title: The unspoken disease: symptom experience in women with vulval neoplasia and surgical treatment: a qualitative study.
abstract: Women with vulval neoplasia often experience severe post-surgical complications. This study focuses on symptom experience of women during the first 6 months following surgical treatment for vulval neoplasia considering their socio-cultural context. In this qualitative study using a critical hermeneutic approach, narrative interviews were conducted. A purposeful sample of 20 patients was recruited from one Swiss and two German university hospitals. Content analysis was employed to analyse the transcribed interviews considering women's experiences and social perceptions. Narratives showed eight interrelated themes: delayed diagnosis, disclosed disease, disturbed self-image, changed vulva care, experienced wound-related symptoms, evoked emotions, affected interpersonal interactions and feared illness progression. The women experienced a general lack of information pertaining to above themes and all described strategies used to handle their situation, which affected their distress. The communication, assessment and treatment of symptoms were hampered by the society's and the health system's tendency to overlook these symptoms and leave them in the realm of the unspeakable. Health professionals need new strategies to support these women to recognise, assess and evaluate the seriousness of symptoms, and to communicate their symptom experience so that timely medical treatment is sought. This support may minimise potentially preventable complications and symptom-related distress.
authors.affiliation: Department of Obstetrics and Gynaecology, Inselspital, University Hospital Berne, Berne, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Senn
authors.forename: D
authors.initials: D
authors.lastname: Gafner
authors.forename: M B
authors.initials: MB
authors.lastname: Happ
authors.forename: M
authors.initials: M
authors.lastname: Eicher
authors.forename: M D
authors.initials: MD
authors.lastname: Mueller
authors.forename: S
authors.initials: S
authors.lastname: Engberg
authors.forename: R
authors.initials: R
authors.lastname: Spirig
mesh_terms: D000328:Adult; D000368:Aged; D057210:Delayed Diagnosis / Q000523:psychology; D005239:Fear; D005260:Female; D005858:Germany; D006801:Humans; D007398:Interpersonal Relations; D008875:Middle Aged; D017060:Patient Satisfaction; D036301:Qualitative Research; D012648:Self Care; D012649:Self Concept; D013557:Switzerland; D014846:Vulvar Neoplasms / Q000523:psychology* / Q000601:surgery*