Dyspareunia After Childbirth: Does Psychosocial Context Play a Role?

Introduction

Dyspareunia is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Dyspareunia after childbirth is quite common and have a range of repercussions to women's lives, including their sexual functioning. It could be affected by different risk factors. While role of obstetric factors including mode of delivery has been largely investigated, the influence of psychosocial factors remains unclear.

Aims

Our purpose was to determine frequency of postpartum dyspareunia and identify related psychosocial factors.

Methods

Thirty women between 2 and 6 months postpartum were recruited in consultation of maternity and neonatology center of Tunis. Data were taken from medical file and questionnaire designed to record psychosocial data and postpartum sexual function.

Results

The mean age of women was 28.74 ± 8.4 years. Dyspareunia was reported by 43.33% of women. Dyspareunia was not associated to professional status. On the other hand, dyspareunia was significantly associated to fatigue (P = 0.024), lack of familial support (P = 0.03), conjugal conflicts (P = 0.01).

Conclusion

We have found an association between dyspareunia after childbirth and several psychosocial factors, pointing out the influence of social and psychological aspects in the sexual function in women. Thus, management of sexual disorders should take in consideration psychological dimension and involve an appropriate psychological care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Surgical treatment of breast lesions: preliminary results of the screening program of the Ariana area]

OBJECTIVE

To report clinical, radiological and histological characteristics of the infraclinical breast lesions patients recruited via the large scale mammography breast cancer screening of l'Ariana state in Tunisia.

MATERIALS AND METHODS

Retrospective study over a period of 2 years. The recruitment of patients made on the occasion of the program of breast cancer screening.

RESULTS

During this period, 22 patients in our unity had had a surgical excision after wire localization. Ten patients were recruited by means of systematic breast cancer screening. In these cases, the mammographic findings were classified B.I.R.A.D.S 4 in 7 cases and BIRADS type 5 in 3 cases. Definitive histology concluded to benign disease in 4 cases and malignancy 6 cases. This collaboration enables the diagnosis an invasive ductal carcinoma in three cases.

CONCLUSION

The surgical excision after wire localization for non palpable breast lesions allows diagnosis of high-risk benign lesions and low-stage breast cancer. It is a reliable technique which indications have to be based on clinical and radiological strict criteria. This procedure is at present, and in developed countries, widely outstripped with the stereotactic core needle biopsy.

[Management of breast cancer detected by a mammography program in the Ariana area of Tunisia]

OBJECTIVE

To report the epidemiological and anatomoclinical features of breast cancers referred to a department of gynecology from the screening program of l'Ariana state in Tunisia.

MATERIAL AND METHODS

A longitudinal retrospective Study was done over a period of 4 years (2004-2006 ) at the unit "A" gynecology department of the maternity of Tunis. We collected all the cases with histologically confirmed breast cancer diagnosed within the mammography screening program of l'Ariana state, referred to our unit for treatment.

RESULTS

10 patients with histologically confirmed breast cancer were collected during the study period, treated at our unit. Mean age of patients was of 48.8 years. Clinical examination was initially negative in 50% of cases. Mean clinical tumor size was 18 mm, while invasive ductual carcinoma represents the most frequent histological type. One patient (10%) had histological axillary involvement. Conservative surgery was performed for 8 (80%) of the 10 patients.

CONCLUSION

This pilot study of mammography screening confined to a Tunisian state, precludes to the future profile of BC In Tunisia, showing that an early diagnosis can lead to a dramatic reduction of mean clinical tumor size, less histological poor prognostic features, more conservative surgery and a slight improvement of survival. A structured extended screening program must be installed to achieve these goals but requires an important financial and human investment.

[Evolution of maternal mortality in a level 3 Tunisian maternity from 1998 to 2007]

INTRODUCTION

The action plan for the maternal mortality is generally based on research studies' results carried out within hospital structure.

OBJECTIVES

Determination and follow-up of the evolution of maternal mortality from 1998 to 2007 in a level 3 Tunisian maternity and identification of its main causes.

PATIENTS AND METHODS

It is a retrospective study carried out between January 1998 and December 2007. In our service, since 1984, maternal deaths are systematically recorded. Information about deaths are collected from the following sources: childbirth folder, folder of hospitalization in reanimation, after the autopsy, through information collected beside the family, or by the National System of Maternal Death Surveillance, only since 1999.

RESULTS

Thirty-one mother deaths were colligated during the study. The average age of patients was around 33 years. The global maternal mortality rate during the study was about 56 deaths for 100,000 live births. The trend was characterized by a net decrease to this rate to 2003, and stagnation after that or even an increase in 2007. Deaths were due, in 81% of cases, to a direct obstetric reason. Hemorrhage was the principal etiology, which was implicated in 35.48% of the total cases. Complications of preeclampsia were incriminated in 19.35% of the total number of cases. In this set, transfer rate was about 48.38%.

CONCLUSION

The evolution over the years shows a net regression of maternal mortality. However, the trend was characterized by a recent stagnation. However most of cases were avoidable. Much progress has to be carried out in the cases of peripartum hemorrhages and preeclampsia, since they represent the main death causes.

[Imaging of gestational trophoblastic disease]

INTRODUCTION

Trophoblastic diseases correspond to a very heterogeneous group.

OBJECTIVE

To establish the importance of imaging in the management of trophoblastic diseases.

PATIENTS AND METHODS

Retrospective study from 1995 to 2008, including all patients with a gestational throphoblastic disease in our department.

RESULTS

Seventy-four cases were identified with 58 molar pregnancies, 14 trophoblastic tumors and two cases of hydatiform mole coexistent with a twin live fetus. Ultrasound's sensibility in case of hydatiform moles was 75.86%. It was sharply more important in case of a complete mole with a detection rate of 96.15% against 28% in case of partial mole. In trophoblastic tumors, ultrasound coupled with Doppler had shown signs of invasion in half of the cases. Four patients presented with lung metastases. Magnetic resonance imaging was performed in two cases.

DISCUSSION AND CONCLUSION

Ultrasound is of high-performance in the positive diagnosis of complete moles. Furthermore, it shows signs of invasion in case of trophoblastic tumors. In those cases, a radiological assessment guides the management even in the absence of histological proofs.

[Fertiloscopy: Tunisian experiment]

OBJECTIVE

The purpose of this study was to estimate the place and the results of fertiloscopy in the management of female infertility.

MATERIALS AND METHODS

Retrospective study over a period of eight years including the patients presenting infertility without pathology raising of an evident surgical indication. We analyzed the perioperative data, the results as well as the complications of this intervention.

RESULTS

One hundred and eighty-eight fertiloscopic procedures succeeded (84%). For 84 patients (37.6%) we realized a coelioscopy. In 44% for failure of the exam and in 66% for lesions found in the fertiloscopy and requiring surgery. Two complications without major consequence will be deplored: two rectal injuries.

CONCLUSION

Fertiloscopy is a safe and reliable procedure. It can be substituted to laparoscopy in the routine assessment of infertile women management in case of not obvious surgical indication.