Psychological gender of patients with polycystic ovary syndrome.

OBJECTIVE: We compared women with polycystic ovary syndrome (PCOS) to a control group with regard to intensity of hirsutism and psychological gender. DESIGN: Cohort study, 2005-2009. SETTING: Gynecological endocrinology clinic and gynecological practice, Silesian area, Poland. SAMPLE: 89 women aged 17-42 years with PCOS, in two groups (S1, S2) by age < or ≥31 years, and age-stratified controls of 45 healthy women. METHODS: We used the General Health Questionnaire (GHQ 12), Ferriman-Gallwey score and Psychological Gender Inventory, to assess masculinity and femininity through self-reported possession of socially desirable, stereotypical personality traits (masculine, feminine, androgynous, undifferentiated), supplemented by questions concerning social status (education, profession) and gynecological history. All questionnaires were anonymous and independently answered during clinic visits. MAIN OUTCOME MEASURES: Influence of PCOS and concomitant hirsutism on psychological gender. RESULTS: Hirsutism (moderate or severe intensity) was observed in a considerably higher number of women from both PCOS groups compared with controls (S1: 49.0 vs. 20.0%, p < 0.05, S2: 41.9 vs. 16.7%, p < 0.05, respectively). Women ≥31 years with PCOS more often viewed themselves as sexually undifferentiated compared with controls (31.8 vs. 6.7%, p < 0.01), less likely to identify with a female gender scheme (18.2 vs. 33.3%), and more likely to see themselves as androgynous (50.0 vs. 40.9%). CONCLUSIONS: Women with PCOS have, depending on age and severity of disease, problems with psychological gender identification. Duration and severity of PCOS can negatively affect the self-image of patients, lead to a disturbed identification with the female-gender scheme and, associated with it, social roles.

Premenstrual disorders in Polish adolescent girls: prevalence and risk factors.

AIM: The aim of the study was to evaluate the prevalence and risk factors of premenstrual disorders among Polish adolescent girls. MATERIAL AND METHODS: A total of 2500 females from the Upper Silesian region of Poland, aged 16 to 45 years, were eligible for a prospective population-based study. The subjects were recruited randomly by the regional public opinion research centre. The preliminary study population consisted of 1540 females. Seventy-two adolescent girls, aged 16 to 19 years, were included in the final analysis. The research was based on a self-prepared questionnaire containing socio-economic status, general health, medical and reproductive history, premenstrual symptoms based on American College of Obstetricians and Gynecologists criteria for diagnosing premenstrual syndrome as well as American Psychiatric Association criteria for premenstrual dysphoric disorder and patient prospective daily ratings of symptoms. RESULTS: The mean age of the studied population was 17.27±0.97 years. In the studied population the majority of the adolescent girls lived in large cities of over 50,000 citizens (54.29%), were physically active declaring daily physical exercise (55.22%) and sexually active (54.17%). Study results indicated that the prevalence of premenstrual syndrome and premenstrual dysphoric disorder was 76.39% and 4.17%, respectively. The final statistical analysis revealed that only place of residence (large cities) increased the risk of premenstrual syndrome (OR=3.58; P=0.01). CONCLUSION: Adolescent females living in urban areas are more vulnerable to premenstrual syndrome. Reproductive, sexual and socio-economic factors are not significant risk factors for premenstrual syndrome.

Physical activity and sexuality in perimenopausal women.

OBJECTIVES: To determine if there is a link between physical activity and sexual functioning in perimenopausal women, by comparing groups of women with low, moderate and high physical activity levels with regard to selected domains of their sexual functioning. METHODS: The research involved 400 healthy Polish women, aged 45-55 years. The final analysis encompassed 336 women who fulfilled all the inclusion criteria. The research tool was a two-part questionnaire. The first part covered the socio-economic status, patient history, and gynaecological-obstetric history. Part two consisted of an extended version of the International Physical Activity Questionnaire long form, evaluating the level of physical activity over the last seven days, and the Female Sexual Function Index. RESULTS: The mean age of the respondents was 50.56 ±â€Š2.33 years. The analysis showed statistically significant differences between all the domains of physical activity and the FSFI of the studied women. In the group of women without sexual disorders, respondents with a low physical activity level in all questionnaire domains were the least numerous. CONCLUSIONS: In perimenopausal women an association is seen between high levels of general physical activity and better sexual functioning.

Recommendations of the Polish Gynecological Society concerning child sexual abuse.

The World Health Organisation defines child sexual abuse as the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society. Child sexual abuse is evidenced by this activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person. It is estimated that in the world on average one in 3-4 women and one in 6-10 men were victims of sexual abuse in childhood. In Poland, according to the estimates of the Child's Rights Protection Committee, approximately 20% of girls and 5-6% of boys under the age of 15 years has suffered sexual abuse. In 2007 there was an increase in violence victims in all age categories, but the most alarming data concerned minors under 13 years. Girls fall victim to sexual abuse three times more frequently than boys. Sexual abuse of boys frequently involves violence. Data show that there are fewer women than men who execute such actions against a minor. Most victims (49-84%) know the perpetrator, and approximately 14-20% of acts of violence take place within the family. This article presents recommendations of the Polish Gynecological Society concerning procedures in cases of suspected sexual abuse of children.

Sexual satisfaction in females with premenstrual symptoms.

INTRODUCTION: The impact of premenstrual symptoms, such as the premenstrual syndrome (PMS) and the premenstrual dysphoric disorder (PMDD), on sexual satisfaction, sexual distress, and sexual behaviors has not yet been established. AIMS: To assess the correlates and risk factors of sexual satisfaction and to evaluate sexual behaviors among Polish women with premenstrual symptoms. METHODS: 2,500 females, aged 18 to 45 years, from the Upper Silesian region of Poland were eligible for the questionnaire-based, prospective population study. All the inclusion criteria were met by 1,540 women who constituted the final study group. The participants were further divided into two subgroups: PMS+ (749 females) and PMS- (791 healthy subjects). Two additional subgroups were created: PMDD+ encompassing 32 subjects diagnosed with PMDD, and PMDD- comprising 32 healthy women, matched to the PMDD+ females for age, marital status, education level, employment status, place of living, and body mass index. A multiple logistic regression analysis was performed to evaluate the influence of PMS on sexual satisfaction and adjust for potential confounders. MAIN OUTCOME MEASURE: To evaluate risk factors for sexual dissatisfaction in a population of Polish females of reproductive age, diagnosed with PMS and PMDD. RESULTS: Women from the PMS+ group were less sexually satisfied than PMS- (77.73% vs. 88.66%, P=0.001) and reported more sexual distress (28.65% vs. 15.24%, P=0.001). There were no significant differences in sexual satisfaction between PMDD- and PMDD+. Sexual satisfaction correlated positively with a higher frequency of sexual intercourses and a higher level of education. The presence of PMS correlated negatively with sexual satisfaction, even after adjusting for potential confounders in the multivariate logistic regression model (odds ratio=0.48; confidence interval: 0.26-0.89; P=0.02). CONCLUSIONS: The presence of PMS is a risk factor for sexual dissatisfaction in Polish women of reproductive age.

Quality of life, mental health and self-esteem in hirsute adolescent females.

AIMS: The aim of the study was to evaluate the influence of hirsutism on general quality of life, self-esteem and the prevalence of anxiety and depressive symptoms among adolescent girls. METHODS: Fifty adolescent females with hirsutism, aged 13-18 years, were enrolled in the research group. The control group comprised 50 non-hirsute adolescents. A specific questionnaire was used as the research tool. It included self-evaluation inventories: Short Form-36 Health Survey Version 2, Hospital Anxiety and Depression Scale and Rosenberg Self-Esteem Scale. RESULTS: Quality of life indices for hirsute girls scored lower than for the controls and statistically significantly so with regard to physical functioning (p = 0.04), general health (p = 0.002) and social functioning (p = 0.007). Anxiety was diagnosed in 26% in the group of hirsute girls as compared with 10% of the controls (p = 0.03). The study analysis revealed more clinically significant problems of low self-esteem in hirsute adolescents compared with non-hirsute girls (14% vs. 2%). CONCLUSIONS: Hirsutism is associated with a decreased quality of life, a higher prevalence of anxiety disorder and lower self-esteem in adolescent females. The mother's level of education is associated with the quality of life in adolescent girls.

[Partner relationships in menopausal period]. / Relacje partnerskie w okresie klimakterium.

OBJECTIVES: Evaluation of partner relationships in menopausal period. MATERIAL AND METHODS: A questionnaire study was performed in a group of 67 women (age: 45-55 years) and their partners. The inclusion criteria were: presence of climacteric symptoms, stable partnership, consent to research. 40 women and their spouses were included into the final study group. The investigative tool was based on 3 scales: Marriage Bond Scale (SWM); Scale of Attractiveness (SKAT); GREEN Scale evaluating intensification of menopausal symptoms and a set of additional questions concerning socio-demographical data, marital sexuality and substitute hormonal therapy. RESULTS: Mean age of respondents was 52 years. Most of the women demonstrated an amenorrhea (90%). Climacteric symptoms such as: hot flush, stress, depressive moods (87.5% each), musculoarticular pain (80%) occurred in various degree. 97.5% of women did not use a substitute hormonal treatment. The mean result of SWM for women and their partners scored 237 which is 79% of the total value. A correlation between exacerbation of menopausal signs and SWM score was not found. The co-attractiveness ratio counted on the basis of SKAT scale scored 30 points on average, which constitutes 74% of the maximum. Approximately 58% of the men accepted symptoms related to menopause in their partners; they tolerated changes appearing in the climacteric period, however; 100% of men did not talk about menopausal problems with their partners and did not support them in this difficult time. CONCLUSIONS: Men find their partners attractive in the perimenopausal period, accepting their partners and problems related to menopause. Most of the male respondents understand changes occurring in their partners, however, they do not help them to deal with them.

Diabetes mellitus and sexuality--does it really matter?

INTRODUCTION: The extent to which diabetes may influence sexuality has not yet been established. Identifying the risk factors of female sexual dysfunctions will facilitate the introduction of effective therapeutic models that aim to normalize the glycemic control and will enhance sexual functioning. AIMS: To evaluate the influence of diabetes mellitus on female sexual functions, behaviors and depressive symptoms as well as to establish the predictors for female sexual dysfunctions in diabetic subjects. MAIN OUTCOME MEASURES: To asses reported female sexual dysfunctions by using Female Sexual Function Index in diabetic females. METHODS: A total of 544 females living in the upper Silesia region aged 18-55 years old were eligible for this questionnaire-based, retrospective, cross-section study. The study group included females with diabetes mellitus (N = 264), regardless its type and duration; healthy non-diabetic subjects were controls. The Blatt-Kuppermann Index was used to evaluate climacteric symptoms, the Back Depression Inventory-to screen for depressive symptoms and the Female Sexual Function Index-for sexual dysfunction in female (FSD). RESULTS: Multiple logistic regression revealed that the risk of desire and arousal dysfunction was lower in respondents for whom having a satisfactory sexual life was extremely important compared to those for whom it was slightly important or not important at all (referent) (OR: 0.05 and 0.01, respectively). Respondents highly satisfied with sexual contacts with their partner were at lover risk of desire, arousal, and orgasmic disorders and FSD compared to referent subjects (OR: 0.12; 0.03; 0.01 and 0.03 respectively). Depressive symptoms were associated with higher prevalence of arousal disorders and FSD (OR: 13.6 and 3.57, respectively), diabetes-orgasmic dysfunctions (OR = 10.1). CONCLUSIONS: In women, the presence of diabetes is an independent predictor of orgasmic dysfunctions. However, the presence of depressive symptoms, individual perception of sexual needs and partner-related factors are stronger predictors of female sexual dysfunctions.

[Double aortic arch: prenatal case report]. / Podwójny luk aorty: opis przypadku.

We have presented a case of prenatal double aortic arch, diagnosed by ultrasound, to demonstrate the importance of 3-vessel view by detecting aortic arch abnormalities. Double aortic arch is one the most common types of the vascular ring. The suspicion of a double aortic arch is raised by detecting the U-sign which is formed by the combination of both aortic arches and the left ductus arteriosus. In the 3-vessel view the ascending aorta and aortic arch are pointing to the right, whereas the left arch points to the left, and the trachea is seen between. The 4-chamber view appears normal, but the descending aorta is deviated medially. Literature review revealed an association between double aortic arch and congenital heart diseases in approximately 20% of cases; most often tetralogy of Fallot, transposition of great vessels, ventricular septal defects. Rarely there can be atresia of the segment of the aortic arch, which can be difficult to differentiate from other aortic arch anomalies associated with chromosomal abnormalities such as microdeletion of chromosome 22q11.

Sexual functions and depressive symptoms after photodynamic therapy for vulvar lichen sclerosus in postmenopausal women from the Upper Silesian Region of Poland.

INTRODUCTION: Although lichen sclerosus (LS) may affect women's physical functioning, mood, and quality of life, restricting their physical activities, sexual, and non-sexual contacts, there are limited data on the sexual functioning of women diagnosed with LS. AIMS: The aim of the study was to evaluate the influence of photodynamic therapy for vulvar LS on sexual functions and depressive symptoms in postmenopausal women from the Upper Silesian Region of Poland. METHODS: A total of 65 women aged 50-70 visiting an outpatient clinic for assessment of vulvar dermatoses were screened for the clinical trial. Finally, 37 women who met all the inclusion/exclusion criteria were included in the study. All the subjects were treated by topical laser therapy (photodynamic therapy). Sexual functions and depressive symptoms were assessed before and after the therapy using Female Sexual Function Index and Beck Depression Inventory, respectively. MAIN OUTCOME MEASURES: Sexual behaviors, sexual functions, and depressive symptoms in females after photodynamic therapy for vulvar LS. RESULTS: The total FSFI score was significantly lower after the treatment of vulvar LS as compared with the baseline (median 24.6 vs. 15.9). However, the prevalence of clinically significant FSD was stable throughout the medical intervention except lubrication disorders (higher prevalence after the treatment: 40% vs. 68.57%). Although the scores of BDI at the baseline dropped significantly after the photodynamic therapy (median 12.0 and 9.0, respectively), there were no significant differences in the prevalence of depressive symptoms (48.65% vs. 45.94%). CONCLUSIONS: Topical laser therapy for vulvar LS has a good clinical outcome, especially in the context of no major negative effects on sexual functioning and the positive impact on the severity of depressive symptoms in postmenopausal women. However, patients should be informed about the possible lubrication disorders following the treatment.

[Female sexual response cycle]. / Cykl reakcji seksualnej u kobiety.

The key to understand female sexual response cycle is a multidimensional approach to sexual reactions, where emotional satisfaction (emotional intimacy with the partner) might be more important than physical satisfaction (orgasm). Such holistic approach might in fact make the diagnosis and treatment of female sexual dysfunctions, which are becoming increasingly common in clinical and gynecological practice, easier and more effective. The aim of the study is to present contemporary model of female sexual response cycle and to encourage specialists to view female sexuality in more broad and holistic perspective.

Evaluation of marital and sexual interactions of Polish infertile couples.

INTRODUCTION: The World Health Organization defines infertility as inability to conceive despite regular sexual intercourse sustained for a period exceeding 12 months with no contraceptive methods. AIM: The aim of this study was to evaluate the effect of infertility on marital and sexual interactions among infertile couples. METHODS: Two hundred six infertile couples were qualified to the study as the research group. The control group consisted of 190 fertile couples. MAIN OUTCOME MEASURES: A specific questionnaire was used as a research tool in this study. It included the sociodemographic part, infertility status, and validated scales: Polish version of Index of Marital Satisfaction and Index of Sexual Satisfaction. Statistica 6.0 (Medical University of Silesia; Katowice, Poland) was used in the statistical analysis. The statistical analysis made use of: Mann-Whitney U-test, chi-square with Yates' continuity correction, ancova log-linear analysis of covariance, and logistic regression analysis. RESULTS: The study showed a significantly better partner relationship in female infertile as compared with female fertile. Clinically significant disorders of partnership stability were observed in 11.65% of studied women and in 20% of controls. Marital adjustment and sexual satisfaction were comparable among male groups. The probability of marital disorders increased with: age above 30 (odds ratio [OR] = 1.6), female sex (OR = 1.5), and lower education (OR = 1.7) among the study population. Diagnosed male factor and infertility duration of 3-6 years were connected with the highest relationship instability and the lowest sexual satisfaction both in female and male infertile. CONCLUSIONS: The risk factors of marital dissatisfaction in infertility include: female sex, age over 30, lower education level, diagnosis of male infertility, and infertility duration of 3-6 years.

[The statement of Polish Gynecological Society experts on oral use of contraceptive 75 microg desogestrel minipill in different clinical cases--state of art in 2008]. / Stanowisko Zespolu Ekspertów Polskiego Towarzystwa Ginekologicznego dotyczace zastosowania antykoncepcyjnej minitabletki gestagennej zawierajacej 75 microg dezogestrelu w wybranych sytuacjach klinicznych--stan wiedzy na 2008 rok.

Recent epidemiologic studies indicate that use of combined oral contraception is associated with a increase in the incidence of cardiovascular disease (venous thromboembolism, pulmonary embolism, myocardial infarction and stroke). The risk of cardiovascular disease is strongly related to estrogen dose, progestogen type and other factors for example thrombogenic mutations and cigarette smoking among female over age 35. The progestogen only contraception is safe alternative to combined hormonal contraception. Progestogen only pill (POP) has different levels of action (local and/or central) which may vary from one drug to another. As for the cardiovascular disease risk, progestogens are not considered to be risk factors. Desogestrel containing POP is advised in the following cases: bad tolerance of exogenous oestrogens; in order to counteract an endogenous hyperoestrogenosis; medical, metabolic or cardiovascular contraindications to estroprogestogen contraception. Lastly, POP should be used as a prime contraception in some particular situations (breast feeding, endometriosis, adenomyosis, cigarette smoking, contraception for older women). These recommendations present the actual system of care in that population of women in Poland.

Depression and anxiety among Polish infertile couples--an evaluative prevalence study.

AIM: The aim of this study was to evaluate the influence of infertility on the severity of anxiety and depression in infertile couples. MATERIAL AND METHODS: This was a cross-sectional study of differences between infertile couples (206 women and 188 men) and fertile couples (n = 190) with symptoms of depression and anxiety, as measured by the Beck Depression Inventory and Beck Anxiety Inventory. RESULTS: Infertile women (35.44%) scored above the cut-off for severe symptoms of depression, compared with 19.47% of fertile women. In the case of anxiety evaluation there was significant total prevalence among infertile women (15.53%). In the male groups there was a comparable frequency of negative results for depression and anxiety and their intensity. Among Female Infertile, depression occurred most frequently in combined infertility, whilst among Male Infertile in male infertility, with a time-frame of 3-6 years causing the creation and severity of depressive symptoms. CONCLUSION: The risk factors of depression and anxiety in infertility include: female sex, age over 30, lower level of education, lack of occupational activity, diagnosed male infertility and infertility duration of 3-6 years.

Biopsychosocial functioning of women after mastectomy.

AIMS: The aim of this work was to identify the problems of women after total mastectomy and partial mastectomy with regard to various factors and intensity of discomfort which affect the quality of life. BACKGROUND: The loss of the attribute of femininity, maternity and sexuality, as the mammary gland is perceived by patients, is a highly traumatic experience, frequently resulting in re-evaluation of life and functioning to date. DESIGN AND METHODS: The survey encompassed 494 women after operational treatment of breast cancer with varying time since the procedure. The research group consisted of women after radical mastectomy, and the control group consisted of patients after partial mastectomy. RESULTS: The intensity of post-traumatic stress was an important factor affecting the level of depression and anxiety. This correlation appeared to be statistically highly significant in the group of women after total mastectomy. Life satisfaction, the level of depression and anxiety in women after such an operation were dependent on the intensity of post-traumatic stress and they caused inferior biopsychosocial functioning. CONCLUSIONS: Women after mastectomy require professional long-term support; this need should result in the enhancement of services provided in relevant women's support groups. RELEVANCE TO CLINICAL PRACTICE: When evaluating holistically the life of women after mastectomy, all spheres of everyday functioning should be taken into account: physical, cognitive, emotional and social.

[Emergency contraception--awareness among young women from Upper Silesia region]. / Antykoncepcja awaryjna--swiadomosc mlodych kobiet z terenu Górnego Slaska.

OBJECTIVES: Evaluation of prevalence, acceptation and awareness about emergency contraception among young woman from Upper Silesia region. MATERIAL AND METHODS: A questionnaire study was performed in a group of 396 female students of Silesia colleges and universities, aged from 19 to 29. Self-prepared questionnaire was used to evaluate the research group. We asked questions about sexual life, birth control and emergency contraception. Statistica 6.0 software was used for statistical analysis. RESULTS: Mean age of the respondents was 22.1 (+/-1.54) years. Most of the respondents were sexually active (66%), mean age of the first sexual intercourse was 19.1 years. Almost all of the respondents heard about emergency contraception, but the majority claimed that it was not a safe method of birth control and should not be administered without prescription. Half of the women perceived emergency contraception as an abortive method. Thus, most of them would not use any kind of emergency contraception, the reason being either that they were against abortion or that the very concept of emergency contraception was against their personal beliefs. 12.7% of the sexually active woman applied emergency contraception and 10 women (3.7%) used it more than once. CONCLUSIONS: The use of emergency contraception among young woman from Upper Silesia is connected with sexual intercourse without protection. Those young women identify emergency contraception as an abortive method. Knowledge about emergency contraception in this group is not only limited but also incorrect.

[Health-related quality of life in women with endometriosis]. / Jakosc zycia u kobiet z endometrioza.

According to definition, endometriosis is a chronic gynaecological disease which results from ectopic location of the endometrium outside the uterine cavity. On the basis of various researches it is estimated that prevalence of endometriosis in the general population is 10% and the disease concerns women mainly in reproductive age. As an effect of the disease, following common gynaecological and psychiatric symptoms appear: chronic pelvic pain which occurs in different circumstances, depressive and anxiety disturbances. In relation to pathological changes, decrease of health-related quality of life (QOL) is observed. The topic of medical researches concerns frequently an influence of pharmacological and surgical treatment on QOL improvement in women with endometriosis. To achieve objective results in evaluation of quality of life, it is recommended to use standardized and validated questionnaires, such as EHP-30, EHP-5, SF-36, WHOQOF-100 or WHOQOL-BREF.

[Obesity and its consequences for pregnant women]. / Otylosc i jej konsekwencje dla kobiet w ciazy.

Obesity is an increasingly common disease complicating the course of pregnancy, labour and post-birth recovery. Therefore, conscious decision about conception seems to be vital as maternal obesity can also influence the baby's birth weight and health. The cascade of complications that may occur in the perinatal period in women with excessive BMI has a negative impact on the mother and the child, what translates directly into significant problems--of obstetric and gynaecological, pediatric and often also physiotherapeutic nature.

[Prenatally reported fetal ovarian cysts--treatment and prognosis]. / Torbiele jajnika wykrywane prenatalnie u plodu--postepowanie i rokowanie.

We present 6 case reports of ovarian cysts, diagnosed in the prenatal and postnatal period, as well as treatment. There was no need for invasive prenatal therapy in any of the reported fetuses. Most of the cysts disappeared spontaneously (in one case uncomplicated cyst rupture in fetus have been observed), only in one case laparoscopy was performed after birth.