Dyspareunia Symptoms Research Articles

The relationship of pelvic pain symptoms with CA-125 levels in endometriosis cases

Aim: This study aims to investigate the relationship between CA-125 levels and pelvic pain symptoms in patients with endometriosis.Material and Methods: This study consisted of retrospective data of 31 patients who were admitted to the outpatient clinic of Faculty of Medicine, Amasya University between 01 January 2013 and 01 January 2018 for complaints of pelvic pain, dysmenorrhea or infertility, who had a preliminary diagnosis of endometriosis by clinical and ultrasonography examination and diagnosed with endometriosis by laparoscopy or laparotomy as well as 35 patients who received diagnostic laparoscopy for any reason or laparotomy or laparoscopy for benign or tubal ligation. The study included patients aged 18 to 45 years old. Patient data were recorded via an information form which included age, presence of infertility, duration of infertility, preoperative CA-125 values, presence of dysmenorrhea and dyspareunia symptoms, previous operation for endometriosis, presence of additional gynecological pathology, disease stage, operation notes, primary complaints, preoperative TVS information, gravida, parity, abortion and living children, used medication, if any, chronical diseases, if any. Results: The blood CA-125 levels were statistically significant in the patients considering the presence of chronic pelvic pain, dysmenorrhea and infertility (p 0.05). Mean CA-125 levels were 51.43 U/ml in patients with chronic pelvic pain symptoms. Mean CA-125 levels were 45.45 (U/ml) in patients with dysmenorrhea. Mean CA-125 was 45.67 (U/ml) in infertile patients and 45.58 (U/ml) in patients with endometriosis. Mean CA-125 levels in patients with additional gynecological diseases were 38.29 (U/ml), which was not statistically significant.Conclusion: This study demonstrated that CA-125 levels were significantly associated with pelvic pain symptoms, infertility and endometriosis. In light of the results, preoperative serum CA-125 levels are a predictor and should be considered for patients with chronic pelvic pain.Keywords: Endometriosis; CA-125; pelvic pain.

Does intravaginal diazepam relieve symptoms of dyspareunia associated with pelvic floor dysfunction?

Does intravaginal diazepam relieve symptoms of dyspareunia associated with pelvic floor dysfunction?

Ultra-low doses of TX-004HR to improve symptoms of vulvar and vaginal atrophy (VVA) while maintaining serum levels of estradiol within the normal postmenopausal range.

10074Background: More than 60% of postmenopausal breast cancer (BC) patients have symptoms of dyspareunia and vaginal dryness that often result from endocrine therapy, and are challenging to treat....

Nerve Growth Factor Is Associated With Sexual Pain in Women With Endometriosis.

Endometriosis is present in 1 in 10 reproductive-age women, and half experience deep dyspareunia (pelvic pain with sexual intercourse). Our objective was to investigate nerve growth factor (NGF) and its receptors (TrkA/p75NTR) in endometriosis-associated deep dyspareunia. A total of 32 women with endometriosis in the posterior pelvic compartment (cul-de-sac/uterosacrals) were included, either with (n = 17) or without (n = 15) deep dyspareunia symptoms confirmed by endovaginal ultrasound-assisted palpation on examination. Expression of NGF, TrkA, and p75NTR in the surgically excised cul-de-sac/uterosacral endometriosis was examined by immunohistochemistry and Histoscore blinded to pain phenotypes. Additionally, endometriotic stromal cells (ESCs; n = 3) from ectopic endometriosis lesions were cultured and incubated with/without NGF and/or Trk inhibitor K252a, followed by expression analysis of prostaglandin-endoperoxide synthase 2 (PTGS-2)/cyclooxygenase 2 (COX-2; reverse transcription quantitative real-time polymerase chain reaction and Western blot) and prostaglandin E2 (PGE2) secretion (enzyme-linked immunosorbent assay). We found that the immunointensity of NGF and TrkA, but not p75NTR, was significantly elevated in endometriotic stroma and epithelium from women with deep dyspareunia compared to women without deep dyspareunia. Nerve growth factor immunoreactivity in the stroma was also significantly associated with deep dyspareunia intensity and local nerve bundle density. In cultured ESCs, NGF significantly increased PTGS-2/COX-2 mRNA and protein levels as well as PGE2 secretion, and these effects could be abolished by pretreatment of Trk inhibitor K252a. In conclusion, elevated NGF levels were associated with deep dyspareunia in women with cul-de-sac/uterosacral endometriosis. This association may be mediated by increased nerve bundle density and by COX-2/PGE2 stimulation via Trk receptor. Nerve growth factor signaling may play an important role in endometriosis-associated sexual pain.

Dyspareunia is associated with chronic pain in premenopausal women with sickle cell disease

ABSTRACTObjectives: Pain is common in women with sickle cell disease (SCD), but the prevalence of dyspareunia in this unique patient population is unknown. In this study, we sought to determine whether chronic pain is associated with an increased prevalence of dyspareunia in premenopausal women with SCD.Methods: A cross-sectional study of premenopausal women with SCD was systematically assessed for symptoms of dyspareunia and chronic pain using a standard questionnaire. These results were correlated with each subject's clinical pain phenotype determined by a review of the patient's electronic medical record.Results: Ninety-one premenopausal women with SCD were examined. Thirty-two percent of the women reported dyspareunia. Women with dyspareunia were more likely to have a history of chronic pain (90% versus 61%, p = .006), report more pain days per week (median (interquartile range): 6 (4–7) vs. 3 (0–7), p = .005)), and had a higher oral morphine equivalent dose (145 (45–226) mg vs. 60 (9–160) mg, p = .030). Using a multivariable classification tree analysis, number of days of pain experienced per week was an important predictor of dyspareunia (p = .001).Conclusion: Dyspareunia is common in women with SCD, and more common in women with SCD and chronic pain. Providers should assess women with SCD for dyspareunia, especially those with a chronic pain syndrome.

Visual improvements in vaginal mucosa correlate with symptoms of VVA: data from a double-blind, placebo-controlled trial.

Objective:To evaluate the response of the vaginal mucosa with TX-004HR and its correlation with vulvar and vaginal atrophy (VVA) symptoms, and whether visual examination is a useful measure for assessing VVA.Methods:REJOICE was a 12-week, phase 3, multicenter, randomized, double-blind, placebo-controlled study of a vaginal, muco-adhesive, 17β-estradiol softgel capsule (TX-004HR 4, 10, and 25 μg) in postmenopausal women with VVA and moderate-to-severe dyspareunia. Treatments were self-administered vaginally once per day for 2 weeks, then twice per week for 10 weeks. The vagina was visually examined at baseline and at weeks 2, 6, 8, and 12; changes were evaluated using a 4-item scale for vaginal color, vaginal epithelial integrity, vaginal epithelial surface thickness, and vaginal secretions.Results:Significant improvements were observed with all three TX-004HR doses versus placebo in vaginal color (least square mean score changes of −0.96 to −1.06 for TX-004HR doses vs −0.60 for placebo at week 12), epithelial integrity (−0.97 to −1.07 vs −0.60), epithelial surface thickness (−0.94 to −1.03 vs −0.61), and secretions (−1.01 to −1.06 vs −0.64) (P < 0.001 for all comparisons at all time points). Both Pearson's correlations and logistic regression receiver-operating characteristic curve analyses significantly correlated the sum of the individual visual assessment scores with dyspareunia (P < 0.0001) and vaginal dryness (P < 0.0001) at 12 weeks.Conclusions:Greater improvements in the vaginal mucosa of postmenopausal women with VVA and moderate-to-severe dyspareunia were observed with TX-004HR versus placebo, and vaginal mucosa assessment scores correlated with vaginal symptoms of dyspareunia and dryness. Visual vaginal assessment by healthcare professionals is a useful measure for diagnosing VVA and assessing response to treatment.

CO2-laser for the genitourinary syndrome of menopause. How many laser sessions?

ObjectivesThe aim of this prospective study was to assess the efficacy of 3, 4 or 5 CO2-laser sessions for the management of the genitourinary syndrome of menopause (GSM). MethodsPostmenopausal women with moderate to severe symptoms of dyspareunia, wanting to resume/retain sexual activity, were treated with 3–5 laser sessions depending on symptom severity/presence, sexual function, clinical findings and women’s preference following the third laser application. Main outcomesSeverity of dyspareunia, dryness, sexual function, sexual satisfaction and frequency of sexual intercourse defined the primary outcomes. Vaginal Maturation Value (VMV) and Vaginal Health Index Score (VHIS) defined the secondary ones. ResultsFifty-five women received three sessions, 53 an extra fourth and 22 an extra fifth. Following the third, fourth and fifth laser sessions, respectively: dyspareunia completely regressed in 15/55 (27%), 32/55 (58%) and 38/47 (81%) of participants; dryness completely regressed in 20/55 (36%), 36/55 (66%) and 44/51 (86%); normal sexual function resumed in 23/55 (41%), 37/54 (69%) and 41/49 (84%); VMV regained non-atrophic values in 29/55 (53%), 38/55 (69%) and 42/50 (84%); and VHIS regained non-atrophic values in 44/55 (80%), 53/55 (96%) and 55/55 (100%) of participants. ConclusionResults of this study indicate that CO2-laser therapy may contribute to complete regression of dyspareunia and dryness and reestablishment of normal sexual function in postmenopausal women, in a dose-response manner. An extra fourth or fifth session may further increase the GSM symptom-free rate.

Evaluating sexual nursing care intervention for reducing sexual dysfunction in Indonesian cervical cancer survivors

Objective:This study aims to describe the factors affecting successful nursing care intervention on sexuality.Methods:A one-group pre- and post-test design was used. Fifty-three cervical cancer survivors and their spouses were administered with nursing care intervention on sexuality in three sessions and evaluated after 6 weeks.Results:Sexual intervention reduced dyspareunia symptoms, improved vaginal lubrication, improved sexual satisfaction, and enhanced sexual arousal, sexual desire, and orgasm among cancer survivors and their spouses. The other influencing factors also simultaneously contributed to the success of nursing care intervention.Conclusions:Nursing care intervention on sexuality could be a part of supportive nursing care and an important aspect in standard nursing care for cancer patients in Indonesia.

Transverse incision transvaginal rectocele repair combined with levatorplasty and biological graft insertion: technical details and case series outcomes.

The purpose of this report is twofold: first, to detail our operative approach to rectocele repair, and second, to report on the outcomes. Transverse incision transvaginal rectocele repair combined with levatorplasty and biological graft placement is detailed using hand-drawn sketches and intraoperative photographs. All patients with symptoms of functional constipation and non-emptying rectocele operated on from May 2007 to March 2013 at our institution were enrolled in this study. Data from a prospectively maintained database were retrospectively analyzed. Preoperative and postoperative functional outcomes were studied using a validated 31-point obstructed defecation (OD) scoring system. Follow-up was 1 year. Twenty-three patients underwent the procedure. The mean age of patients was 55 years (range 28-79 years). The OD severity score improved from the preoperative mean of 21.6 to postoperative mean of 5.5 (p = 0.001). Three out of four patients with initial symptoms of dyspareunia (75%) reported significant improvement in dyspareunia, while 2 out of 19 patients without initial symptoms of dyspareunia (11%) reported mild dyspareunia following the repair. One patient (4%) required operative drainage of a hematoma. Another patient (4%) developed symptomatic recurrence which was confirmed radiologically. In properly selected patients, the technique described leads to significant improvement in symptoms of OD and low recurrence without an increased rate of dyspareunia.

What new therapeutic options exist for the relief of menopausal symptoms?

Two new products recently approved for the treatment of menopausal symptoms contain estrogen receptor agonists/antagonists, which have varying effects on bone, breast, endometrial, and vaginal tissues. Ospemifene improves symptoms of dyspareunia associated with vulvovaginal atrophy. Bazedoxifene combined with conjugated estrogens improves vasomotor symptoms and bone mineral density in postmenopausal women. Clinicians must consider the increased risk for venous and arterial thromboembolic disease posed by these drugs. Clinical trials are ongoing to fully evaluate the drugs' efficacy and safety compared with traditional estrogen-based regimens.

V2-08 ROBOTIC-ASSISTED LAPAROSCOPIC REMOVAL OF EXTRUDED SACROCOLPOPEXY MESH

You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2015V2-08 ROBOTIC-ASSISTED LAPAROSCOPIC REMOVAL OF EXTRUDED SACROCOLPOPEXY MESH Kai-wen Chuang, Christopher Hartman, Akin Carons, Manaf Alom, Paras Shah, Lee Richstone, and Farzeen Firoozi Kai-wen ChuangKai-wen Chuang More articles by this author , Christopher HartmanChristopher Hartman More articles by this author , Akin CaronsAkin Carons More articles by this author , Manaf AlomManaf Alom More articles by this author , Paras ShahParas Shah More articles by this author , Lee RichstoneLee Richstone More articles by this author , and Farzeen FirooziFarzeen Firoozi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.333AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Mesh sacrocolpopexy is an effective treatment strategy for both high grade and refractory pelvic organ prolapse. Graft erosion into the vagina, bladder or urethra, however, is a recognized complication of nonabsorbable mesh and can result in significant morbidity. The management of an eroded sacrocolpopexy mesh can be technically challenging and traditionally requires an abdominal laparotomy which carries its own perioperative morbidity. We demonstrate a minimally invasive robotic approach to removing the sacrocolpopexy mesh extruding in the vagina. METHODS Vaginal exam demonstrated the extruded mesh at the apex of the vagina. With the patient in Trendenlenberg position and employing robotic assistance, the pelvis was thoroughly examined. The Sigmoid colon was identified, mobilized and reflected laterally, hence exposing the sacral promontory. A fibrous band enveloping the mesh was identified from the sacral promontory to the apex of the vagina. The mesh was dissected and excised in its entirety. A vaginotomy was performed to access the vagina portion of the mesh and this was excised. The vaginal defect was closed in two layers and a foley catheter was placed. RESULTS Duration of procedure was 150 minutes. Estimated blood loss was 10cc. Vaginal packing and foley catheter were placed postoperatively and removed on postoperative day 1. Currently, the patient reports resolution of her lower back pain and vaginal discharge as well as improvement in dyspareunia symptoms. CONCLUSIONS Transabdominal robotic-assisted laparoscopic removal of sacrocolpopexy mesh is an effective, safe, and less morbid alternative to the traditional open approach for the management of mesh extrusion. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e100 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kai-wen Chuang More articles by this author Christopher Hartman More articles by this author Akin Carons More articles by this author Manaf Alom More articles by this author Paras Shah More articles by this author Lee Richstone More articles by this author Farzeen Firoozi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Concurrent deep-superficial dyspareunia: prevalence, associations, and outcomes in a multidisciplinary vulvodynia program.

Little is known about women with concurrent diagnoses of deep dyspareunia and superficial dyspareunia. The aim of this study was to determine the prevalence, associations, and outcome of women with concurrent deep-superficial dyspareunia. This is a prospective study of a multidisciplinary vulvodynia program (n = 150; mean age 28.7 ± 6.4 years). Women with superficial dyspareunia due to provoked vestibulodynia were divided into two groups: those also having deep dyspareunia (i.e., concurrent deep-superficial dyspareunia) and those with only superficial dyspareunia due to provoked vestibulodynia. Demographics, dyspareunia-related factors, other pain conditions, and psychological variables at pretreatment were tested for an association with concurrent deep-superficial dyspareunia. Outcome in both groups was assessed to 6 months posttreatment. Level of dyspareunia pain (0-10) and Female Sexual Distress Scale were the main outcome measures. The prevalence of concurrent deep-superficial dyspareunia was 44% (66/150) among women with superficial dyspareunia due to provoked vestibulodynia. At pretreatment, on multiple logistic regression, concurrent deep-superficial dyspareunia was independently associated with a higher level of dyspareunia pain (odds ratio [OR] = 1.19 [1.01-1.39], P = 0.030), diagnosis of endometriosis (OR = 4.30 [1.16-15.90], P = 0.022), history of bladder problems (OR = 3.84 [1.37-10.76], P = 0.008), and more depression symptoms (OR = 1.07 [1.02-1.12], P = 0.007), with no difference in the Female Sexual Distress Scale. At 6 months posttreatment, women with concurrent deep-superficial dyspareunia improved in the level of dyspareunia pain and in the Female Sexual Distress Scale to the same degree as women with only superficial dyspareunia due to provoked vestibulodynia. Concurrent deep-superficial dyspareunia is reported by almost half of women in a multidisciplinary vulvodynia program. In women with provoked vestibulodynia, concurrent deep-superficial dyspareunia may be related to endometriosis or interstitial cystitis, and is associated with depression and more severe dyspareunia symptoms. Standardized multidisciplinary care is effective for women with concurrent dyspareunia.

The clinical relevance of the effect of ospemifene on symptoms of vulvar and vaginal atrophy

Objectives To explore clinically relevant differences in severity of vulvar and vaginal atrophy (VVA) in postmenopausal women treated with ospemifene compared with placebo.Methods Analysis of two multicenter, randomized, double-blind, 12-week phase-III studies in postmenopausal women (40–80 years, with VVA, treated with ospemifene 60 mg/day or placebo (Study 310 and Study 821)). Severity of vaginal dryness and dyspareunia were evaluated using a four-point scoring system and clinically relevant differences between ospemifene and placebo were analyzed and are presented as improvement (reduction in ≥ 1 unit on four-point scoring system), substantial improvement (reduction in 2–3 units on four-point scoring system) and relief (severity score of mild/none after 12 weeks).Results In Study 310, significantly more women with a most bothersome symptom of dyspareunia had improvement (68.3% vs. 54.1%; p = 0.0255) or relief (57.5% vs. 41.8%; p = 0.0205) in the severity of dyspareunia from baseline to week 12 with ospemifene compared with placebo. For those with a most bothersome symptom of vaginal dryness, significantly more experienced improvement (74.6% vs. 57.7%; p = 0.0101), substantial improvement (42.4% vs. 26.9%; p = 0.0172) and relief (66.1% vs. 49.0%; p = 0.0140) of vaginal dryness from baseline to week 12 with ospemifene compared with placebo. Proportions of women with improvement/substantial improvement/relief of symptoms of vaginal dryness or dyspareunia were similar in Study 821. Clinically relevant differences were noticeable by week 4.Conclusions Treatment with ospemifene was consistently associated with greater improvement, substantial improvement or relief in the severity of the most bothersome symptoms of vaginal dryness or dyspareunia compared with placebo.

Ospemifene: a novel selective estrogen receptor modulator for treatment of dyspareunia.

Ospemifene is a novel, oral selective estrogen receptor modulator that has been approved in the USA for treatment of dyspareunia. The decline in estrogen during menopause creates vulvovaginal changes that can cause symptoms that adversely impact women psychosexually. Many women are reluctant to discuss painful sex and providers must proactively inquire about sexuality issues. Ospemifene has been shown to reverse changes associated with vulvovaginal atrophy and relieve symptoms of dyspareunia. Safety studies of treatment up to 52 weeks have shown ospemifene to be safe with no impact on endometrial hyperplasia/carcinoma, venous thrombotic events or pelvic organ prolapse. Further studies are needed to evaluate its role in bone and breast health.

Pelvic Congestion Syndrome and Pelvic Varicosities

Pelvic venous insufficiency (PVI), defined as retrograde flow in the gonadal and internal iliac veins, is the underlying cause of pelvic congestion syndrome (PCS), a common cause of disabling chronic pelvic pain in women of child-bearing age. PCS is a chronic pain syndrome characterized by positional pelvic pain that is worse in the upright position and is associated with pelvic and vulvar varicosities as well as symptoms of dyspareunia and postcoital pain. Through collaterals to the lower extremity venous system, PVI may also contribute to varicose vein formation and recurrence in the lower extremities. Endovascular embolization of the ovarian and internal iliac veins has become the treatment of choice for PVI and PCS. This article reviews the pelvic retroperitoneal venous anatomy, pathophysiology of PCS, treatment options and techniques, and clinical outcomes of embolotherapy for PCS.

Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy

The aim of this work was to study the role of ospemifene, a novel selective estrogen receptor modulator, in the treatment of vulvar and vaginal atrophy in postmenopausal women with moderate to severe dyspareunia and physiological vaginal changes. This multicenter phase 3 study used a randomized, double-blind, parallel-group design to compare the efficacy, safety, and tolerability of oral ospemifene 60 mg/day versus placebo. A total of 605 women aged 40 to 80 years who self-reported a most bothersome symptom of dyspareunia and had a diagnosis of vulvar and vaginal atrophy were randomized to take a once-daily dose of ospemifene (n = 303) or placebo (n = 302) for 12 weeks. Analysis of the intent-to-treat (n = 605) population found the efficacy of ospemifene to be significantly greater than that of placebo for each of the following coprimary endpoints: percentages of parabasal and superficial cells, vaginal pH, and severity of dyspareunia. With ospemifene, the percentage of parabasal cells and vaginal pH significantly decreased; the percentage of superficial cells significantly increased; and dyspareunia was significantly reduced versus placebo (all P < 0.0001, except for dyspareunia: P = 0.0001). Among the randomized women, 186 (61.4%) in the ospemifene group and 154 (51.0%) in the placebo group reported at least one treatment-emergent adverse event. Hot flushes were the most frequently reported treatment-related adverse event (ospemifene 6.6% vs placebo 3.6%); only one participant discontinued in each group. As determined by the investigators, no serious adverse events related to the study drug were reported. In this study, once-daily oral ospemifene 60 mg was effective for the treatment of vulvar and vaginal atrophy in postmenopausal women with dyspareunia.

Assessing comprehension of clinical research

Background Comprehension and retention of study-related concepts by research subjects are understudied, particularly in certain areas of women's health such as menopausal hormone therapy (MHT). Methods In a multi-center trial of MHT, a 9-item participant comprehension questionnaire (PCQ) tested knowledge of key concerns relating to MHT at two study sites. The PCQ was administered at baseline. At study site1, PCQ was re-administered to assess information retention months later. Multivariable analyses assessed predictors of participant comprehension after adjusting for age, race, education, annual family income (AFI), menopausal symptoms and study site. Results 151 participants ( n = 89 at site I, n = 62 at site II) completed the PCQ at baseline; 71 participants from site I completed the follow-up PCQ. Participant comprehension at baseline was influenced by age, marital status, education, symptom of dyspareunia, season of enrollment and AFI < $40,000. Significant improvement in correct responses was observed at follow-up compared to baseline ( p = 0.02); season and low AFI < $20,000 were predictive of likelihood for correctly answering < 5/9 at follow up. Conclusion Assessing participant comprehension of research-related concepts using a PCQ identifies a need for ongoing reinforcement of relevant details, especially in symptomatic early menopausal women of lower education and income. Improved participant comprehension at follow up is reassuring and reflects success of the research team in communicating study-related concepts to participants enrolled in longitudinal studies.

Early Dyspareunia Experience in Young Women: Confusion, Consequences, and Help‐seeking Barriers

Recurrent painful intercourse or dyspareunia is a highly prevalent health problem associated with impairments in sexual function and psychosocial well-being. Despite its particularly high prevalence in young women, little is known about how young women experience the onset of dyspareunia and how they attempt to manage or address the problem. To explore the subjective experience of early dyspareunia symptoms in young women so as to model its cognitive, emotional, behavioral, and help-seeking trajectory. Using a qualitative methodology broadly based on grounded theory, 14 young women reporting recurrent entry and/or deep pain with intercourse underwent in-depth semistructured interviews asking them to describe their personal experience with dyspareunia symptoms. The Female Sexual Function Index was used to screen women with symptoms of dyspareunia. The main outcome measure was a semistructured interview inquiring about the cognitions and emotions associated with the experience of pain with intercourse, causal attributions for the pain, interference with personal, relational, and sexual well-being, and help-seeking decisions. The model/theory that emerged suggested a sequence of experiences that began with confusion about the onset of pain and a relatively fruitless search for causal attributions. Attempts to self-manage the pain via a number of cognitive and behavioral strategies provided little relief. Deleterious consequences on sexual function, well-being, and relationships ensued, and women reported a number of barriers to help-seeking. The findings from this study suggest that a lack of public health information about dyspareunia and the reluctance of health care providers to inquire about sexual problems may contribute to many young women delaying treatment for a serious sexual health problem with potentially negative biopsychosocial outcomes.

Psychiatric Comorbidity in Women with Chronic Pelvic Pain

Chronic pain syndromes are often treatment refractory and pose an enormous burden of suffering for the individual. Chronic pelvic pain (CPP) is generally defined as noncyclic pain of at least 6 months duration and severe enough to require medical care or cause disability. CPP has been estimated to have a prevalence of 15% among women of reproductive age. Women are at increased risk for both major depression and chronic pain syndromes such as CPP, and are more likely to report antecedent stressful events, have higher rates of physical and sexual abuse, and subsequently develop posttraumatic stress disorder. High rates of sexual and physical abuse and other trauma have been shown among women with CPP, including symptoms of dyspareunia (pain during intercourse), dysmenorrhea (pain during menstruation), and vulvar pain. A detailed and comprehensive evaluation of the patient with CPP should include a thorough gynecologic exam and a full mental health assessment. Treatment of CPP must include an integrated approach targeted at both the psychiatric comorbidity and pain symptoms. A multidisciplinary treatment team offers the best chance for success with CPP, and it is critical to suggest psychiatric treatment (psychopharmacology and/or psychotherapy) in addition to traditional medical and surgical approaches.

The relationship between serum testosterone levels and bladder storage symptoms in a female population with polycystic ovary syndrome

To examine the relationship between bladder symptoms and serum testosterone levels in women with polycystic ovary syndrome (PCOS). A total of 140 patients diagnosed with PCOS according to ESHRE/ASRM criteria in two clinics were evaluated for the effects of testosterone on bladder symptoms. The effect of testosterone on bladder symptoms was quantified by self-administered pelvic pain and urgency/frequency questionnaire (PUFq) and an extra special question performed for urge incontinence. Ultrasonographic bladder capacity and postvoid residual volume were also recorded in all patients. Correlation between serum testosterone level and total, symptom and bother scores of PUFq, score of each question of PUFq separately, and ultrasonographic findings were analyzed. The median (range) age, testosterone, DHEAS, estradiol, glucose, urine pH, urine density, ultrasonographic bladder capacity, and PUFq score were 25 years (17-40), 53 ng/dl (25-229), 258 µg/dl (92-645), 74 pg/ml (20-184), 81 mg/dl (62-128), 5.5 (4.8-7.0), 1.015 (1.001-1.028), 400 ml (100-650), and 2.5 (0-23), respectively. Significant positive correlation was found between serum testosterone level and total, symptom and bother scores of PUFq, symptom of dyspareunia, urgency, nocturia, and bladder/pelvic pain. There was no correlation between serum testosterone level and ultrasonographic findings such as bladder capacity, postvoid residual volume and symptom of frequency. This study indicates that women who have higher serum testosterone level are more likely to report bladder symptoms.