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Bruno MT, Caruso G, Torrisi E, Grimaldi R, Abate B, Luciani FS, Basile S, Panella MM. The Impact of Diagnosis of Human Papillomavirus (HPV) Infection and Electrosurgical Excision Procedure (LEEP) for Cervical Intraepithelial Neoplasia 3 (CIN3) on Women's Sexual Lives. Diagnostics (Basel) 2024; 14:911. [PMID: 38732325 PMCID: PMC11083130 DOI: 10.3390/diagnostics14090911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
The aim of the study was to assess sexual health in women who underwent Loop Electrosurgical Excisional Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia 3 (CIN 3). One hundred thirty-one women were enrolled, and the Female Sexual Function Index (FSFI) questionnaire was administered before LEEP and 6 months after the procedure. In almost all of the participants, data revealed a statistically significant worsening in sexual quality of life after LEEP. Therefore, clinicians should be aware of these possible negative effects on sexual behavior, and provide women with appropriate, wide-ranging, and detailed counseling. The data obtained in the present study should help to plan appropriate counseling from communicating HPV diagnosis and medical treatment to CIN3 surgical procedure.
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Affiliation(s)
- Maria Teresa Bruno
- Department of General Surgery and Medical-Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy (E.T.); (R.G.)
- Multidisciplinary Research Center in Papillomavirus Pathology, University of Catania, 95123 Catania, Italy
| | - Giuseppe Caruso
- Department of General Surgery and Medical-Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy (E.T.); (R.G.)
| | - Elena Torrisi
- Department of General Surgery and Medical-Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy (E.T.); (R.G.)
| | - Raffaela Grimaldi
- Department of General Surgery and Medical-Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy (E.T.); (R.G.)
| | - Biagio Abate
- Department of General Surgery and Medical-Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy (E.T.); (R.G.)
| | - Francesco Saverio Luciani
- Methods and Models Department for the Economy, Territory and Finance, La Sapienza University of Rome, 00185 Rome, Italy;
| | - Susanna Basile
- Psychologist and Clinical Sexologist, 95123 Catania, Italy;
| | - Marco Marzio Panella
- Department of General Surgery and Medical-Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy (E.T.); (R.G.)
- Multidisciplinary Research Center in Papillomavirus Pathology, University of Catania, 95123 Catania, Italy
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Peng H, Liu W, Jiang J, Du H. Extensive lesions and a positive cone margin are strong predictors of residual disease in subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3 study design. BMC Womens Health 2023; 23:454. [PMID: 37641051 PMCID: PMC10464471 DOI: 10.1186/s12905-023-02568-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND This study aimed to determine the predictive factors for post-conization of residual disease in subsequent hysterectomy for cervical intraepithelial neoplasia grade 2 or 3. METHODS This retrospective study included 267 patients with histologically confirmed cervical intraepithelial neoplasia grade 2 or 3 who underwent hysterectomy within 7 months after conization. Clinical data (e.g., age, menopausal status, gravidity, parity, type of transformation zone, conization method) as well as pathological data pertaining to conization and hysterectomy were collected from medical records. A logistic regression model was used to analyze the relationship between the variables and risk of residual lesions in hysterectomy samples. RESULTS Overall, 70 (26.2%) patients had residual lesions in their hysterectomy specimens. Univariate analyses revealed that age ≥ 50 years (p=0.019), endocervical gland involvement(p=0.013), positive margin(p < 0.001), and involvement of 3-4 quadrants(p < 0.001) were risk factors for residual lesions. Conversely, postmenopausal status, gravidity ≥ 3, parity ≥ 2, loop electrosurgical excision procedure, and type III transformation zone were not risk factors for residual lesions. A positive margin(p < 0.001) and multiple-quadrant involvement(p < 0.001) were identified as independent risk factors for residual lesions on multivariate analysis. CONCLUSIONS Multiple-quadrant involvement and a positive cone margin were reliable predictive factors for residual disease. Total hysterectomy or repeated cervical conization should be considered for patients with these two risk factors. The identification of high-risk patients with extensive lesions by colposcopic examination before conization is indispensable, as it will enable surgeons to perform conization with consideration of risk factors and possibly improve the approach used for the excisional procedure. For high-risk patients, colposcope-guided cold-knife conization is preferred when resources permit.
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Affiliation(s)
- Hongfa Peng
- Department of Obstetrics and Gynecology, Second hospital of Hebei medical university, Shijiazhuang City, 050000, Hebei, China
| | - Wencan Liu
- Department of Obstetrics and Gynecology, Second hospital of Hebei medical university, Shijiazhuang City, 050000, Hebei, China
| | - Jingjing Jiang
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang City, 050051, Hebei, China.
| | - Hui Du
- Department of Obstetrics and Gynecology, Second hospital of Hebei medical university, Shijiazhuang City, 050000, Hebei, China.
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Sikorska M, Pawłowska A, Antosik-Wójcińska A, Zyguła A, Suchońska B, Dominiak M. The Impact of HPV Diagnosis and the Electrosurgical Excision Procedure (LEEP) on Mental Health and Sexual Functioning: A Systematic Review. Cancers (Basel) 2023; 15:cancers15082226. [PMID: 37190155 DOI: 10.3390/cancers15082226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
The impact of HPV diagnosis and subsequent treatment with the electrosurgical excision procedure (LEEP) on anxiety, depression, psychosocial quality of life, and sexual functioning has not been thoroughly investigated. The aim of this review was to systematically summarize the available knowledge on this topic, according to PRISMA guidelines. Data from observational and intervention studies were analyzed. A total of 60 records were included, of which 50 papers addressed the impact of HPV diagnosis on patients' psychosocial status, while 10 studies addressed the impact of the implemented LEEP procedure on patients' mental health and sexual functioning. The results indicated a negative impact of HPV diagnosis on the occurrence of depressive and anxiety symptoms, poorer quality of life, as well as on the sexual functioning of the affected women. The results of the studies to date have not confirmed the negative impact of the LEEP procedure on mental health and sexual life, although more research is needed in this area. It is necessary to implement additional procedures to minimize anxiety and distress in patients receiving a diagnosis of HPV or abnormal cytology and to improve awareness of sexually transmitted pathogens.
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Affiliation(s)
- Michalina Sikorska
- Medical Center of Postgraduate Education, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
| | | | - Anna Antosik-Wójcińska
- Department of Psychiatry, Faculty of Medicine, Collegium Medicum, Cardinal Wyszynski University in Warsaw, Woycickiego 1/3, 01-938 Warsaw, Poland
| | | | - Barbara Suchońska
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, 1/3 Starynkiewicza Sq, 02-015 Warsaw, Poland
| | - Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
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Hansen J, Kirkegaard P, Folmann B, Bungum HF, Hammer A. "I feel reassured, but there is no guarantee." How do women with a future childbearing desire respond to active surveillance of cervical intraepithelial neoplasia grade 2? A qualitative study. Acta Obstet Gynecol Scand 2022; 101:616-623. [PMID: 35383881 DOI: 10.1111/aogs.14354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/23/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In Denmark, women with a future childbearing desire diagnosed with cervical intraepithelial neoplasia grade 2 (CIN2) are recommended active surveillance instead of excisional treatment. However, we have limited and contradictory knowledge about how active surveillance of CIN2 may affect women emotionally. The aim of this study was to explore thoughts and emotional responses in women undergoing active surveillance of CIN2 and to explore how active surveillance may affect women's future childbearing desire. MATERIAL AND METHODS This qualitative study was conducted in the gynecological outpatient clinic, the Department of Obstetrics and Gynecology, Gødstrup Hospital, Denmark. Women of childbearing age undergoing active surveillance with colposcopy, biopsy and smear every 6 months due to CIN2 were eligible for enrollment. In-depth semi-structured interviews were conducted. The interviews were audiotaped and transcribed verbatim. A thematic analysis was performed using a phenomenological approach. RESULTS A total of 20 women were included. All women experienced nervousness and anxiety when they were diagnosed with CIN2 initially. Their main concern was whether they had cancer. Most women carried on with their everyday lives with only minor occasional worries about CIN2, often prompted just before check-up. However, some women were particularly nervous and found the period between check-ups frustrating and challenging. Women did not want to postpone their plans for pregnancy because of CIN2, but experienced the worries and check-ups associated with active surveillance as disruptive elements in their family planning. Women preparing for fertility treatment had their startup unnecessarily delayed due to active surveillance of CIN2, as clinical guidelines were inconsistent across subspecialties. Various factors influenced women's emotional well-being: life circumstances, information needs, and mental and physical discomfort during colposcopic examination. CONCLUSIONS Women felt that worries and check-ups due to active surveillance of CIN2 were disrupting elements in their family planning, although they did not affect their every-day life. Some women, however, were particularly anxious, demonstrating the importance of including women's experiences and preferences in clinical counseling. The fact that fertility treatment was delayed due inconsistent guidelines across subspecialties, suggests a need for a revision of current guidelines.
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Affiliation(s)
- Joan Hansen
- Gødstrup Hospital, NIDO Denmark, Gødstrup, Denmark
| | - Pia Kirkegaard
- Department of Public Health Programs, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Birgitte Folmann
- Gødstrup Hospital, NIDO Denmark, Gødstrup, Denmark.,University College South Denmark, Kolding, Denmark
| | | | - Anne Hammer
- Gødstrup Hospital, NIDO Denmark, Gødstrup, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Adcock A, Stevenson K, Cram F, MacDonald EJ, Geller S, Hermens J, Lawton B. He Tapu Te Whare Tangata (sacred house of humanity): Under-screened Māori women talk about HPV self-testing cervical screening clinical pathways. Int J Gynaecol Obstet 2021; 155:275-281. [PMID: 34382217 DOI: 10.1002/ijgo.13873] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/12/2021] [Accepted: 08/10/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To develop an in-depth understanding of HPV self-testing cervical screening clinical pathways for never-/under-screened Māori women. METHODS Based on a community-based cluster randomized controlled trial in Aotearoa (New Zealand), a Kaupapa Māori (by Māori, for Māori) qualitative study enrolled Māori women who met the eligibility criteria of the HPV trial intervention (aged 25-69 years, no screen in >4 years). In total, 28 were recruited (22 had a negative test, six had a positive test and colposcopy). They were asked about their clinical pathway. RESULTS The HPV self-test was seen as empowering and promoting bodily autonomy, although some women expressed fears or misconceptions about this new technology. While those with a negative test were relieved, for the six women who had a positive test, there were many fears, compounded by seeking out information on the Internet. When attending colposcopy, the importance of support and responsive care was emphasized. CONCLUSION HPV self-testing has the potential to improve access to cervical screening and reduce inequities for Māori. Care must be taken in the delivery of screening and colposcopy results. Primary care and colposcopy services need to take special care with never-/under-screened Māori women to provide sensitive, responsive care, and mitigate trauma.
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Affiliation(s)
- Anna Adcock
- Te Tātai Hauora o Hine Centre for Women's Health Research, Te Herenga Waka Victoria University of Wellington, Wellington, Aotearoa New Zealand
| | - Kendall Stevenson
- Te Tātai Hauora o Hine Centre for Women's Health Research, Te Herenga Waka Victoria University of Wellington, Wellington, Aotearoa New Zealand.,The Dragon Institute for Innovation, Auckland, Aotearoa New Zealand
| | - Fiona Cram
- Katoa Ltd., Auckland, Aotearoa New Zealand
| | - Evelyn Jane MacDonald
- Te Tātai Hauora o Hine Centre for Women's Health Research, Te Herenga Waka Victoria University of Wellington, Wellington, Aotearoa New Zealand
| | - Stacie Geller
- Division of Academic Internal Medicine, Department of Medicine, Center for Research on Women and Gender, College of Medicine, University of Illinois, Chicago, Illinois, USA
| | - Jordanna Hermens
- Te Tātai Hauora o Hine Centre for Women's Health Research, Te Herenga Waka Victoria University of Wellington, Wellington, Aotearoa New Zealand
| | - Beverley Lawton
- Te Tātai Hauora o Hine Centre for Women's Health Research, Te Herenga Waka Victoria University of Wellington, Wellington, Aotearoa New Zealand
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Asymmetric Power Relations in Gynaecological Consultations for Cervical Cancer Prevention: Biomedical and Gender Issues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157850. [PMID: 34360140 PMCID: PMC8345629 DOI: 10.3390/ijerph18157850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
A generic qualitative research, using a poststructuralist feminist perspective, was conducted in a Spanish gynaecology unit with the following aims: (a) to analyse how asymmetric power relations in relation to biomedical knowledge and gender shape the medical encounters between gynaecologists and women diagnosed with cervical intraepithelial neoplasia and (b) to explore the cognitive, moral, and emotional responses expressed by patients. A total of 21 women diagnosed with cervical intraepithelial neoplasia were recruited through purposive sampling. Semi-structured interviews were recorded and transcribed, and a thematic analysis was carried out. Two major themes were identified: (a) gendered relations in cervical intraepithelial neoplasia medical encounters are based on hidden, judgmental moral assumptions, making women feel irresponsible and blamed for contracting the human papillomavirus infection; (b) biomedical power is based on the positivist assumption of a single truth (scientific knowledge), creating asymmetric relations rendering women ignorant and infantilised. Women reacted vehemently during the interviews, revealing a nexus of cognitive, moral, and emotional reactions. In medical encounters for management of cervical intraepithelial neoplasia, patients feel they are being morally judged and given limited information, generating emotional distress. Healthcare professionals should question whether their practices are based on stereotypical gender assumptions which lead to power asymmetries during encounters.
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Quality of Life in Vulvar Lichen Sclerosus Patients Treated With Long-Term Topical Corticosteroids. J Low Genit Tract Dis 2021; 25:158-165. [PMID: 33746196 DOI: 10.1097/lgt.0000000000000599] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the quality of life in vulvar lichen sclerosus (VLS) patients treated with long-term, individualized topical corticosteroids. METHODS A prospective cross-sectional study comparing new pretreatment and long-term treated VLS patients attending a dermatogynecology practice in Sydney, Australia. Participants were invited to complete the Vulvar Quality of Life Index (VQLI). The VQLI scores were compared between the 2 groups. RESULTS A total of 204 biopsy-proven VLS patients-68 new pretreatment and 136 treated patients on topical corticosteroids for 2 years or longer. Treated participants scored lower in all VQLI components, including total score (median = 2.0 [interquartile range {IQR} = 0.0-6.0] vs 13.5 [IQR = 7.5-22.0]; p < .001), symptoms (median = 0.5 [IQR = 0.0-0.5] vs 1.3 [IQR = 0.8-2.0]; p < .001), anxiety (median = 0.0 [IQR = 0.0-0.3] vs 0.8 [IQR = 1.1-2.0]; p < .001), activities of daily living (median = 0.2 [IQR = 0.0-0.3] vs 0.5 [IQR = 0.2-1.1]; p < .001), and sexuality (median = 0.0 [IQR = 0.0-0.7] vs 1.0 [IQR = 0.0-2.0]; p < .001). A higher proportion of treated patients achieved total scores of 0-5, representing nil to minimal impact of VLS on quality of life (98 [72.1%] vs 8 [11.8%]; p < .001). Mild and reversible adverse effects were developed in 11 patients (8.1%). Partially compliant patients were 12 times as likely to develop scarring progression than fully compliant patients (7 [22.6%] vs 2 [1.9%]; p < .001). CONCLUSIONS Long-term, individualized topical corticosteroid treatment is safe and effective in maintaining disease remission and improves the quality of life of VLS patients. Fully compliant patients demonstrate better treatment outcomes than partially compliant patients.
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Murphy B, McShane CM, Santin O, Treanor C, Byrne B, Donnelly M, Anderson LA. Patient's perspectives of living with a precancerous condition: Monoclonal gammopathy of undetermined significance (MGUS). Eur J Oncol Nurs 2021; 51:101901. [PMID: 33503552 DOI: 10.1016/j.ejon.2021.101901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/08/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to investigate patient experiences of living with monoclonal gammopathy of undetermined significance (MGUS). Living with a premalignant condition such as MGUS may elicit negative psychosocial effects including increased anxiety and fear of progression to cancer. To date, no study utilising qualitative methodology has explored the lived experiences of MGUS patients. METHODS Data was collected via two focus groups and six telephone interviews. MGUS patients (n=14) were recruited via nurse-led haematology telephone-clinics in Northern Ireland. Interviews were transcribed verbatim and the data subjected to thematic analysis. OUTCOME Thematic analysis identified 3 overarching themes; (1) The psychosocial impact of an MGUS diagnosis, (2) Knowledge of MGUS and (3) Experiences of MGUS health services. Patients with MGUS reported experiencing poor psychological adjustment to their condition particularly at the point of diagnosis and approaching follow-up appointments. Feelings of isolation, poor information-provision, increased uncertainty and limited psychosocial support for MGUS patients were also reported. Patients did however reflect positively on their experience of being followed up via nurse-led telephone clinics. CONCLUSIONS Provision of patient friendly information guides at diagnosis, and additional psychosocial support services such as nurse-led telephone clinics and coordinated patient groups may help MGUS patients adjust better to their diagnosis and in doing so improve quality of life in this patient population.
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Affiliation(s)
- Blain Murphy
- Institute for Global Food Security (IGFS), School of Biological Sciences, Queen's University Belfast, UK
| | | | - Olinda Santin
- School of Nursing and Midwifery, Queen's University Belfast, UK
| | | | - Bronagh Byrne
- Centre for Public Health, Queen's University Belfast, UK
| | | | - Lesley A Anderson
- Centre for Public Health, Queen's University Belfast, UK; Aberdeen Centre for Health Data Science, University of Aberdeen, UK.
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Wijaya M, Lee G, Fischer G. Quality of life of women with untreated vulval lichen sclerosus assessed with vulval quality of life index (VQLI). Australas J Dermatol 2021; 62:177-182. [PMID: 33508152 DOI: 10.1111/ajd.13530] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVE The diagnosis of vulval lichen sclerosus (VLS) is often delayed, and little is known about quality of life (QoL) of women with it prior to receiving diagnosis and treatment. This study aimed to investigate the impact on QoL on patients with previously untreated VLS using the Vulval Quality of Life Index (VQLI). METHODS A prospective cross-sectional survey of patients attending a dermato-gynaecology practice in Sydney, Australia from March 2018 to November 2019. Patients with a new biopsy-proven diagnosis of VLS not previously commenced on topical corticosteroid treatment were invited to complete the VQLI. RESULTS A total of 68 participants with median age of 58 (interquartile range, IQR 48-67) years. Median symptom duration was 24 (IQR 11-60) months. Scarring was present in 53% of participants. The median total score was 13.5 (IQR 7.5-22.0), global score 1.0 (IQR 1.0-2.0). Twelve per cent had nil to minimal effect on QoL, 38% had a mild effect on QoL, 28% had a moderate effect on QoL, 22% had a severe effect on QoL, and none had a very severe effect on QoL. The highest-scoring domains were symptoms, followed by sexuality, anxiety and activities of daily living. CONCLUSION There was significant impairment in all QoL areas of women with untreated VLS. Most experienced moderate-to-severe impairment as a result of the disease and approximately half had already developed scarring at the time of diagnosis. The findings emphasise the importance of improved awareness, early diagnosis and early commencement of treatment in VLS.
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Affiliation(s)
- Marlene Wijaya
- Faculty of Medicine, Northern Clinical School, University of Sydney, Australia.,Department of Dermatology, Royal North Shore Hospital, Australia
| | - Geoffrey Lee
- Faculty of Medicine, Northern Clinical School, University of Sydney, Australia
| | - Gayle Fischer
- Faculty of Medicine, Northern Clinical School, University of Sydney, Australia.,Department of Dermatology, Royal North Shore Hospital, Australia.,North Shore Private Hospital, St Leonards, New South Wales, Australia
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Er Güneri S, Şen S. Women's experiences after abnormal Pap smear results: a qualitative study. J Psychosom Obstet Gynaecol 2020; 41:22-29. [PMID: 31452433 DOI: 10.1080/0167482x.2019.1657090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: Abnormal Pap smear result means there have been cell changes on the cervix but are not cancer. Women with abnormal test result may be affected from this situation. What do women with abnormal Pap smear results experience from a biopsychosocial perspective?Objective: This study aimed to explore the experiences of women with abnormal Pap smear results according to the biopsychosocial model.Methods: This phenomenological study's data were collected in interviews with 12 women who had abnormal Pap smear test results. Data collection tool consists of two parts that are an "Women's Information Form (WIF)" identifying women and semi-structured "Interview Form". Interviews were done face-to-face by using in-depth interviews technique. Semi-structured interview was recorded in audio recording device. Thematic approach was used to assess the data.Results: The average age of the women was 42.5 ± 3.64, their age at first sexual intercourse was 23.0 ± 2.8 years and all of them were legally married. Five main themes were determined, which were grouped under the Biopsychosocial Model Domains. The Biological Domain themes were Perception of Health and Disease, and Cervical Cancer Risk Factors; the Psychological Domain themes were Positive Feelings and Negative Feelings; the Social Domain theme was Continuing Social Life.Conclusions: It was concluded that the cultural beliefs, perceptions, emotions and practices of women with abnormal Pap smear results should be considered in the diagnostic and treatment processes. These characteristics of women's experience are also important to consider when developing strategies to address barriers to effective cervical screening, diagnosis and treatment.
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Affiliation(s)
- Sezer Er Güneri
- Obstetrics and Gynecology Nursing Department, Nursing Faculty, Ege University, Izmir, Turkey
| | - Selma Şen
- Midwifery Department, Health Science Faculty, Manisa Celal Bayar University, Manisa, Turkey
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11
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Freijomil-Vázquez C, Gastaldo D, Coronado C, Movilla-Fernández MJ. When risk becomes illness: The personal and social consequences of cervical intraepithelial neoplasia medical surveillance. PLoS One 2019; 14:e0226261. [PMID: 31841543 PMCID: PMC6913976 DOI: 10.1371/journal.pone.0226261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/23/2019] [Indexed: 11/19/2022] Open
Abstract
Background After the early detection of cervical intraepithelial neoplasia (CIN), medical surveillance of the precancerous lesions is carried out to control risk factors to avoid the development of cervical cancer. Objective To explore the effects of medical surveillance on the personal and social lives of women undergoing CIN follow-up and treatment. Methodology A generic qualitative study using a poststructuralist perspective of risk management was carried out in a gynecology clinic in a public hospital of the Galician Health Care System (Spain). Participants were selected through purposive sampling. The sample consisted of 21 women with a confirmed diagnosis of CIN. Semistructured interviews were recorded and transcribed, and a thematic analysis was carried out, including researcher triangulation to verify the results of the analysis. Findings Two main themes emerged from the participants’ experiences: CIN medical surveillance encounters and risk management strategies are shaped by the biomedical discourse, and the effects of “risk treatment” for patients include (a) profound changes expected of patients, (b) increased patient risk management, and (c) resistance to risk management. While doctors’ surveillance aimed to prevent the development of cervical cancer, women felt they were sick because they had to follow strict recommendations over an unspecified period of time and live with the possibility of a life-threatening disease. Clinical risk management resulted in the medicalization of women’s personal and social lives and produced great uncertainty. Conclusions This study is the first to conceptualize CIN medical surveillance as an illness experience for patients. It also problematizes the effects of preventative practices in women’s lives. Patients deal with great uncertainty, as CIN medical surveillance performed by gynecologists simultaneously trivializes the changes expected of patients and underestimates the effects of medical recommendations on patients’ personal wellbeing and social relations.
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Affiliation(s)
- Carla Freijomil-Vázquez
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Ferrol, Spain
- Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain
- * E-mail:
| | - Denise Gastaldo
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Canada
| | - Carmen Coronado
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Ferrol, Spain
- Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain
| | - María-Jesús Movilla-Fernández
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Ferrol, Spain
- Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain
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Freijomil-Vázquez C, Gastaldo D, Coronado C, Movilla-Fernández MJ. Health care informational challenges for women diagnosed with cervical intraepithelial neoplasia: a qualitative study. BMC WOMENS HEALTH 2019; 19:112. [PMID: 31477083 PMCID: PMC6720084 DOI: 10.1186/s12905-019-0811-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/23/2019] [Indexed: 12/01/2022]
Abstract
Background Internationally, women with cervical intraepithelial neoplasia (CIN) lack knowledge about their disease, which limits their ability to take responsibility for self-care and creates negative psychosocial effects, including marital problems. Normally, screening is performed in primary care, and in case of abnormal results, the patient is referred to specialized care for follow-up and treatment. Given the lack of international literature regarding patients’ experiences in primary and specialized healthcare, our study aims to: (a) investigate how women with CIN perceive the communication and management of information by healthcare providers at different moments of their healthcare and (b) identify these women’s informational needs. Methods A qualitative exploratory study was carried out in a gynecology unit of a public hospital of the Galician Health Care Service (Spain). Participants were selected through purposive sampling. The sample consisted of 21 women aged 21 to 52 years old with a confirmed diagnosis of CIN. Semistructured interviews were recorded and transcribed. A thematic analysis was carried out, including triangulation of researchers for analysis verification. Results Two analytical themes were identified. The first was communication gaps in the diagnosis and management of information in primary and specialized healthcare. These gaps occurred in the following moments of the healthcare process: (a) cervical cancer screening in primary care, (b) waiting time until referral to specialized care, (c) first consultation in specialized care, and (d) after consultation in specialized care. The second theme was participants’ unmatched informational needs. The doubts and informational needs of women during their healthcare process related to the following subthemes: (a) HPV transmission, (b) HPV infection symptoms and consequences, and (c) CIN treatment and follow-up. Conclusions This study shows that women who have a diagnosis of CIN experience important healthcare informational challenges when accessing primary and specialized care that have several implications for their wellbeing. The information given is limited, which makes it difficult for women to understand and participate in the decision making regarding the prevention and treatment of CIN. Service coordination among different levels of care and the availability of educational materials at any given time would improve the patients’ healthcare experience.
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Affiliation(s)
- Carla Freijomil-Vázquez
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Campus de Esteiro, CP: 15403, Ferrol, Spain. .,Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain.
| | - Denise Gastaldo
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Centre for Critical Qualitative Health Research (CQ), University of Toronto, Toronto, Canada
| | - Carmen Coronado
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Campus de Esteiro, CP: 15403, Ferrol, Spain.,Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain
| | - María-Jesús Movilla-Fernández
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Campus de Esteiro, CP: 15403, Ferrol, Spain.,Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain
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13
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Sparić R, Papoutsis D, Kadija S, Stefanović R, Antonakou A, Nejković L, Kesić V. Psychosexual outcomes in women of reproductive age at more than two-years from excisional cervical treatment - a cross-sectional study. J Psychosom Obstet Gynaecol 2019. [PMID: 29527976 DOI: 10.1080/0167482x.2018.1445220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Purpose: To investigate the long-term psychosexual outcomes in women following excisional cervical treatment. Materials and methods: Women with cold-knife conization (CKC) or large loop excision of the transformation zone (LLETZ) treatment were interviewed after a follow-up colposcopy visit. Their demographics, treatment and psychosexual characteristics were recorded. Results: One hundred and forty six women with a mean age of 35.2 ± 5.4 years underwent either LLETZ (68.5%) or CKC (31.5%) treatment within 4.7 ± 2.7 years (range: 2-15) before the interview. 27.4% of women were less interested in sexual intercourse following treatment in comparison with their interest before. Those women with less interest in sexual intercourse after treatment had higher anxiety and depression scores and were more worried about disease progression. Women with post-treatment complications were at risk of less interest in sexual intercourse and of greater anxiety and depression. Women with abnormal smears at follow-up were at risk of greater anxiety. The type of treatment and grade of dysplasia did not affect their interest in sexual intercourse or the anxiety and depression scores. Conclusions: Approximately, one-third of women at more than two years post-treatment may suffer from less interest in sexual intercourse, have relatively greater anxiety and depression, and might still be concerned about the possibility of disease progression.
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Affiliation(s)
- Radmila Sparić
- a School of Medicine , University of Belgrade , Belgrade , Serbia.,b Clinic for Gynecology and Obstetrics , Clinical Centre of Serbia , Belgrade , Serbia
| | - Dimitrios Papoutsis
- c Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals , NHS Trust , Telford , UK
| | - Saša Kadija
- a School of Medicine , University of Belgrade , Belgrade , Serbia.,b Clinic for Gynecology and Obstetrics , Clinical Centre of Serbia , Belgrade , Serbia
| | - Radomir Stefanović
- d Department for Histopathology , Clinical Center of Serbia , Belgrade , Serbia
| | - Angeliki Antonakou
- c Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals , NHS Trust , Telford , UK.,e Department of Midwifery , Midwifery School, "Alexander" Technological Educational Institute of Thessaloniki , Thessaloniki , Greece
| | - Lazar Nejković
- a School of Medicine , University of Belgrade , Belgrade , Serbia.,f Clinic for Gynecology and Obstetrics "Narodni Front" , Belgrade , Serbia
| | - Vesna Kesić
- a School of Medicine , University of Belgrade , Belgrade , Serbia.,b Clinic for Gynecology and Obstetrics , Clinical Centre of Serbia , Belgrade , Serbia
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14
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Nagele E, Trutnovsky G, Greimel E, Dorfer M, Haas J, Reich O. Do different treatment strategies influence women's level of psychosexual distress? Observational cohort study of women with premalignant HPV-associated genital lesions. Eur J Obstet Gynecol Reprod Biol 2019; 236:205-209. [PMID: 30965187 DOI: 10.1016/j.ejogrb.2019.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/28/2019] [Accepted: 03/31/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the impact of different treatment strategies - surgical treatment or watchful waiting- on sexual activity, psychosocial distress, and fear of progression in women with Human Papillomavirus (HPV)-associated premalignant genital lesions. STUDY DESIGN Observational cohort study of women diagnosed with HPV-associated premalignant lesions of the cervix, vagina or vulva. Patients were stratified into two groups depending on the severity of their premalignancy: surgical treatment or watchful waiting. Validated patient administered questionnaires, i.e. Fear of Progression questionnaire (FoP-Q), Cervical Dysplasia Distress Questionnaire (CDDQ), and Sexual Activity Questionnaire (SAQ) were completed after clinical evaluation (baseline), at 6- and 12-months follow-ups. RESULTS 209 women treated with surgery (N = 125) were compared with women who were monitored in regular intervals (N = 82). During an observational period of 12 months there were no significant differences in fear of progression, psychosocial distress, and sexual activity (p > 0.05). The level of concerns and anxiety about the future, and fear of progression were present, mostly at baseline. While there was a small increase of tension from visit to visit in both groups, patients generally were able to cope with their clinical situation quite well. CONCLUSIONS Fear of progression, psychosocial distress and sexual activity in women with precancerous HPV- associated premalignant genital lesions seem to be independent from type of treatment. Both treatment strategies may be applied without major psychological sequelae, as long as adequate information is provided.
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Affiliation(s)
- Eva Nagele
- Div. of Gynecology, Obstetrics and Gynecology, Medical University of Graz, Austria
| | - Gerda Trutnovsky
- Div. of Gynecology, Obstetrics and Gynecology, Medical University of Graz, Austria.
| | - Elfriede Greimel
- Div. of Gynecology, Obstetrics and Gynecology, Medical University of Graz, Austria
| | - Martha Dorfer
- Div. of Gynecology, Obstetrics and Gynecology, Medical University of Graz, Austria
| | - Josef Haas
- Div. of Gynecology, Obstetrics and Gynecology, Medical University of Graz, Austria
| | - Olaf Reich
- Div. of Gynecology, Obstetrics and Gynecology, Medical University of Graz, Austria
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15
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Manga S, Kiyang E, DeMarco RF. Barriers and facilitators of follow-up among women with precancerous lesions of the cervix in Cameroon: a qualitative pilot study. Int J Womens Health 2019; 11:229-239. [PMID: 31015770 PMCID: PMC6448541 DOI: 10.2147/ijwh.s196112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This pilot study explores the barriers to adherence to follow-up among women with cervical precancer in urban Cameroon. While follow-up of women with a positive screening of cervical precancer is the most important aspect of cervical cancer secondary prevention, women with cervical precancer do not adhere frequently to recommended follow-up schedule in Cameroon. The aim of the study was to explore and describe the barriers and facilitators to follow-up for cervical precancer among women infected and uninfected with HIV in Cameroon. Participants and methods A qualitative research design was used to answer the research questions. Participants included eight HIV-infected and -uninfected women diagnosed with cervical precancer and 19 nurses. Data were collected by in-depth individual patient interviews and focus groups with nurses. An interview guide with open-ended questions, using the social ecological model as a framework, included questions that addressed the complexities of the lives of individuals and professionals within a relational context. The interviews were audio-taped and transcribed verbatim in English language. Thematic analysis of data was completed with no epistemological or theoretical perspective underpinning the analyses. Results Four major themes emerged from the study. They were clinic, personal, and social barriers, and strategies to improve follow-up. Conclusion The use of reminder phone calls and fee reduction, coupled with peer counseling and navigation of women who have been diagnosed with cervical precancer, could be effective ways of improving adherence to follow-up. Further research is needed to explore the same phenomenon among women in rural areas, especially those who were initially attended to in mobile clinics.
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Affiliation(s)
- Simon Manga
- Women's Health Program, Cameroon Baptist Convention Health Services, Bamenda, Cameroon, .,College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA,
| | - Edith Kiyang
- Women's Health Program, Cameroon Baptist Convention Health Services, Bamenda, Cameroon,
| | - Rosanna F DeMarco
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA,
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16
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Kristiansen BK, Andersen B, Bro F, Svanholm H, Vedsted P. Direct notification of cervical cytology results to women improves follow-up in cervical cancer screening - A cluster-randomised trial. Prev Med Rep 2018; 13:118-125. [PMID: 30568870 PMCID: PMC6296289 DOI: 10.1016/j.pmedr.2018.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/23/2018] [Accepted: 11/22/2018] [Indexed: 11/27/2022] Open
Abstract
Up to half of all women do not receive follow-up as recommended after cervical cytology testing and are thus at increased risk of dysplasia progression. Women from lower social positions are at increased risk of not receiving follow-up. Sample takers, often general practitioners, convey results to women, but communication problems constitute a challenge. We aimed to investigate the effect of direct notification of cervical cytology results on follow-up rates. In a 1:1 cluster-randomised controlled trial, we assessed if having the pathology department convey cervical cytology results directly to the investigated women improved timely follow-up, compared with conveying the results via the general practitioner as usual. All women with a cervical cytology performed in a general practice in the Central Denmark Region (2013-2014) and receiving follow-up recommendation were included (n = 11,833). The proportion of women without timely follow-up was lower in the group with direct notifications than in the control group of women receiving usual care, regardless of age, educational status, cohabitation status and ethnicity. Among the women with the most severe cervical cytology diagnoses who are recommended gynaecological follow-up within 3 months, the percentage without timely follow-up was 15.1% in the intervention group and 19.5% in the control group (prevalence difference: -0.04 (95%CI: -0.07; -0.02)). Improved timely follow-up was also observed for women with a recommendation to have follow-up performed at 3 and 12 months. Cervical cytology results conveyed directly by letter to women increased the proportion of women with timely follow-up without raising inequality in follow-up measured by social position. Trial registration: ClinicalTrials.gov (TRN: NCT02002468) 29 November 2013.
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Key Words
- AGC, Atypical Glandular Cells
- AIS, adenocarcinoma in situ
- ASC-H, atypical squamous cells cannot exclude HSIL
- ASC-US, Atypical Squamous Cells of Undetermined Significance
- CCU, cancer of the cervix uteri
- CDR, Central Denmark Region
- DPDB, Danish National Pathology Registry and Data Bank
- Early detection of cancer
- GP, general practitioner
- General practice
- HSIL, High-grade Squamous Intraepithelial Lesion
- ICC, intra-cluster correlation coefficient
- LSIL, Low-grade Squamous Intraepithelial Lesion
- Mass screening
- PD, prevalence differences
- PR, prevalence ratio
- Quality of health care
- SNOMED, Systematized Nomenclature of Medicine
- Socioeconomic factors
- Uterine cervical dysplasia
- hrHPV-pos., high-risk Human Papilloma Virus positive
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Affiliation(s)
- Bettina Kjær Kristiansen
- Research Unit for General Practice, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark.,Department for Public Health Programmes, Randers Regional Hospital, 8930 Randers, Denmark
| | - Berit Andersen
- Department for Public Health Programmes, Randers Regional Hospital, 8930 Randers, Denmark
| | - Flemming Bro
- Research Unit for General Practice, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Hans Svanholm
- Department of Pathology, Randers Regional Hospital, 8930 Randers, Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
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17
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Dubbeldam I, Sanders J, Spooren W, Meijman FJ, van den Haak M. Motives for Health Information Behavior: Patterns More Refined Than Traditional Dichotomies. A Study Among Women in a Cervix Treatment Process. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2018. [DOI: 10.1080/15398285.2018.1425071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Inge Dubbeldam
- Stichting Amsterdamse Gezondheidscentra (SAG Health Centres), Amsterdam, The Netherlands
| | - José Sanders
- Faculty of Arts, Centre for Language Studies, Radboud University, Nijmegen, The Netherlands
| | - Wilbert Spooren
- Faculty of Arts, Centre for Language Studies, Radboud University, Nijmegen, The Netherlands
| | - Frans J. Meijman
- VU Medical Centre, VU University Amsterdam, Amsterdam, The Netherlands
| | - Maaike van den Haak
- Faculty of Humanities, Language Network Institute, VU University Amsterdam, Amsterdam, The Netherlands
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18
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Huber J, Pötsch B, Gantschacher M, Templ M. Routine Treatment of Cervical Cytological Cell Changes: Diagnostic Standard, Prevention and Routine Treatment of Cervical Cytological Cell Changes - An Assessment of Primary and Secondary Prevention and Routine Treatment Data in the Context of an Anonymous Data Collection from Practicing Gynaecologists; an Academic, Non-Interventional Study. Geburtshilfe Frauenheilkd 2016; 76:1086-1091. [PMID: 27761030 DOI: 10.1055/s-0042-105286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Introduction: Diagnosis and treatment of vaginal and cervical cytological cell changes are described in European and national guidelines. The aim of this data collection was to evaluate the remission rates of PAP III and PAP III D cytological findings in patients over a period of 3-4 months. Method: The current state of affairs in managing suspicious and cytological findings (PAP III, and III D) in gynecological practice was assessed in the context of a data collection survey. An evaluation over a period of 24 months was conducted on preventative measures, the occurrence and changes to normal/suspect/pathological findings and therapy management (for suspicious or pathological findings). Results: 307 female patients were included in the analysis. At the time of the survey 186 patients (60.6 %) had PAP III and 119 (38.8 %) had PAP III D findings. The spontaneous remission rate of untreated PAP III patients was 6 % and that of untreated PAP III D patients was 11 %. The remission rates of patients treated with a vaginal gel were 77 % for PAP III and 71 % for PAP III D. Conclusion: A new treatment option was used in gynecological practice on patients with PAP III and PAP III D findings between confirmation and the next follow-up with excellent success.
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Affiliation(s)
- J Huber
- ANISNet Academic Non-Interventional Study Net; Specialist in Gynecology and Obstetrics, Vienna, Austria
| | - B Pötsch
- Specialist in Gynecology and Obstetrics, Leibnitz, Austria
| | - M Gantschacher
- Head of Department of Health Legislation and Health Science, and WHO Austrian Drug Monitoring Center, Sigmund Freud Private University, Vienna; Assistant Director of the ESQH Vienna Office, Vienna, Austria
| | - M Templ
- Data-analysis OG, Vienna, Austria
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Cervical screening program and the psychological impact of an abnormal Pap smear: a self-assessment questionnaire study of 590 patients. Arch Gynecol Obstet 2015. [PMID: 26202136 DOI: 10.1007/s00404-015-3821-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Invasive cervical cancer is today the fourth most common cancer of women in western civilization. Screening programs have led to a continuously decrease. Nevertheless, both screening and a positive test result are known to be associated with a negative psychological impact. Screening programs in European countries differ and thus psychological impact might as well. The aim of this study was to evaluate the psychological impact of women with an abnormal Pap smear in a German cohort. METHODS Between July 2013 and May 2014, a self-assessment questionnaire was distributed to 595 patients that were referred to a special clinic for cervical dysplasia for further evaluation of an abnormal Pap smear. Patients were recruited in five different centers. RESULTS Most patients (45.9 %) were informed about the test result via phone call by their doctor. 68.8 % of the patients felt anxious and 26.3 % even felt panic. After having talked to their physician, 51.4 % of our cohort still felt worried and only 24.4 % felt reassured. Concerning disease management, 48.4 % underwent a control Pap smear in 6 months. The preferred information source was the physician (63.9 %). Compared to the results in other European countries, our study cohort showed differences concerning age distribution, patients living in a partnership, number of children and especially disease management. CONCLUSION Cancer screening itself and abnormal test results have an impact on patient's feelings. To reduce the psychological impact, patients need to be better informed about the risks and benefits of cancer screening programs and in case of cervical cancer screening about the meaning of an abnormal test result. Our results underline the importance of a trustful physician-patient relationship in that matter.
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20
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Tamayo Acevedo LS, Gil Cano PA, Tamayo Acevedo LE. Lo que no se ve, no existe: percepciones sobre cáncer y papilomavirus humano en jóvenes universitarios, Medellín, Colombia, 2014. AQUICHAN 2015. [DOI: 10.5294/aqui.2015.15.2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: comprender las percepciones de los estudiantes de pregrado de la Universidad de Antioquia, Colombia, sobre los cánceres de cuello uterino, canal anal, orofaringe y pene, y cómo los relacionan con la infección por PVH. Materiales y métodos: estudio etnográfico, realizado de marzo del 2013 a abril del 2014, participaron 23 mujeres y 14 hombres en ocho grupos de discusión. Sus discursos fueron grabados, transcritos y analizados con el método argumentativo. Resultados: en general, los/as jóvenes relacionaron el cáncer cervicouterino con el PVH, pero no con los tipos de cáncer en canal anal, orofaringe y pene, sobre los cuales tenían poco conocimiento o desconocían. El pensar que las mujeres son las que contraen el cáncer cervical y contagian a los hombres con el PVH no les permitió imaginar que existieran otros cánceres asociados al PVH. Conclusión: las percepciones y la falta de claridad en la relación PVH y otros cánceres, pueden incrementar el riesgo de infección por las prácticas sexuales y en el tiempo aumentar la prevalencia de estos cánceres.
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21
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Cendejas BR, Smith-McCune KK, Khan MJ. Does treatment for cervical and vulvar dysplasia impact women's sexual health? Am J Obstet Gynecol 2015; 212:291-7. [PMID: 24881827 DOI: 10.1016/j.ajog.2014.05.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/20/2014] [Accepted: 05/27/2014] [Indexed: 11/17/2022]
Abstract
Human papillomavirus-associated disease represents an immense public health burden worldwide. Persistent human papillomavirus infection can lead to the development of cervical dysplasia and vulvar dysplasia, both of which have been increasing in incidence in women in recent years. Numerous studies have focused on methods for screening and diagnosis of cervical dysplasia, but few have looked at the effects of treatment on women's psychological and sexual health. Even fewer studies have addressed these issues in women with vulvar dysplasia. The aim of this article was to provide a comprehensive review of the existing evidence concerning the impact of therapy for cervical and vulvar precancers on women's sexual function and sexual relationships. We performed a search of the medical literature for the time period up to and including August 2013 on PubMed. The findings from a limited number of studies to date indicate that psychosexual vulnerability increases after diagnosis and treatment of both cervical and vulvar dysplasia. More in-depth research is needed to better understand the effects of different treatment modalities on women's sexual health and relationships during and following treatment.
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Affiliation(s)
- Blanca R Cendejas
- University of California, San Francisco, School of Medicine, San Francisco, California
| | - Karen K Smith-McCune
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Michelle J Khan
- Division of Women's Reproductive Healthcare, Department of Obstetrics and Gynecology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
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22
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Park YS, Park JS. Predictors of Follow-up Screening in Women with Abnormal Pap Smears. ASIAN ONCOLOGY NURSING 2014. [DOI: 10.5388/aon.2014.14.2.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Young Suk Park
- Keimyung University Dongsan Medical Center, Daegu, Korea
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23
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Baxi SS, Shuman AG, Corner GW, Shuk E, Sherman EJ, Elkin EB, Hay JL, Pfister DG. Sharing a diagnosis of HPV-related head and neck cancer: the emotions, the confusion, and what patients want to know. Head Neck 2013; 35:1534-41. [PMID: 23169350 PMCID: PMC3689851 DOI: 10.1002/hed.23182] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Oropharyngeal cancers are increasingly associated with human papillomavirus (HPV). Little is known about the experience of patients receiving this diagnosis. METHODS Semistructured interviews were conducted with ten survivors of HPV-related oropharyngeal cancer. The interviews were transcribed, and recurring themes were identified. RESULTS Physicians were a trusted source of information regarding HPV. Framing the diagnosis in terms of prognosis resonated with patients. The uncertainty about transmission, latency, and communicability colored the dialogue about HPV. Despite some understanding of prevalence and transmission, patients worried about their partner's risk. Patients sought information about HPV on the Internet, but it was not easily navigable. Emotional reactions to the diagnosis remained mostly cancer-centric rather than HPV-centric. A patient-education handout was developed in response to patient questions. CONCLUSIONS Additional educational resources explaining the facts about HPV in HNSCC in a consistent way including content of highest priority to patients may improve understanding of HPV.
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Affiliation(s)
- Shrujal S. Baxi
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
| | - Andrew G. Shuman
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
- Department of Public Health, Weil Medical College of Cornell University, New York, NY 10021
| | - Geoffrey W. Corner
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
| | - Elyse Shuk
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
| | - Eric J. Sherman
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
- Department of Medicine, Weil Medical College of Cornell University, New York, NY 10021
| | - Elena B. Elkin
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
- Department of Public Health, Weil Medical College of Cornell University, New York, NY 10021
| | - Jennifer L. Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
- Department of Psychiatry, Weil Medical College of Cornell University, New York, NY 10021
| | - David G. Pfister
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
- Department of Medicine, Weil Medical College of Cornell University, New York, NY 10021
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24
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Recent progress in the application of nanotechnology for prevention and treatment of human papillomavirus infection. Ther Deliv 2012; 3:1005-17. [PMID: 22946433 DOI: 10.4155/tde.12.78] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Human papillomavirus (HPV) causes benign and malignant infections of the anogenital tract. Cervical cancer, caused by high-risk HPV types 16, 18, 31, 33, 35, 45, 56 and 58, is the second most common cancer in women and the fifth most common cancer overall. Prevention and treatment of HPV infection may be revolutionized using nanotechnology tools such as vaccines based on virus-like particles and nanoscale drug-delivery systems. Advances in both virus-like particle design and noninvasive delivery of antiviral protein drugs, such as IFNalpha, may provide new opportunities to take on the challenge of global elimination of HPV infections. Biphasic vesicle cream formulation, representing a new class of dermal delivery system for protein drugs, is an alternative to injectable dosage form to deliver IFNalpha for the treatment of HPV infections, showing efficacy in low-grade squamous epithelical lesions of the cervix.
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Mortensen GL, Larsen HK. The quality of life of patients with genital warts: a qualitative study. BMC Public Health 2010; 10:113. [PMID: 20205944 PMCID: PMC2848198 DOI: 10.1186/1471-2458-10-113] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 03/07/2010] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Genital warts, which are caused by infection with human papillomavirus (HPV), are one of the most common sexually transmitted diseases in Europe. Although genital warts are commonly perceived as a non-serious condition, treatment is often long, of varying effectiveness and the recurrence rate is high. Very few studies have been performed on the personal consequences of genital warts. The aim of this qualitative study, set in Denmark, was to examine the ways in which genital warts may affect patients' quality of life. METHODS To obtain an in-depth understanding of patients' perceptions of genital warts, we used qualitative focus-group interviews with five men and five women aged between 18 and 30 years who had genital warts. The interview guide was based on a literature review that identified important issues and questions. The data were analysed using a medical anthropological approach. RESULTS Patients' experiences were related to cultural conceptions of venereal diseases and the respective identities and sexuality of the sexes. The disease had negative psychological and social effects both for men and for women and it affected their sex and love lives, in particular. The psychological burden of the disease was increased by the uncertain timeline and the varying effectiveness of treatment. We identified a need for more patient information about the disease and its psycho-sexual aspects. CONCLUSIONS The men and women participating in this study considered their quality of life to be significantly lowered because of genital warts. The experiences described by the participants give insights that may be valuable in treatment and counselling.The quadrivalent HPV vaccine that has now been added to the childhood vaccination programme for girls in Denmark for the prevention of cervical cancer can also prevent 90% of cases of genital warts. Our results suggest that HPV vaccination could considerably reduce the largely unacknowledged psychological and social burden associated with genital warts, in men as well as women.
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Affiliation(s)
| | - Helle K Larsen
- Venereal Diseases Clinic, Bispebjerg Hospital, Bispebjerg Bakke 23, 4 Tvaervej, 1 sal, 2400 Copenhagen NV, Denmark
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