Correlation between sexual abuse and somatization in women with somatic and nonsomatic chronic pelvic pain

Article Abstract:

Chronic pelvic pain is a commonly reported gynecologic problem and is the reason between 10 to 19 percent of hysterectomies are performed. Studies comparing women with such pain with those that are free of it have found significantly different psychological profiles, with pain sufferers more likely to experience depression and other problems. It is thought the pain causes these problems and not vice versa. Studies examining psychological profiles in women with chronic pain with and without an identifiable physiologic cause have not revealed significant differences. However, a problem with these studies is that they relied on laparoscopy, endoscopic examination of the peritoneal cavity, to determine if there was a physiologic cause underlying the pain. Recent studies have found that many such causes may not be detected with this technique, while other studies have shown that women who have experienced sexual or physical abuse are more likely to have high somatization scores (meaning that they experience physical symptoms that are psychological in nature). This study examined both whether there were demographic and psychosocial differences between women who had somatic (physically identifiable) vs nonsomatic chronic pelvic pain and whether a history of sexual abuse was related to chronic pelvic pain. Determination if pain was somatic or nonsomatic was made by means other than laparoscopy. A medical and personal history questionnaire was given to 99 women suffering from chronic pelvic pain as well a somatization test. Medical results were used to categorize the women into two groups, those with and those without a likely somatic cause of the pain. Results showed that 47 had somatic pain and 52 nonsomatic pain. The women with somatic pain were significantly older than those with nonsomatic pain. The group with nonsomatic pain tended to be younger at time of first intercourse (average age, 15.2 versus 17.9 years), to have had more sexual partners (average of 6.7 versus 4.6), and they reported a much higher rate of sexual abuse (67 percent versus 28 percent). Somatization scores were much higher in women reporting a history of sexual abuse who had nonsomatic pain (10.3 versus 5.9). These results indicate that women with chronic pelvic pain with a somatic cause and women with a nonsomatic cause differ greatly on psychosocial profiles. A previous history of sexual abuse is strongly associated both with nonsomatic chronic pelvic pain and high somatization scores. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Causes of, Complications and side effects, Somatoform disorders, Surveys, Child sexual abuse, Pelvic pain

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Quality assurance indicators and short-term outcome of hysterectomy

Article Abstract:

Since 1986, assessment of health care organizations by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has been ''outcome-oriented''; that is, based on the health care actually delivered. Accordingly, structure (the resources and equipment of the organization), outcome (short- and long-term consequences of a procedure), and indicators (a variable related to structure, process, or outcome of health care) are to be monitored when health care is evaluated. Fifteen indicators developed by The American College of Obstetricians and Gynecologists (ACOG) concerning gynecologic health care were applied to a data base concerning hysterectomy, an operation performed 650,000 times each year in the US. An evaluation is provided of the accuracy of these indicators and their impact. Two hundred fifty-seven hysterectomies were reviewed; the presence of an indicator or a major complication, the length of hospitalization, and other factors, were noted for one naval hospital. Sixty-eight of the procedures were performed abdominally and the remainder, vaginally. One hundred thirty-five ACOG quality assurance indicators were identified in 114 cases; there were 82 examples of complications and major morbidity. Most of these involved fever and related signs. All cases associated with a morbidity indicator developed morbidity; thus, the positive predictive value for morbidity indicators was 100 percent. The negative predictive value was 98 percent, for an overall accuracy of 99 percent. ACOG indicators that screened for appropriateness of care had a positive predictive value of 28 percent. The cases reviewed had a high prevalence of major morbidity, which could bias the evaluation of ACOG indicators. Overall, if such indicators were adopted on a large scale, it is likely that screening outcomes could be accelerated and comparisons among institutions and regions could be facilitated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Statistics, Medical care, Quality management, Medical care quality, Gynecology

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The impact of a quality assurance process on the frequency and confirmation rate of hysterectomy

Article Abstract:

The incidence of hysterectomy, the surgical removal of the uterus, reached a peak in 1975 in the United States, when approximately 725,000 hysterectomies were performed. Since 1980, the number of hysterectomies performed each year has remained constant at 650,000, which is one-third higher than is reported in some Western European countries. In the United States, the incidence of hysterectomy is highest in the South and lowest in the Northeast. The factors that determine whether a hysterectomy is necessary have not been clearly established. A criteria-based quality assurance process was developed in which the surgeon was required before the operation to select a reason for performing the hysterectomy from a list of accepted conditions indicating a need for hysterectomy. The effect of this quality assurance process on the frequency of hysterectomy was assessed at a large military teaching hospital. The initiation of the quality assurance process was associated with a 24 percent decrease in the overall frequency of hysterectomies. There were fewer hysterectomies performed for chronic pelvic pain, recurrent bleeding from the uterus, preinvasive disease, and severe infection of the uterus. Adenomyosis is the overgrowth of the endometrium, the inner lining of the uterus, into the muscular layer of the uterus; this was the only condition for which there was an increased rate of hysterectomy. However, the increase due to adenomyosis was totally reversed during the last part of the study. The initiation of the quality assurance process for hysterectomy was also associated with an increased rate of confirmation of need for hysterectomy by microscopic examination of abnormal tissue. These findings suggest that the quality assurance process reduces the incidence of hysterectomies and improves the accuracy of diagnosis before the hysterectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Standards, Usage, Women, Surgery, Women's health, Uterus

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