cuatro: 1. Identificar indicadores actuales que influyen en la presencia de disfunciones sexuales de las participantes. 2. Identificar indicadores que hayan influido en el desarrollo insatisfactorio de la sexualidad de las participantes. 3. Identificar elementos de la percepción que tienen las participantes de la vida en pareja de sus padres, que pudieron impactar en su sexualidad. 4. Identificar procesos que dentro de la dinámica familiar impactaron la vida sexual de las participantes. Material y método Se utilizó el método cualitativo-interpretativo, estudio de casos y exploratorio. El escenario fue el Departamento de Psicología del Instituto Nacional de Perinatología (INPerlER), se entrevistó a tres participantes pacientes de éste. La primera sin disfunción sexual (SDS), la segunda con dispareunia (D) y, la tercera con vaginismo (V). Se utilizó la entrevista en profundidad semi-estructurada y se trabajó con análisis de contenido. Las categorías se organizaron de acuerdo a los objetivos específicos. Resultados La sistematización de los datos se realizó dividiendo las unidades de análisis por cada participante de cada objetivo específico. Se detectaron dos condiciones: las internas y las relaciónales, así como dos tipos de indicadores: los de riesgo y los protectores. Lo que marcó la diferencia fue el predominio de los indicadores protectores sobre los de riesgo en la participante SDS. Entre los indicadores de riesgo se encuentran sentimientos de desventaja, de inutilidad y devaluatorios, ligados a una tendencia a la sumisión; ello como consecuencia de causas remotas, como haber enfrentado una doble moral familiar. El conflicto entre deseo y prohibición sexual genera confusión, estableciéndose una asociación doloroso y llena de temores hacia la sexualidad. Otro elemento encontrado, consecuencia de lo anterior, es la violencia al propio cuerpo, la anulación del deseo, falta de autocuidado y problemas en la interacción con el sexo opuesto en su vida actual. De los indicadores protectores están las respuestas conductuales asertivas, la claridad de sus afectos, ubicación de los problemas, búsqueda de información sexual, apertura en la comunicación familiar y con la pareja, búsqueda de satisfacción de su sexualidad y autocuidado. Entre los indicadores que comparten se encuentra una limitada educación sexual, pobre comunicación en el núcleo familiar y estereotipos de género muy polarizados de los padres. Conclusiones Es la combinación de elementos específicos que se presentan de manera cotidiana los que implican un mayor riesgo para desarrollar estas disfunciones sexuales, los modelos de intervención no pueden únicamente centrarse en las técnicas sexuales y deben contemplar los indicadores relacionados con estas alteraciones. Cabe señalar que los resultados son producto de un estudio exploratorio que abre las puertas para nuevas líneas de investigación y de los cuales no se pueden hacer generalizaciones.
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Background At the Department of Psychology of the National Institute of Perinatology Isidro Espinosa de los Reyes (INPerIER) -a medical unit specialized in reproductive problems-, a line of investigation on human sexuality was opened due to the high numbers of patients with some kind of problem in their sexual lives. We have been performing exploratory studies where we have found a high prevalence of sexual disorders, i.e. 52% in women and 38.8% in men, in addition to other comparative studies. These studies revealed that people with disturbances in their sexual life were in a disadvantageous position when considering factors such as self-concept, assertivity, levels of anxiety, marital satisfaction, style of communication and marital communication, when compared to population not showing sexual problems. This brought us to the conclusion that the presentation of one or more sexual disorders is a risk factor that deserves exhaustive studies from the psychological point of view. Our studies, made in groups of men and women showing sexual disorders, lead to the need of studying risk factors related with every sexual disorder. We have a hypothesis that not all disorders show in a similar manner and that it is in the different combination of factors where the specificity to provide elements that can help improve intervention plans lies. Objective The general objective of this work was to identify the frequency, differences, relationships and combinations between the feminine sexual dysfunctions known as sexual pain disorders: dyspareunia and vaginismus, and some intervening variables. These were gender role and self-esteem (psychological factors) and background (child sexual traumatic experience, sexual information, sexual fears, masturbation and conjugal problems), in order to create a profile of each one of these sexual disorders so that it provides elements for intervention plans. Material and methods This was a non-experimental, transversal, retrospective field study with a correlational-multivariate design and an independent sample divided into three groups with individuals selected by intentional sampling according to pre-established quotas. This work belongs to a wider research study of some risk factors found in male and female sexual dysfunctions, whose original sample consisted of 400 participants; out of this group we selected only participants with dyspareunia and vaginismus and they were compared with the same number of participants who showed no sexual disorder. So, the sample classification remained as follows: Group 1, no sexual dysfunctions; group 2, with dyspareunia, and group 3 with vaginismus. Women participating are frequent attendees of the National Institute of Perinatology (INPerIER) and had to meet all the inclusion criteria. For the allocation into groups and the collection of sexual background data we used the codified clinical history for female sexuality (CCHFS). Measurement of personality factors was performed with the Masculinity and Femininity Inventory (MFI) and with Coppersmith's self-esteem inventory. A questionnaire on sexuality and the other instruments was provided and filled in one single session at the outpatient room. For the analysis of results, we used central tendency measurements to describe controlled socio-demographic factors such as age, civil status and schooling. The statistical analysis consisted on determining the frequency of the presence of sexual dysfunctions within the group of women with sexual dysfunctions, out of which we got the patients presenting dyspareunia and vaginismus for group allocation. Then we made an analysis to compare the groups. The first group was set to be the one with no dysfunctions, the second one with dyspareunia and the third one with vaginismus, in order to get the significative differences and the relationship between groups and personality factors under study (gender role and self-esteem); for these we used the t-Student test and ETA coefficient. For the analysis of sexual background (child sexual traumatic experience, sexual information, sexual fears, masturbation and conjugal problems) and their relationship with dysfunctions, we used X² and Cramer's V. Factors resulting related were used to perform a discriminant analysis so as to propose explanational profiles; all variables found to be related, psychological factors and sexual background were included in the analysis. Statistical data analysis was made with the software SPSS version 11. Results The description of the samples shows a normal distribution with an average for groups of age and schooling as follows: for group 1, age 31.9±5.32, years in school 10.9±3.17; for group 2, age 32.7±5.54, years in school 10.2±2.8; and for group 3, age 33.7±3.1, years in school, 9.9±2.5. From every statistical analysis variables were isolated and personality factors studied, indicating women with dyspareunia showed a decrease in masculinity features and in their levels of self-esteem, and an increase in submissive features, when compared to women with no sexual dysfunctions. As to the analysis of the results of sexual background, in the dyspaurenia group we found a relationship with conjugal problems, suggesting these variables have a significant intervention in the presence of dyspaurenia during women's adult life. The discriminant analysis launched a factor out of four variables, with 75.9% of the cases correctly classified, demonstrating that women with dyspaurenia within this percentage have related indicators, discriminating variables constituting an explanational approximation. Results of the group of women with vaginismus indicate a decrease in the self-esteem feature and an increase in the submissive features. Analysis of sexual background showed a relation between women with vaginismus and sexual fears, a decrease in sexual information and presence of conjugal problems. Described background data have a significant intervention in these women's adult life. The discriminant analysis launched a factor out of five variables, with 84.1% of the cases correctly classified, demonstrating that women with vaginismus within this percentage have these related indicators, discriminating variables constituting an explanational approximation. Conclusion The isolation of variables with the purpose of detecting the factors related to the presence of the two sexual disorders, dyspareunia and vaginismus, has as its main target to provide indicators of risk that facilitate the creation of intervention plans, in order to avoid making generalizations for the handling of sexual disorders.
Antecedentes En el Departamento de Psicología del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPerIER), se encontró una alta prevalencia de disfunciones sexuales: 52% en las mujeres y 38.8% en los hombres, además de que otros estudios comparativos indican que la población que presentó alteraciones en la vida sexual mostró siempre desventaja en factores como el autoconcepto, la asertividad, la satisfacción marital, el estilo de comunicación y la comunicación marital, en comparación con la población que no presenta problemas sexuales. Por esto es necesario estudiar factores de riesgo relacionados con cada una de las disfunciones sexuales, bajo la hipótesis de que no todas se comportan igual y es en la diferencia de la combinación de factores donde se encuentra la especificidad que puede aportar elementos que mejoren los planes de intervención. Objetivo Identificar la frecuencia, la diferencia, la relación y la combinación entre las disfunciones sexuales femeninas (dispareunia y vaginismo) el papel de género y la autoestima (factores psicológicos), y algunos antecedentes sexuales (experiencia sexual infantil traumática, información sexual, temores a la sexualidad, masturbación y problemas conyugales) para generar un perfil de cada una de estas disfunciones sexuales que aporten elementos para los planes de intervención. Material y método Estudio no experimental, de campo, retrospectivo, transversal, con un diseño correlacional-multivariado de una muestra independiente dividida en tres grupos, seleccionados mediante un muestreo intencional por cuota. Este trabajo forma parte de una investigación más amplia sobre el estudio de algunos factores de riesgo en las disfunciones sexuales femeninas y masculinas, cuya muestra original constó de 400 participantes. De éstos sólo se tomaron las participantes con dispareunia y vaginismo las que se compararon con el mismo número de participantes que no presentaron ninguna disfunción sexual. Las muestras quedaron clasificadas de la siguiente manera: Grupo 1: sin disfunciones sexuales, grupo 2: con dispareunia y grupo 3: con vaginismo. Las participantes asisten al INPerIER y debieron cubrir todos los criterios de inclusión. Para la clasificación de los grupos y de los antecedentes sexuales se utilizó la Historia Clínica Codificada de la Sexualidad Femenina (HCCSF). Se utilizó el Inventario de Masculinidad y Feminidad (IMAFE), y el Inventario de Autoestima de Coopersmith. Él análisis estadístico se realizó con la prueba t de Student, el coeficiente ETA, la X² y una V de Cramer. Finalmente se aplicó un análisis discriminante para proponer los perfiles explicativos. Se trabajó con el paquete estadístico SPSS versión 11. Resultados Se encontró una distribución normal. Los resultados indican que las mujeres con diapareunia presentan una disminución en las características de masculinidad y los niveles de autoestima y un incremento en las características de sumisión, así como relación con problemas conyugales. En el grupo de mujeres con vaginismo hay disminución en la autoestima, incremento en las características de sumisión, relación con temores a la sexualidad, con una pobre información sexual y problemas conyugales. En los demás factores no se encontró relación. Conclusiones El aislar variables para detectar factores relacionados con la presencia de estas dos disfunciones sexuales, tiene como objetivo final descubrir indicadores de riesgo que puedan facilitar los planes de intervención con una mayor especificidad y no hacer generalizaciones de manejo para todas las disfunciones.
RESUMO
The systematic study of sexuality is relatively recent if we consider the works of Freud and Kinsey and the studies performed during the first half of the XXth century. The fact of undertaking the sex problem has allowed an even deeper understanding of this phenomenon, by all means complex. Later on, Masters, Johnson and Kolodny created the model of human sexual response and its alterations. Kaplan's works as well as Labrador and Crespo's are directed to conceptualize the etiology of sexual dysfunctions as phenomena evolving from both recent and remote causes, i.e., they can be explained as multi-causal events. At the Department of Psychology of the National Institute of Perinatology (INPerIER), we have detected a high proportion of couples with problems in their sexual lives. The prevalence of sexual dysfunction found was 52% in women and 38.8% in men. Therefore, we decided to initiate a line of investigation on human sexuality, to which this work belongs. The aim was to identify the frequency, difference, relation and combination of three sexual dysfunctions: erectile dysfunction, male orgasmic disorder and precocious ejaculation, as well as some intervening factors that were divided in two types. a) Personality factors, including gender role: prescriptions, norms and expectations according to rules set by the society which are introjected by the individual. When the expression of masculinity and femininity polarizes reaching machisms and submissive behavior, this can result in a negative influence for the development of sexuality. Another personality factor is the level of self-esteem, which greatly determines the conduct of individuals and is defined as the personal judgment of value towards oneself; it is expressed in the form of attitudes of the individual towards himself. b) The existence of some sexual background such as the report of having suffered child traumatic experience of sexual abuse; availability of sex information; presence or absence of sex fears; masturbation during adolescence and absence or presence of conjugal problems. It must be said that the division of intervening factors into types allowed us to propose profiles for the indicators related with the presence of the aforementioned male sexual dysfunctions. These dysfunctions are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Material and methods This was a non-experimental, one-sample, retrospective, transversal, multivariate-correlational field study of independent observations, with samples allocated in two groups. Samples We got non-probabilistic samples from couples of patients recently accepted for service at the institution, according to pre-established quotas. Sample size consisted of 200 men, with 100 men showing no sexual dysfunction (group 1) and 100 men with evidence of sexual dysfunction (group 2). Results of erectile dysfunction, male orgasmic disorder and precocious ejaculation are presented here; they were compared with the same number of participants showing no sexual dysfunction. Participants were limited to individuals who met the following criteria: age range, 22 to 45 years old; elementary school as the minimum schooling; no history of mental illness or chronic disease that could condition the presence of male sexual dysfunctions. Socio-demographic factors controlled in this study included age, civil status and schooling; the classification variable was set to be the presence of male sexual dysfunctions. Instruments For the classification of groups, in order to detect the type of dysfunction present, and for the sake of capturing sexual background data, we used the male version of the questionnaire of sexuality, based on the codified clinical history for female sexuality. For the measurement of gender role, we used the Inventory of Masculinity-Femininity (IMAFE), which measures four orientations: male, female, machismo and submission. For the measurement of self-esteem we used Coopersmith Self-Esteem Inventory, and the validation technique suggested by Lara, Verduzco, Acevedo and Cortés. Participants were approached at the external consultation area at the INPerIER. Instruments described above were applied as well as clinical histories obtained in one single session, individually, once the participant had signed the informed consent letter required by the Committee of Ethics of the INPerIER. Results The most frequent dysfunction detected was precocious ejaculation, which was present in 48 participants. Thirty four men were reported with erectile dysfunction and 15 men showed male orgasmic disorders. In a previous article, we presented the results of hypoactive sexual disorder, the sexual dysfunction more frequently found (55 male participants reported it). In this case we observed that out of 100 participants studied, the overall number of dysfunctions found was 152, including hypoactive sexual disorder, which can be interpreted as one and a half dysfunctions per man. For the sake of establishing the relationship of each sexual dysfunction with personality factors, we estimated the ETA coefficient. In the case of the relation between sexual dysfunctions and sexual background we calculated Cramer's V. Once we established the relations between the personality factors and the background that were used to develop profiles, we performed a discriminant analysis, which included all variables we found related and we came out with the following results: For erectile dysfunction we found a relation with three variables: negative relation with femininity and self-esteem, and positive relation with conjugal problems. In the case of the male orgasmic disorder, we found a relation with five variables: negative relation with femininity and self-esteem, and positive relation with child sexual traumatic experience, masturbation and conjugal problems. In the case of precocious ejaculation, we detected a relation with four variables: negative relation with masculinity, femininity and self-esteem, and positive relation with conjugal problems. The relations that became evident in every dysfunction showed that in this proportion, the discriminant variables provided us with an approximate explanation. Discussion The frequency of sexual dysfunctions can be described as high. The analysis of the results made evident that two factors are always present in these sexual dysfunctions: a tendency to show low self-esteem and the presence of conjugal problems. Alongside the different dimensions of gender roles, there is a decrease of the masculinity features in the case of precocious ejaculation; the reduction of femininity features is found in the three dysfunctions under study. There is a tendency to inhibition of both the sexual expressions and the affective expressions (femininity features), which are found combined in the case of precocious ejaculation, combined as well with a decrease of the masculinity features. When it comes to the sexual background, we observed that the history of child sexual traumatic experience is a risk indicator for the orgasmic disorder, as well as the report of practicing masturbation during adolescence. We can infer from this that this can be due to the type of masturbation limited to a biological discharge and not to the exploration addressed to a self-knowledge of the body. Another indicator present only in the orgasmic disorder is the fear of sexuality. It can be observed that the sexual dysfunction that presents more indicators is the male orgasmic disorder. For what we explained here, it becomes relevant to develop integral intervention plans for the adequate exploration of indicators related to these dysfunctions.
El estudio sistematizado de la sexualidad es relativamente reciente y ha permitido una comprensión más profunda de este fenómeno, por demás complejo. Masters, Johnson y Kolodny generaron el modelo de la respuesta sexual humana y sus alteraciones, o sea, las disfunciones sexuales. Los trabajos de Kaplan y de Labrador y Crespo han conceptualizado la etiología de las disfunciones sexuales como fenómenos que se deben tanto a causas recientes como remotas. En el departamento de Psicología del Instituto Nacional de Perinatología (INPerIER), la prevalencia encontrada de disfunciones sexuales fue, en las mujeres, de 52%, y de 38.8% en los hombres, por lo que se generó una línea de investigación de sexualidad humana de la cual forma parte este estudio que tiene por objetivo identificar la frecuencia, la diferencia, la relación y la combinación entre tres disfunciones sexuales masculinas: el trastorno de la erección, el trastorno del orgasmo y la eyaculación precoz, y algunos factores intervinientes: a) factores de personalidad, como el papel de género y el nivel de autoestima y b) algunos antecedentes sexuales, como son el reporte de haber sufrido una experiencia sexual infantil traumática, el tener o no información sexual, la presencia o no de temores a la sexualidad, masturbación durante la adolescencia y el tener o no problemas conyugales, y así proponer perfiles de los indicadores relacionados con la presencia de estas disfunciones sexuales clasificadas en el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-IV-TR). Material y método Diseño correlacional-multivariado, de una muestra dividida en dos y de observaciones independientes, fue un estudio no experimental de campo, retrospectivo y transversal. Muestra Se capturó una muestra no probabilística de las parejas de las pacientes recién aceptadas en el INPerIER para su atención mediante un muestreo intencional por cuota. La muestra fue de 200 hombres, 100 sin disfunciones sexuales (grupo 1) y 100 con disfunciones sexuales (grupo 2) de los cuales se presentan los resultados del trastorno de la erección, trastorno orgásmico masculino y eyaculación precoz que se compararon con el mismo número de participantes que no tuvieron ninguna disfunción sexual. Los participantes debieron cubrir con los criterios de inclusión: edad de 22 a 45 años, educación mínima de primaria, sin diagnóstico previo de enfermedad mental o crónica que pudiera condicionar la presencia de disfunciones sexuales. Los factores sociodemográficos controlados fueron: edad, estado civil y escolaridad; la variable de clasificación fue la presencia de estas disfunciones sexuales masculinas. Instrumentos Para detectar el tipo de disfunción y la captura de los antecedentes, se utilizó el Cuestionario de la Sexualidad versión para Hombres. Para la medición del papel de género se utilizó el Inventario de Masculinidad-Feminidad IMAFE. Para medir la autoestima se utilizó el Inventario de Autoestima de Coopersmith, validación mexicana. Resultados La disfunción más frecuente fue la eyaculación precoz, reportada por 48 participantes, 34 reportaron trastorno de la erección y 15 trastorno del orgasmo. Las relaciones se realizaron con el coeficiente ETA y con la V de Cramer, además de un análisis discriminante. Se encontró en trastorno de la erección relación negativa con feminidad y autoestima y positiva con problemas conyugales. En trastorno del orgasmo, relación negativa con feminidad y autoestima y positiva con experiencia sexual infantil traumática, masturbación y problemas conyugales. En eyaculación precoz, relación negativa con masculinidad, feminidad y autoestima y positiva con problemas conyugales.
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At the Department of Psychology of the Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes' (INPERIER), a hospital specialized in reproductive problems, we have detected a high proportion of couples with sexual problems. Therefore we decided to develope a line of research on human sexuality. Ever since, several exploratory studies have taken place with the aim of assessing the prevalence and the frequency of sexual dysfunction in both women and men attending the INPERIER. Our studies showed that 52% of women had one or more sexual dysfunctions and 38.8% of men had one or more sexual dysfunctions. Objective The main purpose of the study was to identify (in women and men) the relationship and the combination between hypoactive sexual desire disorder and some intervening variables catalogued as personality factors: gender role, self-esteem and locus of control. We also analysed sexual backgrounds by indentifying: child sexual traumatic experience, sexual information available, sex fears, masturbation and couple problems; in order to propose a profile of the relationship between psychological factors and hypoactive sexual desire in women and men. Material and methods A non-experimental, retrospective, transversal, field study with a correlation-multivariate design was used, which consisted of two independent samples divided into four groups selected through intentional sampling by quotas. This study is part of a larger research study aimed to assess risk factors for feminine and masculine sexual dysfunctions, whose original sample size was 400 participants. Out of this sample only participants with hypoactive sexual desire were selected, so in the end the groups included 58 women and 55 men. However, they were compared with the same number of participants with no sexual dysfunction. The groups were organized as follows: Group 1, women or men with no sexual dysfunction; Group 2, women or men who presented hypoactive sexual desire disorder. The participants included in the study were INPERIER regular patients. Samples were handled individually. In order to have an accurate sample all participants had to cover the selection criteria. Additionally, in order to place participants in the right group we used the Codified Clinical History Form on Female Sexuality (CCHFFS) for women -which also was used to examine their sexual background information- and in the case of men, we used the Male Sexuality Questionnaire. Furthermore the measurement of personality items was done by using the Inventory of Masculinity and Femininity IMAFE, the Coppersmith Self-Esteem Inventory and the Internal-External Locus of Control Scales. Sexuality questionnaires as well as other measurement instruments were applied at the External Clinic area during a single session followed by the transcription of data. In order to analyse the results we applied measures of central tendency to describe the socio-demographic factors (such as: age, civil status and education); for the analysis of personality factors (role of gender, self-esteem and locus of control) and its relationship with hypoactive sexual desire disorder we used the Student's T-test and estimated the Eta coefficient. The analysis of sexual background (child sexual traumatic experience, sexual information, sex fears, masturbation and couple problems) and its relationship with hypoactive sexual desire disorder was calculated by χ² and Cramer's V. Data analysis was performed with the statistical and data management package SPSS version 11. Results The thrown results showed that the descriptive analysis of data from women and men had a normal distribution. Also, results indicate that women with a hypoactive sexual desire disorder present a decrease in masculinity features and in their self-esteem level, and an increase in the submissive features when compared to women with no sexual dysfunction. When we analyzed the results of the sexual background in this group, we found a relationship between hypoactive sexual desire and child sexual traumatic experience, and between sex fears and couple problems, suggesting that these variables significantly intervene in the presence of hypoactive sexual desire disorder during women's adult life. In the discriminant analysis we obtained just one factor out of the six previously isolated variables with 75% of the cases correctly classified, indicating that this proportion of women with hypoactive sexual desire disorder are related to such indicators, the variables discriminated were an approximate explanation for the disorder. The results in the other group showed that in men with hypoactive sexual desire disorder there is a decrease in masculinity and femininity features and in the levels of self-esteem, plus an increase in the submissive features when compared to men with no sexual dysfunction. When we analyzed sexual background information, we found in the group with hypoactive sexual desire disorder that sex fears and couple problems significantly intervene in men's adult life. The discriminant analysis revealed a single factor with the six variables previously isolated, with 68.6% of cases correctly classified, which shows that men with hypoactive sexual desire disorder also have a relationship with the indicators, being the discriminated variables an approximate explanation. Conclusions When we discussed the results, we observed differences in two ways. First, for both women and men there was a decrease in masculinity features, defined as conducts directed to action, with well-defined, self-affirmed and self-reflective targets. Also there was a decrease in self-esteem, defined as the personal value judgment expressed as the individual's attitudes towards himself and the subjective experience transmitted to others; when masculinity features and self-esteem are diminished they may have an impact on sexuality, becoming a risk factor. In the group of men we also observed a decrease in the femininity features, defined as the traits aimed at feelings and abstraction, the expression of affection, the desire to provide protection as well as to experience nature feelings. When these three factors predominate they turn out to be a protective factor for an adequate practice of sexuality; both masculinity and femininity features could appear together or independently. In a second way, both in women and men we observed an increase in the submissive behavior, a risk indicator for the development of sexuality, because of the presence of self-denial, dependency, conformism, shyness and the capacity to endure suffering, features all shown as particular conducts. When it comes to sexual background in women, we found a close relationship with child sexual traumatic experience, sex fears and couple problems. In the case of men, the hypoactive sexual desire disorder was related to sex fears and couple problems. In this respect, in the review made by Basson, she mentions a new body of evidence that confirms what we have found in this study. She indicates that there are psychological factors that inhibit sexuality in women, for example, a history of child sexual traumatic experience may have a major impact in their sexual development, particularly in desire.
En el Departamento de Psicología del Instituto Nacional de Perinatología <
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BACKGROUND: One difficulty that a woman with urinary incontinence faces up is quality and control of her sexual life, the more it is complicated the more it affects her in different ways. These complications require, as well as medical treatment, evaluation and special psychological intervention to integrally recovery. OBJECTIVE: To know frequency and origin of sexual disturbances in women with urinary incontinence. PATIENTS AND METHODS: Demographical, confirmatory, descriptive, transversal, retrospective with non-experimental design study. Seventy patients, ranging from 21 to 59-years-old, with diagnosis of urinary incontinence were selected. Three groups were conformed: Group 1, patients with sexual dysfunction before the manifestation of urinary incontinence; Group 2, patients with sexual dysfunction due to urinary incontinence, and Group 3, patients with no sexual problems neither before nor after the urinary incontinence problem. Codified Clinical History Form on Female Sexuality was used to classify patients; diagnosis was performed with the DSM-IV-TR. RESULTS: Forty-six percent of patients had sexual dysfunctions (mainly dysrythmia and orgasmic disorder), 37% showed sexual disorder associated with urinary incontinence (dyspaurenia and hypoactive sexual desire), and 17% had no sexual problems. CONCLUSIONS: As proper appraisal will define intervention strategies, patients with medical sexual problems must be evaluated by a psychology to establish diagnose and for adequate approach.
Assuntos
Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/terapia , Incontinência Urinária/complicações , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Disfunções Sexuais Fisiológicas/etiologia , Adulto JovemRESUMO
OBJECTIVE: To propose a short version of the Goldberg's General Health Questionnaire that can be applied as a screening test in non-specialized in mental health public institutions. PATIENTS AND METHODS: Women older than 18 years from Instituto Nacional de Perinatología consult. General Health Questionnaire application (30 items), during nine consecutive months. It was used the 7/8 cut-off point to differentiate between case and non-case patients. Descriptive, of factorial analysis, sensibility and specificity statistical process were used. An agreement analysis between versions was done, and the new version of 15 items was applied to an independent sample. With goodness-of-fit chi2 test, and to corroborate equality between both versions, proportions obtained were compared. RESULTS: With 15 items it was generated an instrument that demonstrates its utility to screen psychological uneasiness cases, with a sensitivity of 0.988, specificity of 0.828 and a Cronbach's alpha of 0.910. CONCLUSIONS: Short version of the General Health Questionnaire is a reliable instrument to timely identify psychological uneasiness in women, and to derive them to a mental health institution.
Assuntos
Doenças dos Genitais Femininos/psicologia , Complicações na Gravidez/psicologia , Inquéritos e Questionários , Adulto , Feminino , Doenças dos Genitais Femininos/complicações , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/etiologia , GravidezRESUMO
El objetivo del estudio fue valorar a pacientes con pérdidas perinatales remitidas y no al Departamento de Psicología, para determinar si es eficiente el proceso de derivación a la psicoterapia de grupo. Se hizo un estudio con 140 pacientes; 95 pasaron a psicoterapia y 45 no. La validez estadística se determinó con la prueba no paramétrica de Wilcoxon. Se aplicó el CGS de Goldberg, el IDARE de Spielberger y la EAMD de Zung. De las pacientes caso valoradas con el Idare Rasgo-Estado, 70 por ciento son derivadas a grupo terapéutico; con el CGS 80 por ciento y con la EAMD, 62 por ciento). Un poco más de la mitad de aquellas detectadas como no caso a través del EAMD, y el IDARE, entran a psicoterapia; con el CGS, casi 90 por ciento>. Los resultados muestran una alta eficiencia en la captura de pacientes con problemática emocional significativa, siendo un poco menor en la depresión.
The objective of the study was to evaluate patients with perinatal losses referred and not referred to the Psychology Department to determine the efficiency of the referral process to group psychotherapy. Lhe study was carried out with 140 patients; 95 were referred to psychotherapy, while 45 were not. Statistical validity was determined using Wilcoxon's Matched Pairs Lest. Lhe instruments assessed were Goldberg's General Health Questionnaire (GHQ), Spielberger's State Lrait Anxiety Inventory (SLAI), and Zung's Self-Rating Depression Scale (SRDS). Lhe analysis showed that from the case patients, 70 percent> of those evaluated with the SLAI were referred to group therapy, as were 80 percent> of those evaluated with the GHQ, and 62 percent> of those evaluated with the SRDS. Slightly more than half of those detected as non-case patients with the SRDS and the SLAI entered psychotherapy; as did 90 percent> of those evaluated with the GHQ. Lhe Results show a high efficiency in the referral of patients with significant emotional problems, although with slightly inferior results in the case of depression.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Aborto Habitual/psicologia , Encaminhamento e Consulta , Unidade Hospitalar de Psiquiatria , Inquéritos e Questionários , Depressão/psicologia , Estudos Retrospectivos , Estudos Transversais , Fatores Socioeconômicos , Perinatologia/métodos , Planos e Programas de Saúde , Testes Psicológicos , Psicoterapia de Grupo , Seleção de Pacientes , Sintomas Afetivos/psicologiaRESUMO
OBJECTIVE: To discriminate variables that could account for depression and anxiety in women with infertility. The independent variables were gender role, assertive behavior and self-esteem; the dependent variables were depression and anxiety. PATIENTS AND METHODS: The sample consisted of 240 women selected through a special program intended to choose patients based on infertility medical criteria. Five tests translated into Spanish language were administered: Masculinity and femininity questionnaire, Assertive behavior questionnaire, Self-esteem questionnaire, Depression self-assessment scale (ZUNG) and State-trait anxiety inventory. Intervening variables were obtained through discriminant analysis. Three explaining models were built with p = 0.005. RESULTS: For the psychologic variable of the self-esteem, the cut point marked by the instrument is 17 points (+/-5), so that, 75% (180) of the women had a normal self-esteem and 25% (60) obtained a low self-esteem score. As for the anxiety-feature, 60% (144) were normal and 40% (96) were over the cut point. For anxiety-state, 52.9% (127) were below the cut point and 47.1% (113) over. In depression, the last variable, 67.9% (163) of them were below and 32.1% (77) over the cut point. CONCLUSIONS: Patients showing low self-esteem will tend to show depression and anxiety symptoms chronically, no matter their disorder.
Assuntos
Ansiedade/psicologia , Depressão/psicologia , Infertilidade Feminina/psicologia , Adulto , Ansiedade/complicações , Depressão/complicações , Feminino , Identidade de Gênero , Humanos , Infertilidade Feminina/complicações , Escalas de Graduação Psiquiátrica , Autoimagem , Inquéritos e QuestionáriosRESUMO
Antecedentes: El embarazo y el puerperio son factores de riesgo para la aparición de psicopatología. El padecimiento de un trastorno mental pregestacional es un factor de alto riesgo perinatal que requiere atención psicológica. Objetivo: Presentar los resultados de un grupo de psicoterapia focalizada, breve y con objetivos específicos. Material y método: Se evaluó un grupo de 24 mujeres. Se obtuvo información sociodemográfica, obstétrica y neonatal. Las mujeres se manejaron en sesiones que fueron grupales. Resultados: El trastorno depresivo fue el diagnóstico más frecuente, seguido del trastorno bipolar, de ansiedad, personalidad y abuso de sustancias. Resalta el hecho de que nueve de las 24 pacientes padecían ideación suicida en el mes previo al embarazo y cinco de ellas, contaban con al menos un intento suicida. Durante el proceso de psicoterapia u hospitalización, no hubo intentos de suicidio y ninguna de las nueve mujeres con diagnóstico de depresión presentó depresión puerperal, sólo una presentó autolesiones. La psicoterapia grupal breve y el esquema mixto, fueron efectivos en el manejo sintomático de las pacientes.
Introduction: Pregnancy and postpartum are considered high risk factors for the development of psychopathologies. Suffering a mental disorder previous pregnancy constitutes a high risk perinatal factor, which requires psychological attention. Objective: Present the results of psychological attention group with focalized, brief and specific objectives. Results: The most common mental disorder within the sample was depression followed by bipolar, anxiety, personality and addiction respectively. It is important to mention that 9 out of the 24 patients had suicidal ideation the month previous to her pregnancy, 5 of them had at least one suicidal attempt. During the psychotherapy process or hospitalization, none of the patients in the sample, tried to commit suicide, neither the 9 patients with depression presented postpartum depression, only one patient of the whole sample presented self-harm. Brief group psychotherapy and combined treatment were effective to manage the symptoms of the patients.
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Objetivo: Identificar el origen de factores de riesgo como el rol de género y la asertividad en la evaluación de las disfunciones sexuales. Método: Se estudiaron pacientes de nuevo ingreso en el Instituto Nacional de Perinatología y se conformaron dos grupos: 100 sin disfunciones y 100 con disfunciones. Se llevó a cabo un estudio de población, descriptivo, transversal, en el que la muestra se seleccionó mediante un procedimiento de selección por cuota y de observaciones independientes. Se utilizó la Historia Clínica Codificada de Sexualidad Femenina,19 y para la clasificación de los grupos: el Inventario de Masculinidad-Feminidad15 y la Escala Multidimensional de Asertividad.16 Resultados: Se encontraron diferencias significativas en la dimensión masculinidad y asertividad en situaciones cotidianas con puntaje mayor en el grupo sin disfunciones sexuales; en las dimensiones de sumisión, asertividad indirecta y no asertividad en puntaje fue mayor en el grupo con disfunciones sexuales. Conclusiones: El rol de género de sumisión, la asertividad indirecta y la no asertividad están asociadas a la presencia de disfunciones sexuales femeninas, o sea, con un funcionamiento sexual insatisfactorio.
Objective: To appraise risk factors, gender role and asertivity, in order to evaluate sexual dysfunctions. Methods: From the first ingress patients, there were taken two groups: 100 patients without sexual dysfunction and 100 with sexual dysfunction. The study was retrospective, transversal descriptive study, not experimental comparative design. It was used the Codificated Female Sexual Clinical History, for classifying the groups, The Masculinity-Femininity Inventory and the Multidimetional Asertivity Scale. Results: There were found differences in masculinity dimension and asertivity in daily situations with greater score in group without sexual dysfunction; in submission, indirect asertivity and non- asertivity dimensions, the score was great in the group with sexual dysfunctions. Conclusions: Submission, indirect asertivity and not asertivity is associated to the presence of female sexual dysfunctions.
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Summary Sexual dysfunctions are a high frequency problem that should be studied because of its significance for individual health. For that reason, approaches to sexuality, sexual dysfunctions prevalence among women and men of a population sample in Mexico City, and the particular frequency of each dysfunction, will convey the possibility of suggesting more precise and focused treatment strategies, as well as the generation of ground lines for the investigation of the specific factors that could be related to them. Based on researches conducted by many pioneers who have approached the study of human sexuality, Masters and Johnson built up, for the first time during the 1960s, the human sexual response and its dysfunctions. Also, they hold the hypothesis that the way to understand human sexuality must relay on the study of the human sexual response cycle. This consists of five phases: sexual urge phase, excitement phase, plateau phase, orgasmic phase and resolution phase. Masters and Johnson needed to define those phases, so they described and delimited inherent sexual dysfunctions, which may not always be present -but could be- in human sexuality. In order to give a precise and correct diagnosis, researchers have to define and classify sexual dysfunctions. In this sense, Rubio defines them as "a group of syndromes in which the erotical processes of sexual response are undesirable for the individual or for the social group, and occurs persistently and recurrently". Researchers of the Department of Psychology at the National Institute of Perinatology (Instituto Nacional de Perinatología, INPer) in Mexico City, which is a third level institution (specialties hospital) dedicated to people with reproduction problems, realized that investigation about sexual problems will lead to a broad and objective panorama (not hypothetical) of factors like prevalence, types, and gender comparisons of sexual problems among Mexican population. Main objective. This research seeks to state the prevalence, percentage, frequency, and types of both male and female sexual dysfunctions, as well as the differences between them, in a sample of Mexican population living in Mexico City. The research also intends to analyze some variables related to the sexual life of the population under study: sexual information they have previously received, traumatic sexual experiences and childhood trauma. Method (material and procedures): Researchers used the Clinical Record of Feminine Sexuality (Historia Clínica de la Sexualidad Femenina) and the Questionnaire of Sexuality, Male Version (Cuestionario de Sexualidad, Versión Hombres), both validated for Mexican population. The type of study that researchers conducted was populational, screening, descriptive, longitudinal, and retrospective. The study was performed using a non-experimental design with two samples drawn from INPer (patients and others); one of the samples consisted of 384 female participants and the other consisted of 363 male individuals (non partners of the patients included in the sample). Each participant was included into one of two groups: Group 1 comprised individuals without dysfunction and Group 2 included participants with sexual dysfunction. This classification was made when individuals were accepted at the INPer as patients, and before they were included in any medical treatment or intervention. Sample size was representative of the number of individuals accepted as patients of INPer that year. Inclusion criteria for men and women consisted of a level of education at least of elementary school -so they could understand the questionnaires- having a sexual partner for a year or more, without previous diagnostic of mental retardation or psychosis, nor medical conditions like neurological or endocrine syndromes, cardiopathies, vascular problems or genital infections, that could influence or determine sexual dysfunctions. Patients were included in Group 1 (control group) without sexual dysfunctions, or in Group 2 (experimental group) with sexual dysfunctions, based upon the results of the Clinical records in women as well as in men, which is intended to determine presence or absence of sexual dysfunctions and the kind of dysfunction that each individual has. The questionnaire, besides classifying sexual dysfunction, explores sexual life. The 10 types of sexual dysfunctions are: 1. sexual urge disorder (hypoactive sexual desire), 2. aversion to sex disorder, 3. female arousal disorder, 4, male erectile dysfunction, 5. female orgasm disorder, 6. male orgasm disorder, premature ejaculation, pain associated with intercourse disorder (dyspareunia), 9. vaginism (defined and classified following the Diagnostic and Statistical Manual of Mental Disorders-Text Revised (DSM-IV-TR), and 10. dysrythmia (as stated by Alvarez-Gayou, persistent and recurrent inability to obtain satisfaction in one of the partners due to the difference in sexual urge for sexual activity frequency, when conditions are adequate and the problem is not related to physical problems). Results: Prevalence in women was 52%; in men it was 38.8%. Mean in women with sexual dysfunctions was 2.52 dysfunctions by patient; mean in men with sexual dysfunctions was 1.48 by patient. Dysrythmia was the most frequent dysfunction both, in males and females. Concerning variables related to sexual activity, childhood trauma for women, masturbation for men and information about sexuality for both men and women, were the main ones. Conclusion: Prevalence of sexual dysfunctions and frequency by patient in individuals attending the INPer is lower in men's population. Having an effective and sound information about sexuality is essential for sexuality development. Another important topic are traumatic sexual experiences that are more frequent in female population and are also associated with sexual dysfunctions; men are less jeopardized for that kind of experiences. Masturbation practice is related to the absence of sexual dysfunctions in men. On the other hand, that practice is not significant for women. Results of this research led us to change attention strategies; this will have a repercussion in the effective treatments and decreased periods of time to solve the problem. Regarding the possibility to generalize the results, research could be directed to determine prevalence in populations with no reproduction risk and then compare them with the population of the study; hypothetically, results would not have a significant variability given the control of variables.
RESUMO
Objetivo. Se busca la posible asociación existente entre disfunciones sexuales y el Indice de Masa Corporal (IMC) para el caso de mujeres no embarazadas y el peso Esperado para la Talla y la Edad Gestacional (P/t y EG) para el caso de mujeres embarazadas, en pacientes en edad reproductiva que asisten a consulta de esterilidad y control prenatal en el Instituto Nacional de Perinatología. Material y métodos. El presente es un estudio exploratorio conformado por 200 pacientes atendidas en este Instituto, divididas en dos grupos: 100 mujeres sin disfunción sexual y 100 mujeres con disfunción sexual. Ambos grupos con escolaridad mínima de primaria. Se utilizó la Historia Clínica Codificada de la Sexualidad Femenina y se calculó el IMC para pacientes embarazadas y no embarazadas. Se utilizó un procedimiento de diferencia de medias. Resultados. Del grupo 1 se encontraron 54 pacientes con obesidad y 46 sin obesidad; en el grupo 2 se encontraron 52 pacientes con obesidad y 48 sin obesidad. Del grupo 1 la edad promedio fue de 30 años, el motivo de ingreso al Instituto fue principalmente por embarazo de alto riesgo (54 pacientes) y predominó el grado 1 de obesidad (34 pacientes). En el grupo 2 la edad promedio fue de 29 años, el motivo de ingreso al Instituo fue principalmente por embarazo de alto riesgo (45 pacientes) y predominó el grado 1 de obesidad (28 pacientes). Conclusiones. En la comparación entre los grupos no se encontraron diferencias significativas entre el grupo sin disfunciones sexuales y el grupo con disfunciones sexuales con respecto al IMC. La obesidad no parece ser un factor que esté relacionado con la funcionalidad sexual del individuo. Pacientes con o sin obesidad pueden presentar o no, de forma semejante, disfunciones sexuales. Es importante crear nuevas areas de estudio con el fin de encontrar otros factores que se encuentren relacionados con las disfunciones sexuales
Assuntos
Humanos , Feminino , Obesidade/classificação , Orgasmo , Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Índice de Massa CorporalRESUMO
Objetivo. Determinar las diferencias en la satisfacción marital entre parejas fértiles y estériles, a fin de obtener datos objetivo sobre el impacto diferencial entre sus miembros. Material y método. El diseño de investigación fue ex-post-facto de dos muestras independientes. Se seleccionaron 60 parejas diagnósticadas con esterilidad primaria, de la clínica de esterilidad y fisiología de la reproducción del Instituto Nacional de Perinatología, la cual fue dividida en dos grupos: por factor femenino y por factor masculino. El instrumento utilizado fue la Escala de Satisfacción Marital de Pick y Andrade (1988). Resultados. Los resultados muestran diferencias estadísticamente significativas en las escalas de Satisfacción con la Interacción Conyugal y Satisfacción con los aspectos Estructurales del Cónyuge. Se encontraron también diferencias entre los promedios de la normatización original de la prueba y los promedios de la población de nuestra investigación, lo cual se puede explicar porque son muestras con problemática diferentes. Conclusiones. Los resultados del estudio nos muestran la complejidad de los fenómenos emocionales de la pareja ante un mismo evento reproductivo, en donde se entremezclan factores individuales de pareja y psicosociales. Esto nos permitió comparar a través del cruce de los resultados, el impacto sufrido en las diferentes áreas de la satisfacción marital tanto por las parejas como por cada uno de sus miembros
Assuntos
Humanos , Masculino , Feminino , Adulto , Escolaridade , Emoções , Infertilidade/psicologia , Comportamento Sexual , Parceiros Sexuais/psicologiaRESUMO
Objetivo. Determinar como se afectan los niveles de autoconcepto y satisfacción marital en mujeres con disfunción sexual. Material y métodos. La presente investigación de diseño ex-post facto, de dos grupos independientes. La muestra consistió en 300 mujeres seleccionadas por cuota que realizaban los trámites para ingresar al Instituto Nacional de Perinatología. Los instrumentos aplicados fueron: historia clínica codificada de la sexualidad femenina, escala de autoconcepto de Tenneessee y la escala de satisfacción marital. La muestra se dividió en dos grupos, el primero con 139 mujeres que no presentan disfunción sexual y un segundo grupo con 161 pacientes que presentan disfunción sexual. Resultados. La disfunción más frecuente fue la disritmia (42.4 por ciento). El total de disfunciones fue de 362, 60 mujeres refirieron una disfunción y en el otro extremo en dos casos se informaron siete diferentes alteraciones. La media del autoconcepto en las mujeres con disfunción fue de 355.61 mientras que en las mujeres sin disfunción la media correspondió a 334.09 con una diferencia estadísticamente significativa. En cuanto a la satisfacción marital se observó que las primeras obtuvieron un puntaje de 33.05 y las segundas 40.18 existiendo diferencias estadísticamente significativas entre los grupos. Conclusiones. Se encontró una elevada prevalencia de disfunciones sexuales en la población estudiada y llama la atención que en ningún caso fue motivo de consulta. Las evidencias encontradas indican que las disfunciones sexuales se encuentran estrechamente relacionadas con un bajo autoconcepto así como la disminución en la satisfacción marital