No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Psychological, Behavioral, and Interpersonal Impact of Human Papillomavirus and Pap Test Results
Abstract
The purpose of this study was to explore the short-term psychological, behavioral, and interpersonal impact of human papillomavirus (HPV) and Pap results in adolescent and young adult women.
Sexually active young women 14-21 years of age were recruited using a purposeful sampling strategy from a hospital-based teen health center. Participants underwent HPV DNA and Pap testing at baseline. At a follow-up visit 2 weeks later, they received test results and participated in individual interviews designed to examine the impact of test results. Interview data were analyzed using framework analysis, a qualitative analytical method.
The mean age of the 100 participants was 17.2 years, and 82% were black. Fifty-one percent were HPV positive, and 23% had abnormal Pap tests. Psychological responses consisted of affective reactions to abnormal results, empowerment through knowledge of results, and self-confidence to prevent future disease. Personal behavioral intentions encompassed safe sexual behaviors, partner monitoring, and return for screening. Anticipated interpersonal consequences focused on the impact of communication about test results on relationships. Psychosocial and behavioral responses were influenced by the personal meaning participants derived from HPV and Pap results (e.g., perceptions of personal risk and anticipated stigma), cognitive understanding of test results, and such factors as coping mechanisms, locus of control, and relationship quality.
An understanding of young women's responses to HPV and Pap test results may help guide clinical interventions designed to prevent possibly harmful psychosocial and interpersonal responses to HPV and Pap testing but promote healthy sexual behaviors and regular screening.
... Recientemente, se ha comenzado a dar importancia a la implicación de factores de carácter psicológico y social en el diagnóstico y tratamiento del VPH. Estudios han demostrado que el vivir con VPH puede conllevar un impacto significativo a nivel emocional y social, lo que repercute el bienestar y la calidad de vida de las personas con este virus (Dominiak et al., 2013;Kahn et al., 2005;Wang et al., 2010) No obstante, también se ha reportado que el diagnóstico de VPH puede influir en la adopción de comportamientos más saludables como el dejar de fumar, alimentarse mejor, tener relaciones sexuales protegidas y procurar el monitoreo de sí mismos e inclusive de la pareja, lo que puede llegar a generar un sentido de empoderamiento y autoconfianza para la prevención de futuras enfermedades (Juraskova, Butow, Sharpe y Campion, 2007;Kahn et al., 2005). ...
... Recientemente, se ha comenzado a dar importancia a la implicación de factores de carácter psicológico y social en el diagnóstico y tratamiento del VPH. Estudios han demostrado que el vivir con VPH puede conllevar un impacto significativo a nivel emocional y social, lo que repercute el bienestar y la calidad de vida de las personas con este virus (Dominiak et al., 2013;Kahn et al., 2005;Wang et al., 2010) No obstante, también se ha reportado que el diagnóstico de VPH puede influir en la adopción de comportamientos más saludables como el dejar de fumar, alimentarse mejor, tener relaciones sexuales protegidas y procurar el monitoreo de sí mismos e inclusive de la pareja, lo que puede llegar a generar un sentido de empoderamiento y autoconfianza para la prevención de futuras enfermedades (Juraskova, Butow, Sharpe y Campion, 2007;Kahn et al., 2005). ...
... Predomina el miedo, temor o preocupación al curso de la infección, al dolor, a la pérdida del útero, al desfiguramiento, al impacto en la fertilidad, al desarrollo de cáncer y a la muerte (Arellano y Castro, 2013;Bertram y Magnussen, 2008;Braun et al., 2016;Castro y Arellano, 2010;Juraskova et al., 2007;León et al., 2016León et al., , 2014 , 2007). El desconocimiento del diagnóstico genera angustia, lo que se ve acompañado de incertidumbre por la desinformación y estrés por el desconocimiento sobre cómo se había adquirido el virus (Bertram y Magnussen, 2008;Kahn et al., 2005;Kahn et al., 2007;Kosenko, Harvey y Hurley, 2014;León et al., 2014;Sharpe, Brandt y McCree, 2006;Waller et al., 2007). También se presenta ansiedad por el estado de salud, la cual se ve aumentada por la falta de información (Waller et al., 2007). ...
Objetivo: explorar qué se ha investigado sobre la experiencia de ser diagnosticado y el vivir con la infección por Virus del Papiloma Humano (VPH) en personas adultas. Metodología: se realizó una revisión de literatura basada en el diseño de scoping review de Arksey y O´Malley. Resultados: la experiencia de la persona adulta con la infección por VPH implica considerar principalmente cuatro áreas: la psicosocial, la sexual, la cognitiva y la atención a la salud. Discusión: aunque la mayoría de los hallazgos se centran en aspectos negativos del VPH, algunos muestran evidencia de beneficios o aspectos positivos a partir del diagnóstico. Conclusiones: el VPH conlleva un impacto considerable desde el momento de su detección hasta el tratamiento, lo que implica afecciones en las distintas áreas de la vida de las personas que van desde cuestiones emocionales hasta el seguimiento adecuado del proceso de atención.
... 10 It has been long known that positive HPV test results cause additional anxiety, stress, and negative emotional responses in women. [11][12][13][14] Several studies have evaluated the impact of HPV diagnosis on women's psychology as well as social and sexual lives through interviews with infected women after they were informed about their statuses. 10,11,[13][14][15] Additionally, Mercan et al., Leite et al., and Kitchener et al. have evaluated these effects with validated questionnaires. ...
... [11][12][13][14] Several studies have evaluated the impact of HPV diagnosis on women's psychology as well as social and sexual lives through interviews with infected women after they were informed about their statuses. 10,11,[13][14][15] Additionally, Mercan et al., Leite et al., and Kitchener et al. have evaluated these effects with validated questionnaires. [16][17][18] However, there is still a need for studies that use objective and validated questionnaires to evaluate the changes in the sexual functions and anxiety levels of women following HPV diagnosis. ...
... The FSFI scores ranged from 2.0 to 36.0, with higher scores indicating better sexual function and categorized into four groups: normal sexual function (total FSFI score ≥ 26.55), mild risk for a female sexual disorder (FSD) (total FSFI score 18-26.55), moderate risk for FSD (total FSFI score [11][12][13][14][15][16][17], and severe risk for FSD (total FSFI score ≤ 10). ...
Objective studies that use validated questionnaires are needed to evaluate the changes in the sexual functions of women diagnosed with Human papillomavirus (HPV) infection.
METHOD OF STUDY:
The study comprised 80 sexually active women diagnosed with a high-risk-HPV infection. These patients were divided into four groups as follows: Group 1, HPV 16/18-positive and normal cytology; Group 2, HPV 16/18-positive and abnormal cytology; Group 3, non-16/18 HPV-positive and abnormal cytology; and Group 4, non-16/18 HPV-positive and normal cytology. The sexual functions and anxiety statuses of the patients were assessed via the Female Sexual Function Index (FSFI) and Beck Anxiety Inventory (BAI) questionnaires, respectively, at their first clinical visits and then 2 months later.
RESULTS:
There was no statistically significant difference among the study groups in terms of the overall FSFI and domain sub-scores at either of the visits. Women who tested positive for the high-risk HPV 16/18 strains had a significantly less sexual desire after being informed about the test results. Those with HPV 16/18 and normal cytology had significantly higher anxiety levels at their second than first visits. The BAI scores of the HPV 16/18-positive women (normal or abnormal cytology) at the second visit were significantly higher than those of non-16/18 HPV-positive women with normal cytology. There was no significant difference between the patients with normal and abnormal cytology results regarding the difference of BAI, overall and domain FSFI sub-scores at the first and second visits. The desire and lubrication domain scores of the HPV 16/18-positive patients significantly decreased after the first visit compared with those of the non-16/18 HPV-positive patients.
CONCLUSION:
HPV 16/18 positivity decreases women's total FSFI and desire domain sub-scores. This article is protected by copyright. All rights reserved.
... 10 It has been long known that positive HPV test results cause additional anxiety, stress, and negative emotional responses in women. [11][12][13][14] Several studies have evaluated the impact of HPV diagnosis on women's psychology as well as social and sexual lives through interviews with infected women after they were informed about their statuses. 10,11,[13][14][15] Additionally, Mercan et al, 16 Leite et al, 17 and ...
... [11][12][13][14] Several studies have evaluated the impact of HPV diagnosis on women's psychology as well as social and sexual lives through interviews with infected women after they were informed about their statuses. 10,11,[13][14][15] Additionally, Mercan et al, 16 Leite et al, 17 and ...
... The FSFI scores ranged from 2.0 to 36.0, with higher scores indicating better sexual function and categorized into four groups: normal sexual function (total FSFI score ≥ 26.55), mild risk for a female sexual disorder (FSD) (total FSFI score 18-26.55), moderate risk for FSD (total FSFI score [11][12][13][14][15][16][17], and severe risk for FSD (total FSFI score ≤ 10). ...
Problem:
Objective studies that use validated questionnaires are needed to evaluate the changes in the sexual functions of women diagnosed with Human papillomavirus (HPV) infection.
Method of study:
The study comprised 80 sexually active women diagnosed with a high-risk-HPV infection. These patients were divided into four groups as follows: Group 1, HPV 16/18-positive and normal cytology; Group 2, HPV 16/18-positive and abnormal cytology; Group 3, non-16/18 HPV-positive and abnormal cytology; and Group 4, non-16/18 HPV-positive and normal cytology. The sexual functions and anxiety statuses of the patients were assessed via the Female Sexual Function Index (FSFI) and Beck Anxiety Inventory (BAI) questionnaires, respectively, at their first clinical visits and then 2 months later.
Results:
There was no statistically significant difference among the study groups in terms of the overall FSFI and domain sub-scores at either of the visits. Women who tested positive for the high-risk HPV 16/18 strains had a significantly less sexual desire after being informed about the test results. Those with HPV 16/18 and normal cytology had significantly higher anxiety levels at their second than first visits. The BAI scores of the HPV 16/18-positive women (normal or abnormal cytology) at the second visit were significantly higher than those of non-16/18 HPV-positive women with normal cytology. There was no significant difference between the patients with normal and abnormal cytology results regarding the difference of BAI, overall and domain FSFI sub-scores at the first and second visits. The desire and lubrication domain scores of the HPV 16/18-positive patients significantly decreased after the first visit compared with those of the non-16/18 HPV-positive patients.
Conclusion:
HPV 16/18 positivity decreases women's total FSFI and desire domain sub-scores. This article is protected by copyright. All rights reserved.
... This positive consequence of testing has been previously found in women in the context of cervical cancer screening. 29 The relation between emotional distress related to the results and the feelings of control over one's own health have been analysed chiefly through psychological constructs. However, we may also consider the influence of society and the assumptions that surround a masculine role and gender identity. ...
... However, we may also consider the influence of society and the assumptions that surround a masculine role and gender identity. 30 29 and reported that the disclosure of their HPV status was a source of anxiety. 36 In the present study, however, social rejection appeared to be a minor concern. ...
... Echoing results in HIV-positive men undergoing anal cancer screening34 and in men receiving prostate biopsy screening,35 we found that men receiving an initial alarming test result and then a reassuring result at the follow-up biopsy appeared more positive than men who received an initial less severe result that persisted.Participants in the present study in general claimed that screening and results did not affect their way of thinking about their sexuality, and they reported little intention to modify their sexual behaviour. This contrasts with women receiving HPV and Pap test results in cervical cancer screening, who reported intentions of continuing or changing one's sexual behaviours and monitoring sexual partners.29 Some men in this study indicated feelings of guilt about having had passive role in sexual intercourses, assuming that this may account for their abnormal result. ...
Objective:
Human papillomavirus (HPV)-related anal cancer rates are increasing and are particularly high in gay, bisexual and other men who have sex with men (GBM/MSM), especially HIV-positive individuals. Although screening programs for high-risk populations have been advocated, concerns about possible adverse psychological consequences exist. This study aimed to investigate GBM/MSM's experience, understanding and emotional response to screening techniques for anal cancer, to determine how best to minimise psychological distress in future programs.
Methods:
In-depth qualitative face-to-face interviews were carried out with 21 GBM/MSM participating in the 'Study of the Prevention of Anal Cancer' in Sydney, Australia between June 2013-June 2014. Non-random, purposive sampling was used to ensure heterogeneity with respect to HIV-status and screening test results. Framework Analysis method was used to organise the data and identify emerging themes.
Results:
Knowledge about anal cancer, HPV and the link between them was limited. Abnormal screening results impacted participants' sense of wellbeing and were associated with anxiety and concern about developing anal cancer. HIV-negative men receiving abnormal results showed higher levels of distress compared to their HIV-positive counterparts. Consultations with general practitioners about abnormal results had an important role in increasing participants' understanding and in moderating their anxiety.
Conclusion:
Anal cancer screening should be accompanied by health education around anal cancer, its aetiology and the meaning of associated test results. Simple and effective communication strategies should be encouraged. Collaboration with general practitioners could assist the process of education and reporting test results.
... A diverse nature of psychosocial effects was noted in women with abnormal Pap smear such as shock, anxiety, depression, fear, self-blame, hopelessness, and rage which is also influenced by other factors such as lower socioeconomic status, unable to understand thoroughly the information given about the Pap smear results, and thinking themselves in a higher risk of cervical cancer. [4,9,10] Furthermore, these women subsequently developed traumatic emotional experiences such as the impact on relationships and intimacy with their partners to a negative influence on sexual relations and self-esteem. [11][12][13][14] Besides that, it was noted that the psychological distress due to abnormal Pap smear was found to be significantly higher in women at reproductive age and with low levels of health literacy as compared to menopause age women, especially when they were informed about the need of colposcopy and the risk of cervical cancer. ...
... [24] Moreover, some other studies in the United States reported no anxiety and distress among older women as some showed refutation of the results, and some perceive cervical cancer as a matter of fate and have fatalistic beliefs with the lack of personal susceptibility to cervical cancer. [9,25] Overall, the main reasons reported contributing to the psychosocial burden among women (anxious, fearful, self-blame, powerlessness, disbelief, depression, and anger) in this domain were lack of understanding of abnormal Pap smear results and higher perceived risk of developing cervical cancer which also have negative impact on perception of self. [10,11,26] Domain 3: Worry about human papillomavirus infectivity Women of reproductive age were found to have a significantly higher mean score not only in general but also in both individual items of this domain "worry about HPV infectivity" compared to a menopausal group of women. ...
... [23] Moreover, it was also reported a negative impact on a sexual partner when they knew about abnormal Pap smear result, and this was associated with depression in some women and even some partners showed a negative reaction on abnormal Pap smear results. [4,9,11] Therefore, abnormal Pap smear results can have a psychosocial effect on the woman's life. [27] ...
Introduction: Women with abnormal Pap smear results are facing psychosocial problems such as fear, anxiety, mental stress, and defaulted follow-ups. This study aims to identify psychosocial burden differences in mean score between reproductive age group and menopausal age group women with abnormal Pap smear results.
Materials and Methods: A total of seventy women with abnormal Pap smear results were recruited from three Ministry of Health, Tertiary Hospital on the East Coast of Malaysia (Kuala Terengganu, Kota Bharu, and Kuantan). The self-administered PEAPS-Q-14 questionnaire was answered by the participants and data were analyzed using descriptive and independent t-test.
Results: Mean age of respondents was 44.79; the majority were Malays (84.3%) and Muslims (88.6%). Only two domains are significant differences between the age groups of 0.003), and worry about human papillomavirus (HPV) infectivity (P < 0.005).
Conclusion: Psychosocial burden due to abnormal Pap smear results in terms of mental stress, overwhelming beliefs, and feelings of guilt and worry of HPV infection and possibility of cervical cancer were noted more in reproductive age groups as compared to the menopausal age group. Health-care providers should be aware of these psychosocial effects whereby they can refer such patients to a gynecologic oncologist for proper counseling at the proper time so that the negative impact due to this psychosocial burden can be prevented.
... Although there are clinical differences between the two genes, they are similar in that both have implications for the health of the couple and future children, and both are integrally related to dyadic interests in sexuality and childbearing. Research on STIs in dating couples suggests that women generally disclose or intend to disclose their infection status to partners in noncasual relationships, and worry about anger or rejection as a result (Green et al., 2003;Kahn et al., 2005;Mc-Caffrey, Waller, Nazroo, & Wardle, 2006). Motivations to disclose include awareness of health implications for partners, attempts to strengthen relationships by sharing information, and a desire to share fully in response to increasing intimacy (Green et al., 2003;Kahn et al., 2005). ...
... Research on STIs in dating couples suggests that women generally disclose or intend to disclose their infection status to partners in noncasual relationships, and worry about anger or rejection as a result (Green et al., 2003;Kahn et al., 2005;Mc-Caffrey, Waller, Nazroo, & Wardle, 2006). Motivations to disclose include awareness of health implications for partners, attempts to strengthen relationships by sharing information, and a desire to share fully in response to increasing intimacy (Green et al., 2003;Kahn et al., 2005). Disclosure is less common in casual relationships (Kahn et al., 2005), or when the STI is not perceived as a threat to the partner's health (McCaffrey et al., 2006). ...
... Motivations to disclose include awareness of health implications for partners, attempts to strengthen relationships by sharing information, and a desire to share fully in response to increasing intimacy (Green et al., 2003;Kahn et al., 2005). Disclosure is less common in casual relationships (Kahn et al., 2005), or when the STI is not perceived as a threat to the partner's health (McCaffrey et al., 2006). Research on HPV disclosure suggests that women who frame disclosure as increased risk of cervical cancer or abnormal PAP result, rather than as an STI, receive more support from partners and felt more comfortable during the process (McCaffrey et al., 2006). ...
BRCA1/2-positive women who learn their mutation status early in the life-course face unique challenges related to navigating the tasks of young adulthood. Using qualitative methods and grounded theory, the authors analyzed in-depth interviews with 11 women aged 26 to 35 who learned their mutation status before marriage. Their narratives illustrate the complexity of relationship formation, and highlight the potential for relationship-bonding and intimacy-building in the course of sharing mutation information. Disclosing BRCA mutation status to dating partners is often preceded by feelings of fear and anxiety, yet many participants reported that doing so has positive effects on relationships. Partners' abilities to respond with interest, empathy, and affection are associated with increased future intimacy, consistent with generally accepted principles within the family/couple systems field. Individual cancer risk perception and familial cancer experiences may affect the disclosure experience, which can be understood via Attachment Theory. Our findings provide clinical insight, identify new areas for research, and suggest ways to assist this unique population in their adjustment to being BRCA mutation-positive. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Η μελέτη [158] Έχει αποδειχτεί ότι πολλές γυναίκες αποφεύγουν να κάνουν το τεστ Παπανικολάου επειδή δεν θέλουν να μπουν στη διαδικασία αναμονής του αποτελέσματος και στην αγωνία που αυτή συνεπάγεται [173], [174], [175], [176], [149]. Οι γυναίκες που υποβάλλονται σε έλεγχο ρουτίνας για καρκίνο του τραχήλου της μήτρας πρέπει να ενημερώνονται εκ των προτέρων για την καρκινογένεση στον τράχηλο της μήτρας, το ρόλο του ιού HPV, τη λογική του μαζικού ελέγχου ρουτίνας, την αξιοπιστία του ΠΑΠ τεστ και την πιθανή ανάγκη για επιπρόσθετες εξετάσεις. ...
... Οι γυναίκες που υποβάλλονται σε έλεγχο ρουτίνας για καρκίνο του τραχήλου της μήτρας πρέπει να ενημερώνονται εκ των προτέρων για την καρκινογένεση στον τράχηλο της μήτρας, το ρόλο του ιού HPV, τη λογική του μαζικού ελέγχου ρουτίνας, την αξιοπιστία του ΠΑΠ τεστ και την πιθανή ανάγκη για επιπρόσθετες εξετάσεις. Αυτό μπορεί να γίνει και μέσω προκαταρκτικής ενημέρωσης με ενημερωτικά φυλλάδια έτσι ώστε να μειωθεί το άγχος των γυναικών [173], [174], [175], [149]. Σε περίπτωση που τα αποτελέσματα του Παπ τεστ υποδεικνύουν αλλοιώσεις σχετικές με HPV, ο καλύτερος τρόπος πληροφόρησης είναι η προσωπική ενημέρωση από εξειδικευμένο ιατρό. ...
... Particularly in highly industrialized countries, qualitative studies on HPV-DNA testing have shown that when questioned about possible infection, women manifest adverse feelings related to stigmatization, and anxiety and preoccupation toward their sexual partners (Clarke et al. 1996;da Silva Marquez Ferreira and Gimenez 2005;Kahn et al. 2005;Maissi et al. 2004;McCaffery 78 C. WIESNER ET AL. et al. 2006;Waller, Marlow, and Wardle 2007;Waller, McCaffery et al. 2007;Wright et al. 2004). In an effort to overcome some of the anxiety and psychological distress often experienced upon HPV diagnosis and during the period of management, particularly for participants in HPV screening programs, mass education must accompany screening protocols. ...
... Various studies have revealed the tendency among some women, upon learning of the relationship between cancer and HPV, to overestimate the risk of cancer, so accentuating feelings of fear and anxiety (Clarke et al. 1996;da Silva Marquez Ferreira and Gimenez 2005;Kahn et al. 2005;Maissi et al. 2004;Waller, Marlow, and Wardle 2007;Wardle, Pernet, and Stephens 1995). However, when they learn that there is a good possibility that their HPV infection will reach clearance, their anxiety is greatly reduced. ...
Identifying DNA of Human papillomavirus (HPV) has been proposed as a new screening method for cervical cancer control. Conventionally, health education for screening programs is based on scientific information without considering any community cognitive processes. We examine HPV social representations of 124 men and women from diverse educational status living in Bogotá, Colombia. The social representation of HPV involves a series of figurative nuclei derived from meanings linked to scientific information. While women focused on symbols associated to contagion, men focused on its venereal character. Figurative nuclei also included long-term uncertainty, need or urgent treatment, and feelings of imminent death associated with cancer and chronic sexually transmitted infections. The social representation of HPV impeded many participants from clearly understanding written information about HPV transmission, clearance, and cancer risk; they are built into a framework of values, which must be deconstructed to allow women full participation in HPV screening programs.
... Higher scores on the item "I would be embarrassed to get tested for HPV because it is a sexually transmitted infection" among the underscreened women are consistent with the findings of systematic reviews by Tatar et al. [30] and Nothacker et al. [31], which identified stigma as a barrier to HPV testing. Without adequate education and clear recommendations from health authorities, stigma not only poses challenges to screening uptake but also contributes psychosocial distress after a positive test result [42] and increases the likelihood of failing to maintain preventive behaviours like screening [43]. ...
As Canadian provinces and territories prepare to transition to HPV-based primary screening for cervical cancer, failure to identify and address potential barriers to screening could hinder program implementation. We examined screening-eligible Canadians’ attitudes towards and knowledge of cervical screening. A nationally representative sample of screening-eligible Canadians (N = 3724) completed a web-based survey in the summer of 2022. Oversampling ensured that half of the sample were underscreened for cervical cancer (>3 years since previous screening or never screened). The participants completed validated scales of cervical cancer, HPV, and HPV test knowledge and HPV test and self-sampling attitudes and beliefs. Between-group differences (underscreened vs. adequately screened) were calculated for scales and items using independent sample t-tests or chi-square tests. The underscreened participants (n = 1871) demonstrated significantly lower knowledge of cervical cancer, HPV, and the HPV test. The adequately screened participants (n = 1853) scored higher on the Confidence and Worries subscales of the HPV attitudes and beliefs test. The underscreened participants scored higher on the Personal Barriers and Social Norms subscales. The underscreened participants also endorsed greater Autonomy conferred by self-sampling. Our findings suggest important differential patterns of knowledge, attitudes, and beliefs between the underscreened and adequately screened Canadians. These findings highlight the need to develop targeted communication strategies and promote patient-centered, tailored approaches in cervical screening programs.
... All sexually transmitted infections, including HPV, have an adverse effect on women's psychosocial and sexual lives (6). Several studies found that positive HPV test results can lead to distress, anxiety, and depression, as well as sexual dysfunction in women (7)(8)(9), resulting in decreased quality of life (10). Given that many women experience adverse psychological and sexual consequences after being diagnosed with HPV (11), the impact of HPV on mental health and sexual function should be addressed to help alleviate the psychosexual burden. ...
We aimed to evaluate the psychosexual impact of being diagnosed with human papillomavirus (HPV). A cross-sectional study was conducted to assess the anxiety and depression levels and sexual functions in women with and without HPV between March and May 2021. Beck anxiety inventory (BAI), the Beck depression inventory (BDI), and the Libido scoring system scales (LSSS) were used as scales. A total of 575 respondents were included; 292 (50.2%) HPV-negative, and 283 (49.8%) HPV-positive, of whom 170 (60,1%) had high risk HPV genotypes 16/18 and 113 (39,9%) had non-16/18 high risk HPV-positive patients. There was no significant association between HPV-negative and HPV-positive patients in terms of sociodemographic characteristics. While 21.6% of the HPV-positive group experienced masturbation, it was 15.1% in the HPV-negative group (p=0.044). While severe depression was 4.9% in HPV-positive women, this rate was 1.4% in HPV-negative women (p=0.002). The present study showed that being diagnosed with HPV made a significant difference in sexual function, except for sexual interest, but increased anxiety and depression scores. Sexual dysfunction following an HPV diagnosis cannot be explained solely by depression and anxiety.
... However, being included in screening programs can also produce calmness because patients perceive some level of control over their anal health, 17 which also occurs among women included in cervical cancer screening programs. 35 Most of the participants in this work had shared the information on their healthcare with their family and social environment. Nonetheless, some did not share this clinical information and preferred to deal with the process alone. ...
Background:
To the best of our knowledge, no studies have yet examined the emotional repercussions of the care processes among people infected with the human immunodeficiency virus who participate in preventive anal cancer screening programs.
Objective:
This study aimed to explore the knowledge, emotions, sexuality, barriers, and facilitators perceived by this patient group during the process of anal cancer screening and diagnosis.
Methods:
Detailed, semistructured, qualitative interviews were completed with 17 men and 3 women to explore their knowledge, experiences, and emotions regarding the screening process. Purposive sampling was conducted on the basis of age, gender, and type of lesion diagnosed in the anal biopsy.
Results:
Four major themes were identified: 1) knowledge of the disease and its treatment, 2) emotions perceived by the patients, 3) the influence of screening on sexual practices, and 4) facilitators and obstacles during the care provision process. Patients reported appropriate knowledge of anal cancer and human papillomavirus. Predominant emotions were worry and fear with avoidance as one of the coping strategies.
Conclusion:
These results suggest that communication of information and clinical results can be improved.
Implication for practice:
Understanding the facilitators and barriers to the program will allow the integration of interventions designed to improve healthcare provision into direct care.
... Thus, feelings of shame, an intense negative emotion that elicits withdrawal and avoidance coping (Fischer and Tangney 1995), are often associated with STDs. Indeed, shame, distress, upset (McCaffery et al. 2006), and anticipated stigma (Daley et al. 2010;Kahn et al. 2005) were some of the common psychological responses among HPV positive women. Stigma and shame can affect both patients and non-patients by acting as a barrier to seeking prevention and treatment (Batchelder et al. 2020). ...
In this research, we seek to provide effective message strategies to communicate stigma associated health issues such as the human papillomavirus (HPV), by exploring the roles of humor, STD information, and objective HPV knowledge. Conducted with a 2 (Humor: no vs. yes) x 2 (STD information: no vs. yes) between-subjects experiment with objective HPV knowledge as a measured moderator, findings suggested that for the lower HPV knowledge subjects, the humor ads produced higher attention to the ad, more favorable ad attitudes (Aad), and greater behavioral intention to seek HPV prevention and treatment than the no-humor ads when there is no STD information. However, when STD information was present, for the lower HPV knowledge individuals, the no-humor ads produced greater attention and more positive Aad than the humor ads. Humor and STD information in the ads did not affect higher HPV knowledge individuals. Implications for theory as well as practice are discussed.
... This clinical recommendation would likely increase the frequency of cervical Pap smears in the United States, a population with a low annual incidence of cervical cancer (1.4/100,000 women), and also increase the associated costs and emotional distress. 4,5 Current recommendations in the United States, from the American Society for Colposcopy and Cervical Pathology, emphasize the use of human papilloma virus (HPV) testing.² HPV testing was not a consideration in the Swedish trial because that retrospective study was conducted before increased use of HPV testing. ...
... Embodied therein is empowerment, whereby women would be well-informed about available options, actively participating in decision-making regarding cervical screening. Such a strategy has been successful in other cervical screening contexts (43,44) and is likely to enhance fuller participation in the needed long-term follow-up for these women at increased cervical cancer risk. ...
Women treated for high-grade cervical-intraepithelial-neoplasia (CIN) require long-term follow-up with high-risk human-papillomavirus (HPV) testing. Self-sampling for HPV is well-accepted among these patients, but its role in follow-up for this group requires investigation. The present study examined how well HPV findings from self-sampled vaginal (VSS) and urine specimens correctly identified women from this cohort with recurrent CIN2+ compared with samples collected by clinicians. At 1st post-conization follow-up, 531 patients (99.8% participation) gave urine samples, performed VSS, underwent colposcopy with punch biopsy of visible lesions and clinician-collected cervical sampling for HPV analysis and liquid-based cytology. A total of 113 patients with positive HPV and/or abnormal cytology at 1st follow-up underwent 2nd follow-up. At 1st follow-up, all patients with recurrent CIN3 had positive HPV results by all methods. Clinician sampling and VSS revealed HPV16 positivity in 50% of recurrent cases and urine sampling revealed HPV16 positivity in 25% of recurrent cases. At 2nd follow-up, all 7 newly-detected CIN2/3 recurrences were associated with HPV positivity on VSS and clinician-samples. Only clinician-collected samples detected HPV positivity for two adenocarcinoma-in-situ recurrences, and both were HPV18 positive. A total of 77 patients had abnormal cytology at 1st follow-up, for which HPV positivity via VSS yielded highest sensitivity. The HPV findings were positive from VSS in 12 patients with high-grade squamous-intraepithelial-lesions (HSIL), and 11 patients with HSIL had positive HPV findings in clinician-collected and urine samples. All methods for assessing HPV presence yielded significant age-adjusted odds ratios for predicting abnormal lesions at 1st follow-up. For overall HPV results, Cohen's kappa revealed substantial agreement between VSS and clinician sampling, and moderate agreement between urine and clinician sampling. Clinician sampling and VSS were highly concordant for HPV16. Insofar as the pathology was squamous (not glandular), VSS appeared as sensitive as clinician sampling for HPV in predicting outcome among the present cohort. Since VSS can be performed at home, this option can maximize participation in the required long-term follow-up for these women at high-risk.
... Em pesquisas que não envolveram viagens, relacionadas a aceitação de vacinas contra o HPV (Anhang et al., 2004;Hoover et al., 2000;Kahn et al., 2003;Kahn et al., 2005;Mays et al., 2000;Mays et al., 2004), a gravidade percebida das infecções do HPV, embora os que acreditassem que a doença era grave e houvesse mais probabilidade de aceitar a vacina, a gravidade percebida não estava relacionada à aceitabilidade da vacina. (Brewer;Fazekas, 2007). ...
A compreensão do comportamento dos turistas auxilia o setor turístico a gerenciar de forma mais eficaz a crise. Este estudo tem como objetivo analisar as percepções dos riscos de viagens aéreas durante a pandemia da Covid-19 no estado de Santa Catarina, Brasil. Para tal, estas percepções são examinadas utilizando quatro dimensões: intenção de viagem, gravidade percebida, suscetibilidade percebida e autoeficácia. O instrumento de coleta de dados com a finalidade de mensuração de construtos foi um questionário construído na plataforma Google Forms e disponibilizado online na rede social Facebook por meio de mídia patrocinada direcionada à residentes do estado de Santa Catarina. Foram obtidos 819 questionários válidos. Foi utilizada a análise de médias bem como a comparação entre elas, teste Mann-Whitney e Kruskal-Wallis. Todas as análises foram feitas por meio do software IBM SPSS Statistics versão 23. As conclusões sugerem que após dez semanas do primeiro caso de Covid-19 no estado, os moradores de Santa Catarina ainda não estão inclinados a viajar embora estas percepções estejam reduzindo progressivamente. A flexibilização do comércio, na sexta semana, influenciou negativamente em todas as dimensões. As descobertas avançam na literatura sobre pandemia e intenção de viagens aéreas e oferecem implicações importantes para os responsáveis por políticas públicas e pesquisadores interessados.
... The results indicate that younger women have higher quality of life related with physical health compared with mental health; similar studies found that young women prefer to have HPV testing as diagnostic technique because they consider it more effective and precise than other similar methods, besides having greater confidence in their being [24,25] and greater access to information [26]. It is also possible that younger women have lower scores in the mental health component due to worries about the implications this may have in their sexuality and fertility. ...
Background
Information obtained in studies on the impact of human papilloma virus (HPV) testing on health-related quality of life is contradictory.Objective
To assess the impact on health-related quality of life of the HPV test, colposcopy, and cytology as triage strategies after a cytology with atypical squamous cells of undetermined significance (ASCUS) in Medellín, Colombia.Methods
We carried out a nested analysis on the randomized pragmatic trial (ASCUS-COL). Women with ASCUS were assigned randomly to one of the 3 arms (Pap smear, colposcopy, HPV). Participants completed a questionnaire at baseline, two weeks after receiving the results of the triage tests and one year after the second questionnaire. We used the SF-36 to assess health-related quality of life.ResultsThe sum score of the physical health component (PHC) and mental health component (MHC) increased significantly over time for the whole sample and there were no statistically significant differences between arms of PHC = survey 1: mean 52.4 (SD 8.21) vs. survey 3: mean 54.4 (SD 8.16) p < 0.0001 and of MHC = survey 1: mean 44.9 (SD 11.72) vs. survey 3: mean 48.1 (SD 11.20) p < 0.0001. A lower MHC occurred in women with lesser schooling, belonging to the public health care regimen, higher number of live births, and separated. A lower PHC was associated with the cytology arm, higher age, lesser schooling, and belonging to the subsidized regime. The risk of having depression went from 42% in the first survey to 26% in the third.Conclusion
The triage strategies affected health-related quality of life in the same manner.ClinicalTrials.gov Identifier: NCT02067468.
... Prior literature has shown that women often do not understand the implications of a positive HPV test or what a positive HPV diagnosis means [22,23]. An HPV diagnosis is often associated with stigma, anxiety, and distress [22,24,25]. An interaction with a healthcare provider may alleviate these negative feelings more so than an impersonal contact method such as a mailed letter or text message. ...
Background:
Self-sampling for HPV testing may be a method to increase overall cervical cancer screening rates among Black women, who are underscreened for cervical cancer in parts of the US. The purpose of this study was to assess preferred characteristics for delivery of HPV self-sampling kits, return of HPV self-sampling kits, and communication of HPV test results and explore sociodemographic factors (income, education, and marital status) associated with acceptability of self-sampling for HPV testing.
Methods:
Survey data were gathered at an Indiana minority health fair. Participants evaluated 9 scenarios that varied along 3 dimensions: HPV self-sampling kit delivery (mail, pharmacy pick-up, or clinic pick-up), HPV self-sampling kit return (mail, pharmacy drop-off, or clinic drop-off), and HPV test results (mail, phone call, or text message). The 9 scenarios were produced from a fractional factorial design and rated on a 0 to 100 scale. Ratings-based conjoint analysis (RBCA) determined how each dimension influenced ratings. A measure for acceptability of self-sampling was obtained from the ratings of all 9 scenarios. The acceptability measure was regressed on sociodemographics.
Results:
The 98 participants ranged in age from 21 to 65 (M = 45). Across the 9 scenarios, overall acceptability to self-sample had a mean of 60.9 (SD = 31.3). RBCA indicated that HPV self-sampling kit return had the most influence on ratings, followed by HPV self-sampling kit delivery, and finally, HPV test result communication. Thirty-six percent of participants rated all self-sampling scenarios the same. Sociodemographic characteristics were not associated with acceptability of self-sampling.
Conclusions:
Self-sampling for HPV testing was found to be generally acceptable to Black women in this pilot survey study. This information could be used by researchers developing self-sampling interventions and the implementation of self-sampling among providers.
... 12 In effect, as a consequence of the known sexual transmission of the infection, HPV positivity has connotations of promiscuity, stigmatization, impurity, and can result in shame, worries about future sexual relationships and questions about the women's or their partner's sexual behavior. [13][14][15] HPV results can also produce anxiety, fear of death, and disease denial, or women not considering it necessary to continue diagnosis, treatment and follow-up. [16][17][18] It has been shown that believing that an abnormal screening test is indicative of cancer and inevitable death, in addition to its association with a sexually transmitted disease can act as barriers for diagnosis and treatment of precancerous lesions. ...
Human papillomavirus (HPV) testing can have a negative impact on women’s lives which might also result in abandoning the follow-up and treatment process. This study measured the psycho-social impact of HPV-positivity among HPV-tested women from Jujuy, Argentina, a middle-low income setting.
In this cross-sectional study (2015-2016), the psycho-social impact of HPV-positivity was measured using the Psycho-Estampa Scale, specifically designed and validated to be used in screening contexts. We measured mean scores for each of the five scale domains, and the Overall Impact score (Values from 1: No impact to 4: Heavy impact). We compared scores according to cytology triage diagnosis using ordinal logistic regression.
A total of 163 HPV-positive women were recruited at the Centro Carlos Alvarado hospital and included in the study sample; of these, 124 (76.1%) had normal triage cytologies. The overall Impact score was low and moderate (mean:2.53, SD:0.65). The highest psycho-social impact was measured in the Worries about cancer and treatment domain (mean score:3.6, SD:0.5), followed by Sexuality domain (mean:2.5; SD:1). The Uncertainty about information provided by health providers domain had the lowest mean score (mean:2.14, SD:0.73). Compared to women with normal cytologies (n=124), women with abnormal cytologies (n=39) had a higher likelihood of greater overall Psycho-social Impact (OR: 2.91; p=0.0036). No statistically significant differences were found in scores of specific domains according to cytology results.
It is important to devise specific counseling interventions to reduce the psycho-social impact of HPV-Testing as primary screening and its potential effect on completion of the diagnosis/ treatment process.
... 24 Some women were worried that their partner would accuse them of infidelity 37 39 and felt that disclosure might cause harm to their relationship or even lead to it ending. 33 37 39 In extreme cases, women ended relationships because of a fear of rejection following disclosure. 38 When is disclosure necessary? ...
Background
Human papillomavirus (HPV)-based cervical screening is now replacing cytology-based screening in several countries and many women in screening programmes will consequently receive HPV-positive results. Because of the sexually transmitted nature of HPV, receiving an HPV-positive result may raise questions about disclosing the infection to a sexual partner.
Objective
To review the quantitative and qualitative literature exploring women’s concerns about disclosing a high-risk cervical HPV infection to a sexual partner.
Methods
We searched MEDLINE, PsycINFO, CINAHL Plus, Web of Science and EMBASE for studies reporting at least one disclosure-related outcome among women with high-risk HPV. We also searched the grey literature and carried out forward/backward citation searches. A narrative synthesis for quantitative studies and a thematic synthesis for qualitative studies were conducted.
Results
Thirteen articles met the inclusion criteria (12 qualitative, 1 quantitative). In the quantitative study, 60% of HPV-positive women felt disclosing an HPV result was ‘risky’. Concerns about disclosing HPV to a sexual partner were influenced by the stigma that is associated with having an STI and uncertainty about how their partner would respond. Women questioned how, when and to whom they should disclose their HPV-positive status.
Conclusions
The studies included in this review provide rich information about the range of concerns women have, the reasons for these concerns, and the questions women have about disclosing HPV to sexual partners. As studies were predominantly qualitative, the prevalence of concerns is unclear.
... Women expressed other causes of fear and anxiety such as "scary" public health campaigns, finding out about HPV and cervical cancer for the first time, and waiting for their results. This is consistent with research in high-income countries where HPV-DNA testing and cervical cancer screening have been shown to generate anxiety and distress [46][47][48]. Having one's information needs met was the same protective factor against screening-anxiety mentioned by these women as women in high-income-settings [24,40,49]. ...
Abstract Background Cervical cancer is the most common cancer in women in Ghana, but knowledge and experience of women who have had cervical screening is under-evaluated. This study examined knowledge and understanding of HPV and cervical cancer and evaluated experiences of screening in a cohort of women of mixed HIV status. Methods This was a mixed methods study using questionnaires and focus group discussions, with a knowledge score constructed from the questionnaire. HIV-positive and HIV-negative women were recruited from a larger cervical screening study in Ghana and were interviewed 6 months after receiving screening. Quantitative data was analyzed and triangulated with qualitative data following thematic analysis using the framework approach. Results A total of 131 women were included (HIV-positive, n = 60). Over 80% of participants had a knowledge score deemed adequate. There was no difference between HIV-status groups in overall knowledge scores (p = 0.1), but variation was seen in individual knowledge items. HIV-positive women were more likely to correctly identify HPV as being sexually-transmitted (p = 0.05), and HIV negative women to correctly identify the stages in developing cervical cancer (p
... Likewise, there are concerns regarding the relationship of the virus with cervical cancer and, hence, can produce anxiety, depression and worries about fertility (Kahn et al., 2005(Kahn et al., , 2007Kwan et al., 2011;Wiesner Ceballos et al., 2009). The literature suggests that cancer related experiences can have a life-altering impact even in relatively stable measures such as anxiety (Ozkaraman, D€ ug€ um, € Ozen Yılmaz, & Usta Yesilbalkan, 2018;Schneider et al., 2016;Villar et al., 2017). ...
Objective: To assess the psychosocial impact of human papillomavirus (HPV) testing, colposcopy, and Pap-smear, as triage strategies after a Pap-smear with atypical squamous cells of undetermined significance (ASCUS). We also sought to evaluate the psychosocial impact based on the results of the strategies. Methods: Nested within a randomised pragmatic trial, which compared an immediate colposcopy, repeat Pap-smear, and high risk HPV test, we enrolled 675 women between 2012 and 2014. Participants completed surveys at enrollment, two weeks after triage test results, and 1 year thereafter to assess cervical cancer and HPV knowledge, self-esteem, anxiety and HPV impact (HIP). Results: Knowledge, self-esteem, anxiety and HIP improved with no differences among arms. At the baseline, 31.4% and 32.7% of the participants had state anxiety and trait anxiety, respectively, which decreased to 10.7% and 13.3% in the last survey. Compared to HPV-negative women, HPV-positive women in the second survey had worse HIP scores (HPV–: M 22.9 [SD: 15.20]; HPV+: M 35.9 [SD: 19.91]; p < 0.001), trait anxiety (HPV–: M 15.4 [SD 12.73]; HPV+: M 22.9 [SD 13.29]; p = 0.001), and state anxiety (HPV-: M 10.7 [SD 11.25]; HPV+: M 21.4 [SD 14.81]; p < 0.001). Conclusions: HPV testing as a triage strategy for women with ASCUS does not differ from colposcopies or Pap-smears in terms of psychosocial outcomes.
... Two scales to assess the mother's personal beliefs about Pap testing (a four-item scale) and beliefs about HPV vaccines (a seven-item scale) were adopted in 2006 from previous GUTS work and informed by a conceptual model guided by theories of health behavior, including the theory of planned behavior, social cognitive theory, and the health belief model (Kahn et al., 2005(Kahn et al., , 2007Kahn, Rosenthal, Hamann, & Bernstein, 2003). The Pap testing beliefs scale included items assessing the mother's belief that a Pap test decreases the risk of cervical cancer, gives peace of mind to know result, helps to take control of her health, and is painful. ...
Objectives:
Our objective was to explore how mothers' attitudes and relationships with their daughters may impact the cervical cancer prevention behaviors of daughters with diverse sexual orientations.
Methods:
We examined 8,143 mother-daughter dyads from the Nurses' Health Study 2 and Growing Up Today Study. During the daughter's adolescence, each mother reported her beliefs about the importance of regular Pap testing for her daughter, the frequency of communication with her daughter about Pap testing, her beliefs about Pap testing and human papillomavirus (HPV) vaccines, and her acceptance of sexual minorities (e.g., bisexuals, lesbians). Mothers and daughters separately reported relationship satisfaction. Log-binomial models were used to examine the longitudinal association between maternal factors and daughter's receipt of a Pap test and HPV vaccination.
Results:
Nearly all maternal factors predicted the daughter's likelihood to have a Pap test and HPV vaccination. Higher levels of acceptance for sexual minorities and better relationship quality were also positively associated with these cervical cancer prevention behaviors. Yet, after adjusting for the maternal factors, there was little attenuation of the existing sexual orientation-related disparities in Pap tests or HPV vaccination.
Conclusions:
Mothers can play an important role in their daughters' cervical cancer prevention behaviors through novel processes like being more accepting of sexual minorities and having a good relationship quality. However, in this study, maternal factors did not explain much of the sexual orientation-related disparities in cervical cancer prevention. Efforts to ensure a mother is accepting of sexual minorities and has a good relationship quality with her daughter may improve that daughter's reproductive health.
... They then responded to statements relating to how they would expect to feel: five statements related to shame, three related to anxiety, and eight related to stigma (see Appendix D). Nine worry statements were also developed based on a review of the literature (McCaffery et al., 2003(McCaffery et al., & 2006Kahn et al., 2005) (Appendix D). Response options to all statements were 'strongly disagree', 'disagree', 'agree' or 'strongly agree'. ...
Some cervical cancer screening programmes are replacing cytology with human papillomavirus (HPV) DNA testing as the primary screening test. Concerns have been previously raised around the potential psychosocial impact of testing positive for HPV. We analysed socio-economic variations in anticipated adverse reactions to testing positive for HPV in women of screening age in the general population. A questionnaire was mailed to a random sample of 5553 women aged 20-64 in 2010, selected through primary care in Ireland. This included questions on: socio-economics; HPV knowledge; and women's anticipated adverse psychosocial responses to testing HPV positive (shame, anxiety, stigma and worry). Multivariable linear regression was used to identify socio-economic factors significantly associated with each anticipated adverse reaction. The response rate was 62% (n = 3470). In multivariate analyses, having only attained primary level education were significantly associated with higher mean scores for all four adverse outcomes. Religion was significantly associated with all four adverse outcomes. Age was associated with anxiety and worry; younger women (<30 years) had the highest mean scores. Being married/cohabiting was significantly associated with significantly lower shame and worry scores. Not working was significantly associated with higher mean anxiety and worry scores. Our large population-based survey found significant socio-economic variations in anticipated adverse reactions to testing HPV positive. In order to minimise possible negative impacts on screening uptake and alleviate potential adverse psychological effects of HPV-based screening on women, screening programmes may need to develop specific messages around HPV infection and HPV screening that target certain subgroups of women.
... To the best of our knowledge, there have not yet been any published studies explicitly examining the relationship between HPV self-sampling and empowerment. However, a qualitative interview study of young women undergoing HPV DNA and cytological testing indicates that empowerment through the knowledge of results and the possibility to prevent future disease was a key outcome of their participation in the screening program [49]. Moreover, it has been reported that increased empowerment is significantly related to intention to participate in cervical cancer screening programs [50]. ...
Objective
Self-sampling to test for high risk human papilloma virus (HPV) is becoming an increasingly important component of cervical cancer screening. The aim of this observational study is to examine how women treated for high-grade cervical intraepithelial neoplasia (CIN) view HPV self-sampling.
Methods
Invited to participate in the present study were patients who had undergone treatment of high-grade CIN (grade 2 or higher) and were followed-up at 6-months at the Karolinska University Hospital, Stockholm. The participants were instructed as to how to perform HPV self-sampling. Thereafter, the participants completed a questionnaire about HPV self-sampling and other cervical cancer screening methods, as well as about self-perceived risk of cervical cancer without regular gynecologic follow-up and about specific knowledge regarding HPV, CIN and cervical cancer.
Results
Altogether 479 women enrolled in this study. The participation rate was 96.6%. Nearly 75% of the participants stated they would consider performing the HPV self-sampling prior to their next gynecologic follow-up. Confidence in HPV self-sampling was a significant independent predictor of willingness to perform HPV self-sampling. However, confidence in HPV self-sampling was significantly lower than confidence in Papanicolaou smears and in HPV testing with samples collected by health professionals. Higher specific knowledge about HPV, CIN and cervical cancer was also a significant independent predictor of willingness to perform HPV self-sampling, as was having travelled longer distance to attend gynecologic follow-up. Participants with lower income and without completed university education expressed significantly higher confidence in HPV self-sampling and lower confidence in Papanicolaou smears than the other women.
Conclusions
To the best of our knowledge, this is the first study to examine the views of women treated for high-grade CIN vis-à-vis HPV self-sampling. The latter is an acceptable option for the vast majority of this cohort of women.
... Testing positive for HPV infection can cause some women to feel upset and distressed. [11][12][13] ...
Web appendix 1: Balance sheet of pros and cons of HPV triage versus repeat Pap testing: evidence and presentation used in a patient decision aid (in italics)
... In a qualitative study conducted from 2001-2003, women with HPV expressed negative feelings such as guilt, blame, and disclosure concerns [McCaffery et al., 2006]. Furthermore, Kahn and colleagues found the majority of HPV positive women in their study had disclosure concerns and were reluctant to disclose to people other than sexual partners [Kahn et al., 2005]. It is discouraging that the blogs written on Experience Project revealed the same feelings and concerns as previous literature, despite the advances in HPV awareness and prevention that have happened over the past decade. ...
Purpose:
Human papillomavirus (HPV) is the most common sexually transmitted virus worldwide. Our purpose was to examine people's experiences with HPV using narratives posted on a website entitled, Experience Project.
Method:
We conducted a content analysis of 127 HPV narratives to identify stigma, emotion-focused and problem-focused coping, and misinformation.
Results:
Negative self-image was the most commonly identified type of stigma. There were more instances of problem-focused than emotion-focused coping. Sources of confusion were mostly about HPV treatment and side effects/symptoms.
Conclusions:
These findings have implications for how nurses and other health professionals can care for individuals living with HPV. Based on these findings, it would be beneficial for clinics/providers to implement on-line forums where myths about HPV can be debunked and accurate information provided. Both patients and the public need to be better informed about HPV, in order to decrease the negative stigma that can create a mental burden for individuals with HPV.
... HPV testing can have important social and psychological effects on women and can potentially damage their wellbeing particularly when used outside an organized prevention program. The magnitude of these effects depends on the characteristics of the woman concerned, her prior knowledge of HPV, the communication content and skills of the health D DAVID PUBLISHING professional [11]. Negative psychosocial responses to HPV diagnosis, include: anxiety; fear; anger; shame or stigma; regret; overestimation of cancer risk; concerns about loss of reproductive functions; concerns about negative reactions from friends, family, or sexual partners; concerns about partner infidelity or hostility; changes in physical intimacy activities; sexual refusal; isolation; urgent need for treatment; depression [12,13]. ...
Inappropriate testing for HPV types on healthy subjects increases costs without benefit and potentially results in overtreatment. HPV testing also has a negative psychosocial impact on women, increasing anxiety, stress, and concerns on sexual relationships. Giving the fact that HPV testing has been shown to have similar sensitivity but more overdiagnosis than cytology, and also giving the fact that false negative results may be higher than previously suspected, primary screening with HPV tests in European countries should be reconsidered. Resources saved in molecular testing may well be addressed in implementing vaccination strategies which are still underused, and may possibly include males as well as women.
... This conceptual identification needs to be understood in biological as well as social terms, since HPV testing intrudes on the intimacy of asymptomatic sexually active couples aged 30 to 65 years (Meijer et al. 2009). Particularly in highly industrialized countries, qualitative studies on HPV-DNA testing have shown that when questioned about possible infection, women manifest adverse feelings related to stigmatization, and anxiety and preoccupation toward their sexual partners (Clarke et al. 1996; da Silva Marquez Ferreira and Gimenez 2005; Kahn et al. 2005; Maissi et al. 2004; McCaffery et al. 2006; Waller, Marlow, and Wardle 2007; Waller, McCaffery et al. 2007; Wright et al. 2004). In an effort to overcome some of the anxiety and psychological distress often experienced upon HPV diagnosis and during the period of management, particularly for participants in HPV screening programs, mass education must accompany screening protocols. ...
Presentar los efectos psicológicos y sociales que tuvieron las mujeres, residentes en Bogotá, sometidas a la prueba de ADN del VPH, y la manera como los médicos comunican los riesgos a sus pacientes.
... Studies on women who have had anomalous Pap Test results have highlighted psychological consequences like anxiety, fear of cancer, sexual problems, changes in body image, difficulty in reproductive functions, hypochondria, a sense of neglect, anger, and fear of being labelled [6][7][8]. ...
The possibility to acquire sexually transmitted diseases generates bio-psycho-social conflicts affecting women's daily lives. We try to investigate the knowledge of women on the concept of being infected by the human papilloma virus (HPV) and to understand the significance they attributed to their condition as HPV carriers. Studies on women who have had anomalous Pap Test results have highlighted psychological consequences like anxiety, fear of cancer, sexual problems, changes in body image, difficulty in reproductive functions, hypochondria, a sense of heedlessness and anger. We think that it is possible to understand the necessity of assistance, orientation and the opportunity to listen to them, offering individualized quality care.
... Secondly, If we analyse risk factors associated with HPV contagion, we reveal that many of them are present or may be present in certain psychopathologies such as the impulse control disorder [19]. This could be another line of investigation. ...
A clear relationship between infection by Human Papillomavirus (HPV) and mental health problems does not seem to exist. Nonetheless, the presence of psychological symptoms – such as fear, guilt, shame and anxiety– are frequent in people who suffer the disease. A series of myths and false beliefs exist which may lead to great psychological discomfort. The diagnosis supposes putting into effect a process of adaptation. In this adaptation process to the disease, various defence mechanisms may appear. The importance of informing the patient – by the health professional – in a true and precise way, and allowing time for the patients to express their doubts about everything that is worrying them in order to face the emotional impact that giving the news to their partner and family may suppose should be highlighted. The disease leads to changes in lifestyle and quality of life. The aim is to help the patient in this process.
... The incidence of cervical cancer and more in general of HPV-related genital disease can be reduced through the synergic implementation of prophylactic HPV vaccination programmes and improving adherence to screening and treatment of precancerous lesions. To avoid overdiagnosis and overtreatment [97][98][99][100][101][102][103], low-grade lesions are not to be treated: provided good adherence to follow-up, a ''wait and see'' policy can be adopted to separate the vast majority of these lesions with a high regressive potential from the few that will progress over time. Since the lag time from precancerous to cancerous changes is quite long, there is no need to hurry in most of these circumstances. ...
There is no cure currently available for HPV infections, although ablative and excisional treatments of some dysplasias often result in a clinical and virological cure. Effective control measures of HPV-associated cancers rely on the prevention at four different levels. Apart from sexual abstinence, primary prevention is realized through vaccines targeting the most frequent HPV types: negative attitudes towards HPV vaccination and high costs are the main obstacles. The aim of secondary prevention is to detect precancerous changes before they develop into invasive cancer, while tertiary prevention involves actual treatment of high-grade lesions: in many countries routine screening with cytology is being challenged with HPV DNA testing. Quaternary prevention comprehends those actions adopted to mitigate or avoid unnecessary or excessive medical interventions, and may well be addressed in avoiding treatments for low-grade intraepithelial neoplasia. Though some gynecologists commonly recommend treatment for low-grade disease and women tend to prefer active management if not properly informed, harms arising from unnecessary treatments, increased costs, work overload for second-level health services, and induced psychosocial distress are causing on-going problems. Prevention efforts of genital HPV-associated cancers should concentrate in: (1) enhancing primary prevention through vaccination of all eligible subjects, (2) achieving high levels of adherence to routine screening programs, (3) treating precancerous lesions, and (4) monitoring current guidelines recommendations to avoid overtreatments. Novel research projects should be designed to study the delicate mechanisms of immune response to HPV.
... (10,27) Related data from the cervical cancer literature suggest that a better understanding of patients' responses to HPV may help guide interventions to diminish harmful psychosocial and interpersonal reactions while also promoting healthy sexual activity. (28) Similar studies are warranted in patients diagnosed with HPV-related head and neck cancer to examine the negative potential impact of an HPV diagnosis on sexual intimacy. ...
Background:
Oropharyngeal cancers are increasingly associated with human papillomavirus (HPV). Little is known about the experience of patients receiving this diagnosis.
Methods:
Semistructured interviews were conducted with ten survivors of HPV-related oropharyngeal cancer. The interviews were transcribed, and recurring themes were identified.
Results:
Physicians were a trusted source of information regarding HPV. Framing the diagnosis in terms of prognosis resonated with patients. The uncertainty about transmission, latency, and communicability colored the dialogue about HPV. Despite some understanding of prevalence and transmission, patients worried about their partner's risk. Patients sought information about HPV on the Internet, but it was not easily navigable. Emotional reactions to the diagnosis remained mostly cancer-centric rather than HPV-centric. A patient-education handout was developed in response to patient questions.
Conclusions:
Additional educational resources explaining the facts about HPV in HNSCC in a consistent way including content of highest priority to patients may improve understanding of HPV.
... HPV infection has physically and emotionally negative consequences for college-aged women. 37,38 Future studies may seek to examine (1) why college-aged women do not perceive themselves at risk of HPV infection; (2) the relationship between knowledge, attitudes, and sexual behaviors related to HPV and HPV vaccine; and (3) whether receiving the HPV vaccine encourages unsafe sex practice or not. HPV prevention intervention studies are needed. ...
To identify human papillomavirus (HPV) infection and HPV vaccine-related attitudes among college-aged women and the relationship between HPV vaccine uptake and subsequent sexual behaviors.
PubMed, MEDLINE, CINAHL, and Google Scholar searches were performed from 2006, the date after the first HPV vaccine became available, to present.
Of the 13 studies identified, most were cross-sectional. College-aged women saw HPV infection as serious and had positive attitudes toward the HPV vaccine. Barriers (ie, cost, lack of insurance coverage) existed that prevented women from obtaining the vaccine and many women did not see themselves at risk for HPV. The vaccine uptake rate, although increasing, has been slow.
College-aged women in the United States may need unbiased information about HPV and HPV vaccine. Studies that focus on risk perception and the relationship between knowledge, attitudes, vaccine uptake, and sexual behaviors are needed to inform interventions and public health programs.
... Partnerships with strong emotional ties in general appear to be important in STI disclosure (11)(12)(13)(14), and consistent with the literature, we found that honesty and caring for the partner were important promoters of HR-HPV disclosure (6, 10) while embarrassment (6, 10) and presumed protection from condom use (10) were commonly reported disincentives. We did not find fear of rejection (6) or stigma perception (10) to be barriers, and blame (15) was not a major reason for disclosure. ...
A survey was administered to male university students who tested positive for high-risk human papillomavirus. Disclosure was more likely in men with fewer partners, in main partnerships, and in longer partnerships. Disclosure was associated with discussing the Pap test/human papillomavirus vaccine with female partners and not associated with a worsening relationship.
... The research team (AG, JK, TM, and SG) organized and analyzed the interview data using framework analysis, a method for qualitative analysis consisting of 5 sequential analytic phases, which results in the development of a thematic framework, 19 and which is described in detail in our previous manuscripts based on other qualitative studies. [20][21][22][23] ...
Introduction. The aims of this qualitative study were to explore (a) the factors influencing mothers' decisions to vaccinate 11- to 12-year-old daughters against human papillomavirus (HPV) and (b) the mothers' and daughters' perspectives about HPV vaccine-related decision making. Methods. Participants were girls (N = 33) who had received an HPV vaccine and their mothers (N = 32), recruited from suburban and urban pediatric practices. Semistructured interviews were conducted with girls and mothers separately, and data were analyzed using framework analysis. Results. The primary factors influencing mothers' decisions to vaccinate daughters against HPV were (a) mother's beliefs and experiences; (b) interactions with clinicians, friends, and family members; and (c) exposure to media reports/marketing. Most daughters believed the decision to be vaccinated was a mutual one, although most mothers believed the decision was theirs. Conclusions. This study provides novel insights into perspectives on decision making about HPV vaccination among mothers and 11- to12-year-old daughters, which can be used in interventions to improve vaccination rates.
Cervical cancer is preventable through HPV vaccination and screening however, uptake falls below national targets. A scoping review was conducted to describe stigmas related to HPV infection and vaccination and cervical cancer and screening in the US. Results were organized into the domains proposed by Stangl and colleagues' Health Stigma and Discrimination Framework. Common drivers of stigma were fear of social judgement and rejection, self-blame, and shame. Positive facilitators included social norms that provided motivation to receive HPV vaccination and screening. Gender and social norms were notable negative facilitators of stigma. HPV infection and cervical cancer resulted in stigma marking through the belief that both result from incautious behavior—either multiple sexual partners or failing to get screening. Stereotyping and prejudice were stigma practices attributed to HPV infection and cervical cancer through these same behaviors. Stigma experiences related to HPV infection, cervical cancer, and abnormal screening results included altered self-image based on perceived/anticipated stigma, as well as discrimination. This review advances understanding of the multiple dimensions of stigma associated with these outcomes in the US population. Three areas warrant additional consideration. Future studies should 1) assess how stigma dimensions affect uptake of cervical cancer preventions efforts; 2) focus on US women most affected by cervical cancer incidence and mortality to identify potential differences in these dimensions and tailor interventions accordingly; 3) include women from geographic areas of the US with high rates of cervical cancer to adapt interventions that address potential regional variations in resources and need.
Baseline information on knowledge, attitude and perception towards Human
Papilloma Virus (HPV) infection is crucial to establish a progressive track of practice
on HPV immunization program to defeat the challenges faced by HPV related
diseases and cancers. The present study aimed at developing population specific
intervention tool (questionnaires) including informative educational tool (pamphlet)
and to assess the impact of these tools on knowledge, attitude, perception and/or
practice (KAP) changes among the three study populations (adolescents, adults and
parents). A cross sectional study was conducted in urban and rural areas of Kedah
state, Kedah Malaysia. The participants were selected using convenience sampling
and data was collected using standardized and validated questionnaires. The
participants’ demographic data, knowledge, attitude, perception/ practice about HPV
infection and HPV vaccination were assessed at baseline, and after intervention and
at three to six months among 2928 adolescents, 942 adults and 858 parents. The
research findings showed a significant improvement in knowledge scores among
adolescents from 37% at baseline to 67% (p < .001), after intervention and 66% to
88% (p < .001) at pre and post-test after 3-6 months of intervention. The median KAP
score also improved significantly from [Mdn = 47 (IQR =12)] at baseline to [Mdn = 57 (IQR
= 10)] at intervention and [Mdn = 47 (IQR = 12)] at post 3-6 months intervention. Among
xx
adults, the knowledge score improved from 63% at baseline to 89% (p < .001), after
intervention and 66% to 90% (p < .001) at pre and post-test after 3-6 months of
intervention. The median KAP score also improved significantly from [Mdn = 56 (IQR =
10)] at baseline to [Mdn = 88 (IQR = 18)] at intervention and [Mdn = 87 (IQR = 17)] at post
3-6 months intervention. Among parents, the knowledge score improved from 66% at
baseline to 89% (p < .001), after intervention and 73% to 94% (p < .001) at pre and
post-test after 3-6 months of intervention. The median KAP score also improved
significantly from [Mdn = 50 (IQR = 22)] at baseline to [Mdn = 62 (IQR = 11)] at
intervention and [Mdn = 73 (IQR = 5)] at post 3-6 months intervention. The protocol
significantly increased knowledge and KAP scores about HPV in the study
population, regardless of sociodemographic characteristics and risk behaviors.
Effective, informative and appropriate educational protocols about HPV infection
and HPV vaccination are particularly important and regular, booster education
campaigns are required to prevent adverse psychosocial responses and promote
healthy sexual practice and Pap screening behaviors in adolescents and adults.
Furthermore, the research finding provides an insight into utilization of trained
counselling teachers in secondary schools for prevention of health related diseases in
nation’s interest.
In this commentary, we briefly summarize knowledge on stigma associated with human papillomavirus (HPV). In addition, we provide suggestions for health care providers to de-stigmatize HPV and improve the delivery of care.
Aim
The aim of this study was to examine the psychosocial adjustment trajectory, focusing on psychological distress, sexual relationships and health care information, as well as factors which have an impact on adjustment on receiving a positive diagnosis of human papillomavirus infection.
Background
Human papillomavirus is a common sexually transmitted infection in females. To date, knowledge of the longitudinal psychosocial response to the diagnosis of human papillomavirus is limited.
Design
A prospective longitudinal design was conducted with a convenience sample.
Methods
Women aged 20‐65 years old were followed at one, 6 and 12 months after a diagnosis of HPV. Participants completed measures of initial emotional distress and followed‐up psychosocial adjustment. A mixed‐effects model was applied to analyze the longitudinal changes in psychosocial adjustment.
Results
Seventy human papillomavirus positive women participated in the study with nearly 20% of the women reporting emotional distress during their first visit. Mixed‐effects model analyses showed that a trajectory of psychosocial adjustment in health care orientation, sexual relationship and psychosocial distress occur from one to 6 months after HPV diagnosis. However, a declining trend from 6‐12 months was significant in health care orientation. Initial emotional distress was associated with changes in psychological adjustment.
Conclusions
Psychosocial adjustment to human papillomavirus was worse at one month compared with 6 and 12 months after diagnosis. Healthcare providers should offer health information and psychosocial support to women according to their disease progression.
This article is protected by copyright. All rights reserved.
This article examines fat college students’ experiences of stigma. Fourteen college students and recent graduates describe their experiences of discrimination and stigma during their college careers. From these interviews, themes of hyper(in)visibility, anticipated stigma, spaces where stigma is more salient, and stigma management emerged. Fat students experience hyper(in)visibility: They are simultaneously hypervisible and invisible, on campus. This experience is impacted by gender and age. This hyper(in)visibility—combined with past experienced stigma—created a sense of anticipated stigma in students. Experiences of hyper(in)visiblity and anticipated stigma are made more salient by the size and shape of various campus spaces: classrooms, dining halls, student recreation centers, and recreational drinking spaces. Fat students often managed this stigma by avoiding these spaces and withdrawing from campus life. Students also embraced other stigma-resistance strategies and found peer groups and campuses spaces to facilitate this resistance.
A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in Bethesda, MD, September 14-15, 2012, to revise the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. The group’s goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS) following adoption of cervical cancer screening guidelines incorporating longer screening intervals and co-testing. In addition to literature review, data from almost 1.4 million women in the Kaiser Permanente Northern California Medical Care Plan provided evidence on risk after abnormal tests. Where data were available, guidelines prescribed similar management for women with similar risks for CIN 3, AIS, and cancer. Most prior guidelines were reaffirmed. Examples of updates include: Human papillomavirus–negative atypical squamous cells of undetermined significance results are followed with co-testing at 3 years before return to routine screening and are not sufficient for exiting women from screening at age 65 years; women aged 21–24 years need less invasive management, especially for minor abnormalities; postcolposcopy management strategies incorporate co-testing; endocervical sampling reported as CIN 1 should be managed as CIN 1; unsatisfactory cytology should be repeated in most circumstances, even when HPV results from co-testing are known, while most cases of negative cytology with absent or insufficient endocervical cells or transformation zone component can be managed without intensive follow-up.
Introduction:
Recent policy revisions allow greater inclusion of military women in operational and/or deployable positions (ie, shipboard, overseas, and war zone duty assignments), but these positions can create unique health care challenges. Military members are often transient due to deployments and change of duty stations, impacting timely follow-up care for treatable health conditions. There has been minimal research on challenges or strategies in preventive health screening and follow-up for US military women.
Methods:
The purpose of this qualitative research study was to describe US Navy women's experiences with abnormal cervical cancer screenings requiring colposcopic follow-up care. Ship- and shored-based women receiving care at a military colposcopy clinic completed interviews about their experience. Two forms of narrative analysis, Labov's sociolinguistic structural analysis and Braun and Clarke's thematic analysis, were employed to gain a more robust understanding of the women's experiences.
Results:
The sample was comprised of 26 women (16 ship-based, 10 shore-based). Five themes were identified: 1) It's like this bombshell (initial abnormal results notification); 2) I didn't understand (self-discovery process); 3) Freaked (emotional toll); 4) It's kind of like this back and forth (scheduling and navigating care); and 5) It really opened my eyes (lessons learned).
Discussion:
The women's stories highlighted some issues unique to military health care, such as operational demands and follow-up care; other issues are likely common for most women learning about an abnormal cervical cancer screening result. Areas important for practice and future research include improving notification practices, providing information, understanding women's fear, and continuity of care. Research exploring educational initiatives and self-management practices are critical within military populations.
Adolescence, the developmental stage between childhood and adulthood, is a time when youth begin to explore sexual and romantic intimacy with others as part of their biological, psychological, and social maturation. Although such intimate relationships can be, and ideally are, supportive, nurturing, enjoyable, and healthy, in some cases the relationships are marked by violence, coercion, and abuse. It is often observed that both male and female adolescents use aggression or violence in intimate relationships, however, a range of social, psychological, and biological factors shape the context of this violence, including motivation, meaning, and impact, in ways that put girls at particular risk of negative consequences. Adolescent girls are particularly susceptible to adverse consequences associated with (primarily heterosexual) sexual activity, including unwanted pregnancy and sexually transmitted infections. Violence from an intimate or sexual partner can further exacerbate these risks by interfering with methods of risk reduction on the part of adolescent girls, such as abstinence from sex or use of protective elements, such as condoms. Sexual risk prevention messages that ignore the impact of violence on adolescents' intimate relationships and discussions of partner violence that deny gender differences in experience or risk are misleading and fail to offer adequate support to adolescent girls who are negotiating violent intimate relationships.
Patient-clinician interactions in the context of women's reproductive health screenings are rich with psychosocial implications. We used a multimethod approach to collect narratives and self-report responses from 38 young women about their screening experiences. We used content analysis to identify five broad themes in women's narratives of their experience: (1) emotional discomfort, (2) communication, (3) uncertainty, (4) physical pain, and (5) health understanding. We examined relationships among narrative themes, subjective emotional appraisals of the screening experience, and individual differences. We also identified a negative relationship between self-reported psychological presence during the screening visit and perceived powerlessness, such that participants who engaged in detachment strategies during their interaction with the clinician reported feeling less powerful as patients.
To explore emotional responses, and predictors of negative reactions, among women undergoing human papillomavirus (HPV) tests in routine clinical practice.
Exploratory qualitative interview study.
A large busy colposcopy clinic in a Dublin hospital.
Twenty-seven women who had had an HPV DNA test in the previous 6 months following one or more low-grade cytology tests or treatment for cervical intraepithelial neoplasia (CIN).
In-depth semi-structured interviews were conducted. Interview transcripts were analysed using a thematic approach (Framework Analysis).
Women's emotional responses and predictors of negative emotional reactions.
For most women, having a test for high-risk HPV types generated little negative or positive emotional impact. Adverse emotional responses related to HPV infection rather than testing. Factors that influenced whether women experienced negative emotional responses were: concerns over abnormal cytology or diagnosis of CIN; HPV knowledge; awareness of HPV being sexually transmitted; awareness of HPV prevalence; and HPV information needs. Women's concerns about abnormal cytology/CIN dominated all other issues.
These qualitative data suggest that in the context of follow up of abnormal cytology or treatment for CIN, the emotional impact of HPV testing may be modest: women's primary concerns at this time relate to abnormal cytology/CIN.
The spectrum of HPV infections ranges from subclinical infection and genital warts to intraepithelial neoplasia and cancer. The infectious potential as well as the necessary check-ups and therapies place a heavy emotional and psychosocial burden on the patient. Moreover, knowledge about the infection and its sequelae is limited. A stepwise concept of counselling including medical information and psychosocial counselling is advisable to improve individual adaptive strategies. After diagnosis a crisis intervention is useful which sensitively recognizes and comments the patient's reaction to the HPV diagnosis and offers key information on the infection. When answering questions, positive statements should be made and written information should be provided for the patient to read through at home. Supportive counselling during subsequent check-ups is important and should include the offer of partner interventions and, in the case of genital warts, education about self monitoring together with specific information regarding further measures. Additional outpatient care needs to include information on measures conducive to good health and the strengthening of the patient’s immune system as well as preventive measures to be taken against further infections.
Understanding the function of social support in communication about women's sexual health topics is an important avenue of research for communication scholars. The goal of the present study was to examine the role of social support in young women's communication about receiving or not receiving the genital HPV vaccine, Gardasil. In 10 focus groups, 52 female participants between ages 18 and 24 revealed instances of informational, tangible, emotional, and experiential support from physicians, friends, and family.
A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in Bethesda, MD, September 14-15, 2012, to revise the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. The group's goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS) following adoption of cervical cancer screening guidelines incorporating longer screening intervals and co-testing. In addition to literature review, data from almost 1.4 million women in the Kaiser Permanente Northern California Medical Care Plan provided evidence on risk after abnormal tests. Where data were available, guidelines prescribed similar management for women with similar risks for CIN 3, AIS, and cancer. Most prior guidelines were reaffirmed. Examples of updates include: Human papillomavirus-negative atypical squamous cells of undetermined significance results are followed with co-testing at 3 years before return to routine screening and are not sufficient for exiting women from screening at age 65 years; women aged 21-24 years need less invasive management, especially for minor abnormalities; postcolposcopy management strategies incorporate co-testing; endocervical sampling reported as CIN 1 should be managed as CIN 1; unsatisfactory cytology should be repeated in most circumstances, even when HPV results from co-testing are known, while most cases of negative cytology with absent or insufficient endocervical cells or transformation zone component can be managed without intensive follow-up.
Offering rapid HIV testing improves rates of testing in adults, but little is known about whether offering adolescents a choice of testing methods increases rates of testing. The aims of the study were to determine rates of HIV testing in adolescents when different testing methods were offered and explore factors associated with agreement to be tested for HIV. Participants (n= 200, sexually experienced 13-22 year olds) were recruited from an urban adolescent clinic, completed a 99-item theory-based survey and were offered their choice of venipuncture, rapid fingerstick or rapid oral fluid HIV testing. Approximately half (49.5%) agreed to HIV testing. Male gender, parental completion of high school, intention to test for HIV if offered by clinician and higher perceived likelihood of current HIV infection were independently associated with agreement to test. Combining new strategies, such as opt-out testing, with routine testing may be needed to improve rates of adolescent HIV testing.
Prevalence of human papillomavirus (HPV) is high in both men and women, yet men have seldom been involved in HPV education/prevention programmes, and their disclosure of known HPV infection has rarely been studied. This analysis sought to determine factors associated with men's HPV test result disclosure and HPV-related information sharing with partners.
From 2007 to 2010, men enrolled in a psychosocial study of responses to HP testing who reported having a female main sexual partner (N=251) completed surveys including questions about HPV test results, disclosure of HPV test results to partner(s), relationship characteristics and stigma (for those who reported HPV-positive results) approximately 3 weeks after receiving an HPV test result. Logistic regression was conducted to determine factors associated with disclosure of HPV test results in cross-sectional analysis.
Most men disclosed their test results to a main partner (82%). Self-reported HPV-negative test result, a high school education and a higher commitment to a sexual partner were significantly associated with increased disclosure in multivariable analysis. Men who disclosed (vs those who did not) were significantly more likely to provide their partners with HPV-related information. Among men who disclosed to their main partner, nearly half reported that partner asked them questions about HPV.
Results from this study highlight the critical role that men who are symptomatic for, who are tested for or who are vaccinated against HPV can play in educating their sexual partners, independent of whether they actually disclose their test results.
To test the self-determination model of health-related behavior by examining whether the degree to which adolescents experience an appeal to not smoke as autonomy supportive would affect their autonomous motivation for not smoking and, in turn, their behavior of either refraining from smoking or smoking less, and to validate the measures of perceived autonomy support and autonomous motivation for not smoking.
Two studies of physicians presenting information about not smoking using 2 message styles, 1 of which was designed to be more autonomy supportive. The preliminary study involved nonrandomized assignment to message style and only immediate assessment of perceptions, motivation, and behavior, while the primary study involved randomized assignment and 4-month longitudinal assessments.
Nearly 400 ninth- through 12th-grade students at 2 suburban high schools in upstate New York.
Adolescents' perceptions of the presentations' autonomy supportiveness of the presenters, as well as adolescents' autonomous motivation for not smoking and their self-reports of smoking. The primary study also assessed change in students' autonomous motivation and change in their self-reported smoking during 4 months.
In both studies, the measures were reliable and valid. Students perceived significantly (P = .04 and P<.001, respectively) greater autonomy support in the "It's Your Choice" presentation, after controlling for whether the students were smokers. Perceived autonomy supportiveness of the presentation was positively correlated with autonomous reasons for not smoking in the preliminary study and with increases in autonomous motivation for not smoking in the primary study. Change in autonomous reasons for not smoking significantly (P<.001) predicted reduction in smoking during 4 months.
When adolescents perceived messages about not smoking as autonomy supportive, they had more autonomous motivation for not smoking, and that, in turn, predicted a decrease in their self-reports of smoking.
This study assessed the psychological impact of the first time diagnosis of human papillomavirus (HPV) in consecutive clients attending the Hamilton Sexual Health Clinic, and sought to determine whether this changed over time. Clients with a diagnosis other than HPV and those found to have no diagnosis were compared with HPV clients. All participants completed a battery of questionnaires following their initial visit and again at 4 weeks. The battery consisted of the General Health Questionnaire, Illness Attitude Scales, the International Index of Erectile Function or the Brief Index of Sexual Function for Women, and a 6-question test of the client's knowledge of HPV. One hundred and one participants completed the first questionnaires and 47 of those completed follow-up questionnaires. We found those diagnosed with first episode of HPV had considerable psychological difficulties. However these were no different to those associated with other sexually transmitted infections (STIs) or even those with no active diagnosis.
To define the incidence and characterise the clinical presentation of sexually transmitted infections (STI) in people aged <or=16 years old attending a genitourinary clinic in south east London.
Cross sectional analysis of clients aged <or=16 years attending one genitourinary clinic. A subgroup was identified for priority treatment. Data collected included age, reason for presentation, diagnosis, contraceptive use, and adherence to therapy. Diagnoses were compared to the KC60 codes for female attendances of all ages.
144 females and 18 males with a mean age of 15.4 years attended, of whom 49% were symptomatic. Compared to other attenders, clients aged <or=16 years were significantly more likely to have an STI (64% versus 22%, p <0.00000001); 27 were pregnant (of whom 96% requested a termination of pregnancy); 47% did not return for follow up; and 12% did not adhere to treatment plan. Those diagnosed with an STI were significantly less likely to reattend (p<0.001).
There is a high rate of STIs in 16 year olds compared to national figures and to general clinic attenders. Poor contraception is often overlooked within the genitourinary medicine clinic. Young attenders frequently fail to reattend for follow up. Priority treatment did not affect outcome. Further strategies are needed to identify ways to improve young people's access to genitourinary medicine clinics.
This study examined attitudes to human papillomavirus (HPV) testing among a purposively selected sample of women from four ethnic groups: white British, African Caribbean, Pakistani and Indian. The design was qualitative, using focus group discussion to elicit women's attitudes towards HPV testing in the context of cervical cancer prevention. The findings indicate that although some women welcomed the possible introduction of HPV testing, they were not fully aware of the sexually transmitted nature of cervical cancer and expressed anxiety, confusion and stigma about HPV as a sexually transmitted infection. The term 'wart virus', often used by medical professionals to describe high-risk HPV to women, appeared to exacerbate stigma and confusion. Testing positive for HPV raised concerns about women's sexual relationships in terms of trust, fidelity, blame and protection, particularly for women in long-term monogamous relationships. Participation in HPV testing also had the potential to communicate messages of distrust, infidelity and promiscuity to women's partners, family and community. Concern about the current lack of available information about HPV was clearly expressed and public education about HPV was seen as necessary for the whole community, not only women. The management of HPV within cervical screening raises important questions about informed participation. Our findings suggest that HPV testing has the potential to cause psychosocial harm to women and their partners and families.
Sexually transmitted infections (STI) occur at high rates in the US compared to other Western nations. Sociocultural indicators such as race and ethnicity, lower socioeconomic status and historically higher rates of certain diseases, such as syphilis, are correlated factors but do not explain fully why STI rates are particularly high in the American Deep South. One salient factor is the stigma associated with STI and its effect on screening and treatment. This paper presents the results of six focus group interviews that were conducted among mainly African-American health workers, patients and students in Alabama, USA. The results showed that STI-related stigma directly and indirectly affected willingness to be treated for STI at public health clinics. Four dimensions of stigma emerged: (1) Religious ideation affected how health workers felt about 'promiscuous' patients (especially women), (2) privacy fears discouraged male patients from seeking treatment at local clinics, (3) racial attitudes affected willingness to be treated for STI and (4) Stigma transference (being "scarlet lettered") emerged as a potent disincentive to treatment. Partner notification was more likely if patients felt betrayed by a sexual partner. Further research is needed to clarify these stigma-related dimensions and the impact on screening, treatment and partner services.
Enhancing patient choice is a central theme of medical ethics and law. Informed consent is the legal process used to promote patient autonomy; shared decision making is a widely promoted ethical approach. These processes may most usefully be seen as distinct in clinically and ethically important respects. The approach outlined in this article uses a model that arrays all medical decisions along 2 axes: risk and certainty. At the extremes of these continua, 4 decision types are produced, each of which constrains the principal actors in predictable ways. Shared decision making is most appropriate in situations of uncertainty, in which 2 or more clinically reasonable alternatives exist. When there is only 1 realistic choice, patient and physician may gather and exchange information; however, the patient cannot be empowered to make choices that do not exist. In contrast, informed consent does not require the presence of clinical choice; it is appropriate for all decisions of significant risk, even if there is only one option. When a clinical decision contains both risk and uncertainty, shared decision making and informed consent are both appropriate. For decisions of lower risk, consent should still be present, but it can be simple rather than informed. Clinicians may use this analysis as a guide to their own interactions with patients. In the continuing effort to provide patients with appropriate decisional authority over their own medical choices, shared decision making, informed consent, and simple consent each has a distinct role to play.
We performed a study to better characterize the natural history of genital human papillomavirus (HPV) infection in a cohort of closely followed adolescent women.
A cohort of 60 adolescent women was followed over a 2.2-year period, on average. A median of 41.5 self-collected vaginal and clinician-obtained cervical swabs were obtained from each subject.
HPV was detected in 45.3% of all adequate specimens, by use of a polymerase chain reaction/reverse blot strip assay. Oncogenic--or high-risk (HR)--HPV types were detected in 38.6% of specimens, and nononcogenic--or low-risk (LR)--types were detected in 19.6% of specimens. During the entire study period, 49 of 60 subjects tested positive for HPV (cumulative prevalence, 81.7%). The most frequently detected HR types were HPV types 52, 16, and 59. Infections with multiple HPV types were common. The median duration of persistence of a specific HPV type was 168 days, and HR types were more persistent than LR types. Abnormal cervical cytological results occurred in 37% of the adolescent women and were significantly associated with HR HPV infection.
The cumulative prevalence of HPV infection in sexually active adolescent women is extremely high, involves numerous HPV types, and frequently results in cervical dysplasia.
Introducing human papillomavirus (HPV) testing into cervical cancer screening has the potential to change the way that women understand cervical cancer, the psychological impact of abnormal screening results and the likelihood of future participation in screening. The study used in-depth interviews to examine how women make sense of information about HPV in the context of cervical cancer screening. A total of 74 women were recruited following participation in HPV testing. Women varied widely in their beliefs about the aetiology of cervical cancer and its relationship with sexual activity, as well as in their understanding of the sexually transmitted nature of HPV. While some women who understood that HPV is sexually transmitted were able to integrate this into their existing model of cervical cancer, others were shocked by the link between cervical cancer and sex, of which they had been previously unaware. Women were generally reassured to know that HPV is common, has no symptoms, can lie dormant for many years, can clear up on its own and need not raise concerns about transmission to sexual partners. Women's understanding of HPV varied considerably, even after participation in testing. The way in which information is presented to women will be crucial in minimising the negative psychological impact of testing positive and ensuring that participation in screening remains high.
A recent report that 93 per cent of invasive cervical cancers worldwide contain human papillomavirus (HPV) may be an underestimate, due to sample inadequacy or integration events affecting the HPV L1 gene, which is the target of the polymerase chain reaction (PCR)‐based test which was used. The formerly HPV‐negative cases from this study have therefore been reanalysed for HPV serum antibodies and HPV DNA. Serology for HPV 16 VLPs, E6, and E7 antibodies was performed on 49 of the 66 cases which were HPV‐negative and a sample of 48 of the 866 cases which were HPV‐positive in the original study. Moreover, 55 of the 66 formerly HPV‐negative biopsies were also reanalysed by a sandwich procedure in which the outer sections in a series of sections are used for histological review, while the inner sections are assayed by three different HPV PCR assays targeting different open reading frames (ORFs). No significant difference was found in serology for HPV 16 proteins between the cases that were originally HPV PCR‐negative and ‐positive. Type‐specific E7 PCR for 14 high‐risk HPV types detected HPV DNA in 38 (69 per cent) of the 55 originally HPV‐negative and amplifiable specimens. The HPV types detected were 16, 18, 31, 33, 39, 45, 52, and 58. Two (4 per cent) additional cases were only HPV DNA‐positive by E1 and/or L1 consensus PCR. Histological analysis of the 55 specimens revealed that 21 were qualitatively inadequate. Only two of the 34 adequate samples were HPV‐negative on all PCR tests, as against 13 of the 21 that were inadequate ( p < 0·001). Combining the data from this and the previous study and excluding inadequate specimens, the worldwide HPV prevalence in cervical carcinomas is 99·7 per cent. The presence of HPV in virtually all cervical cancers implies the highest worldwide attributable fraction so far reported for a specific cause of any major human cancer. The extreme rarity of HPV‐negative cancers reinforces the rationale for HPV testing in addition to, or even instead of, cervical cytology in routine cervical screening. Copyright © 1999 John Wiley & Sons, Ltd.
Purpose:: To examine adolescent girls' perception of control over general health and sexually transmitted disease (STD) acquisition.
Methods:: Adolescents participating in a longitudinal study were asked questions regarding their perception of their locus of control. These questions, adopted from a previous measure, focused on six loci: internal control, control by parents, partners, peers, and health care providers, and chance.
Results:: There were 128 girls (mean age, 17 years; range, 14.5 to 18.8); 82% were black and 18% white. Statistically significant associations were found between control of general health and STD acquisition for each locus of control subscale, with the exception of partner control. However, the girls reported significantly less control over STD acquisition than over general health for health care providers, parents, and by chance, and significantly more partner and internal control over STD acquisition than general health. The correlations between parental control over general health and over STD acquisition were inversely correlated with age. Partner control was positively related to current condom use, but internal control was not.
Conclusions:: The degree of the locus of control was specific for STD acquisition. Girls who believe they should be able to control STD acquisition may not be using condoms. The view of partners as having control over STD acquisition may represent joint communication or coercion. However, in general these findings support the development of female‐controlled methods for STD prevention, such as topical microbicides.
A group of 46 women attending an adolescent dysplasia clinic were surveyed regarding the reported impact of cervical dysplasia on sexual beliefs and behaviors. The adolescents reported being concerned about their future health and having changed their sexual practices. There were no clear relationships between demographic variables or sexual attitudes and changes. The adolescents' self-reports of their behavior were not consistent; those adolescents who reported safer sex practices did not have lower rates of sexually transmitted diseases postbiopsy. The results of this study indicate the important but complex impact of sexually transmitted disease on adolescents and suggests that this impact on adolescents may be different from that on adults.
Most women commonly take an abnormal Pap smear to be indicative of invasive cancer. This fear can permeate their lifestyle to the degree that it may influence receptivity to medical procedures as well as promote cervical intraepithelial neoplasia (CIN) to invasive squamous cell carcinoma of the cervix. This longitudinal study was undertaken to provide baseline data on self-esteem and body image as the patient progresses from the initial visit through the postsurgery visit. Twenty patients ranging in age from 15 to 40 years were followed through diagnosis and treatment with colposcopic biopsy showing 25% CIN I, 45% CIN II, and 30% CIN III. Concern for cancer overrode all other concerns except during the postsurgery visit, at which time loss of attractiveness was paramount. Loss of sexual functioning ranked high in all visits. Self-esteem was lowest and anxiety highest during the initial and postsurgery visits. Positive body image was greatest when the results of the biopsy were received and during the postsurgery visit. Patients and sexual partners exhibited similar patterns of anxiety about the medical condition. Psychological repercussions from CIN occurred even prior to diagnosis.
Coping strategies of adolescent girls in response to the acquisition of a sexually transmitted disease (STD) were evaluated. Perceptions of control over acquisition of an STD and emotional impact were assessed. The sample consisted of 177 adolescent girls recruited from their source of primary care (mean age = 16.8). There were no differences in the use of coping strategies by age group or STD history. Subjects used a wide variety of coping strategies; those who viewed the future acquisition of an STD more negatively used more strategies. Wishful thinking was used by most of the subjects, but was not felt to be helpful; despite this, adolescents with a previous STD were no less likely to use wishful thinking. It was concluded that adolescent health care providers must understand girls' responses to STD and help them develop effective coping skills to reduce the incidence of STD.
To determine whether an educational brochure about abnormal Papanicolaou smears could reduce psychological distress and concerns about cancer and future health, and increase knowledge about dysplasia and the investigation, treatment, and recommended follow-up.
One hundred twenty-five consecutive women with dysplasia on a Papanicolaou smear referred to a colposcopy clinic for their first examination were alternately assigned to receive a mailed educational brochure the same day or to receive no brochure. At the colposcopy clinic, consenting women were given the Brief Symptom Inventory, specific questions about feelings regarding an abnormal smear, and a knowledge quiz about dysplasia, colposcopy, and the recommended follow-up.
Women who received the brochure were significantly less distressed on the Brief Symptom Inventory and were less anxious about the abnormal Papanicolaou smear, the fear of cancer, and their future health than were women not receiving the brochure. Study women also performed significantly better on knowledge questions about dysplasia, colposcopy, and the recommended follow-up.
Given the low cost, ease of delivery, and usefulness of educational brochures in reducing psychological distress and increasing knowledge specific to the condition, an educational brochure should routinely accompany or immediately follow notification about an abnormal Papanicolaou smear.
Few studies have examined the psychological costs of cervical screening, despite expressed concern over possible negative sequelae.
Seventy-five women with mild or moderately dyskaryotic smears, under cytological surveillance, 75 women referred for colposcopy after a first-ever abnormal smear showing severe dyskaryosis, and 75 controls with recent negative cytology were interviewed at home, and their psychological adjustment was assessed.
Levels of distress were higher among women with an abnormal smear than among controls with a recent negative smear. Anxiety (Hospital Anxiety and Depression Scale range 0-21, "normal" range 0-7) was highest among those referred for colposcopy (mean 8.12, controls 5.88, P < 0.001); afterward, distress fell (mean 6.61, P < 0.001) but more problems of social adjustment were evident (surveillance vs controls, P < 0.01). High anxiety was associated with social maladjustment (colposcopy, P < 0.001; surveillance, P < 0.01) and negative feelings about the self (P < 0.05). Current anxiety was unrelated to knowledge about abnormal smears, but in the surveillance group was related to satisfaction with the explanation provided (P < 0.05).
A positive cervical smear may by psychologically traumatic for a significant minority of women, irrespective of management strategy.
The American Social Health Association (ASHA) surveyed people with human papillomavirus (HPV) about their experiences with the disease and its effect on their lives. A sample of 837 was chosen from the subscribers to HPV News, ASHA's quarterly journal for people with HPV. Of the sample, 489 returned completed surveys, which addressed medical history, health care experiences, personal impact, and demographic information. Data analysis was descriptive. Data illustrated that the psychosocial impact of HPV can be serious. More than three-quarters of respondents reported feelings of depression and anger, and two-thirds feelings of shame. Sexual enjoyment and activity were also negatively affected by HPV. Additionally, respondents expressed dissatisfaction with the diagnosing health care providers' counselling on emotional and sexual issues. These results may be instructive to those delivering health services by providing insight into the significant personal impact of HPV on those infected.
To elucidate which components of peer norms influence the process of sexual initiation for young adolescents. Design. Prospective cohort study. Setting. Fourteen elementary and middle schools in an urban public school district. Participants. The 1389 sixth-grade students who completed the questionnaire at the beginning (time 1) and at the end (time 2) of the school year comprise the study sample. Mean age at time 1 was 11.7 years.
Of students entering the sixth grade, 30% (n = 416) reported having already initiated sexual intercourse, 5% (n = 74) reported initiating sexual intercourse during the sixth-grade school year (initiated group), and 63% (n = 873) reported not having initiated sexual intercourse by the end of the sixth-grade school year (never group). Demographic comparisons revealed that students in the initiated group were significantly more likely than students in the never group to be older (11.9 years vs 11.6 years), male (58% vs 37%), African-American (70% vs 51%), attending a poorer school (87% vs 85%), and living in an area with a high proportion of single-parent families (45% vs 41%). Self-reports and reports of peers' participation in nonsexual risk behaviors were more common for students in the initiated group. Students in the initiated group were more likely than students in the never group to perceive: 1) a high prevalence of sexual initiation among peers; 2) social gains associated with early sexual intercourse; and 3) younger age of peers' sexual initiation. Students in the never group were more likely to believe that sexually-experienced 12-year-old boys would be negatively stigmatized compared with students in the initiated group. Three predictive models were developed to test the relationship between peer norms and the process of initiation. These models demonstrate that the strongest predictor of sexual initiation in sixth grade is having high intention to do so at the beginning of sixth grade. The strongest predictor of high intention is belief that most friends have already had sexual intercourse. Perceptions of social gain and stigma for sexually-experienced 12-year-old boys act independently of intention to decrease risk of early sexual initiation.
Early sexual intercourse is not an unplanned experience for many teens. Decisions about initiation are strongly bound to social context with peers playing an important role in creating a sense of normative behavior. Specific components of peer norms impact the process of sexual initiation in both positive and negative ways. Interventions aimed at delaying the onset of sexual initiation need to focus on cohort norms as well as on an individual's perceptions and behaviors.
Our aim was to determine country-specific attitudes and perceptions of patients with genital warts and to understand the psychosexual impact of the disease and its treatment. We used a standardized discussion guide to interview patients with genital warts in Canada, France, Germany, the UK, and the USA about their perceptions and concerns regarding the diagnosis, treatment, and psychosexual impact of the disease. Interviews were conducted in person and lasted approximately 30 min. The study group included 80 men and 86 women with genital warts. Forty-seven per cent were currently undergoing treatment. Overall, 49% of the men had first consulted a general or family practitioner, and 52% of the women had first consulted a gynaecologist. Although all the patients eventually consulted a physician about their warts, one-third delayed seeing a doctor because they thought the condition would resolve on its own or that the problem was not serious. Most patients reported that treatment was associated with pain, discomfort, and embarrassment. Sixty per cent of patients experienced a recurrence after initial clearance with treatment. More than 80% stated that they had had little or no involvement in the selection of treatment. Globally, 52% of men and 61% of women were 'quite concerned' or 'very concerned' about having genital warts, although there were significant variations by country. Approximately two-thirds of patients had made lifestyle changes regarding sexual relationships. In addition, two-thirds believed that there were risks associated with having genital warts; the most common risk identified was a link to cancer (cervical and unspecified). A high level of anxiety is associated with the diagnosis and treatment of genital warts. Patients with genital warts require understanding and an acknowledgement of their concerns. A better understanding of the psychosexual aspect of the disease by health-care providers is pivotal to effective disease management and patient counselling.
A recent report that 93 per cent of invasive cervical cancers worldwide contain human papillomavirus (HPV) may be an underestimate, due to sample inadequacy or integration events affecting the HPV L1 gene, which is the target of the polymerase chain reaction (PCR)-based test which was used. The formerly HPV-negative cases from this study have therefore been reanalyzed for HPV serum antibodies and HPV DNA. Serology for HPV 16 VLPs, E6, and E7 antibodies was performed on 49 of the 66 cases which were HPV-negative and a sample of 48 of the 866 cases which were HPV-positive in the original study. Moreover, 55 of the 66 formerly HPV-negative biopsies were also reanalyzed by a sandwich procedure in which the outer sections in a series of sections are used for histological review, while the inner sections are assayed by three different HPV PCR assays targeting different open reading frames (ORFs). No significant difference was found in serology for HPV 16 proteins between the cases that were originally HPV PCR-negative and -positive. Type-specific E7 PCR for 14 high-risk HPV types detected HPV DNA in 38 (69 per cent) of the 55 originally HPV-negative and amplifiable specimens. The HPV types detected were 16, 18, 31, 33, 39, 45, 52, and 58. Two (4 per cent) additional cases were only HPV DNA-positive by E1 and/or L1 consensus PCR. Histological analysis of the 55 specimens revealed that 21 were qualitatively inadequate. Only two of the 34 adequate samples were HPV-negative on all PCR tests, as against 13 of the 21 that were inadequate ( p< 0.001). Combining the data from this and the previous study and excluding inadequate specimens, the worldwide HPV prevalence in cervical carcinomas is 99.7 per cent. The presence of HPV in virtually all cervical cancers implies the highest worldwide attributable fraction so far reported for a specific cause of any major human cancer. The extreme rarity of HPV-negative cancers reinforces the rationale for HPV testing in addition to, or even instead of, cervical cytology in routine cervical screening.
The aim of this review is to determine the frequency and circumstances under which predicting individuals' risk of illness has adverse psychological effects. Using systematic review methodology, the literature was searched for studies that had assessed the adverse psychological outcomes of risk assessment programmes. The outcomes investigated are emotional (anxiety, depression, distress) cognitive (intrusive thoughts, perceptions of health) and behaviour (work absenteeism). The impact of both positive and negative test results are summarised in terms of the number of studies showing significant effects between and within groups in the short (one month or less) and longer term (more than one month). Where sufficient data were available, a meta-analysis was conducted to assess effect size. Fifty-four studies met the criteria for inclusion. The studies assessed the impact of informing individuals about cardiovascular risk (21), risk of AIDS (eight), risk of cancer (10), risk of Huntington's disease (10), risk of diabetes (two), risk of spinocerebellar ataxia (one) and risk of osteoporosis (two). Overall, the quality of studies assessed was limited, with only two using a randomised design to determine the psychological impact of risk assessment. Receiving a positive test result was associated in the short term in the great majority of studies with depression, anxiety, poorer perceptions of health and psychological distress. Data were available for a quantitative synthesis of results on three outcomes, anxiety, depression and distress. Anxiety and depression were significantly higher in those tested positive compared with those tested negative in the short term but not the longer term. Distress could only be assessed in the longer term: there was no evidence of an increase for those receiving positive test results. The five experimental studies that reported interventions aimed at preventing some of these adverse effects all reported favourable results. There was little evidence of any adverse psychological effects of receiving an unfavourable test result. Adverse psychological effects are a common immediate consequence of positive test results following risk assessment. Results from the few experimental studies reviewed suggest that these adverse outcomes should not be seen as inevitable.
To provide evidence-based consensus guidelines for the management of women with cervical cytological abnormalities and cervical cancer precursors.
A panel of 121 experts in the diagnosis and management of cervical cancer precursors, including representatives from 29 professional organizations, federal agencies, and national and international health organizations, were invited to participate in a consensus conference sponsored by the American Society for Colposcopy and Cervical Pathology (ASCCP). EVIDENCE AND CONSENSUS PROCESS: Guidelines for the management of women with cervical cytological abnormalities were developed through a multistep process. Starting 6 months before the conference, working groups developed draft management guidelines based on formal literature reviews of English-language articles published in 1988-2001, as well as input from the professional community at large, obtained using interactive Internet-based bulletin boards. On September 6-8, 2001, the ASCCP Consensus Conference was held in Bethesda, Md. Guidelines with supporting evidence were presented and underwent discussion, revision, and voting.
Management of women with atypical squamous cells (ASC) depends on whether the Papanicolaou test is subcategorized as of undetermined significance (ASC-US) or as cannot exclude high-grade squamous intraepithelial lesion (HSIL) (ASC-H). Women with ASC-US should be managed using a program of 2 repeat cytology tests, immediate colposcopy, or DNA testing for high-risk types of human papillomavirus (HPV). Testing for HPV DNA is the preferred approach when liquid-based cytology is used for screening. In most instances, women with ASC-H, low-grade squamous intraepithelial lesion, HSIL, and atypical glandular cells should be referred for immediate colposcopic evaluation.
An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical neoplasia and cancer, based on recommendations from a formal review and recent workshop, is presented. The new screening recommendations address when to begin screening, when screening may be discontinued, whether to screen women who have had a hysterectomy, appropriate screening intervals, and new screening technologies, including liquid-based cytology and HPV DNA testing.
High-risk types of HPV are the primary cause of cervical cancer.
This article reports HPV screening and diagnosis from a survey evaluating community-based physicians' screening, testing, and clinical practices for sexually transmitted diseases.
Surveys mailed to physicians (n = 7,300) obtained information on patients they screen for HPV and cases of HPV diagnosed.
Seventy percent (70%) of the physicians returned completed surveys. HPV screening was most frequently conducted in female patients by obstetrician/gynecologists and family practice physicians.
Sexually active young women have relatively high rates of abnormal cervical cytology, yet compliance with return for Papanicolaou smear screening and follow-up appointments is poor. The aim of this study was to determine whether a theory-based model could explain compliance with return visits.
Participants in this longitudinal cohort study were sexually active young women 12-24 years of age presenting to a hospital-based adolescent clinic. Participants completed self-administered surveys and were then followed for up to 15 months to assess for the outcome measure, return. Logistic regression modeling was used to determine variables independently associated with return.
The outcome measure, return, was available for 439 of 490 participants (90%). Mean participant age (+/- standard deviation) was 18.3 (+/- 2.2) years, 49% were black, 23% were Hispanic, and 51% had Medicaid health insurance. Variables independently associated with return included belief that the Papanicolaou smear will not be painful (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.08, 2.83), belief that return for follow-up will prevent cervical cancer (OR 1.83, 95% CI 1.12, 3.07), likelihood that the doctor will be honest (OR 4.07, 95% CI 1.37, 17.5), and low self-reported impulsivity (OR 1.66, 95% CI 1.06, 2.63). Family history of cervical cancer was associated with decreased likelihood of return (OR 0.28, 95% CI 0.08, 0.78).
Specific beliefs about Papanicolaou smears and providers, low self-reported impulsivity, and no family history of cervical cancer are associated with return for Papanicolaou smear screening and follow-up visits. These findings may guide the design of interventions to increase compliance with recommendations for Papanicolaou smear return.
The study was undertaken to provide consensus guidelines for the management of women with histologically confirmed cervical intraepithelial neoplasia (CIN) that can act as a precursor to invasive cervical cancer and represents one of the most common significant gynecologic diseases of women of reproductive age.
An independent panel of 121 experts in various aspects of the diagnosis and management of cervical cancer precursors, including representatives from 29 participating professional organizations, federal agencies, national and international health organizations, and others were invited by the American Society for Colposcopy and Cervical Pathology (ASCCP).Consensus Process: Guidelines for the management of women with CIN were developed through a multistep process. Draft management guidelines were developed by working groups who performed formal literature reviews and obtained input from the professional community at large by way of an interactive internet-based bulletin board. At the ASCCP Consensus Conference, September 6 through 8, 2001, in Bethesda, Md, all guidelines were discussed, revised, and adopted by formal vote.
Evidence-based guidelines have been developed for the management of women with biopsy-confirmed CIN.
Human papillomavirus (HPV) DNA testing was recently approved by the Food and Drug Administration for use as an adjunct to cytology for cervical cancer screening. To help provide guidance to clinicians and patients when using HPV DNA testing as an adjunct to cervical cytology for screening, a workshop was cosponsored by the National Institutes of Health-National Cancer Institute, American Society of Colposcopy and Cervical Pathology (ASCCP), and American Cancer Society. Consensus was reached based on a literature review, expert opinion, and unpublished results from large ongoing screening studies. The conclusions of the workshop were that HPV DNA testing may be added to cervical cytology for screening in women aged 30 years or more. Women whose results are negative by both HPV DNA testing and cytology should not be rescreened before 3 years. Women whose results are negative by cytology, but are high-risk HPV DNA positive, are at a relatively low risk of having high-grade cervical neoplasia, and colposcopy should not be performed routinely in this setting. Instead, HPV DNA testing along with cervical cytology should be repeated in these women at 6 to 12 months. If test results of either are abnormal, colposcopy should then be performed. This guidance should assist clinicians in utilizing HPV DNA testing in an effective manner, while minimizing unnecessary evaluations and treatments.
There is now overwhelming evidence that high-risk, sexually transmitted types of human papillomavirus (HPV) are the main causal agent in cervical cancer. Biobehavioral and psychosocial research is uniquely capable of addressing many of the issues raised by HPV and its link with cervical cancer. In this article we review current findings in this area and identify issues for future research. The first of the three sections explores issues associated with the introduction of HPV testing for the detection and management of cervical abnormalities and the impact of growing public awareness of the sexually transmitted nature of cervical cancer. The implications for public understanding of cervical cancer, psychosocial issues associated with screening, and the potential impact on screening uptake are discussed. The second section addresses the role of biobehavioral factors in the persistence and progression of HPV infection as well as possible interventions to minimize the risk of persistence. Finally, primary prevention of HPV is discussed.
To describe the psychological impact on women of being tested for human papillomavirus (HPV) when smear test results are borderline or mildly dyskaryotic.
Cross sectional questionnaire study.
Two centres participating in an English pilot study of HPV testing in women with borderline or mildly dyskaryotic smear test results.
Women receiving borderline or mildly dyskaryotic smear test results tested for HPV and found to be HPV positive (n = 536) or HPV negative (n = 331); and women not tested for HPV with borderline or mildly dyskaryotic smear results (n = 143) or normal smear results (n = 366).
State anxiety, distress, and concern about test result, assessed within four weeks of receipt of results.
Women with borderline or mildly dyskaryotic smear results who were HPV positive were more anxious, distressed, and concerned than the other three groups. Three variables independently predicted anxiety in HPV positive women: younger age (beta = -0.11, P = 0.03), higher perceived risk of cervical cancer (beta = 0.17, P < 0.001), and reporting that they did not understand the meaning of test results (beta = 0.17, P = 0.001). Testing HPV negative was not reassuring: among women with abnormal smear test results, those who were HPV negative were no less anxious than those who were not tested for HPV.
Informing women more effectively about the meaning of borderline or mildly dyskaryotic smear test results and HPV status, in particular about the absolute risks of cervical cancer and the prevalence of HPV infection, may avoid some anxiety for those who are HPV positive while achieving some reassurance for those who test HPV negative.
Spanish-dominant Latino youth represent a growing yet underserved segment of the U.S. population, especially in terms of protection from sexually transmitted HIV infection. There is evidence to suggest that this subgroup engages in both risk and protective behaviors that may be different from the behaviors of English-dominant Latino youth.
To examine theoretical predictors (attitude, subjective norm, behavioral beliefs, normative beliefs, control beliefs) of sexual intercourse and condom use with a sample of Spanish-dominant Latino youth.
Participants in this study were part of a larger randomized controlled intervention designed to reduce the risk of sexually transmitted HIV among Latino youth. This article is based on preintervention data from 141 Spanish-speaking Latino adolescents (77 girls and 64 boys) who completed a Spanish version of the questionnaire.
Multiple regression analyses showed significant effects of attitudes, perceived partner approval, self-pride, and parental pride on intentions to engage in sexual intercourse. Attitudes, intentions to engage in sex in the next 3 months, self-pride, parental pride, goals, and partner approval predicted sexual intercourse in the preceding 3 months. Attitudes, subjective norms, self-efficacy, partner and parental approval, and impulse control beliefs were significant predictors of intentions to use condoms.
This study represents initial efforts to address the needs of Spanish-dominant Latino youth. The identification of salient beliefs that may predict sexual risk and protective behavior are relevant to the design of culturally and linguistically effective interventions.
The potential for human papillomavirus (HPV) DNA testing in cervical cancer prevention programs has been a topic at the forefront of cervical cancer policy discussions in recent years. To prevent some of the anxiety and psychological distress often experienced on HPV diagnosis and during the period of management, mass patient education must accompany the incorporation of HPV DNA testing into screening protocols. To contribute to a growing body of work that provides an empiric basis for development of effective counseling messages about HPV and HPV testing, this paper highlights women's most common information gaps and psychosocial concerns and describes the different perspectives offered by women's usual sources of information about HPV, including the crucial role of the clinical community in creating a shared decision making environment in which screening decisions and results can be discussed.
To examine the psychosocial impact of testing positive for high risk human papillomavirus (HPV) among women attending primary cervical screening.
Cross sectional survey. Measures were taken at baseline and one week after the receipt of HPV and cytology screening results.
Well women's clinic in London, UK. Population or Sample Four hundred and twenty-eight women aged 20-64 years.
Postal questionnaire survey.
Psychosocial and psychosexual outcomes were anxiety, distress and feelings about current, past and future sexual relationships.
Women with normal cytology who tested positive for HPV (HPV+) were significantly more anxious and distressed than women who were negative (HPV-) using both a state anxiety measure [F(1,267) = 29, P < 0.0001] and a screening specific measure of psychological distress [F(1,267) = 69, P < 0.0001]. Women with an abnormal or unsatisfactory smear result, who tested HPV+, were significantly more distressed than HPV- women with the same smear result [F(1,267) = 8.8, P = 0.002], but there was no significant difference in state anxiety. Irrespective of cytology result, HPV+ women reported feeling significantly worse about their sexual relationships. Approximately one-third of women who tested positive reported feeling worse about past and future sexual relationships compared with less than 2% of HPV- women.
The findings suggest that testing positive for HPV may have an adverse psychosocial impact, with increased anxiety, distress and concern about sexual relationships. Psychosocial outcomes of HPV testing need further investigation and must be considered alongside clinical and economic decisions to include HPV testing in routine cervical screening.
Predictors of sexual intercourse and condom use
- Villarruel Am
- Jemmott
- rd
- Jemmott Ls
- Dl
Villarruel AM, Jemmott JB 3rd, Jemmott LS, Ronis DL. Predictors of sexual intercourse and condom use