Women Attending Gynaecology Clinics Research Articles

Predictive models of endometriosis: towards a screening assessment tool to prioritise women for surgery

Endometriosis is difficult to diagnose clinically due to its many potentially associated symptoms. We generated and externally validated symptom-based models to clinically predict a diagnosis of endometriosis using data from a prospective study of women attending gynecology clinics worldwide - the Women's Health Symptom Survey (WHSS).

Current thoughts on psychosexual disorders in women

Key content The importance of responsive desire in women, triggered by physical and mental arousal rather than spontaneous desire, is now acknowledged. A review of the DSM‐IV classification of sexual dysfunction in 1999 led to retention of the categories of desire, arousal, orgasmic and pain disorder and were expanded to include physical, as well as psychological, causes. A new diagnosis of non‐coital pain disorder was also suggested. Historically, pain syndromes are categorised as dyspareunia or vaginismus, but they often overlap. Management of psychosexual disorders requires an understanding of psychosexual function and an ability to communicate about sexual matters. Learning objectives To gain an understanding of the complexities of the female sexual response and psychosexual problems. To understand that sexual problems are common in women attending gynaecology clinics. To be more willing to communicate with patients about sexual matters. Ethical issues The sensitive nature of sexual problems raises the dilemma of how to talk to women about significant events without causing further trauma. Please cite this article as: Coulson C, Crowley T. Current thoughts on psychosexual disorders in women. The Obstetrician & Gynaecologist 2007;9:217–222.

A Study of Body Mass Index (BMI) of Nepalese Women attending Gynaecology Clinic

This prospective study was carried out to find out the body mass index (BMI) of all the women attending a gynaecological clinic at Kathmandu Valley. Total of 1450 women attended this clinic over the study period. After excluding few hundreds of women, one thousand women of reproductive age (15-49) were enrolled. Detail history was taken, general, systemic and pelvic examinations were performed and a provisional diagnosis was made on the clinical ground. In this process height and weight of each patient was measured then Body Mass Index (BMI) was calculated. Eight percent (8%) of women were underweight and equal numbers of them were obese too. Forty-four point six percent were healthy and 37.3 were overweight. Most of them were diagnosed vaginitis, urinary tract infection (UTI), pelvic inflammatory disease (PID), subfertility, menstrual disorders, and cervical conditions. In eleven percent no gynaecological abnormalities were detected (NAD). Commonly diagnosed conditions were vaginitis, UTI, PID, primary subfertility and menstrual disorders were the commonly diagnosed conditions.

Detection of Mycoplasma genitalium in female cervical samples by Multitarget Real-Time PCR

Mycoplasma genitalum (MG) is associated with variety of urogenital infections such as nongonococcal urethritis (NGU), endometritis and cervicitis. The objective of this study was to demonstrate and evaluate a research polymerase chain reaction (PCR) assay, for the detection of MG in cervical samples of a tested population of women attending gynecology clinics in Bosnia and Herzegovina. The Multitarget Real-Time (MTRT) PCR, utilizing the ABI 7900HT, the sequence detection system, was performed for the detection of MG. Cervical samples (N=97) from females were divided into three types of patient groups: Group 1: patients who had known abnormal clinical cytology reports (N=34); Group 2: patients who reported a history of genitourinary infections (N=22); and Group 3: patients not in either groups 1 or 2 (N=41). Overall, 14,43% (14/97) of those tested were positive for MG. A positive sample was defined as having a cycle threshold cross point (Ct) < 40,0 with a fluorescent detection comparable to the low positive control utilized during the run. This study validated the use of MTRT PCR as a reliable method for the detection of MG in clinical specimens and should facilitate large-scale screening for this organism.

Incontinence during sexual intercourse

Urinary incontinence, the involuntary leakage of urine, is a distressing symptom causing embarrassment and impairing quality of life. When occurring during intercourse, it can lead to the disruption of relationships. Studies have shown that up to 43% of women attending gynaecology clinics complain of a degree of sexual dysfunction when specifically asked. One of the causes is intercourse incontinence, which has been shown to affect up to 25% of women presenting with incontinence. Due to the embarrassing nature of the symptom, patients rarely volunteer it as a symptom, hence stressing the importance of doctors incorporating questions into their history taking. Leakage of urine can occur at different stages of sexual intercourse, namely on arousal, on penetration of the vagina and on achievement of orgasm. Studies have shown that there is a correlation between the urodynamic diagnosis and the stage of intercourse when this occurs. Women with detrusor overactivity tend to leak at orgasm whereas women with urodynamic stress incontinence tend to leak on vaginal penetration. There is, however, no underlying proven theory and despite these associations, laboratory studies have failed to show any cystometric differences. Management of these patients would include a careful history, physical examination and a set of investigations trying to find out the underlying cause. Treatment is difficult as these specific symptoms often do not response to conventional methods of treatment.

The illness experiences of women with fibroids: An exploratory qualitative study

Previous research suggests that women attending gynaecology clinics experience high rates of psychological distress and psychiatric morbidity. Although the reasons for this are poorly understood, certain conditions appear to cause women particularly high levels of anxiety and depression. This paper reports a qualitative study, using Interpretative Phenomenological Analysis (IPA), to examine the illness experiences of women with the common gynaecological condition of fibroids. The study employs semi-structured interviews, guided by Leventhal's self-regulation model, to explore 18 women's understanding and experiences of having fibroids. Qualitative analysis revealed eight themes drawn into two higher-order themes - 'Managing uncertainty' and 'Struggling between defeat and optimism'. These higher-order themes illustrate the multiplicity of experiences and meanings used by women attempting to understand their condition, treatment options and future health outcomes. The differences in women's illness representations may account for differences in their relative distress levels. The findings indicate the importance of considering an individual's illness representations in order to facilitate the provision of appropriate medical and psychological care to women with fibroids.

The association of gynecological symptoms with psychological distress in women of reproductive age: a survey from gynecology clinics in Beirut, Lebanon

To date there has been no previous research into a possible association between psychological distress and gynecologic symptoms in the Arab world. We hypothesized that psychological distress would be associated with specific gynecologic complaints as well as with psychosocial factors.We conducted a cross-sectional study of women attending gynecology clinics in Beirut, Lebanon. The study sample consisted of 355 women aged 18 to 49 years who were seeking healthcare from gynecologists affiliated with two general teaching hospitals in Beirut. Psychological distress was assessed using the General Health Questionnaire (GHQ). Gynecologic complaints were assessed by asking women about presenting gynecologic symptoms.Women who visited the gynecologists for specific complaints, for post-surgical follow-up, or for insertion of coils or other services were more likely to be distressed than women who were attending for a general checkup (χ2 = 9.466, p = 0.024). About 50% of women who reported abdominal pain or breast pain also reported significant psychological distress. Only bleeding and infertility were not significantly associated with psychological distress.It is concluded that a high proportion of women who attend gynecology clinics with specific complaints report psychological distress. Our findings highlight the importance of considering the psychological component of gynecological morbidity.

Jordanian women's attitudes towards cervical screening and cervical cancer

This paper looks at Jordanian women's attitudes towards cervical screening and cervical cancer. The sample consisted of 600 women attending gynaecology clinics at King Hussein Medical Centre, Amman, Jordan. Seventy-five per cent of women had never had a smear before; however, the majority agreed that it is important; 34·5% of women did not know the significance of a positive cervical smear; 77% of women were not aware of causes of cervical cancer. Finally, when asked who would they like to take their cervical smear test, a clear preference was stated for a female doctor or a female nurse. These findings provide a useful background for developing strategies to increase the uptake of cervical smears among Jordanian women. It also emphasises the need to educate and promote awareness of women to risk factors for cervical cancer and to the need for screening programmes.

Hepatitis B and C infections, human immunodeficiency virus and other sexually transmitted infections among women of childbearing age in Côte d'Ivoire, West Africa

Few studies have been conducted in developing countries to estimate the prevalence of hepatitis C virus (HCV) infection and its association with human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). We have screened for hepatitis B virus (HBV) and HCV markers 200 HIV-1-positive, 23 HIV-2-positive and 206 HIV-negative women attending gynaecology clinics in 1995/96 in Abidjan, Côte d'Ivoire, a sample selected among 2198 consecutive consultants. Taking into account the prevalence of 21·7% for HIV in this population, the overall prevalence of anti-HBV core antibody was 81·6%, that for hepatitis B surface antigen was 9·9% and for HCV antibody was 3·3%. HIV infection and other STDs were not associated with HBV or HCV markers. Moreover, HBV and HCV markers were not statistically associated. Our results confirm the high prevalence of HIV in Abidjan and the endemic situation of HBV infection. Furthermore, HCV infection is not infrequent in this developing country setting, not explained by sexual transmission.

Cytological studies in women complaining of leucorrhea

Cytological evaluation of cervical smears has been carried out in 1675 women attending Gynaecology clinic of Queen Mary's Hospital, Lucknow (January 1981 - December 1995) with complaint of vaginal discharge. This was performed to investigate the incidence of cervical cytopathology and associated infections of sexually transmitted diseases in patients with leucorrhea. As expected, maximum number of cervical smears were found to be inflammatory (57.4%). Cervical dysplasia was seen in 81 cases (4.8%) while malignant cells were detected in 2 cases (0.1 %). Trichomona! infection was associated with maximum number of patients with leucorrhea (8.1%) followed by Candida (2.3%). Among viral infections, cytomorphological changes suggestive of Condyloma was seen in 1.1% and that of Herpes simplex in 0.3% of cases. Concomittant presence of cervical dysplasia and sexually transmitted diseases (STDs) was seen in 16.6% of cases with Herpes, 11.1% of condyloma and 0.3% of Trichomonas infections. The incidence of dysplasia showed rise with increasing age and parity. The study highlights the need for Cytological screening of all symptomatic women complaining of discharge and ascertains the utility of cytology in picking up early cervical cancer and associated causative pathogens in patients with leucorrhea.

A PSYCHIATRIC STUDY OF IDIOPATHIC OEDEMA

Twenty-five women with idiopathic oedema and twenty-five women attending gynaecology clinics were assessed by means of a standardised psychiatric interview, an interview on dietary habits, and a specially designed interview on current health. The patients with idiopathic oedema were significantly more depressed and anxious, with a trend towards widespread neurotic symptoms. There was no evidence that diuretic or laxative abuse is an important aetiological factor. In many patients with idiopathic oedema excessive fluid retention may be related to the neuroendocrine abnormalities associated with psychiatric illness.

The internal structure of the McGill pain questionnaire in dysmenorrhoea patients

The McGill pain questionnaire (MPQ) was administered to 166 women attending Gynaecology Clinics complaining of dysmenorrhoea. Responses were subjected to factor analysis with 4 dimensions emerging. These reflected sensory qualities of the pain experience and factors related to the reaction component of the pain. These results are considered in relation to factorial analysis of the MPQ among back patients and in terms of treatment implications.

Knowledge and attitude of women on genital cosmetic surgery at University College Hospital, Ibadan, Nigeria.

Female genital cosmetic surgery (FGCS) is performed in other to restore or enhance the female genitalia. This is a cross-sectional study assessing the knowledge and attitude of 310 women attending gynaecology clinic towards FGCS at University College Hospital, Ibadan, Nigeria. Data were analysed using SPSS 20. Mean age of respondents was 33.28 ± 7.68 years. Majority were married (76.1%) in monogamous family (87.7%) and almost half (49.7%) were multipara. About 56.1% had vaginal delivery of which 84.5% had perineal tear or/and episiotomy. Overall, 27.7% had heard about FGCS and 84.2% had positive attitude towards the procedure. Respondents' age, marital status and occupation were associated with their knowledge and attitude to FGCS. Women with skilled occupation were more likely to have the knowledge and positive attitude to FGCS. The knowledge of FGCS was low; however, majority had positive attitude towards it because of its associated sexual and psychological satisfaction.