Distress and pain during pelvic examinations: effect of sexual violence.
ABSTRACT To estimate the range and severity of distress and pain during pelvic examinations among female veterans with and without histories of sexual violence, and to examine whether posttraumatic stress disorder explains additional variance in examination-related distress and pain above that accounted for by exposure to sexual violence.
We employed a cross-sectional cohort design in which 67 selected female veterans completed self-administered questionnaires to assess history of sexual violence and experiences of distress and pain associated with the pelvic examination. A subsample of 49 completed an assessment for posttraumatic stress disorder approximately 2 weeks later.
Distress associated with the pelvic examination was highest for women with prior sexual violence and posttraumatic stress disorder (median 5.49), next highest for women with sexual violence only (median 2.44), and lowest for women with neither (median 0), P=.015. Higher ratings of pain were also found among women with sexual violence (median 2.5) compared with those without (median 0), P=.04. However, posttraumatic stress disorder was not linked with increased pain from speculum insertion beyond that accounted for by sexual violence; limited power may have precluded detection of this effect.
Distress and pain during pelvic examinations may indicate a history of previous sexual violence, particularly in those with posttraumatic stress disorder. Extra sensitivity to the special needs of this population is warranted and may contribute positively to the quality of patients' experiences.
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ABSTRACT: This article aims to critically analyze research focused on the findings for five chronic conditions: chronic pain, diabetes, cardiovascular disease, HIV and cancer among women veterans to identify opportunities for comparative effectiveness research. We provide a descriptive analysis from the relevant articles in prior systematic reviews. In order to identify potential gaps in research for these specific conditions, we also conducted a literature search to highlight studies focusing on women veterans published since the last systematic review. While the scientific knowledge base has grown for these chronic conditions among women veterans, the vast majority of the published literature remains descriptive and/or observational, with only a few studies examining gender differences and even fewer clinical trials. There is a need to conduct comparative effectiveness research on chronic conditions among women veterans to improve health and healthcare.Journal of comparative effectiveness research. 03/2014; 3(2):155-66.
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ABSTRACT: To understand and manage the sequels of childhood sexual abuse on sexual, anorectal and lower urinary tract functions. Review of articles published in the Medline database, selected according to their scientific relevance and published guidelines on this subject together with our own experience. A history of sexual abuse is frequently found when assessing dysfunction or symptoms of the lower urinary tract. In this context, urinary stress incontinence is rarely involved but it can be linked by epidemiological factors. Dysuria with urgency is the most frequent expressed symptom. When associated with anorectal disorders and pelvic pain or a sexual disorder in particular dyspareunia, a sexual abuse should be evoked and specific questions asked to the patient. Although these symptoms are frequently encountered in 12 to 33% of women, and 8 to 16% of men, few practitioners, whatever their speciality ask about them as routine. It is important that the physician diagnose the existence of sexual abuse, in particular when the symptoms mentioned by the patient are not conclusive, in spite of thorough urological assessment. Patients finding the initial examination difficult and painful and the failure of the initial treatment should lead to questions concerning abuse, if neglected by the initial medical inquiry. Clinicians involved in perineal functional pathology are able to acquire standardized modalities of inquiry about child sexual abuse for a better time management and efficacy in the therapeutic approach. The interest of a multidisciplinary diagnostic and therapeutic approach is primordial, associating psychological therapy and if necessary perineal re-education. This can avoid unnecessary tests and out-patient visits. Directing patients towards a multidisciplinary approach is highly advisable.Progrès en Urologie 07/2013; 23(9):780-92. · 0.80 Impact Factor
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ABSTRACT: An increasing number of young women veterans are returning from war and military service and are seeking reproductive health care from the Veterans Health Administration (VHA). Many of these women seek maternity benefits from the VHA, and yet little is known regarding the number of women veterans utilizing VHA maternity benefits nor the characteristics of pregnant veterans using these benefits. In May 2010, VHA maternity benefits were expanded to include 7 days of infant care, which may serve to entice more women to use VHA maternity benefits. Understanding the changing trends in women veterans seeking maternity benefits will help the VHA to improve the quality of reproductive care over time. The goal of this study was to examine the trends in delivery claims among women veterans receiving VHA maternity benefits over a 5-year period and the characteristics of pregnant veterans utilizing VHA benefits. We undertook a retrospective, national cohort study of pregnant veterans enrolled in VHA care with inpatient deliveries between fiscal years (FY) 2008 and 2012. We included pregnant veterans using VHA maternity benefits for delivery. Measures included annualized numbers and rates of inpatient deliveries and delivery-related costs, as well as cesarean section rates as a quality indicator. During the 5-year study period, there was a significant increase in the number of deliveries to women veterans using VHA maternity benefits. The overall delivery rate increased by 44% over the study period from 12.4 to 17.8 deliveries per 1,000 women veterans. A majority of women using VHA maternity benefits were age 30 or older and had a service-connected disability. From FY 2008 to 2012, the VHA paid more than $46 million in delivery claims to community providers for deliveries to women veterans ($4,993/veteran). Over a 5-year period, the volume of women veterans using VHA maternity benefits increased by 44%. Given this sizeable increase, the VHA must increase its capacity to care for pregnant veterans and ensure care coordination systems are in place to address the needs of pregnant veterans with service-connected disabilities.Women s Health Issues 01/2014; 24(1):e37-e42. · 1.61 Impact Factor