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Hunter W, Pettigrew J, Carpenter KM, Worly B, Coons HL. Improving Sexual Health Across the Life Span Through Integrated Care in Obstetrics and Gynecology. Clin Obstet Gynecol 2024; 67:233-246. [PMID: 38173321 DOI: 10.1097/grf.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Sexual health is a vital part of physical, emotional, and relational well-being among adults across the life span. While patients are reluctant to discuss their sexual concerns, Obstetrics and Gynecology providers are especially well positioned to improve sexual functioning and satisfaction through screening, education, prevention and early intervention, treatment, and integrating behavioral health and sexual medicine services in their clinical practices. This article sets out to provide applied information and perspectives to foster the development of interprofessional sexual medicine services in Obstetrics and Gynecology practices in hospital and community settings.
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Affiliation(s)
- Winnifred Hunter
- Women's Behavioral Health & Wellness Service, University of Colorado School of Medicine/Anschutz Medical Campus, Aurora
| | | | - Kristen M Carpenter
- Department of Psychiatry & Behavioral Health, Psychology, Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Brett Worly
- Department of OB/GYN, The Ohio State University Wexner Medical Center
| | - Helen L Coons
- Women's Mental Health Associates & Health Psychology Solutions, Denver, Colorado
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Grinberg K, Weissman-Fogel I, Lowenstein L, Abramov L, Granot M. How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome? Pain Res Manag 2019; 2019:6091257. [PMID: 31915499 PMCID: PMC6930783 DOI: 10.1155/2019/6091257] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/05/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022]
Abstract
Background Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder comprising structural and functional muscular abnormalities, a dysfunctional pain system, and psychological distress. Myofascial physical Therapy (MPT) that is targeted at improving pelvic muscle functioning is considered a first line nonpharmacological treatment for CPPS, although the precise mechanisms that lead to symptoms alleviation have not yet been elucidated. Purpose This longitudinal study aimed to examine the local and systemic effects of MPT intervention, including biopsychophysiological processes, among CPPS patients. Methods The study included 50 CPPS women. Morphologic assessment of the levator ani and quantitative sensory testing of the pain system were applied alongside with evaluation of pain-related psychological factors using designated questionnaires. All measures were evaluated both before and after MPT in 39 patients. The long-term effects of MPT were evaluated by clinical pain reports obtained at 3 and 9 months following MPT that were compared with a nontreated group of 11 untreated CPPS women. Results Along with an improvement in the clinical pain intensity (p = 0.001) and sensitivity to experimental pain tests (p = 0.001) following MPT, the results also indicate that MPT has anatomical, psychological, and social therapeutic effects (p = 0.04; p = 0.001; p = 0.01, respectively). Furthermore, clinical pain evaluation at 3 and 9 months after MPT revealed a significant improvement in women who received treatment (p = 0.001). Conclusions The findings of this pilot study suggest multisystemic (direct and indirect anatomical, neurophysiological, and psychological) effects of MPT on the multifactorial pain disorder of CPPS and therefore place MPT as a mechanism-based intervention.
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Affiliation(s)
- Keren Grinberg
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- The Department of Nursing, Ruppin Academic Center, Emek Hefer, Israel
| | - Irit Weissman-Fogel
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Lior Lowenstein
- The Department of Obstetrics and Gynecology, Rambam Medical Center and Faculty of Medicine, Technion, Haifa, Israel
| | - Liora Abramov
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, The Sex Therapy Clinic, Tel Aviv, Israel
| | - Michal Granot
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- The Laboratory of Clinical Neurophysiology, Faculty of Medicine, Technion, Haifa, Israel
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A common pronociceptive pain modulation profile typifying subgroups of chronic pelvic pain syndromes is interrelated with enhanced clinical pain. Pain 2018; 158:1021-1029. [PMID: 28178074 DOI: 10.1097/j.pain.0000000000000869] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Provoked vestibulodynia (PVD) and painful bladder syndrome (PBS), subgroups of chronic pelvic pain syndromes (CPPS), are considered to share common biophysiological peripheral mechanisms. In addition, indications of a pronociceptive pain profile coexisting with psychological vulnerability suggest common dysfunctional pain processing and pain modulation in these 2 subgroups of CPPS. We therefore aimed at comparing the pain profile and psychological traits of patients with PVD and PBS to see whether the pain profile contributes to intersubject variability of clinical pain symptoms. Patients with PVD (n = 18) and PBS (n = 21) were compared with healthy controls (n = 20) in their responses to (1) pain psychophysical tests applied to both referred (suprapubis) and remote (hand) body areas and (2) pain-related psychological factors (pain catastrophizing, depression, anxiety, and somatization). We found a similar pronociceptive pain profile in the 2 subgroups of CPPS-enhanced facilitation (ie, hyperalgesia in the referred body area [P < 0.001]) and inefficient inhibition (ie, reduced conditioned pain modulation [P < 0.001] that were associated with both enhanced pain ratings evoked during trigger point examination [P < 0.037]) and higher Brief Pain Inventory ratings (P = 0.002). The latter was also correlated with pain catastrophizing (r = 0.504, P = 0.001) and depression symptoms (r = 0.361, P = 0.024). The findings suggest common mechanisms underlying a dysfunctional nociceptive system in both PVD and PBS. The intersubject variability in the level of dysfunction and its association with disease severity recommends a personalized pain treatment that may alleviate daily pain and dysfunction in patients with CPPS.
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Selected Disorders of the Female Reproductive System. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Merghati-Khoei E, Pirak A, Yazdkhasti M, Rezasoltani P. Sexuality and elderly with chronic diseases: A review of the existing literature. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:136. [PMID: 28331522 PMCID: PMC5348839 DOI: 10.4103/1735-1995.196618] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 07/25/2016] [Accepted: 09/17/2016] [Indexed: 11/10/2022]
Abstract
Background: Increased life expectancy and the growing phenomenon of aging can lead to increased burden of chronic diseases (CDs) which adversely affects the overall health of elderly, their sexuality in particular. Sexual life of an aged population is overlooked in many of the societies. In the present narrative review, we aim to assess the impact of CDs on sexual function of elderly people. Materials and Methods: We used internet databases including PubMed, EMBASE, ISI Web of Science, Google Scholar, SID, Iran Medex, Magiran, IPPF, and UNFPA without time limit. Ninety-eight out of 174 relevant articles were selected which met the inclusion criteria: those articles were research-based in English or Persian (original or review articles) and textbooks; specified one or more CDs and sexual function of the cases; elderly people over the age of sixty, men and women; and coordination between articles and research goals. We excluded qualitative and case studies. We reported the most related CDs with sexual function in literature review and used the biological and psychological impact of the CDs on sexual function of elderly population based on the conceptual model of Verschuren et al. (2010). Results: The results of the studies were classified into the themes including physical, psychological, and cultural and social. Diabetes, cardiovascular, cancerous, and chronic respiratory diseases and also some medications can reduce sexual capacity and desire in particular resulting in negative impact on the quality of elderly sexual life. CDs may influence sexual expressions and responses which adversely affect one's mood and energy so that can cause depression and grief, as well as loss of self-confidence, self-esteem, and self-concept in elderly adults. The factors affecting sexuality of an elderly with CDs include cultural and mythical beliefs about age and illnesses, fear, and embarrass of changed physical appearance. The research conducted among elderly population examining the adverse influence of CDs on aged people's sexual life in general, sexual function and performance, and intimate interaction. Conclusion: It is considered that programs on sexual health needs of aged population for the health-care workers can prove beneficial in improving sexual health.
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Affiliation(s)
- Effat Merghati-Khoei
- Sexologist, The Iranian National Centre for Addiction Studies (INCAS), Institution of Risk Behaviors Reduction, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Pirak
- Department of Midwifery, Instructor, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Mansoureh Yazdkhasti
- Department of Midwifery, Reproductive Health PhD, Assistant Professor, Faculty Member of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| | - Parvaneh Rezasoltani
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Department of Midwifery, Instructor, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Sacral neuromodulation and female sexuality. Int Urogynecol J 2015; 26:1751-7. [PMID: 25876714 DOI: 10.1007/s00192-015-2708-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS An up-to-date review of the impact of a permanent sacral neuromodulation (SNM) implant (Medtronic, Minneapolis, Minnesota, USA) on female sexual function (FSF). METHODS Clinical studies published from January 2001 to February 2014 evaluating the impact and/or safety of permanent SNM on FSF were reviewed. RESULTS Nine studies were selected that investigated the impact on sexual response when the aim of the SNM was to resolve urinary symptoms mainly due to overactive bladder (seven studies) or faecal incontinence. Most women included were of menopausal age. Three studies included sexually inactive women. Post-SNM follow-up varied from 3 to 36 months. Meta-analysis of efficacy results was not possible primarily due to the heterogeneity of the sexual and pelvic dysfunctions. The most specific questionnaire assessing FSF was the Female Sexual Function Index (FSFI) used in six studies. During follow-up all women showed statistically significant improvement (p < 0.05) in at least one FSFI domain compared to baseline. In one study statistically significant improvement (p < 0.05) in the FSFI pain domain was exclusively detected in women with neurological disease. Two studies, however, using the questionnaire to screen for sexual dysfunction did not find any statistically significant differences after SNM. The most severe problems associated with FSF concern loss of libido and reduction in vaginal lubrication which were resolved in one woman following removal of the SNM implant. CONCLUSIONS Actual data are still insufficient to definitely assert the positive effect of SNM on FSF.
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Holbrook S, Wolf S. Selected Disorders of the Female Reproductive System. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_115-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hung M, Su T, Lin Y, Huang W, Lin T, Hsu C, Chuang F, Tsai C, Shen P, Chen G. Changes in Sexual Function of Women with Refractory Interstitial Cystitis/Bladder Pain Syndrome after Intravesical Therapy with a Hyaluronic Acid Solution. J Sex Med 2014; 11:2256-63. [DOI: 10.1111/jsm.12507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chung SD, Keller J, Lin HC. A nationwide population-based study on bladder pain syndrome/interstitial cystitis and ED. Int J Impot Res 2013; 25:224-8. [DOI: 10.1038/ijir.2013.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 10/29/2012] [Accepted: 02/28/2013] [Indexed: 01/09/2023]
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Jang MY, Long CY, Chuang SM, Huang CH, Lin HY, Wu WJ, Juan YS. Sexual dysfunction in women with ketamine cystitis: a case-control study. BJU Int 2011; 110:427-31. [DOI: 10.1111/j.1464-410x.2011.10780.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Impact of intravesical hyaluronic acid and chondroitin sulfate on bladder pain syndrome/interstitial cystitis. Int Urogynecol J 2011; 23:1193-9. [PMID: 21904840 DOI: 10.1007/s00192-011-1546-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 08/10/2011] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Intravesical instillations of hyaluronic acid (HA) and chondroitin sulfate (CS) may lead to regeneration of the damaged glycosaminoglycan layer in interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS Twenty-two patients with IC/BPS received intravesical instillations (40 ml) of sodium HA 1.6% and CS 2.0% in 0.9% saline solution (IALURIL, IBSA) once weekly for 8 weeks, then once every 2 weeks for the next 6 months. RESULTS The score for urgency was reduced from 6.5 to 3.6 (p = 0.0001), with a reduction in pain scores from an average of 5.6 to 3.2 (p = 0.0001). The average urine volume increased from 129.7 to 162 ml (p < 0.0001), with a reduction in the number of voids in 24 h, from 14 to 11.6 (p < 0.0001). The IC Symptom and Problem Index decreased from 25.7 to 20.3 (p < 0.0001), and the Pain Urgency Frequency score, from 18.7 to 12.8 (p < 0.0001). CONCLUSION The treatment appeared to be effective and well tolerated in IC/BPS in this initial experience.
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Gardella B, Porru D, Nappi RE, Daccò MD, Chiesa A, Spinillo A. Interstitial Cystitis is Associated with Vulvodynia and Sexual Dysfunction—A Case-Control Study. J Sex Med 2011; 8:1726-34. [DOI: 10.1111/j.1743-6109.2011.02251.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sacral neuromodulation stimulation for IC/PBS, chronic pelvic pain, and sexual dysfunction. Int Urogynecol J 2010; 21:1553-8. [DOI: 10.1007/s00192-010-1281-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Walid MS, Heaton RL. Dyspareunia: a complex problem requiring a selective approach. Sex Health 2009; 6:250-3. [PMID: 19653964 DOI: 10.1071/sh09033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 06/12/2009] [Indexed: 11/23/2022]
Abstract
Dyspareunia frequently has a multifactorial aetiology. The problem with the term is that it is not specific enough and does not allow for proper discussion of the very important problem of pain with sexual intercourse, a problem that can be very disturbing to a couple's relationship. We present two cases of patients who had multiple potential anatomic reasons for dyspareunia. The clinical picture, treatment strategy and the complex nature of deep penetration pain was discussed. We also proposed a new way of defining dyspareunia to allow a more adequate way of studying and discussing the problem.
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Affiliation(s)
- Mohammad Sami Walid
- Medical Center of Central Georgia, 840 Pine Street, Suite 880, Macon, GA 31201, USA
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Abstract
INTRODUCTION Although vaginismus is a common sexual dysfunction in Turkey, there are only limited data about sexual behavior characteristics and comorbidity with other sexual dysfunctions in vaginismic patients. AIM To investigate the frequency of female sexual dysfunctions (FSDs) in a Turkish clinical sample and to determine the comorbidity of other FSDs in women diagnosed with lifelong vaginismus. METHODS The study included 54 female patients who presented to a psychiatry department with sexual problems/complaints. MAIN OUTCOME MEASURES The subjects were evaluated using a semi-structured questionnaire. The questionnaire was developed by the researchers in order to assess sexually dysfunctional patients and included detailed questions about socio-demographic variables, and general medical and sexual history. All participants were also assessed using the Golombok Rust Inventory of Sexual Satisfaction. RESULTS The most common primary FSD in our sample was vaginismus (75.9%), followed by hypoactive sexual desire (9.2%). Regarding comorbidity, in 36 female patients with lifelong vaginismus, we found dyspareunia in 17 women (47.2%), orgasmic disorder in eight women (22.2%), and sexual desire disorder in six women (16.6%) as a second sexual dysfunction, based on the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision criteria. CONCLUSIONS With respect to FSDs within the Turkish clinical population, vaginismic patients constitute the largest group and cultural factors may play a role in the occurrence of this condition. Additionally, our data indicated that there was a strong correlation between vaginismus and dyspareunia. There was also a high frequency of hypoactive desire and orgasm disorder in vaginismic patients. These results suggest that multidimensional assessment of sexual dysfunction in female patients is of great importance.
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Affiliation(s)
- Sultan Dogan
- Department of Psychiatry, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey.
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Vercellini P, Viganò P, Somigliana E, Abbiati A, Barbara G, Fedele L. Medical, surgical and alternative treatments for chronic pelvic pain in women: a descriptive review. Gynecol Endocrinol 2009; 25:208-21. [PMID: 19296329 DOI: 10.1080/09513590802530940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Several causes of chronic pelvic pain (CPP) are recognised, but in many women a definite diagnosis cannot be made. Few randomised controlled trials on treatment of CPP have been conducted. In a Cochrane systematic review, only medroxy-progesterone acetate, counselling, a multidisciplinary approach and lysis of deep adhesions had a proven benefit. The aim of this descriptive review is to describe the management of CPP, which can focus on treating the pain itself, the underlying cause, or both. Combination drug therapy with medications with different mechanisms of action may improve therapeutic results. Pelvic denervating procedures should be indicated in selected circumstances, as the magnitude of the effect is undefined. Several alternative non-invasive treatments have been proposed including exercise programmes, cognitive and behavioural medicine, physical therapy, dietary modification, massage and acupuncture. When the woman has completed her family and particularly when pelvic varices have been demonstrated, hysterectomy can be considered after a careful pre-operative assessment. However, substantial pain relief may be achieved in no more than 60-70% of the cases. A minority of patients (3-5%) will experience worsening of pain or will develop new symptoms after surgery. Treatment of CPP, generally, requires acceptance of the concept of managing rather than curing symptoms.
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Affiliation(s)
- Paolo Vercellini
- Clinica Ostetrica e Ginecologica I, University of Milan, Milan, Italy.
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Vercellini P, Somigliana E, Viganò P, Abbiati A, Barbara G, Fedele L. Chronic pelvic pain in women: etiology, pathogenesis and diagnostic approach. Gynecol Endocrinol 2009; 25:149-58. [PMID: 19347704 DOI: 10.1080/09513590802549858] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Chronic pelvic pain (CPP), defined as non-cyclic pain of 6 or more months, is a frequent disorder that may negatively affect health-related quality of life. In women several causes are recognised, although in a not negligible proportion of patients a definite diagnosis cannot be made. Different neurophysiological mechanisms are involved in the pathophysiology of CPP. Pain may be classified as nociceptive or non-nociceptive. In the first case the symptom originates from stimulation of a pain-sensitive structure, whereas in the second pain is considered neuropatic or psychogenic. Patients history is crucial and is generally of utmost importance for a correct diagnosis, being sometimes more indicative than several diagnostic investigations. The main contributing factors in women with CPP can still be identified by history and physical examination in most cases. Many disorders of the reproductive tract, urological organs, gastrointestinal, musculoskeletal and psycho-neurological systems may be associated with CPP. Excluding endometriosis, the most frequent causes of CPP are: post-operative adhesions, pelvic varices, interstitial cystitis and irritable bowel syndrome. CPP is a symptom, not a disease, and rarely reflects a single pathologic process. Gaining women's trust and developing a strong patient-physician relationship is of utmost importance for the long-term outcome of care.
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Affiliation(s)
- Paolo Vercellini
- Clinica Ostetrica e Ginecologica I, University of Milan, Milan, Italy.
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Goldstein I. Sexual dysfunction in women: what can urologists contribute? Curr Urol Rep 2008; 9:475-82. [PMID: 18947512 DOI: 10.1007/s11934-008-0081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Urologists have led the basic science and clinical research of organic-based issues in male sexual dysfunction. Concerning scientific, evidence-based, biologic-focused information, the field of sexual dysfunction in women is relatively new compared with sexual dysfunction in men. Basic science, epidemiology, physiology, pathophysiology, diagnosis, and treatment data on women's sexual health issues are now more regularly published than ever before, with the urologic community once again leading the way. This article reviews some pioneering, resourceful, creative, and novel contributions that urologists have made to enhance the understanding of sexual dysfunction in women. As is obvious in infertility treatment, sexual medicine health care requires biologic and psychologic attention to both members of the couple. The goal of all sexual medicine health care providers is to provide the best health care delivery to women and men with sexual health concerns.
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Affiliation(s)
- Irwin Goldstein
- San Diego Sexual Medicine, Alvarado Hospital, San Diego, CA 92120, USA.
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Lombardi G, Mondaini N, Macchiarella A, Cilotti A, Popolo GD. Clinical Female Sexual Outcome after Sacral Neuromodulation Implant for Lower Urinary Tract Symptom (LUTS). J Sex Med 2008; 5:1411-7. [DOI: 10.1111/j.1743-6109.2008.00812.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Graziottin A. Dyspareunia and vaginismus: Review of the literature and treatment. CURRENT SEXUAL HEALTH REPORTS 2008. [DOI: 10.1007/s11930-008-0008-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Rosenbaum TY, Owens A. Continuing Medical Education: The Role of Pelvic Floor Physical Therapy in the Treatment of Pelvic and Genital Pain-Related Sexual Dysfunction (CME). J Sex Med 2008; 5:513-23; quiz 524-5. [DOI: 10.1111/j.1743-6109.2007.00761.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Insight into urogynecologic features of women with interstitial cystitis/painful bladder syndrome. Eur Urol 2008; 54:1145-51. [PMID: 18276064 DOI: 10.1016/j.eururo.2008.01.079] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 01/25/2008] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The prevalence of interstitial cystitis/painful bladder syndrome (IC/PBS) among gynecologic patients attending vulvar disease or pelvic pain clinics is higher than expected. The evaluation of gynecologic characteristics in patients with IC/PBS could be important to delineate a better therapeutic strategy. METHODS We compared clinical gynecologic characteristics including localized and generalized vulvodynia and sexual activity of 47 women with a definite diagnosis of IC/PBS versus 47 negative controls. RESULTS The prevalence of both generalized or localized vulvodynia was 85.1% (40 of 47) in the patients and 6.4% (3 of 47) in the control group (p<0.0001 by Fisher exact test). The mean visual analogue score on generalized or localized vulvodynia evaluated with the cotton swab test was 6.1+/-2.6 (SD) among women with IC/PBS and 0.6+/-1.7 in the control group (p<0.0001 with Mann-Whitney U test). Pain during intercourse was described as unbearable by 15 women with IC/PBS (31.9%) and 2 controls (4.3%; p=0.001 by Fisher exact test). Sexual function was significantly impaired in women with IC as measured by the median total score of the Female Sexual Function Index in comparison with controls (13.8 vs. 28.7; p<0.0001). CONCLUSIONS Patients with a definite diagnosis of IC/PBS appear to have a high risk of vulvodynia with the associated negative implications for sexual activity. The establishment of a multidisciplinary approach with the involvement of the gynecologist appears to be a logical requisite for a correct treatment strategy for these patients.
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Pace G, Vicentini C. Female Sexual Function Evaluation of the Tension-Free Vaginal Tape (TVT) and Transobturator Suburethral Tape (TOT) Incontinence Surgery: Results of a Prospective Study. J Sex Med 2008; 5:387-93. [DOI: 10.1111/j.1743-6109.2007.00708.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Mehta A, Bachmann G. Premenopausal women with sexual dysfunction: the need for a bladder function history. J Sex Med 2007; 5:407-12. [PMID: 18093095 DOI: 10.1111/j.1743-6109.2007.00704.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Despite the high prevalence of both female sexual problems and bladder dysfunction in the premenopausal population, sexual history forms used in primary care offices rarely include questions about the impact of bladder dysfunction on sexual health. AIM To provide a review of the literature that illustrates the relationship between bladder problems and sexual performance of premenopausal women. MAIN OUTCOME MEASURES To objectively support by a review of the literature the need for a complete bladder history in when evaluating premenopausal women with female sexual dysfunction. METHODS Pubmed was searched for all articles (from November 1980 to June 2007) that reported on the effect bladder dysfunction has on premenopausal female sexual function. RESULTS The scant literature available strongly suggested that bladder dysfunction is a contributor to sexual dysfunction and that this medical concern should be considered in all women, regardless of age who present with sexual complaints. CONCLUSION Further studies need to be conducted in order to solidify a direct causal relationship between bladder dysfunction and premenopausal female sexuality. These studies should include a larger sample size, clearly defined types of sexual dysfunction and bladder dysfunction, and appropriate follow-up of patient responses using validated objective and subjective outcome modalities to confirm that the patient responses are factual.
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Affiliation(s)
- Aasta Mehta
- Women's Health Institute, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Nickel JC, Parsons CL, Forrest J, Kaufman D, Evans R, Chen A, Wan G, Xiao X. Improvement in sexual functioning in patients with interstitial cystitis/painful bladder syndrome. J Sex Med 2007; 5:394-9. [PMID: 18086174 DOI: 10.1111/j.1743-6109.2007.00686.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Sexual functioning is one of the strongest predictors of poorer quality of life (QOL) in patients diagnosed with interstitial cystitis/painful bladder syndrome (IC/PBS). AIMS To examine the relationship between symptom reduction and sexual functioning in patients with IC/PBS. METHODS Patients with IC/PBS were treated with 300 mg/day pentosan polysulfate sodium for 32 weeks. MAIN OUTCOME MEASURES Patients completed the O'Leary-Sant Interstitial Cystitis Symptom Index, Short Form-12 QOL, and Medical Outcomes Study Sexual Functioning Scale at baseline, and at 8, 16, 24, and 32 weeks. Treatment responders were defined as those achieving a >/=30% reduction in symptom index from baseline. RESULTS A total of 128 patients were included in the analyses. At baseline, mean symptom index, QOL (physical and mental), and sexual functioning scores were 12.3, 41.7, 45.9, and 56.1, respectively. Patients showed statistically significant improvement in symptom and sexual functioning scores at weeks 8, 16, 24, and 32. At week 32, the mean change in symptom index score from baseline was -2.97 (standard deviation [SD] = 4.66, P < 0.0001), and the mean change in sexual functioning score from baseline was 8.9 (SD = 32.9, P = 0.0054). Reduction in symptom index score was moderately correlated with improvement in sexual functioning score at the end of study (r = -35, P = 0.0002). Positive correlation was observed at the end of the study between the mean change scores of sexual functioning score and physical and mental QOL components (r = 0.46, P < 0.0001 and r = 0.29, P = 0.0023, respectively). Patients achieving a >/=30% reduction in symptom index (responder, N = 47; 44%) had an adjusted mean change in sexual functioning score of 19.8 (standard error [SE] = 4.69), while nonresponders (N = 59, 56%) had an adjusted mean change -0.49 (SE = 4.17) (between groups, P = 0.0020). CONCLUSIONS Sexual dysfunction is moderate to severe in patients with IC/PBS and impacts significantly on QOL. Reduction in symptoms was associated with improvement in the patient-reported outcomes of sexual function.
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Abstract
INTRODUCTION Chronic pelvic pain (CPP) is a common gynecological problem that is also associated with sexual dysfunction. AIM The purpose of this research was to investigate the validity and reliability of Female Sexual Function Index (FSFI) in women with CPP. METHOD One hundred women with CPP and 100 age-matched subjects without CPP were compared in the study. MAIN OUTCOME MEASURES Sexual function was assessed by FSFI. RESULTS Internal consistency (Cronbach's alpha values = 0.91-0.97) was high for all scales. There were significant differences between women with and without CPP for each of the FSFI domain and total scores with very large effect sizes (1.29-2.56) (P < 0.0001, for all). Interdomain correlations of FSFI in the CPP group corresponded well to each other (P < 0.0001, for all). Moreover, test-retest reliability (r = 0.79-0.90) was also within acceptable ranges for this population. CONCLUSION We concluded that the FSFI showed good ability to discriminate between women with and without sexual dysfunctions in the CPP population.
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Affiliation(s)
- Fatma Ferda Verit
- Department of Obstetrics and Gynecology, Harran University Faculty of Medicine, Sanliurfa, Turkey.
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