Victoria M. Grace

Chronic pelvic pain in New Zealand: prevalence, pain severity, diagnoses and use of the health services

Chronic pelvic pain (CPP) in women is often debilitating and isolating. Problems with diagnosis continue to make CPP one of the most perplexing conditions in gynaecology, and one of the most difficult to treat.

Chronic Pelvic Pain in Women in New Zealand: Comparative Well-Being, Comorbidity, and Impact on Work and Other Activities

This article reports the findings of a population-based study in New Zealand that investigated comparative well-being, comorbidity, and the impact of chronic pelvic pain (CPP) on activities. Chronic pelvic pain was defined as lower abdominal pain that is associated with neither the menstrual cycle nor sexual activity. A postal questionnaire was administered to a random sample resulting in a study group of 1,160. The negative impact of CPP on womens general well-being is significant. They were more likely than women without CPP to have other long-standing illnesses, other unspecified conditions involving pain or fatigue, and sleep patterns were more seriously disturbed. Pain restricted their activities. Comparisons with the limited data available from other studies are made.

Problems of communication, diagnosis, and treatment experienced by women using the New Zealand health services for chronic pelvic pain: A quantitative analysis

Women who have used the New Zealand medical services for chronic pelvic pain report problems with diagnosis, communication with the doctor, lack of information, and inappropriate treatment. There is a sense of increasing loss of control as repeated visits to the doctor do not produce an understanding of the pain. I conducted a survey to investigate the extent to which these problems are affecting the total group of women using the health services for pelvic pain in New Zealand and to ascertain if any particular group of women is more likely to be experiencing such problems. The pattern of responses showed that the problematic facets of the medical encounter formed an interactive pattern: Women who had one type of problem tended to have others. Between one fourth and one third of the sample experienced these problems. Problems surrounding communication with the doctor, diagnosis, medication, and surgery are discussed. Women of lower socioeconomic status were found to be more likely to experience these problems.

Mind/Body Dualism in Medicine: The Case of Chronic Pelvic Pain without Organic Pathology A Critical Review of the Literature

Chronic pelvic pain in the absence of organic pathology identifiable in medical terms is considered one of the most perplexing conditions that gynecologists confront. A critical analysis of the medical, psychiatric, and psychological literature on chronic pelvic pain without organic pathology reveals that the dichotomous construct of mind and body underpinning medical research and understanding is a barrier to the successful diagnosis and treatment of this condition, and indeed to the productive engagement of the health professional with the patient. The strict duality of the conditions etiology being understood in either physiological or psychogenic terms has been questioned at times over the last 40 years, but only recently has an “integrative model” been proposed. However, it is argued here that although the development of a multidisciplinary approach is important, only a radical deconstruction of the medical paradigm will truly address the problem and enable a real change in practice.

Factors associated with parents’ decisions to tell their adult offspring about the offspring's donor conception

BACKGROUND Tensions and anxieties surround secrecy within families in the context of gamete donation and family building. This paper presents the views of parents who had kept their use of donor insemination a secret from their offspring. A sub-set of these parents said that they wished to tell their now-adult offspring, and discussed the questions and issues this secrecy raised to them. METHODS In-depth interviews were undertaken with heterosexual parents (of 44 families) who had given birth to children conceived via donor insemination between 1983 and 1987. These interviews comprised a follow-up study, with the first interviews being undertaken when the children were aged up to seven. In this paper, qualitative data relating to a sub-set of 12 parents (from seven families) who now wished to tell their offspring are presented. RESULTS The parents describe the pressures that the secret-keeping had created for them as well as the impact of those pressures. They report on the reasons they now want to share the family building history and the associated fears and anxieties about doing so. The parents all say that they wish they had told their offspring much earlier. In five of the seven families, parents describe how the offspring had raised questions concerning a perceived genetic disconnection between them and their parents. CONCLUSIONS Keeping the use of donor insemination a secret from offspring created considerable pressure for these parents. Despite the secrecy, offspring can become aware of the genetic disconnection.

The Discursive Condition of Viagra

This research investigates the socio-cultural implications of Viagra as a biomedical solution to a medically defined problem. This New Zealand-based research involved interviews with 33 men, to examine how they discursively constituted meanings around masculinity, erections, and the role of Viagra. It is argued that the relationship between discourses of mechanistic functionality of erections, the primacy of the male as performer, and the partners pleasure as measure of success, create the conditions of possibility for a pharmaceutical solution directed at the male. The problem is configured as the uncertainty accompanying the instability evident in the relationship between these discourses. The mens discourse on the solution, Viagra, confirms this analysis.

‘Women get this’: gendered meanings of chronic pelvic pain

Chronic pelvic pain in women is a key site through which explorations of the meanings of female gender and pain might further insights into the broader question of the embodied experience of women in relation to pain. A biocultural approach is used to present an analysis of interviews with 40 New Zealand women in which they reflect on ‘how come’ they have chronic pelvic pain. Women consistently employ a mechanistic rendition of medical discourse and understandings in their constructions of ‘how come’ they have pain, accompanied by a reiteration of ‘not knowing’ and a normalizing of their pelvic pain. We explore how this normalizing works within the narratives to establish womens pelvic pain as intrinsically gendered. Etiological meanings that are constructed in medical terms and yet are unable to be interpreted within a dualist frame of normality and pathology, we argue, permeate and shape gendered experience of chronic pain conditions.

Medicalization and women's knowledge: the construction of understandings of infant feeding experiences in post-WW II New Zealand.

For most of the twentieth century infant feeding knowledge has been constructed by medical scientists and health professionals. However, for a short time around the 1970s, New Zealand women (re)claimed the power to author their own knowledge based upon experience. This coincided with a dramatic return to breastfeeding on a national scale. Using New Zealand womens narratives of their infant feeding experiences over the past 50 years, this article brings to the foreground the importance of womens subjective construction of knowledge, their positioning within it, and the suppression of rudimentary discourses when that power is removed or relinquished in the process of remedicalization.For most of the twentieth century infant feeding knowledge has been constructed by medical scientists and health professionals. However, for a short time around the 1970s, New Zealand women (re)claimed the power to author their own knowledge based upon experience. This coincided with a dramatic return to breastfeeding on a national scale. Using New Zealand womens narratives of their infant feeding experiences over the past 50 years, this article brings to the foreground the importance of womens subjective construction of knowledge, their positioning within it, and the suppression of rudimentary discourses when that power is removed or relinquished in the process of remedicalization.

“How to Say It”: Women's Descriptions of Pelvic Pain

ABSTRACT The present research aimed to compare womens descriptions of chronic pelvic pain, when talking about their pain in narrative mode, with the descriptors used in a common pain assessment tool, the McGill Pain Questionnaire (MPQ). Our intention was to see what we could learn about the relationship between words used in these kinds of assessment tools and meanings of pain experience evident in narratives. This New Zealand-based qualitative study used open-ended interviewing to generate womens experiential narratives of pelvic pain. Forty women of European descent were recruited via a randomly selected national prevalence survey on chronic pelvic pain: 33 had chronic pelvic pain that was not associated with dysmenorrhoea or dyspareunia (CPP); 38 had dysmenorrhoea; 29 had dyspareunia; 24 had all three. The study group was aged between 22 and 51 years. The differences that emerged between the words used by women and those used in the MPQ vocabulary are described. Two main findings emerged: a difference in the relative emphasis placed on sensory descriptors and the absence in womens narratives of affective words used in the MPQ. However, a predominance of an affective dimension of pain was evident in womens narratives, which is described. Given the narrative specificity of the experience of pelvic pain, we conclude that assessment tools using the words and phrases evident in narratives of pain would potentially be more useful, and that such a pain assessment tool would ideally be used in association with narrative techniques incorporated into the clinicians interview with women who present with chronic pelvic pain.

II. The Desiring, Gendered Speakingbeing: Going a Bit Further with Ussher on Women and Depression

Ussher’s (2010) stated concern is to present a theoretical framework that will enable an understanding of the causes of, or reasons for, the reported higher rates of depression among women. She wants to present a theoretical framework that is critical of both the medical naturalist epistemology and its social constructionist rejoinder. Her discussion thus moves through a series of stages. She presents the critique of a medical approach to depression that is based in biology through outlining feminist arguments that it medicalizes women’s misery; she then moves to a social constructionist alternative that insists on shifting understandings of women’s depression to the sociocultural sphere that foregrounds the political, the socioeconomic and discursive aspects contributing to this experience. Through an in-depth, comprehensive discussion of the literature(s) contributing to this debate, Ussher highlights how the concern with a social constructionist alternative can, in its idealist tendency, lose a focus on the very real nature of women’s individual suffering, and importantly also can tend to negate the materiality of this embodied experience. Her suggested framework for understanding how and why women feature so prominently in rates of reported depression is a critical realist approach that incorporates the possibility of analysing the bodily-material, the discursive, the intrapsychic, and the sociocultural contributors to depression so that none are occluded. While not taking issue with this theoretical agenda and therefore recognizing the centrality of each of these ‘levels’ of analysis (somatic, discursive, psychic, sociocultural), I want to suggest that Lacanian psychoanalysis has something important to offer to this discussion. Ussher refers to psychoanalysis at only two points: one through a reference to its importation into American psychiatry in the 1940s to 1960s with its rather oppressive deployment (an unfortunate version of psychoanalysis that Lacan referred to as ‘ego psychology’), and the second to ‘psychoanalytic theories’ more generally, yet here Ussher dismisses their relevance to the project because they have not been used ‘to form the basis for empirical research evaluating causes for women’s higher rates of reported depression’. Given that a critical realist approach is being proposed, presumably