Introduction: Dyspareunia has been traditionally divided into superficial (introital) dyspareunia and deep dyspareunia (pain with deep penetration). While deep dyspareunia can co-exist with a variety of conditions, recent work in endometriosis has demonstrated that coexistence does not necessarily imply causation. Therefore, a reconsideration of the literature is required to clarify the pathophysiology of deep dyspareunia. Aims: To review the pathophysiology of deep dyspareunia, and to propose future research priorities. Methods: Narrative review after appraisal of published frameworks and literature search with the terms (dyspareunia AND endometriosis), (dyspareunia AND deep), (dyspareunia AND (pathophysiology OR etiology)). Main Outcome Variable: Deep dyspareunia (present/absent or along a pain severity scale). Results: Potential etiologies for deep dyspareunia include gynecological, urological, gastrointestinal, nervous system, psychological, and musculoskeletal system related. These etiologies can be classified according to anatomic mechanism (contact with a tender pouch of Douglas, uterus-cervix, bladder, or pelvic floor, with deep penetration). They can also be stratified into four categories (as previously proposed for endometriosis specifically), which can be utilized to personalize management: Type I (primarily gynecologic), Type II (nongynecologic comorbid conditions), Type III (central sensitization and genito-pelvic pain Page 1 of 49 penetration disorder), and Type IV (mixed). Sociocultural and genetic factors and sexual response may also be important for deep dyspareunia. Conclusion: We propose the following eight research priorities for deep dyspareunia: 1) development of deep dyspareunia measurement tools; 2) focus on the population who are avoiding intercourse due to deep dyspareunia; 3) clarification of the role of non-gynecologic comorbidities in the generation of deep dyspareunia; 4) addressing of ethnic and other sociocultural factors; 5) initiation of clinical trials with adequate power for deep dyspareunia outcomes; 6) inclusion of partner variables; 7) elucidation of pathways between psychological factors and deep dyspareunia; and 8) empirical validation of personalized approaches to deep dyspareunia.
INTRODUCTION: Dyspareunia is a challenging symptom of endometriosis-related pelvic pain, exacerbated by suboptimal communication between the patient and healthcare professional (HCP). Our aim was to describe patient-HCP communications regarding diagnosis and management of dyspareunia in endometriosis patients. METHODS: An IRB-approved 24-question online English-language survey was conducted among women 19 years or older who self-identified as having endometriosis and dyspareunia. Women were asked about their interactions with HCPs about dyspareunia. Participants were recruited via MyEndometriosisTeam (a social network for women with endometriosis); members were invited by e-mail. Other participants were solicited via invitations posted on MyEndometriosisTeam’s Facebook page. Invitation to participate included a link to an anonymous survey. RESULTS: Of the 32,865 invited participants, 357 US women completed the survey with an 11% open rate and 10.3% response rate. Most respondents (83%) were between 19 and 29 years old; 85% reported to have discussed painful sex with a gynecologist, while only 33% were told their condition might be dyspareunia. Among those who did not seek help, 34% indicated that they were too embarrassed, while 26% did not think anything could lessen the pain. 42% of women agreed that it would be easier to discuss painful sex if the HCP initiated the discussion. Women reported that HCPs most often recommend surgery (46%) and over-the-counter pain medication (36%) for dyspareunia, while 18% provide no advice. CONCLUSION: In this online survey, the majority of women reported suboptimal communication with HCPs when seeking help for dyspareunia, highlighting the need for better dialogue about dyspareunia between patients and physician.
Introduction: Dyspareunia can be a debilitating symptom of endometriosis. We performed this study to examine women's experiences with painful sexual intercourse, the impact of dyspareunia on patients' lives, and perceptions of interactions with healthcare practitioners. Methods: An anonymous 24-question online survey was provided through the social media network MyEndometriosisTeam.com and was available internationally to women aged 19-55 years who were self-identified as having endometriosis and had painful sexual intercourse within the past 2 years. Results: From June 13 to August 20, 2018, 860 women responded and 638 women completed the survey (United States, n = 361; other countries, n = 277; 74% survey completion rate). Respondents reported high pain levels (mean score, 7.4 ± 1.86; severity scale of 0 [no pain] to 10 [worst imaginable pain]), with 50% reporting severe pain [score of 8 to 10]). Nearly half (47%) reported pain lasting ≥24 hours after intercourse with the pain often leading to avoiding (34%) or stopping (29%) intercourse. Pain impacted patients' lives, causing depression (61%), anxiety (61%), low self-esteem (55%), and relationship strain. Many women feared to seek help (10%). Of those women who approached practitioners, many (36%) did not receive effective treatments. Discussion: Women with dyspareunia related to endometriosis experience severe pain that can negatively impact patients' lives. Dyspareunia may be a challenging topic for discussion for both patient and practitioner, leading to a suboptimal treatment approach and management. Results suggest that practitioners need improved education and training regarding dyspareunia to evaluate and treat patients' sexual pain caused by endometriosis.
In June 2022, the US Supreme Court ruled that the US Constitution does not grant a right to abortion; thus, abortion should be governed by the states ( Dobbs v. Jackson Women’s Health Organization (No. 19-1392, 597 U.S. ___ (2022), 2022 WL 2276808; 2022 U.S. LEXIS 3057)). The Dobbs ruling impacts females’ healthcare during the estimated 39 years they can bear children. It also affects healthcare providers and the organizations in which they work, health insurers, pharmaceutical firms, social media platforms, and employers. Important marketing and policy concerns, including privacy, cross-border commerce, consumer vulnerability, and marketplace information flow will require study as stakeholders respond to this environmental change. We develop a framework for the “typical” female reproductive healthcare journey to identify some of the most important areas of research for marketing and public policy academics and policymakers.
INTRODUCTION The teenage birth rate in West Virginia (WV) remains among the highest in the United States. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend long-acting reversible contraception (LARC) as first-line contraception. Because WV teenagers' LARC use is exceptionally low, the objective of this study was to gain insight into the current knowledge, practice, and beliefs of health care providers (HCP) in WV regarding LARC for adolescent patients. METHODS An electronic survey using Qualtrics.com was distributed to WV HCPs. Of the 2,196 HCPs contacted, 132 respondents returned the survey, and 109 completed usable data. RESULTS A majority of HCPs were aware that LARC (i.e., intrauterine devices and implantable devices) is the first line recommendation of the ACOG and AAP for adolescent birth control. However, HCPs most frequently prescribed combination oral contraceptives and injectables, which are not first-line recommendations. Notably, 59% of HCPs prescribing combination oral contraceptives believed they were prescribing according to COG and AAP recommendations. Forty-one percent of HCPs knew that combination oral contraceptives were not a first-line recommendation but prescribed them most often. The most frequently identified most important reason for not prescribing LARC was that the HCP did not know how to place them (16.5% of respondents), followed by litigious or malpractice action if there is a malfunction or complication (4.6% of respondents). DISCUSSION These results indicate a need to provide adequate LARC training to HCPs in WV.
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