Sex differences in the experience of testing positive for genital chlamydia infection: a qualitative study with implications for public health and for a national screening programme

OBJECTIVES

To explore men's and women's accounts of chlamydia testing, with a view to understanding sex differences in attitudes and in behaviours of public health importance.

METHODS

Semistructured interviews with 24 heterosexual patients (12 men; 12 women) diagnosed with genital chlamydia infection, at a large sexual health clinic in central London were transcribed and analysed using qualitative thematic analysis.

RESULTS

Participants' expressions revealed important sex differences. Women felt anxious about their future reproductive health, feared stigmatisation, and blamed themselves for contracting chlamydia; whereas men generally reported less concern, were unwilling to disclose their condition to sexual partners, and some men projected attributions of blame onto their partners. Delays in seeking care appeared to be related to perceptions of chlamydia as a relatively minor infection, particularly in men.

CONCLUSIONS

Health promotion needs to reflect sex and age differences, emphasising the negative consequences of delayed clinic attendance and exposure to repeat infections. For health professionals to respond appropriately and effectively to increasing numbers of chlamydia infections, there is a need to understand men's avoidant attitudes and behaviours in relation to sexual and reproductive health.

Psychosomatische Beschwerden und Anforderung psychosomatischer Konsile in der Frauenheilkunde

The aim of this study was to identify symptoms of depression, anxiety and somatization disorder in gynecological and obstetrical inpatients by screening questionnaires and to compare this findings with utilisation of a psychosomatic consultation service. 517 patients were screened with HADS (anxiety and depression) and GBB-24 (somatic complaints). 28.7% had pathological and, in addition, 19.8% borderline scores in at least one scale. More than 40% had pathological or borderline scores even in a 4-week follow-up and emphasised that they would have preferred having psychosomatic support in hospital. In only 2.9% psychosomatic consultation service was requested. Physicians in the gynecology department rated anxiety depression and the patients' acceptance of psychological factors of their illness significantly lower than the patients themselves. Our results demonstrate that anxiety and depression in gynecological and obstetric patients are not only a momentary phenomenon. Physicians underestimate the need of psychosomatic consultation.

Symptoms related to the reproductive tract and mental health among women in rural southern India

BACKGROUND

Symptoms related to the reproductive tract and symptoms of psychological distress are commonly seen in women living in South Asia. This study aimed to determine the association, if any, between symptoms related to the reproductive tract and mental health among women in rural southern India.

METHODS

The study was conducted in a community setting of a comprehensive community health programme in a development block in rural southern India. It was a cross-sectional survey with a nested case-control study. The main outcome measure was the probability of mental distress as assessed by the Tamil version of the General Health Questionnaire-12 (GHQ).

RESULTS

Of the 622 subjects recruited, 150 (24.4%) complained of at least one symptom related to the reproductive tract. The commonest symptom was vaginal discharge (17.5%). Significantly higher scores on the GHQ were associated with the presence of many current and past symptoms related to the reproductive tract, and receiving treatment for the same, even after adjusting for age, education, current marital status and type of house, using multiple regression analysis. GHQ scores were positively correlated with a higher number of current and past symptoms. Significantly higher scores were also associated with greater knowledge about prevention of sexually transmitted diseases and reproductive tract infections. Being currently married and educated were significant protective factors. A nested case-control study was done with the presence of a current common mental disorder as the outcome. Symptoms and other factors dated prior to this outcome were considered potential risk factors. Logistic regression models were developed. The presence of a symptom related to the reproductive tract for more than one month (OR 3.6; 95% CI 1.8, 7.2) and a history of similar symptoms over the past year (OR 2.2; 95% CI 1.3, 3.7) were risk factors for the development of common mental disorders. Higher education (OR 0.5; 95% CI 0.3, 0.7) and being currently married (OR 0.2; 95% CI 0.1, 0.6) were protective factors.

CONCLUSION

The cross-sectional data suggest an association between symptoms pertaining to the reproductive tract and psychological distress. The results of the nested case-control study suggest that symptoms related to the reproductive tract are risk factors for common mental disorders, while education and being currently married are protective factors.

The association of gynecological symptoms with psychological distress in women of reproductive age: a survey from gynecology clinics in Beirut, Lebanon

To date there has been no previous research into a possible association between psychological distress and gynecologic symptoms in the Arab world. We hypothesized that psychological distress would be associated with specific gynecologic complaints as well as with psychosocial factors. We conducted a cross-sectional study of women attending gynecology clinics in Beirut, Lebanon. The study sample consisted of 355 women aged 18 to 49 years who were seeking healthcare from gynecologists affiliated with two general teaching hospitals in Beirut. Psychological distress was assessed using the General Health Questionnaire (GHQ). Gynecologic complaints were assessed by asking women about presenting gynecologic symptoms. Women who visited the gynecologists for specific complaints, for post-surgical follow-up, or for insertion of coils or other services were more likely to be distressed than women who were attending for a general checkup (chi 2 = 9.466, p = 0.024). About 50% of women who reported abdominal pain or breast pain also reported significant psychological distress. Only bleeding and infertility were not significantly associated with psychological distress. It is concluded that a high proportion of women who attend gynecology clinics with specific complaints report psychological distress. Our findings highlight the importance of considering the psychological component of gynecological morbidity.

[Prevalence of depressive disorders among perimenopausal women seeking gynecological services]

AIM

The aim of the study was to evaluate the prevalence of depressive disorders in perimenopausal women reporting to gynecologists and to assess a possibility of screening and diagnosing depression in gynecological practice.

METHOD

The study entailed 2262 female patients of the age of 45-55 attending 120 gynecologists in Poland. Patients were first asked to fill in the Beck's Depression Inventory and next examined by their gynecologists to verify the presence of the basic symptoms of depressive episode according to ICD-10 diagnostic criteria. Patients who obtained 12 points or more in BDI total score were referred for a psychiatric consultation, including the MINI questionnaire. The study was monitored by 'Servier Polska'.

RESULTS

32.5% of women aged 45-55 years visiting gynecologists scored 12 points or more on the BDI scale. Patients with high BDI scores reported long-lasting somatic and emotional symptoms associated with menopause more frequently than patients with low BDI scores. Women with high BDI scores also more frequently experienced gynecological surgery in the past, more frequently attended gynecological clinics, and reported more peri- and postmatal mood disorders. 57% of patients did not visit psychiatrists. Depressive disorders were diagnosed in 76% of patients who came for the psychiatric evaluation.

CONCLUSIONS

The study suggests that more than 19% of perimenopausal women attending their gynecologists suffer from depressive disorders. Gynecologists in Poland can diagnose depression accurately and start pharmacological treatment of the disorder in half of the patients.

Somatization disorders in obstetrics and gynecology

Somatization refers to the phenomenon of physical symptoms not being conditioned by physical structural defects but primarily by mental processes. The basic understanding integrating psychodynamic, cognitive behavioral and systemic views conceptualized the underlying process as a signal processing circle in which the perceptual, interpretative and the effective-behavioral part interact in a dysfunctional manner. The clinical entities of this basic mechanism are variable in the localization and intensity of the symptoms which is reflected in the existing classification of ICD 10 and DSM IV. These classifications do not differentiate between gender. In obstetrics and gynecology somatization disorders are quantitatively important and qualitatively distinct. The pathogenetic factors are linked to gender specific biopsychosocial conditions, psychoendocrine interactions and genital organ subjective experiences. Therefore we propose a gender-sensitive classification into three groups of somatization disorders: Somatizing reactions during specific life phases or transitional periods, pychoendocrine disorders and somatoform disorders of the female genital organs. In each group the dysfunction may manifest itself mainly on the perceptual part or the effective-behavioral part of the signal processing circle. The pathogenetic pathways, comorbidities, specific diagnostic and therapeutic interventions for these different groups are summarized.

An exploration of the nature and causes of distress in women attending gynecology outpatient clinics

This study evaluates the distress experienced by women attending gynecology outpatient clinics (GOCs). We investigate causes of this distress and explore women's own experience of their distress. A questionnaire survey of 197 women attending GOCs was carried out, both quantitative and qualitative analyses were undertaken. Thirty-five percent of women showed clinical levels of anxiety, 13% had clinically significant depression and half reported feeling distressed. A range of feelings was reported, though commonly mixed emotions were expressed. Women had a low sense of personal control and uncertainty in relation to their gynecologic problem. Both coincidental stress, such as life changes, and the direct consequences of the gynecologic problem were predictive of anxiety. Qualitative analysis suggested four ways in which women experienced their distress and the gynecologic problem: (i) gynecologic symptoms were a direct cause of distress, (ii) gynecologic symptoms caused distress indirectly through reactions to diagnosis and treatment, (iii) gynecologic symptoms caused distress because of their impact on relationships, social life and self identity, and (iv) distress was unrelated to the gynecologic symptoms. Results highlight diversity and complexity in women's experiences and support the need for a fuller understanding of distress in this group in order to meet their needs adequately and appropriately.

Variables influencing anxiety of patients with abnormal cervical smears referred for colposcopy

The state anxiety scores of women with abnormal cervical smears referred for colposcopy were investigated to identify causes of anxiety, factors influencing anxiety and emotions involved with anxiety, in order to define strategies to reduce this anxiety. Forty-seven women were interviewed and completed a questionnaire and the Spielberger State and Trait Anxiety Inventory (STAI): 22 women prior to their intake consultation at the colposcopy clinic of the University Medical Center St Radboud, Nijmegen, and 25 women during their second visit before the actual colposcopy. The mean State anxiety score was 48.2, without significant differences between the intake and colposcopy consultation. The majority experienced anxiety because of a fear of cancer and/or the colposcopy. The mean State anxiety score was significantly higher in women who considered the level of information provided by the gynecologist/family practitioner insufficient, who experienced a long waiting time, who did not have a partner, and who experienced additional emotions like anger and sadness. In conclusion, patients referred for colposcopy after an abnormal cervical smear result have high levels of anxiety. High levels of anxiety may be reduced by uniform and explicit information about cervical smear results and colposcopy, by reduction of clinic waiting times, by stimulating social support, and by attention to emotions like anger and sadness.

Consultation-liaison psychiatry in obstetrics and gynecology

Data documenting the activity of Modena and Reggio Emilia University Hospital Consultation-Liaison Psychiatry Psychosomatic Service (C-LPPS) to the 59 bed gynecological-obstetric unit are compared to the corresponding European Consultation Liaison Workgroup (ECLW) study results and discussed in the light of recent epidemiological studies suggesting a low rate of detection and psychiatric referral in obstetric and gynecological patients. All psychiatric consultations of gynecological-obstetric inpatients during a 3-year (1996-1998) period were included in this study and data were derived from valid and reliable consultation forms tested for reliability. Within the 3-year period 55 patients were referred to C-LPPS by the gynecological-obstetric unit for psychiatric consultation. Referral rate was 0.5% of the admitted patients in the unit. The gynecological-obstetric group represented 2.5% (vs. 4.5% ECLW study) of all psychiatric consultations requested in the study period. The most frequent reasons for referral were: current psychiatric symptoms (47.3% Modena study vs. 39% ECLW), psychiatric history (20% vs. 7.3%), unexplained physical symptoms (12.7% vs. 16.2%) and coping-compliance problems (3.6% vs. 16.6%). The most common ICD-10 psychiatric diagnoses were: neurotic, anxiety and adjustment disorders (41.8% vs. 31.2%), mood disorders (29% vs. 18.4%), personality disorders (7.3% vs. 6.1%), schizophrenic and other psychotic disorders (5.5% vs. 7%).

Health-related quality of life measurement in women with common benign gynecologic conditions: a systematic review

Endometriosis, menorrhagia, chronic pelvic pain, and polycystic ovary syndrome are major sources of psychologic morbidity and can negatively affect quality of life. Although comparative studies have been published on the measurement of health-related quality of life for gynecologic malignancies, a similar review for these benign gynecologic conditions has not been conducted. Consequently, we searched the literature systematically to identify the impact of symptoms and treatments for these conditions on health status and to report on the types and psychometric properties of the instruments used. Papers were retrieved by systematically searching 6 electronic databases and hand-searching relevant reference lists and bibliographies. Forty-six studies used a questionnaire to measure health status: 34 studies (74%) used standardized instruments; of these, 23 studies (68%) used generic tools. Although a meta analysis was not possible, it appears that women with chronic pelvic pain and conditions that are associated with pelvic pain (such as endometriosis) report worse health-related quality of life. Despite the development of disease-specific questionnaires, only 2 questionnaires were generated from interviews of patients with the condition of interest, and few questionnaires are being used to evaluate the outcomes of treatment on subjective health status.

Female genital mutilation in Switzerland: a survey among gynaecologists

QUESTION UNDER STUDY

To evaluate the situation of Female Genital Mutilation (FGM) in Switzerland.

METHODS

Through a questionnaire, Swiss gynaecologists were asked if they have been confronted to FGMs, if they have been asked to perform infibulations and FGMs. The health representatives (Kantonsärzte/médecins cantonaux) were interviewed on FGM activity at the Canton level. Swiss Medical Schools were asked if FGM was included in the pregraduate curriculum, and an estimated prevalence rate for FGMs in Switzerland was gathered.

RESULTS

Among Swiss gynaecologists, 20% reported having been confronted with patients presenting with FGM and among them 40% had been asked about reinfibulation. Gynaecologists are occasionally asked about the possibility of performing FGMs in Switzerland. No activity concerning FGM is reported by health authorities in the Cantons. Teaching about FGM is not included in the curriculum of any of the Swiss medical schools. Approximately 6,700 girls at risk and women who have undergone FGM live in Switzerland.

CONCLUSION

The extent to which gynaecologists are confronted to women with FGM may justify further action to try to better understand the situation in Switzerland. Improvement of care by better education of health care providers (guidelines) and prevention of new cases by women's education should also be considered.

Genital ulcers, stigma, HIV, and STI control in sub-Saharan Africa

HIV associated stigma is still prevalent throughout Africa despite the spread of the epidemic. Stigma is also attached to sexually transmitted infections (STIs). Despite the importance of STIs, particularly genital ulceration in facilitating heterosexual HIV transmission, policymakers continue to focus mainly on other priorities. It would appear that this lack of public health initiative in tackling genital ulcers is itself an example of stigmatisation. Possible explanations for this include geographical variation in the data and a perception that genital ulcers are not a topic that can be discussed freely and openly. HIV policymakers in countries worst affected by HIV in Africa should examine their own opinions for bias when determining public health priorities for HIV prevention. The importance of genital ulcers should be reassessed and publicised.

Homeopathy in survivors of childhood sexual abuse

The objective of this review was to ascertain the incidence of childhood sexual abuse: to ascertain the long-term effects of childhood sexual abuse and to collate the experiences of homeopaths in caring for survivors. Childhood sexual abuse (CSA) is common with a high percentage of homeopathic patients giving a positive history. It is associated with many common clinical conditions, particularly pelvic pain. Survivors are more likely to present for medical help and to be hospitalised. Homeopaths have found work with such patients to be difficult, with cases being complex and multi-layered. New models for case-analysis have been developed.

Clinical approaches to women's sexual dysfunctions

OBJECTIVES

(1) to delineate the female sexual dysfunctions; (2) to present methods of identifying and treating female sexual problems or concerns.

[Women in reproductive age in the face of prophylactic gynaecological examinations]

In this study attitudes of young women towards prophylactic gynaecological examination were presented. 149 women were included into the questionnaire, all with secondary education in medical field. The most frequent reason of a first visit was the appearance of symptoms and sings, causing anxiety, and fear the second frequent reason was simply a check--visit. The majority of women (64.5%) confirmed the choice of one, regular doctor, to whom they used to report their various health problems.

Gynecologic aspects of Crohn's disease

Because Crohn's disease has a tendency to be transmural and to form fistulas, it may involve contiguous organs. Gynecologic involvement is frequent, diverse and often difficult to diagnose. Inflammation involving adjacent structures has been reported in as many as one third of patients. Enteric fistulas to the vagina, uterus, ovaries, perineum and vulva also have been reported. Diagnosis may not be obvious if pelvic involvement precedes active bowel disease, or if drainage is clear or mucoid. Abscesses, draining sinuses, edema and ulceration of the perineum or vulva are common, and are caused by direct extension from the involved bowel or by granulomas separated from the bowel by normal tissue. Lesions presenting with vulvar hypertrophy, a fluctuant mass or ulceration are easily misdiagnosed. Menstrual abnormalities are reported in more than one half of patients. Pelvic manifestations of Crohn's disease can be psychologically crippling. Patients or physicians may be hesitant to address serious psychosocial morbidity. To optimize management, physicians must be aware of the diverse manifestations, confusing presentations and psychologic morbidity of Crohn's disease.

Mot luuk problems in Northeast Thailand: why women's own health concerns matter as much as disease rates

In this paper, we consider women's illness experiences, above and beyond the presence of clinically identifiable disease. In Northeast Thailand, epidemiological data suggest that the prevalence of major women's reproductive tract infections is relatively low and not a cause for significant public health attention. Conversely, we found that self-reported rates of gynecological complaints are high and a significant women's health concern in rural Northeast villages. Women's embodied experiences and interpretations of these complaints affect their lives dramatically. Moreover, women's responses to gynecological problems (regardless of diagnosed morbidity) constitute an important health issue in their own right. In this regard, we document the dangers of women's self-treatment practices that rely largely on small doses of medically inappropriate antibiotics, the manner in which family life and sexual relations are disrupted by fears that gynecological problems will progress to cervical cancer, health care seeking patterns and expectations from health staff, and most importantly, how women's concerns about the seriousness of recurrent ailments result in substantial suffering. This study demonstrates why attention to women's own health concerns is as important to address in health programs as rates of disease, and why common gynecological problems and work-related complaints are important to take seriously rather than dismiss as psychological or routine and expected. We argue that there is a strong need to conduct ethnographic research on women's health problems as a complement to, and not merely a support for, epidemiological research. An evidence-based approach to health policy needs to be accompanied by a more humanistic approach to understanding health care needs.

Patients with psychiatric disorders in gynecologic practice

OBJECTIVE

The relationship between different gynecologic complaints and somatic symptoms was studied in a gynecologic population in which the prevalence of psychiatric disorders had been established.

STUDY DESIGN

The prevalence of depression and anxiety in the unselected population of 1013 subjects was 27.2% and 12.1%, respectively, as assessed by the Primary Care Evaluation of Mental Disorders (PRIME-MD). The subjects' medical charts were reviewed after the PRIME-MD diagnosis was made.

RESULTS

Depression and anxiety disorders were significantly more common among those seeking care for abdominal pain, those who made frequent and unscheduled visits, and those who were hospitalized for acute care. All the physical symptoms indicated in the PRIME-MD Patient Health Questionnaire were more common among women with a psychiatric diagnosis compared with controls.

CONCLUSIONS

The majority of cases of depression and anxiety in women are undiagnosed and untreated, and patients with these disorders often present with physical symptoms. Because gynecologic outpatients with abdominal pain, frequent and unscheduled visits, and admissions due to acute illness are more likely to have a psychiatric disorder, it is desirable that gynecologists recognize and treat these problems.

Are the physiologically and psychosocially based symptoms in women suffering from gynecological disorders alleviated by means of hysterectomy?

Women experiencing gynecological disorders can suffer from a diversity of symptoms and problems. To what extent women are relieved of their physiologically and psychosocially based symptoms by hysterectomy is an important issue. This study aims to evaluate the long-term impact of hysterectomy on such symptoms and to compare the findings with those of a control group. Women with gynecological disorders experienced physiologically based symptoms, such as pelvic pain and urinary incontinence, to a greater degree than did the control group (p < 0.05), whereas bowel function and menopausal symptoms were equally distributed in the two groups. Furthermore, these women experienced psychosocially based symptoms, such as fatigue and insomnia, to a greater degree than the control group (p < 0.05), whereas the groups did not differ in psychological well-being or sexual function. After hysterectomy, however, pelvic pain and sleeping disturbances were alleviated, and the state of energy and urinary function were improved (p < 0.00). Bowel function, menopausal symptoms, psychological well-being, sexual function, and self-perception as a woman were not influenced by the operation. Both 6 and 12 months after hysterectomy, no differences between the patients and the control group were found, except for the tendency of patients not to gain weight after the operation. The symptoms are mostly improved or unchanged after hysterectomy, and additional problems do not seem to follow the operation.

[Complementary medicine and patient contentedness - a survey]

BACKGROUND

Increasing popularity and concomitant application of complementary and conventional methods by patients and doctors in Germany.

INTENTION

To examine attitudes and patient contentedness.

METHOD

Open, retrospective, postal survey in 1,582 female patients treated with complementary methods between 1991 and 1996, using a structured trilateral questionnaire.

RESULTS

Of 1,582 mailed questionnaires 808 (51%) were evaluable. About 50% of the patients in the survey felt that the results of their complementary treatment were 'very successful' (22%) or 'rather successful' (24%). 80% of the patients were 'very' oder 'rather satisfied' with the complementary treatment. This positive assessment was also found in patients without treatment success. 50% indicated a significant change in health behavior, more than two thirds indicated a change in life-style attitude. More than 90% of the patients would be ready to pay for part of their treatment. Half of the surveyed women used natural remedies without knowledge of their family doctor. Because of a low response rate of 50%, there is the possibility of selection bias which makes a cautious interpretation of these results necessary.

CONCLUSION

Because of the approaches and methods applied, complementary medicine is particularly suited to induce patient treatment satisfaction. Further studies are necessary to verify positive long-term health effects of complementary interventions and treatment.

The quality of life in women suffering from gynecological disorders is improved by means of hysterectomy. Absolute and relative differences between pre- and postoperative measures

BACKGROUND

Gynecological disorders can have adverse effects on a woman's quality of life. Most hysterectomies are thus performed to enhance women's quality of life rather than to save life. This study aims at evaluating the long-term impact of hysterectomy on this outcome variable.

METHODS

The quality of life in 111 women undergoing hysterectomy for benign reasons was tested before, and six and twelve months after, the operation. A control-group of non-hysterectomized women from the normal population was tested once. Ferrans & Powers' Quality of Life Index, consisting of four life domains, was used. This index has a pre-set highest possible obtainable score. For the subjects with a high pre-test score, there was little scope for further measurable improvement after hysterectomy, which gives a false stability in the material. A method for calculating the relative differences was introduced.

RESULTS

The health and functioning domain of the quality of life among women awaiting hysterectomy is significantly lower compared to that of the control-group (p<.01) Both six and twelve months after the hysterectomy, the patients have reached the same level of their health and functioning as the control-group. Using the relative difference-form, it is demonstrated that the subjects have obtained significantly higher levels in all the domains of quality of life after hysterectomy.

CONCLUSIONS

The results of this study show that hysterectomy is associated with a positive long-term impact on a woman's quality of life.