Prevalencia de la infección por el virus del papiloma humano en mujeres con citologías anormales del cérvix uterino y factores de riesgo asociados a la infección

Objectives

To determine the prevalence of human papillomavirus (HPV) infection in women with an abnormal pap smear of the uterine cervix and to determine the risk factors associated with HPV infection.

Subjects and methods

Eighty-one women with a cytological result of atypical cells of unknown origin (ASCUS), low-grade squamous intraepithelial lesions (LG-SIL) or high-grade squamous intraepithelial lesions (HG-SIL) were referred for epidemiological questionnaire, HPV detection performed using the Hybrid Capture II^® test, histological study, and analysis of other sexuallytransmitted diseases.

Results

Cytologic study identified 16 women with ASCUS, 44 with LG-SIL and 21 with HG-SIL. The global prevalence of HPV infection was 67.9% (55 patients) and high-risk HPV (HR-HPV) infection was detected in 50 patients (61.8%). The percentages of HR-HPV infection in women with ASCUS, L-SIL and H-SIL were 31.2%, 63.6% and 80.9%, respectively. The number of sexual partners over a woman’s lifetime was significantly associated with HPV infection (χ² for trend: 4.187; p = 0.0407).

Conclusions

Women with ASCUS detected by cytology are those who could most benefit from HR-HPV detection techniques, because of the lower prevalence of the infection. The main risk factor associated with HPV infection was the number of sexual partners over a woman’s lifetime.     

Prediction of domestic violence against married women in southwestern Turkey

Objective

To determine the prevalence of, and independent risk factors for various domestic violence categories among married women of reproductive age in southwestern Turkey.

Methods

The present cross-sectional study included 260 randomly selected women registered to a family physician in the district of Gönen, Isparta. During home visits between October 1 and December 31, 2012, the women completed a questionnaire that included between four and eight questions for each violence category (physical, verbal, economic, emotional, and sexual) to assess the lifetime presence of domestic violence. Logistic regression models with backward elimination were constructed to define independent risk factors for domestic violence.

Results

In total, 176 (67.7%) women reported any type of domestic violence at least once in their lifetime. Verbal/psychological abuse was the most frequent type (reported by 121 [46.5%] women). Living in a village, young age (19–29 years) of the husband, adolescent age (< 19 years) of the husband at marriage, and problem alcohol use or problem gambling in the partner were independent predictors of domestic violence.

Conclusion

Attention should be given to area of residence, age of both partners at marriage, adolescent marriage, and husband characteristics during screening for domestic violence.     

Assessment of sexual dysfunction and determination of its risk factors in the Republic of Korea

Objective

To assess sexual function among women via self-evaluation of female sexual dysfunction (FSD) and to determine risk factors for FSD among Korean women.

Methods

A preliminary questionnaire-based study in Ansan, Korea, enrolled 935 women between January and December 2010. Participants completed the Female Sexual Function Index and a self-administered survey. Participants were divided into 2 groups: in the recognized group (RG), women were aware of their sexual problems; in the unrecognized group (URG), women were not.

Results

The prevalence of FSD was 46.1% (n = 431). The prevalence of recognized FSD was 21.5% (n = 201), whereas that of unrecognized FSD was 24.6% (n = 230) Younger women showed a significantly more positive attitude toward sex compared with older individuals (P < 0.001). Sexual desire, sexual arousal, dyspareunia, lubrication, and sexual satisfaction were factors of sexual dysfunction in the RG. In the URG, sexual arousal, sexual desire, orgasm, dyspareunia, and sexual satisfaction were identified as significant factors.

Conclusion

Women in the RG had positive attitudes toward sex, whereas those in the URG had negative attitudes. Women who were unsatisfied with their sexual life did not express a need for treatment. The sociocultural background of Korean women should be considered in the diagnosis and treatment of FSD.     

Estudio observacional,transversal, de una muestra representativa de las mujeres españolas en edad fértil,sobre los cuidados,hábitos y promoción de la salud previamente y durante el embarazo: Estudio GESTMUJER

Objective

To identify the use of folic acid and other vitamins in Spanish women of fertile age before and during pregnancy.

Material and method

A representative survey of 1020 Spanish women aged 15 to 49 years was carried out in March 2013.

Results

Only one quarter of Spanish women planned their pregnancies and,as a result, only 28.6% of women took folic acid before becoming pregnant.

Conclusions

There is a lack of information about the role and importance of folic acid to prevent neural tube defects. Institutional campaigns are needed to promote both pregnancy planningand the use of vitamin supplements before and during pregnancy.     

Sexual dysfunction after a first trimester induced abortion in a Chinese population

Objective

To evaluate the short-term effect of a first trimester induced abortion on sexuality in a Chinese population.

Study design

This is a cross-sectional study. One hundred and four women attending the post-abortion clinic 3–4 months after a first trimester induced abortion were recruited. They completed a self-administered questionnaire anonymously. The associations of various factors with sexual behavior after abortion were analyzed by the Chi-square test.

Results

More than 30% of the women reported a reduction in both frequency of vaginal intercourse and sexual desire. Their partners also had a reduction in sexual desire. The reduction of vaginal intercourse is more significant among young, unmarried women and those not having sterilization (P = 0.01). In addition, the prevalence of reduction in sexual desire and enjoyment among those women who had repeated abortion was significantly higher (P < 0.01).

Conclusion

The sexuality of both women and their partners are affected after abortion. It may be due to both psychological trauma and the worry of another unwanted pregnancy. Proper counseling may relieve their anxiety and improve sexual lives.     

Women's quality of life and sexual function after transvaginal anterior repair with mesh insertion

Objective

Current evidence about the impact of pelvic floor surgery on sexual function is conflicting. Only a few studies have reported with validated questionnaires on sexual function after transvaginal mesh repair, with a discrepancy in reported outcomes. The aim of this study was to prospectively explore the impact of anterior repair (AR) with mesh insertion on sexual function, quality of life and dyspareunia.

Study design

69 women with symptomatic stage II or greater prolapse exclusively of the anterior compartment participated in a prospective study on safety and efficacy of two mesh implantation techniques for anterior vaginal wall prolapse repair between September 2007 and May 2009. They were invited to complete the validated condition-specific short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and quality of life (QoL) questionnaires (Pelvic Organ Prolapse (POP) Distress Inventory (POPDI), Urinary Distress Inventory (UDI), POP Impact Questionnaire (POPIQ), and Urinary Impact Questionnaire (UIQ)) pre-operatively and 6 months post-operatively. All data were processed and analyzed in Statistical Computing Environment R, version 2.9.1.

Results

A significant decrease of Qol scores and a significant increase of PISQ-12 scores occurred after surgery. All sexually active women resumed sexual activity postoperatively. The majority of non-sexually active women remained sexually inactive. Postoperatively the frequency of pain during intercourse increased in 31% of cases and decreased or stayed unchanged in 69% of cases. The incidence of de novo dyspareunia after mesh repair was 4% while the incidence of dyspareunia slightly increased from 25% to 29% postoperatively.

Conclusions

The results of this study suggest no deterioration in sexual function, a significant improvement in quality of life and a low incidence of de novo dyspareunia six months after AR with mesh insertion. Despite these findings, the majority of non-sexually active women remain sexually inactive postoperatively. These conclusions should be confirmed in a longer follow-up.     

Psychiatric evaluation of women who were assisted at a university referral center in Campinas,Brazil, following an experience of sexual violence

Objective

To present the sociodemographic characteristics and psychiatric symptoms of women who have been raped.

Methods

Between 2006 and 2010, a retrospective study was conducted of 468 women who underwent psychiatric evaluation at a university referral center in Brazil after an experience of sexual violence.

Results

The women had a mean age of 24.1 years; were predominantly white, unmarried, childless, and employed; had 9–11 years of education; and had a religion. Rape was the first sexual intercourse for 124 (26.8%) of 462 for whom data were available; 53 (13.6%) of 389 had a personal history of sexual violence and 29 (8.0%) of 361 had a family history. No psychiatric symptoms were reported in 146 (32.9%) of 444 women, mild/short-term symptoms were reported in 107 (24.1%), and a psychiatric diagnosis was made for 191 (43.0%). Psychiatric comorbidity was seen in 59 (12.6%) women, and 174 (38.0%) received pharmacologic treatment. All follow-up consultations were attended by 215 (45.9%) of 468 women; 166 (35.5%) attended some, and 87 (18.6%) attended only one during the 6-month follow-up period.

Conclusion

The frequency and severity of psychiatric symptoms and mental disorders among women who have been raped highlights the importance of mental health monitoring.     

Transvaginal Prolift mesh surgery due to advanced pelvic organ prolapse does not impair female sexual function: a prospective study

Objectives

To evaluate sexual function among women with advanced pelvic organ prolapse (POP) before and after Prolift^® vaginal reconstructive mesh surgery.

Study design

Assessments were performed preoperatively and 12–18 months after the surgery, including physical examination using the Pelvic Organ Prolapse Quantification (POP-Q) scale as well as the Female Sexual Function Index (FSFI) questionnaire.

Results

Fifty-nine sexually active patients who underwent vaginal reconstructive surgery due to advanced POP between June 2008 and January 2010 were included in the study. Analysis of the FSFI questionnaire showed no statistically significant differences after surgery, despite proper anatomical results. When comparing the group of women who underwent additional surgical restoration of the perineal body with patients without this procedure we also did not observe any differences in FSFI scores.

Conclusions

Surgical treatment of advanced POP with the Prolift^® system does not negatively influence sexual function, but patients should not expect a significant improvement after this type of operation. Additionally performed surgical restoration of perineal body does not reduce sexual function, either.     

Assessment of female sexual function among women with pelvic organ prolapse or urinary incontinence via an Arabic validated short-form sexual questionnaire

Objective

To assess female sexual function among women with pelvic organ prolapse or urinary incontinence via an Arabic, validated, short-form sexual questionnaire (PISQ-12).

Methods

The present study was conducted among women attending Suez Canal University Hospital, Ismailia, Egypt, between September 2009 and August 2011. In the pilot study, 42 women completed the final version of the Arabic PISQ-12 at recruitment and then 2 weeks later, and the data were compared to evaluate reliability and internal consistency. The formal comparative study included 154 premenopausal sexually active women: 80 control women, and 74 women with some degree of pelvic prolapse with or without stress incontinence. All participants had a vaginal examination and completed the questionnaire. The main outcome measures were the mean questionnaire scores within its 3 domains (behavioral, physical, and partner-related).

Results

The test–retest reliability and internal consistency of the Arabic PISQ-12 were excellent. Validity was approved by an expert panel. The case group had a significantly lower mean total questionnaire score (31.07 ± 4.2 vs 34.7 ± 6.2; P < 0.05) but a higher partner-related score (9.0 ± 2.4 vs 8.4 ± 2.5; P < 0.05).

Conclusion

The Arabic version of PISQ-12 was shown to be an effective and objective method of evaluating sexual function among patients with pelvic organ prolapse.     

Coerced sexual debut and lifetime abortion attempts among women in Rakai, Uganda

Objective

To assess whether reported coercion at sexual debut is associated with a greater lifetime risk of attempting an abortion among women in Rakai, Uganda.

Methods

Analysis of data from sexually experienced, ever-pregnant women in a longitudinal, population-based, open cohort study in 56 rural communities in Rakai, Uganda (n = 4784). For univariate analysis, the t test was used for continuous variables and the Pearson χ² or Fisher exact tests for categorical variables. Multivariate logistic regression was used to control for potential confounding.

Results

Twenty percent of women reported coercion at sexual debut. Compared with women who reported consensual sexual debut, the adjusted odds ratio (OR) of subsequent abortion attempts among coerced women was 1.57 (95% CI, 1.11-2.20).

Conclusion

There is a need to protect women from sexual coercion, implement policies for prevention of violence, and provide comprehensive reproductive health care, including prevention of unwanted pregnancy and unsafe abortions.     

La juventud española y el doble método: un análisis de la situación actual. Resultados de un estudio transversal de una muestra amplia

Objectives

To determine the percentage of Spanish 15-24-year-olds of both sexes that use or know about the double method.

Material and methods

We performed a cross-sectional study in March 2005 through a national survey of a sample of 2015 Spanish 15-24-year-olds. The data were collected in a database specifically designed for the study and were analyzed using the SPSS statistical system.

Results

Seventy percent of the 15-24-year-olds were sexually active. The most widely used contraceptive method was the condom. Only 3.4% of males and 7.3% of females had ever used the double method and this percentage decreased to 0.2% and 2.9%, respectively, in the last sexual relationship. Thirty-one percent of males and 36.8% of females were aware of the double method.

Conclusions

Use and knowledge of the double method are low among young Spaniards.     

Eligibility and willingness of first-year students entering university to participate in a HPV vaccination catch-up program

Objectives

In France, human papillomavirus (HPV) vaccine is routinely recommended for 14-year-old girls; a catch-up vaccination should be offered to girls and women 15–23 years of age before the first time they have sex or within the first year after sexual activity begins. The aim of the present study was to examine the eligibility and willingness of first-year college students of Toulouse University (France) to participate in a HPV vaccination catch-up program, and to estimate their knowledge of HPV vaccination and cervical cancer screening.

Study design

The study was conducted from January to April 2008 simultaneously at the three university medical centres (Science, Literature-Psychology, Law-Social Sciences). Female students entering the University were asked to complete an anonymous questionnaire at the time of their preventive medical visit. The questionnaire included questions on demographics, knowledge about HPV vaccination, sexual behaviour, and willingness to participate in the French vaccination program.

Results

In total, 606 women from the 3 colleges were included. The response rate of the questionnaire was 93.1%. The median age of participants was 19 and 8.3% of them had already been vaccinated. Of the respondents, 67.2% were sexually experienced and 25.3% of sexually experienced students had their first intercourse less than 1 year prior. Knowledge of HPV infections, associated diseases, and prevention was limited, a finding that indicates the need to pursue educational campaigns. Among respondents, 42.7% were eligible for catch-up vaccination, and 64.1% of them were willing to be vaccinated. We did not observe significant differences among the three colleges.

Conclusions

First-year college preventive consultation is an opportunity to vaccinate near 43% of women according to French recommendations. Improved education about HPV-related diseases and their prevention is needed.     

La práctica de “descansos” en el uso de anticoncepción hormonal oral en España. Resultados de cuatro encuestas de ámbito nacional

Objective

To investigate whether Spanish women taking oral contraceptives have pill-free intervals.

Subjects and method

Four national surveys were performed at 2-yearly intervals between 1997 and2003. The number of women aged between 15 and 49 years who were surveyed ranged from 2,076 in 1997 to 2,218 in 2001. Information was obtained from personal interviews.

Results

In 1997, 42% of pill users reported pillfree intervals compared with 37% in 2003. More than 60% of these women reported that these intervals were recommended by a doctor.

Conclusions

A training strategy should be devised, aimed at both health professionals and users of hormonal contraceptives, that would eradicate this incorrect practice.     

Epidemiología de las lesiones precancerosas y verrugas genitales asociadas a infección por virus del papiloma humano en España

Objective

The objective of this study was to estimate the number of cytologies and diagnoses of cervical intraepithelial neoplasia (CIN) and genital warts performed annually in Spain.

Material and methods

Two cross-sectional studies based on retrospective data were conducted among a sample of gynaecologists, urologists and dermatologists in 6 Autonomous Regions considered to be representative of the Spanish population. Study data were extrapolated to the general population, taking into account the age and sex distribution of the Spanish population.

Results

Based on the study results, the estimated number of cases of genital warts that occur annually in Spain was 56,400. It was, also, estimated that 7.6 million cytologies were performed annually in Spain and that 40,530, 26,243 and 28,423 women are annually diagnosed with CIN 1, CIN 2 and CIN 3, respectively.

Conclusions

Lesions related to human papilloma virus (HPV) infection cause substancial morbidity burden in Spain.     

Between life and death: women's experiences of coming close to death, and surviving a severe postpartum haemorrhage and emergency hysterectomy

Objective

to describe women’s experiences of having an emergency hysterectomy following a severe postpartum haemorrhage.

Design

a qualitative research approach was used to guide this study. Data were collected through semi-structured, tape recorded face to face, email internet and telephone interviews.

Setting

three States in Australia: New South Wales, Victoria and Western Australia.

Participants

twenty-one Australian women who experienced a severe post partum followed by an emergency hysterectomy participated in the study. The median age of participants at time of interview was 42 years and the median time since having the hysterectomy was four years.

Findings

a process of inductive analysis revealed the major theme, ‘between life and death’ and three sub-themes, ‘being close to death: bleeding and fear’, ‘having a hysterectomy: devastation and realisation’ and ‘reliving the trauma: flashbacks and memories’.

Conclusion

formulating a plan of care for women identifiably at risk of PPH and ensuring appropriate follow-up counselling is made, is key to help reduce the emotional and psychological symptoms experienced by these women in the aftermath of severe postpartum haemorrhage and hysterectomy.     

Evaluation of confounding factors interfering with sexual function in women with minimal pelvic organ prolapse

Objective

To evaluate the effects of confounding factors on sexual function in women with minimal pelvic organ prolapse (POP).

Methods

A cross-sectional study was conducted at a cervical cancer screening center in Turkey between December 1, 2012, and March 31, 2013. Symptom-free women with stage I or II POP were enrolled to evaluate the association between sexual function and sociodemographic variables, POP, POP-related quality of life, stress incontinence, and overactive bladder.

Results

Of 243 volunteers (mean age 46.0 ± 9.1 years), 188 (77.4%) had a low Female Sexual Function Index score. Women with better sexual function tended to be younger, have a higher salary, not be in the menopause, and have no chronic illness (P < 0.05 for all). There was no difference between the groups in terms of POP Quantification measurements (P > 0.05), apart from transvaginal length (P = 0.011). Overactive bladder was more common (P = 0.005) and more severe (P = 0.002) in women with sexual dysfunction, and their POP-related quality of life was worse (P < 0.05). In a linear regression analysis, high salary had a positive effect and overactive bladder had a negative effect on sexual function.

Conclusion

Sexual dysfunction is highly prevalent in women with minimal POP. Overactive bladder and low income are the major factors adversely affecting sexual function.