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WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity.
BMC Public Health. 2006 Jul 6; 6:177.Health care planning for chronic pelvic pain (CPP), an important cause of morbidity amongst women is hampered due to lack of clear collated summaries of its basic epidemiological data. We systematically reviewed worldwide literature on the prevalence of different types of CPP to assess the geographical distribution of data, and to explore sources of variation in its estimates. We identified data available from Medline (1966 to 2004), Embase (1980 to 2004), PsycINFO (1887 to 2003), LILACS (1982 to 2004), Science Citation index, CINAHL (January 1980 to 2004) and hand searching of reference lists. Two reviewers extracted data independently, using a piloted form, on participants' characteristics, study quality and rates of CPP. We considered a study to be of high quality (valid) if had at least three of the following features: prospective design, validated measurement tool, adequate sampling method, sample size estimation and response rate > 80%. We performed both univariate and multivariate meta-regression analysis to explore heterogeneity of results across studies. There were 178 studies (459975 participants) in 148 articles. Of these, 106 studies were (124259 participants) on dysmenorrhoea, 54 (35973 participants) on dyspareunia and 18 (301756 participants) on noncyclical pain. There were only 19/95 (20%) less developed and 1/45 (2.2%) least developed countries with relevant data in contrast to 22/43 (51.2%) developed countries. Metaregression analysis showed that rates of pain varied according to study quality features. There were 40 (22.5%) high quality studies with representative samples. Amongst them, the rate of dysmenorrhoea was 16.8 to 81%, that of dyspareunia was 8 to 21.8%, and that for noncyclical pain was 2.1 to 24%. There were few valid population based estimates of disease burden due to CPP from less developed countries. The variation in rates of CPP worldwide was due to variable study quality. Where valid data were available, a high disease burden of all types of pelvic pain was found. (author's)
September 1975. 41 p.Information gathered from knowledgeable sources (e.g., obstetricians, family doctors, pharmacists, nurses, family planning workers, and informal social network representatives) indicated the important position that menstrual bleeding, and the social implication related to it, holds in the life of Egyptian women. Menstrual bleeding is a sign of well-being, youth, fertility, and femininity. The majority of knowledgeable sources agreed that a normal cycle length among Eyptian women ranged from 21-32 days, whereas the normal bleeding interval ranged from 3-5 days. Abnormality, however, is a function of personal experience, i.e., a cycle is abnormal when it deviates from the woman's normal pattern. Egyptian women perceive menstrual blood as bad blood that they must lose every month, the retention is thought to result in bodily poisoning. Egyptian women are aware of specific color, smell, and texture of vaginal bleeding, and any change in quality or quantity is alarming. Illiterate women predict and recall their bleeding episodes by using a lunar calender which indicates national or religious ceremonies. Menarch is reported to be an occasion of joy signifying womanhood, whereas menopause is resented and dreaded, associated with drying or shrinking of the uterus. Menstruation is induced by various folk means, because it is believed that retention of blood causes cramping and that blood flow will alleviate that pain. The cleansing ritual after each cycle has both physical and religious importance.