Chronic pelvic pain in women: toward an integrative model.
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Abdominal Pain↗
Biomedical subjects
J F Steege
Publications and source records attributed to J F Steege.
Dyspareunia. A special type of chronic pelvic pain.
The presence of dyspareunia as a specific complaint should be a routine part of the gynecologic history. Even if the patient does not present with this as a chief complaint, the regular inclusion of the question of whether the patient has pain during intercourse can address emotional and physical concerns the patient may leave unspoken unless given the opportunity. Once identified, the symptoms should be dealt with by the clinician potentially as both an organic and as a sexual problem. This will allow the clinician to keep in mind that secondary sexual dysfunction can arise from initially simple organic problems. Patients should be advised at the onset that the process is ongoing and that therapy may be more than just one single treatment approach. Dyspareunia that occurs after a period of good sexual adjustment may be more amenable to an office-based counseling and educational approach, assuming that the patient and her partner are comfortable and cooperative in approaching the problem. Dyspareunia of long standing or in a more complicated relationship may require skills possessed by more highly trained professionals.
Chronic Disease↗
Menstrual cycle effects on caffeine elimination in the human female.
Increases in the levels of sex steroids due to pregnancy or oral contraceptive steroid use are known to decrease significantly the rate at which caffeine is eliminated from the body. An investigation has now been made into whether the changes in sex steroid levels that occur during normal menstrual cycling also affect the rate of caffeine elimination, especially whether hormonal shifts in the luteal phase are associated with slower elimination of caffeine. Repeated 24-hour caffeine elimination studies were conducted during the follicular and luteal phases of the menstrual cycle in 10 healthy women. Comparisons of the follicular and luteal phases revealed that systemic clearance of caffeine was slower in the luteal phase, although the t1/2 did not differ. The slowing effect was related to the proximity to onset of menstruation and to levels of progesterone. The evidence suggests that caffeine elimination may be slowed in the late luteal phase, prior to the onset of menstruation. Such a reduction would lead to increased accumulation of caffeine with repeated self-administration during the day, but the effect may be too small to be of clinical significance in the majority of women.
Administration, Oral↗
Reduced platelet tritium-labeled imipramine binding sites in women with premenstrual syndrome.
OBJECTIVE: We studied the possible role of serotonergic systems in the cause of premenstrual affective symptoms. STUDY DESIGN: The binding of tritium-labeled imipramine to platelets is thought to parallel central nervous system binding and to indicate serotonergic activity. We measured platelet tritium-labeled imipramine binding sites in the follicular and luteal phases in 12 controls and in 9 women with well-documented late luteal phase dysphoric disorder. In statistical analyses we used repeated measures analysis of variance, with Student-Newman-Keuls and Duncan's one-tailed t tests, and Pearson's r. RESULTS: The values of subjects with late luteal phase dysphoric disorder were lower than those of controls (F [1,39] = 5.13, p = 0.03). Both follicular and luteal phase level were lower in subjects with late luteal phase dysphoric disorder but reached statistical significance only in the follicular phase. CONCLUSION: Lower platelet tritium-labeled imipramine binding in women with late luteal phase dysphoric disorder supports the hypothesis that alteration of central serotonergic systems may contribute to premenstrual dysphoric symptoms.
Adult↗
Late luteal phase dysphoric disorder in 670 women evaluated for premenstrual complaints.
OBJECTIVE: The American Psychiatric Association's DSM-IV Work Group on Late Luteal Phase Dysphoric Disorder (LLPDD) reanalyzed existing data from prospective, daily symptom ratings to evaluate the DSM-III-R criteria for LLPDD. The objectives were to 1) evaluate the individual symptoms presently required for the diagnosis and other symptoms, 2) determine the proportion of treatment-seeking women who meet the LLPDD criteria, and 3) explore the association between LLPDD and other mental disorders. METHOD: Data from over 1,000 women seeking evaluation for premenstrual complaints at five U.S. sites were examined. The data from 670 of these women were sufficiently complete to warrant evaluation by four different methods of assessing symptom change. RESULTS: Depending on the assessment method used, 14% to 45% of the women met the criteria for LLPDD. The current DSM-III-R symptoms were classified as positive for 7% to 54% of the women. Each of these symptoms was significantly more common among women with LLPDD regardless of the assessment method used. Five symptoms not presently included were also significantly more common. Women who had had mental disorders in the past, but not present, showed a significantly greater, but very small, relative risk of LLPDD. CONCLUSIONS: The variability in the frequency of LLPDD diagnosis according to method of assessing symptom change underscores the need for a uniform assessment method. The five additional symptoms with frequencies comparable to those of the DSM-III-R symptoms should be studied further for possible inclusion in the criteria.
Data Collection↗
Resolution of chronic pelvic pain after laparoscopic lysis of adhesions.
Thirty women undergoing laparoscopic lysis of adhesions for the treatment of chronic pelvic pain were prospectively evaluated for the presence of a chronic pain syndrome. At follow-up, of those with chronic pain syndrome (10), four (40%) reported continued improvement or resolution of pain during daily activities of dyspareunia, whereas of those without chronic pain syndrome (20), 15 (75%) were better (p = 0.06). When these two complaints are evaluated individually, both pain during daily activities (p less than 0.05) and dyspareunia (p less than 0.05) are more likely to improve after lysis of adhesions in women without chronic pain syndrome. Prognosis was not related to the number of previous operations, adhesion score, or other physical parameters. Laparoscopic lysis of adhesions is generally worthwhile in the treatment of chronic pelvic pain, although the presence of psychosocial compromise warrants preoperative evaluation and concomitant treatment.
Adolescent↗
Relationship of laparoscopic findings to self-report of pelvic pain.
An assessment battery including standardized measures of behavioral and psychosocial factors associated with other chronic pain conditions was administered to 102 women scheduled for laparoscopic surgery. Surgeons who were blinded to the patient's self-reported pain data completed the American Fertility Society classification for endometriosis and adhesions on the basis of observed physical disease. Although American Fertility Society classification scores were significantly related to self-assignment into pain or no-pain groups, the extent of physical disease evaluated by this procedure was not significantly correlated with ratings of pain levels or a number of indexes of impairment. The group of patients with laparoscopically diagnosed pathologic conditions reported higher pain levels and greater interference than the group who reported pain and had negative laparoscopic results; however, some women with observable pathologic conditions reported no pain symptoms.
Female↗
Ovarian remnant syndrome.
Ten patients with "definite" and three patients with "probable" ovarian remnant syndrome are reviewed to emphasize the difficulties in diagnosis and treatment of this clinical problem. Physical examination, clinical history, and follicle-stimulating hormone (FSH) levels were sufficient for diagnosis in most cases. Intravenous pyelography documented ureteral obstruction in two cases. Exogenous estrogen and progestin hormones did not control symptoms. Surgical removal ultimately achieved symptom relief for all women in whom pain was well localized to the remnant, although two patients required two attempts at excision before they were cured. Three patients with more diffuse pain and "probable" ovarian remnants were managed medically. Ovarian remnant syndrome is probably more prevalent than is generally appreciated.
Female↗
Teens and sex: confessions of an imperiled liberal.
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Adolescent↗
Patient satisfaction in Scott and Small-Carrion penile implant recipients: a study of 52 patients.
Physical penile sensations and levels of sexual satisfaction and activity were assessed in a questionnaire survey of 52 penile implant recipients. Although technical surgical success rates were high and 90% of recipients would elect to have surgery again, overall sexual adjustment did not approach premorbid conditions. Reasons for incomplete satisfaction included altered sensations of erection, decreased penile dimensions when compared with recalled preoperative dimensions, and decreased sensations during ejaculation. Some of these changes may have been due to decreased arousal during intercourse. Potential implant recipients should be counseled regarding realistic expectations of the benefits of penile prosthesis implant surgery.
Adult↗
Sexual function in the aging woman.
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Aged↗
Comparison of lifetime psychiatric diagnoses in Premenstrual Syndrome Clinic and community samples.
The purpose of this investigation was to obtain information about lifetime psychiatric diagnoses of women seeking treatment for premenstrual syndrome. The National Institute for Mental Health Diagnostic Interview Schedule (DIS) was administered to 223 women attending a premenstrual syndrome clinic. Rates of symptoms and psychiatric disorders were then compared with DIS data collected from an Epidemiologic Catchment Area (ECA) program community sample of 923 women in the same age group from the same geographic location. Women in the Premenstrual Syndrome Clinic sample met DIS/DSM-III criteria for dysthymia, phobia, obsessive-compulsive disorder, alcohol abuse/dependence, and drug abuse/dependence with a greater frequency than did women from the community sample. There appears to be much overlap between the symptoms for which women seek help from a specialty premenstrual syndrome clinic and symptoms related to several specific affective, anxiety, and substance abuse disorders. Further investigation is needed to determine whether premenstrual syndrome is strongly associated with DSM-III psychiatric diagnoses or whether current psychiatric classification systems are inadequate for differentiation.
Adult↗
Premenstrual symptoms in black and white community samples.
Premenstrual syndrome specialty clinics are reported to be almost exclusively attended by white women. This racial discrepancy has raised the question of whether there is a lower prevalence or severity of symptoms during the premenstruum among black women. The authors evaluated selected premenstrual symptoms in a representative community-based sample and found no difference in the prevalence or severity of premenstrual symptoms reported by black and white women, except for a higher prevalence of food cravings among blacks. Exploration of broader sociocultural factors may explain the observed racial difference in seeking help for premenstrual complaints.
Black or African American↗
Bioavailability of nasally administered progesterone.
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Administration, Intranasal↗
Psychological assessment of women seeking treatment for premenstrual syndrome.
One hundred (100) women who sought evaluation for premenstrual syndrome were administered a battery of standardized psychological tests, including a Minnesota Multiphasic Personality Inventory (MMPI), Beck Depression Inventory (BDI) and Short Marital Adjustment Scale (MAS), during the follicular phase of the menstrual cycle. A BDI was repeated in the luteal phase of the menstrual cycle. MMPI profiles were classified by code type using Lachar system as follows: 'Normal'--36%; 'Neurotic'--31%; 'Characterological'--11%, 'Psychotic'--5%, 'Unclassified'--17%. A common feature of MMPI profiles was a low Scale 5 (Mf). BDI scores had several patterns; however, a significant group (25%) appeared to have clinically significant continuous depression regardless of superimposed premenstrual changes. About half of the women (42%) reported marital distress (MAS scores less than 100) at the time of evaluation.
Adult↗
Relationships among premenstrual symptoms and menstrual cycle characteristics.
The severity of premenstrual syndrome symptoms has been described by different investigators as varying directly or inversely with the severity of dysmenorrhea. In a large population of women undergoing comprehensive psychological and medical evaluation for premenstrual syndrome complaints, the authors examined the relationship between menstrual cycle parameters and premenstrual syndrome. The severity of premenstrual symptoms varied directly with the severity of dysmenorrhea and premenstrual spotting but was not associated with any other menstrual cycle parameter. Multivariate analysis revealed that social and psychological variables are more strongly associated with variations in premenstrual symptoms than are any menstrual cycle parameters.
Adult↗
Dyspareunia and vaginismus.
The understanding and treatment of vaginismus and dyspareunia have been greatly advanced by discoveries in sexual physiology and by the integration of the psychological sciences into clinical medicine. Historical evaluation of these problems should attend to their chronology, the impact on the individual and her relationships, and prior attempts at solution; and one should keep in mind common theories of etiology of sexual dysfunction. Physical examination, both as an educational instrument for the patient and as a means of localizing pain, can be most informative when undertaken with a thorough knowledge of the physiology of sexual response. Particular foci of dyspareunia may be amenable to various combinations of physical and psychological treatment.
Dyspareunia↗
Pain during sex response due to occlusion of the Bartholin gland duct.
The greater vestibular glands produce a secretion during the plateau stage of sexual response. If the duct of the gland is partially or completely occluded, the secretion cannot be released and pain results from the pressure of the entrapped secretion. The pain is specific in its location and is elicited regardless of the mode of sexual stimulation. Four cases are presented in which duct occlusion appears to be the cause of pain during sex response. The gland was removed in 3 cases. In the fourth a marsupialization procedure was performed. The procedures were curative in all 4 cases. Relevant anatomy and sexual physiology are discussed.
Adult↗