ABSTRACT
To date there is no international guideline on chronic pelvic pain available that focuses on medical, psychosomatic and psychological diagnostics and treatment of this complicated disease pattern. In this paper, a European working group, which was established in October 2010, aims to bridge this gap. The working group decided to use the current German guideline as source text and to transform it into a European consensus statement by deleting parts that apply only to the conditions of the German health system. The literature search included papers published up to and including December 2010, using Medline search and by adding some new search terms. This manuscript reports the essential facts of the above-mentioned consensus statement. Within this article we use the term "psychosomatic" as the integrated concept of medical and psychosocial aspects of a disease.
Subject(s)
Genital Diseases, Female/complications , Pelvic Pain , Quality of Life , Chronic Pain , Female , Humans , Pain Management/methods , Pain Measurement/methods , Pain Perception , Pelvic Pain/diagnosis , Pelvic Pain/etiology , Pelvic Pain/physiopathology , Pelvic Pain/psychology , Practice Guidelines as TopicABSTRACT
BACKGROUND: The objective of this study was to evaluate the impact of rheumatoid arthritis (RA) on patients' sexuality and identify disease and other factors such as fatigue that most influence sexual relationships. METHODS: A specific pretested questionnaire was sent to all members of a French patient association (ANDAR). Questions related to demographics, disease status, quality of life (utility, EQ-5D), pain, psychological status (mood), fatigue and emotional and sexual relationships. To isolate the impact of RA, an attempt was made to include a matched sample from the general population. RESULTS: The analysis included 1271 patients, but only 70 controls agreed to participate and comparisons should therefore be considered with caution. The two groups were similar in terms of age, gender distribution, living conditions and diseases other than RA. However, patients scored worse for global health, mood, fatigue, had a lower utility (0.55 versus 0.65). Controls were more active sexually (69% versus 63%), in particular women (71% versus 60%). Age, gender, living alone, physical function and mood were significant predictors for being sexually active for patients; for controls, age and overall quality of life (utility) were significant predictors. CONCLUSIONS: While it is known that RA has a negative impact on patients' sexuality, there have been few attempts to quantify the problem. Our study highlights the negative impact of RA on patients' sexuality, and triggers the question how to include this aspect into care.
Subject(s)
Arthritis, Rheumatoid/psychology , Quality of Life , Sexual Behavior , Affect , Aged , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/epidemiology , Case-Control Studies , Disability Evaluation , Fatigue/epidemiology , Fatigue/psychology , Female , France/epidemiology , Health Surveys , Humans , Logistic Models , Male , Middle Aged , Odds Ratio , Pain Measurement , Risk Factors , Surveys and QuestionnairesABSTRACT
INTRODUCTION: The anatomy and function of the G-spot remain highly controversial. Ultrasound studies of the clitoral complex during intercourse have been conducted to gain insight into the role of the clitoris and its relation to vagina and urethra during arousal and penetration. AIM: Our task was to visualize the anterior vaginal wall and its relationship to the clitoris during intercourse. METHODS: The ultrasound was performed during coitus of a volunteer couple with the Voluson® General Electric® Sonography system (Zipf, Austria) and a 12-MHz flat probe. The woman was in a gynecologic position, and her companion penetrated her with his erected penis from a standing position. We performed a coronal section on the top of the vulva during the penetration. MAIN OUTCOME MEASURE: We focused on the size of the clitoral bodies before and after coitus. RESULTS: The coronal section demonstrated that the penis inflated the vagina and stretched the root of the clitoris that has consequently a very close relationship with the anterior vaginal wall. This could explain the pleasurable sensitivity of this anterior vaginal area called the G-spot. CONCLUSIONS: The clitoris and vagina must be seen as an anatomical and functional unit being activated by vaginal penetration during intercourse.
Subject(s)
Arousal/physiology , Clitoris/diagnostic imaging , Coitus/physiology , Urethra/diagnostic imaging , Vagina/diagnostic imaging , Adult , Coitus/psychology , Female , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Male , Orgasm/physiology , Penis/diagnostic imaging , UltrasonographyABSTRACT
Female sexuality is complex and a variety of schemes have evolved to attempt the definition and categorization of the various kinds of female sexual dysfunction. This paper reviews some of the current systems of classification and describes how understanding these systems can help the physician in evaluating the individual patient, who may present with overlapping features of several co-morbid sexual dysfunctions.
Subject(s)
Sexual Dysfunction, Physiological/classification , Sexual Dysfunctions, Psychological/classification , Sexuality , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , International Classification of Diseases , Sexual Dysfunction, Physiological/physiopathologyABSTRACT
Over the past 40 years or so, a number of models have been proposed to understand the female sexual response. Early, simpler, linear models have evolved to incorporate more sophisticated understanding of the complexity of female sexuality. Updated sexual response models can help therapists in understanding how to help women with various sexual dysfunctions.
