RESUMO
INTRODUCTION AND HYPOTHESIS: Almost 20% of women will suffer from sexual abuse at some point in their lives. This is a known risk factor for developing chronic pelvic pain (CPP), which is a major health problem worldwide. We conducted a pilot study in a Gynecology Outpatient Clinic to find the correlation between these two clinical entities and provide better evidence for their diagnosis and treatment. METHODS: A semi-structured interview for the evaluation of sexual violence in women (EVS) was used as a screening tool and a complement to routine gynecological examination to identify patients suffering from sexual abuse. Patients included were also assessed for comorbidities, including CPP, and other coexisting mental health problems. RESULTS: Of the 61 patients screened, 33 (54.1%) had pelvic pain. Also, 11 patients (18%) had suffered sexual abuse at some point in their lives, which was only disclosed when the specific interview was performed. Ten patients (90.8%) out of 11 that had been sexually abused also had pelvic pain. This was found to be statistically significant in this sample (p = 0.008) with a more than 11-fold greater risk of having pelvic pain (OR, 11.7; 95% CI, 1.4-98.7). Most patients did not have psychological violence (77%) but those that did (23%) had a seven-fold greater risk of having pelvic pain (OR, 7.4; 95% CI, 1.5-36.9). CONCLUSION: Specific tools should intentionally be used for evaluating sexual abuse and chronic pelvic pain, since a strong correlation exists between these two entities and they are seldom reported by patients.
Assuntos
Ginecologia , Delitos Sexuais , Instituições de Assistência Ambulatorial , Feminino , Humanos , Dor Pélvica , Projetos Piloto , Inquéritos e QuestionáriosRESUMO
Thirty-one women aged 28 to 51 years with symptomatic uterine leiomyomas who desired uterine preservation underwent outpatient laparoscopic, ultrasound-guided, radiofrequency volumetric thermal ablation using the Halt 2000 System. Postoperative follow-up occurred at 3, 6, and 12 months. The primary outcome measures were patient safety, frequency of adverse events, repeat intervention rate because of symptoms of myoma, symptom severity, and health-related quality-of-life scores from the validated Uterine Fibroid Symptom and Quality-of-Life Questionnaire. Secondary outcome measures were uterine volume changes over time. At 3, 6, and 12 months, respectively, mean symptom severity scores improved significantly compared with baseline, by 59.7% (95% confidence interval [CI], 44.8-74.7], 71.7% [95% CI, 55.7%-87.7%], and 82.0% (95% CI, 70.9%-93.1%). The increase in mean health-related quality-of-life scores over time reached statistical significance (p <.001): 60.15 (95% CI, 51.6%-68.7%) at baseline, 87.9 (95% CI, 82.1%-93.7%) at 3 months, 90.8 (95% CI, 82.1%-99.5%) at 6 months, and 97.8 (95% CI, 96.2-99.4) at 12 months. Mean (SD) uterine volume decreased from 194.4 (105.9 cm(3)) at baseline to 159.5 (66.8) at 3 months, 147.2 (73.0 cm(3)) at 6 months, and 113.2 (53.5 cm(3)) at 12 months (p = .006). There were no procedure-related repeat hospitalizations, repeat treatments, or any procedures related to symptoms of myoma after radiofrequency ablation. An anterior abdominal wall vascular injury was discovered in the early postoperative period and resolved after vessel ligation. Volumetric thermal ablation using the Halt 2000 System produced significant reduction in symptoms and improvement in quality of life at 1 year after treatment, with an excellent safety profile. Additional larger multicenter studies are needed to confirm these results.