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1.
Neurourol Urodyn ; 38(8): 2333-2350, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31483064

RESUMO

OBJECTIVE: To investigate changes in whole body pain during urologic chronic pelvic pain syndrome (UCPPS) flares. MATERIALS AND METHODS: UCPPS participants at one site of the multidisciplinary approach to the study of chronic pelvic pain research network reported their daily flare status and pain levels in 7 pelvic/genital and 42 extrapelvic body areas (scale = 0-10) for 10 days at baseline and during their first flare. Linear mixed models and conditional logistic regression were used to investigate symptom changes during flares. Analyses were stratified by chronic overlapping pain condition (COPC) status. RESULTS: Fifty-five out of 60 participants completed the study, 27 of whom provided information on both nonflare (n = 281) and flare (n = 208) days. Pelvic/genital pain intensity (mean change = 3.20 of 10) and widespreadness (mean = 1.48) increased significantly during flares for all participants (all P interaction > .1), whereas extrapelvic pain intensity increased significantly only among participants with COPCs (mean = 2.09; P interaction < .0001). Pelvic/genital and extrapelvic pain also varied on nonflare days but symptom fluctuations were generally ≤1 point (80.0%-100% of participants). Increases of ≥2 points in pelvic/genital pain intensity (odds ratio (OR) = 22.0, 95% confidence interval (CI) = 4.0-118.6) and ≥1 point in urination-related pain (OR = 9.10, 95% CI = 1.74-47.7) were independently associated with flare onset for all participants. CONCLUSION: Our observations of extrapelvic pain increases during flares for patients with COPCs and our independent associations between pelvic/genital/urination-related pain intensity and flare onset may provide insight into mechanisms underlying flare development (eg, common biologic pathways between UCPPS phenotypes and flares), flare management (eg, local vs systemic therapies by COPC status), and patient flare definitions.


Assuntos
Medição da Dor , Dor Pélvica/psicologia , Doenças Urológicas/psicologia , Cistite Intersticial/complicações , Feminino , Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Femininos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pélvica/etiologia , Transtornos Urinários/complicações , Transtornos Urinários/psicologia , Doenças Urológicas/complicações
2.
Am J Clin Dermatol ; 20(5): 639-646, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31313079

RESUMO

Psoriasis involving the genital skin occurs in up to two-thirds of psoriasis patients but is often overlooked by physicians. Furthermore, psoriasis objective and subjective severity indexes for common plaque psoriasis often neglect the impact this small area of psoriasis can have on a patient. It can have a significant impact on patients' psychosocial function due to intrusive physical symptoms such as genital itch and pain, and a detrimental impact on sexual health and impaired relationships. The mainstay of treatment is topical therapy. In patients with genital psoriasis refractory to traditional topical treatment, biologic treatments may greatly improve patient outcomes.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Doenças dos Genitais Femininos/terapia , Doenças dos Genitais Masculinos/terapia , Fototerapia/métodos , Psoríase/terapia , Fatores Biológicos/uso terapêutico , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/psicologia , Genitália Feminina/patologia , Genitália Masculina/patologia , Humanos , Masculino , Psoríase/diagnóstico , Psoríase/psicologia , Angústia Psicológica , Qualidade de Vida , Índice de Gravidade de Doença , Saúde Sexual , Pele/patologia , Resultado do Tratamento
3.
Maturitas ; 125: 57-62, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31133219

RESUMO

OBJECTIVES: Treatments for genitourinary syndrome of menopause (GSM) may not be suitable for all women, may not be completely effective, and may cause adverse effects. Therefore, there is a need to explore new treatment approaches. The objectives were to evaluate the feasibility of using a pelvic floor muscle training (PFMT) program in postmenopausal women with GSM, and to investigate its effect on symptoms, signs, activities of daily living (ADL), quality of life (QoL) and sexual function. STUDY DESIGN: Postmenopausal women with GSM participated in a single-arm feasibility study embedded in a randomized controlled trial (RCT) on PFMT for urinary incontinence. This substudy was composed of two pre-intervention evaluations, a 12-week PFMT program and a post-intervention evaluation. MAIN OUTCOME MEASURES: Feasibility was defined as study completion and participation in physiotherapy sessions and in-home exercises. The effects of the PFMT program were assessed by measuring GSM symptoms ('Most Bothersome Symptom' approach, ICIQ-UI SF), GSM signs (Vaginal Health assessment scale), GSM's impact on ADL (Atrophy Symptom questionnaire), QoL and sexual function (ICIQ-VS, ICIQ-FLUTSsex) and leakage episodes. RESULTS: Thirty-two women participated. The study completion rate was high (91%), as was participation in treatment sessions (96%) and in-home exercises (95%). Post-intervention, there were significant reductions in GSM symptoms and signs (p < 0.01) as well as in its impacts on ADL, QoL and sexual function (p < 0.05). CONCLUSIONS: A study including a PFMT program is feasible, and the outcomes indicate PFMT to be an effective treatment approach for postmenopausal women with GSM and urinary incontinence. This intervention should be assessed through a RCT.


Assuntos
Atrofia/fisiopatologia , Terapia por Exercício/métodos , Menopausa , Diafragma da Pelve/fisiopatologia , Incontinência Urinária/reabilitação , Vagina/fisiopatologia , Atividades Cotidianas , Idoso , Atrofia/patologia , Terapia por Estimulação Elétrica , Estudos de Viabilidade , Feminino , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Femininos/reabilitação , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Sexualidade , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/psicologia , Vagina/patologia
4.
Br J Dermatol ; 180(3): 647-656, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30188572

RESUMO

BACKGROUND: Genital psoriasis is often under-recognized. OBJECTIVES: To assess the instantaneous prevalence of genital psoriasis and describe its clinical features, association with a particular subtype of psoriasis and its impact on general and sexual quality of life (QoL). METHODS: GENIPSO is a prospective study conducted by private and hospital-based dermatologists. This study featured the consecutive inclusion of patients consulting for extragenital psoriasis. The clinical features of psoriasis and genital psoriasis were recorded and QoL and sexual health questionnaires were distributed to patients. RESULTS: Overall, 335 of 776 patients (43·2%) included in the study had genital involvement. All were aware that they had genital lesions but only 135 patients (40%) declared that they had been previously examined. Genital lesions were associated with male sex, severity of psoriasis, age of onset > 20 years, inverse psoriasis and involvement of scalp, nail and external auditory canal, but were not associated with obesity, psoriatic arthritis and active sex life. Itching was the main symptom. Genital psoriasis was associated with impairment of QoL and sexual health according to the Dermatology Life Quality Index and the Female Sexual Function Index. CONCLUSIONS: Genital psoriasis has a high prevalence in patients consulting for extragenital psoriasis, which affects QoL, and should be taken into account by dermatologists in order to optimize global care.


Assuntos
Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Psoríase/epidemiologia , Qualidade de Vida , Saúde Sexual , Adulto , Idoso , Estudos Transversais , Feminino , França/epidemiologia , Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/complicações , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Psoríase/complicações , Psoríase/diagnóstico , Psoríase/psicologia , Encaminhamento e Consulta/estatística & dados numéricos , Índice de Gravidade de Doença , Inquéritos e Questionários/estatística & dados numéricos
5.
Sex Med Rev ; 7(1): 2-12, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30301706

RESUMO

INTRODUCTION: Persistent genital arousal disorder (PGAD) is a highly distressing and poorly understood condition characterized by unwanted sensations of genital arousal in the absence of subjective sexual desire. Research has shown that some individuals with PGAD also report orgasm, urinary, and pain symptoms, with 1 recent study specifically comparing a "painful persistent genital arousal symptom" group to a "non-painful persistent genital arousal symptom" group on various indicators given the highly frequent report of comorbid genitopelvic pain in their sample. AIM: To review literature on PGAD focusing on the presence of pain symptoms. METHODS: A literature review through May 2018 was undertaken to identify articles that discuss pain characteristics in individuals with persistent sexual arousal syndrome, persistent genital arousal disorder, symptoms of persistent genital arousal, and restless genital syndrome. MAIN OUTCOME MEASURE: A review of pain/discomfort associated with persistent genital arousal, and the proposal of a new theoretical framework of genitopelvic dysesthesias. RESULTS: PGAD is a distressing condition that is associated with a significant, negative impacts on psychosocial and daily functioning. Although it is clear that unwanted and persistent genital arousal is the hallmark symptom of PGAD, symptoms of pain and discomfort are also frequently reported. Based on the results of this review, a model of genitopelvic dysesthesias is proposed, with subcategories of unpleasant sensations that are based on patients' primary complaint: arousal, arousal and pain, or pain (and other sensations). CONCLUSION: The proposed model can provide an important framework for conceptualizing conditions characterized by unpleasant genitopelvic sensations. A model such as this one can benefit highly misunderstood conditions that are questioned in terms of their legitimacy and severity-such as PGAD-by conceptualizing them as sensory disorders, which in turn can reduce stigma, unify research efforts, and potentially improve access to care. Pukall CF, Jackowich R, Mooney K, et al. Genital Sensations in Persistent Genital Arousal Disorder: A Case for an Overarching Nosology of Genitopelvic Dysesthesias? Sex Med Rev 2019;7:2-12.


Assuntos
Doenças dos Genitais Femininos/fisiopatologia , Doenças dos Genitais Masculinos/fisiopatologia , Genitália/inervação , Parestesia/fisiopatologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Ansiedade , Nível de Alerta/fisiologia , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/psicologia , Humanos , Masculino , Parestesia/complicações , Parestesia/psicologia , Qualidade de Vida , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/psicologia
6.
Acta Clin Croat ; 58(3): 410-416, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31969751

RESUMO

The aim of the study was to assess the role of behavioral factors in persistence of human papillomavirus (HPV) genital infection. Out of a cohort of 605 women included in a study of HPV infection prevalence, 142 HPV positive women (aged 18-57) were retested after a 12-month interval. None of the patients underwent surgical treatment during that period. Selected patients were asked for a second smear for cytologic analysis and HPV genotyping. A questionnaire that included information regarding reproductive health, sexual activity and smoking status was filled-in. After 12 months, 46 of 142 (32.39%) women had persistent HPV infection, with genotypes 16 and 18 found in 27 cases. On the other hand, 17 of 142 (11.97%) women had acquired new infections replacing the baseline genotypes. In our study, smoking (OR=2.320, p=0.0330) and sexual behavior (OR=5.333, p=0.0180 for more than three sexual partners; OR=2.427, p=0.0238 for cases where the partner was involved in another sexual relationship) were associated with viral persistence, while long-term contraception did not yield statistically significant results.


Assuntos
Doenças dos Genitais Femininos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus , Comportamento Sexual , Adulto , Estudos de Coortes , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Femininos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/psicologia , Prevalência , Fatores de Risco , Romênia/epidemiologia , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/psicologia , Fumar/epidemiologia
7.
Zhonghua Fu Chan Ke Za Zhi ; 53(5): 313-318, 2018 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-29804349

RESUMO

Objective: To assess the disease burden for gynecological disease in China in 2016. Methods: Data were extracted from the global burden of disease study 2016 (GBD 2016) . The burden of gynecological disease among age groups and provinces groups was assessed by prevalence rate, mortality rate, years lived with disability (YLD) , years of life lost due to premature mortality (YLL) and disability-adjusted life years (DALY) . An average world population age-structure for the period 2010-2035 was adopted to calculate age-standardized rates. Results: In 2016, the prevalence rate of gynecological disease in women aged 15 years and above in China was 24.94%, of which was 36.71% to women of childbearing age. The number of DALY from gynecological disease was 2 727 637.82 life years in 2016, with the DALY rate was 411.12/100 000 and standardized DALY rate was 341.80/100 000. The first three gynecological diseases with highest DALY and DALY rate among Chinese women aged ≥15 years were premenstrual syndrome (815 004.64 life years, 122.84/100 000) , uterine fibroids (281 976.67 life years, 42.5/100 000) and endometriosis (154 792.89 life years, 23.33/100 000) . The DALY caused by gynecological disease in Guangdong (220 871.19 life years) , Shandong (190 968.72 life years) , Henan (171 273.92 life years) , Jiangsu (168 404.27 life years) and Sichuan (144 358.5 life years) were higher than other provinces. The standardized DALY rate attributable to gynecological disease were highest in Xinjiang Uygur Autonomous Region (404.00/100 000) , Shanghai (394.90/100 000) , Heilongjiang (382.00/100 000) , Beijing (365.70/100 000) and Jiangsu (357.50/100 000). Conclusions: Gynecological disease is a great threat to women's reproductive health. Effective measures should be taken to address the issue, especially to women of childbearing age.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Efeitos Psicossociais da Doença , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Femininos/psicologia , Anos de Vida Ajustados por Qualidade de Vida , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , China/epidemiologia , Pessoas com Deficiência , Feminino , Humanos , Masculino , Síndrome Pré-Menstrual , Prevalência , Padrões de Referência , Saúde da Mulher
8.
Rev Bras Ginecol Obstet ; 40(2): 72-78, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29342494

RESUMO

OBJECTIVE: To analyze the reaction of women after reading the Informed Consent Form (ICF) before undergoing elective gynecological/urogynecological surgeries. METHODS: A qualitative study with 53 women was conducted between September 2014 and May 2015. The analysis of the content was conducted after a scripted interview was made in a reserved room and transcribed verbatim. We read the ICF once more in front of the patient, and then she was interviewed according to a script of questions about emotions and reactions that occurred about the procedure and her expectations about the intra- and postoperative period. RESULTS: The women had a mean age of 52 years, they were multiparous, and most had only a few years of schooling (54.7%). The majority (60.4%) of them had undergone urogynecological surgeries. Hysterectomy and colpoperineoplasty were the most frequent procedures. Ten women had not undergone any previous abdominal surgery. Fear (34.6%) was the feeling that emerged most frequently from the interviews after reading the ICF, followed by indifference (30.8%) and resignation (13.5%). Nine women considered their reaction unexpected after reading the ICF. Three patients did not consider the information contained in the ICF to be sufficient, and 3 had questions about the surgery after reading the document. CONCLUSION: Reading the ICF generates fear in most women; however, they believe this feeling did not interfere in their decision-making process.


Assuntos
Atitude , Termos de Consentimento , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Leitura , Autorrelato
9.
Salud Publica Mex ; 60(6): 624-632, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30699267

RESUMO

OBJECTIVE: To estimate the burden of genital warts (GW)in Mexico. MATERIALS AND METHODS: We estimated the annual incidence of GW based on data reported by specialist physicians. We also assessed GW treatment practices, the average cost of treatment, and the psychosocial burden of GW among patients. RESULTS: The annual incidence of GW in Mexico was estimated to be 547 200 cases. Treatment procedures vary by specialist and patient gender. The estimated annual cost was $195 million USD. The psychosocial impact of GW was slightly greater in males than females. CONCLUSIONS: This is the first evaluation of the burden of GW in Mexico. Our data suggest that GW are common, with significant health-related costs and psychosocial impact.


Assuntos
Doenças do Ânus/epidemiologia , Condiloma Acuminado/epidemiologia , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Adulto , Doenças do Ânus/economia , Doenças do Ânus/psicologia , Doenças do Ânus/terapia , Terapia Combinada , Condiloma Acuminado/economia , Condiloma Acuminado/psicologia , Condiloma Acuminado/terapia , Efeitos Psicossociais da Doença , Feminino , Doenças dos Genitais Femininos/economia , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Femininos/terapia , Doenças dos Genitais Masculinos/economia , Doenças dos Genitais Masculinos/psicologia , Doenças dos Genitais Masculinos/terapia , Custos de Cuidados de Saúde , Inquéritos Epidemiológicos , Humanos , Incidência , Masculino , Medicina/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Vacinas contra Papillomavirus , Prevalência , Qualidade de Vida
10.
Nat Rev Urol ; 15(1): 25-41, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29182603

RESUMO

Genital pain is a prevalent, complex, and disabling health concern in women. Efforts to study this chronic pain condition have been complicated by the fact that genital pain is heterogeneous and exists at the intersection of different biopsychosocial disciplines. Thus, organization of theoretical ideas and empirical findings across research areas is required to improve our understanding of how biopsychosocial factors affect the development and maintenance of the pain, the reporting of symptoms, and the choice of treatment. In the past, the study of physical markers has received the most research attention; an assimilation of the psychosocial variables underlying genital pain is, therefore, particularly needed to inform the field about the rapidly growing literature and stimulate interdisciplinary work. Current research lacks specificity, fails to capture the unique features of different pain conditions, and yields conflicting evidence, which makes it difficult to draw uniform conclusions. Although considerable advances have been made, confusion remains at the nosological, aetiological, theoretical, methodological, and treatment levels. This lack of consensus has important theoretical and clinical implications because inconsistent criteria and empirical disagreement can lead to misdiagnoses and interfere with the development of sound theoretical models and effective treatments to manage female genital pain and its physical and psychological sequelae.


Assuntos
Dor Crônica/psicologia , Doenças dos Genitais Femininos/psicologia , Dor Pélvica/psicologia , Anestésicos Locais , Pesquisa Biomédica , Dor Crônica/diagnóstico , Dor Crônica/terapia , Terapia Cognitivo-Comportamental , Erros de Diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/terapia , Humanos , Atenção Plena , Modelos Psicológicos , Medição da Dor , Dor Pélvica/diagnóstico , Dor Pélvica/terapia , Teoria Psicológica , Parceiros Sexuais
11.
Eur J Contracept Reprod Health Care ; 22(5): 375-380, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29131725

RESUMO

OBJECTIVES: Unintended pregnancy contributes to morbidities, such as obstetric fistula. Furthermore, after fistula repair, women should avoid pregnancy for a year to prevent its breakdown. Our study objective was to evaluate the contraceptive knowledge, practices and intentions of women undergoing obstetric fistula repair at a centre in Malawi. METHODS: This cross-sectional study used a standardised survey to examine the contraceptive knowledge, practices and intentions of women undergoing obstetric fistula repair in Lilongwe, Malawi, between September 2011 and November 2014. Log binomial models were used to examine correlates of prior and planned contraceptive use. RESULTS: The analysis included 569 women, of whom 61.3% had heard of, and 38.7% had used a modern method of contraception. Women aged 20-49 years, married, with secondary education or higher and with living children were significantly more likely to report prior use of a modern contraceptive method. Of the 354 women who still had reproductive potential (premenopausal women who had not undergone sterilisation) and answered questions on future contraceptive use, less than half (41.6%) planned to use a modern method of contraception after fistula repair. Planned modern contraceptive use was significantly associated with being currently married and having secondary education or higher. CONCLUSIONS: Contraceptive knowledge, prior use and planned future use were low in our study population. To increase contraceptive use among women undergoing obstetric fistula repair, interventions in the postoperative period must seek to increase their family planning knowledge and access to contraceptive methods.


Assuntos
Anticoncepção/psicologia , Fístula/psicologia , Doenças dos Genitais Femininos/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Complicações na Gravidez/psicologia , Adulto , Comportamento Contraceptivo/psicologia , Estudos Transversais , Feminino , Fístula/cirurgia , Doenças dos Genitais Femininos/cirurgia , Humanos , Intenção , Malaui , Casamento/psicologia , Gravidez , Complicações na Gravidez/cirurgia , Inquéritos e Questionários , Adulto Jovem
12.
Complement Ther Clin Pract ; 28: 4-8, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28779936

RESUMO

OBJECTIVE: To assess the effects of yoga nidra on psychological problems in women with menstrual disorders. METHODS: A search was conducted using CINAHL, the Cochrane library, Embase, PsycINFO, and PubMed electronic databases, and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), to identify randomized controlled trials (RCTs) published in any language up to and including July 2016, which reported the psychological effects of yoga nidra in women with menstrual disorders. RESULTS: Two potential trials were identified and both were included in the review. A significant difference was observed between experimental and control groups in that anxiety and depression were significantly decreased in the experimental group when compared with the control group. CONCLUSIONS: There is evidence from two RCTs that yoga nidra may have favorable effects in terms of reducing psychological problems in women with menstrual disorders.


Assuntos
Ansiedade/prevenção & controle , Depressão/prevenção & controle , Doenças dos Genitais Femininos/psicologia , Meditação/psicologia , Menstruação/psicologia , Ioga/psicologia , Transtorno Depressivo , Feminino , Humanos
13.
Sex Transm Dis ; 44(7): 417-422, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28608791

RESUMO

BACKGROUND: Repeat chlamydia detection after treatment is common, and there is concern that treatment failure may be a cause. METHODS: Within a randomized trial, we established a prospective cohort of 600 participants with anogenital chlamydia diagnoses (200 each of women, heterosexual men, and men who have sex with men [MSM]). Participants were invited for repeat testing at 3 months and to complete a behavioral survey at 4 months. Positive samples were analyzed for organism DNA load and genovar. We estimated repeat chlamydia positivity, reinfection and treatment failure rates, and investigated the biological and behavioral factors associated with a repeat positive test. RESULTS: A total of 290 participants (100 women, 89 heterosexual men, 101 MSM) were retested at 1 to 4 months, with 43 repeat positives, including 26 classed as reinfection and 9 as treatment failures. Comparing MSM with heterosexual men and women combined, repeat positivity was higher (20.8% vs 11.6%, P = 0.04), and treatment failure was higher (6.9% vs 1.1%, P = 0.01), but there was no difference in reinfection rates (11.9% vs 7.4%, P = 0.21). Among MSM, the odds of repeat positivity increased by 90% with each additional log organism load in the original specimen (baseline) (adjusted odds ratio, 1.9; 95% confidence interval, 1.1-3.2). Among heterosexuals, the odds of repeat positivity decreased by 10% with each additional week delay in being retested for chlamydia (adjusted odds ratio, 0.9; 95% confidence interval, 0.8-0.9). CONCLUSIONS: Positive retests were more common among MSM than heterosexuals. Treatment failure was more common in MSM with rectal chlamydia, reinforcing concerns about azithromycin treatment failure.


Assuntos
Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Chlamydia trachomatis/efeitos dos fármacos , Heterossexualidade/psicologia , Homossexualidade Masculina/psicologia , Cooperação do Paciente , Adulto , Antibacterianos/uso terapêutico , Austrália/epidemiologia , Azitromicina/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Feminino , Seguimentos , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/tratamento farmacológico , Doenças dos Genitais Masculinos/psicologia , Humanos , Masculino , Programas de Rastreamento/métodos , Estudos Prospectivos , Doenças Retais/diagnóstico , Doenças Retais/tratamento farmacológico , Doenças Retais/psicologia , Recidiva , Falha de Tratamento , Adulto Jovem
14.
Int Urogynecol J ; 28(6): 893-897, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27822885

RESUMO

INTRODUCTION AND HYPOTHESIS: High levels of mental health dysfunction have been identified in women with genital tract fistula. The aim of this study was to use the General Health Questionnaire-28 (GHQ-28) to screen women in western Uganda with severe pelvic organ prolapse, chronic fourth-degree obstetric tear and genital tract fistula for risk of mental health dysfunction. METHODS: Women undergoing surgery for severe pelvic organ prolapse, chronic fourth-degree obstetric tear, and genital tract fistula were interviewed using the GHQ-28 to screen for the risk of mental health dysfunction. RESULTS: A total of 125 women completed the GHQ-28, including 22 with pelvic organ prolapse, 47 with fourth-degree obstetric tear, 21 with genital tract fistula, and 35 controls. Nearly all women with these serious gynaecological conditions were positive for the risk of mental health dysfunction. In the domain assessing symptoms of severe depression, women with fourth-degree obstetric tear and genital tract fistula scored higher than women with pelvic organ prolapse. CONCLUSIONS: A significant risk of mental health dysfunction was identified in women with severe pelvic organ prolapse and chronic fourth-degree obstetric tear. These rates are similar to the high rates of mental health dysfunction in women with genital tract fistula. Identification and management of mental health dysfunction in women with these conditions should be a priority.


Assuntos
Parto Obstétrico/efeitos adversos , Transtorno Depressivo Maior/etiologia , Fístula/psicologia , Doenças dos Genitais Femininos/psicologia , Prolapso de Órgão Pélvico/psicologia , Adulto , Parto Obstétrico/psicologia , Feminino , Genitália Feminina/lesões , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Fatores de Risco , Uganda , Fístula Vaginal/psicologia
15.
BMC Pregnancy Childbirth ; 16: 2, 2016 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-26732574

RESUMO

BACKGROUND: Obstetric fistula affects a woman's life physically, psychosocially, and economically. Although surgery can repair the physical damage of fistula, the devastating consequences that affect a woman's quality of life may persist when she reintegrates into her community. This qualitative study assessed long-term outcomes among women who underwent obstetric fistula repair in Malawi. We explored three domains: overall quality of life before and after repair, fertility and pregnancy outcomes after repair, and understanding of fistula. METHODS: In-depth interviews were conducted in Chichewa with 20 women from seven districts across Central Malawi. All women were interviewed 1 to 2 years after surgical repair for obstetric fistula at the Fistula Care Centre in Lilongwe, Malawi. Interviews were independently coded and analyzed using content analysis. RESULTS: About half of women were married and nine of 20 women reported some degree of urinary incontinence. With the exception of relationship challenges, women's concerns before and after repair were different. Additionally, repair had resolved many of the concerns women had before repair. However, challenges, both directly and indirectly related to fistula, persisted. Improvements in quality of life at the individual level included feelings of freedom, confidence and personal growth, and improved income-earning ability. Interpersonal quality of life improvements included improved relationships with family and friends, reduced stigma, and increased participation with their communities. Nearly half of women desired future pregnancies, but many were uncertain about their ability to bear children and feared additional pregnancies could cause fistula recurrence. Most women were well informed about fistula development but myths about witchcraft and fear of delivery were present. Nearly all women would recommend fistula repair to other women, and many were advocates in their communities. CONCLUSIONS: Nearly all women believed their quality of life had improved at the individual and interpersonal levels since fistula repair, even among women who continued to have urinary incontinence. Contrary to other studies, women reported they were welcomed back by their communities and had limited challenges when reintegrating. Despite the overall improvements in quality of life, many continued to have relationship problems and were concerned about future fertility. These issues need to be further explored in other studies.


Assuntos
Fístula/psicologia , Doenças dos Genitais Femininos/psicologia , Procedimentos Cirúrgicos Obstétricos/psicologia , Adulto , Idoso , Feminino , Fístula/cirurgia , Doenças dos Genitais Femininos/cirurgia , Humanos , Malaui , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Obstétricos/efeitos adversos , Procedimentos Cirúrgicos Obstétricos/métodos , Gravidez , Pesquisa Qualitativa , Qualidade de Vida , Estigma Social , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia , Fístula Vaginal/psicologia , Fístula Vaginal/cirurgia , Adulto Jovem
16.
Pan Afr Med J ; 25: 79, 2016.
Artigo em Francês | MEDLINE | ID: mdl-28292042

RESUMO

Any illness is viewed as inherently evil, so it must be eradicated because it often significantly affect the quality of life. Vaginal hysterectomy is indicated in patients with some severe gynecological conditions; it is beneficial but can also have a detrimental impact on women's quality of life. The aim of our study was to explore subjective experience of the disease and vaginal hysterectomy (VH) among women before and after surgery. We conducted a qualitative prospective study based on clinical data collection over a period of 12 months; it involved women who had undergone vaginal hysterectomy. Those who decided not to take part in this study or lack of phone contact were not enrolled. During their disease, women experienced: discomfort during sex 26/40 (65%); vaginal bleeding 12/40 (30%); 13/40 pelvic pain (32.5%). Postoperatively, transient dyspareunia 30/40 (75%); headache after anesthesia 4/40 (10%) were noted. Women's psychological experience before VH was dominated by surgery fear in all patients, sleep disorders 38/40 (95%), anxiety 30/40 (75%), feelings of shame related to difficulty in performing the sexual intercourse because of prolapse 26/40 (65%) and/or because of genital bleeding due to uterine fibroids 14/40 (35%). The feeling of loss of femininity was reported in 26/40 women with uterine prolapse (65%), changes in self-esteem in 26/40 (65%). These subjective assessments were improved in women undergoing VH, offsetting the loss of their reproductive organ. No information was given by women to their loved ones and family members before surgery, reflecting their feeling of embarrassment or shame. The cessation of symptoms was observed in all cases, although in one case (1.25%) a new complication (rectal lesion) was noted. As regards sexual activity, all couples declared their satisfaction after treatment. Women's dramatic experience of the disease and vaginal hysterectomy improved significantly after surgery.


Assuntos
Doenças dos Genitais Femininos/cirurgia , Histerectomia Vaginal/psicologia , Qualidade de Vida , Comportamento Sexual/psicologia , Adulto , Idoso , Congo , Feminino , Doenças dos Genitais Femininos/psicologia , Hospitais Universitários , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos
17.
BMC Cancer ; 15: 587, 2015 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-26272451

RESUMO

BACKGROUND: Medical research studies are becoming increasingly important for optimizing the prevention, diagnosis and treatment of illnesses. Participation in research studies can have many benefits for patients. In randomized and controlled clinical studies, they can receive the best possible medical care currently available. However, only a small proportion of patients nowadays are treated within the framework of medical research. The primary endpoint of this study was to discover what level of knowledge patients have about clinical studies and how they currently perceive them, in order to identify ways of optimizing the information provided about studies from the patients' point of view. METHODS: The study included 2546 patients (breast cancer 21.6%, gynecological cancer 8.3%, obstetrics 32.7%, endometriosis 7.8%, fertility treatment 3.2%, other benign gynecological illnesses 19.2%, no information for 7.2%) in the outpatient clinic (45.2%) and in the in-patient sector (54.8%) at the Department of Gynecology at Erlangen University Hospital and associated centers. In the single-center study, conducted between January 2011 and January 2012, the patients were asked about their level of knowledge regarding the background to medical research studies and the ways in which they are carried out and used. The patients were also asked how they perceived medical studies and how they thought study conditions might be optimized. The three-page questionnaire was included in the feedback sheet received by patients as part of the hospital's quality management system. RESULTS: As a whole, the group only had moderate knowledge about clinical studies. A majority of the respondents considered that studies were valuable (91.6%), but only a few were also willing to take part in them (58.4%). Knowledge and willingness to participate strongly depended on age (P < 0.001), educational level (P < 0.001) and patient group (P < 0.001). Most patients would prefer to decide about participating in studies through a discussion with their outpatient physicians. CONCLUSIONS: The information that patients have about clinical studies affects whether they participate in them. It is therefore extremely important for patients to be well informed, for their anxieties about participation to be relieved, and for the benefits of participation to be explained to them.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/psicologia , Estudos Clínicos como Assunto/psicologia , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Femininos/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pesquisa Biomédica , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
19.
J Am Acad Dermatol ; 72(6): 978-83, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25824273

RESUMO

BACKGROUND: Genital involvement has significant psychosexual implications for psoriasis patients. OBJECTIVE: This study was designed to ascertain factors associated with the development of genital psoriasis and its impact on quality of life and sexual functioning. METHODS: This was an observational, multicenter study of 354 consecutive psoriasis patients. RESULTS: One hundred thirty-four patients (38%) had current genital involvement while 224 (63%) had a current and/or previous history of genital involvement. Eighty-seven percent reported itch, 39% pain, 42% dyspareunia, 32% a worsening of their genital psoriasis after intercourse, and 43% a decreased frequency of intercourse. Younger age of onset of psoriasis, male sex, more severe disease, and involvement of the scalp, flexures, and nails were associated with the presence of genital disease. There was no association with circumcision or obesity. Patients with genital psoriasis had more impairment in quality of life and sexual health as determined by the Dermatology Life Quality Index (P < .0001), the Center for Epidemiological Studies-Depression Scale (P = .01), and the Relationship and Sexuality Scale (P < .0001). LIMITATIONS: This was a descriptive study from 2 tertiary referral centers where patients were likely to have more severe psoriasis. CONCLUSION: This study highlights the high prevalence of genital psoriasis and its profound impact on quality of life and sexual health.


Assuntos
Psoríase/complicações , Qualidade de Vida , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Psicogênicas/epidemiologia , Administração Tópica , Adolescente , Adulto , Fatores Etários , Idoso , Fármacos Dermatológicos/uso terapêutico , Feminino , Doenças dos Genitais Femininos/etiologia , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/etiologia , Doenças dos Genitais Masculinos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Perfil de Impacto da Doença , Adulto Jovem
20.
Med Care ; 53(4 Suppl 1): S93-6, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25767984

RESUMO

OBJECTIVE: This pilot study aims to ascertain the prevalence of self-reported premenstrual, perinatal, and perimenopausal influences on mental health, and of gynecologic conditions that could interact with psychiatric conditions, among women veterans receiving psychiatric care within a Veterans Administration (VA) Women's Health Clinic (WHC). METHODS: Participants included all women veterans (N=68) who received psychiatric evaluations within a VA WHC over a 5-month period. This setting encompasses colocated and coordinated primary care, gynecologic and mental health services. Evaluations included a Women's Mental Health Questionnaire, a psychiatric interview, and medical record review. Deidentified data were extracted from a clinical data repository for this descriptive study. RESULTS: High proportions of study participants reported that their emotional problems intensified premenstrually (42.6%), during pregnancy (33.3%), in the postpartum period (33.3%), or during perimenopause (18.2%). Unintended pregnancy (70.0% of pregnancies) and pregnancy loss (63.5% of women who had been pregnant) were prominent sex-linked stressors. Dyspareunia (22.1% of participants) and pelvic pain (17.6% of participants) were frequent comorbidities. CONCLUSIONS: Among women veterans receiving psychiatric care within a VA WHC, there are high rates of self-reported premenstrual, perinatal, and perimenopausal influences on mental health. This population also has substantial comorbidity of psychiatric disorders with dyspareunia and pelvic pain. This underscores the importance of recognizing and addressing women veterans' sex-specific care needs, including interactions among reproductive cycle phases, gynecologic pain, and psychiatric symptoms. The findings support the need for greater awareness of the sex-specific mental health needs of women veterans, and for more definitive studies to further characterize these needs.


Assuntos
Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Femininos/terapia , Necessidades e Demandas de Serviços de Saúde , Transtornos Mentais/terapia , Saúde dos Veteranos , Saúde da Mulher , Adulto , Feminino , Doenças dos Genitais Femininos/epidemiologia , Hospitais de Veteranos , Humanos , Entrevista Psicológica , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Projetos Piloto , Gravidez , Prevalência , Inquéritos e Questionários
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