Contributions of physical and sexual abuse to women's experiences with chronic pelvic pain

OBJECTIVE: To examine the roles of physical and sexual abuse in women with chronic pelvic pain using multi-dimensional pain assessment and to compare the chronic pelvic pain experiences of women with physical abuse to those of women with sexual abuse. STUDY DESIGN: Structured questionnaires were used to measure self-reported abuse, pain severity, psychological distress, physical functioning, interpersonalfunctioning, and coping in 63 women attending a tertiary care gynecologic clinic for diagnosis and treatment of chronic pelvic pain. RESULTS: Women with chronic pelvic pain who reported abuse demonstrated significantly more psychological distress than did women who reported no abuse, but there were no differences in pain severity, physical functioning, interpersonal functioning or coping. Women with physical abuse reported more overall psychological distress, depression, anxiety and somatization than women who reported no physical abuse. Women who reported sexual abuse showed more overall psychological distress and anxiety than women who reported no sexual abuse. While physical abuse was more consistently associated with psychological distress than was sexual abuse, both types of abuse were risk factors for distress. CONCLUSION: These results suggest that both physical and sexual abuse are associated with psychological distress in women with chronic pelvic pain but not with other domains of pain experience. Additional research to improve identification and treatment of women with both chronic pelvic pain and abuse is indicated.     

A comparative study of women with chronic pelvic pain, chronic nonpelvic pain and those with no history of pain attending general practitioners

Objective To investigate and compare the demographic and psychosocial profiles of women with chronic pelvic pain, chronic pain in a different site, and those with no history of pain with specific reference to a history of sexual abuse.
Design A prospective comparative study.
Setting Pelvic Pain Clinic at Leicester General Hospital NHS Trust, Pain Management Clinic at Leicester Royal Infirmary NHS Trust and two General Practices.
Participants Thirty women with chronic pelvic pain, 30 women with chronic pain in a different site and 30 women attending their general practitioner with no history of pain.
Interventions A specifically designed patient profile questionnaire to identify and explore incidents of sexual and physical abuse was administered to each woman by a research psychologist for confidential self-completion. Data were also collected on other demographic, medical and psychosocial characteristics.
Results Women with chronic pelvic pain were found to have a higher lifetime prevalence of sexual abuse, involving penetration or other genital contact compared with the two comparison groups. The prevalence of physical abuse was the same in all groups. Women in the pelvic pain group were more likely to have approached their GP for symptoms not related to pelvic pain than women in the other two groups and the incidence of clinical anxiety was significantly higher in this group compared with the pain-free group. The prevalence of sexual problems was much higher in the group with pelvic pain compared with the other two groups.
Conclusion These findings indicate that women with chronic pelvic pain have a higher incidence of past sexual abuse compared with women in a comparison pain group and with women with no pain.     

Psychosocial and sexual functioning in women with vulvodynia and chronic pelvic pain. A comparative evaluation

OBJECTIVE: To determine whether women with vulvodynia differ from women with chronic pelvic pain and normal controls in their psychological functioning, somatic preoccupation, pain experience and sexual functioning. STUDY DESIGN: Cross-sectional, self-report study of women presenting to University of Michigan specialty and general clinics for the treatment of vulvodynia or chronic pelvic pain or seeking a routine gynecologic examination. All subjects completed questionnaires assessing demographic characteristics, pain, depressive symptoms, general affective state, marital adjustment, functional activity, somatic complaints, exposures, and medical and sexual history. Univariate analyses, chi 2 tests, analyses of variance and logistic regression were used to assess associations between these variables and the diagnostic category. RESULTS: Women with vulvodynia (n = 31) were similar to asymptomatic control women (n = 23) in demographic characteristics, sexual relationship variables, sexual behaviors, current and past depression, somatic sensitivity, and history of sexual or physical abuse. Women with chronic pelvic pain (n = 18) were younger and less educated than the other two groups and were more likely to have a history of physical and sexual abuse, to report recent depression and to screen positive for current depression, to have more work absences and to have more somatic complaints. CONCLUSION: Women with vulvodynia are psychologically similar to control women but differ significantly from women with chronic pelvic pain. A primary psychological cause of vulvodynia is not supported.     

Chronic pelvic pain and previous sexual abuse

OBJECTIVE: To determine whether there is an association between history of sexual abuse and development of chronic pelvic pain. METHODS: We studied 36 women with chronic pelvic pain, 23 with chronic low back pain, and 20 healthy women with reference to experience of sexual abuse, physical violence, and emotional neglect in childhood. Semistructured interviews were used to collect data. Assessment of severity of sexual abuse was based on Russell's criteria, and emotional and physical abuse were determined according to Briere's and Adler's definitions, respectively. RESULTS: In terms of experience of sexual abuse in general, the three groups did not differ statistically significantly from each other (P =.128). However, 22% of patients with chronic pelvic pain were sexually abused before their 15th birthdays, significantly more frequently than the other two groups (chronic low back pain 0%, P =.019, pain-free control 0%, P =.028). Women with chronic pelvic pain were exposed more frequently to physical violence (38%) and suffered more emotional neglect (25%) in their childhoods than women in the pain-free control group (physical abuse 5%, P =.012; emotional abuse 0%, P =.018). With regard to physical abuse and emotional neglect, the women with chronic pelvic pain did not differ from those with chronic low back pain (physical abuse 30.4%, P =.385; emotional abuse 21.7%, P =.571). CONCLUSION: Besides physical and emotional trauma, there is a significant association between sexual victimization before age 15 years and later chronic pelvic pain.     

The association between chronic pelvic pain, psychiatric diagnoses, and childhood sexual abuse

Twenty-five women with chronic pelvic pain who had undergone diagnostic laparoscopy and 30 women who had laparoscopic examinations for tubal sterilization or infertility investigation were compared psychologically using structured psychiatric and sexual abuse interviews. Results of the fiberoptic pelvic examination were rated independently using the American Fertility Society classification of endometriosis. Compared with controls, the patients with chronic pelvic pain showed significantly greater prevalence of lifetime major depression, current major depression, lifetime substance abuse, adult sexual dysfunction, and somatization. They were also significantly more likely than controls to have been a victim of childhood and adult sexual abuse. There were no significant differences in either the degree or type of pelvic disease between patients with pelvic pain and controls.     

ORIGINAL RESEARCH—PAIN: Sexual Functioning in Women with Chronic Pelvic Pain: The Role of Anxiety and Depression

IntroductionChronic pelvic pain (CPP) in women is a long lasting and often disabling condition. It seems reasonable to expect that as a result of the pain, extreme fatigue and/or emotional problems, women with CPP may report a variety of sexual problems.AimThe present study investigated differences in the report of sexual problems in women with CPP compared with healthy controls, and whether the association of CPP with sexual problems was moderated or mediated by somatic and psychological factors as manifested in women suffering from CPP.MethodOne hundred fifty-four women with CPP and 58 age-matched controls completed self-report measures for sexual functioning, pain, physical impairment, anxiety, depression, and sexual and physical abuse.Main Outcome MeasureGolombok Rust Inventory of Sexual Satisfaction.ResultsWomen with CPP reported higher levels of vaginistic complaints, sexual avoidance, nonsensuality and sexual dissatisfaction than healthy controls. Sexual problems were associated with anxiety, depression, and sexual abuse history but not with somatic factors as pain and physical impairment. Anxiety as well as depression, irrespective of the report of sexual abuse experiences, mediated the effect of CPP on sexual problems. Sexual abuse was a general predictor of sexual problems in both women with CPP and controls.ConclusionsAnxiety and depression constitute important factors in the evaluation of sexual problems in women with CPP. ter Kuile MM, Weijenborg PTM, and Spinhoven P. Sexual functioning in women with chronic pelvic pain: The role of anxiety and depression.     

Incidence and Risk Factors for Pelvic Pain After Mesh Implant Surgery for the Treatment of Pelvic Floor Disorders

Study Objective

Our aim was to assess incidence and risk factors for pelvic pain after pelvic mesh implantation.

History of physical and sexual abuse in women with chronic pelvic pain

The history of physical and sexual abuse in childhood and adulthood was assessed in 31 women with chronic pelvic pain, 142 women with chronic pain in other locations, and 32 controls. Thirty-nine percent of patients with chronic pelvic pain had been physically abused in childhood. This percentage was significantly greater than that observed in other chronic-pain patients (18.4%) or controls (9.4%), though the prevalence of childhood sexual abuse did not differ among the groups (19.4, 16.3, and 12.5%, respectively). Abuse in adulthood was less common and was not significantly more likely to have occurred in patients with chronic pelvic pain than in other chronic-pain patients or controls. These data suggest that pelvic pain is unlikely to be specifically and psychodynamically related to sexual abuse but that the pernicious nature of abuse, whether physical or sexual, may promote the chronicity of painful conditions.     

Sexual problems of women with chronic pelvic pain

Eighty-one women with chronic pelvic pain caused by a gynaecological abnormality (group 1) were compared with 81 women with chronic pelvic pain without a demonstrable gynaecological disease (group II). A control group of 46 pain-free women was included (group III). All patients were tested on the Sexual Experience Scale (SES). Women from group I and group II did not differ significantly on the four subscales of the SES. There was, however, a significant difference when groups I and II were compared with group III, regarding the SES scores. From these results it can be concluded that patients with chronic pelvic pain have more sexual problems compared with pain-free patients. A model for practical work in the outpatient clinic has been constructed and introduced.     

A history of sexual abuse and health: a Nordic multicentre study

OBJECTIVES: To determine if a history of sexual abuse is associated with objective and subjective indicators of health and if certain abusive incidents had a stronger impact on health than others. DESIGN: A cross-sectional, multicentre study. SETTING: Five gynaecological departments in the five Nordic countries. SAMPLE: Three thousand five hundred and thirty-nine gynaecology patients. METHODS: The NorVold Abuse Questionnaire (NorAQ) on abuse history and current health was mailed to all patients who consented to participate. MAIN OUTCOME MEASURES: Reason for index visit at the gynaeocological clinic as well as several questions on health were recorded. General health status was measured as self-estimated health, psychosomatic symptoms (headache, abdominal pain, muscle, weakness, dizziness), number of health care visits and number of periods on sick leave. RESULT: A history of sexual abuse was reported by 20.7% of respondents. A history of sexual abuse was significantly associated with chronic pelvic pain as reason for index visit (P < 0.01), laparoscopic surgery (P < 0.01), psychosomatic symptoms (P < 0.01), self-estimated poor health (P < 0.01), many health care visits (P < 0.01) and high incidence of sick leave (P < 0.01). Several subgroups within the group of sexually abused women were more likely to report poor health: women abused as both children and adults, women who experienced additional emotional and/or physical abuse and women abused by a person they knew. CONCLUSION: Sexual abuse has a profound impact on women's health. Taking a history of sexual abuse seems particularly warranted when the patient presents with chronic pelvic pain or symptoms of a vague and diffuse nature.     

Pain Characteristics,Psychosocial Wellbeing,and Sexual Wellbeing of Women Diagnosed With Provoked Vestibulodynia and a History of Sexual Abuse

ObjectiveProvoked vestibulodynia (PVD) is a common chronic pain condition characterized by pain at the vulvar vestibule elicited by touch. Both PVD and sexual abuse lead to negative psychosocial and sexual consequences. However, little is known about the wellbeing of women with PVD and a history of sexual abuse. The aim of this study was to characterize a sample of women seeking treatment for PVD who have experienced sexual abuse.MethodsA total of 404 women diagnosed with PVD completed self-report questionnaires of PVD symptoms and psychosocial and sexual wellbeing before and after participating in a multidisciplinary PVD treatment program. History of sexual abuse was assessed via self-report, and women were dichotomized into groups.ResultsNo significant differences were found on sociodemographic variables, baseline psychosocial or sexual functioning between women with and without a self-reported history of sexual abuse (n = 40 and n = 364, respectively). Significantly more women with a history of sexual abuse than without reported other comorbid chronic pain conditions and radiating PVD pain. History of sexual abuse did not affect improvements in sexual distress scores following multidisciplinary treatment for their PVD.ConclusionTen percent of women in our sample self-reported a history of sexual abuse, but the two groups did not differ significantly with respect to their baseline psychosocial or sexual functioning concerns, and both groups reported reductions in sexual distress following treatment for PVD. These findings indicate that a history of sexual abuse does not significantly affect the efficacy of multidisciplinary treatment approaches for PVD.     

Sexual behavior and findings on laparoscopy or laparotomy in women with severe chronic pelvic pain

OBJECTIVE: To identify features of sexual behavior in women with and without chronic pelvic pain. STUDY DESIGN: A group of 41 women with chronic pelvic pain of more than 6 months' duration and scheduled to undergo laparoscopy or laparotomy were surveyed to obtain information on their sexual activity. The results were compared with a control group of 86 women of similar age and socioeconomic status who underwent planned tubal ligation for permanent contraception. RESULTS: Women with pelvic pain initiated sexual relations at a later age and had a higher rate of dyspareunia than women in the control group. There were no significant differences between groups in any other characteristics of sexual behavior. CONCLUSION: Dyspareunia, the only feature of sexual relations that differed significantly between women with and without chronic pelvic pain, should be accorded greater attention as a painful symptom and not be dismissed as simply a type of sexual dysfunction.     

Bad experience, good birthing: Dutch low-risk pregnant women with a history of sexual abuse

OBJECTIVE: The long-term effects on women in childbirth with a history of sexual abuse have only been studied to a limited degree. We estimated the prevalence of lifetime experience among low-risk pregnant women (non-clinical) in The Netherlands as well as the association with (1) psycho-social outcomes, and (2) the birth process. METHODS: Study of 625 randomly selected low-risk pregnant women. At 20-24 weeks gestation, participants completed a questionnaire covering socio-demographic variables, sexual attitude, and psychological determinants. Midwives recorded details of the birth process. RESULTS: Nearly one-in-nine (11.2%) women had experienced sexual abuse. They were on average younger, more likely to smoke, and had lower household income. They reported more conflicting feelings about sex than women who did not report a history of abuse (p = 0.02). Multiparous women with a history of sexual abuse reported more emotional distress (p = 0.037), more internal beliefs concerning health (p = 0.004), and they were also more likely to suffer pelvic pain (p = 0.045). Sexually-abused women reported higher levels of autonomy (p = < 0.001). Referral rates to secondary care were equal. Sexually-abused women were less likely to receive episiotomies (p < 0.005). CONCLUSION: Little difference was observed in major birth-related technical interventions between women with and without a history of sexual abuse.     

Gynaecological symptoms associated with physical and sexual violence

OBJECTIVE: The study aims to describe the prevalence of violent physical and sexual experiences in female outpatients and to identify specific gynaecological symptoms that are associated with a history of abuse. STUDY DESIGN: We performed a cross-sectional study among native German women. The confidential self-administered questionnaire included items on physical and sexual abuse and on the patient's medical history. Of a total of 1941 eligible women, 730 (37.6%) participated in the survey. We calculated prevalence rates of physical and sexual abuse and compared victims and non-victims of violence with respect to specific symptoms and complaints. We developed multivariate models for pelvic pain and vaginal infection. RESULTS: The lifetime prevalence of severe physical violence by any kind of perpetrator was 35.5%. 13.5% of participants reported a completed rape. The lifetime prevalence of physical and/or sexual intimate partner violence (IPV) was 28.3%. Physical and sexual abuse is significantly associated with irregular menstrual cycle, urinary tract infections and pelvic pain independent of menses. CONCLUSIONS: Physical and sexual violence are associated with many gynecological symptoms. Especially gynecologists and general practitioners have to be aware that their patients might be victims of violence. This is important for adequate diagnosis and therapy and to avoid retraumatization in affected women.     

The association of sexual abuse with pelvic pain complaints in a primary care population

OBJECTIVE: Our purpose was to determine the prevalence of sexual abuse during childhood and adulthood and its association with pelvic and other pain complaints in a population of reproductive-aged women. STUDY DESIGN: A 10-page questionnaire was administered to 581 nonpregnant women aged 18 to 45 years examined in primary care offices. RESULTS: The reported incidences of childhood and adult sexual abuse were 26% and 28%. In regression analyses, with the exception of irritable bowel syndrome, women with only a history of childhood sexual abuse and no abuse later in life are not more likely than nonabused women to report pain syndromes. By contrast, with the exception of dysmenorrhea, all pain complaints studied were more common in women reporting abuse both as children and as adults. CONCLUSIONS: Sexual abuse that occurs during childhood and again as an adult is strongly associated with pelvic pain complaints.(Am J Obstet Gynecol 1997;177:12)     

History of Sexual and Physical Abuse in Women with Dyspareunia: Association with Pain,Psychosocial Adjustment,and Sexual Functioning

AimDyspareunia is a women's sexual health problem that still often goes undiagnosed despite its high prevalence and its detrimental impact on sexual, relationship, and psychological adjustment. Although sexual and physical abuse may constitute risk factors for the development of dyspareunia, the effects of past abuse on current pain and associated sexual and psychosocial impairments have never been examined. Thus, the aim of this study is to determine the relation between a history of sexual and physical abuse and a series of pain, psychological, dyadic, and sexual functioning variables in a sample of women with dyspareunia.MethodsA hundred and fifty-one women took part in the study via health professional referrals and advertisements in local newspapers. Each participant underwent a standardized gynecological examination and a structured interview in order to confirm the diagnosis of dyspareunia. They also completed self-report questionnaires investigating past sexual and physical abuse, in addition to current pain, psychosocial adjustment, and sexual functioning. Dependent measures included: (i) The Brief Symptom Inventory; (ii) the Sexual History Form; and (iii) the Locke-Wallace Marital Adjustment Scale. Pain was assessed via the McGill Pain Questionnaire and a visual analogue scale.ResultsResults revealed that a history of sexual abuse involving penetration was associated with poorer psychological adjustment and sexual functioning. Additionally, findings showed that women who perceived a link between their dyspareunia and their past sexual abuse reported worse sexual functioning than those who did not. Finally, the experience of sexual abuse was not associated with pain intensity and physical abuse was not associated with any of the outcome measures.ConclusionsFindings suggest that the presence of a sexual abuse history in women with dyspareunia is associated with increased psychological distress and sexual impairment, although there is no relation between a history of physical abuse and these outcomes. Leclerc B, Bergeron S, Binik YM, and Khalifé S. History of sexual and physical abuse in women with dyspareunia: Association with pain, psychosocial adjustment and sexual functioning.     

The prevalence of sexual dysfunction and associated risk factors in women with chronic pelvic pain: a cross-sectional study

The aims of the study were to determine the prevalence of sexual dysfunction, its subtypes and associated risk factors in women with chronic pelvic pain (CPP) as compared to a general female population. We evaluated 112 women (mean age 34.73 ± 8.07; age range 18–50) complaining of CPP with a comprehensive history including female sexual function index (FSFI) and several general assessment questions (GAQs), a complete physical examination and routine laboratory tests. A group of 108 healthy women (mean age 33.28 ± 7.95; age range 19–52) without CPP were enrolled as cross-sectional controls. According to the general population, the incidence of female sexual dysfunction (FSD) was 67.8% in women with CPP and 32.2% in women without CPP (P < 0.0001). Among 112 CPP patients, 78 (69.6%) of them had FSD and 34 (30.4%) patients did not have FSD in the study (P < 0.0001). In that 78 patients, 42 patients (53.8%) had hypoactive sexual desire disorder, 26 patients (33.3%) had sexual arousal disorder, 17 patients (21.7%) had orgasmic disorder and finally 58 patients (74.3%) had sexual pain disorder. The FSFI scores in both groups were as follows: (patients vs. controls; median value; P value, respectively): desire: 3.31 versus 3.98 (P < 0.0001); arousal: 3.58 versus 4.35 (P < 0.0001); lubrication: 4.20 versus 4.88 (P < 0.0001); orgasm: 3.70 versus 4.48 (P < 0.0001); sexual satisfaction: 3.80 versus 4.64 (P < 0.0001); sexual pain: 2.75 versus 4.98 (P < 0.0001) and total FSFI score: 21.35 versus 27.29 (P < 0.0001). The prevalence of FSD was higher in women with CPP than in a general healthy population not complaining of CPP. Investigation of female sexuality was essential for these patients.     

Psychological and endocrine correlates of chronic pelvic pain associated with adhesions

Chronic pelvic pain (CPP) is a frequent and often unexplained gynecological complaint. We attempted to evaluate stress history, psychological features and hypothalamic-pituitary-adrenal (HPA) axis function in a group of patients suffering from CPP associated with pelvic adhesions. We recruited 10 patients with CPP and adhesions and 14 painfree, infertile control patients who underwent gynecological examination and diagnostic laparoscopy in a general hospital. Psychological assessment included structured interviews on sexual and physical abuse experiences and major life events as well as questionnaires on pain characteristics and depression. To evaluate HPA axis function, we measured plasma adrenocorticotropin (ACTH) and salivary cortisol responses to the administration of 100 micrograms human corticotropin-releasing factor (CRF). Results revealed high, but not statistically increased, prevalence rates of sexual and physical abuse for patients with CPP and adhesions as compared to controls. Patients with CPP and adhesions reported a significantly higher total number of major life events. Mean depression scores were normal in both groups. Patients with CPP and adhesions demonstrated normal plasma ACTH, but decreased salivary cortisol levels in the CRF stimulation test. These preliminary findings suggest that stress and neuroendocrine changes may also contribute to the pathophysiology of CPP with an identified organic correlate.     

Sexuality and Psychopathological Aspects in Premenopausal Women with Metabolic Syndrome

IntroductionMetabolic syndrome (MetS) is a cluster of cardiovascular risk factors that have been suggested to impact female sexual function.AimsThis study aims to assess the prevalence of female sexual dysfunction (FSD) in premenopausal women with MetS compared with healthy controls (HC). Psychopathological aspects and the relationship to FSD were also evaluated in both groups.MethodsTwo hundred four premenopausal women, of whom 98 had diagnosis of MetS, were asked to complete the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), and the Middlesex Hospital Questionnaire (MHQ). Routine laboratory tests and anthropometric measurements were routinely performed.Main Outcome MeasuresFSFI and FSDS questionnaires, prevalence of FSD, and MHQ scores.ResultsIn the MetS group compared with the HC group, we found: a lower global FSFI score (P = 0.005), higher prevalence of pathological scores compared with HC group, and lower scores in the desire, arousal, lubrication, and orgasm domains. An inverse correlation between the FSFI score and the number of risk factors for MetS was detected. MetS women reported significantly higher total scores in the somatization and depression domains when compared with the HC group. The logistic regression showed that high triglycerides (odds ratio [OR] 3.097; 95% confidence interval [CI] 1.272–7.542; P = 0.026) and somatization (OR 7.068; CI 95% 2.291–21.812; P = 0.001) are independently associated with FSD in premenopausal women.ConclusionsOur results indicate a higher prevalence of sexual dysfunction in MetS women. A number of risk factors for MetS are positively associated with FSD and higher triglycerides seem to be the strongest predictors of sexual dysfunction. Psychopathological dimensions such as somatization are strongly associated with sexual dysfunction. Alvisi S, Baldassarre M, Lambertini M, Martelli V, Berra M, Moscatiello S, Marchesini G, Venturoli S, and Meriggiola MC. Sexuality and psychopathological aspects in premenopausal women with metabolic syndrome. J Sex Med 2014;11:2020–2028.