Factors associated with gynaecological morbidities and treatment-seeking behaviour among adolescent girls residing in Bihar and Uttar Pradesh, India

BACKGROUND

Gynaecological morbidities are more common than reproductive and contraceptive morbidities and constitute a substantial proportion of disease burden in women. This study aimed to examine the prevalence and factors associated with gynaecological morbidities and the treatment-seeking behaviour among adolescent girls residing in Bihar and Uttar Pradesh, India.

METHODOLOGY

The study utilized data from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey with a sample size of 14,625 adolescents girls aged 10-19 years. We defined gynaecological morbidity in dichotomous form, created from five questions on different morbidities. Further, the treatment-seeking behaviour was assessed for reported gynaecological morbidities three months prior to the survey. Univariate and bivariate analysis was used to perform analysis to carve out the preliminary results. Additionally, the study employed the heckprobit selection model, a two-equation model, to identify the determinants of outcome variables.

RESULTS

Overall, about one-fourth (23.6%) of the adolescent girls reported suffering from gynaecological morbidities, and only one-third of them went for treatment. Non-Scheduled Caste/Scheduled Tribe (Non-SC/ST) adolescents were significantly less likely to have gynaecological morbidities (β: -0.12; CI: -0.18, -0.06) compared to SC/ST counterparts; however, they were more likely to go for the treatment (β: 0.09; CI: 0.00, 0.19). The adolescents who had 8-9 (β: 0.17; CI: 0.05, 0.29) or ten and above years of education (β: 0.21; CI: 0.09, 0.34) had a higher likelihood of going for the treatment than adolescents with no education. Moreover, adolescents who belonged to rural areas were less likely to go for the treatment of gynaecological morbidities (β: -0.09; CI: -0.17, -0.01) than urban counterparts.

CONCLUSION

Multi-pronged interventions are the need of the hour to raise awareness about the healthcare-seeking behaviour for gynaecological morbidities, especially in rural areas. Adolescent girls shall be prioritized as they may lack the knowledge for gynaecological morbidities, and such morbidities may go unnoticed for years. Mobile clinics may be used to disseminate appropriate knowledge among adolescents and screen asymptomatic adolescents for any possible gynaecological morbidity.

Genital Psoriasis and Associated Factors of Sexual Avoidance - A People-centered Cross-sectional Study in Germany

Patients with genital psoriasis show poorer outcomes regarding quality of life and sexual distress than those without. This study aimed to assess the occurrence of genital psoriasis and to determine factors associated with the avoidance of sexual activities due to psoriasis in a non-clinical setting. A cross-sectional, person-centered, and online-based nationwide survey was conducted in Germany between March and June 2019. A multiple logistic regression model was used to analyze the data. Furthermore, free-text answers were provided. Overall, 344 individuals with psoriasis participated. Of these, 198 (57.6%) reported having genital psoriasis and 261 (75.9%) currently received medical care. Duration of psoriasis, subjective overall severity, and pain during sex were associated with the avoidance of sexual activities. Most prevalent reasons to avoid sexual activities were ‘shame,’ ‘pain,’ and ‘fear of rejection.’ Sexual distress was high in this sample and a person-centered care approach needs to be further promoted.

Is healthcare-seeking with gynaecological alarm symptoms influenced by personal and professional relations? A Danish population-based, cross-sectional study

OBJECTIVES

To identify the personal and professional relations of women experiencing gynaecological alarm symptoms, to analyse if involving a personal relation is related to healthcare-seeking with gynaecological alarm symptoms, and to analyse if having an available social network is associated with involvement of this relation.

DESIGN

Web-based, population-based, cross-sectional questionnaire survey.

SETTING

The general population in Denmark.

PARTICIPANTS

The study invited 100 000 individuals randomly drawn from the Danish Civil Registration System. Pregnant women and women who did not answer relevant questions about social network were excluded. A total of 5053 women who experienced at least one gynaecological alarm symptom were included in the study. PRIMARY AND SECONDARY OUTCOMES: (1) Personal and professional relations that women experiencing gynaecological alarm symptoms involve; (2) the association between involving a personal relation and healthcare-seeking; and (3) the association between having an available social network and involvement of this relation.

RESULTS

The general practitioner (GP) was the most involved professional relation, while the spouse/partner was the most involved personal relation. When experiencing gynaecological alarm symptoms, more than 50% of women did not involve a professional relation and 20% did not involve a personal relation. For all four gynaecological alarm symptoms, the odds of involving the GP were higher in the oldest age group. Women were two to seven times more likely to involve their GP if they had personal relation involvement. No statistically significant association was found between having an available social network and involving the GP.

CONCLUSION

Involving a personal relation in healthcare-seeking was associated with increased involvement of the GP, who consequently was the most involved professional relation when experiencing gynaecological alarm symptoms. Spouse/partner was the most involved personal relation. The oldest age group had the highest odds of involving the GP. No association was found between having an available social network and involving the GP.

Genital Psoriasis: Impact on Quality of Life and Treatment Options

Psoriasis involving the genital skin occurs in up to two-thirds of psoriasis patients but is often overlooked by physicians. Furthermore, psoriasis objective and subjective severity indexes for common plaque psoriasis often neglect the impact this small area of psoriasis can have on a patient. It can have a significant impact on patients' psychosocial function due to intrusive physical symptoms such as genital itch and pain, and a detrimental impact on sexual health and impaired relationships. The mainstay of treatment is topical therapy. In patients with genital psoriasis refractory to traditional topical treatment, biologic treatments may greatly improve patient outcomes.

Genital psoriasis awareness program: physical and psychological care for patients with genital psoriasis

Genital psoriasis is a neglected manifestation of psoriasis, although it affects numerous patients and has major effects on sexual quality of life (SQoL). We aimed to assess the value of specialised care for patients with genital psoriasis. Patients were treated for at least one year at a specialised research outpatient clinic with extensive attention for genital lesions and SQoL. The genital lesions were treated according to a stepwise algorithm. First follow-up was planned after 6 weeks; subsequent follow-up visits were scheduled every 3 months. At every visit, psoriasis severity and SQoL were measured with validated tools. Differences in scores between visits were analysed by a mixed model for repeated measures. Forty-two patients were included (M:F = 25:17). All objective and subjective genital psoriasis severity and QoL parameters improved significantly within the first follow-up period of approximately 6 weeks. In female patients, SQoL also significantly improved. In conclusion, genital psoriasis can relatively easy be treated within limited time exposure, resulting in significant improvement of QoL. Prompt and simple adjustments in the provided care are enough to accomplish this.

[Social integration of women operated for obstetric urogenital fistula]

OBJECTIVE

To study the social integration of women supported in the urology department of the University Hospital of Point G for obstetric urogenital fistula.

PATIENTS AND METHOD

Prospective study conducted over a period of 13 months from June 2008 to June 2009 in the Department of Urology at the University Hospital of Point G. The study included all patients who have been operated on at least twice for obstetric fistula genitourinary. Records of surgical, medical records and tracking sheets for each patient were the media database.

RESULTS

Situation before treatment: before surgical treatment, 76.92% of patients were rejected by their spouses. The family attended the patient in 84.62% of cases. Situation after treatment: after treatment, 90.31% of women with fistula lived in the matrimonial home or family. The resumption of business activity was announced by 11.2% of patients. Among the women, 93.7% participated in housework. The number of patient intervention ranged from two to five. Healing (fistula closed and no sphincter dysfunction) was complete in 50% of cases. Among the women, 11.54% had sphincter dysfunction after closure of the fistula, which makes a total of fistula closed more than 61% after at least two attempts.

CONCLUSION

The urogenital fistulas are not a fatal disease but is a real handicap for women who suffer to conduct a socio-cultural and economic mainstream. Generally excluded from the ongoing operations of the company, these women are more integrated after successful surgical treatment of the fistula.

[Uterovaginal agenesis and polycystic ovary syndrome: psychological disturbance in adolescence]

Mayer-Rokitansky-Küster-Hauser Syndrome (MRKHS) is characterized by complete or partial absence of the vagina, uterus and proximal fallopian tubes and diagnosis is usually made in late adolescence, when primary amenorrhea appears as the major symptom. Polycystic Ovary Syndrome (PCOS), which is the most common endocrine disorder among women of reproductive age, includes a variety of clinical manifestations (menstrual irregularities, hirsuitism, acne, alopecia, obesity and infertility), due to androgen hypersecretion, insulin resistance and chronic anovulation. Both MRKHS and PCOS have been studied concerning the psychological aspects and have been associated with emotional distress as well as self-esteem, body image, identity and femininity impairment. The purpose of this study was to assess psychological functioning in adolescents with uterovaginal agenesis and primary amenorrhea due to MRKHS and those with hyperandrogenism and oligomenorrhea due to PCOS, compared with healthy adolescents. The participants were 70 adolescent girls, of whom 24 with MRKHS, 22 with PCOS and 24 healthy eumenorrheic adolescents (control group) matched by age and school grade. Psychological assessment included self report questionnaires, standardized in Greek population sample. Particularly, the "Beck Depression Inventory" (BDI), the "State-Trait Anxiety Inventory" (STAI-Gr) and the "Youth Self Report" (YSR) were used to measure depression, anxiety and psychopathology respectively, while the "Symptom Checklist-90-R" was used to measure psychopathology for the patients >18 years old. The results showed significantly higher scores on the state - anxiety scale for the MRKHS group compared with the control group. The MRKHS patients in late adolescence (18-20 years old) presented also significantly higher scores in depression and psychopathology scales (symptoms of anxiety, aggressive behavior and phobic disorder) than PCOS patients of the same age. On the contrary, regarding PCOS patients, age was negative correlated with attention problems and PCOS patients >18 reported significantly more somatic complaints compared with age-mate MRKHS patients and controls. PCO syndrome's clinical manifestations, including menstrual disorders, hirsuitism, acne, alopecia, obesity and infertility, may cause significant emotional distress. Nevertheless, they appear in great variety and our sample is characterized by mild features of hyperandrogenism and oligomenorrhea. This may explain findings of milder psychological disturbance associated with PCOS in this sample in comparison to other studies. As far as MRKHS is concerned, diagnosis and loss of reproductive ability, especially in late adolescence, obstruct emotional stability, physical maturity and sexual identity development ending that are expected in this period of life. Undoubtedly, the management of MRKHS in adolescence constitutes a complex multidisciplinary issue and psychological support of patients is needed in order to prevent possible psychological consequences and to achieve a normal transition to adulthood. Among the limitations of this study is the small sample size, which limits the generalisability of the reported results, especially in "Youth Self Report" and in "Symptom Checklist-90-R" questionnaires, where the sample was divided according to the age. Nevertheless, the very low incidence of MRKHS (1/5000) emphasize the value of the present results, which support the need for further investigation.

The effects of reduction operation with genital lymphedema on the frequency of erysipelas and the quality of life

Genital lymphedema represents a severe disability for patients particularly when complicated by erysipelas, the most frequent complication. The objectives of this study were: to investigate the frequency of erysipelas in patients with genital lymphedema and genital lymphatic cysts who underwent evaluation for surgical treatment, to observe the influence of resection operations on the frequency of erysipelas, and to measure changes in the quality of life due to the resection. A total of 93 patients with genital lymphedema were studied. All patients underwent integrated care treatment in the Földi Clinic, Hinterzarten and the Department of Plastic and Hand Surgery of the University Hospital Freiburg during the period between 1997 and 2007. 44 of these patients underwent surgical treatment of genital lymphedema. The results indicate that lymphatic cysts were the most important risk-aggravating factor for recurrent erysipelas with lymphorrhea in the genital region (p < 0.001). Following the resection operation, however, the number of erysipelas incidents significantly decreased (p < 0.001). In addition, the antibiotic dose could be reduced after surgery (p = 0.039) and an improved quality of life was achieved (p < 0.001).

The role of consulting psychiatrists for obstetric and gynecologic inpatients

BACKGROUND

The purpose of this study was to investigate the consultation psychiatry service to the Obstetrics and Gynecology Department in a general hospital, focusing on referral patterns and consultation recommendations.

METHOD

A retrospective review of the medical charts and consultation records of obstetric and gynecological patients referred for psychiatric consultation from Dec. 2003 to Nov. 2009 was performed.

RESULTS

One hundred and eleven patients were referred during the 6-year period, a psychiatric referral rate of 0.11% among 99,098 obstetric and gynecologic admissions. Obstetric and gynecologic consultations comprised 0.64% of all psychiatric consultations. The most common reasons for referral were depression (52.25%), past psychiatric history (31.53%), insomnia (29.73%) and confusion (24.32%). The most common DSM-IV psychiatric diagnoses were depressive disorder (37.84%), schizophrenia and other psychoses (20.72%), delirium (17.12%) and adjustment disorder (10.81%). The most frequent physical diagnoses of referred patients were neoplasms (72.97%), infectious diseases (42.34%) and complications of pregnancy and puerperium (17.12%). Recommendations included pharmacological intervention (89.19%) and psychological management (72.07%).

CONCLUSION

The psychiatric referral rate of obstetric and gynecological inpatients was relatively low compared with that of other departments. More collaboration and liaison between gynecologists and consultation psychiatrists may provide better care for obstetric and gynecological inpatients.

Pain and depression in gynecology patients

BACKGROUND

The prevalence and consequences of comorbid pain and depression in gynecology patients are understudied.

OBJECTIVE

The purpose of the study was to determine the prevalence of pain, depression, and their co-occurrence among gynecology patients, and to examine how pain and depression are associated with additional comorbid mental disorders.

METHOD

Self-reported pain, depressive symptoms, other mental-disorder symptoms, functional status, interpersonal distress, and abuse were assessed in 1,647 gynecology patients by use of the Patient Health Questionnaire and the Medical Outcomes Study (SF-20).

RESULTS

Moderate-to-severe pain was reported by 29% of patients; depression, by 21%; with both present in 10.3%. Comorbid pain and depression was associated with anxiety, suicidal or death ideation, functional impairment, interpersonal distress, and physical or sexual abuse.

DISCUSSION

Innovative approaches are needed to assess and treat gynecology patients with comorbid pain and depression, given the degree of overlap between them.

[Reproductive potential of women with epilepsy]

An aim of the article was to study reproductive health of 218 women with epilepsy who were long-term treated with antiepileptic drugs (AED). A comparison group included 47 patients with polycystic ovary syndrome (PCOS). Women with epilepsy were stratified into 2 groups: group 1 included 107 women of reproductive age and group 2 - 111 pregnant women with epilepsy. In group 1, 27,7% women had ovary dysfunction, 7,2% - hypoprogesteronemia and 27% - hyperprolactinemia. There was no signs characteristic of diagnosis of PCOS in women with epilepsy compared to the women with PCOS. Menstrual cycle disturbances were reversible. The pregnant women were stratified into 2 subgroups: subgroup A consisted of women who were prepared for pregnancy by the epileptologist, subgroup B included women with unplanned pregnancy. The comparative study of the pregnancy course in these subgroups revealed that in subgroup A the compliance to treatment was higher and pregnancy and delivery were more successful as compared to subgroup B. Preparing for pregnancy and its planning together with epileptologist allows to control for seizures using minimal doses of AED and decreases pregnancy and delivery complications.

Validation and clinical use of the CECA, a disease-specific quality of life questionnaire for patients with anogenital condylomata acuminata

The aim of this validation study was to assess the measurement properties of the CECA (Spanish acronym for the Specific Questionnaire for Condylomata Acuminata) in patients with anogenital condylomas. A total of 247 patients aged > 18 years completed the questionnaire on 2 occasions as well as the Dermatology Life Quality Index (DLQI). The CECA questionnaire showed good internal consistency (Cronbach's alpha values of 0.86 and 0.91 in the emotional and sexual activity dimensions) and good testretest reliability (intraclass correlation coefficient 0.76 emotional dimension, 0.82 sexual activity dimension). Patients with de novo lesions and those with more extensive lesions and larger number of warts showed poorer health-related quality of life. CECA and DLQI scores correlated moderately. Patients whose lesions cleared at follow-up or with a reduction of >or= 50% showed a better improvement of health-related quality of life. The CECA questionnaire is a valid, reliable and sensitive tool for the assessment of health-related quality of life in patients with anogenital warts.

[Brief version (15 items) of the General Health Questionnaire for opportune detection of psychological uneasiness in women]

OBJECTIVE

To propose a short version of the Goldberg's General Health Questionnaire that can be applied as a screening test in non-specialized in mental health public institutions.

PATIENTS AND METHODS

Women older than 18 years from Instituto Nacional de Perinatología consult. General Health Questionnaire application (30 items), during nine consecutive months. It was used the 7/8 cut-off point to differentiate between case and non-case patients. Descriptive, of factorial analysis, sensibility and specificity statistical process were used. An agreement analysis between versions was done, and the new version of 15 items was applied to an independent sample. With goodness-of-fit chi2 test, and to corroborate equality between both versions, proportions obtained were compared.

RESULTS

With 15 items it was generated an instrument that demonstrates its utility to screen psychological uneasiness cases, with a sensitivity of 0.988, specificity of 0.828 and a Cronbach's alpha of 0.910.

CONCLUSIONS

Short version of the General Health Questionnaire is a reliable instrument to timely identify psychological uneasiness in women, and to derive them to a mental health institution.

Gynaecological operation as an objective stressor in women

OBJECTIVES

The purpose of the study was to verify the usefulness of Number Scale of 0-10 points (used to assess pain) and the concentration of prolactin (PRL) in the blood serum for the evaluation of stress in patients undergoing surgical intervention on gynaecological wards.

MATERIAL AND METHODS

The study was carried out among 200 patients with different gynaecological illnesses operated in The Department of Reproduction and Andrology Skubiszewski Medical University of Lublin. The study used a questionnaire and Medical Documentation Analysis Sheet, especially constructed for the purpose of study, and Numerical Scale 0-10 to self-evaluate the stress level. Moreover, prolactin (PRL) concentration as a marker of stress reaction in the blood serum has been evaluated as well. The differences were determined by U Mann-Whitney and Kruskal-Wallis tests. Wilcoxon's test was used to compare the parameters examined on two levels in dependent groups. The calculations assumed 5% conclusion error and p<0.05 as statistically significant different.

RESULTS

The patients reported higher stress prior to the operation than after it (p<0.001). PRL concentrations were significantly higher in the patients after the operation (p<0.001). No correlation between subjective level of stress and PRL concentrations before operation (p=0.254) have been found. The patients who reported higher stress had higher PRL concentrations in the postoperative period. The highest PRL concentrations were observed in the patients who underwent laparoscopy and laparoscopy with hysteroscopy and the lowest values were noted among the patients after hysteroscopy.

CONCLUSIONS

Surgical intervention was perceived by women as stressful, disregarding the type and extent of an operation. Patients' subjective evaluation revealed higher stress level before the operation while they were waiting for the surgery. Contrary to that, prolactin concentration was higher in the first day after the surgery. Therefore, prolactin was not an objective marker of psychological stress in the examined group. Trauma caused by surgical intervention as a biological stressor induced an increased prolactin concentration in blood serum during the postoperative period.

[The medical social characteristics of gynecological morbidity]

The dynamics of the gynecological morbidity in the antenatal clinic was analyzed. To establish the fullness of the clinical social pattern of the consulting contingent 500 women's visits to the out-patient reception in the antenatal clinic were investigated. The gynecological pathology as reported by the women while taking their case history and the gynecological diseases registered during the out-patient reception at the time of research carrying out was analyzed. The study of the nature and the rate of gynecological pathology during the out-patient reception gives an insight of both the structure of gynecological pathology and the directions of the organization of the ambulatory care. In view of the aforesaid the major organizational issue is to actively reveal and to prevent the gynecological diseases in the antenatal clinic.

Patterns of maternal care seeking behaviours in rural Bangladesh

OBJECTIVE

Seeking care from a basic or comprehensive facility in response to obstetric complications is a key behaviour promoted in safe motherhood programmes. This study examined definitions of care seeking for maternal health complications used by families in rural Bangladesh, and the frequency and determinants of locally-defined care seeking practices.

METHODS

We conducted 24 semi-structured qualitative interviews with women who had recently given birth to characterize care seeking behaviours in response to perceived complications. Based on these findings, a quantitative household questionnaire was developed and administered to 1490 women, half of whom reported a 'serious or very serious' complication during their last pregnancy and/or delivery (n=769; 52%), and were included in the quantitative analysis.

RESULTS

Informants described three care seeking patterns in qualitative interviews: (i) sending a family member to purchase treatment to administer in the home; (ii) sending for a provider to treat the woman in the home and (iii) taking the woman outside the home to a facility or provider's office. The quantitative survey revealed that most women sought care for 'serious' complications (86%), with 42% seeking multiple sources of care. The majority of women purchased a treatment to administer at home (68%), while 20% brought a provider to the home. Thirty per cent of women were taken to a provider or facility.

CONCLUSIONS

Families generally seek care for complications, but care seeking does not correspond to definitions used by maternal health programmes. Local definitions of care seeking must be considered in intervention design so that promotion of care seeking increases for facility-based care for life-threatening emergencies rather than unintentionally increasing the use of home-based treatments of little medical value for prevention of mortality.

Psychosomatic obstetrics and gynecology--a neglected field?

PURPOSE OF REVIEW

The purpose of the review was to evaluate recent studies in the field of psychosomatic obstetrics and gynecology for new directions in research.

RECENT FINDINGS

Psychosomatic obstetrics and gynecology covers a wide canvas, and the present review shows extensive research in some areas and large gaps in others. There have been significant developments in the field of pregnancy-related psychiatric morbidity, particularly anxiety states and posttraumatic stress disorder; however, there is a need for better and more specific measurement and screening methods. Among gynecological conditions there have been advances in research on chronic pelvic pain and gynecological cancers, but most other gynecological conditions have been neglected. What is encouraging is the increasing amount of research from the developing world and the focus on common reproductive conditions based on community studies. In addition, in light of the recent findings and concerns related to hormone replacement therapy, research on mood disorders related to menopause is increasing, with refinement in measurements, definitions, and treatment methods.

SUMMARY

While studies on prevalence and risk factors abound, what is missing are well conducted intervention studies. The next phase of research should focus on preventive and intervention studies that are easily adaptable the world over.

Emotional state and coping style among gynecologic patients undergoing surgery

The aim of the present study was to investigate changes in emotional state and the relationship between emotional state and demographic/clinical factors and coping style among gynecologic patients undergoing surgery. Using the Japanese version of the Profile of Mood States (POMS), 90 patients (benign disease: 32, malignancy: 58) were examined on three occasions: before surgery, before discharge, and 3 months after discharge. They were also examined using the Coping Inventory for Stressful Situations (CISS) on one occasion before discharge. The scores for the subscales depression, anger, and confusion were the highest after discharge while those for anxiety were the highest before surgery. The average scores of the POMS subscales for all subjects were within the normal range. With regard to the relationship between these emotional states and other factors, multiple regressions showed that the principal determinants of anxiety before surgery were religious belief, psychological symptoms during hospitalization and emotion-oriented (E) coping style; further, it was found that depression after discharge could be explained by chemotherapy, duration of hospitalization, and E coping style. The principal determinants of anger after discharge and vigor before surgery were length of education and E coping style, and severity of disease, chemotherapy, E coping style and task-oriented coping style, respectively. Those of post-discharge fatigue and confusion were length of education, psychological symptoms, and E coping style. In summary it is suggested that the following should be taken into account in patients undergoing gynecologic surgery: anxiety before surgery, depression, anger, and confusion after surgery, including coping styles.

Resources and costs associated with incidental extracolonic findings from CT colonogaphy: a study in a symptomatic population

CT colonography (CTC) is increasingly used to detect colonic polyps and cancers, but its impact in practice is also influenced by frequent detection of extracolonic lesions. We have previously documented the frequency and nature of such lesions. The current study was performed to assess the clinical resources and costs associated with the investigation and treatment of extracolonic lesions. We reviewed the reports of 225 consecutive CTC examinations carried out on patients with symptoms of bowel cancer. 116 of the 225 were reported to have one or more extracolonic findings. All 116 patients with an abnormality were followed up for 12-24 months. 24 patients underwent further actions (outpatient attendance, investigations, or surgical procedures) as a result of previously undiagnosed lesions unrelated to bowel cancer. The costs of these further actions were derived from the NHS Reference Costs manual 2004. The total cost for further investigations and interventions was 34,329 pounds sterling and the mean cost over the sample of 225 patients was 153 pounds sterling--more than the cost of the CTC itself. The costs were mainly generated by surgical procedures. Resources consumed as a result of extracolonic findings approximately doubled the costs of diagnostic CTC. These costs, along with inconvenience, anxiety, morbidity and occasionally even mortality suffered by patients, must be offset by the good done to some of those with sub-clinical but potentially lethal diseases.

Psychological and physical factors influencing the health-related quality of life of patients of a department of gynecology in a university hospital

The aim of our study was to assess the physical and mental quality of life of in-patients of a Gynecological University Hospital and the factors influencing the quality of life. 715 women, who were treated in hospital with non-malignant or malignant gynecological or obstetrical diseases, took part in the study. Besides demographical data and relevant medical parameters the quality of life (SF-12), anxiety and depression (HADS) as well as physical discomforts (GBB) were assessed. The physical quality of life of the study population was significantly lower than that of the normal population (p < 0.001). Patients with obstetric diseases in comparison with patients with malignant gynecological and other gynecological diseases had the lowest physical quality of life. Regarding the mental factor, patients with malignant gynecological diseases feel most impaired, followed by those with other gynecological and obstetrical conditions. The multivariate analysis of the quality of life showed that up to 60% of the variance could be explained. The lowest variance elucidation was found in obstetrical patients in whom the physical complaints elucidated only a small part of the variance. Our results show on the one hand the high impairment of mental and especially of physical quality of life in women who are in hospital with gynecological or obstetrical diseases. On the other hand they show the great significance of the quality of life as an outcome parameter. These findings should be considered in gynecological in-patient treatments by using integrated psychosomatic care.

Psychological health in patients with genital and oral erosive lichen planus

BACKGROUND

Erosive lichen planus is a severe, recurrent and recalcitrant disease that affects several mucosal areas, mostly the genital area and the mouth, but also, for example, the oesophagus and perianal area. The disease causes serious symptoms, because of the raw, de-epithelialized mucosa and healing with scars/adhesions, which affect the patient's life in many ways. It causes, for example, difficulties in eating, drinking and going to the bathroom. Treatment is complicated and, so far, few therapeutic drugs other than steroids have been reported.

OBJECTIVES

As the disease has severe implications on the patient's life it is important to investigate the psychological health of the patients, as well as the influence of stress on their health and wellbeing, in order to improve treatment. STUDY DESIGN, SUBJECTS AND METHODS: Forty-nine consecutive patients with erosive lichen planus were included during a 1-year period. The study was carried out as 'state-of-the-last-month', and stress, state anxiety, depression and 'erosive lichen planus factors', i.e. symptoms affecting daily life, were assessed.

RESULTS

Eighty-seven per cent of the patients had symptoms, severely affecting daily life. Unexpectedly, oral symptoms seemed to be the most prominent. Our results showed that depression, anxiety and stress were more common in patients with erosive lichen planus than in a control group.

DISCUSSION AND CONCLUSIONS

Erosive lichen planus is a severe disease with symptoms and complications affecting the patient's life. Our results indicate that their psychological health is also affected and emphasize the need for close collaboration between physicians, dentists with special knowledge in oral medicine and counsellors/psychologists to optimize handling of these patients.

Effekte psychosomatischer Interventionen im Konsildienst einer Universitätsfrauenklinik

The influence of psychotherapeutic interventions on the long-term course of anxiety and depression of inpatients of a Gynaecological University Hospital was examined in a prospective naturalistic provision study. All patients admitted to hospital within a year were examined regarding anxiety and depression (HADS). The patients who had conspicuous values in their questionnaires were randomly assigned to an intervention or a control group. There was a follow-up examination for them one year after the first examination. In the first examination 715 participants took part, in the follow-up examination there were 429. Women with malignant gynaecological diseases suffer more severely from anxiety (t=7.02; p<0.001) and depression (t=3.87; p<0.001) in comparison with the normal population. Women suffering from general gynaecological (t=7.75; p<0.001) and obstetrical diseases (t=5.95; p<0.001) are significantly more anxious. Whereas the anxiety in patients with general gynaecological (F=3.02; p=0.031) as well as in patients with obstetrical diseases (F=3.52; p=0.017) can be reduced significantly in the long-term by psychotherapeutic interventions, depression cannot or only slightly be influenced. This shows that low-frequent psychotherapeutic interventions with psycho-educative, supportive approaches (e. g. in the framework of psychosomatic consultation and liaison service) have positive effects on anxiety in the long run, whereas depression is to be influenced rather by long-term interventions or classic depth-psychological or behaviour therapeutic interventions.

Psychological wellbeing after laparoscopic and abdominal hysterectomy-a randomised controlled multicentre study

OBJECTIVE

To compare laparoscopic hysterectomy and abdominal total hysterectomy regarding influence on postoperative psychological wellbeing and surgical measures.

DESIGN

A prospective, open, randomised multicentre trial.

SETTING

Five hospitals in the South East of Sweden.

POPULATION

Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study, and 119 women completed the study. Fifty-six women were randomised to abdominal hysterectomy and 63 to laparoscopic hysterectomy.

METHODS

Psychometric tests measuring general wellbeing, depression and anxiety preoperatively and 5 weeks and 6 months postoperatively.

MAIN OUTCOME MEASURES

Effects of operating method on the psychological wellbeing postoperatively. Analysis of data regarding operating time, peroperative and postoperative complications, blood loss, hospital stay and recovery time.

RESULTS

No significant differences in the scores were observed between the two groups in any of the four psychometric tests. Both the surgical methods were associated with a significantly higher degree of psychological wellbeing 5 weeks postoperatively compared with preoperatively. The operating time was significantly longer for the laparoscopic hysterectomy group, but the duration of the stay in hospital and sick-leave were significantly shorter for laparoscopic hysterectomy group compared with the abdominal hysterectomy group.

CONCLUSIONS

General psychological wellbeing is equal after laparoscopic and abdominal hysterectomy within 6 months after the operation. The advantages of the laparoscopic hysterectomy are the shorter stay in hospital and shorter sick-leave, but these issues must be balanced by a longer duration of the operation.

Women's preferences for information and complication seriousness ratings related to elective medical procedures

OBJECTIVE

To study the preferences of patients for information related to elective procedures.

METHODS

A survey was carried out using a sample of 187 women. The majority of whom were on a low-income, who obtained obstetric or gynaecological services at St Joseph Regional Medical Center in Milwaukee, Wisconsin, while they were in a waiting room.

RESULTS

Many of the complications, including those that are uncommon and less serious, were considered to be relevant to the medical decisions of most patients. Average seriousness ratings associated with complications of various elective procedures were in the range of moderate to high. A frequency of complications of 1:100 or higher would factor into most women's elective treatment decisions. Women indicated a preference for receiving as much or more information pertaining to complications associated with particular elective obstetric or gynaecological procedures as other elective procedures.

CONCLUSION

Most women wish to be informed of risks and treatment alternatives, rate many complications as serious, and are likely to use information provided to make elective treatment decisions.

Gender disadvantage and reproductive health risk factors for common mental disorders in women: a community survey in India

BACKGROUND

Gender disadvantage and reproductive health are major determinants of women's health in developing countries.

OBJECTIVE

To determine the association of factors indicative of gender disadvantage and reproductive health with the risk of common mental disorders (CMDs) in women.

DESIGN

Cross-sectional survey from November 1, 2001, to June 15, 2003.

PARTICIPANTS

A total of 3000 women randomly selected from a sampling frame of women aged 18 to 45 years in Goa; 2494 women participated.

MAIN OUTCOME MEASURES

The primary outcome was the presence of a CMD, as defined by the Revised Clinical Interview Schedule. An interview and blood and vaginal/urine specimens were collected to ascertain risk factors.

RESULTS

The prevalence of CMD was 6.6% (95% confidence interval [CI], 5.7%-7.6%). Mixed anxiety-depressive disorder was the most common diagnosis (64.8%). Factors independently associated with the risk for CMD were factors indicative of gender disadvantage, particularly sexual violence by the husband (odds ratio [OR], 2.3; 95% CI, 1.1-4.6), being widowed or separated (OR, 5.4; 95% CI, 1.0-30.0), having low autonomy in decision making (OR, 1.98; 95% CI, 1.2-3.2), and having low levels of support from one's family (OR, 2.2; 95% CI, 1.4-3.3); reproductive health factors, particularly gynecological complaints such as vaginal discharge (OR, 3.2; 95% CI, 2.2-4.8) and dyspareunia (OR, 2.5; 95% CI, 1.4-4.6); and factors indicative of severe economic difficulties, such as hunger (OR, 2.7; 95% CI, 1.6-4.6). There was no association between biological indicators (anemia and reproductive tract infections) and CMD.

CONCLUSIONS

The clinical assessment of CMD in women must include exploration of violence and gender disadvantage. Gynecological symptoms may be somatic equivalents of CMD in women in Asian cultures.

Relationship of reproductive cycle-associated and non-reproductive cycle-associated psychological problems in women

OBJECTIVE

To determine the frequency of past psychological problems associated with the reproductive cycle in women seeking routine gynecological care.

METHODS

Three hundred and sixty-eight women of menopausal age seen at a university medical center gynecology clinic were mailed a questionnaire requesting information about past mood or anxiety problems associated with specific reproductive cycle or hormone use times, such as the premenstruum, pregnancy, postpartum, perimenopause, following total hysterectomy with bilateral salpingo-oophorectomy, and during oral contraceptive or hormone replacement treatment. Chi-square analysis was done between groups categorized as with and without reproductively associated psychological problems (RAPP) and with or without non-reproductively related psychological problems (non-RAPP). Relative risk of women with RAPP having non-RAPP also was calculated. Results-One hundred thirteen women returned the questionnaire. Fifty percent of these women reported a past history of reproductive cycle-associated psychological problems (RAPP). Of these, 37% also reported psychological problems at times in their lives not associated with particular reproductive cycle (non-RAPP) times. However, of the 50% of women who reported no history of RAPP, only 14% reported non-RAPP. This was a significant difference between the groups (p = .0064). There was also a 2.7 times greater risk of women with RAPP also having non-RAPP (RR 2.7).

CONCLUSIONS

Women with reproductively associated psychological problems have a greater risk of also having psychological problems at non-reproductively associated times.

Are women with chlamydia infection who self-refer to genitourinary medicine clinics different?

The objective of this study was to explore whether patients with Chlamydia trachomatis infection who self-refer to genitourinary medicine clinics have different demographic characteristics to those who initially attend other agencies. This study took place in three genitourinary medicine clinics from Birmingham, Nottingham and Sheffield. Demographic and post-code data were collected from female patients diagnosed with genital chlamydia infection in 2000. Townsend scores, as an index of socioeconomic status, were derived from post-codes from a subset of the cohort (from Birmingham). Comparison was made between those who were diagnosed by genitourinary medicine clinics and those diagnosed in the community and referred to genitourinary medicine clinics for further management. Data were collected from 1047 genitourinary medicine and 816 non-genitourinary medicine women, of whom 686 (84.1%) attended genitourinary medicine clinics following referral. After excluding those with incomplete data, 1614 (987 genitourinary medicine and 627 non-genitourinary medicine) patients were included in the study. Using logistic regression analysis, we were unable to demonstrate any significant differences in age or Townsend scores between genitourinary medicine and non-genitourinary medicine patients. However, significantly more Black Caribbean (odds ratio [OR] = 2.72, 95% confidence interval [CI]: 2.22, 3.20) and single women (OR = 1.97, 95% CI: 1.64, 2.29) self-referred to genitourinary medicine clinics compared with other health-care settings. This trend was consistent between Birmingham and Nottingham. In Sheffield, there was no difference in marital status. Ethnicity was not a factor as there were no Black Caribbean patients in the Sheffield cohort. Women who were diagnosed with genital chlamydia infection in genitourinary medicine clinics have some different demographic characteristics to those who were diagnosed in the community.

Mental health screening in women with genital tract fistulae

There is little information regarding the mental health status of women with genital tract fistulae in developing countries. The aim of this prospective observational study was to screen women at Dhaka Medical College Hospital, Bangladesh (December 2003 to June 2004), and Addis Ababa Fistula Hospital, Ethiopia (June to July 2004), with genital tract fistula for mental health dysfunction. Women presenting to the above institutions were screened using the General Health Questionnaire (GHQ-28) prior to fistula surgery. As the women were illiterate, the questionnaire was completed with the assistance of a medical officer, nurse or interpreter. The female staff members acted as controls. Sixty-eight women with fistulae and 28 controls completed the GHQ-28. Sixty-six of the 68 women with fistulae screened positive to probable mental health dysfunction compared with 9 of the 28 controls. We conclude that women with genital tract fistula are at high risk of mental health dysfunction. If the high rates of positive screening are confirmed on psychiatric evaluation, then the management of women with genital tract fistulas must include routine psychological/psychiatric assessment and treatment.

Informational needs, health locus of control and uncertainty among women hospitalized with gynecological diseases

BACKGROUND

Only a few studies on perceptions of uncertainty in illness have provided empirical evidence for the relationships of informational needs and the health locus of control with uncertainty among hospitalized women with gynecological diseases. The purpose of this study was to test Mishel's Theory of Uncertainty in Illness (1990) among women hospitalized with gynecological diseases.

METHODS

Taiwan. The convenience sample consisted of 81 hospitalized women with gynecological diseases, who were invited to complete a set of self-administered questionnaires prior to receiving any treatment. Path analysis was used to determine the relationships of informational needs and the health locus of control with uncertainty.

RESULTS

The study findings suggested that hospitalized women's information needs are substantial, and they reported lower levels of uncertainty during hospitalization. Women's experience of uncertainty may be elevated by decreasing the informational needs as moderated by the beliefs that their health outcomes are under the control of chance. Three predictors in this model, i.e., informational needs moderated by the interaction of chance control, years of education, and number of treatments explained 30% of the variance of uncertainty of hospitalized women with gynecological diseases.

CONCLUSIONS

The study findings suggest that healthcare professionals should carefully assess uncertainty levels among female patients with lower education and who believed that their health status depends upon external forces such as fate, luck, or chance.

Psychische Befindlichkeit und gesundheitsbezogene Lebensqualität bei stationären Patientinnen einer Universitätsfrauenklinik

The desire and necessity for psychosomatic support were investigated in a gynecological ward of the University of Dresden clinic. Data on anxiety, depression, physical complaints, physical as well as psychological quality of life were collected. The 392 examined women were admitted to the hospital because of gynecological, obstetric or oncological diseases. 39.5 % of the examined patients expressed a desire for psychosomatic support during their stay. Anxiety and depression levels of these patients were higher and the psychological quality of life level lower than for those without the desire for psychosomatic support. Comparing gynecological, obstetric with oncological patients the latter show higher levels of depression and lower psychological quality of life. In contrast the physical quality of life is the lowest for obstetric patients. Our results show that inpatients of a gynecological clinic are physically and psychologically impaired and have a high desire for psychosomatic support.

"It's about time": College women's perceptions of gynecologic health

PURPOSE

To examine college women's perceptions of gynecologic health, with a particular emphasis on healthcare decision making. Women's perceptions of health promotion efforts that would influence gynecologic health were also examined.

DATA SOURCES

Verbatim transcripts of individual and focus group interviews from 34 college women, 18-25 years of age, were thematically analyzed. Questions related to women's decisions to seek gynecologic health care and their healthcare experiences with providers.

CONCLUSIONS

Three themes were identified: (dis)connecting with their changing bodies, experiencing the healthcare encounter, and making healthcare decisions. Results suggest that college can be "the time" when college women begin to think about and act on decisions about gynecologic health. Implications for practice By acknowledging college women's multidimensional definitions of health and knowledge of healthy behaviors, advanced practice nurses can assist women in developing strategies for enacting these definitions and integrating desired healthy behaviors into their busy college lives.

Combination of qualitative and quantitative methods for developing a new Health Related Quality of Life measure for patients with anogenital warts

Background

Anogenital warts are the most easily recognized sign of genital Human Papilloma Virus infection. The objective was to develop a short, valid and reliable questionnaire to measure Health Related Quality of Life (HRQL) in patients with anogenital warts.

Methods

First a literature review was performed to identify relevant papers describing the impact of anogenital warts in HRQL; second the main domains were identified by some experts in a focus group, and third in-depth-semi-structured interviews were conducted in patients with anogenital warts to identify the initial set of items. A qualitative reduction of the initial set of items was performed based on the mean scoring of the experts for the three scales: clarity, frequency and importance. The initial questionnaire was pilot tested in 135 patients. Rasch analysis was performed with the results of the questionnaire in order to refine the instrument. Spearman's correlation was calculated between the initial questionnaire and the reduced version. Additionally the measurement properties (validity and reliability) of the resulting final questionnaire were tested and compared using standard procedures (Cronbach's Alpha and item-total correlation).

Results

the main domains identified as affected in patient's life were: sexual, colleagues and partner relationships. After a proper qualitative reduction the initial set of 134 items was reduced to 22. The questionnaire was pilot tested in 135 patients and two dimensions were identified after the multifactorial analysis: emotional dimension and sexual activity dimension. As a result of the Rasch analysis the questionnaire was reduced to 10 items. High correlation was found between the initial and the reduced version for the two dimensions. Cronbach's alpha values were acceptable (0.86).

Conclusion

The initial 22 items questionnaire was reduced by Rasch analysis to a version of 10 items, with two dimensions: emotional and sexual. The results suggest the adequacy of the 10 items to evaluate HRQL of patients with anogenital warts in a valid and reliable way.

Coping Style and Women's Participation in Breast and Gynecological Screening

The purpose of this project was to determine the role of coping style in women's practice of breast and gynecological screening behaviors. Women were classified into one of four coping groups based on measures of vigilance and screening distress. Data were analyzed from a subset of 85 U.S. women who participated in a larger longitudinal study designed to examine self-reported screening participation. Results indicate frequency of screening participation and importance of obtaining immediate mammography feedback differed across coping style groups. Women characterized as high in vigilance and screening distress were most at risk for nonparticipation in screening.

[Psychosomatic aspects of urogynaecology: model considerations on the pathogenesis, diagnosis and therapy]

Disorders of micturition and other symptoms in the area of the lower urinary tract are frequent in gynaecological consultation. The uro-gynaecological clinical symptoms and diseases refer to the following syndromes: irritable bladder, recurrent cystitis, interstitial cystitis, urinary retention and forms of incontinence. In view of the great aetiological importance of depression and its psycho-neuroendocrine associations with urge symptoms correlating with oestrogen deficiency, the option of employing newer approaches, and also psychopharmacological approaches, must be considered. In the pathogenesis, the stress and conflict model offers approaches to explanation and treatment. The psychosomatically oriented diagnosis and treatment of symptoms and disorders of the lower urinary tract in women is primarily the task of the gynaecologist, who has to go beyond investigations for organic diseases and must also clarify and treat the psychological dimensions. If there is major psychiatric comorbidity, referral to a doctor specialising in psychotherapeutic medicine and psychotherapy is required, or to a specialist in psychiatry and psychotherapy in the case of clinical and neurophysiological implications and symptoms from the depressive spectrum.

The impact of matching the patient's vocabulary: a randomized control trial

BACKGROUND

Research in general practice emphasizes the importance of matched models, beliefs and vocabulary in the consultation.

OBJECTIVE

The present study aimed to explore the impact of matched and unmatched vocabulary on patient satisfaction with consultations.

METHODS

The study took place in one inner city general practice. Patients (n=62) were randomized to either matched or unmatched vocabulary consultations when consulting for problems relating to sexual or bodily function or anatomy. Matched consultations required the doctor to use the same vocabulary as the patient. Unmatched consultations required the doctor to use medical vocabulary. Completed questionnaires were received from 60 patients. The main outcome measure was patient satisfaction (using the Medical Interview Satisfaction Scale). This assesses total satisfaction and has four subscales: distress relief; communication comfort; rapport; and compliance intent. Doctor satisfaction with the consultation was also assessed.

RESULTS

The results showed that the two groups were comparable for demographic variables and doctor satisfaction. However, patients in the matched consultation group had significantly higher total satisfaction scores and higher ratings of rapport, communication comfort, distress relief and compliance intent than those in the unmatched group.

CONCLUSION

The results indicate that a doctor's choice of vocabulary affects patient satisfaction immediately after a general practice consultation and that using the same vocabulary as the patient can improve patient outcomes.

Domestic violence: prevalence and association with gynaecological symptoms

OBJECTIVE

To determine the prevalence of domestic violence in a population of women attending a gynaecology outpatient clinic in the United Kingdom and also to investigate whether women who reported domestic violence were more likely to complain of certain gynaecological symptoms.

DESIGN

Questionnaire survey.

SETTING

A gynaecology outpatient clinic in a North of England Hospital.

SAMPLE

Nine hundred and twenty consecutive clinic attenders.

METHODS

Anonymous confidential questionnaire given to women.

MAIN OUTCOME MEASURES

Disclosure of a past history of domestic violence and gynaecological complaints.

RESULTS

Nine hundred and twenty consecutive women were included and 825 questionnaires were returned (90% response rate). The prevalence of physical abuse was 21% (171/825). Thirty-four (4%) had experienced violence in the past year. Domestic violence is three times less common in women over 50 years old. Ex-husbands (32%) and ex-boyfriends (29%) were the main perpetrators. Forty-eight percent women who had experienced physical violence also had forced sexual activity. Of the 15 presenting symptoms reported by the women, lower abdominal pain, dysmenorrhoea, dyspareunia, smear abnormalities, cancer worries and bowel symptoms were significantly more common complaints in the group who reported domestic violence. The women with domestic violence also had significantly more consultations; however, the duration of their symptoms was not significantly different.

CONCLUSION

The prevalence of domestic violence in a cohort of women who attended the gynaecology outpatient clinic in a North of England Hospital was 21%. Women who are subjected to domestic violence tend to have more consultations and are more likely to complain of certain symptoms.

Psychometric properties of the Body Image Scale in women with benign gynaecological conditions

OBJECTIVES

To evaluate the psychometric properties of the Body Image Scale (originally designed for use in cancer) in women with benign gynaecological conditions.

STUDY DESIGN

Prospective completion of the Body Image Scale by women participating in the EVALUATE Hysterectomy Trial. The scale was completed pre-operatively, then 6 weeks, 4 and 12 months post-operatively. The psychometric properties were evaluated by assessing the reliability, response prevalence, discriminant validity and sensitivity to change. Factor analysis was also conducted to determine the scale structure.

RESULTS

The Body Image Scale showed good reliability and clinical validity. Differences between sub-groups of women were detected, demonstrating good discriminant validity. The Body Image Scale was shown to be responsive to changes in body image.

CONCLUSIONS

The Body Image Scale was shown to be a reliable and valid tool for assessing body image in women with benign gynaecological conditions and for use in clinical trials involving such women.

Psychological factors in pelvic/urogenital pain: the influence of site of pain versus sex

Chronic pelvic pain (CPP), a fairly common gynecological complaint in women, has been associated with multiple psychological sequelae, including depression and somatization. Previous work has compared these patients to gynecological controls and women with headache, but has failed to include male comparison groups with a comparable site of chronic pain. In order to test possible sex and pain site differences, the present study compared 22 women with CPP, 22 men with either penile or testicular pain, 22 women with low back pain and 28 men with low back pain referred for a psychological evaluation as part of multidisciplinary pain treatment. Depression, coping, pain intensity and interference were assessed. Two-way analyses of variance (sex by pain site) were conducted to determine if there were group differences on demographic variables and medical history. Pain duration, age, and pain severity differed among the groups and were entered as covariates in hierarchical regression analyses designed to identify predictors of adjustment and pain coping. Sex and pain site did not contribute independently to the prediction of depressive symptoms. Pain site predicted physical functioning with low back pain patients reporting greater pain-related interference. Similar findings were demonstrated for coping. A variety of pain-coping strategies, including catastrophizing, were more frequently utilized by low back pain patients, regardless of sex. In the present study, pain severity and pain site explained more variance in depressive symptoms, physical functioning, and pain-coping than sex.

[Model of short-term psychological intervention in psychosomatic gynaecology]

This article proposes a rapid psychological intervention model in psychosomatic gynaecology. The work draws from the method developed by Dr H. Davanloo (Intensive Short Term Dynamic Psychotherapy). First it consists in identifying and clarifying the defence mechanisms, second in exercising pressure on them. This pressure causes an increase in anxiety, an intensification of the defence mechanisms and the development of an intrapsychic crisis that induces emotions and painful feelings linked to past traumata. This activation of the unconscious can activate somatic symptoms (pain, unconscious movements, tics, muscular tensions) that highlight the link between the physical and psychic aspects. This work allows a rapid access to the painful emotions that turn to symptom. It indicates the therapeutic intervention zones and levels. It allows translating psychic reality in a simple, fast and efficient way. It brings heightened consciousness and comprehension for the therapist and the patient.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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