Ingela Danielsson

Prevalence and incidence of prolonged and severe dyspareunia in women: results from a population study.

Aims: The principle aim of this study was to investigate the prevalence and incidence of prolonged (≥6 months) and severe dyspareunia in a non-patient population of women, and to explore the rate of recovery as well as the inclination to seek medical care. Another aim was to compare the use of oral contraceptives among women who had ever had dyspareunia and those who had not. Methods: A total of 3,017 women aged 20—60 participating in a screening program for cervical cancer answered a questionnaire about possible painful coitus. Results: The prevalence was 9.3% for the whole group and 13% for women aged 20—29 and 6.5% for the women aged 50—60, with a risk ratio of 2.0 (95% CI 1.4—2.8) for the youngest age group compared with the oldest. The incidence risk ratio was 9.3 (95% CI 2.8—30.9) for the youngest age group compared with the oldest. Using age-specific incidence rates, a rising incidence of dyspareunia in young women was demonstrated. Of the women who had ever had prolonged and severe dyspareunia 28% had consulted a physician for their symptoms; 20% recovered after treatment, while 31% recovered spontaneously. No differences were found in the use of oral contraceptives between the women who had had dyspareunia and those who had not. Conclusions: Prolonged and severe dyspareunia is a great health problem among all women and especially young women, for whom a rising incidence of dyspareunia is suggested and discussed. Surprisingly few women have consulted a physician, raising the question of why this is the case and what can be done about it.

EMG biofeedback versus topical lidocaine gel : a randomized study for the treatment of women with vulvar vestibulitis

Background. To evaluate the efficacy of electromyographic biofeedback and topical lidocaine treatment for women with vulvar vestibulitis. Methods. A prospective randomized study where 46 women with vulvar vestibulitis were randomized to receive either electromyographic biofeedback or topical lidocaine treatment for four months. Assessments with vulvar pressure pain thresholds and questionnaires regarding quality of life, psychosocial adjustments, and sexual functioning were made before treatment, after treatment, and at six‐ and 12‐month follow‐ups. Nonparametric statistical methods were used to analyze differences in outcomes. Results. Nine women (9/46) dropped out during the treatment period. Both treatments showed significantly improved values for vestibular pressure pain thresholds, quality of life measurements, and sexual functioning at the 12‐month follow‐up. No differences were found between the two treatment groups. No severe side effects were reported. Conclusions. Four months’ treatment with electromyographic biofeedback and topical lidocaine gave statistically significant improvements on vestibular pain measurements, sexual functioning, and psychosocial adjustments at the 12‐month follow‐up. No differences in outcome between the two treatments were observed but a larger sample may be needed to obtain significance. The treatments were well tolerated but the compliance to the electromyographic biofeedback training program was low. A combination of both treatments could potentially benefit many women with vulvar vestibulitis.

Vulvar vestibulitis: medical, psychosexual and psychosocial aspects, a case‐control study

Background. Vulvar vestibulitis is suspected to be increasingly prevalent among young women, but the etiology is still unclear. The aim of this study was to explore the differences in medical, psychosexual and psychosocial factors between women with vulvar vestibulitis and a control group.

Acupuncture for the treatment of vulvar vestibulitis: A pilot study

Background. The study was conducted to obtain a preliminary indication of the effectiveness of acupuncture in the treatment of vulvar vestibulitis but also to obtain information how well the women tolerate the treatment.

Fear of crime and psychological and physical abuse associated with ill health in a Swedish population aged 65-84 years

OBJECTIVES To assess the association between fear of crime and/or psychological and/or physical abuse in relation to self-reported physical and psychological health, using a large representative sample of elderly women and men in Sweden. STUDY DESIGN Cross-sectional national survey. METHODS Data were taken from a nationwide representative public health survey (2006). Men and women between the ages of 65 and 84 years were selected for the present analyses (4386 men and 4974 women). The response rate for this age group was 59% for men and 70% for women. RESULTS Psychological and physical abuse against elderly women and men led to higher odds ratios for negative health outcomes, independently of socio-economic status. Strong correlation was found between psychological abuse and negative health outcomes in both men and women, while the correlation was less strong for physical abuse, especially among women. The men had high odds ratios for suicidal thoughts and even for attempted suicide in connection with physical and psychological abuse and fear of crime. CONCLUSIONS The study provides representative results addressing an extensive negative health outcome panorama caused by fear of crime and exposure to abuse.

Gendered patterns of high violence exposure among Swedish youth

Objective. The WHO describes violence as a global public health problem. In contrast to domestic violence, violence against youth has been little explored. Our aims were to investigate the prevalence and gender differences in relation to emotional, physical and sexual abuse among young men and women attending youth health centers in Sweden, the current adverse effects of the abuse and the perpetrators of the abuse. Design. Cross‐sectional study. Setting. Nationally representative youth health centers in Sweden. Population and methods. In total, 2,250 women and 920 men aged 15–23 years answered a validated questionnaire about emotional, physical and sexual abuse. Results. A total of 33% (CI: 31–35) of the young women and 18% (CI: 16–21) of the young men had been exposed to emotional abuse during the past year. For physical abuse, 18% (CI: 17–20) of the women and 27% (CI: 24–30) of the men stated that they had been abused during the past year. The gender differences for sexual abuse were pronounced, with 14% (CI: 12–15) of the young women and 4.7% (CI: 3.3–6.0) of the men stating that they had been abused during the past 12 months. The young women reported more severe adverse effects from all types of abuse and were more often abused by a person close to them. Conclusions. The exposure to violence among young people is alarming and presents prominent gender differences, and should be taken into serious consideration as it is a matter of health, democracy and human rights.

Long-term health consequences of violence exposure in adolescence: a 26–year prospective study

BackgroundViolence victimization represents a serious risk factor for health related symptoms, for both men and women. The aim of this study was to evaluate the long-term effects of violence exposure in late adolescence and early adulthood on adult health, physical as well as mental, using a long-term prospective population-based study, with a follow up of 9, 19, and 26 years.MethodsThe primary data source is a longitudinal panel from one of the longest running social science surveys in the world, the Swedish Level-of-Living surveys (LNU). We analyzed three cohorts, individuals aged 15–19 in 1974 and 1981, and individuals aged 18–19 in 1991 which were followed up 2000. Structured interviews on childhood, family relationships, life-events, living conditions, health history and status, working conditions, behavioral, psychosocial, and demographic variables were repeatedly used in all cohorts.ResultsMultivariate models of violence exposures in adolescence in the 1974–91 cohorts as predictors of adult health in 2000 are reported for both men and women. Women exposed to violence had raised odds ratios for ill health, measured as heavy illness burden, and poor self rated health, after controlling for possible confounders. No such associations were found for men.ConclusionsThis study’s findings provide additional empirical support for the importance of policies and practices to identify and prevent violence exposure in adolescence and young adulthood and to supply treatments for adolescence exposed to violence and above all the young women.

Higher Risk of Violence Exposure in Men and Women With Physical or Sensory Disabilities Results From a Public Health Survey

The World Health Organization has declared that violence is a global public health problem. The prevalence of violence exposure among adults with intellectual and unspecific disabilities has been demonstrated in several studies, whereas only a few articles on people with sensory disabilities have been published. The aim of this study was to investigate the prevalence and risk for exposure to physical violence, psychological offence, or threats of violence in people with physical and/or sensory disabilities, compared with people with no such disabilities, controlling for socioeconomic data. Data from a public health survey were analyzed. A nationally representative sample of women and men aged 16 to 84 years had answered a questionnaire. In the present study, the whole sample, comprised of 25,461 women and 21,545 men, was used. Women with auditory disabilities were generally more often violence exposed than non-disabled women, whereas men with physical disabilities were more often violence exposed than non-impaired men. Some age groups among both women and men with visual disabilities had higher prevalence rates than women and men without disabilities. The adjusted odds ratios (ORs) were significantly higher among the auditory impairment group for exposure to physical (OR = 1.4, confidence interval [CI] = [1.1, 1.9]) and psychological (OR = 1.4, CI = [1.1, 1.8]) violence among women. Men with physical disabilities had raised odds ratios for physical violence (OR = 1.7, CI = [1.2, 2.4]) and psychological violence (OR = 1.4, CI = [1.0, 2.0]) compared with the non-disabled group. Both men and women with a physical or sensory disability showed higher odds of being exposed to violence than men and women without a disability. The results indicated that socioeconomic situation, smoking, and hazardous drinking strengthened the association between impairment and violence.

Violence victimisation—a watershed for young women’s mental and physical health

Purpose: The association between victimisation and adverse health in children is well established but few studies have addressed the effect of victimisation, especially multiple victimisations, in older adolescents and young adults. The aim of this study was to assess self-reported health in young women (15–22 years) victimised to one or more types of violence, compared with non-victimised. Methods: Young women visiting youth health centres in Sweden answered a questionnaire constructed from standardised instruments addressing violence victimisation (emotional, physical, sexual and family violence), socio-demographics, substance use and physical and mental health. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and attributable risk (AR) were assessed. Results: Of 1051 women (73% of eligible women), 25% were lifetime victims of one type of violence and 31% of two or more types of violence. Sexual-minority young women were more victimised than heterosexual women. Violence victimisation increased the risk for adverse health outcomes, especially evident for those multiply victimised. Victims of two or more types of violence had AOR 11.8 (CI 6.9–20.1) for post-traumatic stress symptoms, 6.3 (CI 3.9–10.2) for anxiety symptoms and 10.8 (CI 5.2–22.5) for suicide ideation. The AR of victimisation accounted for 41% of post-traumatic stress symptoms, 30% of anxiety symptoms and 27% of suicide ideation. Stratified analyses showed that lower economic resources did not influence health negatively for non-victimised, whereas it multiplicatively reinforced ill-health when combined with violence victimisation. Conclusion: Violence victimisation, and particularly multiple victimisations, was strongly associated with mental ill-health in young women, especially evident in those with low economic resources.

Symptoms after obstetric sphincter injuries have little effect on quality of life

Objective. To compare the prevalence of anal incontinence and dyspareunia in women with or without obstetric sphincter injury after standardizing the suture technique. Design. Retrospective case–control study. Setting. Regional hospital, Sweden. Population. 305 women with an obstetric sphincter injury and 297 women with spontaneous vaginal delivery. Methods. In order to standardize and improve the repairing skills of sphincter injuries, collaboration between obstetricians and colorectal surgeons was begun in 2000. Inner and external sphincters were repaired in two layers with continuous monofilament polidioxane sutures. The participating women received a questionnaire with validated questions on anal incontinence, dyspareunia and quality of life. The follow‐up time was 15 months to 8 years. Main outcome measures. Anal incontinence, dyspareunia and quality of life. Results. Of the sphincter group, 72% returned the questionnaire, as did 67% in the control group. Significantly more women in the sphincter group suffered from incontinence of flatus and loose stool compared to controls (p < 0.05). There was no significant difference of incontinence of solid stool, soiling, or fecal urgency between the groups. The quality of life questions showed no significant difference between the groups. In the sphincter group, there was significantly more superficial coital pain compared to controls (p= 0.02). Significantly more women with complete sphincter injury reported anal incontinence than women with a partial sphincter injury. Conclusion. In spite of increased rate of anal incontinence and dyspareunia after anal sphincter rupture, there was no statistically significant reduction in the womens quality of life.