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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is estimated that more than 120 million females have undergone female genital mutilation (FGM) and that 2 million more girls are at risk of mutilation each year. In response to this enormous health problem, the World Health Organization (WHO) convened a Technical Working Group Meeting on the subject in July 1995. The working group defined FGM as "the removal of part or all of the external female genitalia and/or injury to the female genital organs for cultural or other nontherapeutic reasons." The working group also provided four classifications for different types of FGM. FGM is usually performed by traditional practitioners (the WHO is opposed to the medicalization of this procedure) on girls and young women of any age (but the average age is decreasing). The origins of FGM are unknown, and a variety of reasons are forwarded in its defense. The health complications are known, however, and include the immediate complications of hemorrhage, severe pain, fractured bones, possible HIV transmission, and shock; longterm complications such as keloid scar formation, painful intercourse, chronic infection, and problems in pregnancy and childbirth; and psychological problems associated with sexual dysfunction caused by painful intercourse, the loss of trust in care-givers, and depression. Human rights instruments exist that oblige states to eliminate such harmful procedures, but gaps exist in information about types and prevalence of FGM. Because FGM involves human rights and health issues, a multidisciplinary approach will be necessary for its eradication. An action agenda calls for adoption of clear national policies, establishment of interagency coalitions, research, community outreach, and training of health workers.
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PMID:Combating female genital mutilation: an agenda for the next decade. 905 Jan 93

Systemic sclerosis (SSc), a multisystem disease involving the microvascular system and the connective tissue, is considered one of the most difficult rheumatic diseases to treat. The natural history of the disease evolves from an edematous to a scleroatrophic phase following two different temporal patterns: acute or chronic. The former leads to early death, and the latter evolves slowly toward severe disability that deserves rehabilitative intervention. Despite the poor prognosis, recent improvements in diagnosis and treatment have led to longer patient survival, thus increasing the need to intervene against the development of tissue fibrosis and contractures by using appropriate integrated rehabilitation programs. This article does not review the medico-pharmacological management of visceral manifestations of the disease. Rather, it is divided into six parts, which include analyses of the changes in skin, joints and tendons, and muscle induced by SSc; examination of the existing literature on rehabilitation strategies and treatments; discussions of the pain and peripheral sensory-motor system involvement that are present to a greater or lesser extent in almost all patients and influence not only the duration and outcome of rehabilitation but also the patient's family, social life, and working ability; and consideration of ergonomic and occupational interventions. No controlled studies have been done on the few rehabilitation guidelines and specific protocols identified, so it must be emphasized that this article is a summary of opinions expressed in the literature and the authors' own findings. Particularly lacking are studies on such aspects as ergonomics, work intervention, or the management of sexual dysfunction. Experience gained in the rehabilitation of skin burns and other rheumatic diseases forms the basis for a logical approach to SSc patients.
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PMID:Systemic sclerosis (scleroderma): an integrated challenge in rehabilitation. 955 20

This study investigated the clinical attributes of dyspareunia and the variables used to classify it. A systematic clinical description of the pain symptomatology was obtained through the administration of a structured interview and standardized pain measures to 112 women suffering from dyspareunia, ranging in age from 19 to 65. Subjects also underwent three different gynecological examinations and completed standardized measures of psychopathology, marital adjustment, and sexual attitudes, the results of which were used to test the ability of three different classification systems, including the DSM-IV, to predict physical and psychosocial outcomes. Using classification analysis, temporal pattern and location of the pain were found to be the best predictors of physical diagnoses, although none of the taxa in the three classification systems tested were related to psychosocial outcomes. Sexual impairment of women suffering from dyspareunia notwithstanding, the results support the consideration of dyspareunia as primarily a pain syndrome, rather than a sexual dysfunction.
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PMID:Dyspareunia: sexual dysfunction or pain syndrome? 930 18

People with HIV or AIDS who are experiencing pain, fatigue, sexual dysfunction, bowel and bladder dysfunction, and self-care deficits are being cared for by rehabilitation nurses in the home setting. The home care rehabilitation nurse provides instruction and care to clients, their families, and caregivers regarding physical manifestations of the disease and issues such as the importance of involving the client in household activities and activities of daily living. In addition to working with an interdisciplinary team to meet clients' needs, home care rehabilitation nurses work and consult with the generalist nursing staff to offer recommendations about rehabilitation nursing care for clients with HIV or AIDS.
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PMID:The rehabilitation nurse in the home care setting: care of the client with HIV or AIDS. 934 44

The first phase of the female sexual response, associated with neurotransmitter-mediated vascular smooth muscle relaxation, results in increased vaginal lubrication, wall engorgement and luminal diameter as well as increased clitoral length and diameter. Specific physiologic impairments of vasculogenic female sexual dysfunction include vaginal engorgement and clitoral erectile insufficiency syndromes. These syndromes exist when during sexual stimulation abnormal arterial circulation into the vagina or clitoris, usually from atherosclerotic vascular disease, interferes with normal vascular physiologic processes. Clinical symptoms may include delayed vaginal engorgement, diminished vaginal lubrication, pain or discomfort with intercourse, diminished vaginal sensation, diminished vaginal orgasm, diminished clitoral sensation or diminished clitoral orgasm. An animal model of this syndrome, with significant physiologic responses between the control and the atherosclerotic pelvic nerve stimulated hemodynamic responses, is discussed. Non-atherosclerotic, traumatic vascular disease of the ilio-hypogastric-pudendal arterial bed from pelvic fractures or blunt perineal trauma may also result in diminished vaginal/clitoral arterial blood flow following sexual stimulation. Diagnostic studies assessing the hemodynamic integrity of the ilio-hypogastric-pudendal arterial bed to the vagina and clitoris and new oral/topical pharmacologic strategies for enhancing vaginal/clitoral blood flow in patients with vasculogenic female sexual dysfunction are discussed. There is a growing body of evidence that women with sexual dysfunction will commonly have physiologic abnormalities, such as vasculogenic female sexual dysfunction, contributing to their overall sexual health problems.
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PMID:Vasculogenic female sexual dysfunction: vaginal engorgement and clitoral erectile insufficiency syndromes. 964 67

The conventional view that sexual function is not adversely affected by lower urinary tract symptoms (LUTS), assumed to be caused by enlargement secondary to benign prostatic hyperplasia (BPH), was investigated in this study of 423 men aged 40 years and over in a community population in the UK and 1271 urology clinic attenders aged 45 years and over in 12 countries, using the ICSmale and ICSsex questionnaires. Sexual dysfunction was found to be common: in the community, age standardized prevalences of reduced rigidity of erections were 53%, reduced ejaculation 47%, and pain on ejaculation 5%; in clinic men, age standardized prevalences of reduced rigidity of erections were 60%, reduced ejaculation 62%, and pain on ejaculation 17%. Sex lives were reported to be spoiled by LUTS in 8% of community men and 46% in the clinic. There were negative trends for age in the extent to which clinic men were bothered by these symptoms, although older men were still very concerned. Significantly raised odds ratios of sexual dysfunction were found in those with LUTS, especially storage symptoms associated with incontinence. Urinary flow rates were not associated with sexual symptoms. Sexual dysfunction is, therefore, strongly associated with LUTS, is a matter of concern to the men affected, and should be taken into account when managing patients with LUTS.
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PMID:Sexual dysfunction in men with lower urinary tract symptoms. 974 16

Vulval pain can be acute or chronic. Usually patients present to their general practitioner when the pain is acute but, when specialist advice is required, vulval pain can present a real dilemma over to whom to refer patients. Genitourinary medicine, gynaecology, dermatology and sexual dysfunction clinics all play an important part in the holistic management of this symptom. Consultation in a sympathetic environment with appropriate investigations and collaboration between different disciplines may provide a diagnosis and management.
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PMID:Management of vulval pain--whose responsibility? 974 49

Vulvodynia is a problem most family physicians can expect to encounter. It is a syndrome of unexplained vulvar pain, frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction and psychologic distress. The patient's vulvar pain usually has an acute onset and, in most cases, becomes a chronic problem lasting months to years. The pain is often described as burning or stinging, or a feeling of rawness or irritation. Vulvodynia may have multiple causes, with several subsets, including cyclic vulvovaginitis, vulvar vestibulitis syndrome, essential (dysesthetic) vulvodynia and vulvar dermatoses. Evaluation should include a thorough history and physical examination as well as cultures for bacteria and fungus, KOH microscopic examination and biopsy of any suspicious areas. Proper treatment mandates that the correct type of vulvodynia be identified. Depending on the specific diagnosis, treatment may include fluconazole, calcium citrate, tricyclic antidepressants, topical corticosteroids, physical therapy with biofeedback, surgery or laser therapy. Since vulvodynia is often a chronic condition, regular medical follow-up and referral to a support group are helpful for most patients.
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PMID:Vulvodynia and vulvar vestibulitis: challenges in diagnosis and management. 1019 96

The basic strategies and methods for assessing and treating vaginismus were proposed by the early 20th century and have not essentially changed. Etiological theories have changed over time but are not supported by controlled empirical studies. This critical review of the literature disputes the widely held belief that vaginismus is an easily diagnosed and easily treated sexual dysfunction. We propose a reconceptualization of vaginismus as either an aversion/phobia of vaginal penetration or a genital pain disorder.
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PMID:Does vaginismus exist? A critical review of the literature. 1034 80

Ovarian cancer presents a range of physical and psychological symptoms during stages of diagnosis, treatment, and survival. Women at risk for ovarian cancer who attend screening programs are vulnerable to high levels of depression and anxiety, particularly young women with poor social support. Multiple physiological stressors of surgical menopause, steroid therapy, and pain present during active treatment that place women at high risk of depression and anxiety during this time. Symptoms of anxiety and depression are also prevalent immediately after chemotherapy and during palliative care. Screening for psychological distress may be useful to identify women who will benefit from psychological counseling. They should be referred to a mental health professional affiliated with the hospital at which they are receiving oncology services. Brief group or individual supportive psychotherapies are effective in relieving psychological distress. Face-to-face psychological intervention should be tailored to the patient's degree of physical mobility. Pain, discomfort, and severe mood symptoms should be addressed pharmacologically, when possible, by a psychiatric consultant knowledgeable in oncology psychiatry. Survivors experience chronic fear of recurrence, sexual dysfunction, and identity disturbance. Reports that ovarian cancer can result in positive life changes, such as closer interpersonal relationships, are encouraging and may provide hope to patients who become despairing about the future.
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PMID:Psychological aspects of ovarian cancer. 1037 Mar 61


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