RESUMO

OBJECTIVE: Few large-scale studies have focused on the effect of gynecologic cancer compared with other biopsychosocial factors on willingness to seek treatment among women with sexual dysfunction. The aim of study was to identify predictors of the intention to treat female sexual dysfunction (FSD) among sociodemographic factors, physiologic factors, psychologic factors, gynecologic cancer, and health belief model (HBM). MATERIALS AND METHODS: This study was a cross-sectional, hospital-based survey conducted from October 2013 to September 2019. Participants included healthy women and gynecologic cancer survivors who were aged 20 years or older and had been in a monogamous relationship for at least 12 months. They were enrolled in the gynecologic departments in southern Taiwan. Those who met DSM-5 criteria of sexual dysfunction were analyzed with Structural equation modeling. Intention to seek treatment was the primary outcome. RESULTS: 448 of 643 women met DSM-5 sexual dysfunction. The mean age was 42.0 years (range: 21.8-68.1 years). Fifty-eight percent of women reported sexual treatment intention. The model fit was good: χ2 = 367.42, P < .001, χ2/df = 2.83, CFI = 0.933, TLI = 0.921, and RMSEA = 0.066 (95%CI: 0.058-0.074). Perceived severity, perceived benefits, perceived barriers, cue to action, self-efficacy and university education at least significantly predicted treatment intention. There were no significant differences in treatment intention regarding age and gynecologic cancer. Self-efficacy was the strongest predictor, which directly affected treatment intention (P = .001). Perceived severity was the second strongest predictor, mainly affecting treatment intention indirectly (P = .01). Perceived barriers was the third strongest predictor (P = .001), indirectly and negatively affected treatment intention. CONCLUSIONS: Five out of six HBM factors and university education at least could significantly predict the intention to treat FSD. Gynecologic cancer was not a significant predictor.

Assuntos

Neoplasias dos Genitais Femininos , Disfunções Sexuais Fisiológicas , Adulto , Estudos Transversais , Feminino , Neoplasias dos Genitais Femininos/complicações , Modelo de Crenças de Saúde , Humanos , Intenção , Análise de Classes Latentes , Inquéritos e Questionários

RESUMO

BACKGROUND: In gynecologic cancer survivors, female sexual dysfunction (FSD) remains under-investigated. We attempted to estimate the prevalence of FSD associated with distress in gynecologic cancer survivors using diagnostic and statistical manual of mental disorders fifth edition (DSM-5) diagnostic criteria and to identify women at risk for FSD. METHODS: We conducted a cross-sectional analysis of premenopausal women aged 20-50 with various gynecologic cancers at least one year after treatment between January 2017 and December 2019. Data of sociodemographics and physical conditions were collected via face-to-face interview during outpatient clinic visits. The domains we used to define FSD were based on DSM-5 diagnostic criteria. Statistical analysis was carried out using Student's t test, Chi-square test and multiple logistic regression. RESULTS: A total of 126 gynecologic cancer survivors with a mean age of 42.4 years were included for analysis and 55 of them (43.7%) were diagnosed as having FSD associated with distress based on DSM-5 criteria. More than half of women (65.1%) reported decreased sexual satisfaction after cancer treatment. According to DSM-5 definition, the most common female sexual disorders were sexual interest/arousal disorder (70.9%), followed by genitopelvic pain/penetration disorder (60.0%), and orgasmic disorder (20.0%). In multiple logistic regression model, endometrial cancer diagnosis was the only independent factor predicting less influence of cancer treatment on FSD (OR 0.370; 95% CI 0.160, 0.856). CONCLUSION: The first study to use DSM-5 criteria for estimation of FSD prevalence. This enables clinicians to identify which women are actually needed to seek medical help. A prevalence of 43.7% of FSD associated with distress was found in a group of gynecologic cancer survivors with the most common being sexual interest/arousal disorder. Endometrial cancer survivors were at low risk for developing FSD after treatment.

Assuntos

Sobreviventes de Câncer , Neoplasias do Endométrio , Neoplasias dos Genitais Femininos , Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Adulto , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/epidemiologia , Feminino , Neoplasias dos Genitais Femininos/complicações , Neoplasias dos Genitais Femininos/epidemiologia , Humanos , Prevalência , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/epidemiologia , Sobreviventes

RESUMO

OBJECTIVE: Hypoactive Sexual Desire Disorder (HSDD) was the most common subtype of female sexual dysfunction; however, little was known about why Chinese women with HSDD were willing to seek medical help. This study aimed to identify predictive factors of seeking treatment for HSDD. MATERIALS AND METHODS: 260 outpatient premenopausal women who met the DSM-IV-TR criteria for HSDD for at least 6 months were recruited. All cases were divided into groups of willing to be treated and unwilling to be treated. The main outcome measures in this study were the Sexual Desire Relationship Distress Scale (SDRDS) score, physical and psychosexual characteristics, and Health Belief Model (HBM) variables. RESULTS: Women with willingness to be treated were significantly associated with fewer experiences of sexual assault (P = 0.033), longer relationship with a partner (P = 0.039), greater agreement about the severity of mental health injury as a result of HSDD (P = 0.008), more cues to action of sexual treatment (P < 0.05), higher self-efficacy (P < 0.05), and lesser treatment barriers including embarrassment about discussing desire problems with a physician (P = 0.026) and partner disagreement (P = 0.005). A relationship of more than 36 months (OR = 7.92), cues to action (OR = 1.70), and self-efficacy (OR = 1.76) could significantly predict willingness to be treated. CONCLUSIONS: HBM was useful in predicting treatment intent in premenopausal women with HSDD. These findings suggest ways to increase the rate of those seeking treatment in the future.

Assuntos

Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Disfunções Sexuais Psicogênicas/psicologia , Adulto , Estudos Transversais , Constrangimento , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pré-Menopausa , Autoeficácia , Disfunções Sexuais Psicogênicas/terapia , Parceiros Sexuais/psicologia , Inquéritos e Questionários , Taiwan

RESUMO

STUDY OBJECTIVE: To evaluate the efficacy of intraoperative infusion of bupivacaine solution for the relief of pain after operative gynecologic laparoscopy. DESIGN: Prospective, double-blind, randomized, controlled trial (Canadian Task Force classification I4). SETTING: Tertiary teaching hospital. PATIENTS: Ninety-one women aged 16 to 69 years who underwent gynecologic laparoscopic surgery from November 2002 through November 2003. INTERVENTIONS: Group A (n = 30): intraperitoneal infusion of a mixture of 10 mL of 0.5% bupivacaine (50 mg) with epinephrine (1:500) in 40 mL of Ringer's lactate solution postoperatively. Group B (n = 30): the same mixture solution infusion preoperatively and postoperatively (total 100 mg bupivacaine). Group C (n = 31): placebo. MEASUREMENTS AND MAIN RESULTS: Shoulder tip pain (STP), abdominal parietal pain (APP), and abdominal visceral pain (AVP) were recorded on a visual analog scale at 2, 4, 8, 16, and 24 hours postoperatively. A total of 79 patients fulfilled the study criteria. The overall incidence of STP was 60.8%. Abdominal visceral pain in group B was significantly less than in group C at 2 and 4 hours postoperatively (p = .011 and p = .010, respectively). No statistically significant difference was found in length of hospital stay, postoperative meperidine consumption, or side effects. CONCLUSION: Intraperitoneal bupivacaine administration both immediately after placement of trocars and at the end of surgery was found to be effective in reducing the intensity of AVP but not in reducing STP, APP, or postoperative analgesia consumption after nonadvanced gynecologic laparoscopic procedures. The duration of the analgesic effect of bupivacaine instilled into the peritoneal cavity did not exceed 8 hours and probably was not dose related.

Assuntos

Dor Abdominal/prevenção & controle , Anestésicos Locais , Bupivacaína , Procedimentos Cirúrgicos em Ginecologia , Laparoscopia , Dor Pós-Operatória/prevenção & controle , Adolescente , Adulto , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Infusões Parenterais , Pessoa de Meia-Idade , Cuidados Pré-Operatórios

Assuntos

Embolização Terapêutica , Placenta Acreta/complicações , Hemorragia Pós-Parto/etiologia , Hemorragia Uterina/etiologia , Útero/irrigação sanguínea , Adulto , Artérias , Cateterismo , Embolização Terapêutica/efeitos adversos , Tratamento de Emergência , Feminino , Humanos , Histerectomia , Artéria Ilíaca/cirurgia , Ligadura , MEDLINE , Placenta Acreta/terapia , Placenta Prévia/complicações , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/cirurgia , Hemorragia Pós-Parto/terapia , Gravidez , Falha de Tratamento , Doenças Uterinas/complicações , Doenças Uterinas/cirurgia , Hemorragia Uterina/cirurgia , Hemorragia Uterina/terapia

RESUMO

OBJECTIVE: To determine the accuracy of differential diagnosis by team consultation of abortion in progression, low-lying implantation/cervicoisthmic pregnancy, and cervical pregnancy (CP) in patients referred for suspicion of abnormal implantation on the lower segment and cervix of the uterus and to determine the efficacy of endoscopic surgery with uterine artery blockade followed by cervical evacuation in the treatment of confirmed CP. DESIGN: Prospective observational study under multiple-clinic and multiple-hospital cooperation. SETTING: Tertiary clinical and academic medical center. PATIENT(S): Twenty-seven women with a tentative diagnosis of CP made at their primary gynecologists' offices from July 1999 to June 2003. INTERVENTION(S): Second-opinion ultrasound scanning with transabdominal and transvaginal approach and optional color Doppler use. For patients with confirmed CP, a new treatment modality with laparoscopy-assisted uterine artery ligation followed by hysteroscopic local endocervical resection to remove the ectopic pregnancy was employed. For patients with abortion in progression or low-lying implantation/cervicoisthmic pregnancy (non-CP) requiring termination, dilatation and curettage (D&C) was performed under transabdominal ultrasound guidance. MAIN OUTCOME MEASURE(S): Fulfillment of ultrasound-based diagnostic criteria and operative course, convalescence, and commencement of menstruation in those patients with confirmed CP. RESULT(S): Cervical pregnancy was diagnosed in six (22.2%) patients at

Assuntos

Colo do Útero/cirurgia , Histeroscopia , Laparoscopia , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/cirurgia , Útero/irrigação sanguínea , Aborto Espontâneo/diagnóstico por imagem , Adulto , Artérias , Perda Sanguínea Cirúrgica , Diagnóstico Diferencial , Feminino , Humanos , Ligadura , Menstruação , Período Pós-Operatório , Gravidez , Estudos Prospectivos , Fatores de Tempo , Ultrassonografia Doppler em Cores

RESUMO

We prenatally diagnosed MELAS syndrome in a fetus whose mother and older brother had the MELAS-specific A3243G mutation. The mutant mtDNA level of the amniotic fluid cells was not significantly different from that of the postnatal peripheral blood and hair follicle samples. The obstetrical course was uncomplicated except for transient exacerbation of the mother's diabetes, which required insulin control. At term, the infant was macrosomic, and the delivery was complicated by shoulder dystocia. MELAS syndrome in itself does not influence either the prenatal course of the mother or the fetal outcome. In contrast to the fulminating clinical course of this mother's first child, MELAS symptoms did not develop in her second child until age four, despite similar high tissue levels of mutant mtDNA. The phenotypic diversity in two offspring with similar higher levels of mutant mtDNA suggests that prenatal genetic diagnosis of cultured amniotic cells may yield results that are poor prognosticators of fetal outcome.

Assuntos

Macrossomia Fetal , Síndrome MELAS/diagnóstico , Diagnóstico Pré-Natal , Adulto , DNA Mitocondrial/genética , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Síndrome MELAS/genética , Masculino , Mutação Puntual/genética , Gravidez