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Intercourse, painful [keywords]
- Congenital vesicovaginal fistula: spontaneous or forced? Two cases and literature review. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Jul 19.
Congenital vesicovaginal fistula is an exceedingly rare entity. There is no consensus regarding the nature and origin of this condition. We report two cases with congenital vesicovaginal fistula and compile previously reported cases in the English literature. Theories behind the genesis of this anomaly will be briefly presented.We describe the presentation, diagnostic workup, and management of two patients with congenital vesicovaginal fistula. Previously reported cases were retrieved through an extensive English literature review using Medline and PubMed. Cases are tabulated based on the presence or absence of vaginal menstrual outflow obstruction.Two women, aged 23 and 17, had had cyclic hematuria since puberty that was perceived as normal menstruation. One woman presented with an inability to have sexual intercourse, and the other with severe cyclic pelvic pain. Diagnostic workup unveiled congenital vesicovaginal fistula and distal vaginal agenesis in both. One had abnormal ureteric insertion, while the other had a history of anomalies unrelated to the urogenital system. Successful surgical correction of fistula was undertaken in both. An English literature review revealed 23 reported cases of congenital vesicovaginal fistula. While 74 % had concomitant menstrual outflow obstruction, the remaining had normal menstruation per vagina.Congenital vesicovaginal fistula can present as an isolated anomaly, or associated with complex malformations of a wide spectrum. The presenting symptoms as well as the age at diagnosis vary widely. While the term "congenital" implies its genesis before birth, a congenital vesicovaginal fistula can be a manifestation of faulty embryological development, but also the result of outflow obstruction.
- Experiences with nausea and vomiting during pregnancy in Turkish women based on roy adaptation model: a content analysis. [Journal Article]
- Asian Nurs Res (Korean Soc Nurs Sci) 2013 Dec; 7(4):175-81.
This qualitative study aimed to explore how Turkish women experience nausea and vomiting in pregnancy based on the Roy Adaptation Model.To collect data, in-depth interviews were undertaken with 35 pregnant women who had nausea and vomiting. The sample of the study included pregnant women who were in their first 12 weeks of gestation, did not have medical problems and had nausea, retching and/or vomiting for at least the last 3 days. Data were collected in semi-structured interview form based on the Roy Adaptation Model and with a background data sheet. Data were analyzed using direct content analysis.Data were classified into four adaptive modes according to the Roy Adaptation Model. The behaviors in the physiological mode were nausea, vomiting, fatigue, changes in sleep patterns, inadequate nutrition, inguinal pain, burning sensation and irritation in the throat, ketosis, and urinary incontinence. The behaviors in the self-concept mode were feeling weak, crying, inadequate self-care, changes in sexual intercourse, and social isolation. The behaviors in the role function mode were being unable to fulfill the responsibilities at home and work. The behaviors in the interdependence mode were dissatisfaction with relationships.The study findings help nursing staff detect the stimuli and the behaviors of pregnant women with nausea and vomiting. Further research may evaluate the impact of a counseling program prepared under the guidance of a nursing model on nausea and vomiting in pregnancy.
- Sexual activity and functioning in ovarian cancer survivors: an internet-based evaluation. [JOURNAL ARTICLE]
- Climacteric 2014 Jul 16.:1-5.
Objectives Sexual dysfunction is a known complication of treatment for many cancers, but there have been relatively few studies investigating outcomes for ovarian cancer survivors. We have previously reported that women treated for ovarian cancer experience persistent psychological and physical problems. Sexual functioning was highlighted as a significant factor and we sought to investigate this further. Methods Women were invited to complete a questionnaire using both paper and online response formats. A validated tool, the Sexual Activity Questionnaire, was used to obtain information from women following a diagnosis of ovarian cancer. Results Across all responders (n = 102, mean age 51.3 years), 63% of women reported their ovarian cancer diagnosis had negatively changed their sex life. The most common reasons given for an absence of sexual activity were a lack of interest in sex, physical problems that prevented sex or no partner. Of the 46% of responders who stated they were sexually active, 77% reported pain or discomfort during intercourse and 87% described vaginal dryness. Conclusion For the majority of women, treatment for ovarian cancer negatively impacts on their sex lives. Many of the symptoms described by participants are potentially reversible and clinicians should be open to raising the issue of sexual functioning with their patients.
- [Parental attitudes recollected by patients and neurotic disorders picture--sexuality-related and sexuality-unrelated symptoms]. [English Abstract, Journal Article]
- Psychiatr Pol 2013 Sep-Oct; 47(5):827-51.
To evaluate the risks associated with non-optimal characteristics of the picture of parents in the patient's memories, concerning the sexuality-related symptoms and other areas of neurotic disorders.Coexistence of memories of parental attitudes and the current symptoms were analyzed on the basis of KO"0" Checklist and Life Inventory completed prior to treatment in the day hospital for neurotic disorders.In questionnaires, obtained from 2582 females and 1347 males between 1980-2002, there was a significant incidence of memories of adverse parental attitudes, the feeling of not being loved, the parent indifference, rejection. Regression analysis showed a significant relationship between the parental attitudes and symptoms, for instance reluctance of men to sexual contacts coexisted (OR = 3.41) with hostile mother's attitude, the same association in women was weaker (OR = 1.64) but still significant. Also, the absence of mother in childhood was associated with a risk of disruptions in the conduct of intercourse (erectile dysfunction or pain) in women (OR = 2.43) and men (OR = 3.29). Other analyzed symptoms, also sexuality -unrelated, though weaker and less frequently, were associated with non-optimal pictures of parents, e.g. pessimism in women with the hostile mother (OR = 1.97). Higher global severity of symptoms was associated with non-optimal parental attitudes.The type of recollected attitudes of parents was associated with a higher incidence of symptoms, primarily in the field of sexuality, and with other selected symptoms, as well as with higher global symptom level. The results indicate importance of life circumstances in the development of psychopathology and encourage to further research.
- Feasibility of collecting vulvar pain variability and its correlates using prospective collection with smartphones. [Journal Article]
- Pain Res Treat 2014.:659863.
Context. Vulvar pain level may fluctuate in women with vulvodynia even in the absence of therapy; however, there is little evidence suggesting which factors may be associated with variability.
Objective.Determine the feasibility of using smartphones to collect prospective data on vulvar pain and factors that may influence vulvar pain level. Methods. 24 clinically confirmed women were enrolled from a population-based study and asked to answer five questions using their smartphones each week for one month. Questions assessed vulvar pain level (0-10), presence of pain upon wakening, pain elsewhere in their body, treatment use, and intercourse.
Results.Women completed 100% of their scheduled surveys, with acceptability measures highly endorsed. Vulvar pain ratings had a standard deviation within women of 1.6, with greater variation on average among those with higher average pain levels (P < 0.001). On the weeks when a woman reported waking with pain, her vulvar pain level was higher by 1.82 on average (P < 0.001). Overall, average vulvar pain level was not significantly associated with the frequency of reporting other body pains (P = 0.64).
Conclusion.Our smartphone tracking system promoted excellent compliance with weekly tracking of factors that are otherwise difficult to recall, some of which were highly associated with vulvar pain level.
- The impact of vaginal penetration difficulties on the sexual functioning of women and their male partners. [JOURNAL ARTICLE]
- Eur J Contracept Reprod Health Care 2014 Jul 7.:1-7.
Objectives To compare the sexual function of women with and without vaginal penetration difficulties (VPDs) and relate it to the sexual function of their male partners. Methods All consenting women attending a sexual medicine centre during 2005-2007 completed the Female Sexual Function Index (FSFI) and answered questions about five VPDs (placement of a tampon, gynaecological examination, insertion of her or her partner's finger, and penile-vaginal intercourse). Male partners filled the International Index of Erectile Function (IIEF). Results Full data were available for 223 women, and 118 male partners. Male partners of women with VPDs (n = 53) had lower sexual desire (p = 0.0225). The number of VPDs in the women concerned negatively correlated with their partners' desire (r = - 0.18339, p = 0.0468) and erectile function (r = - 0.19848, p = 0.0312). All women with at least one VPD (n = 109) reported significantly more sexual pain (p < 0.0001) and had worse sexual function scores (p = 0.014) than women with no VPDs (n = 114). Women with VPDs other than penile-vaginal penetration had worse orgasmic functioning (p = 0.0119). Conclusions The women's VPDs are correlated with worse sexual functioning for them and for their male partners. The five VPDs are a practical and useful tool for identifying impaired sexual functioning.
- A Prospective Two-year Examination of Cognitive and Behavioral Correlates of Provoked Vestibulodynia Outcomes. [JOURNAL ARTICLE]
- Clin J Pain 2014 Jun 26.
Provoked vestibulodynia (PVD) is a common genital pain disorder in women, which is associated with sexual dysfunction and lowered sexual satisfaction. A potentially applicable cognitive-behavioral model of chronic pain and disability is the fear-avoidance model (FAM) of pain. The FAM posits that cognitive variables, such as pain catastrophizing, fear, and anxiety lead to avoidance of pain-provoking behaviors (intercourse), resulting in continued pain and disability. Although some of the FAM variables have been shown to be associated with PVD pain and sexuality outcomes, the model as a whole has never been tested in this population. An additional protective factor, pain self-efficacy, is also associated with PVD, but has not been tested within the FAM model. AIM:: Using a two-year longitudinal design, we aimed to examine (1) whether initial levels (T1) of the independent FAM variables and pain self-efficacy were associated with changes in pain, sexual function and sexual satisfaction over the two-year time period, (2) the prospective contribution of changes in cognitive-affective (FAM) variables to changes in pain, and sexuality outcomes and (3) whether these were mediated by behavioral change (avoidance of intercourse).A sample of 222 women with PVD completed self-report measures of FAM variables, self-efficacy, pain, sexual function and sexual satisfaction at Time 1 and at a two-year follow-up. Structural equation modeling with latent difference scores was used to examine changes and to examine mediation between variables.Questionnaires included the Pain Catastrophizing Scale, McGill Pain Questionnaire, Trait Anxiety Inventory, Pain Self-Efficacy Scale, and Global Measure of Sexual Satisfaction, Female Sexual Function Index.Participants who reported higher self-efficacy at T1 reported greater declines in pain, greater increases in sexual satisfaction, and greater declines in sexual function over the two time points. The overall change model did not support the FAM using negative cognitive-affective variables. Only increases in pain self-efficacy were associated with reductions in pain intensity. The relationship between changes in self-efficacy and changes in pain was partially mediated through changes in avoidance (more intercourse attempts). The same pattern of results was found for changes in sexual satisfaction as the outcome, and a partial mediation effect was found. There were no significant predictors of changes in sexual function other than T1 self-efficacy.Changes in both cognitive and behavioral variables were significantly associated with improved pain and sexual satisfaction outcomes. However, it was the positive changes in self-efficacy that better predicted changes in avoidance behavior, pain and sexual satisfaction. Cognitive behavioral therapy is often focused on changing negative pain-related cognitions to reduce avoidance and pain, but the present results demonstrate the potential importance of bolstering positive self-beliefs as well. Indeed, before engaging in exposure therapies, self-efficacy beliefs should be assessed and potentially targeted to improve adherence to exposure strategies.
- Hysteroscopy- and laparoscopy-based diagnosis and treatment of girls with unbroken hymen with an obstructing uterine septum: two case reports. [JOURNAL ARTICLE]
- J Med Case Rep 2014 Jun 24; 8(1):222.
Obstructing uterine septum is a rare uterine malformation. Patients with obstructing uterine septum are usually treated with laparouterotomy, causing obvious injury to both the uterus and body of the patients. Therefore, using the natural channel of the vagina is undoubtedly the best way to carry out the surgery. However, obstructing uterine septum usually occurs in puberty in girls without a history of sexual intercourse, thus iatrogenic damage to the hymen during the diagnosis and treatment cannot probably be avoided. However, Chinese people traditionally tend to use hymen intactness as a standard to judge whether an unmarried woman is chaste. Therefore, in China, to protect the hymen from damage during hysteroscopic diagnosis and treatment is of special significance for girls and women with unbroken hymens. None of the previously reported cases were treated with electrosurgical obstructing uterine septum excision based on B-ultrasound-guided hymen-protecting hysteroscopy and laparoscopy.Case 1 patient was a virgo intacta 13-year-old Chinese girl. She was admitted due to an 8-day post-menstruation lower abdominal pain. With the guidance of B-ultrasound, we observed a 30mmx20mm mixed echogenicity mass in her uterine cavity. Case 2 patient was a virgo intacta 14-year-old Chinese girl. She was admitted to our hospital more than 6 months after secondary dysmenorrhea and 6 days after B-ultrasound-diagnosed uterine malformations. We observed a 30mmx25mm mixed echoic area in her uterine cavity with the guidance of B-ultrasound.Both patients were surgically treated without hymen damage with B-ultrasound-guided combined therapy of hysteroscopy and laparoscopy. A needle electrode with an 8mm diameter was placed into their uterine cavities under hysteroscopy. After obstructing uterine septum removal, their uterine cavities showed normal morphology. To protect their hymens, misoprostol was placed into their rectums to soften their cervices, so that the hysteroscope could be inserted into their cavities without damaging their hymens.Virgo intacta women with obstructing uterine septum could be treated with electrosurgical obstructing uterine septum excision based on B-ultrasound-guided hymen-protecting hysteroscopy and laparoscopy.
- Treatment of dyspareunia secondary to vulvovaginal atrophy. [Journal Article]
- Nurs Womens Health 2014 Jun; 18(3):237-41.
Declining estrogen levels associated with menopause can result in vulvovaginal atrophy and some degree of dyspareunia for more than half of all women in menopause. In 2013, the U.S. Food and Drug Administration approved ospemifene, a nonhormonal oral medication for the treatment of dyspareunia in menopause. This article will provide an overview of ospemifene and its indications, side effects and implications for nurses.
- Inflammation and inflammatory control in interstitial cystitis/bladder pain syndrome: Associations with painful symptoms. [JOURNAL ARTICLE]
- Pain 2014 Jun 5.
Toll-like receptors (TLR) are known to play a role in chronic pain, from animal models and limited research in humans, but their role in interstitial cystitis/bladder pain syndrome (IC/BPS) is unknown. Similarly, alterations of the hypothalamic-pituitary-adrenal axis have been reported in some pain conditions. Our objectives were to identify inflammatory processes that might distinguish individuals with IC/BPS from healthy controls (HC) and to examine their associations with IC/BPS symptoms. Female participants (58IC/BPS patients and 28HCs) completed pain and urinary symptom questionnaires and collected saliva for cortisol as part of the Multidisciplinary Approach to Pelvic Pain study. Inflammatory cytokines were assayed in plasma, and in TLR-2- and TLR-4-stimulated peripheral blood mononuclear cells. Controlling for BMI and negative affect, between-group differences were analyzed by general linear models, and relationships between symptoms and inflammatory variables were analyzed by regression. Compared to HCs, IC/BPS patients had higher levels of plasma interleukin-6 (P=.040), greater interleukin-1β responsive to TLR-2 stimulation (P=.040), and flatter diurnal cortisol slopes (P=.010), indicating inflammatory dysregulation. In IC/BPS patients, inflammation after TLR-4 stimulation was associated with multiple symptoms, including genitourinary pain (P=.010), sexual pain (P=.002), and marginally with urinary symptoms (P=.068). Genitourinary pain severity (P=.008), frequency (P=.001), and pain with intercourse (P=.002) were strongly associated with TLR-4 inflammatory response. TLR-4 appears to play a central role in painful symptoms of IC/BPS patients, which may be linked to poor endogenous inflammatory control. These findings may help to identify new mechanisms in IC/BPS and lead to new therapeutic approaches.