Women in pain : the course and diagnostics of chronic pelvic pain

The main subject of this thesis is pelvic pain in women in secondary and/or tertiary medical care. Studies aim to examine: 1. The clinical course of acute abdominal pain and risks of pain persistence. 2. The clinical course of chronic pelvic pain (CPP) and predictors of recovery. 3. The moderating and /or mediating factors of sexual functioning. 4. The reliability of videotaped compared to real-time laparoscopic findings. Results show that pain persisted in 30% of women after an acute episode of abdominal pain. A low education level and an abuse history at a younger age were risks for chronicity. Recovery from pain was observed in 20% to 25% of women with CPP. Only a decrease in catastrophizing pain was associated with an improvement in pain and adjustment. Women with CPP reported more sexual problems than pain free controls. Anxiety and depression moderated sexual problems, while sexual abuse was a non-specific predictor. Finally, the evaluations of videotaped laparoscopies to score endometriosis were reliable, apart from ovarian lesions. In case of adhesions such evaluations were inconsistent. Main conclusion: CPP in women has to be considered as a chronic pain condition in general. A model to assess women with CPP and facilitate pain management is suggested.LUMC / Geneeskund

A retrospective study on persistent pain after childbirth in the Netherlands

Research into fetal development and medicin

Sexual Functioning in Women with Chronic Pelvic Pain: The Role of Anxiety and Depression

Introduction. Chronic pelvic pain (CPP) in women is a long lasting and often disabling condition. It seems reasonable to expect that as a result of the pain, extreme fatigue and/or emotional problems, women with CPP may report a variety of sexual problems. Aim. The present study investigated differences in the report of sexual problems in women with CPP compared with healthy controls, and whether the association of CPP with sexual problems was moderated or mediated by somatic and psychological factors as manifested in women suffering from CPP. Method. One hundred fifty-four women with CPP and 58 age-matched controls completed self-report measures for sexual functioning, pain, physical impairment, anxiety, depression, and sexual and physical abuse. Main Outcome Measure. Golombok Rust Inventory of Sexual Satisfaction. Results. Women with CPP reported higher levels of vaginistic complaints, sexual avoidance, nonsensuality and sexual dissatisfaction than healthy controls. Sexual problems were associated with anxiety, depression, and sexual abuse history but not with somatic factors as pain and physical impairment. Anxiety as well as depression, irrespective of the report of sexual abuse experiences, mediated the effect of CPP on sexual problems. Sexual abuse was a general predictor of sexual problems in both women with CPP and controls. Conclusions. Anxiety and depression constitute important factors in the evaluation of sexual problems in women with CPP. ter Kuile MM, Weijenborg PTM, and Spinhoven P. Sexual functioning in women with chronic pelvic pain: The role of anxiety and depression. J Sex Med 2010;7:1901-1910.Stress-related psychiatric disorders across the life spa

A randomized, placebo-controlled laboratory study of the effects of D-cycloserine on sexual memory consolidation in women

Rationale and objective The aim of this study was to investigate the possible facilitating effect of the partial NMDA receptor agonist D-cycloserine (DCS) on memory consolidation of conditioned sexual responses and to examine the capability of DCS to reduce context-specificity of learning. Methods In a randomized placebo-controlled double-blind trial, 50 healthy females were exposed to a differential conditioning procedure. Two pictures of a male abdomen were used as conditional stimuli (CSs), of which one (the CS+) was followed by the unconditional stimulus (US), a genital vibrotactile stimulus. After the conditioning session on day 1, participants received either 125 mg of DCS or a placebo. The effects of DCS on affect, sexual arousal and US expectancy in response to the CS+ and CS- were examined 24 h after the conditioning procedure. Results A main effect of DCS was found on affect at the first test trials (p = 0.04, eta(2)(p) = 0.09), and a similar non-significant but trend level effect was found for sexual arousal (p = 0.06, eta(2)(p) = 0.07), which appeared to persist over a longer time (p = 0.07, eta(2)(p) = 0.08). Unexpectedly, ratings of positive affect and sexual arousal in response to both the CS+ and the CS- were higher in the DCS condition compared to the control condition, possibly indicating that DCS administration reduced stimulus specificity. Since the results did not show clear evidence for context learning, we were not able to test effects on context-specificity of learning. Conclusion Although largely inconclusive, the results provide tentative support for a facilitating effect of DCS on affect and sexual arousal in response to stimuli that were presented in a sexual conditioning procedure, however, no conclusions can be drawn about effects of DCS on sexual reward learning, since the design and results do not lend themselves to unambiguous interpretation.GynecologyCervix cance

Predictors of outcome in a cohort of women with chronic pelvic pain - a follow up study

Gynecolog

Acute abdominal pain in women at an emergency department: predictors of chronicity

BACKGROUND: Persistence of pain after acute abdominal pain has been encountered but predictors of chronicity are insufficiently known. AIMS: To assess the course of acute abdominal pain and to explore whether chronicity is predicted by baseline demographic and clinical variables. METHODS: A follow-up study was conducted on all consecutive women who had visited an emergency department of a secondary care teaching hospital for acute abdominal pain. After a mean of 2.3years 115 women (58%) completed questionnaires. RESULTS: At follow-up 34 women (30%) still suffered from abdominal pain complaints for more than 3months the past year. Low education level (Exp(B)=4.21, p=0.017) and having experienced abuse before the age of 16 (Exp(B)=3.14, p=0.016) were significantly and independently associated with chronicity. No other socio-demographic or clinical factors predicted the outcome. CONCLUSION: At a 2.3year follow-up period nearly one third of all women with acute abdominal pain still suffered from pain. Low education level and abuse at younger age showed to be risk factors for pain persistence.Gynecolog

Sexual functioning, sexual esteem, genital self-image and psychological and relational functioning in women with Mayer-Rokitansky-Kuster-Hauser syndrome: a case-control study

Item does not contain fulltextSTUDY QUESTION: Do sexual functioning, sexual esteem, genital self-image and psychological and relational functioning in women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome differ from a comparison group of women without the condition? SUMMARY ANSWER: In comparison to controls, women with MRKH with a non-surgically or surgically created neovagina did not differ in psychological and relational functioning but reported lower sexual esteem and more negative genital self-image, intercourse-related pain, clinically relevant sexual distress and sexual dysfunction, with sexual esteem levels strongly associated with sexual distress and sexual dysfunction. WHAT IS KNOWN ALREADY: Studies on sexual functioning measured with standardized questionnaires in women with MRKH syndrome compared with women without the condition have yielded contradictory results. Factors associated with sexual functioning in this patient population have rarely been investigated. STUDY DESIGN, SIZE, DURATION: Between November 2015 and May 2017, 54 women with MRKH syndrome with a neovagina and 79 age-matched healthy women without the condition were enrolled in this case-control study. PARTICIPANTS/MATERIALS, SETTING, METHODS: All participants had to be at least 18-years old and had to live in a steady heterosexual relationship. Women with MRKH syndrome were asked to participate by their (former) gynecologists at three university hospitals and by MRKH peer support group. Controls were recruited via advertisement in local newspapers and social media. Standardized questionnaires were administered to assess sexual functioning, sexual esteem, genital self-image and psychological and relational functioning. MAIN RESULTS AND THE ROLE OF CHANCE: Women with MRKH syndrome with a surgically or non-surgically created neovagina reported significantly more pain during intercourse (P < 0.05, d = 0.5), but did not differ in overall sexual functioning from control women. More women with MRKH syndrome reported clinically relevant sexuality-related distress (P < 0.05, odds ratio (OR): 2.756, 95% CI 1.219-6.232) and suffered a sexual dysfunction (P < 0.05, OR: 2.654, 95% CI: 1.088-6.471) in comparison with controls. MRKH women scored significantly lower on the sexual esteem scale (SES) (P < 0.01, d = 0.5) and the female genital self-image scale (FGSIS) (P < 0.01, d = 0.6) than controls. No significant differences were found between the two groups regarding psychological distress, anxiety and depression, global self-esteem and relational dissatisfaction. Sexual esteem was significantly associated with the presence of clinically relevant sexual distress (ss = 0.455, P = 0.001) and suffering a sexual dysfunction (ss = 0.554, P = 0.001) and explained, respectively, 40% and 28% of the variance. LIMITATIONS, REASONS FOR CAUTION: Given the nature of the study focusing on sexual functioning, a potential selection bias cannot be excluded. It is possible that those women with the most severe sexual and/or psychological disturbances did or did not choose to participate in our study. WIDER IMPLICATIONS OF THE FINDINGS: The study results add new data to the very limited knowledge about psychosexual functioning of women with MRKH syndrome and are of importance for more adequate counseling and treatment of these women. STUDY FUNDING/COMPETING INTEREST(S): The research was financially supported by the Dutch Scientific Society of Sexology (Nederlandse wetenschappelijke Vereniging Voor Seksuologie). The funding was unrestricted, and there was no involvement in the conduct of the research. There are no conflicts of interest to declare

Vulvar Vestibulitis Syndrome: An important factor in the evaluation of lifelong vaginismus?

The aim of the study was to investigate the prevalence of vulvar vestibulitis syndrome (VVS) in a sample of women suffering from lifelong vaginismus (N=91). Lifelong vaginismus is defined as "having a history of never having been able to experience penile entry of the vagina". The results with respect to VVS are compared with the results of women who are suffering from pain during intercourse (superficial dyspareunia) (N = 84). Both patients groups were recruited from two treatment outcome studies. Using a standard physical examination, erythema was found in 77%, pain "on touch" in 69% and erythema and pain on the same location was seen in 56% of the patients with lifelong vaginismus. Furthermore, it was found that erythema (94%), pain (98%) and erythema and pain on the same location (92%) were more frequently found in patients with dyspareunia compared to women with lifelong vaginismus. It is concluded that pain is an integral part of the experiences in the majority of women with lifelong vaginismus