Conceptualization and Inventory of the Sexual and Psychological Burden of Women With Pelvic Floor Complaints; A Mixed-Method Study

Abstract

Introduction Despite the fact that the literature reports various restrictions and types of distress in women with pelvic floor complaints, a comprehensive overview of women's sexual and psychological burden emerging from these complaints is lacking, which compromises our ability to assess and grasp the impact to women. Aim This study was performed to conceptualize women's sexual and psychological burden and create a more comprehensive overview on this topic from both women's and health care providers’ perspectives. Furthermore, this research intended to identify items to populate a to-be-developed instrument to assess sexual and psychological burden. Methods In Group Concept Mapping, 125 statements were used about restrictions and distress that women with pelvic floor complaints experienced. Women with, and health care providers with and without pelvic floor complaints (13 women and 3 men) sorted the statements into comprehensive self-labeled clusters and rated their nature and severity. Multidimensional scaling and hierarchical cluster analyses were performed to identify a conceptual model of coherent clusters of statements. Item-total correlations of severity scores were calculated to identify statements that can be used in future research to represent women's sexual and psychological burden. Main Outcome Measure A conceptual model emerged, and outcomes of item-total correlations were then examined again using the conceptual model. Results Seven distress clusters were identified, namely, loss of control, sexual distress, feeling insecure, feeling wronged, feeling helpless, feeling angry, and feeling disappointed. Feeling insecure appeared more pervasive than other distresses. Furthermore, 33 statements were identified that can be used in future research to develop an instrument to assess sexual and psychological burden representing both women's and health care providers’ perspectives. Conclusion The conceptual model and list of statements may concisely represent the sexual and psychological burden of women with pelvic floor complaints from both women's and health care providers’ perspectives on this topic.

Measuring the psychological burden of women with pelvic floor complaints: The psychometric characteristics of a new instrument

“…Women’s psychological burden was questioned using the previously selected statements from the conceptual model 21 , which constituted a preliminary item pool. Participants were asked to answer the applicability of the provided 33 items as follows: “Please click on the dot that represents the applicability of this statement to you as best as possible whilst keeping your physical complaints in mind”.…”

“…Internal consistency . To assess the reliability of the items included in the new scale, item-total correlation analysis was performed, using the data on the 33 representative psychological distress items of all seven clusters of distress in the conceptual model 21 . In the first step items with a negative correlation were deleted.…”

“…The available evidence from previous studies is inconclusive because it mostly focused on specific complaints and specific domains of life. Two mixed-method studies were performed by the same authorship team among Dutch young adult pregnant, parous, and nulliparous women with PFC 20 , 21 . In the first study, women were interviewed about the restrictions and distress they experienced related to their PFC.…”

“…The study provided a comprehensive overview of women’s psychological burden with PFC based on text-mining analyses 20 . In the second study, a conceptual model of women’s psychological burden with PFC was developed including 125 statements about women’s lived experiences with PFC from the interviews using Group Concept Mapping methodology 21 . Although these studies have added to the understanding of women’s psychological burden with PFC, a valid instrument to measure this burden is not yet available.…”

“…These 33 items represent the theoretical and experience-based content of the seven types of distress emerging in the model. These types of distress were Loss of Control , Feeling Insecure , Feeling Wronged , Feeling Helpless , Sexual Distress , Feeling Angry , and Feeling Disappointed 21 . The 33 items were viewed in the present study as candidate items for instrument development and further psychometric testing.…”