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Obstetrics & Gynecology 2007;110:633-642
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Effect of Noncancerous Pelvic Problems on Health-Related Quality of Life and Sexual Functioning

Miriam Kuppermann, PhD, MPH1,2,4, Lee A. Learman, MD, PhD1,2, Michael Schembri, BS1, Steven Gregorich, PhD3,4, Alison Jacoby, MD1, Rebecca A. Jackson, MD1,2, Elena Gates, MD1, Christina Wassel-Fyr, MS3, James Lewis, MD5 and A. Eugene Washington, MD, MSc1,2,4

From the Departments of 1Obstetrics, Gynecology & Reproductive Sciences, 2Epidemiology & Biostatistics, and 3Medicine, and the 4Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California; and the 5Department of Obstetrics and Gynecology, Kaiser Permanente, San Francisco, California.

OBJECTIVE: To assess the effect of abnormal uterine bleeding and pelvic pain and pressure on health-related quality of life and sexual functioning and assess treatment satisfaction.

METHODS: This is a cross-sectional study of 1,493 sociodemographically diverse women who were seeking care for noncancerous pelvic problems and who had not undergone hysterectomy. Participants were asked about symptoms, attitudes, health-related quality of life, sexual functioning, and treatment satisfaction. Preference for current health was measured using the time tradeoff metric, which asked respondents to estimate the number of years of life they would be willing to trade off to not have a uterine condition. Multivariable logistic regression was used to identify determinants of treatment satisfaction.

RESULTS: Most (82.7%) participants reported a complete lack of or only partial symptom resolution, and 42.3% reported that their pelvic problems interfered with their ability to have and enjoy sex. Mean Short Form-12 Physical (43–49) and Mental (41–44) Component Summary scores were substantially lower than population norms for women aged 40–49 years. Mean current health time tradeoff scores ranged from 0.78 to 0.88. Satisfaction with Western medicines ranged from 31.3% (progestin intrauterine device) to 58.2% (opiates) and with uterine-preserving surgery from 20.0% (dilation and curettage) to 51.0% (myomectomy); 27.7 % of the women who used acupuncture were satisfied. Participants with lower educational attainment, greater symptom resolution, and less interference of pelvic problems with sex were more likely to be satisfied.

CONCLUSION: Noncancerous pelvic problems are associated with serious decrements in health-related quality of life and sexual functioning and low rates of treatment satisfaction.

LEVEL OF EVIDENCE: II






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