Impact of Chronic Pelvic Pain on Female Sexual Function

Adriana Peterson Mariano Salata Romão, Ricardo Gorayeb, Gustavo Salata Romão, Omero Benedicto Poli-Neto, Antonio Alberto Nogueira

Department of Gynecology and Obstetrics, School of Medicine, University of S?o Paulo, S?o Paulo, Brazil..
Department of Neurosciences and Behavioral Sciences, School of Medicine, University of S?o Paulo, S?o Paulo, Brazil.
Department of Surgery and Anatomy, University Hospital, Faculty of Medicine of Ribeir?o Preto, University of S?o Paulo, Ribeir?o Preto, Brazil..
Federal University of S?o Carlos, S?o Carlos, Brazil..

DOI: 10.4236/ijcm.2013.43031                

Abstract

The objective of the present study was to determine the prevalence of sexual dysfunction and depression in women with chronic pelvic pain (CPP). A case-control study was conducted on 66 women, 36 of them with CPP and 30 without this diagnosis. Depression was evaluated using the Beck Depression Inventory (BDI) and sexual dysfunction was evaluated using the Female Sexual Function Index (FSFI). Data were analyzed statistically by the Mann-Whitney test, Fisher exact test, chisquare test, and Spearman correlation test. Regarding sociodemographic data, no significant differences were detected between populations with respect to the variables studied (age, schooling, number of children, income, salary, and marital status), indicating group homogeneity and thus increasing the reliability of the data. A cut-off of 26.55 points was used to calculate the total score for sexual function. In the group of women with CPP, 94.4% were at high risk for sexual dysfunction. Comparison of FSFI scores showed that the domains of sexual function, such as orgasm, lubrication and pain differed significantly between women with and without CPPP. Correlations were detected between the following items: orgasm × age (r = -0.01904), orgasm × number of children (r =-0. 00947), orgasm × body mass index (BMI) (r =-0.00 955), relationship × age (r = 0.03952), income × relationship (r =-0.014680), relationship × number of children (r =-0.03623), depression × relationship (r =-0.16091), desire × age (r = -0.45255), desire × number of children (r = -0.01824), lubrication × excitement (r = 0.04198), and lubrication × BMI (r = -0.01608). The prevalence of depression detected in the present study was 38.9% among women with pain and 3.3% among control women. It was observed that women with CPP suffer a negative interference regarding sexual function compared to controls. Thus, it can be seen that a specific approach related to sexuality is extremely important within the context of women with CPP. Depression was clearly associated with CPP and therefore an interdisciplinary approach is fundamental in order to solve this problem.

Keywords

Chronic Pelvic Pain; Sexual Function; Depression; Women

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. Milburn, R. C. Reiter and A. T. Rhomberg, “Multi-disciplinary Approach to Chronic Pelvic Pain,” Obstetrics & Gynecology Clinics of North America, Vol. 20, No. 4, 1993, pp. 643-661.
[2]	F. M. Howard, “The Role of Laparoscopy in the Evaluation of Chronic Pelvic Pain: Pitfalls with a Negative Laparoscopy,” Journal of the American Association of Gynecologic Laparoscopists, Vol. 4, No. 1, 1996, pp. 85-94. doi:10.1016/S1074-3804(96)80116-2
[3]	G. P. Kurita, “Adesão ao Tratamento da dor CrÔnica: Estudo de Variáveis Demográficas, Terapêuticas e Psicossociais,” Arquivos de Neuro-Psiquiatria, Vol. 61, No. 2B, 2003, pp. 416-425. doi:10.1590/S0004-282X2003000300017
[4]	C. P. Lorençatto and M. J. Navarro, “Depression in Women with Endometriosis with and without Chronic Pelvic Pain,” Acta Obstetricia et Gynecologica Scandinavica, Vol. 85, No. 1, 2006, pp. 88-92. doi:10.1080/00016340500456118
[5]	A. P. Romao, R. Gorayeb, et al., “High Levels of Anxiety and Depression Have a Negative Effect on Quality of Life of Women with Chronic Pelvic Pain,” International Journal of Clinical Practice, Vol. 63, No. 5, 2009, pp. 707-711. doi:10.1111/j.1742-1241.2009.02034.x
[6]	A. P. Romao, R. Gorayeb, et al., “Chronic Pelvic Pain: Multifactorial Influences,” Journal of Evaluation in Clinical Practice, Vol. 17, No. 6, 2011, pp. 1137-1139. doi:10.1111/j.1365-2753.2010.01485.x
[7]	T. A. Gelbaya and H. E. El-Halwagy, “Focus on Primary Care: Chronic Pelvic Pain in Women,” Obstetrical & Gynecological Survey, Vol. 56, No. 12, 2001, pp. 757-764. doi:10.1097/00006254-200112000-00002
[8]	R. Basson, “Human Sex-Response Cycles,” Journal of Sex & Marital Therapy, Vol. 27, No. 1, 2001, pp. 33-43. doi:10.1080/00926230152035831
[9]	J. M. Ferguson, “The Effects of Antidepressants on Sexual Functioning in Depressed Patients: A Review,” Journal of Clinical Psychiatry, Vol. 62, Suppl. 3, 2001, pp. 22-34.
[10]	D. Michelson, M. Schmidt, J. Lee and R. Tepner, “Changes in Sexual Function during Acute and Six-Month Fluoxetine Therapy: A Prospective Assessment,” urnal of Sex & Marital Therapy, Vol. 27, No. 3, 2001, pp. 289-302. doi:10.1080/009262301750257146
[11]	R. Rosen, C. Brown, J. Heiman, S. Leiblum, C. M. Meston, R. Shabsigh, D. Ferguson and R. D’Agostinho, “The Female Sexual Function Index (FSFI): A Multi-dimensional Self-Report Instrument for the Assessment of Female Sexual Function,” Journal of Sex & Marital Therapy, Vol. 26, No. 2, 2000, pp. 191-208. doi:10.1080/009262300278597
[12]	R. V. Pacagnella, O. M. Rodrigues Jr. and C. Souza, “Adaptação Transcultural do Female Sexual Index,” Cadernos de Saúde Pública, Vol. 24, No. 2, 2008, pp. 416-426. doi:10.1590/S0102-311X2008000200021
[13]	G. V. Hamilton and K. Macgrowan, “What is Wrong with Marriage?” 1929.
[14]	A. W. Beck, M. Mendelson, J. Mock and G. Erbaugh, “An Inventory for Measuring Depression,” Archives of General Psychiatry, Vol. 4, No. 6, 1961, pp. 53-63. doi:10.1001/archpsyc.1961.01710120031004
[15]	A. T. Beck, R. A. Steer and M. G. Garbin, “Psychometric Properties of the Beck Depression Inventory: Twenty- Five Years of Evaluation,” Clinical Psychology Review, Vol. 8, No. 1, 1988, pp. 77-100. doi:10.1016/0272-7358(88)90050-5
[16]	C. A. M Pimenta, D. A. L. M. Cruz and J. L. F. Santos, “Instrumentos Para AvaliaÇão de Dor: O Que há de novo em Nosso Meio,” Arq Brasil Neurocirurg, Vol. 17, No. 1, 1988, pp. 15-24.
[17]	M. P. A. Fleck, S. Louzada, M. Xavier, E. Chachamovich, G. Vieira, L. Santos and V. Pinzon, “ApliocaÇão da Versão em Português do Instrumento Abreviado de AvaliaÇão de Qualidade de vida Whoqol-Bref,” Revista de Saúde Pública, Vol. 34, No. 2, 2000, pp. 178-183. doi:10.1590/S0034-89102000000200012
[18]	M. Wiegel, C. Meston and R. Rosen, “The Female Sexual Function Index (FSFI): Cross-Validation and Development of Clinical Cutoff Scores,” Journal of Sex & Marital Therapy, Vol. 31, No. 1, 2005, pp. 1-20. doi:10.1080/00926230590475206
[19]	F. F. Verit, A. Verit and E. Yeni, “The Prevalence of Sexual Dysfunction and Associated Risk Factors in Womem with Chronic Pelvic Pain: Cross-Sectional Study,” Archives of Gynecology and Obstetrics, Vol. 274, No. 5, 2006, pp. 297-302. doi:10.1007/s00404-006-0178-3
[20]	S. Cayan, E. Akbay, M. Bozly, B. Canpolat and D. Acar, “The Prevalence of Female Sexual Dysfunction and Potential Risk Factors That May Impair Sexual Function in Turkish Women,” Urologia Internationalis, Vol. 72, 2004, pp. 52-57. doi:10.1159/000075273
[21]	T. Maruta, D. Osborne, D. W. Swanson and J. M. Halling, “Chronic Pain Patients and Spouses: Marital and Sexual Adjustment,” Mayo Clinic Proceedings, Vol. 56, No. 5, 1981, pp. 307-310.
[22]	T. N. Monga, G. Tan, H. J. Ostermann, U. Monga and M. Grabois, “Sexuality and Sexual Adjustment of Patients with Chronic Pain,” Disability and Rehabilitation, Vol. 20, No. 9, 1998, pp. 317-329. doi:10.3109/09638289809166089
[23]	N. Ambler, A. C. Williams, P. Hill, R. Gunary and G. Cratchley, “Sexual Difficulties of Chronic Pain Patients,” Clinical Journal of Pain, Vol. 17, No. 2, 2001, pp. 138-145. doi:10.1097/00002508-200106000-00006
[24]	S. Kingsberg, “The Impact of Aging on Sexual Function in Women and Their Partners,” Archives of Sexual Behavior, Vol. 31, No. 5, 2002, pp. 431-437. doi:10.1023/A:1019844209233
[25]	R. Hayes and L. Dennerstein, “The Impact of Aging on Sexual Function and Sexual Dysfunction in Women: A Review of Population-Based Studies,” Journal of Sexual Medicine, Vol. 2, No. 3, 2005, pp. 317-330. doi:10.1111/j.1743-6109.2005.20356.x
[26]	N. D. Vogeltanz, S. C. Wilsnack, et al., “Sociodemographic Characteristics and Drinking Status as Predictors of Older Women’s Health,” Journal of General Psychology, Vol. 126, No. 2, 1999, pp. 135-147. doi:10.1080/00221309909595357
[27]	E. O. Laumann, A. Paik and R. C. Rosen, “Sexual Dysfunction in the United States: Prevalence and Predictors,” Journal of the American Medical Association, Vol. 281, No. 6, 1999, pp. 537-544.
[28]	R. Shabsigh, “Female Sexual Function and Dysfunction,” In: P. C. Walsh, A. B. Retik, E. D. Vaughan and A. J. Wein, Eds., Campbell’s Urology, 8th Edition, W. Saunders, Philadelphia, 2002..
[29]	J. B. Blumel, P. Cataldo, A. Carrasco, H. Izaguirre and S. Sarrá, “índice de Function Sexual Femenina: Un Test Para Evaluar la Sexualidad de la Mujer,” Revista Chilena de Obstetricia y Ginecología, Vol. 69, No. 2, 2004, pp. 118-125. doi:10.4067/S0717-75262004000200006
[30]	C. H. N. Abdo, W. M. Oliveira Jr., E. D. Moreira Jr. and J. A. S. Fittipaldi, “Prevalence of Sexual Dysfunction and Correlated Conditions in a Sample of Brazilian Women: Results of the Brazilian Study on Sexual Behavior (BSSB),” International Journal of Impotence Research, Vol. 16, 2004, pp. 160-166. doi:10.1038/sj.ijir.3901198
[31]	R. Renaer, H. Vertommen, P. Nijs, et al., “Psychological Aspects of Chronic Pelvic Pain in Women,” American Journal of Obstetrics and Gynecology, Vol. 134, No. 1, 1979, pp. 75-80.
[32]	H. Gomibuchi, M. Doi, et al., “Is Personality Involved in the Expression of Dysmenorrhea in Patients with Endometriosis?” American Journal of Obstetrics and Gynecology, Vol. 169, No. 3, 1993, pp. 723-725.
[33]	G. Tan, U. Monga, J. Thornby and T. Monga, “Sexual Functioning, Age, and Depression Revisited,” Sexuality and Disability, Vol. 16, No. 2, 1998, pp. 77-86. doi:10.1023/A:1023023924804
[34]	M. J. Bair, W. Katon and K. Kroenke, “Depression and Pain Comorbidity: A Literature Review,” Archives of Internal Medicine, Vol. 163, No. 20, 2003, pp. 2433-2445. doi:10.1001/archinte.163.20.2433
[35]	M. M. C. Castro, L. Quarantini, S. Batista-Neves, et al., “Validade da Escala Hospitalar de Ansiedade e Depress?o em Pacientes com dor Cr?nica,” Revista Brasileira de Anestesiologia, Vol. 56, No. 5, 2006, pp. 470-477. doi:10.1590/S0034-70942006000500005
[36]	DSM-IV-TR, “Manual Diagnóstico e Estatístico de Transtornos Mentais,” Porto Alegre, 2002.