Genital Chronic Graft-versus-Host Disease in Females: A Cross-Sectional Study

AbstractUsing the National Institutes of Health (NIH) consensus criteria for chronic graft-versus-host disease (cGVHD), we assessed the prevalence, symptoms, and clinical signs of female genital cGVHD in a cross-sectional population-based study. Forty-two women were evaluated at a median of 80 months (range, 13 to 148 months) after undergoing hematopoietic stem cell transplantation (HSCT). Medical history, ongoing medications, and genital signs and symptoms were recorded. Gynecologic examination for the diagnosis and clinical scoring of genital cGVHD was combined with clinical scoring of extragenital cGVHD for the estimation of each patient's global cGVHD score. Biopsy specimens from the genital mucosa were obtained from 38 patients. Genital cGVHD was diagnosed in 22 of 42 patients (52%). Its presence was associated with systemic corticoid steroid treatment of extragenital cGVHD (P = .001), older age (P = .07), and HSCT from a sibling donor (P = .002). Five patients had isolated genital cGVHD. Dryness, pain, smarting pain (P < .05 for all), and dyspareunia (P = .001) were observed more frequently in the women with genital cGVHD. Twelve patients had advanced genital cGVHD (clinical score 3), which was the main factor explaining the high rate (15 of 42) of severe global cGVHD. The rate of genital cGVHD was similar (P = .37) in patients with a follow-up of ≥80 months (10 of 22) and those with a follow-up of <80 months (12 of 20). We found no convincing relationship between clinical diagnosis and histopathological assessment of mucosal biopsy specimens. In our group of women with a long follow-up after HSCT, genital cGVHD was common and in many cases incorrectly diagnosed. Genital cGVHD causes genital symptoms and affects sexual life, and may present without any other cGVHD, warranting early and continuous gynecologic surveillance in all women after HSCT

The experience and responses of Swedish health professionals to patients requesting virginity restoration (hymen repair)

An important determinant of family honour in many cultures is the chastity of women, with much importance attributed to virginity until marriage. The traditional proof of virginity is bleeding from the ruptured hymen, which has led some women to request genital surgery to “restore” virginity, or hymen repair. The aim of this study was to investigate whether Swedish health care providers have had experience of patients requesting this surgery. Questionnaires were sent to 1,086 gynaecologists, midwives, youth welfare and social officers, and school nurses and doctors in four Swedish cities. Of the 507 who returned the questionnaire, 271 had seen patients seeking virginity-related care. Of these, 14 had turned the patients away; 221 had made 429 referrals, mostly to a welfare officer or a gynaecologist; and 26 had referred patients to a plastic surgeon. Nine gynaecologists had carried out such surgery themselves. Swedish authorities have to date focused on this issue primarily from a social and legal perspective. No guidelines exist on how health professionals should deal with requests for surgery to restore virginity. Further research is needed on how best to meet the needs of this group of patients in a multi-ethnic society and how to address requests for hymen repair. Without this, medical practitioners and counsellors will remain uncertain and ambivalent, and a variety of approaches will persist

Victim characteristics of PTSD versus Non-PTSD.

<p><i>Note.</i> Independent t-test for continuous variables presented in means and standard deviations (SD). Pearsons chi-test for categorical variables presented in percent. OR = odds ratio. CI = confidence interval. *p<.05. **p<.01. ***<.001.</p><p>Victim characteristics of PTSD versus Non-PTSD.</p

Psychometrics at baseline of PTSD versus Non-PTSD.

<p><i>Note.</i> Independent t-test for continuous variables presented in means (M) and standard deviations (SD). Pearsons chi-test for categorical variables presented in percent. OR = odds ratio. CI = confidence interval. BDI = Beck Depression Inventory. SASRQ = The Stanford Acute Stress Reaction Questionnaire. PDS = The Posttraumatic Stress Diagnostic Scale. *p<.05. **p<.01.***<.001.</p><p>Psychometrics at baseline of PTSD versus Non-PTSD.</p

Flow-chart of study population.

<p>Flow-chart of study population.</p

Assault characteristics of PTSD versus Non-PTSD group.

<p><i>Note.</i> Pearsons chi-test for categorical variables presented in percent. OR = odds ratio. CI = confidence interval. *p<.05. **p<.01.***<.001.</p><p>Assault characteristics of PTSD versus Non-PTSD group.</p

Neuroticism-related personality traits are associated with posttraumatic stress after abortion : findings from a Swedish multi-center cohort study

Background: Most women who choose to terminate a pregnancy cope well following an abortion, although some women experience severe psychological distress. The general interpretation in the field is that the most consistent predictor of mental disorders after induced abortion is the mental health issues that women present with prior to the abortion. We have previously demonstrated that few women develop posttraumatic stress disorder (PTSD) or posttraumatic stress symptoms (PTSS) after induced abortion. Neuroticism is one predictor of importance for PTSD, and may thus be relevant as a risk factor for the development of PTSD or PTSS after abortion. We therefore compared Neuroticism-related personality trait scores of women who developed PTSD or PTSS after abortion to those of women with no evidence of PTSD or PTSS before or after the abortion. Methods: A Swedish multi-center cohort study including six Obstetrics and Gynecology Departments, where 1294 abortion-seeking women were included. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used to evaluate PTSD and PTSS. Measurements were made at the first visit and at three and six month after the abortion. The Swedish universities Scales of Personality (SSP) was used for assessment of Neuroticism-related personality traits. Multiple logistic regression analyses were performed to investigate the risk factors for development of PTSD or PTSS post abortion. Results: Women who developed PTSD or PTSS after the abortion had higher scores than the comparison group on several of the personality traits associated with Neuroticism, specifically Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Embitterment. Women who reported high, or very high, scores on Neuroticism had adjusted odds ratios for PTSD/PTSS development of 2.6 (CI 95% 1.2-5.6) and 2.9 (CI 95% 1.3-6.6), respectively. Conclusion: High scores on Neuroticism-related personality traits influence the risk of PTSD or PTSS post abortion. This finding supports the argument that the most consistent predictor of mental disorders after abortion is pre-existing mental health status

Posttraumatic stress among women after induced abortion : a Swedish multi-centre cohort study

BACKGROUND: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion. METHODS: This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student's t-test were used to compare data between groups. RESULTS: The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion. CONCLUSION: Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support