RESUMEN
PURPOSE: To evaluate the quality of life, sexual function, anxiety, and depression of women with endometriosis according to pain symptoms and infertility. METHODS: This cross-sectional multicenter study included 229 women with endometriosis followed up at a tertiary hospital in Campinas, a tertiary hospital in São Paulo, and a reproductive medicine clinic in Campinas from 2018 to 2021. The women were divided into four groups according to the presence of pain symptoms and infertility. The Endometriosis Health Profile Questionnaire, Female Sexual Function Index, Beck Depression Inventory, and Beck Anxiety Index were applied to assess quality of life, sexual function, depression, and anxiety of women with endometriosis. RESULTS: The women were grouped as follows: group 1 (45 women without infertility and without pain), group 2 (73 women without infertility and with pain), group 3 (49 women with infertility and without pain), and group 4 (62 women with infertility and pain). Of the women with infertility, the majority had primary infertility. Most women had deep endometriosis (p = 0.608). Women with pain had higher anxiety and depression scores and worse quality of life than women without pain (p < 0.001). Regarding sexual function, all the groups were at risk for sexual dysfunction (p = 0.671). The group of women with pain and infertility have worse anxiety scores (25.31 ± 15.96) and depression (18.81 ± 11.16) than the other groups. CONCLUSION: Pain symptoms worsen anxiety, depression, and quality of life of women with endometriosis and when associated with infertility, greater impairment of psychological aspects may occur.
Asunto(s)
Ansiedad , Depresión , Endometriosis , Infertilidad Femenina , Calidad de Vida , Humanos , Femenino , Endometriosis/psicología , Endometriosis/complicaciones , Estudios Transversales , Adulto , Depresión/psicología , Depresión/etiología , Ansiedad/psicología , Infertilidad Femenina/psicología , Infertilidad Femenina/etiología , Encuestas y Cuestionarios , Dolor Pélvico/psicología , Dolor Pélvico/etiología , Disfunciones Sexuales Fisiológicas/psicología , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/epidemiología , Brasil/epidemiología , Escalas de Valoración PsiquiátricaRESUMEN
The objective is to evaluate quality of life, anxiety, and depression in women with endometriosis, and to correlate these parameters with pain intensity. This multicenter cross-sectional study was conducted on 102 women with endometriosis from 2017 to 2020. The women were divided into two groups according to the pain intensity: group 1 (severe pain, 62 women) and group 2 (mild/moderate pain, 40 women). The Endometriosis Health Profile Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory were used to assess quality of life and levels of anxiety and depression, respectively. In both groups, mean age and mean body mass index were similar (pË 0.5). Most women had deep endometriosis and were on treatment, but group 2 had a longer treatment time (p = 0.044). Group 1 exhibited more depression and anxiety than group 2 (17.1 ± 9.98 vs. 11.15 ± 9.25, p = 0.003 and 23.71 ± 12.92 vs 12.58 ± 10.53, p = 0.001, respectively). Women with high pain had a significantly worse quality of life than those with low pain (48.88 ± 16.02 vs. 23.32 ± 15.93, p < 0.001). Women with endometriosis and high pain intensity have a worse quality of life, and more severe levels of anxiety and depression.
Asunto(s)
Endometriosis , Humanos , Femenino , Endometriosis/epidemiología , Endometriosis/psicología , Calidad de Vida/psicología , Dolor Pélvico/psicología , Dimensión del Dolor , Estudios Transversales , Depresión/epidemiología , Depresión/psicología , Ansiedad/epidemiología , Ansiedad/psicologíaRESUMEN
BACKGROUND: Endometriosis is a pathophysiological condition characterized by glands and stroma outside the uterus in regions such as the bladder, ureter, fallopian tubes, peritoneum, ovaries, and even in extra pelvic sites. One of the main clinical problems of endometriosis is chronic pelvic pain (CPP), which considerably affects the patients' quality of life. Patients with endometriosis may, cyclically or non-cyclically (80% of cases) experience CPP. High levels of anxiety and depression have been described in patients with endometriosis related to CPP; however, this has not been evaluated in endometriosis women with different types of CPP. Therefore, the research question of this study was whether there is a difference in the emotional dysregulation due to the type of pain experienced by women with endometriosis? METHODS: This work was performed in the National Institute of Perinatology (INPer) in Mexico City from January 2019 to March 2020 and aimed to determine if there are differences in emotional dysregulation in patients with cyclical and non-cyclical CPP. 49 women from 18 to 52 years-old diagnosed with endometriosis presenting cyclical and non-cyclical CPP answered several batteries made up of Mini-Mental State Examination, Visual Analog Scale, Beck's Depression Inventory, State Trait-Anxiety Inventory, and Generalized Anxiety Inventory. Mann-Whitney U and Student's t-test for independent samples to compare the difference between groups was used. Relative risk estimation was performed to determine the association between non-cyclical and cyclical CPP with probability of presenting emotional dysregulation. RESULTS: We observed that patients with non-cyclical CPP exhibited higher levels of depression and anxiety (trait-state and generalized anxiety) than patients with cyclical pain, p < 0.05 was considered significant. No differences were observed in pain intensity, but there was a higher probability of developing emotional dysregulation (anxiety or depression) in patients with non-cyclical CPP. No differences were observed in cognitive impairment. CONCLUSIONS: Our data suggest that patients with non-cyclical (persistent) CPP present a higher emotional dysregulation than those with cyclical pain.
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Dolor Crónico , Endometriosis , Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Endometriosis/diagnóstico , Calidad de Vida/psicología , Dolor Pélvico/etiología , Dolor Pélvico/psicología , Ansiedad/psicologíaRESUMEN
OBJECTIVE: This study evaluated religiosity and its association with mental health, quality of life, and the intensity of pelvic pain in women with chronic pelvic pain. METHODS: A cross-sectional study was conducted with 100 women with chronic pelvic pain. Religiosity was investigated using the Duke University Religion Index. Quality of life was evaluated using the abbreviated version of the World Health Organization's quality of life instrument. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale, while pain intensity was evaluated using a visual analog scale. RESULTS: Almost half the participants attended religious services at least once a week and 62% prayed, meditated, or studied the Bible at least once a day. There was no association between religiosity and anxiety or depression. The intrinsic religiosity score was lower for women with mixed anxiety-depressive disorder compared to those without mixed anxiety-depressive disorder. There was a positive association between intrinsic religiosity and the psychological health domain of the quality of life instrument. There was no association between religiosity and pain intensity. CONCLUSIONS: Women with chronic pelvic pain were strongly religious. Women with mixed anxiety-depressive disorder had lower levels of intrinsic religiosity. On the other hand, intrinsic religiosity was positively associated with quality of life in women with chronic pelvic pain. Religiosity was not associated with the intensity of pelvic pain. These data suggest that health-care professionals should take religiosity into account when treating women with chronic pelvic pain.
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Dolor Crónico/psicología , Salud Mental , Dolor Pélvico/psicología , Calidad de Vida/psicología , Religión , Adaptación Psicológica/fisiología , Adulto , Ansiedad/psicología , Estudios Transversales , Depresión/psicología , Femenino , Humanos , Persona de Mediana Edad , Adulto JovenRESUMEN
INTRODUCTION AND HYPOTHESIS: This study was designed to assess the effect of gynecological morbidities on Mexican women's self-rated health status and emotional health. METHODS: A cross-sectional population-based study was conducted among Mexican women aged 25-54. We analyzed information on 1,303 participants living in Hermosillo, Mexico. Multiple logistic regression was used to assess the effect of having any one of three kinds of pelvic pain, urinary incontinence or both of these conditions on women's self-rated health. Additionally, we conducted analysis of variance and multiple linear regression to test the effect of these gynecological morbidities on women's self-reported emotional health. RESULTS: Nearly one-third (31.2%) of participants rated their health as fair to very poor. Women reporting of at least one gynecological morbidity were more likely to rate their health as fair to very poor. In adjusted analyses, in addition to older age, low educational attainment, marital status other than single, lack of access to medical care, recurrent kidney infection, asthma, diabetes, and, reporting one or concurrent gynecological morbidities were associated with increased odds (adjusted odds ratios = 1.53-3.91) of reporting fair to very poor self-rated health. Women who did not report any gynecological morbidity had significantly lower mean scores for anxiety/fear 0.30 (±0.30) than women with two to four conditions (anxiety/fear 0.45 ± 0.31). CONCLUSION: Pelvic pain, urinary incontinence, and the co-occurrence of these conditions have a negative impact on women's perception of their health status and their emotional health.
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Autoevaluación Diagnóstica , Dolor Pélvico/psicología , Incontinencia Urinaria/psicología , Adulto , Estudios Transversales , Emociones , Femenino , Humanos , Modelos Logísticos , México , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , AutoinformeRESUMEN
Objective: To determine the correlations between coping strategies, depression, stress levels and pain perception in patients with endometriosis. Methods: This prospective and exploratory study included 171 women undergoing treatment for endometriosis between April and August 2014. The questionnaires used were Brief COPE, Beck Depression Inventory, Lipp's Stress Symptom Inventory for Adults and Visual Analogue Scale. Clinical data were collected from electronic medical records. Results: Patients with endometriosis who used positive coping strategies had better adaptation to stress (p<0.004) and less depression (p<0.004). The presence and intensity of depression, stress and acyclic pelvic pain were directly associated (p<0.05). The intensity of dysmenorrhea was associated with the degree of depression (p<0.001), whereas acyclic pelvic pain was associated with the degree of depression (p<0.001), stress level (p<0.001) and stress type (p<0.001). Conclusion: We found a positive association between coping, depression levels, type and levels of stress and pain intensity in patients with endometriosis. The use of maladaptive coping strategies focused on emotion is correlated with increase in depression and stress.
Objetivo: Observar a correlação entre estratégias de enfrentamento, depressão, níveis de estresse e percepção de dor em pacientes com endometriose. Métodos: Estudo prospectivo e exploratório, que incluiu 171 mulheres em tratamento por endometriose entre abril e agosto de 2014. Foram utilizadas as escalas: COPE Breve, Inventário de Depressão de Beck, Inventário de Sintomas de Stress para Adultos de Lipp e a Escala Visual Analógica. Os dados clínicos foram coletados do prontuário eletrônico. Resultados: Pacientes com endometriose que utilizaram estratégias positivas de enfrentamento apresentaram melhor adaptação ao estresse (p<0,004) e menos depressão (p<0,004). A presença e a intensidade da depressão, do estresse e da dor pélvica estiveram diretamente associadas (p<0,05). A intensidade da dismenorreia foi associada com o grau de depressão (p<0,001), enquanto a intensidade da dor pélvica acíclica esteve associada com o grau de depressão (p<0,001), nível de estresse (p<0,001) e tipo de estresse (p<0,001). Conclusão: Houve associação positiva entre coping, níveis de depressão, tipo e níveis de estresse e intensidade da dor nas pacientes com endometriose. A utilização de estratégias de coping desadaptativa focada na emoção está correlacionada com o aumento da depressão e do estresse.
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Adaptación Psicológica/fisiología , Depresión/psicología , Endometriosis/psicología , Endometriosis/terapia , Dolor Pélvico/psicología , Estrés Psicológico/psicología , Adulto , Depresión/prevención & control , Femenino , Humanos , Dolor Pélvico/prevención & control , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Estrés Psicológico/prevención & control , Encuestas y Cuestionarios , Resultado del Tratamiento , Escala Visual AnalógicaRESUMEN
ABSTRACT Objective To determine the correlations between coping strategies, depression, stress levels and pain perception in patients with endometriosis. Methods This prospective and exploratory study included 171 women undergoing treatment for endometriosis between April and August 2014. The questionnaires used were Brief COPE, Beck Depression Inventory, Lipp’s Stress Symptom Inventory for Adults and Visual Analogue Scale. Clinical data were collected from electronic medical records. Results Patients with endometriosis who used positive coping strategies had better adaptation to stress (p<0.004) and less depression (p<0.004). The presence and intensity of depression, stress and acyclic pelvic pain were directly associated (p<0.05). The intensity of dysmenorrhea was associated with the degree of depression (p<0.001), whereas acyclic pelvic pain was associated with the degree of depression (p<0.001), stress level (p<0.001) and stress type (p<0.001). Conclusion We found a positive association between coping, depression levels, type and levels of stress and pain intensity in patients with endometriosis. The use of maladaptive coping strategies focused on emotion is correlated with increase in depression and stress.
RESUMO Objetivo Observar a correlação entre estratégias de enfrentamento, depressão, níveis de estresse e percepção de dor em pacientes com endometriose. Métodos Estudo prospectivo e exploratório, que incluiu 171 mulheres em tratamento por endometriose entre abril e agosto de 2014. Foram utilizadas as escalas: COPE Breve, Inventário de Depressão de Beck, Inventário de Sintomas de Stress para Adultos de Lipp e a Escala Visual Analógica. Os dados clínicos foram coletados do prontuário eletrônico. Resultados Pacientes com endometriose que utilizaram estratégias positivas de enfrentamento apresentaram melhor adaptação ao estresse (p<0,004) e menos depressão (p<0,004). A presença e a intensidade da depressão, do estresse e da dor pélvica estiveram diretamente associadas (p<0,05). A intensidade da dismenorreia foi associada com o grau de depressão (p<0,001), enquanto a intensidade da dor pélvica acíclica esteve associada com o grau de depressão (p<0,001), nível de estresse (p<0,001) e tipo de estresse (p<0,001). Conclusão Houve associação positiva entre coping, níveis de depressão, tipo e níveis de estresse e intensidade da dor nas pacientes com endometriose. A utilização de estratégias de coping desadaptativa focada na emoção está correlacionada com o aumento da depressão e do estresse.
Asunto(s)
Humanos , Femenino , Adulto , Estrés Psicológico/psicología , Adaptación Psicológica/fisiología , Dolor Pélvico/psicología , Depresión/psicología , Endometriosis/psicología , Endometriosis/terapia , Escalas de Valoración Psiquiátrica , Estrés Psicológico/prevención & control , Índice de Severidad de la Enfermedad , Estudios Prospectivos , Encuestas y Cuestionarios , Reproducibilidad de los Resultados , Resultado del Tratamiento , Dolor Pélvico/prevención & control , Depresión/prevención & control , Escala Visual AnalógicaRESUMEN
OBJECTIVES: To understand the meaning women with pain-associated endometriosis attribute to yoga practice regarding their physical and emotional state at the beginning of the practice; pain management by integrating body and mind; secondary benefits of the practice of yoga, such as self-knowledge, self-care, and autonomy; and the role of the yoga group as psychosocial support. DESIGN: Qualitative study conducted simultaneously with a randomized clinical trial. SETTING: Public university hospital in southeastern Brazil between August 2013 and December 2014. PARTICIPANTS: Fifteen women with pain-associated endometriosis who practiced yoga for 8 weeks. INTERVENTION: After completing the twice-a-week program, all women participated in a single, semi-structured interview. Interviews were recorded and transcribed verbatim, and thematic analyses were performed. OUTCOME MEASURES: The main themes of analysis were women's expectations regarding the practice of yoga, physical and emotional state of women at the beginning of yoga practice, control and pain management through the integration of body and mind, secondary benefits, acquisition of self-knowledge and autonomy, and the role of yoga group as psychosocial support. RESULTS: All participants reported that yoga was beneficial to control pelvic pain. They related that they were aware of the integration of body and psyche during yoga practice and that this helped in the management of pain. Women said they had identified a relationship between pain management and breathing techniques (pranayama) learned in yoga and that breathing increased their ability to be introspective, which relieved pain. The participants have developed greater self-knowledge, autonomy, and self-care and have reduced the use of pain and psychiatric medications. They created ties among themselves, suggesting that the yoga group allowed psychosocial support. CONCLUSIONS: Bodily and psychosocial mechanisms to control pain were identified in women with endometriosis. To reach such control, it is crucial that mind and body integrative techniques are learned.
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Endometriosis/terapia , Manejo del Dolor/métodos , Manejo del Dolor/psicología , Dolor Pélvico/terapia , Yoga/psicología , Adulto , Endometriosis/fisiopatología , Endometriosis/psicología , Femenino , Humanos , Persona de Mediana Edad , Dolor Pélvico/fisiopatología , Dolor Pélvico/psicología , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the perceptions of women with endometriosis and chronic pelvic pain regarding their social ties. METHODS: A qualitative study was undertaken of women with chronic pelvic pain and endometriosis. Focus groups discussions among four to six participants were performed until saturation at the Clinics Hospital of Ribeirão Preto Medical School, Ribeirão Preto, southwest Brazil, between February 2013 and January 2014. Transcripts were analyzed according to the grounded theory approach and the emerging categories were coded using the WebQDA platform. RESULTS: Six focus group discussions took place, with a total of 29 patients. Social isolation was the main emerging theme. Social isolation was associated with a lack of understanding about endometriosis symptoms and with resignation in face of recurrent pain episodes. Avoiding partner intimacy and isolation from family and friends were components of social isolation. CONCLUSION: Women with endometriosis develop progressive social isolation after the onset of chronic pelvic pain. This finding is important for the multidisciplinary management of the disease.
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Endometriosis/psicología , Dolor Pélvico/psicología , Aislamiento Social/psicología , Adulto , Brasil , Dolor Crónico/psicología , Femenino , Grupos Focales , Humanos , Persona de Mediana Edad , Investigación Cualitativa , Adulto JovenRESUMEN
OBJECTIVE: Patient autonomy has great importance for a valid informed consent in clinical practice. Our objectives were to quantify the domains of patient autonomy and to evaluate the variables that can affect patient autonomy in women with chronic pelvic pain. METHODS: This study is a cross sectional survey performed in a tertiary care University Hospital. Fifty-two consecutive women scheduled for laparoscopic management of chronic pelvic were included. Three major components of autonomy (competence, information or freedom) were evaluated using a Likert scale with 24 validated affirmatives. RESULTS: Competence scores (0.85 vs 0.92; p = 0.006) and information scores (0.90 vs 0.93; p = 0.02) were low for women with less than eight years of school attendance. Information scores were low in the presence of anxiety (0.91 vs 0.93; p = 0.05) or depression (0.90 vs 0.93; p = 0.01). CONCLUSIONS: Our data show that systematic evaluation of patient autonomy can provide clinical relevant information in gynecology. Low educational level, anxiety and depression might reduce the patient autonomy in women with chronic pelvic pain.
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Depresión , Dolor Pélvico/psicología , Adulto , Ansiedad , Dolor Crónico/psicología , Estudios Transversales , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Objective Patient autonomy has great importance for a valid informed consent in clinical practice. Our objectives were to quantify thedomains of patient autonomy and to evaluate the variables that can affect patient autonomy in women with chronic pelvic pain. Methods This study is a cross sectional survey performed in a tertiary care University Hospital. Fifty-two consecutive women scheduled for laparoscopic management of chronic pelvic were included. Three major components of autonomy (competence, information or freedom) were evaluated using a Likert scale with 24 validated affirmatives. Results Competence scores (0.85 vs 0.92; p = 0.006) and information scores (0.90 vs 0.93; p = 0.02) were low for women with less than eight years of school attendance. Information scores were low in the presence of anxiety (0.91 vs 0.93; p = 0.05) or depression (0.90 vs 0.93; p = 0.01). Conclusions Our data show that systematic evaluation of patient autonomy can provide clinical relevant information in gynecology. Low educational level, anxiety and depression might reduce the patient autonomy in women with chronic pelvic pain.
Objetivo A autonomia da paciente é de grande importância para que o consentimento informado seja válido na prática clínica. Nossos objetivos foram quantificar os domínios da autonomia e avaliar variáveis que modificam a autonomia em mulheres com dor pélvica crônica. Métodos Este é um estudo transversal realizado em um Hospital Universitário terciário. Foram incluídas consecutivamente 52 mulheres com dor pélvica crônica agendadas para videolaparoscopia. Foi utilizada uma escala Likert com 24 afirmativas validadas para quantificar os três principais componentes da autonomia (competência, informação e liberdade). Resultados Os escores de competência (0,85 vs 0,92; p = 0,006) e informação (0,90 vs 0,93; p = 0,02) foram menores para mulheres com ensino fundamental incompleto. Os escores de informação foram menores em mulheres com sintomas de ansiedade (0,91 vs 0,93; p = 0,05) ou depressão (0,90 vs 0,93; p = 0,01). Conclusões Nossos dados mostram que a quantificação da autonomia pode produzir informações relevantes para a prática clínica em ginecologia. O nível educacional e a presença de ansiedade e depressão podem afetar a autonomia de mulheres com dor pélvica crônica.
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Humanos , Femenino , Adulto , Persona de Mediana Edad , Depresión , Dolor Pélvico/psicología , Ansiedad , Dolor Crónico/psicología , Estudios TransversalesRESUMEN
Os objetivos deste estudo transversal foram comparar a qualidade de vida e as caracteriÌsticas socioeconoÌmicas de mulheres com e sem dor peÌlvica e investigar achados cliÌnicos e ciruÌrgicos de mulheres com dor peÌlvica croÌnica. Os dados foram coletados em um hospital puÌblico, de GoiaÌnia/GO, Brasil. A intensidade da dor foi aferida pela escala analoÌgica visual e qualidade de vida avaliada pelo SF-36. A maioria das mulheres classificou a dor como intensa (52%) e conviviam com a dor haÌ 8,8 (±7,7) anos. Mulheres do grupo com dor peÌlvica croÌnica apresentaram escores inferiores em todas as dimensoÌes avaliadas pelo SF-36 (p< 0,05), exceto na dimensaÌo sauÌde mental, quando comparado com o grupo sem dor. A correlaçaÌo foi negativa (p=0,017) entre a intensidade da dor e a dimensaÌo dor do SF-36. A dor peÌlvica apresentou impacto negativo significativo na qualidade de vida, com prejuiÌzos para a sauÌde fiÌsica e mental das mulheres.
The objective of this cross-sectional study was to compare the quality of life and socioeconomic characteristics of women with and without pelvic pain and investigate clinical and surgical findings about women with chronic pelvic pain. Data were collected in a public hospital in GoiaÌnia, GoiaÌs, Brazil. Pain intensity was measured using the visual analogical scale, whereas quality of life was assessed through the SF-36. Most women classified pain as intensive (52%) and lived with pain for 8.8 (±7.7) years. Women belonging to the group of chronic pelvic pain scored less in all dimensions evaluated by the SF-36 (p< 0.05), except for the mental health dimension, when compared to the painless group. Correlation was negative (p=0,017) between pain intensity and the SF-36 bodily pain dimension. Pelvic pain presented significant negative impact on quality of life with losses to the physical and mental health of women.
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Humanos , Femenino , Adulto , Dolor Pélvico/epidemiología , Dolor Pélvico/enfermería , Dolor Pélvico/psicología , Calidad de Vida , Salud de la MujerRESUMEN
Chronic pelvic pain (CPP) is a highly prevalent clinical condition and is recognized as a public health problem. Although the number of qualitative studies related to the topic is increasing, it is essential that this knowledge be presented in a synthesized manner, grounded in the context of the care provided to patients with CPP, in order to increase the clinical and research applicability of the findings. Little attention is given to CPP in undergraduate courses and in meetings for the continuing education of health professionals, the approach to CPP typically being based on the biomedical model. We believe that qualitative research can provide insights into CPP and form the basis for a biopsychosocial approach to the condition, which can in turn lead to better results, including resolution of the pain and greater patient/health professional satisfaction. Therefore, we conducted a metasynthesis of seven qualitative studies of CPP, the principal themes of which were as follows: (a) coping with CPP versus secondary gain; (b) the great importance of determining the cause of the pain; (c) expectations regarding the doctor-patient relationship; and (d) gender issues. We hope that the present study can aid in restoring the humanistic aspects of CPP treatment.
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Adaptación Psicológica , Actitud Frente a la Salud , Dolor Pélvico/terapia , Relaciones Médico-Paciente , Trastornos Psicofisiológicos/terapia , Enfermedad Crónica , Femenino , Humanos , Dolor Pélvico/diagnóstico , Dolor Pélvico/psicología , Trastornos Psicofisiológicos/diagnóstico , Trastornos Psicofisiológicos/psicología , Investigación CualitativaRESUMEN
BACKGROUND: Pain is strongly related to poor quality of life. We performed a cross-sectional study in a university hospital to investigate quality of life in women suffering from chronic pelvic pain (CPP) due to endometriosis and others conditions. METHODS: Fifty-seven patients aged between 25 and 48 years-old submitted to laparoscopy because of CPP were evaluated for quality of life and depressive symptoms. Quality of life was accessed by a quality of life instrument [World Health Organization Quality of Life Assessment-Bref (WHOQOL-bref)]. Causes of pelvic pain were determined and severity of CPP was measured with a visual analogue scale. According to the intensity of pelvic pain score, patients were classified in two groups (group Low CPP < 25th percentile visual analogue scale and group High CPP > 25th percentile). Four dimensions on quality of life were measured (physical, psychological, social and environmental). We stratified the analysis of quality of life according CPP causes (presence or not of endometriosis in laparoscopy). RESULTS: Patients with higher pain scores presented lower quality of life status in psychological and environmental dimensions. We found a negative correlation between pain scores and psychological dimension of quality of life (r = -0.310, P = .02). Quality of life scores were similar between groups with and without endometriosis (physical 54.2 ± 12.8 and 51.1 ± 13.8, P = 0.504; psychological 56.2 ± 14.4 and 62.8 ± 12.4, P = 0.182; social 55.6 ± 18.2 and 62.1 ± 19.1, P = 0.325; environmental 59.2 ± 11.7 61.2 ± 10.8, P = 0.608; respectively) CONCLUSIONS: Higher pain scores are correlated to lower quality of life; however the fact of having endometriosis in addition to CPP does not have an additional impact upon the quality of life.
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Endometriosis/psicología , Dolor Pélvico/psicología , Calidad de Vida/psicología , Adulto , Ansiedad/psicología , Enfermedad Crónica/psicología , Estudios Transversales , Depresión/psicología , Endometriosis/complicaciones , Endometriosis/diagnóstico , Endometriosis/fisiopatología , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Pélvico/clasificación , Dolor Pélvico/etiología , Dolor Pélvico/fisiopatología , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
RATIONALE: Chronic pelvic pain (CPP) is a common and complex disease whose cause is often clinically inexplicable, with diagnosis and treatment being more difficult. From a clinical viewpoint, CPP is defined as non-cyclic, non-menstrual pain lasting at least 6 months and sufficiently severe to interfere with habitual activities and requiring clinical or surgical treatment. Thus, CPP is a syndrome resulting from a complex interaction of the nervous, musculoskeletal and endocrine systems and also influenced by psychological and sociocultural factors. CPP is influenced by emotional aspects with an impact on quality of life, and involving high costs for health services. Its aetiology is not always clear and a cure or significant improvement of symptoms is not always obtained with the treatments employed, with constant frustration of the professionals involved. It can be seen that its treatment is often unsatisfactory, simply providing temporary relief of symptoms. METHODS: In the present study, we reviewed the bibliography regarding pelvic pain, with emphasis on emotional aspects and on the importance of a multidimensional approach to the care for these patients. RESULTS AND CONCLUSIONS: New investigations are needed to clarify these relations and interventions in a more effective manner. Interdisciplinary care can minimize the impact of the disease, helping the patients to cope with symptoms and improving their quality of life.
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Dolor Pélvico/psicología , Enfermedad Crónica , Emociones , Humanos , Calidad de Vida , SíndromeRESUMEN
INTRODUCTION: Chronic pelvic pain (CPP) is one of the most frequent symptoms in women of reproductive age. This is an enigmatic clinical condition that results from the complex interactions of physiological and psychological factors with direct impact on the social, marital, and professional lives of women. AIM: To evaluate the quality of life and sexual satisfaction of women who suffer from CPP with or without endometriosis. METHOD: Forty-nine patients who had been diagnosed with endometriosis and 35 patients with CPP diagnosed with another gynecological condition, all 84 of whom were treated at the Chronic Pelvic Pain and Endometriosis Clinic at Universidade Federal de São Paulo (UNIFESP) from January to July of 2008. The controls were 50 healthy women from the Family Planning Clinic at UNIFESP. MAIN OUTCOME MEASURES: World Health Organization Quality of Life Assessment-Bref (WHOQOL-BREF) quality of life questionnaire and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). RESULTS: No statistically significant differences were observed between the groups with CPP symptoms, in either the results from the WHOQOL-BREF or in the GRISS questionnaire. In both questionnaires, differences were observed when the two groups of symptomatic women were compared with the group of healthy women. CONCLUSION: CPP caused by endometriosis or other gynecological conditions leads to a significant reduction of quality of life and sexual satisfaction.
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Endometriosis/psicología , Dolor Pélvico/psicología , Calidad de Vida/psicología , Conducta Sexual/psicología , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Satisfacción Personal , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: To determine the prevalence of pelvic muscle tenderness in women with chronic pelvic pain (CPP) and to assess the importance of evaluating muscle tenderness in such women. DESIGN: Observational study of 48 healthy female volunteers and 108 women with CPP, who were clinically evaluated for pelvic muscle tenderness by two researchers blinded to all clinical data. RESULTS: The frequency of clinically detected pelvic muscle tenderness was significantly higher in women with CPP than in healthy volunteers (58.3% vs 4.2%, P < 0.001). Among women with CPP, those with pelvic muscle tenderness had higher Beck Depression Index scores (22 [6-42] vs 13 [3-39], P = 0.02) and higher rates of dyspareunia (63.5% [40/63] vs 28.9% [13/45], P < 0.004) and constipation (46.0% [29/63] vs 26.7% [12/45], P = 0.05) than those without pelvic muscle tenderness. CONCLUSION: Tenderness of pelvic muscles was highly prevalent among women with CPP and was associated with higher BDI scores and higher rates of dyspareunia and constipation. Determination of pelvic muscle tenderness may help in identifying women who require more intense treatment for CPP.
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Músculo Esquelético/patología , Dolor Pélvico/diagnóstico , Adulto , Enfermedad Crónica , Estreñimiento/complicaciones , Estreñimiento/epidemiología , Estudios Transversales , Depresión/epidemiología , Depresión/psicología , Dispareunia/complicaciones , Dispareunia/epidemiología , Femenino , Humanos , Modelos Logísticos , Dimensión del Dolor , Diafragma Pélvico/fisiología , Dolor Pélvico/patología , Dolor Pélvico/psicología , Examen FísicoRESUMEN
BACKGROUND: Chronic pelvic pain (CPP) is a common and complex disease whose cause is often clinically inexplicable, with consequent difficulty in diagnosis and treatment. Patients with CPP have high levels of anxiety and depression, with a consequent impairment of their quality of life. AIMS: The objective of this study was to determine the prevalence of anxiety and depression and their impact on the quality of life of women with CPP. MATERIALS AND METHODS: A cross-sectional controlled study was conducted on 52 patients with CPP and 54 women without pain. Depression and anxiety were evaluated by the Hospital Anxiety and Depression Scale, and quality of life was evaluated by the World Health Organization Quality of life Whoqol-bref questionnaire. Data were analysed statistically by the Mann-Whitney U-test, the Fisher exact test, chi-square test and Spearman correlation test. RESULTS: The prevalence of anxiety was 73% and 37% in the CPP and control groups, respectively, and the prevalence of depression was 40% and 30% respectively. Significant differences between groups were observed in the physical, psychological and social domains. Patients with higher anxiety and depression scores present lower quality of life scores. DISCUSSION: The fact that DPC is a syndromic complex, many patients enter a chronic cycle of search for improvement of medical symptoms. The constant presence of pain may be responsible for affective changes in dynamics, family, social and sexual. Initially the person is facing the loss of a healthy body and active, to a state of dependence and limitations. In this study, patients with higher scores of anxiety and depression scores had lower quality of life and patients with lower scores of anxiety and depression had scores of quality of life. These results show that perhaps the depression and anxiety may be related to the negative impact on quality of life of these patients. CONCLUSION: In view of this association, we emphasise the importance of a specific approach to the treatment of anxiety and depression together with clinical treatment to improve the quality of life of these patients.
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Trastornos de Ansiedad/etiología , Trastorno Depresivo/etiología , Dolor Pélvico/psicología , Calidad de Vida , Adolescente , Adulto , Enfermedad Crónica , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Adulto JovenRESUMEN
A dor pélvica crônica (DPC) é uma sintomatologia comum e complexa, muitas vezes de causa inexplicável clinicamente, tornando o diagnóstico e tratamento mais difíceis. Do ponto de vista clínico, é definida como dor não cíclica ou não menstrual, com duração de pelo menos seis meses, suficientemente grave para interferir nas atividades habituais e que necessita de tratamento clínico ou cirúrgico. A DPC é, portanto, uma síndrome que resulta da complexa interação entre os sistemas: nervoso, musculoesquelético e endócrino, influenciado ainda por fatores psicológicos e socioculturais. Sua prevalência é de 3,8% em mulheres de 15 a 73 anos e de 14 a 24% em mulheres na idade reprodutiva, com impacto direto na vida conjugal, social, profissional e sexual. Como não há uma doença clara que justifica a DPC, há de se pensar em fatores psicogênicos. O fator psicológico pode estar presente de forma isolada ou concomitante, em até 60% dos casos das mulheres com DPC, sendo mais comumente representado pela depressão e ansiedade. A dor crônica tem efeito negativo no funcionamento sexual das mulheres acometidas. A DPC parece estar associada particularmente ao abuso sexual. Têm surgido evidências da associação entre a violência sexual e algumas queixas ginecológicas, como dismenorreia e dor pélvica. Neste estudo, realizou-se revisão bibliográfica sobre os aspectos emocionais e sexuais da mulher com DPC.
Chronic pelvic pain (CPP) is a common and complex symptoms often of clinically unexplained causes, which makes its diagnosis a more difficult task. From a clinical point of view, it is defined as a non-cyclic and non-menstrual pain lasting at least six months and sufficiently severe to interfere with habitual activities and to require clinical or surgical treatment. CPP syndrome results from complex interactions between nervous, musculoskeletal and endocrine system and psychological, social and cultural factors. Its prevalence is 3.8% among women aged 15 to 73 years and 14 to 24% among women of reproductive age, with a direct impact on marital, social, professional and sexual life. Since there is no clear disease justifying CPP, psychogenic factors should be considered. The psychological factors may be present in isolation or co-occur in up to 60% of women with CPP, being most commonly represented by depression an anxiety. Chronic pain has a negative effect on the sexual functioning of affected women. CPP seems to be particularly associated with sexual abuse. Evidence has been obtained by the association of sexual violence and some gynecologic complaints such as dysmenorhea and pelvic pain. In the present study, it was performed a review of the literature on the emotional and sexual aspects of women with CPP.
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Femenino , Conducta Sexual/fisiología , Dolor Pélvico/psicología , Abuso Sexual Infantil/psicología , Literatura de Revisión como Asunto , Delitos Sexuales , Disfunciones Sexuales Psicológicas , Ansiedad/etiología , Depresión/etiología , Grupo de Atención al PacienteRESUMEN
The objective of this study was to evaluate the perceived stress index, quality of life, and hypothalamus-pituitary-adrenal axis activity in women with endometriosis and chronic pelvic pain. For the study, 93 women with endometriosis and 82 healthy women volunteered. The visual analogue scale (VAS) (0=no pain; 10=severe pain) was used to determine pain intensity; the perceived stress questionnaire (PSQ) defined stress index, and the health-related quality-of-life (HRQOL)-SF-36 questionnaire was used to evaluate quality of life. Salivary cortisol was measured at 0800, 1600, and 2000 h and the awakening cortisol response was assessed to evaluate the hypothalamus-pituitary-adrenal axis activity. The results show that women with endometriosis and chronic pelvic pain of moderate intensity (4.1+/-0.58, mean+/-SEM) have higher levels of perceived stress (0.55+/-0.01 versus 0.42+/-0.01, p<0.05), a poorer quality of life expressed as lower scores for all items of the inventory and hypocortisolism. Lower levels of salivary cortisol were observed in all three samples collected, as well as in the awakening cortisol response, for women with endometriosis (0.19+/-0.09 microg/dl) when compared with controls (0.78+/-0.08 microg/dl, p<0.05 l), and it was independent of pain intensity and Mental health (MH) scores in SF-36. We concluded that women with endometriosis and chronic pelvic pain show low concentrations of salivary cortisol and a high level of perceived stress, associated with a poor quality of life. Whether the hypocortisolism was an adaptive response to the aversive symptoms of the disorder or a feature related to the etiology of endometriosis remains to be elucidated.