Study design, materials and methods
Original transversal study with a quantitative approach. The interviews were conducted between September and December 2017, in 41 women who reported having Chronic Pelvic Pain (CPP) attending the urology and gynecology outpatient clinics. It was used a structured instrument for this purpose and the average duration of interviews was 30 minutes.
The instrument used contained questions related to the presence or absence of conditions that might be associated with the DPC, including difficulty in the sphincter training phase, history of nocturnal enuresis or other lower urinary tract symptoms in childhood, like reprimand in childhood related with symptoms of lower urinary tract and traumatic sexual initiation.
In addition to the variables cited, it was possible to raise a history of depression or anxiety (self-reported) and use of medication for these conditions.
Four participants chose not to answer the questions, so they were not computed in the data.
Results
The results showed that 30 (81%) of the women did not remember how the unfurl was, 4 (10.80%) was easy and 3 (8.10%) was difficult. Twelve (32.45%) urinated in bed when they were child. Thirteen (35.14%) parents fought or physically assaulted for bed-wetting.
The age of sexual initiation had a minimum of 11 years and old and the maximum at 24 years old. The mean was 16.19 years. The median was 16 years. The standard deviation was 2.62 years.
Twelve women (32.45%) had difficulty initiating sexual activity. Pain was related in 3 (8.10%), sexual violence in 6 (16.23%), low sexual desire for 1 (2.72%), fear 2 (5.40%) and 25 (67.55%) did not want to report.
For the treatment of pain, 23 (62.16%) used a drug therapy, 1 (2.72%) used radiofrequency, 2 (5.40%) used medication plus physiotherapy, 3 (8.10%) used medication plus surgery. Surgery alone was used in 2 (5.40%), physiotherapy plus surgery for 1 (2.72%), medication plus conservative treatment for 3 (8.10%), no treatment for 1 (2.72%) and surgery medication and physiotherapy for 1 (2.72%).
Anxiety was reported by 22 patients (59.45%) and depression in 13 (35.14%). 11 (29.72%) did not report these diagnoses/symptoms.
Interpretation of results
The data reveal a trauma in the conditions experienced by the patients. Among them, sexual abuse and violence as punishment for bed-wetting.
Concluding message
It is clear that a person-centered approach has many advantages in identifying the path to treatment. The questions of the questionnaire applied in the patients came up in informal conversations with the participants of a larger study. In that study, patients reported a lot of suffering with the pain, but have seen their health professionals focusing only in the location and biological aspects of pain, not giving much attention to how their patients really feel about their pain and the possible traumas behind it.
Attending people centering the focus only on the biological aspects of the disease has lost ground to a more people-centered care model. Studies have shown that more than 75% of people seek for care with the people-centered model. Thus, a link is established between the professional and the person, which reflects in the patient's decision and adherence to the treatment (1).
A holistic approach captivates the patient and allows us a more assertive therapeutic pathway and increases adherence to the treatment of those who are under our care.