The impact of cryotherapy for symptomatic cervical ectropion on female sexual function and quality of life.

In rare cases, cervical ectropion causes symptoms such as abundant leucorrhoea, postcoital bleeding, recurrent cervicitis, pelvic pain, and dyspareunia. Cryotherapy is a commonly used treatment for symptomatic cervical ectropion. We assessed the impact of cryotherapy on sexual function and quality of life among patients with symptomatic cervical ectropion. In this prospective observational study, 73 patients were assessed before and six months after cryotherapy treatment using the Female Sexual Function Index (FSFI) and Short Form-12 Health Survey questionnaires. The double-freeze cryotherapy procedure was performed using a cryotherapy unit, and liquid nitrogen was used as a refrigerant. The mean physical and mental quality of life scores were significantly improved after treatment. With the exception of the pain domain, the overall and domain FSFI scores exhibited no significant differences before and after cryotherapy. The sexual pain domain scores were significantly increased after treatment. There was a statistically significant improvement in vaginal discharge, pelvic pain, and postcoital bleeding symptoms after the cryotherapy. We concluded that cryotherapy is an effective and feasible treatment for symptomatic cervical ectropion. Although cryotherapy results in improved quality of life scores, it has no significant impact on female sexual function.Impact statementWhat is already known on this subject? Cryotherapy is the most preferred treatment option for symptomatic cervical ectropion. Its feasibility and effectiveness with respect to symptom relief have been observed in previous studies. No study has evaluated quality of life and sexual function after cryotherapy among patients with symptomatic cervical ectropion.What do the results of this study add? Although the patients' quality of life scores were significantly improved after treatment, no significant improvement was observed in overall and domain sexual function scores, with the exception of the pain domain. The sexual pain domain scores were significantly improved after cryotherapy.What are the implications of these findings for clinical practice and/or further research? Patients should not expect better sexual function after cryotherapy. Comparative studies should seek to identify the ideal treatment option, which would result in both symptom relief and better sexual function.

Association between Trichomonas vaginalis infection and cervical lesions: a population-based, nested case-control study in Taiwan.

Trichomonas vaginalis is the most common nonviral sexually transmitted infection. According to the 2019 WHO cancer report, cervical cancer is the fourth most frequent cancer in women. However, previous research, which has not included a large-scale study to date, has revealed that Trichomonas vaginalis increases cervical cancer risk. In this study, we investigated a group of Asian females in Taiwan to determine the association between trichomoniasis and the risk of developing cervical lesions, including cancer, neoplasm, and dysplasia. We conducted a nested case-control study by using the National Health Insurance (NHI) program database in Taiwan. The International Classification of Diseases, 9th Revision classifications (ICD-9-CM) was used to categorize all of the medical conditions for each patient in the case and control groups. The adjusted odds ratio (AOR) and 95% confidence interval (CI) for the association between trichomoniasis and cervical lesions were estimated using multivariable conditional logistic regression to adjust for all comorbidities and variables. In total, 54,003 individuals were enrolled in the case group and 216,012 were enrolled in the control group. Trichomonas vaginalis exposure had a significant association with cervical lesions (AOR 2.656, 95% CI = 1.411-5.353, p = 0.003), especially cervical cancer (AOR 3.684, 95% CI = 1.622-6.094, p = 0.001). In patients with both trichomoniasis and depression, the relative risk increased 7.480-fold compared to those without trichomoniasis or depression. In conclusion, female patients with Trichomonas vaginalis exposure had a significantly higher risk of developing cervical lesions (especially cervical cancer) than those without exposure.

Vaginoscopy Against Standard Treatment: a randomised controlled trial.

OBJECTIVE: To evaluate whether vaginoscopy or standard hysteroscopy was more successful in the outpatient setting. DESIGN: Randomised controlled multicentre trial. SETTING: Outpatient hysteroscopy clinics at two UK hospitals. POPULATION: 1597 women aged 16 or older undergoing an outpatient hysteroscopy. METHODS: Women were allocated to vaginoscopy or standard hysteroscopy using third party randomisation stratified by menopausal status with no blinding of participants or clinicians. MAIN OUTCOME MEASURES: The primary outcome was 'success', a composite endpoint defined as: a complete procedure, no complications, a level of pain acceptable to the patient, and no sign of genitourinary tract infection 2 weeks after the procedure. RESULTS: Vaginoscopy was significantly more successful than standard hysteroscopy [647/726 (89%) versus 621/734 (85%), respectively; relative risk (RR) 1.05, 95% CI 1.01-1.10; P = 0.01]. The median time taken to complete vaginoscopy was 2 minutes compared with 3 minutes for standard hysteroscopy (P < 0.001). The mean pain score was 42.7 for vaginoscopy, which was significantly less than standard hysteroscopy 46.4 (P = 0.02). Operative complications occurred in five women receiving vaginoscopy and 19 women receiving standard hysteroscopy (RR 0.26, 95% CI 0.10-0.69). CONCLUSIONS: Vaginoscopy is quicker to perform, less painful, and more successful than standard hysteroscopy and therefore should be considered the technique of choice for outpatient hysteroscopy. TWEETABLE ABSTRACT: Vaginoscopy is quicker to perform, less painful, and more successful than standard hysteroscopy.

Measuring the psychosocial burden in women with low-grade abnormal cervical cytology in the TOMBOLA trial: psychometric properties of the Process and Outcome Specific Measure (POSM).

Background: There is a need for an instrument to measure the psychosocial burden of receiving an abnormal cervical cytology result which can be used regardless of the clinical management women receive.Methods: 3331 women completed the POSM as part of baseline psychosocial assessment in a trial of management of low grade cervical cytological abnormalities. Factor analysis and reliability assessment of the POSM were conducted.Results: Two factors were extracted from the POSM: Factor 1, containing items related to worry; and Factor 2 containing items relating to satisfaction with information and support received and change in the way women felt about themselves. Factor 1 had good reliability (Cronbach's alpha 0.769), however reliability of the Factor 2 was poorer(0.482). Data collected at four subsequent time points demonstrated that the factor structure was stable over time.Conclusion: This study demonstrates the presence and reliability of a scale measuring worries within the POSM. This analysis will inform its future use in this population and in other related contexts.

Psychosocial impact of alternative management policies for low-grade cervical abnormalities: results from the TOMBOLA randomised controlled trial.

BACKGROUND: Large numbers of women who participate in cervical screening require follow-up for minor cytological abnormalities. Little is known about the psychological consequences of alternative management policies for these women. We compared, over 30-months, psychosocial outcomes of two policies: cytological surveillance (repeat cervical cytology tests in primary care) and a hospital-based colposcopy examination. METHODS: Women attending for a routine cytology test within the UK NHS Cervical Screening Programmes were eligible to participate. 3399 women, aged 20-59 years, with low-grade abnormal cytology, were randomised to cytological surveillance (six-monthly tests; n = 1703) or initial colposcopy with biopsies and/or subsequent treatment based on colposcopic and histological findings (n = 1696). At 12, 18, 24 and 30-months post-recruitment, women completed the Hospital Anxiety and Depression Scale (HADS). A subgroup (n = 2354) completed the Impact of Event Scale (IES) six weeks after the colposcopy episode or first surveillance cytology test. Primary outcomes were percentages over the entire follow-up period of significant depression (≥ 8) and significant anxiety (≥ 11; "30-month percentages"). Secondary outcomes were point prevalences of significant depression, significant anxiety and procedure-related distress (≥ 9). Outcomes were compared between arms by calculating fully-adjusted odds ratios (ORs) for initial colposcopy versus cytological surveillance. RESULTS: There was no significant difference in 30-month percentages of significant depression (OR = 0.99, 95% CI 0.80-1.21) or anxiety (OR = 0.97, 95% CI 0.81-1.16) between arms. At the six-week assessment, anxiety and distress, but not depression, were significantly less common in the initial colposcopy arm (anxiety: 7.9% vs 13.4%; OR = 0.55, 95% CI 0.38-0.81; distress: 30.6% vs 39.3%, OR = 0.67 95% CI 0.54-0.84). Neither anxiety nor depression differed between arms at subsequent time-points. CONCLUSIONS: There was no difference in the longer-term psychosocial impact of management policies based on cytological surveillance or initial colposcopy. Policy-makers, clinicians, and women themselves can be reassured that neither management policy has a significantly greater psychosocial cost. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN 34841617.

The effect of HPV infection on a couple's relationship: a qualitative study in Taiwan.

OBJECTIVE: The purpose of this study is to explore the effect of human papillomavirus (HPV) on the sexual lives of women and their partners. MATERIALS AND METHODS: Twenty oncogenic or high-risk HPV infected cases were collected via purposive sampling. At a tertiary medical center in Taipei, 20 women underwent a 2-hour in-depth interview. The content of each interview was analyzed qualitatively regarding (1) effect of HPV infection on a couple's relationship; (2) effect of HPV infection on sexual life; (3) partner support and social support; (4) myths about love and marriage; and (5) sexual myths. RESULTS: The better a couple's relationship, the less these patients struggled to confront the issue (HPV infection). Most patients urged partners to have check-ups and advised friends about Pap smear tests. Couple relationships were generally not affected by HPV infection, unlike their sexual lifestyles. Most patients fulfilled the traditional Chinese female role of maintaining the relationship. However, due to the physical and psychosocial discomfort of treatment and fear of infection, some had no desire for sex, while others lessened their sex frequency. Most patients received very little support from their partner, family, and friends. The relationship quality was affected by marital and sexual myths held by patients. CONCLUSION: Cervical HPV infection has a negative effect on women's sexual relationships. Thus, more attention from health care providers is required.

Psychosocial factors in risk of cervical intraepithelial lesions.

BACKGROUND: This study examines the relationship among psychosocial factors, behavioral risks for abnormal cervical cytology, and abnormal cervical cytology. METHODS: A self-administered questionnaire was used to measure perceived stress, discrimination, lifetime stressful events, optimism, social support, and psychological state. Women with normal Pap smears attending a primary care clinic and women attending a colposcopy clinic because of an abnormal Pap smear were eligible. The scores between the two groups were compared. RESULTS: A total of 265 women participated in the study. There were no significant relationships between psychosocial factors and cervical cytology status. In a regression model, age (B = -0.057, p = 0.001) was predictive of having abnormal cervical cytology. Smoking was correlated with an increased family Apgar score (p = 0.021), Perceived Stress Scale (PSS) score (p = 0.049), and Revised Life Stressor Checklist score (p < 0.001). A higher mean number of lifetime male partners was related to increased family Apgar score (p = 0.012), Revised Life Stressor Checklist score (p < 0.001), and major event discrimination (p < 0.001). Earlier age at coitarche was associated with increased family Apgar score (p < 0.001). CONCLUSIONS: These results do not support that psychosocial factors play a role in the risk of developing abnormal cervical cytology. Behavioral risks for developing abnormal cervical cytology are associated with life stressors, family function, and perceived discrimination.

Women defining themselves: shared stories of private hell.

In this phenomenological study women who had experienced an abnormal Pap result in the past were asked to share something about themselves as women, prior to describing their experience of having an abnormal Pap result. From their responses, we hear stories of how their sense of self was intricately entwined with their experiences of physical, emotional or sexual violence and/or a profound sense of grief and loss. The stories of violence, trauma and loss alert the nurse and midwife to the possibility that giving a woman information, for example that her Pap test result is abnormal, may compound existing feelings of fear and create a new threat to the woman's sense of 'self'.

Embodied risk: my body, myself?

Risk has become a dominant way to interpret who gets sick and why. A distinction has been drawn between two categories of risk: those arising from the environment, and those resulting from an individual's lifestyle. We identify a third category that might be called corporeal or embodied risk which has received little scholarly attention. Embodied risks are so called because they are located in the body of the person said to be "at risk". Environmental risks are due to something that happens to a person; lifestyle risks occur because of something a person does or does not do, while embodied risks say something about who the person is. To investigate how people experience health risks--especially risks identified as characteristics of their bodies--we conducted detailed interviews with 29 women who were told they had an abnormal Pap smear. All health risks pose problems for people who are diagnosed as "at risk": They must translate probabilistic statements about populations into terms that have personal meaning; they must cope with uncertainty; they must consider what it means to be in danger of developing an illness even though most have no symptoms; and they must mobilise appropriate surveillance and perhaps risk reduction. However, limiting attention to environmental and lifestyle risk (and the distinction between them) neglects the additional challenges posed by corporeal risks: the simultaneous presence of disease now and the possibility of more consequential disease in the future; the necessity to submit to ongoing medical surveillance; a tendency to exacerbate the cartesian split between body and self; and the absence of medical or popular discourses through which to interpret and respond to embodied risk. We call upon medicine and public health practitioners to work together with people who are at risk to formulate languages and approaches that can reflect both scientific accuracy (as it is currently understood), and the needs of people to integrate health threats into their daily personal lives.

A biographical disruption: the case of an abnormal pap smear.

In this study we explore the biographical disruption resulting from a diagnosis of an abnormal Pap smear and the consequent process of biographical reconstruction. This is a qualitative study of thirteen women between the ages of 19 and 54 years who were diagnosed with an abnormal Pap smear and underwent colposcopy treatment. Data collection was through individual in-depth interviews, which were transcribed and analyzed by a team of researchers for important themes. An opportunistic sampling strategy was used. The inherent ambiguity in the diagnosis, its treatment strategies, the prognosis of their condition, and patients' fear of cancer all made the process of biographical reconstruction more problematic. By putting their faith in medicine and mobilizing their personal resources, women attempted to reestablish a positive personal and social self. Further exploration of the long-term psychosocial impact of this diagnosis is warranted so that women's emotional as well as medical needs are adequately addressed.

Risk factors for noncompliance in a colposcopy clinic.

OBJECTIVE: To evaluate demographic characteristics as risk factors for noncompliance with colposcopy clinic follow-up. STUDY DESIGN: A retrospective, case-control study was performed on patients evaluated in the Women & Infants' Hospital colposcopy clinic between January 1, 1992, and December 31, 1993. Data extracted from chart review included demographic characteristics, insurance status, smoking status, cytologic and histologic grade treatment received, number of appointments kept and missed, number of attempts to contact the patient and degree of compliance with colposcopy follow-up. A scoring system was created to assess a patient's level of compliance by evaluating the number of appointments kept and missed. RESULTS: After review of the first 80 patients, a noncompliance rate of 23% was determined based on our scoring system. A total of 86 noncompliant patients were then compared to 93 compliant patients. Women who were noncompliant with follow-up were more likely to be on Medicaid or to have no insurance when compared to compliant patients (odds ratio [OR] = 2.4, confidence interval [CI] .85, 6.7), but this difference did not reach statistical significance (P = .07). Noncompliant patients were less likely to have high grade lesions than compliant patients (OR = .34; CI .13, .85; P = .01). CONCLUSION: Patients with lower grade lesions may be more likely to be noncompliant with recommended follow-up than patients with high grade lesions. This association may be due to a reduced emphasis on follow-up and patient education in women with low grade lesions. Increased educational efforts should be made to attempt to reduce high rates of noncompliance in this group of women.

"I hope I don't have cancer": colposcopy and minority women.

PURPOSE: To determine what women scheduled for colposcopy knew about the procedure and to understand their concerns about the test and its implications. DESIGN: Descriptive, exploratory, qualitative. SAMPLE AND SETTING: All women scheduled for colposcopy in a three-month period (n = 29) in an inner-city academic center in the northeast United States. The sample consisted of African American (66%), Hispanic (31%), and white (3%) women ranging in age from 17-59 years (x = 39 years). METHODS: Women were interviewed on the telephone or in person and were asked seven open-ended questions about why they were referred and what they expected would happen at the appointment. Interviews were content analyzed. FINDINGS: Four themes common to the women's responses emerged from the interview data: fear about their health, apprehension about the colposcopy, uncertainty about the meaning of the Pap test, and pervasive lack of knowledge. CONCLUSIONS: These results suggest that women in this study scheduled for colposcopy had little factual information about the test or its implications, were anxious about the appointment, and wanted more complete information. IMPLICATIONS FOR NURSING PRACTICE: Nurses cannot assume that women understand the reasons for their referral for colposcopy or the implications of the test. These study results imply that lengthened appointment time might be required to provide appropriate education and help alleviate women's anxiety. Future nursing research should examine the effect of anticipatory counselling and education for this group of women.

PEAPS-Q: a questionnaire to measure the psychosocial effects of having an abnormal pap smear. Psychosocial Effects of Abnormal Pap Smears Questionnaire.

We have developed the Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q) which measures distress experienced by women undergoing follow-up investigation after an abnormal Pap smear result. A thorough literature review and qualitative research resulted in the development of a questionnaire which was tested on 350 women attending a Family Planning New South Wales (FPNSW) clinic. This sample included women at different stages of management after detection of a cervical abnormality: 93 first colposcopy clients and 257 follow-up colposcopy clients. Factor analysis identified four dimensions of distress: experience of medical procedures, beliefs/feelings about cervical abnormality and changes in perception of oneself, worry about infectivity and effect on sexual relationships. Repeatability of the PEAPS-Q was indicated by intra-class correlations of 0.88 overall and at least 0.60 for each scale. Internal consistency was shown by Cronbach's alpha of 0.84 overall and at least 0.72 for each scale. Validity was demonstrated by the correlation of scale scores with the 12-item General Health Questionnaire (GHQ) score of 0.32 (95% CI 0.22-0.41). The PEAPS-Q is a valid, reliable and multidimensional instrument for quantifying distress experienced by women with abnormal Pap smears.

Factors affecting patient compliance among women with abnormal Pap smears.

The relationship among health beliefs, health locus of control and diagnosis with Human papillomavirus and compliance with medical recommendations for an abnormal Pap test was explored through use of a survey in a sample 272 women. A total of 29 women (11%) indicated they failed to comply with the medical recommendation. Logistic regression analysis was used to assess relative risk for noncompliance. Two items from the health belief scale were statistically significant. Women who agree with the statement, "The uncertainty about my Pap test makes me nervous," were four times as likely to comply with the medical recommendations as compared to women who disagreed with the statement. Women who agreed with the statement, "I have not been able to cope with my abnormal pap test," were three times as likely to not comply with the recommendations as compared to women who disagreed. There were no statistically significant relationships between compliance and locus of control, Human Papillomavirus diagnosis, or demographic variables.

Cervical screening: default and compliance.

Health visitors could play a key role in educating at risk women about the benefits of cervical screening. Jane Martin and Peter J Main examine some of the models which outline barriers to screening uptake and consider which will help the health visitor to increase the knowledge and understanding of at risk clients.