Sexual Consequences Research Articles

Living with and beyond cancer: What can be achieved by multi-organization collaboration.

59 Background: The London Cancer Alliance (LCA), created in 2011, is an integrated cancer system consisting of 14 NHS organisations serving a population of 5.7 million. The multi-professional Survivorship Pathway Group has 18 members including a service user. The purpose of the group is to provide expert clinical leadership for the development and implementation of the pathways to imbed the Recovery Package (Holistic needs assessment (HNA)/care plan, treatment summaries, health and well-being events, cancer care reviews), treatment and management of the consequences of cancer into standard practice of cancer care. Methods: Data is collected quarterly for each NHS organisations’- HNA and care plan, treatment summaries, health and well-being events against defined metrics. Data Collection is in its fourth year. To support the implementation, guidelines have been developed, support and information provided and educational fora run. Results: The number of HNAs completed within 31 days of diagnosis from 487 to 2646 (an increase of 543%) and for HNAs completed within 6 weeks of completing treatment from 185 to 905 (an increase of 489%) (RM Partners Overall 2016) since Q2 2013/14 until Q2 2015/16. The group have mapped service availability across the LCA and developed robust survivorship pathways for lymphedema, complementary services, sexual consequences, GI consequences, onco-fertility, allied health professional rehabilitation and health and wellbeing events. Guidelines have also been developed and published on survivorship, lymphoedema, health and well-being events, gastro-intestinal and sexual consequences, complementary therapies, developing patient information leaflets, gaining patient and carer feedback. Furthermore, over 15 fora have been run on diverse topics. Conclusions: Collaborative working across London organisations has proved to be feasible and productive. The impact of the group has been demonstrated through the significant uptake in implementation of the Recovery Package. Future directions include an improvement in collection of HCP agreed data sets, the embedding of treatment summary templates into Trust cancer data systems, and further role out of electronic HNA.

A study to identify subjective gaps in survivorship knowledge of health care professionals in London.

63 Background: The London Cancer Alliance (LCA), created in 2011, is an integrated cancer system consisting of 14 NHS organisations serving a population of 5.7 million. The multi-professional Survivorship Pathway Group aims to improve the outcomes of adults living with and beyond cancer. Methods: A 14-15 point questionnaire was developed to identify gaps in survivorship knowledge of oncology health care professionals (HCP) working in London. We were interested in HCP’s knowledge of the existence of the Recovery Package (Holistic Needs Assessment and care plan, Treatment Summary, access to a Health and Wellbeing Event and Cancer Care Review). The survey was uploaded onto Smart Survey and sent to 434 HCPs. Results: 167 surveys were anonymously completed. The distribution of respondents included Clinical Nurse Specialists(CNS), physiotherapists, dieticians, oncologists. The majority of respondents worked in specialist centers (44%), with 35% working in acute secondary care, 27% in acute tertiary care and 6% in the community. HCPs from all tumour groups were represented, though breast cancer and head and neck cancer were best represented. The majority of respondents were familiar with some or all of the components of the Recovery Package (80%). HCPs were most confident when asking about anxiety/depression (83%) but least confident or confident to some extent asking about changes in cognitive function (49%) and bone health (49%). When addressing needs, HCPs were confident addressing fatigue (47%) but less confident addressing cardiac complications (65%) and sexual concerns (64%). CNSs in particular were confident asking and addressing most concerns but many were not confident or were only somewhat confident addressing menopausal symptoms (34%) or lymphedema (37%). Further training was identified in psychological support, sexual consequences and management of long-term side effects. The predominant research priority identified was long-term side effects. Conclusions: Data from this survey will inform local educational fora, service mapping studies and the LCA Survivorship Research Group’s future strategy.

It Takes Two: Sexual Communication Patterns and the Sexual and Relational Adjustment of Couples Coping With Provoked Vestibulodynia

IntroductionProvoked vestibulodynia (PVD) is a prevalent vulvovaginal pain condition that is associated with sexual and relational consequences for women and their partners. Greater perceived quality of sexual communication has been associated with women's lower pain during intercourse and with couples' better sexual and relational well-being. Whether couples' collaborative (eg, expressing feelings or problem solving) and negative (eg, withdrawing or criticizing) sexual communication patterns (SCPs) are differentially associated with couples' adjustment to PVD is unknown. AimTo examine associations between collaborative and negative SCPs and women's pain and the sexual and relationship adjustment of women with PVD and their partners. MethodsWomen diagnosed with PVD (N = 87) and their partners completed the Sexual Communication Patterns Questionnaire and measurements of pain (women only), sexual functioning, sexual satisfaction, sexual distress, and relationship satisfaction. Main Outcome Measures(i) Numerical rating scale of pain during intercourse, (ii) Female Sexual Function Index and International Index of Erectile Function, (iii) Global Measure of Sexual Satisfaction, (iv) Female Sexual Distress Scale–Revised, and (v) Couple Satisfaction Index. ResultsWhen women reported greater collaborative SCP, they also reported higher sexual and relationship satisfaction. When women reported greater negative SCP, they reported less relationship satisfaction and had partners who reported greater sexual distress. When partners reported greater collaborative SCP, they also reported higher relationship satisfaction and had female partners who were less sexually distressed. When partners reported higher negative SCP, they also reported less relationship satisfaction. There were no associations between SCP and women's or partners' sexual functioning or women's pain. ConclusionCollaborative SCP may benefit couples' sexual and relational well-being, whereas negative SCP may impede sexual and relational adjustment to PVD. Findings provide preliminary support for the need to assess and target collaborative and negative SCPs in psychological interventions for couples affected by PVD.Rancourt KM, Flynn M, Bergeron S, Rosen NO. It Takes Two: Sexual Communication Patterns and the Sexual and Relational Adjustment of Couples Coping With Provoked Vestibulodynia. J Sex Med 2017;14:434–443.

Economic Context and HIV Vulnerability in Adolescents and Young Adults Living in Urban Slums in Kenya: A Qualitative Analysis Based on Scarcity Theory.

Urban slum adolescents and young adults have disproportionately high rates of HIV compared to rural and non-slum urban youth. Yet, few studies have examined youth's perceptions of the economic drivers of HIV. Informed by traditional and behavioral economics, we applied a scarcity theoretical framework to qualitatively examine how poverty influences sexual risk behaviors among adolescents and young adults. Focus group discussions with one hundred twenty youth in Kenyan's urban slums were transcribed, coded, and analyzed using interpretive phenomenology. Results indicated that slum youth made many sexual decisions considered rational from a traditional economics perspective, such as acquiring more sex when resources were available, maximizing wealth through sex, being price-sensitive to costs of condoms or testing services, and taking more risks when protected from adverse sexual consequences. Youth's engagement in sexual risk behaviors was also motivated by scarcity phenomena explained by behavioral economics, such as compensating for sex lost during scarce periods (risk-seeking), valuing economic gains over HIV risks (tunneling, bandwidth tax), and transacting sex as an investment strategy (internal referencing). When scarcity was alleviated, young women additionally described reducing the number of sex partners to account for non-economic preferences (slack). Prevention strategies should address the traditional and behavioral economics of the HIV epidemic.

Bipolar affective disorder and its impact on various aspects of marital relationship.

Bipolar disorder (BD) is a severe mental disorder, which not only has negative consequences on the life of the patient, but also affects the immediate family members. As it often starts early in life, patients who get married often suffer from many negative consequences in their marital life due to the illness. This review focuses on studies which have evaluated marital rates, rate of marital failure, divorce, infertility, and procreation among patients with BD. In addition, this review evaluates the existing literature pertaining to marital adjustment, marital satisfaction, sexual dysfunction, and sexual satisfaction among patients with BD and their partners/spouses. Data suggest that very high proportion of patients with BD get married and marital rates are higher for patients with BD, when compared with those suffering from schizophrenia. In terms of divorce rates, studies suggest that patients with BD have higher rates of divorce. In terms of fertility rates, studies suggest that compared to those without the illness, the fertility rates among patients with BD are lower. In terms of marital adjustment, results are mixed with some studies suggesting poorer marital adjustment among patients and their spouses too. In terms of sexual dysfunction, studies suggest the presence of sexual dysfunction among one-third to half of the patients receiving lithium. To conclude, this review suggests that patients with BD experience multiple negative marital and sexual consequences.

The Voices of Young Sexual Offenders in Norway: A Qualitative Study

Adolescents commit around 20 - 30 percent of all sexual offences and attempts have been made in the literature to distinguish between types of young sexual offenders. This study describes the understanding of nine Norwegian young male sexual offenders regarding sexual offences committed by them during adolescence, their childhood experiences and their suggestions on how to prevent juvenile sexual offending. The participants were interviewed with individual, semi-structured interviews and the rich data were analyzed with systematic text condensation. The young offenders’ understanding of mutuality in the relationship with their minor victim contributed to the sexual offence. Moreover, moral immaturity, learning difficulties or being a refugee, exposure to child pornography, impulsivity and high sexual arousal were described as having impacted on their offending. Findings suggest the need for further studies to understand the risk factors for juvenile sexual offending. Better knowledge about the legal framework of a sexual relationship and consequences of sexual abuse for both offenders and victims were highlighted to be the most important measure to prevent sexual abuse by juveniles in general.

Human Sex Trafficking in America: What Counselors Need to Know

The sexual exploitation of men, women and children through sex trafficking continues to occur in the United States and across the globe at an increasingly alarming rate. Despite misconceptions that sex trafficking requires transportation across state or country borders, the majority of victims are domestically trafficked within their own country by persons of the same nationality (Shelley, 2010; U.S. Department of State, 2009). Rates of forced labor are unknown and notoriously difficult to obtain due to methodological deficiencies (Fedina, 2015) and issues related to reporting and victim identification (Chesnay, 2013; Hyland, 2001; Laczko & Gramegna, 2003). However, the International Labour Organization (n.d.) estimates 27 million people become trafficked annually-4.5 million of whom are victims of forced sexual exploitation. Children and adolescents are exceptionally vulnerable to forced entry into the sex trade. The National Center for Missing and Exploited Children (2014) reported that 1 in 5 runaways are at risk for forced sexual exploitation. This represents an increase from an estimated 1 in 6 in 2014 (Polaris, 2016). Additionally, a study conducted by Estes and Weiner (2002) estimated that 326,000 youth are at risk for child trafficking. Counselors must become educated in recognizing the signs of trafficked persons, vulnerabilities to becoming trafficked, and the processes by which persons are forced into sexual exploitation in order to obtain a deeper understanding of the client's worldview and provide appropriate support.Existing literature addressing the mental health needs of sex trafficked survivors remains extremely limited (Hossain, Zimmerman, Abas, Light, & Watts, 2010; Tsutsumi, Izutsu, Poudyal, Kato, & Marui, 2008). Instead, the current body of research has focused on the sexual consequences of trafficking-related health issues such as sexually transmitted infections and rates of HIV among trafficked women in Asia (Beyrer, 2001; Beyrer & Stachowiak, 2003; Silverman et al., 2006; Silverman et al., 2007). The following article provides a brief overview of the definition, terms and processes associated with human trafficking. Next, the vulnerabilities and signs that a person has been or is currently being trafficked are presented. Finally, we address the clinical implications of working with trafficked survivors and identify trauma-sensitive interventions. Although female pronouns are used in this article, this detail is not intended to minimize the fact that many cisgender men, as well as lesbian, gay, bisexual and transgender persons, become victims of forced sexual exploitation (Martinez & Kelle, 2013; Oram, Stockl, Busza, Howard, & Zimmerman, 2012).Definition, Terms and Processes of Sex TraffickingDespite the growing awareness of modern day slavery, the act of human trafficking is not a new phenomenon. In Imperial Rome, it has been estimated that between 30-40% of the Roman population was comprised of slaves trafficked from nearby countries such as Thrase, Gaul, Britain and Germany (Collingridge, 2006). In fact, during the height of the Roman Empire, wars were fought solely to procure more slaves (Cahill, 1995; Goldsworthy, 2006). Human trafficking was not limited to European countries. Beginning in 1619, both White and African slaves were taken from their countries and imported to Virginia to help construct the colonies (D. Davis, 2006; Jordan & Walsh, 2007). Human trafficking and modern day slavery are acts of social injustice that have historically exploited men, women and children.According to the Trafficking Victims Protection Act (U.S. Department of State, 2000), the act of human trafficking refers to the recruitment, harboring, transportation, provision or obtaining of a person for commercial sex through force, fraud or coercion, or in which the person induced to perform a sex act is under 18 years of age. Despite common misconceptions, for an act to be considered sex trafficking, forced movement across the state is not required (U. …

Management of Bladder Pain Syndrome: Green-top Guideline No. 70.

Management of Bladder Pain Syndrome: Green-top Guideline No. 70.

Colonizing Black Female Bodies Within Patriarchal Capitalism

This article argues that the dynamics underlying the fundamental gendered/raced/sexual relationships that were created under colonialism exist in the same form in global patriarchal capitalism and pop culture, including mainstream music and pornography. It also explores contemporary Black feminist literature that critiques foundational Black feminist thought which views individual examples of “empowered” (wealthy, marketed/marketable) women of color as evidence of Black female liberation. Finally, in an effort to bridge foundational Black feminist thought with contemporary critiques, I discuss media representations of the Black female body in the context of human rights and sexual rights, as this offers global and historical perspective without minimizing the agency of those whose bodies have historically been exploited for profit. Public Health Statement: This study argues that hypersexualized and degrading images of women of color in media contradict the World Health Organization’s current definition of sexual health and sexual rights. Viewing the history and use of this imagery provides a theoretic framework for understanding the negative mental, physical, and sexual health consequences of degrading imagery and can aid in realizing positive sexual health outcomes for women of color.

The consequences of facultative sex in a prey adapting to predation.

A species reproductive mode, along with its associated costs and benefits, can play a significant role in its evolution and survival. Facultative sexuality, being able to reproduce both sexually and asexually, has been deemed evolutionary favourable as the benefits of either mode may be fully realized. In fact, many studies have focused on identifying the benefits of sex and/or the forces selecting for increased rates of sex using facultative sexual species. The costs of either mode, however, can also have a profound impact on a population's evolutionary trajectory. Here, we used experimental evolution and fitness assays to investigate the consequences of facultative sexuality in prey adapting to predation. Specifically, we compared the adaptive response of algal prey populations exposed to constant rotifer predation and which had alternating cycles of asexual and sexual reproduction where sexual episodes were either facultative (sexual and asexual progeny simultaneously propagated) or obligate (only sexual progeny propagated). We found that prey populations with facultative sexual episodes reached a lower final relative fitness and suffered a greater trade-off in traits under selection, that is defence and competitive ability, as compared to prey populations with obligate sexual episodes. Our results suggest that costs associated with sexual reproduction (germination time) and asexual reproduction (selection interference) were amplified in the facultative sexual prey populations, leading to a reduction in the net advantage of sexuality. Additionally, we found evidence that the cost of sex was reduced in the obligate sexual prey populations because increased selection for sex was observed via the spontaneous production of sexual cells. These results show that certain costs associated with facultative sexuality can affect an organism's evolutionary trajectory.

Sexual Assertiveness Mediates the Associations Between Partner Facilitative Responses and Sexual Outcomes in Women With Provoked Vestibulodynia

Provoked vestibulodynia (PVD) is a recurrent idiopathic vulvo-vaginal pain associated with negative sexual and psychological consequences. Facilitative partner responses to pain are currently receiving empirical attention because they are positively associated with women's sexual outcomes. However, the mechanisms through which facilitative responses to pain are associated with these outcomes have not been examined. One potential mechanism is sexual assertiveness, which has been found to be associated with better sexual function and satisfaction in women with PVD. The present study examined whether women's sexual assertiveness mediated the association between women's perception of facilitative partner responses and women's sexual function and satisfaction. Women (N = 140) with PVD symptomatology completed self-reported questionnaires evaluating their perception of their partners' facilitative responses, and their own sexual assertiveness, sexual function, and sexual satisfaction. Dependent measures were sexual function measured by the Female Sexual Function Index and sexual satisfaction assessed by the Global Measure of Sexual Satisfaction Scale. Results indicated that women's higher sexual assertiveness mediated the association between their greater perceived facilitative partner responses and their improved sexual function and satisfaction. Findings suggest a potential mechanism through which partner responses may be associated with women's sexual outcomes.

Endometriosis and Infertility: Impact on Sexuality

Objective: Endometriosis is a condition that has a great impact on women’s life. One of the most important consequences of the disease is infertility that may exacerbate the psychological, relational and sexual consequences on patients. The aim of the present study was to examine quality of life, anxiety, sexual functioning and relationship satisfaction of women with endometriosis and infertility. Infertility is supposed to be associated with a worse clinical profile. Design and Method: Data were collected on 71 patients (39 women with endometriosis and 32 with endometriosis and infertility) aged between 20 and 50 (M=34.21, SD=8.38), recruited in the Gynecological and Obstetrics department of Policlinico Umberto I, Rome. Participants completed: a socio-demographic questionnaire, the World Health Organization Quality of Life (WHOQOL)-Bref for quality of life, the McCoy Female Sexuality Questionnaire (MFS-Q) for sexual and relationship satisfaction, the Female Sexual Functioning Index (FSFI) for sexual functioning and the Hamilton Anxiety Rating Scale (HAM-A) for anxiety symptoms. Results: Women without infertility obtained worse scores: sexual functioning (F(1,69)=10.97 p<.01), sexual (F(1,69)=17.44 p<.001) and relationship satisfaction (F(1,69)=10.18 p<.001) and quality of life (F(1,69)=13.56 p<.001). Conclusions: Contrary to our hypothesis, endometriosis, with or without fertility impairment, has an impact on patients’ relationship, sexuality and quality of life. Therefore, infertility is not the main factor that explains a negative clinical profile. The present study suggests the importance of psychosexual counseling during medical treatment of the disease, and the need of involving partners in the assessment and in the health care decision making.

Prevalence and associated factors of khat use among university students in the University of Gondar, northwest Ethiopia

Habitual khat use has negative psychological, social, sexual, and economic consequences. Therefore, this study was aimed to assess the prevalence of khat use and associated factors among university students in the University of Gondar. Institution-based cross-sectional study was conducted from February to September 2011. Multistage sampling techniques were used to select the study participants. Anonymous self-administered questionnaire was used to collect the data. Epi Info and SPSS softwares were used to enter and analyze the data. Binary logistic regression was used to identify the determinant factors. Independent two-sample “t” test was employed to compare academic performance between khat chewers and non-chewers. Odds ratio with 95% confidence interval was used to assess the strength of the association. P-value <0.05 was considered statistically significant. The current prevalence of khat chewing was 16.4%. Sex, place of upbringing, alcohol use, cigarette smoking, and history of family and friends related chewing khat were statistically associated with khat chewing habit. The prevalence of khat chewing was found moderate and had not any influence on academic performance. Targeted and consistent counseling by a close controller and guidance is recommended as a direct in-campus intervention to tackle this habit.

Revisiting the crossroads: can Oedipus take a gay turn in the 21st C?

Is our foundational story of sexual identity still relevant and valid for today, or is it wrong? Oedipus has been used in the past as a cautionary tale for the consequences of transgressive sexuality, as well as an exemplar of hetero-normative development. Perhaps most influentially he has been used recently to illustrate a mechanism that underpins the concept of a pathological organization of personality, a perverse turning of a blind eye to the truth. But is this reading mistaken? In this article I return to the crossroads with Oedipus to try to give him back – for the first time – his sexual identity. By offering a re-reading of the myth in light of how we understand the impact of internalized stigma on the formation of sexual identity today I hope to show that our psychoanalytic imagination can use the Oedipus myth to encompass a range of different developmental possibilities.

Évaluation des résultats anatomiques, fonctionnels et identitaires après transposition du clitoris chez 30 patientes

Every year 3 millions of young women had undergone female genital mutilation. The psychological, identical and sexual consequences, as well as the treatment were described only recently. After a sociodemographic and cultural reminder, we analyze the anatomical, psychological, identital, and functional results of the reconstructive surgery. We conducted a retrospective monocentric study. Thirty women were included in our series. All the patients operated according to the technique of Pierre Foldes were contacted again, to estimate their motivations for this surgery and study the results on femininity, anatomy, psychology and functionality of this intervention. Twenty-six women were able to be estimated in the long term. Their main motivation was in 77% of the cases the research for a feminine identity. We compared the pre- and postoperative results, as well as different predefined under groups. The results shown a significant improvement between the pre- and the postoperative estimation for each of the items. The patients indicate an improvement: anatomical in 96% of the cases, for identity in 88% of the cases, psychological in 96% of the cases, and for sexuality in 88% of the cases. This technique allows an improvement for anatomy and functionality but also for physical image, well-being and feminity.

HP-02-001 Sexual problems associated with Female Genital Mutilation/Cutting (FGM/C) among Kipsigis women of Mauche Division, Nakuru, Kenya

Investigate the sexual consequences of FGM/C among women in Mauche division of Nakuru County in Kenya. The study was conducted at Mauche division of Nakuru county in Kenya. The community under investigation has over the last three years reported that married mature women and mothers choose to undergo FGM/C a new trend of the practice. Qualitative research methodology was employed where in-depth interviews and case narratives were conducted. A thematic analysis of the recorded and verbatim translations of the data was conducted. The study revealed that women from Mauche suffer from sexual problems as a result of FGM. Women reported a decline in sexual desire and subsequently sexual pleasure. Preliminary data shows that this decrease is attributed to physical and psychological levels of impingement, notably, the missing part and/or the clitoris, linked to no digital stimulation before intercourse by the partner and also husbands/partners consideration of women with clitoridectomy to be sexually cold and therefore preferring uncut women.

Threat of Sexual Disqualification: The Consequences of Erectile Dysfunction and Other Sexual Changes for Gay and Bisexual Men With Prostate Cancer

Gay and bisexual (GB) men with prostate cancer (PCa) have been described as an “invisible diversity” in PCa research due to their lack of visibility, and absence of identification of their needs. This study examined the meaning and consequences of erectile dysfunction (ED) and other sexual changes in 124 GB men with PCa and 21 male partners, through an on-line survey. A sub-sample of 46 men with PCa and seven partners also took part in a one-to-one interview. ED was reported by 72 % of survey respondents, associated with reports of emotional distress, negative impact on gay identities, and feelings of sexual disqualification. Other sexual concerns included loss of libido, climacturia, loss of sensitivity or pain during anal sex, non-ejaculatory orgasms, and reduced penis size. Many of these changes have particular significance in the context of gay sex and gay identities, and can result in feelings of exclusion from a sexual community central to GB men’s lives. However, a number of men were reconciled to sexual changes, did not experience a challenge to identity, and engaged in sexual re-negotiation. The nature of GB relationships, wherein many men are single, engage in casual sex, or have concurrent partners, influenced experiences of distress, identity, and renegotiation. It is concluded that researchers and clinicians need to be aware of the meaning and consequences of sexual changes for GB men when designing studies to examine the impact of PCa on men’s sexuality, advising GB men of the sexual consequences of PCa, and providing information and support to ameliorate sexual changes.

Journey of the Human Papillomavirus (HPV) in a Developing Country over 5 Years (2010 - 2015).

Human papillomavirus (HPV) is a prevalent sexually transmitted infection with serious medical, sexual, and relationship consequences. HPV vaccine protection is available globally but unfortunately vaccine uptake is inconsistent everywhere. From this study, it was observed that the awareness of cervical cancer, HPV virus and HPV vaccination in Malaysia is high, at 83.1%, 73.9% and 73.3% of respondents, respectively. However, a considerably low percentage had undergone HPV vaccination (8.6%) compared to those who had experienced a Pap smear (32.9%). Awareness between cervical cancer and HPV virus and vaccination was low. Health care providers and the governing bodies have to play a vital role in disseminating holistic information on the vaccine and the importance of getting vaccinated to the public more vigorously in Malaysia.

Sexual Activity, Psychosexual Distress, and Fear of Progression in Women With Human Papillomavirus-Related Premalignant Genital Lesions.

Genital human papillomavirus (HPV) infections are very common in women 18 to 30 years old and substantially affect women's sexual health. To examine sexual activity, psychosexual distress, and fear of progression in women diagnosed with HPV-related precancerous genital lesions. In this observational study, women diagnosed with premalignant lesions of the cervix, vagina, or vulva were recruited from a university hospital-based colposcopy clinic. Quantitative data from three validated patient-administered questionnaires (Sexual Activity Questionnaire, German version of the Cervical Dysplasia Distress Questionnaire, and Fear of Progression Questionnaire) were compared within the study population, according to the location of the genital lesion, and with relevant reference populations. Qualitative data from two written open-ended questions about women's thoughts regarding diagnosis and information were analyzed. Two-hundred nine women completed the questionnaires. Seventy-eight percent of women (n= 162) were referred for evaluation of suspect lesions of the cervix, 8% (n= 17) of the vagina, and 14% (n= 30) of the vulva. There were no significant differences in questionnaire results among the three patient groups, except for sexual consequences (Cervical Dysplasia Distress Questionnaire) and recent sexual activity (Sexual Activity Questionnaire). Women with vulvar lesions were most likely to worry about sexual consequences (ie, being unable to have children, being sexually less attractive, or infecting a sexual partner; P= .04). The Sexual Activity Questionnaire subscales sexual pleasure (P= .15) and sexual habits (P= 1.00) were similar to those in a healthy control population, whereas sexual discomfort (P= .51) was comparable to that in a reference population of women who survived cervical cancer. The subscale partner-specific concerns (Fear of Progression Questionnaire) was similar to that in a reference population of patients with cancer (P= .28). HPV-related precancerous genital lesions, especially of the vulva, are likely to cause concerns about sexual health. Effective information and communication are important to lessen negative sexual consequences and anxiety.

Comparing the Prevalence, Risk Factors, and Repercussions of Postpartum Genito-Pelvic Pain and Dyspareunia.

Childbirth is a risk factor for developing genito-pelvic pain and/or dyspareunia during the postpartum period and potentially in the longer term. These two types of pain can occur simultaneously or sequentially and could be affected by different risk factors and have a range of repercussions to women's lives, including their sexual functioning. This study reviewed the available evidence to compare and contrast the prevalence, risk factors, and repercussions of postpartum genito-pelvic pain vs dyspareunia. All available data related to postpartum genito-pelvic pain and dyspareunia were reviewed. A description of the prevalence, risk factors, and sexual and psychological consequences of postpartum genito-pelvic pain and dyspareunia and the methodologic limitations of previous studies. The prevalence of postpartum genito-pelvic pain is much lower than that of postpartum dyspareunia. There is evidence of converging and differential risk factors for acute and persistent experiences of these two types of pain. Postpartum genito-pelvic pain and dyspareunia are associated with impaired sexual functioning. Rarely are these pain experiences examined together to make direct comparisons. There has been a critical lack of studies examining postpartum genito-pelvic pain and dyspareunia together and integrating biomedical and psychosocial risk factors. This approach should be spearheaded by a multidisciplinary group of researchers of diverse and relevant expertise, including obstetricians, gynecologists, anesthesiologists, and psychologists.