Sexual function of women with infertility / Função sexual de mulheres com infertilidade

Abstract Objective To assess the sexual function, anxiety, and depression of infertile women relative to a control group. Methods Infertile women (infertile group, IG) of reproductive age were invited to participate in this controlled study. A control group (CG) of women was recruited from the general population of the same city. Sexual function was assessed by the Female Sexual Function Index (FSFI), and anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). Results A total of 280 women participated in the present study, 140 in the IG and 140 in the CG. The analysis of the FSFI scores showed that 47 women (33.57%) in the IG and 49 women (35%) in the CG had sexual dysfunction (FSFI ≤ 26.55; p = 0.90). Women with anxiety or depression had a greater risk of sexual dysfunction, and sexual dysfunction increased the risk of anxiety and depression. Married women had a lower risk of depression than single women who were living with their partners. Conclusion Infertilewomenhadno increased riskof sexual dysfunction relativetocontrols. Anxiety and depression increased the risk of sexual dysfunction in the studied population.

Resumo Objetivo Avaliar a função sexual, ansiedade e depressão de mulheres inférteis em relação a um grupo controle. Métodos Mulheres inférteis (grupo infértil, GI) em idade reprodutiva foram convidadas a participar deste estudo. Um grupo controle (GC) de mulheres foi recrutado da população geral da mesma cidade. A função sexual foi avaliada pelo Índice de Função Sexual Feminina (FSFI, na sigla eminglês), e ansiedade e depressão foram medidas pela Escala Hospitalar de Ansiedade e Depressão (HADS, na sigla em inglês). Resultados Um total de 280 mulheres participaram deste estudo, sendo 140 no GI e 140 no GC. A análise dos escores do FSFI mostrou que 47 mulheres (33,57%) no GI e 49 mulheres (35%) no GC apresentaram disfunção sexual (FSFI≤ 26,55; p = 0,90). Mulheres com ansiedade ou depressão tiveram um risco maior de disfunção sexual e a disfunção sexual aumentava o risco de ansiedade e depressão. Asmulheres casadas tiveram um risco menor de depressão do que as mulheres amasiadas. Conclusão As mulheres inférteis não apresentaram risco aumentado de disfunção sexual em relação aos controles. Ansiedade e depressão aumentaram o risco de disfunção sexual na população estudada.

Sexual Function of Women with Infertility.

OBJECTIVE: To assess the sexual function, anxiety, and depression of infertile women relative to a control group. METHODS: Infertile women (infertile group, IG) of reproductive age were invited to participate in this controlled study. A control group (CG) of women was recruited from the general population of the same city. Sexual function was assessed by the Female Sexual Function Index (FSFI), and anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS: A total of 280 women participated in the present study, 140 in the IG and 140 in the CG. The analysis of the FSFI scores showed that 47 women (33.57%) in the IG and 49 women (35%) in the CG had sexual dysfunction (FSFI ≤ 26.55; p = 0.90). Women with anxiety or depression had a greater risk of sexual dysfunction, and sexual dysfunction increased the risk of anxiety and depression. Married women had a lower risk of depression than single women who were living with their partners. CONCLUSION: Infertile women had no increased risk of sexual dysfunction relative to controls. Anxiety and depression increased the risk of sexual dysfunction in the studied population.

OBJETIVO: Avaliar a função sexual, ansiedade e depressão de mulheres inférteis em relação a um grupo controle. MéTODOS: Mulheres inférteis (grupo infértil, GI) em idade reprodutiva foram convidadas a participar deste estudo. Um grupo controle (GC) de mulheres foi recrutado da população geral da mesma cidade. A função sexual foi avaliada pelo Índice de Função Sexual Feminina (FSFI, na sigla em inglês), e ansiedade e depressão foram medidas pela Escala Hospitalar de Ansiedade e Depressão (HADS, na sigla em inglês). RESULTADOS: Um total de 280 mulheres participaram deste estudo, sendo 140 no GI e 140 no GC. A análise dos escores do FSFI mostrou que 47 mulheres (33,57%) no GI e 49 mulheres (35%) no GC apresentaram disfunção sexual (FSFI ≤ 26,55; p = 0,90). Mulheres com ansiedade ou depressão tiveram um risco maior de disfunção sexual e a disfunção sexual aumentava o risco de ansiedade e depressão. As mulheres casadas tiveram um risco menor de depressão do que as mulheres amasiadas. CONCLUSãO: As mulheres inférteis não apresentaram risco aumentado de disfunção sexual em relação aos controles. Ansiedade e depressão aumentaram o risco de disfunção sexual na população estudada.

History of childhood maltreatment and symptoms of anxiety and depression in women with chronic pelvic pain.

OBJECTIVE: To determine the prevalence of physical, sexual and emotional abuse and physical and emotional neglect suffered by women with chronic pelvic pain (CPP) during childhood and whether these occurrences are associated with symptoms of pain, anxiety and depression. METHODS: A case-control study was conducted on 154 women older than 18 years, 77 of them healthy and 77 with CPP. A history of sexual, physical, and emotional abuse and physical and emotional neglect was determined using the Childhood Trauma Questionnaire (CTQ). Anxiety and depression symptoms were determined using the Hospital Anxiety and Depression (HAD) scale. Pain intensity was determined using a visual analog scale (VAS). The quantitative variables were compared by the Wilcoxon test, and the qualitative variables were compared by the Chi-square test or exact Fisher test when appropriate. Correlation between the CTQ, HAD and VAS scores was estimated by the Spearman's p coefficient. Independent association of the variables with the presence of CPP was determined by logistic multiple regression analysis. RESULTS: The prevalence of childhood maltreatment was 77.9% and 64.9%, respectively, for women with CPP and healthy women (p = 0.07). Emotional neglect was more frequent among women with CPP than among healthy women (58.4% versus 41.5%, p = 0.04). There was a moderate correlation between anxiety and depression symptoms and CTQ scores for women with CPP. Unemployment (OR = 4.15, 95% CI 1.73-9.94; ORadj = 3.30, 95% CI 1.26-8.55) was independently associated with the presence of CPP. CONCLUSIONS: Women with CPP reported emotional neglect abuse more frequently than healthy women. There was a direct correlation between maltreatment scores and anxiety and depression scores. On the other hand, CPP was independently associated only with unemployment.

Clinical Characteristics in a Sample of Transsexual People / Características clínicas de uma amostra de pessoas transexuais

Abstract Purpose To assess the clinical characteristics of subjects with gender dysphoria (GD). Method A cross-sectional study of adults with GD. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Sociodemographic data, clinical data and life habits were recorded. Results Total of 44 subjects participated in the study: 36 (82%) trans women and 8 (18%) trans men. Forty-three (98%) of the GD patients had anxiety (36 [100%] trans women and 7 [87.5%] trans men), and 36 (82%) had depression (29 [80.5%] trans women and 7 [87.5%] trans men). Suicide had been attempted by 32 (73%) subjects. The rates of depression were lower among the subjects living with partners, parents, or other people than among those living alone (p = 0.03), and it was also lower among the subjects who were married compared to those who were dating or single (p = 0.03). Conclusion Improving the relationship status may reduce the prevalence of depressive symptoms in GD patients. There was a high rate of attempted suicide in this sample.

Resumo Objetivo Avaliar as características clínicas de indivíduos com disforia de gênero (DG). Método Estudo transversal com pessoas transexuais. Os sintomas de ansiedade e depressão foram medidos usando a Escala Hospitalar de Ansiedade e Depressão. Os dados sociodemográficos, os dados clínicos, e os hábitos de vida foram registrados por meio de um questionário. Resultados Um total de 44 indivíduos participou do estudo: 36 (82%)mulheres trans, e 8 (18%) homens trans. Quarenta e três (98%) destes apresentaram ansiedade, sendo 36 (100%) mulheres trans e 7 (87,5%) homens trans, e 36 (82%) apresentaram depressão, sendo 29 (80,5%) mulheres trans, e 7 (87,5%) homens trans. Um total de 32 (73%) indivíduos já haviam tentado suicídio. Os indivíduos que vivem comparceiros, pais ou outras pessoas tiveramuma menor taxa de depressão do que aqueles que vivem sozinhos (p = 0,03), e os indivíduos que eram casados tiveram uma menor taxa de depressão do que aqueles que estavam namorando ou solteiros (p = 0,03). Conclusão A melhoria do status de relacionamento pode reduzir a prevalência de sintomas depressivos empessoas transexuais. Encontrou-se uma alta taxa de tentativas de suicídio nessa amostra.

The Preference of Women and Men Regarding Female Genital Depilation / A preferência de mulheres e homens em relação à depilação genital feminina

Abstract Purpose To evaluate the preferences of women and men regarding female pubic hair depilation and identify possible reasons for these preferences. Methods This is a cross-sectional study of men and women over 18 years old who were invited by the official blog of our institution to respond anonymously to an online and self-administered questionnairemade by the researchers. The analyses weremade using the Statistical Analysis System (SAS, SAS Inc., Cary, NC, US) software, version 9.3, and contingency tables were used to verify the distribution of variables. The univariate statistical analysis was performed using the Pearson chi-squared test, and the differences for values of p < 0.05 were considered significant. Results We obtained data from 69,920 subjects (52,787 women and 17,133 men). Themean age was 31.9 years formen, and 28.5 years for women. Most women (64.3%) and men (62.2%) preferred complete removal of female pubic hair, and this preference wasmore pronounced in younger women andmen. Most women reported performing depilation at home (55.8%), with 44.4% using hot wax and 40.1% using a razor blade. About half of the women (44.7%) and men (50.1%) reported sexual activity, having intercourse 2 to 3 times per week. The frequency of intercourse and sexual satisfaction in women correlated with total pubic hair removal. Conclusion Most Brazilian women and men prefer the complete removal of female pubic hair, especially those who are younger andmore sexually active.Women who are satisfied with the appearance of their own genitalia have a stronger preference for complete removal of pubic hair.

Resumo Objetivos Avaliar a preferência de mulheres e homens emrelação à depilação genital feminina, e identificar possíveis razões envolvidas nessa preferência. Método Estudo transversal em que homens e mulheres com mais de 18 anos foram convidados por meio do blog oficial de nossa instituição a responder anonimamente a um formulário on-line e autoadministrado de autoria dos pesquisadores. As análises foram realizadas no programa Statistical Analysis System (SAS, SAS Inc., Cary, Carolina do Norte, EUA), versão 9.3, e tabelas de contingência foram construídas para verificar a distribuição entre as variáveis. A análise estatística univariada foi realizada com o teste qui-quadrado de Pearson, e foram consideradas significativas as diferenças para p < 0,05. Resultados Foram obtidos dados de 69.920 indivíduos (52.787 mulheres e 17.133 homens). A idade média dos indivíduos foi de 31,9 anos entre os homens, e de 28,5 entre as mulheres. A maioria das mulheres (64,3%) e dos homens (62,2%) preferiram a genitália feminina completamente depilada, e essa preferência foi mais pronunciada em mulheres e homens mais jovens. A maioria das mulheres afirmaram se depilar em casa (55,8%), e 44,4% delas usam cera quente, e 40,1% utilizam lâmina de barbear. Quase metade das mulheres (44,7%) e metade dos homens (50,1%) alegaram ter frequência sexual de 2 a 3 vezes por semana. A frequência sexual das mulheres e a satisfação com sua própria genitália foram positivamente relacionadas com a preferência pela remoção total dos pelos pubianos. Conclusões A maioria das mulheres e dos homens brasileiros preferem a remoção completa dos pelos genitais femininos, o que é ainda mais pronunciado nos indivíduos mais jovens e sexualmente ativos. As mulheres satisfeitas com a aparência de sua própria genitália tendem a preferir a remoção completa dos pelos pubianos.

[Not Available].

Objetivo Avaliar as características clínicas de indivíduos com disforia de gênero (DG). Método Estudo transversal com pessoas transexuais. Os sintomas de ansiedade e depressão foram medidos usando a Escala Hospitalar de Ansiedade e Depressão. Os dados sociodemográficos, os dados clínicos, e os hábitos de vida foram registrados por meio de um questionário. Resultados Um total de 44 indivíduos participou do estudo: 36 (82%) mulheres trans, e 8 (18%) homens trans. Quarenta e três (98%) destes apresentaram ansiedade, sendo 36 (100%) mulheres trans e 7 (87,5%) homens trans, e 36 (82%) apresentaram depressão, sendo 29 (80,5%) mulheres trans, e 7 (87,5%) homens trans. Um total de 32 (73%) indivíduos já haviam tentado suicídio. Os indivíduos que vivem com parceiros, pais ou outras pessoas tiveram uma menor taxa de depressão do que aqueles que vivem sozinhos (p = 0,03), e os indivíduos que eram casados tiveram uma menor taxa de depressão do que aqueles que estavam namorando ou solteiros (p = 0,03). Conclusão A melhoria do status de relacionamento pode reduzir a prevalência de sintomas depressivos em pessoas transexuais. Encontrou-se uma alta taxa de tentativas de suicídio nessa amostra.

The Preference of Women and Men Regarding Female Genital Depilation.

Purpose To evaluate the preferences of women and men regarding female pubic hair depilation and identify possible reasons for these preferences. Methods This is a cross-sectional study of men and women over 18 years old who were invited by the official blog of our institution to respond anonymously to an online and self-administered questionnaire made by the researchers. The analyses were made using the Statistical Analysis System (SAS, SAS Inc., Cary, NC, US) software, version 9.3, and contingency tables were used to verify the distribution of variables. The univariate statistical analysis was performed using the Pearson chi-squared test, and the differences for values of p < 0.05 were considered significant. Results We obtained data from 69,920 subjects (52,787 women and 17,133 men). The mean age was 31.9 years for men, and 28.5 years for women. Most women (64.3%) and men (62.2%) preferred complete removal of female pubic hair, and this preference was more pronounced in younger women and men. Most women reported performing depilation at home (55.8%), with 44.4% using hot wax and 40.1% using a razor blade. About half of the women (44.7%) and men (50.1%) reported sexual activity, having intercourse 2 to 3 times per week. The frequency of intercourse and sexual satisfaction in women correlated with total pubic hair removal. Conclusion Most Brazilian women and men prefer the complete removal of female pubic hair, especially those who are younger and more sexually active. Women who are satisfied with the appearance of their own genitalia have a stronger preference for complete removal of pubic hair.

Objetivos Avaliar a preferência de mulheres e homens em relação à depilação genital feminina, e identificar possíveis razões envolvidas nessa preferência. Método Estudo transversal em que homens e mulheres com mais de 18 anos foram convidados por meio do blog oficial de nossa instituição a responder anonimamente a um formulário on-line e autoadministrado de autoria dos pesquisadores. As análises foram realizadas no programa Statistical Analysis System (SAS, SAS Inc., Cary, Carolina do Norte, EUA), versão 9.3, e tabelas de contingência foram construídas para verificar a distribuição entre as variáveis. A análise estatística univariada foi realizada com o teste qui-quadrado de Pearson, e foram consideradas significativas as diferenças para p < 0,05. Resultados Foram obtidos dados de 69.920 indivíduos (52.787 mulheres e 17.133 homens). A idade média dos indivíduos foi de 31,9 anos entre os homens, e de 28,5 entre as mulheres. A maioria das mulheres (64,3%) e dos homens (62,2%) preferiram a genitália feminina completamente depilada, e essa preferência foi mais pronunciada em mulheres e homens mais jovens. A maioria das mulheres afirmaram se depilar em casa (55,8%), e 44,4% delas usam cera quente, e 40,1% utilizam lâmina de barbear. Quase metade das mulheres (44,7%) e metade dos homens (50,1%) alegaram ter frequência sexual de 2 a 3 vezes por semana. A frequência sexual das mulheres e a satisfação com sua própria genitália foram positivamente relacionadas com a preferência pela remoção total dos pelos pubianos. Conclusões A maioria das mulheres e dos homens brasileiros preferem a remoção completa dos pelos genitais femininos, o que é ainda mais pronunciado nos indivíduos mais jovens e sexualmente ativos. As mulheres satisfeitas com a aparência de sua própria genitália tendem a preferir a remoção completa dos pelos pubianos.

Quality of Life in Women With Breast Cancer Treated With or Without Chemotherapy.

BACKGROUND: The diagnosis and treatment of breast cancer may negatively affect the quality of life (QOL) of women. OBJECTIVES: The aim of this study is to assess QOL in women with breast cancer who were treated with or without chemotherapy and to identify factors associated with improved or worsening QOL in these women. METHODS: This cross-sectional study enrolled 112 women who were treated with chemotherapy (CTX group, with 85 [75.9%] women) or without chemotherapy (non-CTX group, with 27 [24.1%] women) for breast cancer. The Short-Form Health Survey (SF-36) assessed QOL and the Hospital Anxiety and Depression scale assessed anxiety and depression. RESULTS: The overall mean SF-36 score was below 50 in all domains. Relative to CTX women, non-CTX women were significantly older (P = .001) and more likely to engage in physical exercise (P = .002). The non-CTX group had higher scores in the Physical Functioning (P = .001) and Role-Physical (P = .0009) domains of the SF-36 relative to the CTX group, and the fluoruracil + epirubicin + cyclophosphamide group had significantly lower scores in the SF-36 domains Physical Functioning (P = .009) and Role-Physical (P = .02). CONCLUSION: Chemotherapy treatment for breast cancer worsens QOL in the Physical Functioning and the Role-Physical domains of the SF-36 relative to women treated without chemotherapy. IMPLICATIONS FOR PRACTICE: Nurses should assess Physical Functioning and the Role-Physical before treatment, as a woman who was not physically active before breast cancer is not likely to become physically active after treatment. Establishing support groups and providing educational sessions about the disease and its management, supportive care can improve the QOL of this population.

Sexual function of women practicing sex in nonconventional settings.

The quality of sexual intercourse in the context of conjugal visits by women to their jailed partners is unknown. This study aimed to assess the quality of the sex lives and psychological conditions of women attending conjugal visits with their jailed inmate partners. This controlled study involved 124 women between the ages of 18 to 40 years who engaged in sexual relations with their inmate partners (conjugal visit group) or with their partners at home (control group). Sexual function was assessed using a semi-structured questionnaire and the Female Sexual Function Index, and psychological parameters were evaluated using the Hospital Anxiety and Depression scale. The total Female Sexual Function Index scores was similar in the 2 groups. The percentage of women reporting good quality of the relationship was significantly higher in the conjugal visit group. Also, the Hospital Anxiety and Depression scale scores were higher in the conjugal visit group. Depression was a risk factor for sexual dysfunction and had a negative effect on scores in the desire, excitement, lubrication, and sexual satisfaction domains, whereas anxiety was associated with lower sexual desire scores. A regular + poor quality of the relationship and being religious were factors associated with sexual dysfunction. Sexual practices in jail were not a risk for sexual dysfunction in this sample.

Women's poorer satisfaction with their sex lives following gynecologic cancer treatment.

Gynecologic cancer treatment can lead to anatomical changes in the genitalia that may impair sexual response. As a result, the authors aimed to assess women's self-perceptions of their sex lives following gynecologic cancer treatment and the impact of such treatment on sexual function. Thirty sexually active women were examined. At the first meeting with a physician sex therapist, women were asked about their satisfaction with their sexual activities prior to and after gynecologic cancer treatment, either with a partner or alone, and how many times per month they had sexual intercourse prior to the cancer diagnosis and after treatment. Women reported significantly worse sex lives and a significantly lower frequency of sexual relations following cancer treatment. All participants reported pain on vaginal penetration and feeling uncomfortable in discussing their sexual difficulties with the oncologist. The findings show that women experienced impaired sexual function, as well as poorer quality of sexual function, following gynecologic cancer treatment. Nurses should provide basic guidelines about sexual function to all patients who undergo treatment for gynecologic cancer.

Chronic pelvic pain: multifactorial influences.

RATIONALE: Chronic pelvic pain (CPP) is a common and complex disease whose cause is often clinically inexplicable, with diagnosis and treatment being more difficult. From a clinical viewpoint, CPP is defined as non-cyclic, non-menstrual pain lasting at least 6 months and sufficiently severe to interfere with habitual activities and requiring clinical or surgical treatment. Thus, CPP is a syndrome resulting from a complex interaction of the nervous, musculoskeletal and endocrine systems and also influenced by psychological and sociocultural factors. CPP is influenced by emotional aspects with an impact on quality of life, and involving high costs for health services. Its aetiology is not always clear and a cure or significant improvement of symptoms is not always obtained with the treatments employed, with constant frustration of the professionals involved. It can be seen that its treatment is often unsatisfactory, simply providing temporary relief of symptoms. METHODS: In the present study, we reviewed the bibliography regarding pelvic pain, with emphasis on emotional aspects and on the importance of a multidimensional approach to the care for these patients. RESULTS AND CONCLUSIONS: New investigations are needed to clarify these relations and interventions in a more effective manner. Interdisciplinary care can minimize the impact of the disease, helping the patients to cope with symptoms and improving their quality of life.

Sexual dysfunction treatment in a patient with müllerian agenesy submitted to neovaginoplasty: a case report.

Vagina agenesis is a rare entity. Mayer-Rokitansky-Kuster-Hauser syndrome is the most significant cause of vagina agenesis, whereas the second most common cause is complete androgen syndrome. Surgical treatment can propitiate a vaginal reconstruction, but sexual function depends on several factors that affect sexual performance. Many reports focus on the intraoperative and postoperative results and only describe the global approach to these patients, but reports focusing on the management of these patients to enable them to have a normal sexual life are lacking. This case report highlights a multidisciplinary treatment for this kind of morbidity and emphasizes the necessity of incorporating careful attention to sexual health in the treatment of these patients so that they may achieve a good therapeutic response, resulting in a pleasurable sexual life and a good quality of living.

Caracterização clínica e psicossocial da clientela de um ambulatório de esterilidade / Clinical and psychosocial characterization of sterility clinic outpatientsclinic outpatients

Este estudo teve como objetivo descrever características demográficas, clínicas e psicossociais da clientela de um ambulatório de esterilidade e identificar motivação para atendimento psicológico. Tratou-se de estudo retrospectivo, com 50 casais, entrevistados no início do processo de investigação médica. Constatou-se que 80 por cento dos casais estavam na primeira união conjugal, 64 por cento tinham até oito anos de casados, 72 por cento não tinham filhos e 78 por cento vinham tentando engravidar há no máximo seis anos. Desconheciam as causas da infertilidade 36 por cento dos casais, e 78 por cento nunca haviam se submetido a procedimentos de reprodução assistida. Demonstraram interesse em participar de grupo de apoio psicológico 94 por cento dos casais. Referências a medo de abortamento, malformação fetal e parto foram estatisticamente superiores aos medos relacionados à gravidez, procedimento de Reprodução Assistida e responsabilidades com o filho. Esses dados revelam variáveis importantes para a elaboração de intervenções fundamentadas no conhecimento da realidade dos pacientes.(AU)

The objective of this study was to describe the demographic, clinical and psychosocial characteristics of Sterility Clinic outpatients and to identify motivation for psychological care. It is a retrospective study, conducted using 50 couples, interviewed at the beginning of the medical inquiry process. Eighty percent of the couples were in their first marriage, 64 percent had been married for up to 8 years, 72 percent had no children and 78 percent had been trying to conceive for up to 6 years. The causes of infertility were unknown in thirty-six percent of the couples and 78 percent had never being subjected to Assisted Reproduction procedures. Ninety-four percent of the couples showed an interest in participating in a psychological support group. The fear of abortion, fetal malformation and delivery was statistically more frequent than fears related to pregnancy, Assisted Reproduction procedures and the responsibilities of parenthood. These data reveal significant variables for the development of interventions based on the knowledge of patients' circumstances.(AU)

Caracterização clínica e psicossocial da clientela de um ambulatório de esterilidade / Clinical and psychosocial characterization of sterility clinic outpatients

Este estudo teve como objetivo descrever características demográficas, clínicas e psicossociais da clientela de um ambulatório de esterilidade e identificar motivação para atendimento psicológico. Tratou-se de estudo retrospectivo, com 50 casais, entrevistados no início do processo de investigação médica. Constatou-se que 80 por cento dos casais estavam na primeira união conjugal, 64 por cento tinham até oito anos de casados, 72 por cento não tinham filhos e 78 por cento vinham tentando engravidar há no máximo seis anos. Desconheciam as causas da infertilidade 36 por cento dos casais, e 78 por cento nunca haviam se submetido a procedimentos de reprodução assistida. Demonstraram interesse em participar de grupo de apoio psicológico 94 por cento dos casais. Referências a medo de abortamento, malformação fetal e parto foram estatisticamente superiores aos medos relacionados à gravidez, procedimento de Reprodução Assistida e responsabilidades com o filho. Esses dados revelam variáveis importantes para a elaboração de intervenções fundamentadas no conhecimento da realidade dos pacientes.

The objective of this study was to describe the demographic, clinical and psychosocial characteristics of Sterility Clinic outpatients and to identify motivation for psychological care. It is a retrospective study, conducted using 50 couples, interviewed at the beginning of the medical inquiry process. Eighty percent of the couples were in their first marriage, 64 percent had been married for up to 8 years, 72 percent had no children and 78 percent had been trying to conceive for up to 6 years. The causes of infertility were unknown in thirty-six percent of the couples and 78 percent had never being subjected to Assisted Reproduction procedures. Ninety-four percent of the couples showed an interest in participating in a psychological support group. The fear of abortion, fetal malformation and delivery was statistically more frequent than fears related to pregnancy, Assisted Reproduction procedures and the responsibilities of parenthood. These data reveal significant variables for the development of interventions based on the knowledge of patients' circumstances.

O funcionamento psicológico e sexual da mulher com dor pélvica crônica: atualização / The psychological and sexual functioning of women with chronic pelvic pain: an update

A dor pélvica crônica (DPC) é uma sintomatologia comum e complexa, muitas vezes de causa inexplicável clinicamente, tornando o diagnóstico e tratamento mais difíceis. Do ponto de vista clínico, é definida como dor não cíclica ou não menstrual, com duração de pelo menos seis meses, suficientemente grave para interferir nas atividades habituais e que necessita de tratamento clínico ou cirúrgico. A DPC é, portanto, uma síndrome que resulta da complexa interação entre os sistemas: nervoso, musculoesquelético e endócrino, influenciado ainda por fatores psicológicos e socioculturais. Sua prevalência é de 3,8% em mulheres de 15 a 73 anos e de 14 a 24% em mulheres na idade reprodutiva, com impacto direto na vida conjugal, social, profissional e sexual. Como não há uma doença clara que justifica a DPC, há de se pensar em fatores psicogênicos. O fator psicológico pode estar presente de forma isolada ou concomitante, em até 60% dos casos das mulheres com DPC, sendo mais comumente representado pela depressão e ansiedade. A dor crônica tem efeito negativo no funcionamento sexual das mulheres acometidas. A DPC parece estar associada particularmente ao abuso sexual. Têm surgido evidências da associação entre a violência sexual e algumas queixas ginecológicas, como dismenorreia e dor pélvica. Neste estudo, realizou-se revisão bibliográfica sobre os aspectos emocionais e sexuais da mulher com DPC.

Chronic pelvic pain (CPP) is a common and complex symptoms often of clinically unexplained causes, which makes its diagnosis a more difficult task. From a clinical point of view, it is defined as a non-cyclic and non-menstrual pain lasting at least six months and sufficiently severe to interfere with habitual activities and to require clinical or surgical treatment. CPP syndrome results from complex interactions between nervous, musculoskeletal and endocrine system and psychological, social and cultural factors. Its prevalence is 3.8% among women aged 15 to 73 years and 14 to 24% among women of reproductive age, with a direct impact on marital, social, professional and sexual life. Since there is no clear disease justifying CPP, psychogenic factors should be considered. The psychological factors may be present in isolation or co-occur in up to 60% of women with CPP, being most commonly represented by depression an anxiety. Chronic pain has a negative effect on the sexual functioning of affected women. CPP seems to be particularly associated with sexual abuse. Evidence has been obtained by the association of sexual violence and some gynecologic complaints such as dysmenorhea and pelvic pain. In the present study, it was performed a review of the literature on the emotional and sexual aspects of women with CPP.

Abuso sexual na infância e adolescência / Sexual abuse of children and adolescents

O abuso sexual na infância é definido com a situação em que a criança ou o adolescente é usado para satisfação sexual de um adulto ou adolescente mais velho, sendo a violência sempre presumida em menores de 14 anos. É um fenômeno universal que atinge todas as idades, classes sociais, etnias, religiões e culturas e pode ser considerado como qualquer ato ou conduta baseado no gênero, que cause dano ou sofrimento psíquico e sexual à vítima. No Brasil, a violência contra crianças e adolescentes é a primeira causa de morte na faixa etária de cinco a 19 anos e a segunda no período de um a quatro anos. Médicos pediatras e ginecologistas devem ser alertados e capacitados para lidar com questões ligadas ao abuso, tornando-se aptos a atuarem de maneira adequada. A questão do abuso sexual, por ter uma complexidade de fatores envolvidos, não pode ser explicada de forma reducionista ou determinista, devendo assim, ser valorizada a presença de uma equipe interdisciplinar no atendimento a esses pacientes. Neste estudo foi realizada uma revisão bibliográfica sobre o abuso sexual e suas repercussões.

Sexual abuse of children is defined as a situation in which a child or an adolescent is used for the sexual satisfaction of an adult or older adolescent with violence always being presumed for children younger than 14 years. This is a universal phenomenon that involves all ages, social classes, ethnic groups, religions and cultures and that can be considered as any act or conduct based on gender that will cause damage or psychic and sexual suffering to the victim. In Brazil, violence against children and adolescents is the first cause of death in the age range from five to nineteen years and the second in the age range from one to four years. Pediatricians and gynecologists should be alerted and prepared to deal with questions related to abuse, so that they may be qualified to act in adequate manner. Because of the complexity of the factors involved, the question of sexual abuse cannot be explained in a reductionist or deterministic manner. Thus, emphasis should be placed on the presence of an interdisciplinary team to take care of these patients. A review of the literature on sexual abuse and its repercussions was performed in the present study.

Abordagem das disfunções sexuais femininas: [revisão] / The assessment and management of female sexual dysfunction: [review]

A disfunção sexual tem alta prevalência entre as mulheres. No entanto, os médicos raramente avaliam a vida sexual de suas pacientes, ou por se sentirem desconfortáveis em abordar a sexualidade ou porque desconhecem as técnicas de investigação. O modelo PILSET (PLISSIT), uma técnica de abordagem da função sexual humana, é composto por quatro elementos: permissão, informação limitada, sugestão específica e terapia sexual, que favorecem o diálogo entre o médico e a paciente, permitindo o acesso às queixas sexuais. A terapêutica consta de medidas de aconselhamento e orientações básicas sobre a função sexual, farmacoterapia e intervenções nos aspectos anátomo-funcionais do aparato sexual, com impacto positivo na vida sexual da mulher. Esta revisão mostra como usá-lo. Adicionalmente, vários aspectos da função sexual feminina, como prevalência, diagnóstico e outras modalidades de tratamento são discutidos.

Sexual dysfunction prevalence is high among women. However, doctors rarely ask about their patients' sexual life, because they feel uncomfortable or because their knowledge about investigation techniques is insufficient. The PLISSIT model, a useful tool to access human sexual function, is composed by four elements: permission, limited information, specific suggestions, and intensive therapy, that favor dialogue between the doctor and the patient allowing the access to the sexual complaints. The therapeutics consists of counseling measures, drug prescription, basic orientations about sexual function and interventions on anatomic and functional aspects of the sexual apparatus with positive impact in the woman's sexual life. The present review shows how to use it. In addition, many aspects of female sexual dysfunction are discussed, such as prevalence, diagnostic and treatment options for female sexual dysfunction.

[The assessment and management of female sexual dysfunction]. / Abordagem das disfunções sexuais femininas.

Sexual dysfunction prevalence is high among women. However, doctors rarely ask about their patients' sexual life, because they feel uncomfortable or because their knowledge about investigation techniques is insufficient. The PLISSIT model, a useful tool to access human sexual function, is composed by four elements: permission, limited information, specific suggestions, and intensive therapy, that favor dialogue between the doctor and the patient allowing the access to the sexual complaints. The therapeutics consists of counseling measures, drug prescription, basic orientations about sexual function and interventions on anatomic and functional aspects of the sexual apparatus with positive impact in the woman's sexual life. The present review shows how to use it. In addition, many aspects of female sexual dysfunction are discussed, such as prevalence, diagnostic and treatment options for female sexual dysfunction.