Kao and colleagues [1] have recently reported the extent to which levels of estrogens and progesterone, vulvovaginal atrophy, cognitive-emotional factors, and dyadic adjustment are predictive of the intensity of postmenopausal dyspareunic pain. This study was conducted in a final sample of 182 postmenopausal women aged 45–78 years screened by a telephone interview who received a remuneration to undergo a structured interview concerning sociodemographic status as well as medical and pain histories, gynecological examination, cytological evaluation, a blood draw, and to answer a series of self-report questionnaires to measure pain experience, mood (anxiety and depression) and relationship adjustment and satisfaction. Both natural ([i]n[/i] = 153) and surgical ([i]n[/i] = 29) menopausal women were included, as well as those using different forms of hormone therapy.
Hormone levels were not found to be consistent predictors of pain severity. Maturation value and cognitive-emotional variables (e.g. catastrophization, depression, anxiety) were significant predictors of vestibular pain, which affected over 90% of the women. Relationship adjustment variables were inversely associated with pain severity within several genital locations.
The authors concluded that the traditional hypoestrogen and vulvovaginal atrophy conceptualization of postmenopausal dyspareunia is an insufficient explanatory model, and that pain is also influenced by cognitive, affective, and dyadic factors.
Author(s)
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Rossella Nappi
Gynecological Endocrinology & Menopause Unit, University of Pavia, Italy
Citations
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Kao A, Binik YM, Amsel R, et al. Biopsychosocial predictors of postmenopausal dyspareunia: the role of steroid hormones, vulvovaginal atrophy, cognitive-emotional factors, and dyadic adjustment. J Sex Med 2012;9:2066-76.
http://www.ncbi.nlm.nih.gov/pubmed/22621792 -
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Nappi RE, Albani F, Santamaria V, et al. Hormonal and psycho-relational aspects of sexual function during menopausal transition and at early menopause. Maturitas 2010;67:78-83.
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http://www.ncbi.nlm.nih.gov/pubmed/16422792