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1.
Ther Umsch ; 73(9): 565-571, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31113317

RESUMO

Vulvar Pain Abstract. During their lifetime, many women experience vulvar and / or vaginal pain. The reasons of those pains or discomforts can be multiple and sometimes hard to identify and therefore difficult to treat. Besides organic causes such as infections, inflammations, changes after operations and others we can find complex conditions such as vulvodynia and dyspareunia. Vulvodynia is a vulvar pain of at least 3 months duration without clear identifiable cause, which may have potential associated factors. It is important for a successful therapy to identify these factors. It will need an individual access to every woman and there is no single therapy that fits all women. Dyspareunia is also a less common but also complex problem that needs accurate approach and therapy. With this article, we would like to give you insights in these disorders in a practical way in order to make them find their place in our daily practice.


Assuntos
Dispareunia , Doenças da Vulva/diagnóstico , Vulvodinia , Dispareunia/diagnóstico , Feminino , Humanos , Dor/diagnóstico , Dor/etiologia , Disfunções Sexuais Psicogênicas/diagnóstico , Doenças da Vulva/complicações , Vulvodinia/diagnóstico
2.
Univ. med ; 60(1)2019. ilus, tab
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-995084

RESUMO

La menopausia es el periodo de transición en que la mujer culmina su edad reproductiva y trae consigo cambios anatómicos y fisiológicos, manifestados principalmente por síntomas vasomotores y urogenitales, con gran afectación de la calidad de vida de las pacientes. Es de gran importancia conocer las alternativas terapéuticas que existen, la evidencia que las respalda, y así ofrecer la mejor alternativa según indicaciones, eficacia, perfil de efectos adversos y contraindicaciones de cada una. Métodos: Se realizó una búsqueda y selección de la literatura en las bases de datos Cochrane, Pubmed, SciELO, JAMA, en idiomas español e inglés, sin restricción de fecha. Conclusiones: Las terapias actuales no son satisfactorias, bien sea por la baja eficacia en el control de los síntomas o por su asociación con efectos adversos de importancia. Es necesario evaluar acuciosamente el riesgo-beneficio de cada intervención.


Menopause is the transitioning phase of a woman at the end of her reproductive age and which is associated with both anatomical and physiological changes, with great compromise of quality' of Iife. It is of upmost importance to be aware of the currently available therapeutic options, the evidence that supports them, and thus, be able to provide the best alternative according to medical indications, efficacy, adverse effects and counter-indications. Methods: We conducted a search on the databases Cochrane, Pubmed, SciELO, JAMA, both in English and Spanish, without date restrictions. Conclusión: Current therapies are not satisfactory, either because of their low efficacy in symptom control or because of the associated risks. It is necessary to make a thorough evaluation of the benefit/risk relation for every individualized case.


Assuntos
Menopausa , Dispareunia/diagnóstico , Estrogênios/análise
3.
Semin Reprod Med ; 36(2): 152-158, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30566981

RESUMO

A variety of conditions can give rise to the perception of painful sexual intercourse in women with pelvic pain. Female sexual dysfunction may stem from psychological, medical such as endocrinological disturbances, and gynecological pathologies. This article provides a discussion of various conditions, offering diagnostic and therapeutic measures to consider in women with pelvic pain experiencing sexual dysfunction. Treatment and management options are also reviewed.


Assuntos
Dispareunia , Dor Pélvica/complicações , Disfunções Sexuais Fisiológicas , Dispareunia/complicações , Dispareunia/diagnóstico , Dispareunia/psicologia , Dispareunia/terapia , Feminino , Humanos , Relações Profissional-Paciente , Disfunções Sexuais Fisiológicas/complicações , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Fisiológicas/terapia
4.
J Womens Health (Larchmt) ; 27(9): 1114-1123, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30070938

RESUMO

BACKGROUND: Endometriosis has been associated with higher rates of various chronic conditions, but its epidemiological data are fragmented and dated. We sought to compare the incidence of developing commonly occurring comorbidities among patients with and without endometriosis in a large, contemporary patient cohort that reflects real-world clinical practice. MATERIALS AND METHODS: A cohort of women aged 18-49 with incident endometriosis was extracted from the 2006-2015 de-identified Clinformatics® DataMart commercial insurance claims database (OptumInsight, Eden Prairie, MN). Endometriosis was identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 617.x on ≥1 inpatient or emergency department claim or ≥2 outpatient claims. Nonendometriosis control patients were exactly matched 4:1 to cases based on state, insurance plan type, and age (±1 year). Based on a literature review and expert consultation, 22 comorbidities were identified for analysis. The risk of developing a comorbidity post-index date was analyzed with stratified Cox proportional hazards models. RESULTS: There were 26,961 cases and 107,844 controls. Mean age was 36 years. The adjusted risk of developing a comorbid condition among endometriosis cases was statistically significantly higher than the matched controls for all 22 comorbidities (p ≤ 0.001) and was at least twice as large for nine comorbidities (infertility/subfertility, ovarian cyst, uterine fibroids, pelvic inflammatory disorder, interstitial cystitis, irritable bowel syndrome, constipation/dyschezia, ovarian cancer, and endometrial cancer). CONCLUSION: The incidence of developing many comorbidities was significantly higher among endometriosis patients compared with matched women without endometriosis. Additional research is needed to establish the implications for healthcare resource use.


Assuntos
Endometriose/diagnóstico , Laparoscopia , Dor Pélvica/etiologia , Adulto , Estudos de Casos e Controles , Comorbidade , Constipação Intestinal/diagnóstico , Constipação Intestinal/epidemiologia , Dismenorreia/diagnóstico , Dismenorreia/epidemiologia , Dispareunia/diagnóstico , Dispareunia/epidemiologia , Endometriose/epidemiologia , Feminino , Humanos , Incidência , Leiomioma/diagnóstico , Leiomioma/epidemiologia , Pessoa de Meia-Idade , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/epidemiologia , Dor Pélvica/diagnóstico , Dor Pélvica/epidemiologia , Estudos Retrospectivos
5.
J Gynecol Obstet Hum Reprod ; 47(2): 69-79, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29133195

RESUMO

PURPOSE: To develop a questionnaire based on patients' verbal descriptors, to measure the painful symptoms of endometriosis. METHODS: We performed a two-round modified DELPHI procedure mixing endometriosis patients and physicians to select a set of statements to describe the painful symptoms of endometriosis. Each panelist rated each statement based on diagnosis validity and clarity. The clinicians were experts in endometriosis management selected from various geographic regions in France. Patients were women with surgically confirmed endometriosis who volunteered from a patient association and from the recruitment of the participating physicians. The first round questions were derived from words and phrases in narratives of pain by endometriosis patients. RESULTS: Overall, 76 experts were invited, and of these 56 (74%), comprising 33 patients and 23 gynecologists, responded to the first round questionnaire, and 40 (71.4%) to the second round. Among the 48 statements assessed in the first-round questionnaire, 11 were selected after completion of the two round DELPHI procedure. After discussion and rewording of some items, a total of 21 questions were selected during a final face-to-face meeting. The content of the final questionnaire is organized according to four dimensions: (i) spontaneous pelvic pain and dysmenorrhea, (ii) dyspareunia, (iii) painful bowel symptoms, (iv) and other symptoms. We also provide an English (UK) version produced using several steps of translation and back-translation. CONCLUSIONS: The questionnaire has content validity to measure the subjective experiences of patients with painful endometriosis and can provide a solid basis on which to develop an efficient patient-centered outcome to measure the painful symptoms in therapeutic or in diagnostic studies of endometriosis.


Assuntos
Dispareunia/diagnóstico , Endometriose/complicações , Medição da Dor/métodos , Dor Pélvica/diagnóstico , Psicometria/métodos , Inquéritos e Questionários , Adulto , Técnica Delfos , Dismenorreia/diagnóstico , Dismenorreia/etiologia , Dispareunia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor/instrumentação , Dor Pélvica/etiologia , Narrativas Pessoais como Assunto , Médicos , Psicometria/instrumentação
6.
Midwifery ; 58: 27-36, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29277039

RESUMO

OBJECTIVE: The aim is to develop a new tool to evaluate postpartum sexual function and dyspareunia which will facilitate better evaluation of perineal pain in woman after vaginal delivery. DESIGN: The development and validation of the Carol Postpartum Sexual Function and Dyspareunia Assessment Scale. SETTING: The Obstetrics and Gynecology Service of a University Hospital in central Spain. PARTICIPANTS: 102 women after being attended for vaginal birth, and 5 midwife assessors. FINDINGS: 81women reinitiated sexual activity (with vaginal intercourse) during the first three months postpartum. The Carol Postpartum Sexual Function and Dyspareunia Assessment Scale (Carol Scale) was internally reliable with a Cronbach-α value of 0.79 (95%CI0.72-0.85). Cronbach-α coefficients for Carol Scale domains were: preparation for the sexual activity 0.69 (95%CI0.55-0.79), pain or discomfort on caressing the vulval area 0.86 (95%CI0.79-0.91), pain or discomfort related to vaginal intercourse 0.93 (95%CI0.90-0.95) and pain or discomfort after vaginal intercourse 0.86 (95%CI0.78-0.91). CONCLUSIONS: The Carol Postpartum Sexual Function and Dyspareunia Assessment Scale is valid and reliable for measuring sexual function and postpartum dyspareunia in women after being attended for vaginal birth. IMPLICATIONS FOR PRACTICE: The Carol Scale could be used both clinically and in research to improve the quality of care for the mother after childbirth. The scale could help to identify problems in the reinitiation of postpartum sexual activity and, therefore, could contribute to widening the clinical information about these women and help in decision making.


Assuntos
Dispareunia/diagnóstico , Psicometria/normas , Comportamento Sexual/psicologia , Adulto , Dispareunia/psicologia , Feminino , Humanos , Gravidez , Psicometria/instrumentação , Psicometria/métodos , Reprodutibilidade dos Testes , Medição de Risco/métodos , Espanha
8.
Hum Reprod ; 32(9): 1812-1818, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28854723

RESUMO

STUDY QUESTION: Is it possible to develop a validated score that can identify women with Bowel Endometriosis Syndrome (BENS) and be used to monitor the effect of medical and surgical treatment? SUMMARY ANSWER: The BENS score can be used to identify women with BENS and to monitor the effect of medical and surgical treatment of women suffering from bowel endometriosis. WHAT IS KNOWN ALREADY: Endometriosis is a heterogeneous disease with extensive variation in anatomical and clinical presentation, and symptoms do not always correspond to the disease burden. Current endometriosis scoring systems are mainly based on anatomical and surgical findings. STUDY DESIGN, SIZE, DURATION: The score was developed and validated from a cohort of 525 women with medically or surgically treated bowel endometriosis from Aarhus and Copenhagen University Hospitals, Denmark. PARTICIPANTS/MATERIALS, SETTING AND METHODS: Patients filled in questionnaires on pelvic pain, quality of life (QoL) and urinary, sexual and bowel function. Items were selected for the final score using clinical and statistical criteria. The chosen variables were included in a multivariate analysis. Individual score values were designated items to form the BENS score, which was divided into 'no BENS', 'minor BENS' and 'major BENS.' Internal and external validations were performed. MAIN RESULTS AND THE ROLE OF CHANCE: The six most important items were 'pelvic pain', 'use of analgesics', 'dyschezia', 'straining to urinate', 'fecal urgency' and 'satisfaction with sexual life'. The range of the BENS score (0-28) was divided into 0-8 (no BENS), 9-16 (minor BENS) and 17-28 (major BENS). External validation showed a significant association between BENS score and QoL (P = 0.0001). LIMITATIONS, REASONS FOR CAUTION: The BENS scoring system is limited by the fact that it was developed from a single endometriosis unit in Denmark, making it susceptible to social, cultural and demographic bias. WIDER IMPLICATIONS OF THE FINDINGS: It is the first endometriosis classification system to be based directly on the symptomatology of the patient. Validation in other languages will promote comparison of treatments and results across borders. STUDY FUNDING/COMPETING INTEREST(S): No external funding was either sought or obtained for this study. A.F. is an investigator for Bayer, outside this work.


Assuntos
Dispareunia/diagnóstico , Endometriose/diagnóstico , Enteropatias/diagnóstico , Dor Pélvica/diagnóstico , Qualidade de Vida/psicologia , Disfunções Sexuais Fisiológicas/diagnóstico , Adulto , Dispareunia/etiologia , Dispareunia/psicologia , Endometriose/complicações , Endometriose/psicologia , Feminino , Humanos , Enteropatias/complicações , Enteropatias/psicologia , Pessoa de Meia-Idade , Dor Pélvica/etiologia , Dor Pélvica/psicologia , Índice de Gravidade de Doença , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/psicologia , Inquéritos e Questionários , Adulto Jovem
9.
Minerva Ginecol ; 69(4): 381-389, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28381078

RESUMO

Common gynecological and dermatological conditions resulting in sexual pain are often observed in gynecological practice and are easily diagnosed with visual observation and laboratory tests. The lower genital tract diseases we are referring to are vaginitis, vaginoses, dermatoses, hypoestrogenism and endometriosis. All of them affect the vaginal mucosa with diverse mechanisms, their effects lasting for only few days or many months. Furthermore, they change the women's sense of wellbeing sometimes significantly and for a long period. The conditions we mentioned above are recognized promptly with basic gynecological interventions but when burning or sharp pain occurs with light pressure (as in case of penetration attempts) without physical signs we must suspect the genitopelvic pain penetration disorder. This condition was defined for the first time in the Diagnostic and Statistical Manual of Mental Disorders-5 and its dimensions include difficulty or pain at penetration associated with fear, anxiety, and pelvic floor hypertonus. Pain is most often localized at the vulvar vestibule and described as burning, pressure, and itching. These dimensions are iconic of sexual pain associated with vulvodyina and vaginismus but are common also in fibromyalgia, a syndrome of widespread chronic pain of unknown origin; sexual pain in fibromyalgia is mostly attributed both to the joint pathology and to the lower sensitive threshold that are the pathognomonic signs of this condition. In our study we analyzed the characteristics of pain as reported for each disease to evaluate its influence on sexuality and marital relations.


Assuntos
Dispareunia/fisiopatologia , Doenças dos Genitais Femininos/complicações , Qualidade de Vida , Dispareunia/diagnóstico , Dispareunia/etiologia , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/fisiopatologia , Humanos , Comportamento Sexual
10.
J Cutan Med Surg ; 21(5): 418-424, 2017 Sep/Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28453946

RESUMO

BACKGROUND: Genitourinary syndrome of menopause (GSM) is a debilitating condition caused by hypoestrogenism that presents with vaginal dryness and dyspareunia as well as other genital, sexual, and urinary symptoms. Previously known as atrophic vaginitis, the term GSM is now used. OBJECTIVE: To help familiarise dermatologists with diagnosing and managing GSM. METHODS: In total, 218 articles were identified and reviewed by 2 independent authors using PubMed. Articles included were from December 2005 to December 2015. Sixty-seven articles met our inclusion criteria. RESULTS: GSM is a clinical diagnosis, requiring the presence of symptoms that should be bothersome and not accounted for by another condition. A pH test may help with diagnosis as vaginal pH will be increased from acidic to neutral. The Papanicolaou test is not recommended because of poor clinical correlation. First-line treatment is low-dose local vaginal estrogen therapy, which has proven efficacy and safety. Serum estrogen levels are not significantly affected with the exception of creams containing high-dose conjugated equine estrogens. Other options have yet to be approved for use in Canada but show promise. CONCLUSION: GSM is a debilitating and common condition that suffers from barriers to diagnosis and treatment. Current treatments are well tolerated, rewarding, and effective with rapid onset.


Assuntos
Vaginite Atrófica/tratamento farmacológico , Dermatologia , Dispareunia/tratamento farmacológico , Estrogênios/uso terapêutico , Menopausa , Papel do Médico , Vaginite Atrófica/diagnóstico , Dispareunia/diagnóstico , Estrogênios/administração & dosagem , Feminino , Humanos , Concentração de Íons de Hidrogênio , Síndrome , Vagina/química , Cremes, Espumas e Géis Vaginais
11.
J Obstet Gynaecol Can ; 39(3): 145-151, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28343555

RESUMO

OBJECTIVE: To explore factors associated with the diagnosis of provoked vestibulodynia (PVD) through (1) self-reported pain characteristics and (2) Friedrich's criteria (vestibular pain during sexual activity/gynaecological examination). We also identified cases in which incorrect diagnoses were assigned and explored group differences in gynaecological examination presentation and associations with self-reported pain. METHODS: Data were extracted from nine studies conducted in our research laboratory. Information obtained during a telephone interview and a standardized gynaecological examination was compiled for 106 participants with vulvar pain and 106 pain-free control participants, matched for age, hormonal contraceptive use, and parity. RESULTS: Cohen's kappa (0.78) indicated substantial agreement (87.3%) between the telephone interview group categorization and diagnosis after the gynaecological examination. A discriminant function analysis yielded one significant function: Friedrich's first two criteria correctly classified 84.2% of cases, accounting for 76.0% of group membership variance. Of note, those in the other genital pain group were most likely to have received an incorrect diagnosis following the telephone interview (P < 0.001). Paired-samples t tests showed that those with pain reported lower pain intensity during the gynaecological examination than during intercourse (P < 0.001) and that intercourse pain was not necessarily related to pain during the examination. However, many participants (72.8%) indicated that the pain elicited during the cotton swab test was similar to the pain they felt with intercourse. CONCLUSION: These results support the use of a targeted clinical interview and the evaluation of vestibular pain during sexual activity and the gynaecological examination for diagnosing PVD. Caution should be exercised when a patient presents with genital pain symptoms other than those typically observed in PVD. Furthermore, the cotton swab test may underestimate the degree of pain regularly experienced.


Assuntos
Dispareunia/diagnóstico , Exame Ginecológico , Autorrelato , Vulvodinia/diagnóstico , Adolescente , Adulto , Estudos de Casos e Controles , Coito , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Comportamento Sexual , Adulto Jovem
12.
Clin Exp Obstet Gynecol ; 44(2): 268-271, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29746036

RESUMO

This work aimed to analyze the effect of deep infiltrating endometriosis (DIE) in young women. Twenty-seven cases of patients (below 38-years-old) diagnosed with DIE and admitted to the present hospital from January 2008 to July 2014 were reviewed, and their pre- and postoperative states of illness were summarized. The main preoperative symptoms included dysmenorrhea, chronic pelvic pain, dyspareunia, nodule in rectouterine fossa, and reduced level of fertility. All patients underwent surgery (17 laparoscopies and ten laparotomies). Postoperative pathological explanation confirmed DIE in lesions. DIE significantly affects the health of young women.


Assuntos
Endometriose , Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/métodos , Laparotomia/métodos , Adulto , China/epidemiologia , Dismenorreia/diagnóstico , Dismenorreia/etiologia , Dispareunia/diagnóstico , Dispareunia/etiologia , Endometriose/diagnóstico , Endometriose/patologia , Endometriose/fisiopatologia , Endometriose/cirurgia , Feminino , Humanos , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Avaliação de Sintomas/métodos
13.
Anesth Analg ; 123(6): 1535-1545, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27870738

RESUMO

BACKGROUND: Persistent pain after cesarean delivery and vaginal delivery has been the subject of only a few research articles. The primary outcome of our prospective study was the incidence of persistent pain and its association to mode of delivery. We also studied the nature and intensity of pain after delivery. METHODS: A questionnaire was distributed on postpartum day 2 to 1052 women who had given birth vaginally and to 502 who had undergone cesarean delivery in a tertiary maternity hospital in Helsinki, Finland, in 2010. A second questionnaire was mailed to the women 1 year later. We recorded the women's health history, obstetric history and previous pain history, details of cesarean delivery or vaginal delivery, and description of pain, if present. RESULTS: The incidence of persistent pain at 1 year after delivery was greater after cesarean delivery (85/379 [22%]) than after vaginal delivery (58/713 [8%]: P < .001, relative risk 2.8, 95% confidence interval 2.0-3.8). Because of initial differences in the groups, we performed logistic regression analysis with persistent pain as a dependent factor that confirmed the mode of delivery as a predictor of persistent pain. The incidence of persistent pain graded as moderate or more severe (25/379 [7%] vs 25/713 [4%]: P = .022, relative risk 1.9, 95% confidence interval 1.1-3.2) was also greater after cesarean delivery than vaginal delivery. The incidence of persistent pain was significantly more common in women with a history of previous pain and among primiparous women in logistic regression analysis. The women with persistent pain had experienced more pain the day after cesarean delivery (P = .023) and during vaginal delivery (P = .030) than those who did not report persistent pain. Complications such as perineal trauma, episiotomy, vacuum extraction, endometritis, wound infection, or ante- or postpartum depression did not predispose women to persistent pain. Dyspareunia was reported by 41% of women after vaginal delivery and by 2% after cesarean delivery among women with persistent pain at 1 year. CONCLUSIONS: The incidence of persistent pain at 1 year is greater after cesarean delivery than after vaginal delivery. Pain shortly after cesarean delivery and during vaginal delivery correlated with persistent pain.


Assuntos
Cesárea/efeitos adversos , Dispareunia/epidemiologia , Dor do Parto/epidemiologia , Dor Pós-Operatória/epidemiologia , Parto , Adolescente , Adulto , Distribuição de Qui-Quadrado , Dispareunia/diagnóstico , Feminino , Finlândia/epidemiologia , Maternidades , Humanos , Incidência , Dor do Parto/diagnóstico , Modelos Lineares , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Medição da Dor , Dor Pós-Operatória/diagnóstico , Gravidez , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
Obstet Gynecol ; 128(3): 512-8, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27500349

RESUMO

OBJECTIVE: To investigate risk factors for dyspareunia among primiparous women. METHODS: This was a planned secondary analysis using data from the 1- and 6-month postpartum interviews of a prospective study of women who delivered their first neonate in Pennsylvania, 2009-2011. Participants who had resumed sexual intercourse by the 6-month interview (N=2,748) constituted the analytic sample. Women reporting a big or medium problem with painful intercourse at 6 months were categorized as having dyspareunia. Multivariable logistic regression was used to evaluate the effect of patient characteristics, obstetric and psychosocial factors, and breastfeeding on dyspareunia. RESULTS: There were 583 women (21.2%) who reported dyspareunia at 6 months postpartum. Nearly one third of those breastfeeding at 6 months reported dyspareunia (31.5%) compared with 12.7% of those not breastfeeding (adjusted odds ratio [OR] 2.89, 95% confidence interval [CI] 2.33-3.59, P<.001); 32.5% of those reporting a big or medium problem with perineal pain at 1 month reported dyspareunia at 6 months compared with 15.9% of those who did not (adjusted OR 2.45, 95% CI 1.93-3.10, P<.001); 28.3% of women who reported fatigue all or most of the time at 1 month reported dyspareunia at 6 months compared with 18.0% of those who reported fatigue less often (adjusted OR 1.60, 95% CI 1.30-1.98, P<.001); and 24.1% of those who scored in the upper third on the stress scale at 1 month reported dyspareunia at 6 months postpartum compared with 15.6% of those who scored in the lowest third (adjusted OR 1.55, 95% CI 1.18-2.02, P=.001). CONCLUSION: In this prospective cohort study, we identified specific risk factors for dyspareunia in primiparous women that can be discussed at the first postpartum visit, including breastfeeding, perineal pain, fatigue, and stress.


Assuntos
Dispareunia , Paridade/fisiologia , Transtornos Puerperais , Adulto , Aleitamento Materno/estatística & dados numéricos , Dispareunia/diagnóstico , Dispareunia/epidemiologia , Dispareunia/etiologia , Dispareunia/psicologia , Feminino , Humanos , Manejo da Dor/métodos , Medição da Dor/métodos , Pennsylvania/epidemiologia , Período Pós-Parto/fisiologia , Período Pós-Parto/psicologia , Gravidez , Estudos Prospectivos , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/etiologia , Transtornos Puerperais/psicologia , Medição de Risco , Fatores de Risco
15.
Am J Obstet Gynecol ; 215(6): 704-711, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27472999

RESUMO

Genitourinary syndrome of menopause, a new term for a condition more renowned as atrophic vaginitis, is a hypoestrogenic condition with external genital, urological, and sexual implications that affects >50% of postmenopausal women. Due to sexual embarrassment and the sensitive nature of discussing symptoms, genitourinary syndrome of menopause is greatly underdiagnosed. The most up-to-date literature pertaining to clinical manifestations, pathophysiology, etiology, evaluation, and management of genitourinary syndrome of menopause is comprehensively reviewed. Early detection and individually tailored pharmacologic (eg, estrogen therapy, selective estrogen receptor modulator, synthetic steroid, oxytocin, and dehydroepiandrosterone) and/or nonpharmacologic (eg, laser therapies, moisturizers and lubricants, homeopathic remedies, and lifestyle modifications) treatment is paramount for not only improving quality of life but also for preventing exacerbation of symptoms in women with this condition.


Assuntos
Vaginite Atrófica/fisiopatologia , Dispareunia/fisiopatologia , Menopausa , Incontinência Urinária/fisiopatologia , Doenças da Vulva/fisiopatologia , Vaginite Atrófica/diagnóstico , Vaginite Atrófica/metabolismo , Vaginite Atrófica/terapia , Desidroepiandrosterona/uso terapêutico , Dispareunia/diagnóstico , Dispareunia/metabolismo , Dispareunia/terapia , Terapia de Reposição de Estrogênios/métodos , Feminino , Humanos , Estilo de Vida , Terapia com Luz de Baixa Intensidade/métodos , Lubrificantes/uso terapêutico , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Qualidade de Vida , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Síndrome , Incontinência Urinária/diagnóstico , Incontinência Urinária/metabolismo , Incontinência Urinária/terapia , Doenças da Vulva/diagnóstico , Doenças da Vulva/metabolismo , Doenças da Vulva/terapia
16.
J Sex Med ; 13(8): 1255-62, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27329543

RESUMO

INTRODUCTION: Current information processing models propose that heightened attention bias for sex-related threats (eg, pain) and lowered automatic incentive processes ("wanting") may play an important role in the impairment of sexual arousal and the development of sexual dysfunctions such as genitopelvic pain/penetration disorder (GPPPD). Differential threat and incentive processing may also help explain the stronger persistence of coital avoidance in women with vaginismus compared to women with dyspareunia. AIMS: As the first aim, we tested if women with GPPPD show (1) heightened attention for pain and sex, and (2) heightened threat and lower incentive associations with sexual penetration. Second, we examined whether the stronger persistence of coital avoidance in vaginismus vs dyspareunia might be explained by a stronger attentional bias or more dysfunctional automatic threat/incentive associations. METHODS: Women with lifelong vaginismus (n = 37), dyspareunia (n = 29), and a no-symptoms comparison group (n = 51) completed a visual search task to assess attentional bias, and single target implicit-association tests to measure automatic sex-threat and sex-wanting associations. RESULTS: There were no group differences in attentional bias or automatic associations. Correlational analysis showed that slowed detection of sex stimuli and stronger automatic threat associations were related to lowered sexual arousal. CONCLUSION: The findings do not corroborate the view that attentional bias for pain or sex contributes to coital pain, or that differences in coital avoidance may be explained by differences in attentional bias or automatic threat/incentive associations. However, the correlational findings are consistent with the view that automatic threat associations and impaired attention for sex stimuli may interfere with the generation of sexual arousal.


Assuntos
Viés de Atenção/fisiologia , Dispareunia/psicologia , Disfunções Sexuais Psicogênicas/psicologia , Vaginismo/psicologia , Adulto , Nível de Alerta/fisiologia , Estudos de Casos e Controles , Coito/psicologia , Dispareunia/diagnóstico , Emoções , Feminino , Humanos , Motivação , Dor/psicologia , Medição da Dor/métodos , Comportamento Sexual/psicologia , Vaginismo/diagnóstico , Adulto Jovem
17.
J Sex Med ; 13(4): 572-90, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27045258

RESUMO

INTRODUCTION: Vulvodynia constitutes a highly prevalent form of sexual pain in women, and current information regarding its assessment and treatment is needed. AIM: To update the scientific evidence published in 2010, from the Third International Consultation on Sexual Medicine, pertaining to the assessment and treatment of women's sexual pain. METHODS: An expert committee, as part of the Fourth International Consultation on Sexual Medicine, was comprised of researchers and clinicians from biological and social science disciplines for the review of the scientific evidence on the assessment and treatment of women's genital pain. MAIN OUTCOME MEASURES: A review of assessment and treatment strategies involved in vulvodynia. RESULTS: We recommend the following treatments for the management of vulvodynia: psychological interventions, pelvic floor physical therapy, and vestibulectomy (for provoked vestibulodynia). We also support the use of multidisciplinary treatment approaches for the management of vulvodynia; however, more studies are needed to determine which components are most important. We recommend waiting for more empirical evidence before recommending alternative treatment options, anti-inflammatory agents, hormonal agents, and anticonvulsant medications. Although we do not recommend lidocaine, topical corticosteroids, or antidepressant medication for the management of vulvodynia, we suggest that capsaicin, botulinum toxin, and interferon be considered second-line avenues and that their recommendation be revisited once further research is conducted. CONCLUSION: A comprehensive assessment is needed to understand the pain experience of women presenting with vulvodynia. In addition, treatment typically progresses from less invasive to more invasive, and several treatment options are worth pursuing.


Assuntos
Dispareunia/diagnóstico , Dispareunia/terapia , Diafragma da Pelve/fisiopatologia , Comportamento Sexual/psicologia , Vulvodinia/diagnóstico , Vulvodinia/terapia , Inibidores da Liberação da Acetilcolina/administração & dosagem , Adulto , Toxinas Botulínicas/administração & dosagem , Capsaicina/administração & dosagem , Terapia Cognitivo-Comportamental , Terapia Combinada , Dispareunia/fisiopatologia , Dispareunia/psicologia , Feminino , Humanos , Comunicação Interdisciplinar , Interferons/administração & dosagem , Modalidades de Fisioterapia , Fármacos do Sistema Sensorial/administração & dosagem , Vulvodinia/fisiopatologia , Vulvodinia/psicologia
18.
Sex Reprod Healthc ; 7: 65-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26826048

RESUMO

OBJECTIVE: The aim of the study was to identify and describe the experiences of healthcare professionals when meeting women with symptoms that might indicate endometriosis. METHODS: Semi-structured interviews were conducted with 10 gynecologists, six general practitioners and nine midwives working at one university hospital, one central hospital, one private gynecology clinic and five healthcare centers in south-east Sweden. The interviews were recorded and transcribed verbatim and analyzed using qualitative conventional content analysis. RESULTS: Three clusters were identified: the corroborating encounter, the normal variation of menstruation cycles, and the suspicion of endometriosis. The healthcare professionals tried to make a corroborating encounter by acknowledging the woman, taking time to listen, and giving an explanation for the problems. Healthcare professionals had different ways to determine what was normal as regards menstrual pain, ovulation pain and dyspareunia. They also needed to have the competence to act and react when the symptoms indicated endometriosis. CONCLUSIONS: Meeting women with symptoms that might indicate endometriosis is challenging and demands a certain level of competence from healthcare professionals. Sometimes the symptoms are camouflaged as "normal" menstruation pain, making it hard to satisfy the needs of this patient group.


Assuntos
Assistência à Saúde/normas , Endometriose/diagnóstico , Enfermeiras Obstétricas , Dor Pélvica/diagnóstico , Médicos , Competência Profissional , Relações Profissional-Paciente , Adulto , Idoso , Dismenorreia/diagnóstico , Dismenorreia/etiologia , Dispareunia/diagnóstico , Dispareunia/etiologia , Endometriose/complicações , Feminino , Ginecologia , Humanos , Masculino , Menstruação , Pessoa de Meia-Idade , Ovulação , Dor Pélvica/etiologia , Suécia
19.
Eur Urol ; 70(2): 223-6, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26572706

RESUMO

UNLABELLED: Several alterations of orgasmic function that occur after radical prostatectomy (RP) have never been assessed in robot-assisted RP (RARP) series. We sought to assess the prevalence and predictors of recovery from orgasm-associated incontinence (climacturia) and painful orgasm (PO) after RARP and open RP (ORP). Following surgery, sexually active patients who had undergone either RARP or ORP prospectively completed a 28-item questionnaire including sensitive issues regarding sexual function (eg, climacturia and PO). Rates of postoperative climacturia and PO were compared for RARP and ORP patients. Kaplan-Meier analysis was applied to assess estimated rates of recovery from either climacturia or PO after both procedures. Cox regression models tested predictors of recovery from those conditions. Overall, 221 (29.5%) of 749 patients reported climacturia, without differences between RARP and ORP. Conversely, PO was significantly more frequently reported after ORP than after RARP (46 [11.6%] vs 25 [7.1%] patients, respectively; p=0.04). At Kaplan-Meier analysis, recovery from climacturia over time was faster and greater after RARP than after ORP (8.5% vs 5%, respectively, at 24-mo assessment and 48% vs 15%, respectively, at 84-mo assessment; p<0.01). Conversely, no differences were found between groups in terms of postoperative recovery from PO. At multivariable analysis, only RARP achieved independent predictor status for recovery from climacturia after adjusting for other functional outcomes. Conversely, no variables were significantly associated with recovery from postoperative PO. PATIENT SUMMARY: Orgasmic modifications such as climacturia and painful orgasm (PO) are frequently reported after radical prostatectomy. Robotic surgery was associated with a lower rate of postoperative PO and with greater and faster recovery from climacturia.


Assuntos
Dispareunia , Complicações Pós-Operatórias , Prostatectomia , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Disfunções Sexuais Psicogênicas , Incontinência Urinária , Dispareunia/diagnóstico , Dispareunia/epidemiologia , Dispareunia/etiologia , Humanos , Itália/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prevalência , Modelos de Riscos Proporcionais , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Recuperação de Função Fisiológica , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/epidemiologia , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Incontinência Urinária/diagnóstico , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
20.
Arch Gynecol Obstet ; 293(2): 439-45, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26329801

RESUMO

PURPOSE: The link between endometriosis and the presence or intensity of pain is controversial. The aim of the present study was to assess the relationship between chronic pelvic pain (CPP) and severity of endometriosis and the effectiveness of laparoscopic treatment in a 6-month follow-up. METHODS: Prospective observational study in a referral unit. 144 women had laparoscopy to investigate CPP. Symptoms were assessed by a 10-point visual analog scale. The main outcome measure was the frequency and intensity of CPP. RESULTS: No difference in pain was found between women with and without endometriosis. Advanced endometriosis was associated with dysmenorrhea, deep endometriosis with dyspareunia and rectovaginal disease with dyschezia. Laparoscopic treatment improves symptoms. CONCLUSIONS: Women with severe endometriosis are more likely to report severe dysmenorrhoea. Furthermore location of endometriosis in the rectovaginal space is associated with dyschezia and deep endometriosis with dyspareunia. However, the association between presence and stage of endometriosis and severity of symptoms is marginal.


Assuntos
Dor Crônica/etiologia , Endometriose/complicações , Dor Pélvica/etiologia , Adulto , Estudos de Casos e Controles , Dor Crônica/epidemiologia , Dismenorreia/complicações , Dismenorreia/diagnóstico , Dismenorreia/etiologia , Dispareunia/diagnóstico , Dispareunia/etiologia , Endometriose/diagnóstico , Endometriose/patologia , Endometriose/cirurgia , Feminino , Seguimentos , Serviços de Saúde , Humanos , Laparoscopia , Pessoa de Meia-Idade , Medição da Dor , Dor Pélvica/epidemiologia , Estudos Prospectivos , Resultado do Tratamento , Escala Visual Analógica
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