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Intercourse, painful [keywords]
- A multicentre study on knowledge and attitude of nurses in northern Nigeria concerning female genital mutilation. [JOURNAL ARTICLE]
- Eur J Contracept Reprod Health Care 2014 Mar 6.
Objective To determine the knowledge and attitude of nurses in northern Nigeria concerning female genital mutilation (FGM). Methods Cross-sectional study in which 350 nurses working in three tertiary health institutions in northern Nigeria were assessed, using a self-administered questionnaire, with regard to their knowledge of, and attitude to, FGM. Results Two hundred and sixty-five respondents (76%) were female, 190 (54%) were married. Most (249; 71%) were Muslims, and 228 (65%), of Hausa/Fulani ethnicity. Their ages ranged from 18-60 years with a mean of 29.3 ± 8.9. Among the respondents, 318 (91%) had heard of FGM; of these 127 (40%) knew no particular type of FGM. Only 155 (49%) could identify 'Angurya' and 'Gishiri' cuts as forms of FGM. Two hundred and forty-five (77%), 231 (73%) and 200 (63%), respectively, identified haemorrhage; risk of HIV, hepatitis, and tetanus; and painful sexual intercourse as possible complications of FGM. Thirteen (4%) would perform it and also would have it done on their daughters. Conclusion The nurses studied had a high level of awareness of FGM and a good general knowledge of complications associated with FGM. However, only half knew what 'Angurya' and 'Gishiri' cuts were. A few would perform FGM.
- Investigating the sexual function and its associated factors in women with chronic illnesses. [Journal Article]
- J Clin Nurs 2013 Dec; 22(23-24):3484-91.
To evaluate sexual dysfunction and the factors that affect sexual dysfunction in women with chronic disease.Sexual dysfunction is one of the most common problems in women with chronic disease. There is limited understanding of the related factors of sexual dysfunction in women with chronic disease, with research currently limited to other problems and problems related to chronic diseases.This research was conducted as a descriptive survey.This study involved 100 female inpatients at clinics of internal medicine of a university hospital. Data were collected with a patients identification form and a female sexual function index (KCFI). Kruskal-Wallis test, test of significance of difference between two means and test of significance of difference between two pairs were used in the data analysis.Sixty-five percentage of women in the sample were defined to have sexual dysfunction. The majority of women expressed pain during sexual intercourse, problems in orgasm and satisfaction, and reluctance to have sex. Older age, being unemployed, being in menopause, fatigue, sleep disorder, and pain and weakness in extremities were the factors that were found to significantly affect the prevalence of sexual dysfunction (p < 0·05).This study concluded that sexual function of women with chronic disease is affected negatively. Chronic disease-related symptoms, experienced changes in the body and psychosocial problems are changing the lives of women. Ultimately, these changes also affect sexual activity.Determination of the factors affecting sexual activity in women with chronic disease is important for women' ability to cope with sexual dysfunction and keep it under control. To be able to accomplish this, it is necessary for healthcare personnel, the partners and family to work together.
- Urinary tract infections in older women: a clinical review. [Journal Article, Research Support, N.I.H., Extramural, Review]
- JAMA 2014 Feb 26; 311(8):844-54.
Asymptomatic bacteriuria and symptomatic urinary tract infections (UTIs) in older women are commonly encountered in outpatient practice.To review management of asymptomatic bacteriuria and symptomatic UTI and review prevention of recurrent UTIs in older community-dwelling women.A search of Ovid (Medline, PsycINFO, Embase) for English-language human studies conducted among adults aged 65 years and older and published in peer-reviewed journals from 1946 to November 20, 2013.The clinical spectrum of UTIs ranges from asymptomatic bacteriuria, to symptomatic and recurrent UTIs, to sepsis associated with UTI requiring hospitalization. Recent evidence helps differentiate asymptomatic bacteriuria from symptomatic UTI. Asymptomatic bacteriuria is transient in older women, often resolves without any treatment, and is not associated with morbidity or mortality. The diagnosis of symptomatic UTI is made when a patient has both clinical features and laboratory evidence of a urinary infection. Absent other causes, patients presenting with any 2 of the following meet the clinical diagnostic criteria for symptomatic UTI: fever, worsened urinary urgency or frequency, acute dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness. A positive urine culture (≥105 CFU/mL) with no more than 2 uropathogens and pyuria confirms the diagnosis of UTI. Risk factors for recurrent symptomatic UTI include diabetes, functional disability, recent sexual intercourse, prior history of urogynecologic surgery, urinary retention, and urinary incontinence. Testing for UTI is easily performed in the clinic using dipstick tests. When there is a low pretest probability of UTI, a negative dipstick result for leukocyte esterase and nitrites excludes infection. Antibiotics are selected by identifying the uropathogen, knowing local resistance rates, and considering adverse effect profiles. Chronic suppressive antibiotics for 6 to 12 months and vaginal estrogen therapy effectively reduce symptomatic UTI episodes and should be considered in patients with recurrent UTIs.Establishing a diagnosis of symptomatic UTI in older women requires careful clinical evaluation with possible laboratory assessment using urinalysis and urine culture. Asymptomatic bacteriuria should be differentiated from symptomatic UTI. Asymptomatic bacteriuria in older women should not be treated.
- Natural History of Comorbid Orofacial Pain Among Women with Vestibulodynia. [JOURNAL ARTICLE]
- Clin J Pain 2014 Feb 21.
We evaluated the stability of the comorbidity between vulvodynia and orofacial pain (OFP) and its associated clinical characteristics over a two-year follow up period.In an earlier study of vestibulodynia patients, we administered questionnaires assessing demographic data, self-reported pain, anxiety, somatic awareness, and presence of signs and symptoms suggestive of clinical and subclinical orofacial pain (OFP). The present study readministered the same surveys to a subset of the original cohort after a two-year follow up period.Of the 138 women in the previous study, 71 (51%) agreed to participate in the present study. We confirmed our earlier findings that (1) orofacial pain is a highly prevalent (66%) condition among women with vestibulodynia, and (2) compared to women with no OFP symptoms, those with OFP symptoms experience higher levels of anxiety (P=0.005), and somatic awareness (P<0.001). While OFP symptoms showed improvement in many of the vestibulodynia patients (33%) with OFP symptoms at baseline, 13% had either developed new symptoms or transitioned from subclinical to clinical OFP classification. Intercourse-related pain decreased in 69% of patients and increased in 24% of patients. Consistent with our earlier report, we did not observe significant differences with respect to demographics or severity of pain during intercourse among the subgroups.Orofacial pain is a common comorbidity among women with vestibulodynia, although the presence of OFP can vary over time. The comborbidity between vestibulodynia and OFP suggests that common underlying mechanisms may mediate both conditions.
- Female sexual dysfunction: prevalence and risk factors. [Journal Article]
- J Clin Diagn Res 2013 Dec; 7(12):2877-80.
Aim:Sexual dysfunction adversely affects quality of life, self esteem and interpersonal relationships and it may often be responsible for psychopathological disturbances. The purpose of this study was to explore the prevalence and associated risk factors for Female Sexual Dysfunction (FSD) in women with Kurdish culture from western Iran . Material and
Methods:This was a cross-sectional descriptive survey which included 400 women aged 18-50 years old, married, from Ilam-IR, who were interviewed as per the Iranian version of Female Sexual Function Index (FSFI). The subjects were randomly selected from 4 primary health centres.
Results:According to the findings, 185 (46.2%) women reported FSD. Prevalence of FSD increased with age, from 22% in women aged <20 years to 75.7% in women aged 40-50 years. FSD was detected as a desire problem in 45.3% of women, an arousal problem in 37.5%, a lubrication problem in 41.2%, an orgasm problem in 42.0%, a satisfaction problem in 44.5% and a pain problem in 42.5%. The educational level was inversely correlated with the risk of FSD (OR: 1.54 ,95% CI: 1.09-2.13). Patients with FSD were significantly more likely to be older than 40 years (OR: 2.23, 95% CI: 1.12-2.68), who had sexual intercourse fewer than 3 times a week (OR:1.85, 95% CI: 1.23-1.99), who had been married for 10 years or more (OR:1.76, 95% CI: 1.04-1.97), who had 3 children or more (OR: 1.48, 95% CI: 0.97-1.24), who had husbands aged 40 years or more (OR: 2.11, 95% CI: 1.35-2.37) and who were unemployed (OR: 1.34, 95% CI: 1.06-1.63). No significant differences were detected in smoking history, residences and contraception methods used (p>0.05).
Conclusion:FSD needs to be recognized as a significant public health problem in Kurd women. Further research, particularly studies on awareness and competency of physicians in the management of FSD, is required.
- Women's Use and Perceptions of Commercial Lubricants: Prevalence and Characteristics in a Nationally Representative Sample of American Adults. [Journal Article]
- J Sex Med 2014 Mar; 11(3):642-52.
Use of commercial lubricant is common in the United States among adult women. However, little is known about the sexual behaviors for which women use lubricant, women's perceptions of lubricant, or reasons for use, particularly in a nationally representative sample.The aim of this study was to document the prevalence and characteristics of lubricant use among adult women in the United States and their perceptions of lubricants in relation to subjective sexual experiences.Data are from a subset of individuals who were sampled as part of the 2012 National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of U.S. adults ages 18 and older.Sociodemographic characteristics, recent and lifetime commercial lubricant use, lubricant use during specific sexual behaviors, frequency of lubricant use, and reasons for lubricant use of participants were studied for the article.Of the women who participated in the study, 65.5% (n = 1,021) reported ever having used lubricant and 20% had used a lubricant within the past 30 days. Across age groups, lubricant was most commonly used during intercourse (58.3% of women) or partnered sexual play (49.6%). Common reasons for lubricant use included to make sex more comfortable, fun, and pleasurable and to decrease discomfort/pain.Most American women have used lubricant. Also, lubricant is more common as part of partnered intercourse and sexual play or foreplay compared with other solo and partnered sexual behaviors. Clinicians may find it helpful to broaden conversations with patients to include questions about their sexual behaviors, comfort and/or pain during sex, and lubricant use and to share, particularly with younger women, that lubricant use is prevalent and commonly used for reasons related to pleasure as well as comfort. Herbenick B, Reece M, Schick V, Sanders SA, and Fortenberry JD. Women's use and perceptions of commercial lubricants: Prevalence and characteristics in a nationally representative sample of American adults. J Sex Med 2014;11:642-652.
- Pelvic pain and mode of delivery. [JOURNAL ARTICLE]
- Am J Obstet Gynecol 2014 Jan 29.
We sought to determine the long-term effect of mode of delivery on the prevalence and severity of pelvic pain.From 6-11 years after a first delivery, pelvic pain (dysmenorrhea, dyspareunia, and pelvic pain not related to menses or intercourse) was measured using the Oxfordshire Women's Health Study Questionnaire. Obstetrical exposures were assessed by review of the hospital delivery record. The prevalence of moderate to severe pelvic pain was compared between the 577 women who delivered via cesarean for all births and the 538 who delivered at least 1 child vaginally. Other obstetrical exposures were also studied.Prevalence of pelvic pain was similar between women who delivered vaginally and by cesarean. Among women who delivered vaginally, those who experienced at least 1 forceps delivery and women who delivered at least 1 baby ≥4 kg vaginally reported a higher rate of dyspareunia. Perineal trauma was not associated with dyspareunia.Forceps delivery and a vaginal delivery of a baby ≥4 kg are associated with dyspareunia 6-11 years after vaginal birth. Vaginal birth is not associated with a higher rate of pelvic pain when compared to cesarean delivery.
- Brain Processing of Visual Stimuli Representing Sexual Penetration versus Core and Animal-Reminder Disgust in Women with Lifelong Vaginismus. [Journal Article]
- PLoS One 2014 Jan 22; 9(1):e84882.
It has been proposed that disgust evolved to protect humans from contamination. Through eliciting the overwhelming urge to withdraw from the disgusting stimuli, it would facilitate avoidance of contact with pathogens. The physical proximity implied in sexual intercourse provides ample opportunity for contamination and may thus set the stage for eliciting pathogen disgust. Building on this, it has been argued that the involuntary muscle contraction characteristic of vaginismus (i.e., inability to have vaginal penetration) may be elicited by the prospect of penetration by potential contaminants. To further investigate this disgust-based interpretation of vaginismus (in DSM-5 classified as a Genito-Pelvic Pain/Penetration Disorder, GPPPD) we used functional magnetic resonance imaging (fMRI) to examine if women with vaginismus (n = 21) show relatively strong convergence in their brain responses towards sexual penetration- and disgust-related pictures compared to sexually asymptomatic women (n = 21) and women suffering from vulvar pain (dyspareunia/also classified as GPPPD in the DSM-5, n = 21). At the subjective level, both clinical groups rated penetration stimuli as more disgusting than asymptomatic women. However, the brain responses to penetration stimuli did not differ between groups. In addition, there was considerable conjoint brain activity in response to penetration and disgust pictures, which yield for both animal-reminder (e.g., mutilation) and core (e.g., rotten food) disgust domains. However, this overlap in brain activation was similar for all groups. A possible explanation for the lack of vaginismus-specific brain responses lies in the alleged female ambiguity (procreation/pleasure vs. contamination/disgust) toward penetration: generally in women a (default) disgust response tendency may prevail in the absence of sexual readiness. Accordingly, a critical next step would be to examine the processing of penetration stimuli following the induction of sexual arousal.
- Effect of Age and Race On Quality of Life in Young Breast Cancer Survivors. [JOURNAL ARTICLE]
- Clin Breast Cancer 2013 Oct 25.
Given their early age at diagnosis, young breast cancer survivors (YBCSs) face issues that differ widely from their older counterparts.We mailed a survey to 2209 patients who were ≤ 45 years at the time of breast cancer (BC) diagnosis. Each survey was composed of the Quality of Life in Adult Cancer Survivors instrument, Menopause Symptom Scale, and questions aimed at obtaining pertinent background information.One thousand ninety patients completed the survey. Mean age at time of diagnosis was 39.5 years; median years from diagnosis was 6.6 years. Distress related to vaginal dryness (P = .0002) and pain from intercourse (P = .0014) was significantly higher in patients who were < 5 years from diagnosis compared with those > 10 years from diagnosis. In the area of financial problems, black women had greater distress than did white women (P = .0010). Compared with white women, Hispanic women had worse family distress scores (P = .0028) and summary cancer-specific scores (P = .0076). Patients > 10 years from diagnosis had less sexual interest (P = .003) than did women who were closer to diagnosis. Women ≥ 40 years at diagnosis had significantly lower sexual interest (P = .0016) than did women < 40 years. Stage and neoadjuvant chemotherapy did not have a significant effect on quality of life (QOL).Even in comparison to stage and neoadjuvant chemotherapy, race, age at diagnosis, and time from diagnosis have significant long-term effects on QOL after treatment for BC.
- Psychologic, relational, and sexual functioning in women after surgical treatment of vulvar malignancy: a prospective controlled study. [Journal Article, Research Support, Non-U.S. Gov't]
- Int J Gynecol Cancer 2014 Feb; 24(2):372-80.
Vulvectomy for vulvar malignancy can affect sexual functioning based on anatomic, physiologic, psychologic, and relational mechanisms. The aims of this study were to prospectively investigate sexual adjustment of women with vulvar malignancy during a follow-up period of 1 year after vulvectomy and to compare the results with healthy control women.In this prospective controlled study, participants completed the Beck Depression Inventory scale, World Health Organization-5 Well-being scale, Dyadic Adjustment Scale, Short Sexual Functioning Scale, and Specific Sexual Problems Questionnaire to assess various aspects of psychosocial and sexual functioning just before surgery, 6 months, and 1 year after treatment.Twenty-nine women with vulvar malignancy and 29 healthy controls completed the survey. Compared with the presurgery status, no significant differences were found in psychologic, relational, and sexual functioning in women after surgery for vulvar malignancy. Compared with healthy control women, women with vulvar malignancy reported significantly lower psychologic well-being and quality of partner relationship, both before and after treatment. Moreover, significantly more patients with vulvar malignancy reported preoperative and postoperatively sexual dysfunctions than healthy controls, including entry and deep dyspareunia, abdominal pain during intercourse, reduced ability to achieve orgasm, and reduced intensity of orgasm.This prospective study yielded no differences in psychosocial and sexual functioning for women with vulvar malignancy before and after vulvectomy. However, when compared with healthy controls, patients with vulvar malignancy are at high risk for sexual dysfunctions, both before and after surgical treatment.