Challenges in obstetrics and gynaecology psychological perspective


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Women's sexual health challenges a psychological perspective...

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  • Psychological point of view…..I hope you will gain new understanding…
  • Where there is a physical change there will be a psychological changes as well…still we have negative attitude towards sex…that is a major obstacle for seeking treatment…
  • Each transition there is a change, and psychological challenge…also going to present… the important issue related to this topic sexual violence and its psychological consequences…
  • Studies has shown that early menarche brings many negative consequences…we should educate the parents and children about it…
  • Negative consequences…actually the list is very long…but these are all examples…
  • The menarche occur.. For that change….involved…
  • Reason for negative reaction on the part of girls…from their point of view
  • Ideal or late matures shared some common characteristics such as
  • In general woman's menstrual experiences are different…
  • Their experience may be depends on….
  • Second major transition to woman
  • Psychological change and challenges influence their health which is also affect their baby…the consequences may be permanent mark on the child’s development…
  • The consequences may be lifetime…makes subsequent transition difficult…
  • It is a biggest problem, child's future adjustment depends on mothers experience during pregnancy..
  • Mothers attitude towards pregnancy….many factors involved…
  • Usual…
  • Have to attend..don’t ignore…
  • Assess discomfort…
  • Mothers role
  • Husbands role
  • Health providers role
  • Tend to continue in later transition…affects children’s development… emotional and psychological problems of the child…
  • Know the warning signs…
  • It is normal if it is short lived…
  • If symptom persist more than 2 weeks don’t ignore…..
  • Period of improvement is also danger….traumatic aftermath…
  • Grieving process…..slow have to grieve…its normal….
  • On next visit….be aware…of previous history…..
  • Couple counseling is essential…
  • Counseling is essential…
  • Because of hormonal fluctuation and other stressful life event….
  • Difficult period for women….
  • Anger toward god…
  • Thank you for your attentive listening…and thanks for this opportunity provided for me….
  • Challenges in obstetrics and gynaecology psychological perspective

    1. 1. Challenges in Obstetrics and Gynaecology - Psychological Perspective By Dr. K. Kumar, Psychologist Center for Improving Relationship and Personal Effectiveness Women’s sexual health
    2. 2. Changing body and changing the self Mind body relationships •Negative attitude towards sex and sexual organs. •Freud's psychoanalysis theory turning point to new perspective. •Role of repressed sexual desire on physical and psychological health. •New social studies of sexuality have challenged the idea of sex as natural. •Aim is to provide improved care for women patients.
    3. 3. Major Transitions Each transition there is a change, and psychological challenge • Menstruation • Pregnancy • Menopause And also covered.. •Sexual violence against women
    4. 4. Menarche • Transition from child to adult… • first menstrual cycle…
    5. 5. Trend in Puberty Century Age 19 the century 15 - 17 20 the century 13 - 16 21st century 11 – 15 Current study 10 - 14 Early menarche (between 10 & 12 years of age), Ideal menarche (between 12 to14 years) and Late menarche (between 14 to16 years of age). the age at which menarche occurred gradually dropped
    6. 6. Early Menarche Brings many negative consequences… • Less prepared for changes • Have more negative feelings • Poorer body image • Low self-esteem • Greater physical symptoms • More eating related problems • Experience more emotional conflict • Increased incidence of childhood obesity • Risky sexual behaviour and early pregnancy
    7. 7. Adjustment depends on • Age at time • Amount of preparation • Cultural factors • Role model of mother, peer, older sister • Psychological marker
    8. 8. Consequences that girls don’t like • weight gain • pimples • oily skin • body odor • temper and anxiety • confused about sex
    9. 9. Late menarche Ideal leads to better adjustments They shared some common characteristics… •Larger family size •Warmer, supportive and low stress family •Low fat level, dancer, athlete or regular exercise •Closer and positive relationship with father •Have a older siblings •Open communication within the family including fathers presents •Improved health & life style
    10. 10. Premenstrual syndrome (PMS) More than 200 different symptoms have been associated with PMS, but the three most prominent symptoms are – irritability, – tension, – dysphoria (unhappiness). Common emotional symptoms – stress, – anxiety, – insomnia, – headache, – fatigue, – mood swings, – increased emotional sensitivity. Physical symptoms – bloating, – abdominal cramps, – constipation, – joint or muscle pain.
    11. 11. Premenstrual syndrome (PMS) Predictors •Attitude •Expectation •Experience •Role model
    12. 12. Pregnancy • Second major transition to woman
    13. 13. Pregnancy Pregnancy is a time of profound biological, psychological, and interpersonal change in the lives of many women. Adjustment depends on • age, • health, • socioeconomic resources, • work or occupational status, • Availability of social support, • birth history, and • whether the pregnancy is planned or desired. • Personality factors • Family dynamics • Other stress factors
    14. 14. Teen pregnancy • Adolescents appear to have increased risks for certain potentially serious conditions during pregnancy, including •pregnancy-induced hypertension, •anemia, •preterm delivery, •Abortion •having low-birth-weight infants.
    15. 15. Maternal Stress High levels of life-change stress and maternal anxiety increase a woman’s risk of reporting at least one complication during pregnancy. Effect of stress such as • decreased uterine activity in labor, • a longer duration of labor, and • lower newborn Apgar scores • Childs future adjustment
    16. 16. Acceptance The results indicate that the women is less prepared for childbirth and motherhood when acceptance of the pregnancy is low, and she is more likely to have conflicts and fears concerning labor, and to have a longer duration of labor.
    17. 17. Evaluating Acceptance Characteristics such as: 1. Consciously planned and wanted the pregnancy 2. Happy versus depressed during the pregnancy 3. Degree of discomfort during the pregnancy 4. Accepted or rejected changes in her body, 5. Was ambivalent and experienced conflict
    18. 18. Effects on pregnancy Discomfort such as morning sickness and some vomiting through the 5th month; these episodes occasionally triggered short-lived negative feelings, but she still enjoyed being pregnant.
    19. 19. Effects on pregnancy Several women were depressed above and beyond the expected mood swings during their pregnancies; when depression occurred in these cases, it was not short-lived. They may think or feel •anxiety about motherhood, •the trials of labor and delivery, •depression concerning bodily changes, •possible infant anomalies, •isolation in their new role, and •career interruption. •mothering ability, •childrearing responsibilities •Financial security
    20. 20. Effects on pregnancy The degree of discomfort experienced during pregnancy can be another indicator of a woman’s acceptance of the pregnancy. It is important to evaluate the following factors: •Intensity of the discomfort, •Interferes with normal activity, •Managed and tolerated.
    21. 21. Sleep Disorders It is normal for sleep patterns to be altered during pregnancy. The most common pattern consists of longer sleep and more naps in the first trimester, normal sleep in the second trimester, and numerous nighttime awakenings in the third trimester. Frequent awakenings toward the end of pregnancy are partly caused by •increased urinary frequency, •pain, •fetal movements, and •difficulty finding a •comfortable position
    22. 22. Role of social support The significance of the pregnant woman’s relationship with her mother has been emphasized in the literature as an important factor in adaptation to pregnancy and Motherhood. A positive relationship with the mother also predicted successful adaptation to pregnancy. Predicting factors are, • availability • reactions to the pregnancy • willingness Coping skills and communication are important factors in interpersonal relationships and the adaptation to pregnancy.
    23. 23. Role of social support What she needs from others (a) Empathy (understanding, tolerance, supportiveness) (b) Cooperativeness (c) Availability (sharing and communication) (d)Trustworthiness (reliability) Predictor of marital bond (a) Closeness (b)Conflicts (c)The husband’s adjustment to his new role, specifically his identification of a fatherhood role.
    24. 24. Role of social support Preparation for Labor (1) Doubts and fears (2) Level of confidence (3) trust the medical-nursing staff
    25. 25. Depression Mild to moderate symptoms of depression are relatively common during pregnancy, in a woman’s life it is most vulnerable period. Depression can impair the • mother’s nutritional intake and prenatal care, • Using potentially harmful addictive substances, drugs • Suicide attempts. Postnatal depression is an affective disorder lasting more than 2 weeks, • Depression reduces a woman’s ability to function effectively at home or work • Impair relationships with family and friends. • Behavioral and emotional problems in children.
    26. 26. Depression • Diagnosing depression can be more difficult during pregnancy because insomnia, decreased energy, decreased concentration and appetite changes are common to both pregnancy and depression. • Untreated antenatal depression significantly increases the likelihood of postpartum depression.
    27. 27. PTSD 1) women with histories of sexual abuse whose traumatic memories are reactivated by the experience of pregnancy and childbirth 2) women who develop posttraumatic stress disorder as a result of traumatic childbirth experiences 3) women who develop both posttraumatic stress disorder and pregnancy because of a rape, abuse and sexual violence. Even with no preexisting trauma history, childbirth itself is a sufficiently traumatic experience for some women that it produces symptoms of posttraumatic stress disorder.
    28. 28. Maternity blues Maternity blues typically begin 3–4 days after delivery and peak on days 4–5. The most frequently reported symptom is weeping. In the first few hours after delivery, crying may be accompanied by happy feelings. women described themselves as “low spirited” they did not consider themselves to be depressed.
    29. 29. Maternity blues Researchers have also described • irritability, • lack of affection for the baby, • hostility toward the husband, • sleep disturbance, • headaches, • feelings of unreality, • depersonalization, • exhaustion, and • restlessness Dramatic changes in hormone and electrolyte balance and fluid volume level occur during labor and the postpartum period.
    30. 30. Perinatal loss Recent longitudinal, prospective studies indicate that at 6 months after pregnancy loss, women report significantly greater distress, such as •anxiety, •physical complaints, and •especially depression
    31. 31. Effects of Perinatal loss Shock Confusion Memory lapse anxiety, restlessness, irritability, somatic distress. sadness, Preoccupation loneliness, guilt, anger, Hopelessness Over the next year, the parents gradually become reconciled to this permanent loss; everyday activities are resumed, vigor in other relationships and the world in general is renewed, and capacity to feel pleasure is restored.
    32. 32. Perinatal loss aftermath • Flashbacks of the hospital experience, • intense anxiety on returning to the hospital, These feelings may take the form of tired, bored, numbness and angry behavior or of somatic complaints.
    33. 33. Infertility The stigma associated with infertility and the ensuing feelings of • Shame • Failure • Worthlessness A series of feelings experienced by many couples, – Denial – Anger – Isolation – Guilt – Grief Some couples may fail to resolve the problem and continue to seek new treatments, even after every potentially beneficial method has been tried.
    34. 34. Infertility When infertility affects a marriage, a key area that often deteriorates is sexual functioning and enjoyment. • Negative effects on the sex life • lessened sexual desire Most investigators have found that women tend to be more distressed by infertility than are their male partners.
    35. 35. Menopause Menopause is both a natural and a universal event in the human female life cycle. Psychological symptoms have been associated with menopause are, • Depression • Irritability • Mood swing • Accelerated weight gain • Fatigue • Elevated stress
    36. 36. Menopause Certain life stresses may be temporally linked with menopause. •Major illness or disability in her spouse, •Death of her spouse, •Employment uncertainty for either partner, •The need to care for one’s own elderly parent(s), loss of support from important friends or family through illness, death, or geographic relocation. •Adolescent children •Empty nest syndrome •10%–85% decrease in sexual interest.
    37. 37. Sex related Diseases Psychological distress • Anger • Anxiety and fears • Depression • Helplessness • Guilt • Future childbearing and fertility, Similar feelings experienced patients diagnosed with life-threatening illnesses, such as cancer.
    38. 38. Consequences • Family relationships and reproduction • Impaired social functioning • Sexual functioning • Work • Existential issues • Suicidal feelings
    39. 39. What is our role if.. Patients present personal problems like sexual difficulties, partner and family conflicts, stressful life events, Sexual violence, abuse, How can the health professionals respond to these demands and problems?
    40. 40. Violence against women Sexual violence is a serious public health and human rights problem with both short- and long-term consequences on women's – physical, – mental, – Sexual – Reproductive health. Greatest risk of sexual and physical violation will come from someone a woman knows and trusts a parent, a caretaker, a person she is dating, or an intimate partner and teachers.
    41. 41. Forms and contexts of sexual violence • Rape • unwanted sexual advances • sexual harassment • Demanding sex in return for favours • Sexual abuse • Forced marriage • Including the marriage of children • Denial of the right to use contraception • Forced abortion
    42. 42. Symptoms Often the abusers prevent their partners from receiving medical care. Women trapped in abusive relationships may be immobilized by – Depression – Panic attacks – Acute stress disorder, or PTSD Don’t ignore the following symptoms – Sleep and appetite disturbances, – Fatigue, dizziness, – Weight change, – Physical symptoms associated with depression, – Anxiety, or posttraumatic stress. – Suicidal ideation or attempt – History of mental illness or disability
    43. 43. Educate them Anyone seen in a clinical setting should be asked specifically about past and current abuse. It is important to let women know that • Abuse experiences are common. • You are willing to listen. • You believe her and are concerned. • The abuse is not her fault and no one deserves to be treated that way. • Resources are available to help her if she is currently in danger. • She will not be judged or stigmatized as a result of what she has said to you. • All information will be kept confidential
    44. 44. Patient-centered communication Patient-centered communication: In patient-centered communication, the patient gets space and time to tell her story (narrative). The questioning is much more of a Socratic dialogue with reference to the patient’s expression and feedback. There is respect for and response to emotions. • Waiting: Giving the patient time to think and express herself. This means that the physician has to learn “not to talk” but use silence and pause as a means of encouragement. The basic elements of patient-centered communication are as follows ; •Active listening: The health provider learns to listen in a way that encourages the patient to tell her story by • Echoing: Repeating a specific word or expression of the patient to signal attentive listening and that the physician follows the patient’s story. • Mirroring: Reflecting body language or a whole verbal sequence in the words of the patient.
    45. 45. Summary • Each transition involves changes and challenges, most of the women successfully cope up with the demands. • Physical, Psychological distress or temporary, if lasting for more than 2 weeks other factors such as stressful life event or abuse other factors has to be checked and provide extended help. • Not only physical but also psychological help is essential. • Sometime health provider is the only source for her, learn to do more than what you believe, you can
    46. 46. Recommended Readings Books •Psychological Aspects of Women's Health Care; The Interface Between Psychiatry and Obstetrics and Gynecology, Edited by Nada L. Stotland, &Donna E. Stewart. American psychiatry press. • Psychological aspects of women's health care: the interface between psychiatry and obstetrics and gynecology., by Jayne Cockburn & Michael E Pawson. Springer. Web resources Psychosocial Aspects of Selected Issues in Women’s Reproductive Health: Current Status and Future Directions ter2/healthpsychology/integration/reproductive_health.pdf Early life circumstances and their impact on menarche and menopause
    47. 47. About CIRPE CIRPE - Center for Improving Relationship and Personal Effectiveness is a NGO which provide psychotherapy and counselling services for individuals, couples or groups experiencing emotional difficulties. Services: Creating awareness Counseling Training Research
    48. 48. Thank you Reach me @