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Zhang J, Li T, Zhao J, Chai J, Wang L, Cao W, Liu J, Wang F. The causal relationship of depression, anxiety, and neuroticism with endometriosis: A bidirectional 2-sample Mendelian randomization study. Medicine (Baltimore) 2024; 103:e38823. [PMID: 38996127 DOI: 10.1097/md.0000000000038823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
Endometriosis, identified by the abnormal growth of endometrial cells beyond the inner lining of the uterus, often manifests through symptoms like painful menstruation and challenges in conceiving. Observational studies suggest that endometriosis is often comorbid with mental disorders, including anxiety and depression. The nature of these connections, whether they are causal, is still debated and calls for further empirical evidence. We utilized a bidirectional 2-sample Mendelian randomization (MR) approach, harnessing genome-wide association study data to explore the connections among depression, anxiety, neuroticism, and endometriosis. To scrutinize the causative connections between mental health issues and endometriosis, Inverse Variance Weighting (IVW) was employed as the primary analytical tool, complemented by Weighted Median Estimation, Simple mode, Weighted mode, and MR-Egger regression for additional analysis. To examine the potential for reverse causation, reverse MR was applied. To strengthen the reliability of our findings, we carried out sensitivity analyses that included heterogeneity tests, tests for pleiotropy, and leave-one-out analyses. The IVW analysis revealed a significant correlation between the genetic inclination towards depression and a heightened risk of developing endometriosis [Odds Ratio (OR) = 1.151, 95% Confidence Interval (CI) = 1.025-1.293, P = .017]. Similarly, a genetic predisposition to neuroticism was significantly associated with an increased risk of endometriosis (OR = 1.128, 95% CI = 1.038-1.226, P = .004). However, no causative link was found between genetic susceptibility to anxiety and the occurrence of endometriosis. Reverse MR analysis did not support a bidirectional genetic susceptibility between endometriosis and psychiatric disorders. The MR analysis presents genetic data supporting the notion that depression and neuroticism are risk factors for endometriosis. Conversely, it found no evidence of a causal connection between anxiety and the development of endometriosis. Enhancing mental health treatment should be considered a preventive measure against endometriosis.
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Affiliation(s)
- Jiaxun Zhang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Tie Li
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Jinying Zhao
- Changchun University of Chinese Medicine, Changchun, China
| | - Jiapeng Chai
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Lin Wang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Wenxuan Cao
- Department of Pharmaceutical Science, Changchun University of Chinese Medicine, Changchun, China
| | - Jia Liu
- Department of Pharmaceutical Science, Changchun University of Chinese Medicine, Changchun, China
| | - Fuchun Wang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
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Rohloff N, Rothenhöfer M, Götz T, Schäfer SD. Observational pilot study on the influence of an app-based self-management program on the quality of life of women with endometriosis. Arch Gynecol Obstet 2024:10.1007/s00404-024-07468-4. [PMID: 38869629 DOI: 10.1007/s00404-024-07468-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/10/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE Endometriosis can significantly impair the quality of life of those affected. Multimodal self-help measures are recommended but often difficult to access. Smartphone apps have been shown to improve the quality of life for other conditions with chronic pain. The aim of this study was to examine whether there is evidence of beneficial effects of the smartphone app "Endo-App®" and whether a multicenter randomized controlled trial should be planned to substantiate these effects. METHODS In a sample of N = 106 women affected by endometriosis the present study determined the influence of the use of Endo-App® on their quality of life. Among others, the validated questionnaire Endometriosis Health Profile from Oxford University was used for this purpose. RESULTS The use of Endo-App® lead to a highly significant improvement in quality of life already after 2 weeks. A statistically significant change was found for nine out of ten measured variables of quality of life. A series of further analyses validated that the measured positive effects were not due to other confounding factors. CONCLUSION In summary, the results indicate that the quality of life of women with endometriosis improved by the digital self-management tool Endo-App®. More studies are needed to further explore the influence of the app on quality of life and as confirmatory evidence of beneficial effects. For this purpose, a randomized controlled trial should be conducted over a longer period of time. TRIAL REGISTRATION This trial is registered at clinicaltrials.gov under the registration number NCT05528601 on August 18, 2022. It was retrospectively registered.
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Affiliation(s)
- Nadine Rohloff
- Endo Health GmbH, Theaterstraße 56, 09111, Chemnitz, Germany
| | | | - Teresa Götz
- Endo Health GmbH, Theaterstraße 56, 09111, Chemnitz, Germany
| | - Sebastian Daniel Schäfer
- Department of Gynecology and Obstetrics, Clemenshospital Münster, Düesbergweg 124, 48153, Münster, Germany.
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Farenga E, Bulfon M, Dalla Zonca C, Tersar C, Ricci G, Di Lorenzo G, Clarici A. A Psychological Point of View on Endometriosis and Quality of Life: A Narrative Review. J Pers Med 2024; 14:466. [PMID: 38793048 PMCID: PMC11121802 DOI: 10.3390/jpm14050466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Endometriosis is a chronic gynecological disorder with a multifactorial etiology that has not yet been fully elucidated. What is known, however, are the pathological tissue dynamics that lead to the complex symptoms that women suffer from. The known symptoms are mainly fertility problems and pain. Both dimensions have an impact that varies from case to case, but that is certainly decisive concerning a woman's health, specifically by affecting the overall quality of life (QoL). In this publication, we will deal with the descriptive aspects of endometriosis's pathology and then present a review of the aspects impacting QoL and their psycho-social consequences. Finally, the experience of pain in the context of the mind-brain-body relationship will be discussed, describing the complexity of this dimension and emphasizing the importance of a multi-professional approach that considers the relevance of the contribution that a psychotherapy intervention based on up-to-date neurobiological models can make for women with endometriosis. A review of the literature and current knowledge on the neural and psychological aspects of pain lead to the conclusion that it is of the utmost importance to provide informed psychological support, alongside medical treatments and sexual counseling, to patients with endometriosis.
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Affiliation(s)
- Elisa Farenga
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Matteo Bulfon
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Cristiana Dalla Zonca
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Costanza Tersar
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Giuseppe Ricci
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste (UniTS), Cattinara Hospital, Strada di Fiume, 447, 34149 Trieste, Italy;
| | - Giovanni Di Lorenzo
- S.C.U. Obstetrics and Gynaecology Clinic, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria, 65, 34137 Trieste, Italy
| | - Andrea Clarici
- Department of Medical, Surgical and Health Sciences, University of Trieste (UniTS), Cattinara Hospital, Strada di Fiume, 447, 34149 Trieste, Italy;
- Centro Formazione e Ricerca in Psicoterapia a Orientamento Psicoanalitico, Via Antonio Canova, 2, 34129 Trieste, Italy
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Donatti L, Podgaec S, Baracat EC. Efficacy of Cognitive Behavioral Therapy in treating women with endometriosis and chronic pelvic pain: A randomized trial. J Health Psychol 2024:13591053241240198. [PMID: 38566501 DOI: 10.1177/13591053241240198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
This study seeks to assess the efficacy of Cognitive-Behavioral Therapy (CBT) in enhancing coping strategies, alleviating depression, stress, pain perception, and improving the quality of life for women with endometriosis. About 52 patients randomized, categorized into an intervention group (n = 25) and a control group (n = 27) filled out the instruments. A significant positive change was observed in all variables studied within the intervention group compared to the control group. This study introduced a psychological treatment protocol focused on refining coping strategies using CBT techniques. Following the promotion of adaptive coping, there was an improvement in scores related to depression, stress, quality of life, perception of pain, and emotional distress. This suggests that CBT is effective in enhancing the overall emotional wellbeing of women with endometriosis.
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Affiliation(s)
- Lilian Donatti
- Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - Sergio Podgaec
- Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
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Cetera GE, Facchin F, Viganò P, Merli CEM, Frassineti A, Fiorini J, Somigliana E, Vercellini P. "SO FAR AWAY" How Doctors Can Contribute to Making Endometriosis Hell on Earth. A Call for Humanistic Medicine and Empathetic Practice for Genuine Person-Centered Care. A Narrative Review. Int J Womens Health 2024; 16:273-287. [PMID: 38405184 PMCID: PMC10894706 DOI: 10.2147/ijwh.s440542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 02/27/2024] Open
Abstract
"SO FAR AWAY" * How Doctors Can Contribute to Making Endometriosis Hell on Earth [* by Knopfler M. In Dire Straits. Brothers in Arms. Vertigo Records, U.K., 1985]. Abstract The distance physicians may create within the relationship with their patients by not having a humanistic approach to their practice may strongly influence clinical outcomes. The purpose of this paper is to convey the well-known narrative of patient dissatisfaction into pro-action by discussing the aspects of dehumanization, which may occur in the relationship between physicians and women with endometriosis. Eight dimensions of dehumanization are examined and related to everyday scenarios occurring in endometriosis care settings and the possible downstream consequences on patients' clinical outcomes are described. Objectification, which may come across as minimization of pain, may not only increase patients' perception of pain but also lead to undertreatment of unrecognized forms of endometriosis, especially among adolescents. Passivity, that is not favoring shared decision-making nor self-management, may compromise adherence to treatment, reducing patients' trust in physicians and quality of life. The same consequences may result from homogenization, that is giving for granted that all patients have the same access to care. Both isolation, ie not practicing therapeutic empathy, and loss of meaning, ie not supporting patients in the re-definition of their life plans, may affect women's psychological wellbeing and further increase pain perception. Ignoring women's personal journey by not providing clear information on the consequences endometriosis may have on their lives may favor women's self-silencing. Not promoting an un-biased communication and not setting aside scientific polarization are the main features of dislocation, which may jeopardize patient empowerment. Lastly, having a reductionist approach to the body may contribute to chronicization of pain, thus compromising quality of life. This considered, taking time to listen to women with endometriosis and tailoring decisions on the basis of their individual needs should be fostered as a moral duty. Physicians should always keep in mind that they are not only deliverers of treatment; they are a form of treatment themselves.
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Affiliation(s)
- Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Paola Viganò
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Infertility Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Annalisa Frassineti
- Associazione Progetto Endometriosi Organizzazione di Volontariato, Reggio Emilia, Italy
| | - Jessica Fiorini
- Associazione Progetto Endometriosi Organizzazione di Volontariato, Reggio Emilia, Italy
| | - Edgardo Somigliana
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Infertility Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Howard AF, Noga H, Kelly MT, Gholamian B, Lett S, Sutherland J, Yong PJ. Women's Self-Management of Dyspareunia Associated With Endometriosis: A Qualitative Study. THE JOURNAL OF PAIN 2024:104492. [PMID: 38341015 DOI: 10.1016/j.jpain.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/24/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
Given the limitations of medical treatment for endometriosis, self-management is a critical component of symptom management, and providing patients with information and education is a necessary complement to medical interventions. Though 50 to 70% of people with endometriosis experience dyspareunia (painful sex), there is limited knowledge of self-management specific to painful sex. A comprehensive understanding of the self-management strategies used is foundational to developing supportive care interventions that help ease pain and related psychosocial sequelae. The objective was to describe people's experiences of navigating endometriosis-associated painful sex and developing self-management strategies. We analyzed interview data from 20 women using constant comparative and thematic analysis techniques, guided by qualitative interpretive description methodology. Participants (age range 18-44 years) all identified as women and were predominately Caucasian (90%) and heterosexual (80%). Throughout their lives, the women appeared to gradually develop self-management strategies while navigating painful sexual experiences. This complex journey encompassed four phases: 1) viewing painful sex as normal, 2) experiencing evolving thoughts and emotions, 3) coming to understand painful sex and seeking help, and 4) learning strategies to navigate painful sex, these include preparing mentally and physically for sex and communicating with intimate partner(s). Women in this study developed self-management strategies over time through engagement with others who understood their challenges. Future research is warranted regarding initiatives to counter the normalization of painful sex, develop and disseminate patient-facing information, provide education specific to dyspareunia, improve access to multidisciplinary care, facilitate social connections and support, and enhance communication with intimate partners. PERSPECTIVE: In this paper, we report on the experiences of women with endometriosis-associated painful sex and their self-management strategies. Clinicians may be interested in a qualitative exploration of endometriosis-associated painful sex as they seek to further understand their patient's experiences and what strategies can be implemented to alleviate dyspareunia. DATA AVAILABILITY: The data sets generated during and/or analyzed during the current study are not publicly available as participants did not consent to making their data publicly available but are available from the corresponding author on reasonable request.
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Affiliation(s)
- A Fuchsia Howard
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada; Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, British Columbia, Canada
| | - Heather Noga
- Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, British Columbia, Canada
| | - Mary T Kelly
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bita Gholamian
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Lett
- Endometriosis Patient Advisory Board, British Columbia Women's Hospital & Health Centre, Vancouver, British Columbia, Canada
| | - Jessica Sutherland
- Endometriosis Patient Advisory Board, British Columbia Women's Hospital & Health Centre, Vancouver, British Columbia, Canada
| | - Paul J Yong
- Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, British Columbia, Canada; Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Women's Centre for Pelvic Pain & Endometriosis, British Columbia Women's Hospital & Health Centre, Vancouver, British Columbia, Canada
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7
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Brouns F, Van Haaps A, Keszthelyi D, Venema K, Bongers M, Maas J, Mijatovic V. Diet associations in endometriosis: a critical narrative assessment with special reference to gluten. Front Nutr 2023; 10:1166929. [PMID: 37731404 PMCID: PMC10507348 DOI: 10.3389/fnut.2023.1166929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Endometriosis is characterized by the presence of endometrium-like tissue outside the uterus. The etiology remains largely unknown. Despite adequate treatment, patients can still experience symptoms or side effects resulting in therapy incompliance and in self-management strategies such as dietary measures is increasing. A gluten free diet is thought to be contributory in reducing endometriosis-related pain, thereby optimizing quality of life. However, data is conflicting and currently provides no evidence for causality. This narrative review aims to put the effect of dietary self-management strategies on endometriosis in a balanced perspective, especially the effect of gluten and a gluten free diet. Several studies have found a strong overlap in symptoms, metabolic and immune responses associated with endometriosis and those associated with celiac disease, ulcerative colitis, Crohn's disease, irritable bowel syndrome and non-celiac wheat sensitivity. However, it remains unclear whether these diseases and/or disorders are causal to an increased risk of endometriosis. Some studies have found a positive effect on the risk of endometriosis, endometriosis-related symptoms and quality of life (QoL) when women either avoided certain nutrients or foods, or applied a specific nutrient supplementation. This includes the avoidance of red meat and omega-3, an increasing intake of foods rich in anti-oxidants, micronutrients and dietary fibers (e.g., fruit, vegetables) and the appliance of a gluten free diet. However, data from the available studies were generally graded of low quality and it was noted that placebo and/or nocebo effects influenced the reported positive effects. In addition, such effects were no longer seen when adjusting for confounders such as overweight, when a translation was made from in vitro to in vivo, or when the nutrients were not supplemented as isolated sources but as part of a mixed daily diet. Finally, some studies showed that long-term adherence to a gluten free diet is often associated with an impaired diet quality and nutrient intake, leading to negative health outcomes and reduced QoL. Concluding, scientific evidence on the efficacy of dietary interventions on well-defined clinical endpoints of endometriosis is lacking and recommending a gluten free diet to women solely diagnosed with endometriosis should therefore not be advised.
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Affiliation(s)
- Fred Brouns
- Department of Human Biology, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Annelotte Van Haaps
- Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Koen Venema
- Centre for Healthy Eating & Food Innovation (HEFI), Maastricht University, Maastricht, Netherlands
| | - Marlies Bongers
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, Netherlands
- Grow-School of Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Jacques Maas
- Grow-School of Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
- Department of Obstetrics and Gynaecology MUMC+, Maastricht, Netherlands
| | - Velja Mijatovic
- Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
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Samami E, Shahhosseini Z, Khani S, Elyasi F. Pain-focused psychological interventions in women with endometriosis: A systematic review. Neuropsychopharmacol Rep 2023; 43:310-319. [PMID: 37366616 PMCID: PMC10496056 DOI: 10.1002/npr2.12348] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 04/08/2023] [Accepted: 04/30/2023] [Indexed: 06/28/2023] Open
Abstract
AIMS As a chronic inflammatory disease, endometriosis (EMS) is often associated with pain affecting different aspects of women's lives. Up to now, a wide variety of interventions have been implemented to alleviate pain in patients with this condition, including pharmacological, surgical, and rarely non-pharmacological ones. Against this background, this review aimed to investigate pain-focused psychological interventions among EMS women. METHODS A systematic review of the articles published in this field was conducted through a comprehensive search on the databases of Scopus, PubMed, MEDLINE, Web of Science, ScienceDirect, the Cochrane Library, PsycINFO, Google Scholar, and Scientific Information Database (SID). The quality of studies was then assessed by the Jadad Scale. RESULTS In total, 10 articles were entered into this systematic review. The findings further revealed that the pain-focused psychological interventions in patients with EMS were cognitive-behavioral therapy (CBT) (n = 2), mindfulness therapy (n = 4), yoga (n = 2), psychoeducation (n = 1), and progressive muscle relaxation (PMR) training (n = 1). Besides, the findings established that all the given interventions had improved and reduced pain in women living with this condition. Moreover, five articles were of good quality based on the Jadad Scale. CONCLUSION The study results demonstrated that all the listed psychological interventions had affected pain relief and improvement in women suffering from EMS. Considering the limited number of studies in this field and the fact that there were only five articles endowed with good quality, more high-quality studies could provide stronger evidence to support the implementation of the mentioned interventions influencing pain in patients.
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Affiliation(s)
- Elahe Samami
- Student Research CommitteeMazandaran University of Medical SciencesSariIran
| | - Zohreh Shahhosseini
- Sexual and Reproductive Health Research CenterMazandaran University of Medical SciencesSariIran
| | - Soghra Khani
- Sexual and Reproductive Health Research CenterMazandaran University of Medical SciencesSariIran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction InstituteMazandaran University of Medical SciencesSariIran
- Department of Psychiatry, Faculty of MedicineMazandaran University of Medical SciencesSariIran
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Does the Use of the "Proseek ® Multiplex Inflammation I Panel" Demonstrate a Difference in Local and Systemic Immune Responses in Endometriosis Patients with or without Deep-Infiltrating Lesions? Int J Mol Sci 2023; 24:ijms24055022. [PMID: 36902452 PMCID: PMC10003683 DOI: 10.3390/ijms24055022] [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: 12/24/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Endometriotic lesions are able to infiltrate surrounding tissue. This is made possible partly by an altered local and systemic immune response that helps achieve neoangiogenesis, cell proliferation and immune escape. Deep-infiltrating endometriosis (DIE) differs from other subtypes through the invasion of its lesions over 5 mm into affected tissue. Despite the invasive nature of these lesions and the wider range of symptoms they can trigger, DIE is described as a stable disease. This elicits the need for a better understanding of the underlying pathogenesis. We used the "Proseek® Multiplex Inflammation I Panel" in order to simultaneously detect 92 inflammatory proteins in plasma and peritoneal fluid (PF) of controls and patients with endometriosis, as well as in particular patients with DIE, in order to gain a better insight into the systemically and locally involved immune response. Extracellular newly identified receptor for advanced gycation end-products binding protein (EN-RAGE), C-C motif Chemokine ligand 23 (CCL23), Eukaryotic translation initiation factor 4-binding protein 1 (4E-BP1) and human glial cell-line derived neurotrophic factor (hGDNF) were significantly increased in plasma of endometriosis patients compared to controls, whereas Hepatocyte Growth factor (HGF) and TNF-related apoptosis inducing ligand (TRAIL) were decreased. In PF of endometriosis patients, we found Interleukin 18 (IL-18) to be decreased, yet Interleukin 8 (IL-8) and Interleukin 6 (IL-6) to be increased. TNF-related activation-induced cytokine (TRANCE) and C-C motif Chemokine ligand 11 (CCL11) were significantly decreased in plasma, whereas C-C motif Chemokine ligand 23 (CCL23), Stem Cell Factor (SCF) and C-X-C motif chemokine 5 (CXCL5) were significantly increased in PF of patients with DIE compared to endometriosis patients without DIE. Although DIE lesions are characterized by increased angiogenetic and pro-inflammatory properties, our current study seems to support the theory that the systemic immune system does not play a major role in the pathogenesis of these lesions.
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Mavragani A, Pehlivan MJ, Singleton A, Hawkey A, Redfern J, Armour M, Dear B, Duckworth TJ, Ciccia D, Cooper M, Parry KA, Gandhi E, Imani SA. Co-design and Development of EndoSMS, a Supportive Text Message Intervention for Individuals Living With Endometriosis: Mixed Methods Study. JMIR Form Res 2022; 6:e40837. [PMID: 36485029 PMCID: PMC9789499 DOI: 10.2196/40837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/17/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Endometriosis, which affects 1 in 10 people assigned female at birth, is a chronic systemic inflammatory disease with a high symptom burden and adverse socioemotional impacts. There is a need for an accessible, cost-effective, and low-burden intervention to support individuals in managing their endometriosis condition. OBJECTIVE This study aimed to co-design and evaluate the acceptability, readability, and quality of a bank of supportive SMS text messages (EndoSMS) for individuals with endometriosis. METHODS In phase 1 of this mixed method design, 17 consumer representatives (individuals with endometriosis) participated across three 3-hour web-based (Zoom, Zoom Video Communications, Inc) focus groups. The transcripts were encoded and analyzed thematically. In phase 2, consumer representatives (n=14) and health care professionals (n=9) quantitatively rated the acceptability, readability, and appropriateness of the developed text messages in a web-based survey. All the participants initially completed a background survey assessing sociodemographic and medical factors. RESULTS Consumer representatives demonstrated diverse sociodemographic characteristics (Mage=33.29), varying in location (metropolitan vs rural or regional), employment, and relationship and educational statuses. Participants reached a consensus regarding the delivery of 4 SMS text messages per week, delivered randomly throughout the week and in one direction (ie, no reply), with customization for the time of day and use of personal names. Seven main areas of unmet need for which participants required assistance were identified, which subsequently became the topic areas for the developed SMS text messages: emotional health, social support, looking after and caring for your body, patient empowerment, interpersonal issues, general endometriosis information, and physical health. Through a web-based survey, 371 co-designed SMS text messages were highly rated by consumers and health care professionals as clear, useful, and appropriate for individuals with endometriosis. Readability indices (Flesch-Kincaid scale) indicated that the SMS text messages were accessible to individuals with a minimum of 7th grade high school education. CONCLUSIONS On the basis of the needs and preferences of a diverse consumer representative group, we co-designed EndoSMS, a supportive SMS text message program for individuals with endometriosis. The initial evaluation of the SMS text messages by consumer representatives and health professionals suggested the high acceptability and suitability of the developed SMS text messages. Future studies should further evaluate the acceptability and effectiveness of EndoSMS in a broader population of individuals with endometriosis.
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Affiliation(s)
| | - Melissa Jade Pehlivan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Anna Singleton
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Alexandra Hawkey
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Mike Armour
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, Australia.,NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Blake Dear
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Tanya Jane Duckworth
- School of Psychology, Faculty of Medical and Health Sciences, University of Adelaide, Adelaide, Australia
| | | | | | | | - Esther Gandhi
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Sara A Imani
- School of Psychological Sciences, Macquarie University, Sydney, Australia
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11
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Falconer L, Hendricks E, Harcourt D. What is the evidence of effectiveness of non-pharmaceutical, non-surgical, biopsychosocial interventions for body image and pain management in individuals with endometriosis? A systematic review. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2022. [DOI: 10.1177/22840265221139909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Aim: To identify and review the success of non-pharmaceutical, non-surgical biopsychosocial interventions in individuals with endometriosis, in managing pain and improving body image. Methods: Cochrane, EBSCO, IBSS, NICE, Open Grey, OVID, Proquest, Scopus and Science Direct were searched in April 2021, using inclusion and exclusion criteria. Data collection and analysis: Five randomised control trials, and one controlled clinical trial resulted from the search. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Studies were synthesised by intervention type, into physical only, and physical and psychological. Results: Across the six papers, 323 participants were recruited, through medical records or self-referral, and treatments largely administered by specialist practitioners. From the EPHPP quality assessment,2 weak quality papers, and four moderate quality papers found improvements to pain, with large effect sizes in four papers. No studies used established body image measures to examine intervention effects on body image, and all lacked health psychology theoretical basis. There were common issues in selection bias, confounders and blinding. Conclusion: Without gold-standard methodology, evidence of effectiveness cannot be concluded. However, there is promising rationale if these issues are addressed.
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12
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Heng FW, Shorey S. Experiences of endometriosis‐associated infertility among women and their partners: A qualitative systematic review. J Clin Nurs 2022; 31:2706-2715. [DOI: 10.1111/jocn.16145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/11/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine Level 2, Clinical Research Centre National University of Singapore Singapore City Singapore
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13
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Mallorquí A, Martínez-Zamora MA, Carmona F. Anhedonia in endometriosis: An unexplored symptom. Front Psychol 2022; 13:935349. [PMID: 36118502 PMCID: PMC9481352 DOI: 10.3389/fpsyg.2022.935349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Anhedonia is the diminished motivation and sensitivity to pleasurable stimuli. It has been reported to be more prevalent in patients with chronic pain as compared to healthy controls. Endometriosis is a chronic inflammatory systemic disease with a significant psychosocial impact that compromises wellbeing and the day-to-day life of patients. Women with endometriosis show significant psychological distress, even more pervasive when chronic pelvic pain is present. In the current review we will discuss the role of anhedonia in endometriotic chronic pelvic pain. We will also present new lines of research that could lead to more fully clarifying the psychological impact of endometriosis and its detrimental repercussions to quality of life and mental health.
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Affiliation(s)
- Aida Mallorquí
- Clinical Health Psychology Section, Institute of Neuroscience (ICN), Hospital Clínic of Barcelona, Barcelona, Spain
| | - María-Angeles Martínez-Zamora
- Department of Gynecology, Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- *Correspondence: María-Angeles Martínez-Zamora,
| | - Francisco Carmona
- Department of Gynecology, Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Faculty of Medicine, University of Barcelona, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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14
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Xie C, Yin Z, Liu Y. Analysis of characteristic genes and ceRNA regulation mechanism of endometriosis based on full transcriptional sequencing. Front Genet 2022; 13:902329. [PMID: 35938015 PMCID: PMC9353714 DOI: 10.3389/fgene.2022.902329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Endometriosis is a common gynecological disorder that usually causes infertility, pelvic pain, and ovarian masses. This study aimed to mine the characteristic genes of endometriosis, and explore the regulatory mechanism and potential therapeutic drugs based on whole transcriptome sequencing data and resources from public databases, providing a theoretical basis for the diagnosis and treatment of endometriosis. Methods: The transcriptome data of the five eutopic (EU) and ectopic (EC) endometrium samples were obtained from Beijing Obstetrics and Gynecology Hospital, Beijing, China, and dinified as the own data set. The expression and clinical data of EC and EU samples in GSE25628 and GSE7305 datasets were obtained from the GEO database (https://www.ncbi.nlm.nih.gov/gds). Differential gene expression analysis and weighted gene co-expression network analysis (WGCNA) were used to identify the endometriosis-related differentially expressed genes. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted by the “clusterProfiler” R package. Then, characteristic genes for endometriosis were identified by the least absolute shrinkage and selection operator (LASSO) and support vector machine recursive feature elimination (SVM-RFE) algorithm. The expression of characteristic genes was verified by quantitative reverse transcription polymerase chain reaction (qRT-PCR) and western-blot. The receiver operating characteristic (ROC) curve was used to evaluate the discriminatory ability of characteristic genes. We assessed the abundance of infiltrating immune cells in each sample using MCP-counter and ImmuCellAI algorithms. The competitive endogenous RNA (ceRNA) regulatory network of characteristic genes was created by Cytoscape and potential targeting drugs were obtained in the CTD database. Results: 44 endometriosis-related differentially expressed genes were obtained from GSE25628 and the own dataset. Subsequently, LASSO and SVM-RFE algorithms identified four characteristic genes, namely ACLY, PTGFR, ADH1B, and MYOM1. The results of RT-PCR and western-blot were consistent with those of sequencing. The result of ROC curves indicated that the characteristic genes had powerful abilities in distinguishing EC samples from EU samples. Infiltrating immune cells analysis suggested that there was a certain difference in immune microenvironment between EC and EU samples. The characteristic genes were significantly correlated with specific differential immune cells between EC and EU samples. Then, a ceRNA regulatory network of characteristic genes was constructed and showed a total of 7, 11, 11, and 1 miRNA associated with ACLY, ADH1B, PTGFR, and MYOM1, respectively. Finally, we constructed a gene-compound network and mined 30 drugs targeting ACLY, 33 drugs targeting ADH1B, 13 drugs targeting MYOM1, and 12 drugs targeting PTGFR. Conclusion: Comprehensive bioinformatic analysis was used to identify characteristic genes, and explore ceRNA regulatory network and potential therapeutic agents for endometriosis. Altogether, these findings provide new insights into the diagnosis and treatment of endometriosis.
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Affiliation(s)
| | | | - Yong Liu
- *Correspondence: Chengmao Xie, ; Yong Liu,
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15
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Xie C, Lu C, Liu Y, Liu Z. Diagnostic gene biomarkers for predicting immune infiltration in endometriosis. BMC Womens Health 2022; 22:184. [PMID: 35585523 PMCID: PMC9118874 DOI: 10.1186/s12905-022-01765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/06/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To determine the potential diagnostic markers and extent of immune cell infiltration in endometriosis (EMS). Methods Two published profiles (GSE7305 and GSE25628 datasets) were downloaded, and the candidate biomarkers were identified by support vector machine recursive feature elimination analysis and a Lasso regression model. The diagnostic value and expression levels of biomarkers in EMS were verified by quantitative reverse transcription polymerase chain reaction (qRT-PCR) and western blotting, then further validated in the GSE5108 dataset. CIBERSORT was used to estimate the composition pattern of immune cell components in EMS. Results One hundred and fifty-three differential expression genes (DEGs) were identified between EMS and endometrial with 83 upregulated and 51 downregulated genes. Gene sets related to arachidonic acid metabolism, cytokine–cytokine receptor interactions, complement and coagulation cascades, chemokine signaling pathways, and systemic lupus erythematosus were differentially activated in EMS compared with endometrial samples. Aquaporin 1 (AQP1) and ZW10 binding protein (ZWINT) were identified as diagnostic markers of EMS, which were verified using qRT-PCR and western blotting and validated in the GSE5108 dataset. Immune cell infiltrate analysis showed that AQP1 and ZWINT were correlated with M2 macrophages, NK cells, activated dendritic cells, T follicular helper cells, regulatory T cells, memory B cells, activated mast cells, and plasma cells. Conclusion AQP1 and ZWINT could be regarded as diagnostic markers of EMS and may provide a new direction for the study of EMS pathogenesis in the future.
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Affiliation(s)
- Chengmao Xie
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
| | - Chang Lu
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Yong Liu
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Zhaohui Liu
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
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16
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Matloobi M, Amini L, Shahali S, Haghani H, Tahermanesh K, Hassanlouei B, Allahqoli L, Alkatout I. Effect of sex education on sexual function and sexual quality of life in women with endometriosis: A quasi-experimental study. Int J Gynaecol Obstet 2022; 159:702-710. [PMID: 35514234 DOI: 10.1002/ijgo.14254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/22/2022] [Accepted: 05/03/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the effect of a sex education program on sexual function and sexual quality of life in women with endometriosis. METHODS In a quasi-experimental study, women with endometriosis who had undergone laparoscopic surgery were assigned to an intervention group (n = 36) or a control group (n = 36). The intervention group received a sex education program consisting of two sessions a week (90 min each) for two consecutive weeks; the control group received none. Both groups were followed for 12 weeks. Sexual function and sexual quality of life were assessed on the Female Sexual Function Index (FSFI) and the Sexual Quality of life-Female (SQOL-F) questionnaire before the intervention, as well as 8 and 12 weeks after the intervention. Outcomes were analyzed using Student t test, the χ2 test, Fisher exact test, and repeated measures analysis of variance. RESULTS The mean age of the study participants was 36.9 ± 5.7 years. The two groups did not differ significantly in terms of demographics and pre-intervention clinical characteristics. At the end of the study, sex education reduced female sexual dysfunction by 58.1% in the intervention group. The mean FSFI score increased significantly in the intervention group from pre-intervention to 8 and 12 weeks post-intervention compared with the scores in the control group (P < 0.001). CONCLUSIONS Sex education appears to be a promising intervention for reducing sexual dysfunction and improving sexual function and sexual quality of life in women with endometriosis. Future studies should encompass longer periods of follow up to obtain further data on the efficacy of sex education in this setting.
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Affiliation(s)
- Maryam Matloobi
- Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amini
- Nursing Care Research Center (NCRC), Department of Midwifery, Reproductive Health, and pregnancy, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Shadab Shahali
- Department of Midwifery and Reproductive Health, Tarbiat Modares University, Tehran, Iran
| | - Hamid Haghani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Kobra Tahermanesh
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Hassanlouei
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Kiel, Germany
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Márki G, Vásárhelyi D, Rigó A, Kaló Z, Ács N, Bokor A. Challenges of and possible solutions for living with endometriosis: a qualitative study. BMC Womens Health 2022; 22:20. [PMID: 35081940 PMCID: PMC8793269 DOI: 10.1186/s12905-022-01603-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/14/2022] [Indexed: 12/11/2022] Open
Abstract
Background Endometriosis as a chronic gynecological disease has several negative effects on women’s life, thereby placing a huge burden on the patients and the health system. The negative impact of living with endometriosis (impaired quality of life, diverse medical experiences) is detailed in the literature, however, we know less about patients’ self-management, social support, the meaning of life with a chronic disease, and the needs of patients. To implement a proper multidisciplinary approach in practice, we need to have a comprehensive view of the complexity of endometriosis patients’ life and disease history. Methods Four focus group discussions were conducted between October 2014 and November 2015 by a team consisting of medical and psychological specialists. 21 women (age: 31.57; SD = 4.45) with surgical and histological confirmation of endometriosis were included in the study. Discussions were audiotaped and transcribed verbatim, and a 62,051-word corpus was analyzed using content analysis. Results Four main themes emerged from the analysis: (1) the impact of endometriosis on quality of life, (2) medical experiences, (3) complementary and alternative treatments, and (4) different coping strategies in disease management. All themes were interrelated and highly affected by a lack of information and uncertainty caused by endometriosis. A supporting doctor-patient relationship, active coping, and social support were identified as advantages over difficulties. Finding the positive meaning of life after accepting endometriosis increased the possibility of posttraumatic growth. Furthermore, women’s needs were identified at all levels of the ecological approach to health promotion. Conclusions Our results highlight the need for multidisciplinary healthcare programs and interventions to find solutions to the difficulties of women with endometriosis. To achieve this goal, a collaboration of professionals, psychologists, and support organizations is needed in the near future.
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Affiliation(s)
- Gabriella Márki
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, 1064, Hungary.,Institute of Psychology, Eötvös Loránd University, Izabella Street 46, Budapest, 1064, Hungary
| | - Dorottya Vásárhelyi
- Institute of Psychology, Eötvös Loránd University, Izabella Street 46, Budapest, 1064, Hungary
| | - Adrien Rigó
- Institute of Psychology, Eötvös Loránd University, Izabella Street 46, Budapest, 1064, Hungary
| | - Zsuzsa Kaló
- Institute of Psychology, Eötvös Loránd University, Izabella Street 46, Budapest, 1064, Hungary
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Baross Street 27, Budapest, 1088, Hungary
| | - Attila Bokor
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Baross Street 27, Budapest, 1088, Hungary.
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González-Mesa E, Moya-Bejarano D, Butrón-Hinojo CA, Marín-Sánchez P, Blasco-Alonso M, Jimenez-López JS, Villegas-Muñoz E, Lubián-López DM. Correlates of Sexual Function in a Sample of Spanish Women with Endometriosis. J Clin Med 2021; 10:4957. [PMID: 34768476 PMCID: PMC8584302 DOI: 10.3390/jcm10214957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/10/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In the present study, we aim to report on the sexual function of women experiencing symptoms of endometriosis, analysing the clinical and psychosocial factors that may be associated. METHODS A multicentre cross-sectional study was performed to analyse the sexual function in a sample of 196 Spanish women with endometriosis, using the Female Sexual Function Inventory. RESULTS The Female Sexual Function Inventory (FSFI) was validated in our endometriosis study group. The mean FSFI score for the sample was 22.5 (SD 6.6), with 20.9 and 26.9 being in the 25th and 75th percentiles, respectively. Although physical sexual pain and dyspareunia were factors that influenced the sexual function of women with endometriosis, our results show that the impairment was multifactorial. CONCLUSIONS We found impaired sexual function in women diagnosed with endometriosis. The final model included deep endometriosis, depression, age, and unemployment as strongest predictive factors for poor (deteriorated) sexual function.
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Affiliation(s)
- Ernesto González-Mesa
- Department of Obstetrics and Gynecology, School of Medicine, University of Malaga, 29071 Málaga, Spain
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.B.-A.); (J.S.J.-L.); (E.V.-M.)
| | - Davinia Moya-Bejarano
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.B.-A.); (J.S.J.-L.); (E.V.-M.)
| | | | - Pilar Marín-Sánchez
- Department of Obstetrics and Gynecology, University Hospital Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Marta Blasco-Alonso
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.B.-A.); (J.S.J.-L.); (E.V.-M.)
| | - Jesús Salvador Jimenez-López
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.B.-A.); (J.S.J.-L.); (E.V.-M.)
| | - Emilia Villegas-Muñoz
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.B.-A.); (J.S.J.-L.); (E.V.-M.)
| | - Daniel María Lubián-López
- Department of Obstetrics and Gynecology, University Hospital of Jerez de la Frontera, 11407 Cádiz, Spain;
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The Effect of Garlic Tablets on the Endometriosis-Related Pains: A Randomized Placebo-Controlled Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5547058. [PMID: 34335819 PMCID: PMC8315864 DOI: 10.1155/2021/5547058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/13/2021] [Indexed: 12/22/2022]
Abstract
Endometriosis is a common chronic inflammatory disease. Garlic contains components that have antiproliferative, anti-inflammatory, and antioxidative effects. The current study aimed to evaluate the effectiveness of garlic on endometriosis symptoms. This was a randomized placebo-controlled triple-blind clinical trial. A convenience sample of 60 women was randomly allocated into two groups. The intervention group received usual care supplemented with 400 mg garlic tablets, and the placebo group received identical placebo tablets. A four-part Visual Analogue Scale (VAS) was used to measure the severity of pains. The pains were measured on four occasions (before the intervention and on one-, two-, and three-month follow-ups). Data were analyzed using the t-test, chi-square, repeated measures ANOVA, and ANCOVA by SPSS 16. The overall severity of pain reduced from 6.51 ± 0.86 to 1.83 ± 1.25 in the intervention group (p < 0.05). It increased from 6.41 ± 1.12 to 6.65 ± 1.37 in the control group (p = 0.02). The repeated measures ANOVA showed that there is a significant difference in the change of pain scores between intervention and control groups (p < 0.001, np2 = 0.572). Garlic extract can reduce pelvic and back pain, dysmenorrhea, and dyspareunia which are important symptoms of endometriosis.
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20
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Hansen S, Sverrisdóttir UÁ, Rudnicki M. Impact of exercise on pain perception in women with endometriosis: A systematic review. Acta Obstet Gynecol Scand 2021; 100:1595-1601. [PMID: 33999412 DOI: 10.1111/aogs.14169] [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: 01/06/2021] [Revised: 04/16/2021] [Accepted: 05/07/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Endometriosis is challenging to treat. It is a painful and chronic inflammatory disorder that impacts up to 10% of women of reproductive age. Despite available surgical and medical treatment options, recurrence of symptoms is common. Available studies suggest that exercise may have a therapeutic effect on chronic inflammation and thereby on pain perception. This review evaluates whether exercise can decrease pain perception in women with symptomatic endometriosis. MATERIAL AND METHODS This systematic review was conducted according to PRISMA by searching databases Medline and Embase to locate randomized controlled trials and observational studies. Risk of bias was investigated using the Cochrane Collaboration Tool for the Evaluation of Randomized Controlled Trials and the ROBINS-I quality assessment scale. Inclusion criteria were women of reproductive age, laparoscopically confirmed diagnosis of endometriosis, and intervention of any type of exercise. All manuscripts were evaluated by two of the authors and when in doubt a third author was consulted. This review was registered in PROSPERO on November 14, 2020 (CRD42020212309). RESULTS Six articles fulfilled the inclusion criteria and were included in this systematic review. Concerning exercise, two studies showed significant decrease in pain relief but the remaining studies showed either negative or no impact on pain relief. A meta-analysis could not be conducted because of the considerable heterogeneity among the included studies. CONCLUSIONS The present review does not indicate any beneficial effect of exercise on pain in women with endometriosis. There is a need for randomized controlled trials with correct power calculation, well-defined study groups and training programs to be able to answer the question of whether exercise can improve the pain experience in patients with endometriosis.
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Affiliation(s)
- Sara Hansen
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Martin Rudnicki
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
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21
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Yang X, Xu X, Lin L, Xu K, Xu M, Ye J, Shen X. Sexual function in patients with endometriosis: a prospective case-control study in China. J Int Med Res 2021; 49:3000605211004388. [PMID: 33874775 PMCID: PMC8060767 DOI: 10.1177/03000605211004388] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Endometriosis is a common disease in women of childbearing age, leading to sexual dysfunction or loss of libido. We aimed to evaluated the effect of endometriosis on women's sexual function. METHODS We performed a prospective case-control study to determine the effect of endometriosis on women's sexual function using a self-administered questionnaire from September 2017 to August 2018. The simplified Chinese version of the Female Sexual Function Index (FSFI) was used to assess sexual function. RESULTS We found that sexual function of women in the endometriosis group (n=77) in all dimensions was significantly lower compared with that in the control group (n=63). The total FSFI score in patients was 25.5, which tended to be lower than that in the control group (26.7). Sexual arousal, sexual pain, and satisfaction were significantly different between the two groups. Sexual arousal and sexual pain scores were significantly lower in the endometriosis group than in the control group at the ages of 31 to 40 years. CONCLUSION Women with endometriosis suffer from sexual dysfunction, especially those aged 31 to 40 years. Our findings suggest that the quality of sexual life in this subpopulation needs to be improved.
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Affiliation(s)
- Xiaochun Yang
- Women's Hospital School of Medicine, 12377Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xinfen Xu
- Women's Hospital School of Medicine, 12377Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Lili Lin
- Women's Hospital School of Medicine, 12377Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Kaihong Xu
- Women's Hospital School of Medicine, 12377Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Min Xu
- Women's Hospital School of Medicine, 12377Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jinying Ye
- Women's Hospital School of Medicine, 12377Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xiaoli Shen
- Women's Hospital School of Medicine, 12377Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
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22
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Rossi V, Tripodi F, Simonelli C, Galizia R, Nimbi FM. Endometriosis-associated pain: a review of quality of life, sexual health and couple relationship. Minerva Obstet Gynecol 2021; 73:536-552. [PMID: 33904688 DOI: 10.23736/s2724-606x.21.04781-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Endometriosis is a chronic gynecological disease that affects women's quality of life, sexuality, and relationship. Endometriosis-associated pain plays an essential role in well-being impairment. The present review aimed to analyze literature about endometriosis-associated pain and quality of life, sexual health, and quality of the relationship, assessing the role of the biopsychosocial factors involved and the women's pain experience. EVIDENCE ACQUISITION Bibliographic research of relevant articles published from 2015 to 2020 in PubMed, Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library. EVIDENCE SYNTHESIS Endometriosis is associated with impairing all women's quality of life domains, and pain appears to be the most influential variable. The pain mechanism is not simple and implies several biological, psychological, and social factors. Women's sexual health is also impaired, and patients report dyspareunia, sexual dysfunctions, dissatisfaction, and distress. Partners' sexual well being is compromised as well. Endometriosis negatively influences relationship quality, and the illness burden affects both couple members. CONCLUSIONS A multidisciplinary team using a couple-centered and a biopsychosocial approach is crucial to provide appropriate treatment for endometriosis-associated pain. A better comprehension of all bio-psycho-social aspects implicated in women's well-being and pain experience needs more research.
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Affiliation(s)
| | | | - Chiara Simonelli
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Roberta Galizia
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Filippo M Nimbi
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
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Mehdizadeh Kashi A, Niakan G, Ebrahimpour M, Allahqoli L, Hassanlouei B, Gitas G, Alkatout I. A randomized, double-blind, placebo-controlled pilot study of the comparative effects of dienogest and the combined oral contraceptive pill in women with endometriosis. Int J Gynaecol Obstet 2021; 156:124-132. [PMID: 33728657 DOI: 10.1002/ijgo.13677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/26/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare the effects of dienogest and a combined oral contraceptive pill (COCP) after laparoscopic surgery on pain and quality of life in women with severe endometriosis. METHODS A randomized double-blind pilot study was conducted from March 2018 to March 2020 in women with severe endometriosis confirmed by laparoscopic surgery. A total of 108 patients who had undergone laparoscopic surgery received dienogest, COCP, or placebo daily for 6 months. Primary and secondary outcomes were compared between the three groups. RESULTS Treatment with dienogest or COCP was associated with improved self-reported pain after 6 months of treatment, as evidenced by significantly lower scores for pelvic pain and dyspareunia compared with placebo (P < 0.05). Significant differences in overall quality of life score were observed over 6 months in the dienogest, COCP, and placebo groups (mean difference 22.00, 23.45, and 6.45 points, respectively; P < 0.001). Post-hoc analysis revealed a significant difference in overall quality of life score between the placebo group and the dienogest (P < 0.001) and COCP groups (P = 0.004). CONCLUSION Postoperative administration of dienogest or COCP reduced endometriosis-associated pain and improved quality of life in women with severe endometriosis. CLINICAL TRIALS REGISTRATION https://en.irct.ir/trial/43070.
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Affiliation(s)
| | - Gelareh Niakan
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Ebrahimpour
- Department of Psychology, Qaenat Branch, Islamic Azad University, Qaenat, Iran
| | - Leila Allahqoli
- School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Hassanlouei
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Georgios Gitas
- Department of Obstetrics and Gynecology, University Hospital Schleswig Holstein, Luebeck, Germany
| | - Ibrahim Alkatout
- Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
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Assessment of Optimism in Women with Polycystic Ovary Syndrome: A Case Control-Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052352. [PMID: 33670871 PMCID: PMC7957798 DOI: 10.3390/ijerph18052352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 11/23/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a chronic endocrinopathy characterized by hyperandrogenism and anovulation that may pervade psychological dimensions such as dispositional optimism. Considering how PCOS influences mental health and the lack of studies on this matter, this research was aimed at assessing optimism and associated factors in PCOS. A case–control study of 156 patients with PCOS and 117 controls was conducted. All woman filled out the Life Orientation Test-Revised (LOT-R), a self-report questionnaire for measuring dispositional optimism. Medication, pain severity, gynecological, and sociodemographic information was also collected. Lower optimism was found in patients with PCOS compared to controls, even after covariate adjustment (LOT-R global scores: 14.1 vs. 15.9, p = 0.020). Our study provides evidence that a personality characteristic with important implications in illness prognosis may be affected in PCOS. We propose to assess dispositional optimism with the LOT-R scale in the gynecological appointment and tailor medical attention accordingly as a way to improve the comprehensive care of these patients within a multidisciplinary team.
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Wahl KJ, Imtiaz S, Lisonek M, Joseph KS, Smith KB, Yong PJ, Cox SM. Dyspareunia in Their Own Words: A Qualitative Description of Endometriosis-Associated Sexual Pain. Sex Med 2020; 9:100274. [PMID: 33291043 PMCID: PMC7930843 DOI: 10.1016/j.esxm.2020.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/28/2020] [Accepted: 10/12/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Dyspareunia has been called the neglected symptom of endometriosis and is underexplored in clinical and research contexts. Understanding the physical experience and patient-important aspects of endometriosis-associated sexual pain can help advance valid measurement of this symptom. Aims The goal of this research was to characterize the physical experience of endometriosis-associated dyspareunia in the words of people affected by this condition. Methods This was a qualitative descriptive study that included participants with current or previous endometriosis-associated dyspareunia recruited from a data registry. Data collection involved semistructured interviews that began with an open-ended question about dyspareunia followed by prompts related to the nature of sexual pain. Main Outcome Measures Interviews transcripts were subjected to qualitative content analysis using a priori (pain site, onset, character, radiation, associations, time course, and exacerbating/relieving factors) and emergent themes. Results A total of 17 participants completed interviews. Mean participant age was 33.3 years and most were identified as white, college-educated, heterosexual, and partnered. Location, onset, and character were important; interrelated features of endometriosis-associated dyspareunia were: (i) introital pain began with initial penetration and had pulling, burning, and stinging qualities and (ii) pelvic pain was experienced with deep penetration or in certain positions and was described as sharp, stabbing, and cramping. Dyspareunia ranged from mild to severe, had a marked psychosocial impact for some participants, and was managed using a variety of treatments and strategies. Conclusion The endometriosis-associated dyspareunia experienced by participants was heterogenous in presentation, severity, and impact. Our findings have implications for the development of valid patient-reported outcome measures of this symptom. Wahl KJ, Imtiaz S, Lisonek M, et al. Dyspareunia in Their Own Words: A Qualitative Description of Endometriosis-Associated Sexual Pain. Sex Med 2021;9:100274.
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Affiliation(s)
- Kate J Wahl
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Shermeen Imtiaz
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Michelle Lisonek
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - K S Joseph
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Kelly B Smith
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Paul J Yong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
| | - Susan M Cox
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Mira TA, Yela DA, Podgaec S, Baracat EC, Benetti-Pinto CL. Hormonal treatment isolated versus hormonal treatment associated with electrotherapy for pelvic pain control in deep endometriosis: Randomized clinical trial. Eur J Obstet Gynecol Reprod Biol 2020; 255:134-141. [DOI: 10.1016/j.ejogrb.2020.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 11/26/2022]
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Norinho P, Martins MM, Ferreira H. A systematic review on the effects of endometriosis on sexuality and couple's relationship. Facts Views Vis Obgyn 2020; 12:197-205. [PMID: 33123695 PMCID: PMC7580264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Endometriosis is likely to affect sexuality and intimate relationships but the effect endometriosis has on partners remains overlooked and the existing studies show conflicting results. The effect of the disease and its treatment on the couple may be pronounced given the absence of an obvious cause or cure, the likelihood of chronic recurring symptoms, and the potential impact on both sex and fertility. MATERIALS AND METHODS We followed the PRISMA guidelines to conduct this systematic review, which involved a database search of published available research related to the effects of endometriosis treatment on sexual function, couple's relationship and on the partner published between 2000 and 2020. RESULTS The studies considered revealed that women with endometriosis report a significant effect of the disease on sexuality and relationship. Also, most of the published studies suggest that the impact on partners may be profound, affecting many life domains including sex, intimacy and the relationship in general. CONCLUSIONS Data suggests that male partners should not be overlooked in the treatment of endometriosis and that psychosocial support including sexual and couple therapy might be beneficial.
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Affiliation(s)
- P Norinho
- Centre for Psychology at University of Porto, Centro Materno-Infantil do Norte – Centro Hospitalar do Porto, Porto, Portugal
| | - MM Martins
- Centre for Psychology at University of Porto, Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - H Ferreira
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Portugal, Centro Materno- Infantil do Norte – Centro Hospitalar do Porto, Porto, Portugal
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van Poll M, van Barneveld E, Aerts L, Maas JWM, Lim AC, de Greef BTA, Bongers MY, van Hanegem N. Endometriosis and Sexual Quality of Life. Sex Med 2020; 8:532-544. [PMID: 32712127 PMCID: PMC7471125 DOI: 10.1016/j.esxm.2020.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Endometriosis is a benign gynecological disease with a high disease burden and significant, multifaceted impact on health-related quality of life (HRQoL) and sexual quality of life (SQoL). Aim To explore which patient- and disease-specific characteristics were independently associated with SQoL. Methods A literature search was carried out to identify characteristics with an evidence-based or hypothesized effect on SQoL. Subsequently, data on HRQoL in women with endometriosis (n = 224), collected between 2013 and 2018 in a prospective longitudinal Dutch cohort study performed in 7 referral centers, were used to perform a cross-sectional cohort study. Data were collected using an online self-administered survey including the validated Endometriosis Health Profile-30. Inclusion criteria were recently diagnosed endometriosis patients or newly referred patients with a clinical diagnosis of endometriosis. Patients were excluded in case of incomplete answers on the SQoL questions. Univariate analyses and multiple linear regression analyses were performed. Outcomes SQoL, measured by the 5-item “sexual intercourse” dimension score of the modular Endometriosis Health Profile-30 questionnaire, was the primary outcome with scores ranging from 0 to 100 (0 indicating the best and 100 indicating the worst health status). Results Based on a literature search, 29 characteristics potentially associated with SQoL were selected from the survey and included in the analyses. In total, 192 women (mean age 36 years) met the inclusion criteria. The majority of women (86.5%) had had intercourse in the period before completing the survey and the study population showed a mean SQoL score of 47.5 ± 29.6, indicating moderate SQoL. Worse SQoL was independently associated with dyspareunia (P < .001), worse HRQoL (P = .001), severity of dysmenorrhea (P = .017), and unemployed work status (P = .022). Conclusion In a cohort of women with endometriosis, worse SQoL was significantly and independently associated with the presence of dyspareunia, more severe dysmenorrhea, worse HRQoL, and unemployed work status. van Poll M, van Barneveld E, Aerts L, et al. Endometriosis and Sexual Quality of Life. Sex Med 2020;8:532–544.
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Affiliation(s)
- Mikal van Poll
- Department of Obstetrics and Gynaecology, Endometriosis Team, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Esther van Barneveld
- Department of Obstetrics and Gynaecology, Endometriosis Team, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Luca Aerts
- Department of Obstetrics and Gynaecology, Endometriosis Team, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jacques W M Maas
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Arianne C Lim
- Department of Obstetrics and Gynaecology, Endometriosis Team, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bianca T A de Greef
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynaecology, Endometriosis Team, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Nehalennia van Hanegem
- Department of Obstetrics and Gynaecology, Endometriosis Team, Maastricht University Medical Centre, Maastricht, the Netherlands
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Does the Use of the "Proseek ® Multiplex Oncology I Panel" on Peritoneal Fluid Allow a Better Insight in the Pathophysiology of Endometriosis, and in Particular Deep-Infiltrating Endometriosis? J Clin Med 2020; 9:jcm9062009. [PMID: 32604857 PMCID: PMC7355450 DOI: 10.3390/jcm9062009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023] Open
Abstract
Endometriosis appears to share certain cancer-related processes, such as cell attachment, invasion, proliferation and neovascularization, some of which can also be found in other healthy tissues. In order to better understand the altered milieu of the peritoneal cavity, while acknowledging the reported similarities between endometriosis and neoplastic processes, we applied a multiplex oncology panel to search for specific biomarker signatures in the peritoneal fluid of women with endometriosis, women with deep-infiltrating endometriosis (DIE), as well as controls. In total, 84 patients were included in our study, 53 women with endometriosis and 31 controls. Ninety-two proteins were measured in prospectively collected peritoneal fluid (PF) samples, using the "Proseek® Multiplex Oncology I Panel". We first compared patients with endometriosis versus controls, and in a second step, DIE versus endometriosis patients without DIE. Out of the 92 analyzed proteins, few showed significant differences between the groups. In patients with endometriosis, ICOS ligand, Endothelial growth factor, E-selectin, Receptor tyrosine-protein kinase erbB-2, Interleukin-6 receptor alpha, Vascular endothelial growth factor receptor 2, Fms-related tyrosine kinase 3 ligand, C-X-C motif chemokine 10, Epididymal secretory protein E4 and Folate receptor-alpha were decreased, while Interleukin-6 and Interleukin-8 were increased compared to controls. Looking at patients with DIE, we found Chemokine ligand 19, Stem cell factor, Vascular endothelial growth factor D, Interleukin-6 receptor alpha and Melanoma inhibitory activity to be increased compared to endometriosis patients without DIE. We have shown a distinct regulation of the immune response, angiogenesis, cell proliferation, cell adhesion and inhibition of apoptosis in PF of patients with endometriosis compared to controls. The specific protein pattern in the PF of DIE patients provides new evidence that DIE represents a unique entity of extrauterine endometriosis with enhanced angiogenetic and pro-proliferative features.
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30
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La Rosa VL, Barra F, Chiofalo B, Platania A, Di Guardo F, Conway F, Di Angelo Antonio S, Lin LT. An overview on the relationship between endometriosis and infertility: the impact on sexuality and psychological well-being. J Psychosom Obstet Gynaecol 2020; 41:93-97. [PMID: 31466493 DOI: 10.1080/0167482x.2019.1659775] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: Women with endometriosis represent a significant proportion of all outpatient gynecological consultations. Endometriosis is a benign chronic condition characterized by the spreading of endometrial-like tissue outside the uterus. A correlation between endometriosis and infertility has been strongly underlined in the literature about the topic: recent data suggest that up to 50% of women with infertility may suffer from this disease. The aim of this brief commentary is to focus the attention on the importance of a multidisciplinary approach for patients with endometriosis, including an accurate psychological and sexological counselling.Materials and Methods: We propose a brief point of view about a multidisciplinary approach in the treatment of endometriosis and associated infertility.Results and conclusions: Endometriosis is associated to a worse quality of life. Women with endometriosis also report higher levels of psychological conditions such as anxiety and depression. For this reason, an integrative approach is strongly advisable in order to improve social functions and mental health of these women and their partners. This may allow a more correct therapeutic management of these patients, reducing the potential negative impact of the disease on the mental wellbeing of the couple.
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Affiliation(s)
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Francesca Conway
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Di Angelo Antonio
- Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Leonardi M, Horne AW, Vincent K, Sinclair J, Sherman KA, Ciccia D, Condous G, Johnson NP, Armour M. Self-management strategies to consider to combat endometriosis symptoms during the COVID-19 pandemic. Hum Reprod Open 2020; 2020:hoaa028. [PMID: 32509977 PMCID: PMC7263080 DOI: 10.1093/hropen/hoaa028] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 04/30/2020] [Indexed: 12/19/2022] Open
Abstract
The care of patients with endometriosis has been complicated by the coronavirus disease 2019 (COVID-19) pandemic. Medical and allied healthcare appointments and surgeries are being temporarily postponed. Mandatory self-isolation has created new obstacles for individuals with endometriosis seeking pain relief and improvement in their quality of life. Anxieties may be heightened by concerns over whether endometriosis may be an underlying condition that could predispose to severe COVID-19 infection and what constitutes an appropriate indication for presentation for urgent treatment in the epidemic. Furthermore, the restrictions imposed due to COVID-19 can impose negative psychological effects, which patients with endometriosis may be more prone to already. In combination with medical therapies, or as an alternative, we encourage patients to consider self-management strategies to combat endometriosis symptoms during the COVID-19 pandemic. These self-management strategies are divided into problem-focused and emotion-focused strategies, with the former aiming to change the environment to alleviate pain, and the latter address the psychology of living with endometriosis. We put forward this guidance, which is based on evidence and expert opinion, for healthcare providers to utilize during their consultations with patients via telephone or video. Patients may also independently use this article as an educational resource. The strategies discussed are not exclusively restricted to consideration during the COVID-19 pandemic. Most have been researched before this period of time and all will continue to be a part of the biopsychological approach to endometriosis long after COVID-19 restrictions are lifted.
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Affiliation(s)
- Mathew Leonardi
- Acute Gynaecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - Andrew W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Katy Vincent
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Justin Sinclair
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Kerry A Sherman
- Department of Psychology, Centre for Emotional Health, Macquarie University, North Ryde, Australia
| | - Donna Ciccia
- Endometriosis Australia, Sydney South, Australia
| | - George Condous
- Acute Gynaecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, Australia
| | - Neil P Johnson
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Auckland Gynaecology Group and Repromed Auckland, Auckland, New Zealand
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
- Translational Health Research Institute (THRI); Western Sydney University, Penrith, Australia
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Vennberg Karlsson J, Patel H, Premberg A. Experiences of health after dietary changes in endometriosis: a qualitative interview study. BMJ Open 2020; 10:e032321. [PMID: 32102806 PMCID: PMC7044830 DOI: 10.1136/bmjopen-2019-032321] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Endometriosis is a chronic disease with no known cure. Persons affected by this disease often use complementary therapies such as dietary changes to reduce their symptoms, and so it is important to investigate whether and how these therapies affect endometriosis symptoms. The aim of this study was to explore how persons with endometriosis experienced their health after dietary changes. DESIGN Semi-structured qualitative interviews were conducted with 12 persons with endometriosis who had made individual dietary changes aimed at decreasing their endometriosis symptoms. The interviews were recorded and transcribed verbatim, and analysed using thematic analysis. SETTING Region Västra Götaland and the estern part of Central Sweden, Sweden. PARTICIPANTS Twelve persons with endometriosis aged 28 to 44 were recruited from two Swedish endometriosis support forums on the Internet. RESULTS Participants experienced an increase in well-being and a decrease in symptoms following their dietary and lifestyle changes. They also felt that the dietary changes led to increased energy levels and a deeper understanding of how they could affect their health by listening to their body's reactions. The participants understood that they could influence their symptoms through lifestyle changes. Support from family and friends was important in implementing and sustaining the dietary changes. However, the participants stressed the lack of support from healthcare professionals. CONCLUSIONS This study contributes to filling the knowledge gap about dietary strategies in endometriosis and lifestyle change as a method of alleviating suffering and increasing well-being. An important finding is that the participants experienced decreased symptoms and increased well-being after adopting an individually-adapted diet. Healthcare professionals should take their patients' knowledge and experience into consideration, and allow patients to participate in their own care. Further research is necessary to give evidenced-based dietary advices in endometriosis.
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Affiliation(s)
- Jenny Vennberg Karlsson
- Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Primary Health Care, Research and Development Unit, Närhälsan, Västra Götalandsregionen, Vänersborg, Sweden
| | - Harshida Patel
- Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Asa Premberg
- Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Primary Health Care, Research and Developement Unit, Västra Götalandsregionen, Gothenburg, Sweden
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Psychological and mind-body interventions for endometriosis: A systematic review. J Psychosom Res 2019; 124:109756. [PMID: 31443810 DOI: 10.1016/j.jpsychores.2019.109756] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/23/2022]
Abstract
Endometriosis is a common gynecological condition associated with debilitaing pain and poor mental health. This review examines the evidence for psychological and mind-body (PMB) interventions to improve endometriosis pain, psychological distress, sleep and fatigue. Electronic databases searched included PsychINFO, MEDLINE, CINAHL, EMBASE, Cochrane Library, Scopus, and PubMed. Inclusion criteria were women with endometriosis, and interventions that used psychological or mind-body interventions; there were no exclusion criteria regarding study design. Studies were identified and coded using standard criteria, and risk of bias was assessed with established tools relevant to the study design. A total of 12 publications relating to 9 separate studies were identified:- 3 randomized controlled trials, 1 controlled trial, 2 single-arm studies, 1 retrospective cohort study, and 2 case series. Interventions included yoga, mindfulness, relaxation training, cognitive behavioural therapy combined with physical therapy, Chinese medicine combined with psychotherapy, and biofeedback. Results indicate that no studies have yet used gold-standard methodology and, thus, definitive conclusions cannot be offered about PMB efficacy. However, the results of these pilot studies suggest that PMB interventions show promise in alleviating pain, anxiety, depression, stress and fatigue in women with endometriosis, and future well-designed RCTs including active control groups are warranted.
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O'Hara R, Rowe H, Fisher J. Self-management in condition-specific health: a systematic review of the evidence among women diagnosed with endometriosis. BMC WOMENS HEALTH 2019; 19:80. [PMID: 31216998 PMCID: PMC6585070 DOI: 10.1186/s12905-019-0774-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/30/2019] [Indexed: 12/21/2022]
Abstract
Background Endometriosis is a chronic condition, requiring long-term care as there is no cure. Self-management is the active participation of a person in managing their chronic condition and has been associated with improved knowledge, self-efficacy, performance of self-management tasks and some aspects of health status in interventions for other chronic diseases. The aim was to review the available evidence about the impact of self-management on condition-specific health among women with endometriosis. Methods The Medline, PsycINFO, CinahlPlus, Web of Science and Scopus databases were searched and PRISMA guidelines were followed. Search terms were entered both as keywords and mapped to individual database subject headings. Inclusion criteria were: papers that reported investigations of any approach to self-management; among women (at least 18 years) diagnosed with endometriosis and published in English in a peer-reviewed journal. All study designs using quantitative or qualitative methods were eligible for inclusion. Two reviewers independently examined the quality of studies using standard criteria. The systematic review was registered with Prospero (CRD42016042028). Results A total of 1164 records were identified (after duplicates were removed), and 27 papers, reporting 19 studies met inclusion criteria. Two papers reported findings from RCTs of complementary therapies, seven reported survey data and 18 qualitative studies. No study had investigated all elements of self-management. Women with endometriosis utilise a range of self-care activities and complementary therapies to assist them to manage their symptoms. Women reported both positive and negative experiences with health care providers. Conclusions There is some evidence that self-care activities, complementary therapies and positive patient–healthcare provider relationships are important components of self-management for endometriosis. Self-management among women with endometriosis is an emerging field of research and no investigations of all elements of self-management, informed by a comprehensive definition and theoretical framework are available. Health and wellbeing outcomes and barriers and facilitators to self-management for women with endometriosis require further investigation. Electronic supplementary material The online version of this article (10.1186/s12905-019-0774-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca O'Hara
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.
| | - Heather Rowe
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
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35
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Gao J, Liu HQ, Wang Y, Shang YL, Hu F. Effects of psychological care in patients with endometriosis: A systematic review protocol. Medicine (Baltimore) 2019; 98:e14772. [PMID: 30855483 PMCID: PMC6417512 DOI: 10.1097/md.0000000000014772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This systematic review will be proposed for investigating the effects of psychological care (PC) in patients with endometriosis. METHODS We will search the following 7 electronic databases from inception to the present: MEDLINE, EMBASE, SinoMed, Web of Science, Cochrane Library, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will include randomized controlled trials for evaluating the effects of PC in patients with endometriosis. Cochrane risk of bias tool will be used to evaluate the methodological quality for each included study. Two authors will independently carry out the study selection, data extraction, and methodological quality evaluation. Any disagreements will be solved by a third author through discussion. RESULTS This proposed systematic review will use high-quality evidence-based medicine to evaluate the efficacy and safety of PC for endometriosis. The primary outcomes include depression and anxiety. The secondary outcomes consist of pain intensity, health-related quality of life, and adverse events. CONCLUSION The findings of this study will provide convincing evidence to determine whether PC therapy is an effective and safe intervention for patients with endometriosis. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019123292.
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Affiliation(s)
- Juan Gao
- Gynecology Department, Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang
| | - Han-Qiao Liu
- Gynecology Department, College of Pharmacy, Hubei Medical College, Shiyan, China
| | - Yan Wang
- Gynecology Department, Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang
| | - Ya-Li Shang
- Gynecology Department, Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang
| | - Fang Hu
- Gynecology Department, Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang
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Buggio L, Facchin F, Chiappa L, Barbara G, Brambilla M, Vercellini P. Psychosexual Consequences of Female Genital Mutilation and the Impact of Reconstructive Surgery: A Narrative Review. Health Equity 2019; 3:36-46. [PMID: 30805570 PMCID: PMC6386073 DOI: 10.1089/heq.2018.0036] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: We aim to provide a comprehensive overview of the health consequences of female genital mutilation/cutting (FGM/C), with a particular focus on the psychosexual implications of this practice and the overall impact of reconstructive plastic surgery. Methods: A MEDLINE search through PubMed was performed to identify the best quality evidence published studies in English language on long-term health consequences of FGM/C. Results: Women with FGM/C are more likely to develop psychological disorders, such as post-traumatic stress disorder, anxiety, somatization, phobia, and low self-esteem, than those without FGM/C. Most studies showed impaired sexual function in women with FGM/C. In particular, women with FGM/C may be physiologically less capable of becoming sexually stimulated than uncut women. Reconstructive surgery could be beneficial, in terms of both enhanced sexual function and body image. However, prospective studies on the impact of reconstructive surgery are limited, and safety issues should be addressed. Conclusion: Although it is clear that FGM/C can cause devastating immediate and long-term health consequences for girls and women, high-quality data on these issues are limited. Psychosexual complications need to be further analyzed to provide evidence-based guidelines and to improve the health care of women and girls with FGM/C. The best treatment approach involves a multidisciplinary team to deal with the multifaceted FGM/C repercussions.
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Affiliation(s)
- Laura Buggio
- Gynaecology Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Facchin
- Faculty of Psychology, Catholic University of Milan, Milan, Italy
| | - Laura Chiappa
- Health Director, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giussy Barbara
- Department of Obstetrics and Gynecology and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Brambilla
- Plastic Surgery Unit, General Surgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi Milano, Italy
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Mazokopakis EE, Samonis G. Is Vaginal Sexual Intercourse Permitted during Menstruation? A Biblical (Christian) and Medical Approach. MÆDICA 2018; 13:183-188. [PMID: 30568737 DOI: 10.26574/maedica.2018.13.3.183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
According to the Old Testament (Provisions for clean and unclean of the Mosaic Law), a woman during menstruation or a man who has sexual relations with a menstruating woman are perceived as "unclean". When seven days pass after the first day of menstruation, the woman is regarded as "clean" and sexual contact is permitted. The character of these Provisions, according to the New Testament and Fathers of the Christian Church, was mainly pedagogical and aimed at helping the Israelites to transcend from physical purity to purification of the soul and from the worship of stereotypes to spiritual worship. Moreover, sexual contact that occurred during menstruation was considered as prostitution. From a modern medical point of view, sexual intercourse during menstruation is normal and not perversion, but is associated, although remote, with undesirable pregnancy, the development of sexually transmitted diseases (STDs) and possible endometriosis, which affects, inter alia, the health of the reproductive tract. These Provisions were essentially hygiene rules imposed by the social and cultural circumstances of that time and were invested with religious authority. The main aims of the Lawmaker were to promote the Israelites' health, prevent them from contracting STDs, and increase their fertility and birth of healthy offspring. The term "unclean" for each menstruating woman served this aim.
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Affiliation(s)
| | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
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Mira TA, Buen MM, Borges MG, Yela DA, Benetti-Pinto CL. Systematic review and meta-analysis of complementary treatments for women with symptomatic endometriosis. Int J Gynaecol Obstet 2018; 143:2-9. [DOI: 10.1002/ijgo.12576] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/05/2018] [Accepted: 06/25/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Ticiana A.A. Mira
- Department of Obstetrics and Gynecology; School of Medical Sciences; University of Campinas; Campinas Brazil
| | - Mariana M. Buen
- Department of Obstetrics and Gynecology; School of Medical Sciences; University of Campinas; Campinas Brazil
| | - Murilo G. Borges
- Department of Medical Genetics; School of Medical Sciences; University of Campinas; Campinas Brazil
| | - Daniela A. Yela
- Department of Obstetrics and Gynecology; School of Medical Sciences; University of Campinas; Campinas Brazil
| | - Cristina L. Benetti-Pinto
- Department of Obstetrics and Gynecology; School of Medical Sciences; University of Campinas; Campinas Brazil
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