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Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1812
Mainini G. 1, Torella M. 1, di Grazia F. 2, Lizza R. 2, Scaffa C. 1, De Franciscis P. 1
1 Dipartimento di Scienze Ginecologiche, Ostetriche e della Riproduzione, Seconda Università degli Studi di Napoli, Napoli;
2 Divisione di Ginecologia ed Ostetricia, Ospedale Civile di Aversa, Aversa (CE)
Aim. Psychogenic secondary amenorrhea is defined as functional hypothalamic amenorrhea or stress-related amenorrhea when the condition is viewed only in relation to altered neuroendocrine function or to its etiopathogenesis. Various studies have placed the condition on the border between psychiatry and gynecology. Research using semistructured interviews (DSM IV) combined with Paykel’s stress events interview has shown that in mood disorders, especially dysthymia, LH peaks are decreased. Considering the importance sexuality holds and the dynamics of the development of sexual identity in subjects with this condition, we interviewed subjects with psychogenic secondary amenorrhea to examine these parameters.
Methods. In all, 36 subjects with secondary amenorrhea admitted to our unit for neuroendocrine and diagnostic studies on a day-hospital basis were invited to take part in the sexuological interviews.
Results. Of the 36 subjects invited, 21 (58.3%) consented to being interviewed, of which 16 (76.2%) presented with hypogondotropinemic hypothalamic amenorrhea (HH) and 5 (23.8%) with polycystic ovarian syndrome (PCOS). The mean age of the study group was 22.4±4.5 years; the mean duration of amenorrhea was 26.2±20.1 months; the mean Body-Mass Index was 22.4±4.5%; values are expressed as the mean±standard deviation. The 16 subjects with HH had experienced a weight loss of 7.8±8.5% in the months prior to the onset of secondary amenorrhea, and eating disorders within the bulimia-anorexia spectrum were still present at the time of the interview. Regular physical exercise (4-6 times weekly) was practiced by 75% of subjects with HH. A sexual symptom was referred by 42.8% (9 out of 21) subjects, of which 88.8% (8 out of 9) were patients with neuroendocrinological HH. The most frequent symptom in the HH subjects was vaginismus, which arose 3-8 months after menses had ceased.
Conclusion. Our preliminary data depict a portrait of a young woman whose sexual identity has stopped at the preadolescent phase of development. Vaginismus (50% of HH subjects in our sample) may be viewed as the sexual equivalent to anorexia, where the denial of pleasure is present in both cases. In examining the fundamental aspects of female sexual identity (maternity, attractiveness, family role, social role, eroticism), the sexual symptom may help to distinguish between two categories of HH: 1) HH without vaginismus as a denial of maternal and family roles; 2) HH with vaginismus as a denial of maternity, sexual attractiveness, family role and eroticism. In the former, the search for pleasure in eroticism, relationships and attractiveness is maintained. The cessation of menses may merely lead to a denial of the wish to become pregnant and, ultimately, a refusal to accept a woman’s role as mother within the context of a family. Our preliminary data underline the need for thorough diagnostic work-up in patients with hypothalamic secondary amenorrhea in order to plan treatment that is targeted to the whole person.