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Pelvic Pain and Associated Characteristics Among Women in Northern Mexico
– Reported, June 11, 2013
Until recently, reproductive health advocates have focused on a restricted number of morbidity indicators, particularly those associated with lifethreatening diseases. Few studies have paid attention to life-enhancing aspects of sexual and reproductive health, such as enjoyable sex, or health-related quality of life among women of childbearing age.
Yet, the concept of reproductive health extends beyond mortality and should explicitly include a lack of reproductive morbidity and associated disabilities, as well as the full range of conditions, experiences and circumstances that affect womens quality of life across their reproductive life cycle. Because, in part, of this emphasis on life-threatening diseases, the gynecologic conditions that cause pelvic pain traditionally have been neglected in research and service delivery programs in Mexico. Reproductive health programs and research have focused mainly on maternal and child health, contraception, STIs, and cervical and breast cancer.
However, pelvic pain is a major gynecologic complaint among women of reproductive age; some women begin experiencing it as soon as they begin menstruating. Chronic pelvic pain and painful sexual intercourse have been associated with impairments in womens sexual and social functioning. Occurrence of multiple pelvic pain conditions has been reported in some studies.
Some risk factors were common to all three categories of pelvic pain, specifically being younger than and having a history of STIs or pelvic inflammatory disease. Genitourinary symptoms were risk factors for both pain related to intercourse and chronic pelvic pain, while early age at sexual debut and colitis were common risk factors for menstrual pain and intercourse-related pain. These findings are consistent with those of other studies, which have documented that women with one type of pelvic pain tend to have another and that these conditions are associated with the presence of bowel disorders, genitourinary symptoms and STIs or pelvic inflammatory disease.
Having a history of uterine fibroids appeared as a risk factor for both chronic pelvic pain and menstrual pain. Although studies on high BMI and menstrual pain have produced inconsistent results, our data suggest that high BMI is a risk factor for menstrual pain, primarily among women with a history of uterine fibroids. An endocrine pathway has been documented in previous studies, with obesity resulting in hormonal changes that may increase the risk, number and size of fibroids. The presence of fibroids has been related to heavy bleeding and pelvic pressure or pain. Although pain with intercourse was also associated with uterine fibroids in other population-based studies, we did not observe an association in our sample.
Menstrual pain is assumed to be normal by many women, who try to diminish its effect in daily life by drinking hot tea, putting a heating pad on the lower abdominal area or taking pain medication. Analogous information is not available on health routines followed by women with intercourse-related pain and chronic pelvic pain.
Given that talking about sexuality is frowned on in Latin American culture, Mexican women probably avoid discussing sexual health problems with physicians. Sexuality is a private issue; thus, women are highly unlikely to disclose any dysfunction related to sexual activity because of a strong sense of shame and embarrassment. Cultural norms surrounding sexual practices may negatively affect womens sexual health because they may prevent women from getting sexual health information and inhibit them from communicating about sexual matters with sexual partners and health providers. It is not surprising, therefore, that although intercourse-related pain had affected our respondents for an average of six years, only one out of five women had talked with a physician about this condition in the year before the survey.
Compared with women suffering from menstrual pain and pain with intercourse, a substantially higher proportion of those with chronic pelvic pain reported having talked with a physician, having received a diagnosis and having used pain medication. The chronic nature and severity of this pelvic pathology may explain why women were more likely to seek medical help as well as to report that pain interfered with their work and social activities.
Given that a woman may suffer from more than one type of pelvic pain and that these disorders are often difficult to diagnose, Mexican reproductive health programs should address the complexity of the clinical evaluation of symptoms of pelvic pain. Because we know that health care providers generally wait for women to disclose sexual health problems rather than ask about them directly, we suggest a more proactive medical practice in the assessment of pelvic pain, particularly in the evaluation of pain with intercourse. Increasing clinical efforts to address pain and morbidity associated with two of the most common reproductive events in womens lives, menstruation and sexual intercourse, are warranted for women in developing countries.
It is clear that the reproductive health agenda in Mexico should expand to include gynecologic morbidities such as pelvic pain. Given the level of coverage of reproductive health programs in northern Mexico, this region would be an appropriate place to begin a pilot program to screen for and treat gynecologic morbidities. Further studies of the potential relationships among obesity, uterine fibroids and menstrual pain are warranted in the Mexican context, given the high prevalence of obesity among women of reproductive age in this country.
CREDITS.
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