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Sample records for dyspareunia

  1. Vaginal plethysmography in women with dyspareunia

    NARCIS (Netherlands)

    Wouda, JC; Hartman, PM; Bakker, RM; Bakker, JO; van de Wiel, HBM; Schultz, WCMW

    1998-01-01

    We investigated by means of vaginal plethysmography the extent to which the genital reactions of women with dyspareunia (N = 18) differed from those of women without dyspareunia (N = 16) during sexual arousal. In addition, we used questionnaires to investigate whether the genital reaction was correl

  2. Dyspareunia in Postmenopausal Women: A Critical Review

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    Alina Kao

    2008-01-01

    Full Text Available BACKGROUND: Dyspareunia, or pain during sexual intercourse, is among the problems most frequently reported by postmenopausal women. Past literature has almost unanimously attributed dyspareunic pain occurring during or after the menopausal transition to declining estrogen levels and vaginal atrophy.

  3. Mangement of dyspareunia secondary to hymenal remnants.

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    Grillo, L; Grillo, D

    1980-10-01

    At the Sexual Dysfunction Clinic at Keesler USAF Medical Center, 17 women complaining of dyspareunia with painful hymen and demonstrable vaginismus were managed by surgical removal of hymenal remnants followed by directive sexual therapy and progressive vaginal dilatation. All patients were pain free within 8 weeks of the surgical procedures. It is believed that a combined approach is best to break the cycle of pain, fear, vaginismus, and more pain that these women have established.

  4. Disgust and contamination sensitivity in vaginismus and dyspareunia

    NARCIS (Netherlands)

    de Jong, Peter J.; van Overveld, Mark; Weijmar Schultz, Willibrord; Peters, Madelon L.; Buwalda, Femke M.

    2009-01-01

    This study examined the potential role of disgust propensity and contamination sensitivity in vaginismus. Women suffering from vaginismus (n = 20) or dyspareunia (n = 22), and a group of women without sexual complaints (n = 30) completed self report measures indexing their (1) general dispositional

  5. Vaginismus and Dyspareunia : Automatic vs. Deliberate Disgust Responsivity

    NARCIS (Netherlands)

    Borg, Charmaine; de Jong, Peter J.; Schultz, Willibrord Weijmar

    2010-01-01

    Introduction. The difficulty of penetration experienced in vaginismus and dyspareunia may at least partly be due to a disgust-induced defensive response. Aims. To examine if sex stimuli specifically elicit: (i) automatic disgust-related memory associations; (ii) physiological disgust responsivity; a

  6. Disgust and contamination sensitivity in vaginismus and dyspareunia

    NARCIS (Netherlands)

    de Jong, Peter J.; van Overveld, Mark; Weijmar Schultz, Willibrord; Peters, Madelon L.; Buwalda, Femke M.

    This study examined the potential role of disgust propensity and contamination sensitivity in vaginismus. Women suffering from vaginismus (n = 20) or dyspareunia (n = 22), and a group of women without sexual complaints (n = 30) completed self report measures indexing their (1) general dispositional

  7. Dyspareunia in women : a painful affair : the role of fear of pain and sexual arousal

    NARCIS (Netherlands)

    Brauer, Marieke

    2008-01-01

    Dyspareunia, defined as genital pain associated with penile-vaginal intercourse, is a common problem in women. According to the prevailing cognitive-behavioural model of dyspareunia (Spano & Lamont, 1975), fear of pain and diminished sexual arousal are key components in the onset and maintenance of

  8. Collaboration between Couples Counselors and Physical Therapists When Treating Dyspareunia: An Untapped Partnership.

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    Magnuson, Sandy; Collins, Senja

    2002-01-01

    Dyspareunia may be related to psychosocial or physical factors. The purpose of this article is to enlighten counselors who work with couples about manifestations of physiologically based dyspareunia and to suggest ways counselors may collaborate with physical therapists who practice in the medical community. (Contains 10 references.) (GCP)

  9. Dyspareunia and chronic pelvic pain in patients with interstitial cystitis/bladder pain syndrome

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    Ming-Huei Lee

    2015-09-01

    Conclusion: IC/BPS women with dyspareunia have significantly more severe urological pain and a higher PUF scale score than women without dyspareunia. Physicians should consider sexual pain disorder in the management of patients with IC/BPS and use the PUF scale to evaluate not only IC-specific lower urinary tract symptoms, but also sexual pain disorder.

  10. Body image and genital self-image in pre-menopausal women with dyspareunia.

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    Pazmany, Els; Bergeron, Sophie; Van Oudenhove, Lukas; Verhaeghe, Johan; Enzlin, Paul

    2013-08-01

    With a prevalence of 15-21%, dyspareunia is one of the most commonly reported sexual dysfunctions in pre-menopausal women under the age of 40. Studies to date have focused primarily on clinical samples, showing that women with dyspareunia report overall sexual impairment, anxiety, and feelings of sexual inadequacy. However, little is known about their body image and genital self-image and few studies have sampled women exclusively from the general population. The aim of the present, controlled study was to investigate body image and genital self-image in a community sample of pre-menopausal women with self-reported dyspareunia. In total, 330 women completed an online survey, of which 192 (58%) had dyspareunia and 138 (42%) were pain-free control women. In comparison to pain-free control women, women with dyspareunia reported significantly more distress about their body image and a more negative genital self-image. Moreover, findings from a logistic regression, in which trait anxiety was controlled for, showed that a more negative genital self-image was strongly and independently associated with an increased likelihood of reporting dyspareunia. These results suggest that, in women with dyspareunia, body image and genital self-image are significantly poorer and would benefit from more attention from both clinicians and researchers.

  11. Reduced vaginal elasticity, reduced lubrication, and deep and superficial dyspareunia in irradiated gynecological cancer survivors.

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    Stinesen Kollberg, Karin; Waldenström, Ann-Charlotte; Bergmark, Karin; Dunberger, Gail; Rossander, Anna; Wilderäng, Ulrica; Åvall-Lundqvist, Elisabeth; Steineck, Gunnar

    2015-05-01

    The purpose of this study was to examine whether or not vaginal elasticity or lack of lubrication is associated with deep or superficial dyspareunia. We investigated gynecological cancer survivors treated with radiation therapy. In a population-based study with 616 women answering a questionnaire (participation rate 78%) and who were treated with radiotherapy for gynecological cancer, we analyzed information from 243 women (39%) who reported that they had had intercourse during the previous six months. Analyses included log-binomial regression (relative risks) and multiple imputations by chained equations in combination with Bayesian Model Averaging, yielding a posterior probability value. Age range of this cancer recurrent-free group of women was 29-80. Dyspareunia affected 164 of 243 of the women (67%). One hundred thirty-four women (55%) reported superficial pain, 97 women (40%) reported deep pain, and 87 women (36%) reported both types of dyspareunia. The relative risk (RR) of deep dyspareunia was 1.87 (CI 1.41-2.49) with impaired vaginal elasticity compared to normal vaginal elasticity. Age and lower abdominal swelling were separate risk factors for deep dyspareunia. However, effects remain after adjusting for these factors. The relative risk of deep dyspareunia was almost twice as high with impaired vaginal elasticity compared to normal vaginal elasticity. If we wish to treat or even prevent deep dyspareunia in women with gynecological cancer, we may use our knowledge of the pathophysiology of deep dyspareunia and increasingly provide dilators together with instructions on how to use them for stretching exercises in order to retain vaginal elasticity. Results highlight the need for studies with more precise questions distinguishing superficial from deep dyspareunia so that in the future we may be able to primarily try to avoid reduced vaginal elasticity and secondarily reduce the symptoms.

  12. The effect of pelvic floor physical therapy on sexual function in women complaining dyspareunia

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    Parvin Bastani

    2016-10-01

    Full Text Available Background: Dyspareunia is a pain that is occurs in the genital area before, during or after intercourse and is an important factor for sexual dysfunction. The aim of this study was to evaluate the effect of pelvic floor physical therapy on sexual function and muscle strength and endurance of pelvic floor (as a non-invasive therapy in women with dyspareunia. Methods: In this clinical trial study, 32 women in the age range of 20-50-year-old and sexually active with complaints of dyspareunia, before the investigation were examined in terms of genital health and strength and endurance of the pelvic floor muscles. After the confidence of mental health, patients underwent pelvic floor rehabilitation for 10 sessions during 3 months. After assessment, myofascial release techniques and progressive pelvic floor muscles exercise was performed for patients based on their primary strength. Finally, patients were compared in terms of the severity of dyspareunia, sexual performance status (by using female sexual function index questionnaire, improvement of symptoms, pelvic floor muscle strength and endurance before (first session of physiotherapy and after (after 3 months investigation. Results: In the remaining 32 patients with dyspareunia with a mean age of 38±1.24 years, desire index score 0.95 unit, arousal index score 1.01 unit, lubrication index score 0.67 unit, orgasm index score 0.71 unit, satisfaction index score 1.03 unit, pain index score was increased 1.05 unit, strength index score 2.44 unit, endurance index score 7.06 unit were increased in comparison to before the investigation that showed a significant different with P< 0.0001. Conclusion: According to obtained results, pelvic floor physical therapy had a significant effect in women with dyspareunia. So that the severity of dyspareunia, pelvic floor muscle strength and endurance had clinically significant improvement after pelvic floor physiotherapy.

  13. Deep Dyspareunia in Endometriosis: A Proposed Framework Based on Pain Mechanisms and Genito-Pelvic Pain Penetration Disorder.

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    Yong, Paul J

    2017-10-01

    Endometriosis is a common chronic disease affecting 1 in 10 women of reproductive age, with half of women with endometriosis experiencing deep dyspareunia. A review of research studies on endometriosis indicates a need for a validated question or questionnaire for deep dyspareunia. Moreover, placebo-controlled randomized trials have yet to demonstrate a clear benefit for traditional treatments of endometriosis for the outcome of deep dyspareunia. The reason some patients might not respond to traditional treatments is the multifactorial nature of deep dyspareunia in endometriosis, which can include comorbid conditions (eg, interstitial cystitis and bladder pain syndrome) and central sensitization underlying genito-pelvic pain penetration disorder. In general, there is a lack of a framework that integrates these multifactorial causes to provide a standardized approach to deep dyspareunia in endometriosis. To propose a clinical framework for deep dyspareunia based on a synthesis of pain mechanisms with genito-pelvic pain penetration disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Narrative review after literature search with the terms (endometriosis AND dyspareunia) OR (dyspareunia AND deep) and after analysis of placebo-controlled randomized trials. Deep dyspareunia presence or absence or deep dyspareunia severity on a numeric rating scale or visual analog scale. Four types of deep dyspareunia are proposed in women with endometriosis: type I that is directly due to endometriosis; type II that is related to a comorbid condition; type III in which genito-pelvic pain penetration disorder is primary; and type IV that is secondary to a combination of types I to III. Four types of deep dyspareunia in endometriosis are proposed, which can be used as a framework in research studies and in clinical practice. Research trials could phenotype or stratify patients by each type. The framework also could give rise to more personalized

  14. Automatic and Deliberate Affective Associations with Sexual Stimuli in Women with Superficial Dyspareunia

    NARCIS (Netherlands)

    Brauer, M.; de Jong, P.J.; Huijding, J.; Laan, E.; ter Kuile, M.M.

    2009-01-01

    Current views suggest that in women with superficial dyspareunia the prospect of penile-vaginal intercourse automatically activates fear-related associations. The automatic activation of negative associations is assumed to interfere with the development of sexual arousal. In turn, this may further a

  15. Effects of Appraisal of Sexual Stimuli on Sexual Arousal in Women with and Without Superficial Dyspareunia

    NARCIS (Netherlands)

    M. Brauer; M.M. ter Kuile; E. Laan

    2009-01-01

    This study examined the effects of appraisal of sexual stimuli on sexual arousal in women with superficial dyspareunia (n = 50) and sexually functional women (n = 25). To elicit different appraisals of an erotic film fragment, participants received an instruction prior to viewing it, with a focus on

  16. Treating dyspareunia caused by vaginal atrophy: a review of treatment options using vaginal estrogen therapy

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    SA Kingsberg

    2009-08-01

    Full Text Available SA Kingsberg¹, S Kellogg², M Krychman³1University Hospitals Case Medical Center, Case Western Reserve University Cleveland OH, USA; 2The Pelvic and Sexual Health Institute of Philadelphia, Drexel University College of Medicine, Philadelphia, USA; 3Southern California Center for Sexual Health and Survivorship Medicine, Newport Beach, CA, USAAbstract: Vulvovaginal atrophy (VVA and dryness are common symptoms of the decline in endogenous production of estrogen at menopause and often result in dyspareunia. Yet while 10% to 40% of women experience discomfort due to VVA, it is estimated that only 25% seek medical help. The main goals of treatment for vaginal atrophy are to improve symptoms and to restore vaginal and vulvar anatomic changes. Treatment choices for postmenopausal dyspareunia resulting from vulvovaginal atrophy will depend on the underlying etiology and might include individualized treatment. A number of forms of vaginal estrogen and manner of delivery are currently available to treat moderate to severe dyspareunia caused by VVA. They all have been shown to be effective and are often the preferred treatment due to the targeted efficacy for urogenital tissues while resulting in only minimal systemic absorption. Both healthcare professionals and patients often find it difficult to broach the subject of sexual problems associated with VVA. However, with minimal effort to initiate a conversation about these problems, healthcare providers can provide useful information to their postmenopausal patients in order to help them each choose the optimal treatment for their needs and symptoms.Keywords: dyspareunia, postmenopausal vulvovaginal atrophy, vaginal estrogen therapy

  17. AN UNCOMMOM CASE OF A LARGE GARTNER’S CYST PRESENTING AS DYSPAREUNIA

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    Sumit H

    2015-12-01

    Full Text Available Gartner duct cysts are the remnants of the Wolffian duct and are uncommon in adulthood. Most of the mesonephric (Wolffian ducts degenerate, some remnants may persist in the mesovarium where they form the epoophoron and paroophoron. The mesonephric cysts known as Gartner duct cysts are seen in 1%-2% of the women. Diagnosis is usually made with pelvic examination. Here, we present a case of 33 yr. old woman with the chief complaints of dyspareunia and a prolapsing vaginal mass. A diagnosis of Gartner’s duct cyst was made after pelvic examination and ultrasonography. Surgical marsupialization was done with a histopathology report consistent with a Gartner’s cyst.

  18. Management of vaginal dryness and dyspareunia in estrogen sensitive cancer patients.

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    Del Pup, Lino

    2012-09-01

    Cancer patients suffer from vaginal dryness and dyspareunia earlier and longer than the general population, with more severe and distressing symptoms. Life-style advices are the first step and vaginal lubricants can be tried, but they can't completely relieve atrophic symptoms. The most effective therapy is use of vaginal estrogens, but compliance and management are particularly difficult in estrogen sensitive cancer patients because of their systemic absorption. Compliance can be improved if they are begun at a very low dose and gradually increased until the lowest effective dose is reached. Promestriene only possesses an intramucosal effect, it can be used at very low doses in cancer patients suffering from urogenital symptoms.

  19. Perceptions of dyspareunia in postmenopausal women with vulvar and vaginal atrophy: findings from the REVIVE survey.

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    Freedman, Murray A

    2014-07-01

    Symptoms of vulvar and vaginal atrophy (VVA), including dyspareunia and vaginal dryness, have a distinct negative impact on a woman's quality of life. The REVIVE survey highlighted the lack of awareness of VVA symptoms among postmenopausal women with vaginal symptoms, with many women reluctant to initiate discussions with their healthcare professionals despite the presence of vaginal symptoms. The REVIVE survey also provided insights into women's views of VVA treatments. Women reported displeasure with the vaginal administration route, lack of symptom relief with over-the-counter products, and concerns about the safety of estrogen therapies. With the high prevalence of VVA, obstetricians/gynecologists should become vigilant in identifying women with VVA by implementing screening and discussion of symptoms during routine office visits - providing patients with information about appropriate therapies based on the severity and impact of symptoms, keeping in mind individual preferences and perceptions.

  20. Safety and efficacy of ospemifene for the treatment of dyspareunia associated with vulvar and vaginal atrophy due to menopause.

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    Wurz, Gregory T; Kao, Chiao-Jung; DeGregorio, Michael W

    2014-01-01

    During the menopausal transition, women experience a number of symptoms due to declining estrogen levels, including vasomotor symptoms and vulvar and vaginal atrophy (VVA). Unlike vasomotor symptoms, vaginal dryness and dyspareunia, the main symptoms of VVA, typically worsen without treatment and can significantly impact the quality of life. Up to 60% of postmenopausal women may be affected by VVA, but many women unfortunately do not seek treatment due to embarrassment or other factors. After 20+ years in development, ospemifene (Osphena™) was approved by the US Food and Drug Administration in 2013 for treatment of moderate-to-severe dyspareunia associated with VVA due to menopause. As the first non-hormonal alternative to estrogen-based products for this indication, the approval of ospemifene represents a significant milestone in postmenopausal women's health. Ospemifene is a non-steroidal estrogen receptor agonist/antagonist, also known as a selective estrogen receptor modulator (SERM), from the same chemical class as the breast cancer drugs tamoxifen and toremifene. Unlike other selective estrogen receptor modulators, ospemifene exerts a strong, nearly full estrogen agonist effect in the vaginal epithelium, making it well suited for the treatment of dyspareunia in postmenopausal women. Results of Phase III clinical trials showed that ospemifene significantly improved the vaginal maturation index (decreased parabasal cells and increased superficial cells), decreased vaginal pH, and decreased severity of the self-identified most bothersome symptom (dyspareunia or vaginal dryness) compared to placebo. Long-term safety studies revealed that 60 mg ospemifene given daily for 52 weeks was well tolerated and was not associated with any endometrium or breast-related safety concerns. This review discusses the preclinical and clinical data supporting the use of ospemifene for the treatment of dyspareunia associated with VVA due to menopause and provides an overview of

  1. Achieving sustainable quality in maternity services – using audit of incontinence and dyspareunia to identify shortfalls in meeting standards

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    Newburn Mary

    2001-10-01

    Full Text Available Abstract Background Some complications of childbirth (for example, faecal incontinence are a source of social embarrassment for women, and are often under reported. Therefore, it was felt important to determine levels of complications (against established standards and to consider obstetric measures aimed at reducing them. Methods Clinical information was collected on 1036 primiparous women delivering at North and South Staffordshire Acute and Community Trusts over a 5-month period in 1997. A questionnaire was sent to 970 women which included self-assessment of levels of incontinence and dyspareunia prior to pregnancy, at 6 weeks post delivery and 9 to 14 months post delivery. Results The response rate was 48%(470/970. Relatively high levels of obstetric interventions were found. In addition, the rates of instrumental deliveries differed between the two hospitals. The highest rates of postnatal symptoms had occurred at 6 weeks, but for many women problems were still present at the time of the survey. At 9–14 months high rates of dyspareunia (29%(102/347 and urinary incontinence (35%(133/382 were reported. Seventeen women (4% complained of faecal incontinence at this time. Similar rates of urinary incontinence and dyspareunia were seen regardless of mode of delivery. Conclusion Further work should be undertaken to reduce the obstetric interventions, especially instrumental deliveries. Improvements in a number of areas of care should be undertaken, including improved patient information, improved professional communication and improved professional recognition and management of third degree tears. It is likely that these measures would lead to a reduction in incontinence and dyspareunia after childbirth.

  2. Safety and efficacy of ospemifene for the treatment of dyspareunia associated with vulvar and vaginal atrophy due to menopause

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    Wurz GT

    2014-11-01

    Full Text Available Gregory T Wurz, Chiao-Jung Kao, Michael W DeGregorio Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis, Sacramento, CA, USA Abstract: During the menopausal transition, women experience a number of symptoms due to declining estrogen levels, including vasomotor symptoms and vulvar and vaginal atrophy (VVA. Unlike vasomotor symptoms, vaginal dryness and dyspareunia, the main symptoms of VVA, typically worsen without treatment and can significantly impact the quality of life. Up to 60% of postmenopausal women may be affected by VVA, but many women unfortunately do not seek treatment due to embarrassment or other factors. After 20+ years in development, ospemifene (Osphena™ was approved by the US Food and Drug Administration in 2013 for treatment of moderate-to-severe dyspareunia associated with VVA due to menopause. As the first non-hormonal alternative to estrogen-based products for this indication, the approval of ospemifene represents a significant milestone in postmenopausal women’s health. Ospemifene is a non-steroidal estrogen receptor agonist/antagonist, also known as a selective estrogen receptor modulator (SERM, from the same chemical class as the breast cancer drugs tamoxifen and toremifene. Unlike other selective estrogen receptor modulators, ospemifene exerts a strong, nearly full estrogen agonist effect in the vaginal epithelium, making it well suited for the treatment of dyspareunia in postmenopausal women. Results of Phase III clinical trials showed that ospemifene significantly improved the vaginal maturation index (decreased parabasal cells and increased superficial cells, decreased vaginal pH, and decreased severity of the self-identified most bothersome symptom (dyspareunia or vaginal dryness compared to placebo. Long-term safety studies revealed that 60 mg ospemifene given daily for 52 weeks was well tolerated and was not associated with any endometrium or breast

  3. Lack of influence of dyspareunia on the beneficial effect of intravaginal prasterone (dehydroepiandrosterone, DHEA) on sexual dysfunction in postmenopausal women.

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    Labrie, Fernand; Archer, David; Bouchard, Céline; Fortier, Michel; Cusan, Leonello; Gomez, José-Luis; Girard, Ginette; Baron, Mira; Ayotte, Normand; Moreau, Michèle; Dubé, Robert; Côté, Isabelle; Labrie, Claude; Lavoie, Lyne; Gilbert, Lucy; Martel, Céline; Balser, John

    2014-07-01

    We have previously observed that intravaginal prasterone (dehydroepiandrosterone, DHEA) improved all domains of female sexual dysfunction (FSD). Investigate the influence of moderate/severe pain at sexual activity (dyspareunia) (MSD) at baseline on FSD following prasterone administration. The effect of daily administration of prasterone (0, 3.25 mg, 6.5 mg or 13 mg) for 12 weeks on FSD in 215 postmenopausal women with or without MSD at baseline was evaluated in a prospective, randomized, double-blind, and placebo-controlled phase III clinical trial. Differences were examined on desire, arousal and orgasm. Comparable benefits were observed in women not having MSD (n = 56) vs. those having MSD (n = 159). The benefits over placebo in prasterone-treated women for desire, avoiding intimacy and vaginal dryness as well as for the total sexual domain of the MENQOL (Menopause Specific Quality of Life) questionnaire, ranged between 18.0% and 38.2% with P values of <0.05 or <0.01 except in one out of 12 subgroups. For the arousal/sensation, arousal/lubrication and summary score of the ASF (Abbreviated Sexual Function) questionnaire, in the MSD+ group, improvements of 64.2% (P = 0.01), 118% (P = 0.001) and 31.1% (P = 0.03) were observed over placebo, respectively, while similar differences (58.0%, 67.6% and 32.1%) did not reach statistical significance in the MSD- group having up to only 44 prasterone-treated women compared with 119 in the MSD+ group. No MSD at baseline does not apparently affect the effects of intravaginal prasterone on sexual dysfunction. Knowing the absence of significant effects of estrogens on FSD, the present data suggest that vulvovaginal atrophy (VVA) and vulvovaginal sexual dysfunction (VVSD) are two different consequences of sex steroid deficiency at menopause which can respond independently. In addition, the present data seriously question the justification of pain being part of FSD as well as the separation of FSD into

  4. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause.

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    Labrie, Fernand; Archer, David F; Koltun, William; Vachon, Andrée; Young, Douglas; Frenette, Louise; Portman, David; Montesino, Marlene; Côté, Isabelle; Parent, Julie; Lavoie, Lyne; Beauregard, Adam; Martel, Céline; Vaillancourt, Mario; Balser, John; Moyneur, Érick

    2016-03-01

    The aim of this study is to confirm the local beneficial effects of intravaginal dehydroepiandrosterone (DHEA, Prasterone) on moderate to severe dyspareunia or pain at sexual activity, the most frequent symptom of vulvovaginal atrophy due to menopause or genitourinary syndrome of menopause (GSM). In a prospective, randomized, double-blind, and placebo-controlled phase III clinical trial, the effect of daily intravaginal 0.50% DHEA (6.5 mg) (Prasterone, EndoCeutics) was examined on four coprimary objectives, namely percentage of parabasal cells, percentage or superficial cells, vaginal pH, and moderate to severe pain at sexual activity (dyspareunia) identified by the women as their most bothersome vulvovaginal atrophy symptom. The intent-to-treat population included 157 and 325 women in the placebo and DHEA-treated groups, respectively. After daily intravaginal administration of 0.50% DHEA for 12 weeks, when compared to baseline by the analysis of covariance test, the percentage of parabasal cells decreased by 27.7% over placebo (P DHEA (Prasterone) has shown clinically and highly statistically significant effects on the four coprimary parameters suggested by the US Food and Drug Administration. The strictly local action of Prasterone is in line with the absence of significant drug-related adverse events, thus showing the high benefit-to-risk ratio of this treatment based upon the novel understanding of the physiology of sex steroids in women.

  5. The acceptability, feasibility, and efficacy (phase I/II study) of the OVERcome (Olive Oil, Vaginal Exercise, and MoisturizeR) intervention to improve dyspareunia and alleviate sexual problems in women with breast cancer.

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    Juraskova, Ilona; Jarvis, Sherin; Mok, Kelly; Peate, Michelle; Meiser, Bettina; Cheah, Benjamin C; Mireskandari, Shab; Friedlander, Michael

    2013-10-01

    Almost half of breast cancer survivors experience chronic sexual problems. Despite the negative effects of dyspareunia on physical and overall quality of life, sexual dysfunction remains underreported and undertreated in clinical practice. This is likely due to the paucity of evidence-based interventions to improve sexual functioning. The study aims to prospectively evaluate the acceptability, feasibility, and efficacy of a novel intervention (Olive Oil, Vaginal Exercise, and MoisturizeR [OVERcome]) to improve sexual problems following breast cancer treatment. Dyspareunia, sexual functioning, quality of life, distress, and pelvic floor muscles (PFMs) functioning were evaluated. Twenty-five women with dyspareunia were instructed to perform pelvic floor muscle (PFM) relaxation exercises twice/day to prevent/manage PFM overactivity, apply a polycarbophil-based vaginal moisturizer three times/week to alleviate vaginal dryness, use olive oil as a lubricant during intercourse, and complete a weekly compliance diary. PFM relaxation training was administered by a physiotherapist at weeks 0 and 4, with follow-up at weeks 12 and 26. At each visit, women completed validated self-report questionnaires and the physiotherapist recorded objective measures of PFM functioning. OVERcome resulted in significant improvements in dyspareunia, sexual function, and quality of life over time (all Pvaginal moisturizer (88%), and olive oil (73%) as helpful, indicating that the intervention was acceptable. Unexpectedly, six cases (11%) of vaginal stenosis were noted during initial screening. This novel intervention is acceptable to patients with demonstrated efficacy in improving dyspareunia and sexual function following breast cancer. Delivery of the OVERcome intervention appears feasible in a clinical setting, providing a potential treatment for this important clinical issue. The unexpected number of observed cases of stenosis further highlights the underreporting of sexual problems in this

  6. Dyspareunia: Painful Sex for Women

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  7. Pelvic floor tenderness in the etiology of superficial dyspareunia.

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    Yong, Paul J; Mui, Justin; Allaire, Catherine; Williams, Christina

    2014-11-01

    Objectif : Calculer la prévalence de la sensibilité du plancher pelvien au sein de la population des femmes qui connaissent des douleurs pelviennes et déterminer ses implications pour ce qui est des symptômes de la douleur pelvienne. Méthodes : Nous avons mené une analyse rétrospective auprès de patientes connaissant des douleurs pelviennes au sein d’un centre spécialisé tertiaire. La sensibilité du plancher pelvien a été définie comme étant une sensibilité du muscle releveur de l’anus ressentie au moins d’un côté au cours d’un examen pelvien mené au moyen d’un seul doigt. La prévalence de la sensibilité du plancher pelvien au sein de cette cohorte de femmes connaissant des douleurs pelviennes a été comparée à la même prévalence au sein d’une cohorte de femmes exemptes de douleurs fréquentant une clinique de gynécologie. Chez les femmes connaissant des douleurs pelviennes, une régression multiple a été menée en vue d’identifier les variables qui étaient associées de façon indépendante à la sensibilité du plancher pelvien. Résultats : La prévalence de la sensibilité du plancher pelvien était de 40 % (75/189) au sein de la cohorte « douleurs pelviennes »; elle était donc considérablement supérieure à la prévalence de 13 % (4/32) qui a été constatée au sein de la cohorte « absence de douleur » (RC, 4,61; IC à 95 %, 1,55 - 13,7, P = 0,005). Dans le cadre de la régression logistique multiple, la dyspareunie superficielle (RC, 4,45; IC à 95 %, 1,86 - 10,7, P = 0,001), la douleur ressentie au niveau de la paroi abdominale (RC, 4,04; IC à 95 %, 1,44 - 11,3, P = 0,005) et la sensibilité de la base de la vessie (RC, 4,65; IC à 95 %, 1,87 - 11,6, P = 0,001) étaient associées de façon indépendante à la sensibilité du plancher pelvien. Cette dernière était tout aussi présente chez les femmes qui connaissaient une endométriose sous-jacente que chez les femmes qui ne connaissaient pas une telle pathologie. Conclusion : La sensibilité du plancher pelvien est courante chez les femmes qui connaissent des douleurs pelviennes, en présence ou non d’une endométriose, et contribue à la dyspareunie superficielle. Elle a également été associée à la douleur ressentie au niveau de la paroi abdominale et à la sensibilité de la base de la vessie, ce qui semble indiquer que la sensibilisation du système nerveux est impliquée dans son étiologie.

  8. An unusual cause of dyspareunia: secondary cervical perforation by post placental intrauterine contraceptive device

    Directory of Open Access Journals (Sweden)

    Monica Chauhan

    2015-06-01

    Full Text Available Postpartum contraception using intrauterine device Copper T 380 A is considered a valuable option to tackle high rate of unintended pregnancy. This case is presented to highlight the importance of follow up and a vigilant examination on patient reporting with any complaint on follow up, even in the presence of a normally placed thread which is crucial to identify problem and manage complication before this reliable, cost effective and long term postpartum contraceptive solution fails to see its rise. [Int J Reprod Contracept Obstet Gynecol 2015; 4(3.000: 881-883

  9. Vaginismus and dyspareunia : Relationship with general and sex-related moral standards

    NARCIS (Netherlands)

    Borg, Charmaine; de Jong, Peter J.; Schultz, Willibrord Weijmar

    2011-01-01

    Introduction. Relatively strong adherence to conservative values and/or relatively strict sex-related moral standards logically restricts the sexual repertoire and will lower the threshold for experiencing negative emotions in a sexual context. In turn, this may generate withdrawal and avoidance beh

  10. Vaginismus and dyspareunia : Relationship with general and sex-related moral standards

    NARCIS (Netherlands)

    Borg, Charmaine; de Jong, Peter J.; Schultz, Willibrord Weijmar

    2011-01-01

    Introduction. Relatively strong adherence to conservative values and/or relatively strict sex-related moral standards logically restricts the sexual repertoire and will lower the threshold for experiencing negative emotions in a sexual context. In turn, this may generate withdrawal and avoidance beh

  11. The Effect Of Pelvic Floor Physical Therapy On Sexual Function And Pelvic Floor Muscle Strength And Endurance In Women Complaining Dyspareunia

    Directory of Open Access Journals (Sweden)

    Parvin Bastani

    2016-10-01

    Full Text Available Introduction: Total pelvic organ prolapse is one of causes of disability in women with slack in the pelvic floor is mainly due to the damage caused by delivery. In colpoclisis mthod, vaginal mucosa in the anterior - posterior side was sutured and actually kind of blocking is done that is preventing the removal of prolapsed organs. The only problem with this method is the lack of vaginal canal and limitations in sexual function. In the present study, in addition to the prolapse treatment, in order to preserve sexual function, the improving the situation was evaluated in elderly patients with medical problems by changes in the mentioned operation method to the modified partial colpoclisis.

  12. A Rare Cause of Recurrent Urinary Tract Infections, Female Urethral Diverticulum: A Case Report

    Directory of Open Access Journals (Sweden)

    Taha Numan Yikilmaz

    2014-02-01

    Full Text Available A female urethral diverticulum is an uncommon pathologic entity. The most presentation of urethral diverticule has been described as lower urinary tract symptoms and dyspareunia. The case of female is presented, who consult with a vaginal mass and dyspareunia and current literature was reviewed.

  13. Women's sexual pain and its management

    NARCIS (Netherlands)

    Schultz, WW; Basson, R; Binik, Y; Eschenbach, D; Wesselmann, U; Van Lankveld, J

    2005-01-01

    Introduction. Approximately 15% of women have chronic dyspareunia that is poorly understood, infrequently cured, often highly problematic, and distressing. Chronic dyspareunia is an urgent health issue. Aim. To provide recommendations/guidelines concerning state-of-the-art knowledge for the assessme

  14. Sexual function after transvaginal cholecystectomy

    DEFF Research Database (Denmark)

    Donatsky, Anders M; Jørgensen, Lars N; Meisner, Søren

    2014-01-01

    INTRODUCTION: Despite several benefits, patients are concerned that transvaginal cholecystectomy has a negative impact on sexual health. The objective of this systematic review was to assess the impact of transvaginal cholecystectomy on postoperative dyspareunia and sexual function. METHOD......: A literature search was performed in the PubMed and EMBASE databases. Papers reporting on postoperative dyspareunia, vaginal pain or discomfort, and sexual function were included. RESULTS: Seventeen papers reported on dyspareunia and vaginal pain or discomfort. Two papers reported a rate of de novo dyspareunia...... of 3.8% and 12.5%, respectively. One study reported a nonsignificant reduction in painful sexual intercourse and the remaining 14 reported no incidents of dyspareunia. Eight papers reported on sexual function. One paper using a nonvalidated questionnaire found impaired sexual function. The papers...

  15. Surgical reconstitution of a unilaterally avulsed symptomatic puborectalis muscle using autologous fascia lata.

    Science.gov (United States)

    Shobeiri, S Abbas; Chimpiri, A Rao; Allen, Ariel; Nihira, Mikio A; Quiroz, Lieschen H

    2009-08-01

    The puborectalis muscle is an important muscle for the maintenance of fecal continence. We present a novel surgical technique for repair of symptomatic avulsed puborectalis muscle. This woman presented with dyspareunia and fecal incontinence since the vaginal birth of her child 2 years before. The diagnosis of an avulsed right puborectalis was made by physical examination and confirmed by magnetic resonance imaging and three-dimensional ultrasonography. Fascia lata was harvested from the patient's thigh and used to reconstitute the missing portion of the puborectalis muscle. At 12 months postoperatively, the patient was continent of stool and relieved of dyspareunia. The patient's dyspareunia and fecal incontinence were alleviated by restoring normal anatomy.

  16. Site-specific rectocele repair with dermal graft augmentation: comparison of porcine dermal xenograft (Pelvicol) and human dermal allograft.

    Science.gov (United States)

    Biehl, Roger C; Moore, Robert D; Miklos, John R; Kohli, Neeraj; Anand, Indu S; Mattox, T Fleming

    2008-01-01

    This study is a retrospective chart review comparing 195 women who underwent rectocele repair with either a porcine dermal xenograft or human allogenic cadaveric dermal graft augmentation over a two year period. A site-specific defect repair was completed prior to augmentation with the graft. Examinations were performed preoperatively and postoperatively using the pelvic organ prolapse quantification system. Questionnaires were used to assess constipation and dyspareunia. De novo dyspareunia and cure rates for constipation and dyspareunia were not statistically different between the two groups. Site-specific fascial rectocele repairs with xenograft or allograft augmentation were found to have similar complication rates as well as objective and subjective cure rates.

  17. A Survey of TCM Treatment for Endometriosis

    Institute of Scientific and Technical Information of China (English)

    HAN Yu-fen; HOU Li-hui; ZHOU Ya-jie; WU Xiao-ke

    2009-01-01

    @@ Endometriosis (EM) refers to the disorders caused by the endometrial tissues growing out. of the uterine cavity but in other parts of the body,which may include the progressive dysmenorrhea,dyspareunia,sterility,and abnormal menstruation.

  18. Ved smerter i underlivet er deskvamativ inflammatoriskvaginitis en vigtig differentialdiagnose

    DEFF Research Database (Denmark)

    Johannsen, Eva; Baumgartner-Nielsen, Jane; Meinert, Mette

    2015-01-01

    Desquamative inflammatory vaginitis (DIV) is an uncommon, severe form of chronic vaginitis of unknown aetiology. The syndrome is characterised by profuse vaginal discharge, vulvovaginal irritation, dyspareunia and vaginal erythema. As the symptoms and signs are nonspecific, other causes of purulent...

  19. Atrophic vaginitis.

    Science.gov (United States)

    Stika, Catherine S

    2010-01-01

    With the loss of estrogen that occurs with menopause, physiologic and structural changes occur within the vulvovaginal mucosa that lead to a condition commonly called atrophic vaginitis. Although mild genital changes occur in most women, 10-47% of postmenopausal women will develop one or more debilitating symptoms that include vulvovaginal dryness, dyspareunia, vulvar itching or pain, recurrent urinary tract infections, as well as abnormal vaginal discharge. Topical estrogen replacement therapies reverse these mucosal changes and are effective treatments for the symptoms of atrophic vaginitis. Vaginal moisturizers and lubricants also provide symptomatic relief for vaginal dryness and dyspareunia, respectively. © 2010 Wiley Periodicals, Inc.

  20. Pilot study of vaginal plethysmography in women treated with radiotherapy for gynecological cancer

    NARCIS (Netherlands)

    Pras, E; Wouda, J; Willemse, PHB; Midden, ME; Zwart, M; de Vries, EGE; Schultz, WCMW

    2003-01-01

    Objectives. After pelvic radiotherapy for gynecological cancer, changes in the vaginal epithelium might influence sexual arousal and satisfaction, leading to dyspareunia and relational problems. The aim of the study was to determine the feasibility of vaginal plethysmography in order to measure phys

  1. Women's Sexual Pain Disorders

    NARCIS (Netherlands)

    van Lankveld, Jacques J. D. M.; Granot, Michal; Schultz, Willibrord C. M. Weijmar; Binik, Yitzchak M.; Wesselmann, Ursula; Pukall, Caroline F.; Bohm-Starke, Nina; Achtrari, Chahin

    2010-01-01

    Introduction. Women's sexual pain disorders include dyspareunia and vaginismus and there is need for state-of-the-art information in this area. Aim. To update the scientific evidence published in 2004, from the 2nd International Consultation on Sexual Medicine pertaining to the diagnosis and treatme

  2. The Genito-Pelvic Pain/Penetration Disorder Paradigm and Beyond : Theoretical and empirical perspectives

    NARCIS (Netherlands)

    Spoelstra, Symen Kornelis

    2017-01-01

    In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)the female sexual pain disorders vaginismus and dyspareunia have been merged into the genito-pelvic pain/penetration disorder (GPPPD). The major reason behind this merging is that in clinical practice it always

  3. The impact of primary Sjogren's syndrome on female sexual function

    NARCIS (Netherlands)

    van Nimwegen, Jolien F.; Arends, Suzanne; van Zuiden, Greetje S.; Vissink, Arjan; Kroese, Frans G. M.; Bootsma, Hendrika

    2015-01-01

    Objective. Prevalence of vaginal dryness and dyspareunia is high in women with primary SS (pSS). Our aim was to compare sexual function and sexual distress in women with pSS with healthy controls, as well as to assess parameters that are associated with sexual dysfunction and distress in pSS. Method

  4. The Genito-Pelvic Pain/Penetration Disorder Paradigm and Beyond : Theoretical and empirical perspectives

    NARCIS (Netherlands)

    Spoelstra, Symen Kornelis

    2017-01-01

    In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)the female sexual pain disorders vaginismus and dyspareunia have been merged into the genito-pelvic pain/penetration disorder (GPPPD). The major reason behind this merging is that in clinical practice it always

  5. Pilot study of vaginal plethysmography in women treated with radiotherapy for gynecological cancer

    NARCIS (Netherlands)

    Pras, E; Wouda, J; Willemse, PHB; Midden, ME; Zwart, M; de Vries, EGE; Schultz, WCMW

    2003-01-01

    Objectives. After pelvic radiotherapy for gynecological cancer, changes in the vaginal epithelium might influence sexual arousal and satisfaction, leading to dyspareunia and relational problems. The aim of the study was to determine the feasibility of vaginal plethysmography in order to measure

  6. Gynecologic pain related to occupational stress among female factory workers in Tianjin, China

    Science.gov (United States)

    Sznajder, Kristin K; Harlow, Siobán D; Burgard, Sarah A; Wang, Yanrang; Han, Cheng; Liu, Jing

    2014-01-01

    Background: Dysmenorrhea, dyspareunia, and non-cyclic pelvic pain are health concerns for factory workers in China and may be increased by occupational stress. Objectives: To estimate the prevalence and demographic and occupational factors associated with three types of gynecologic pain among female factory workers in Tianjin. Methods: The study included 651 female workers from three factories in Tianjin, China. Logistic regression models were estimated to determine associations between occupational stress and gynecologic pain. Results: Occupational stress including high job strain, exhaustion, and stress related to working conditions was a risk factor for gynecologic pain. High job strain and poor job security were associated with an increased risk for dysmenorrhea. Compulsory overtime and exhaustion were associated with increased non-cyclic pelvic pain. Working overtime and exhaustion were associated with increased dyspareunia. Conclusions: As China’s population of female factory workers grows, research on the reproductive health of this population is essential. PMID:24804338

  7. Graft-versus-Host Disease-Associated Vulvovaginal Symptoms after Bone Marrow Transplantation.

    Science.gov (United States)

    Chung, Christopher P; Sargent, Rachel E; Chung, Nadia T; Lacey, James V; Wakabayashi, Mark T

    2016-02-01

    We conducted a retrospective review to assess the prevalence of graft-versus-host disease (GVHD)-associated gynecologic conditions among bone marrow transplantation (BMT) patients at City of Hope Medical Center. We calculated the associations among the estimated risks of various gynecologic complications, including vaginal stenosis, by performing chi-square tests and t-test statistics. Between 2010 and 2014, 180 patients were referred to the gynecologic clinic after their BMT. One hundred twenty-four patients (69%) had GVHD; among these patients, 51 (41%) experienced dyspareunia and 43 (35%) had vaginal stenosis. GVHD patients were significantly more likely to have vaginal stenosis (P vulvovaginal symptoms, such as dyspareunia and pelvic pain. Patients with GVHD are at high risk for vaginal stenosis requiring the use of a vaginal dilator. However, they are at low risk for developing UI and POP.

  8. Obstetric and gynecological outcome in a patient with traumatic pelvic fracture and perineal injuries.

    Science.gov (United States)

    Goswami, Deepti; Kochhar, Puneet Kaur; Suri, Tarun; Zutshi, Vijay; Batra, Swaraj

    2012-08-01

    A 19-year-old woman presented with pelvic trauma following a road accident. She was hemodynamically stable. Examination revealed perineal injuries and type C pelvic fracture, which was stabilized with an external fixator. The broken ends of the pubic bone were brought together by an orthopedic wire. The detached vaginal wall and torn anal sphincter were surgically repaired after making a diverting colostomy. The postoperative period was uneventful. Colostomy was reversed after 3 months. Postoperatively the patient developed a cystocele, dyspareunia and vaginal pain. She conceived spontaneously and was planned for an elective cesarean at 37 weeks gestation; however, she presented in labor at 36 weeks and had a normal vaginal delivery. Pelvic fractures may be associated with genitourinary and anal sphincter injuries, which require management by a multidisciplinary team. On recovery the patient may develop prolapse, dyspareunia and persistent local pain. Spontaneous conception and normal vaginal delivery are nevertheless possible.

  9. Sexual behavior in a cohort of patient affected by fibromyalgia and/or vulvodynia

    Directory of Open Access Journals (Sweden)

    Anna Ghizzani

    2015-08-01

    Full Text Available Fibromyalgia, characterized by widespread musculoskeletal pain, negatively impacts sexuality by provoking dispareunia, and loss of desire and of dyadic gratification. Chronic pain syndromes tend to associate and FM women have a higher probability to develop vulvodynia than women not affected by fibromyalgia. Vulvodynia, characterized by burning pain that interferes with sexual penetration, is classified as Genitopelvic/Penetration Disorders in DSM 5. The association between Fibromyalgia and vulvodynia is difficult to recognize because patients tend to attribute all symptoms to disease spread and not think that dyspareunia may have different origins. To establish the necessary criteria for the differential diagnosis between the two syndromes, we evaluated the characteristics of dyspareunia and sexual behavior of fibromyalgia patients versus vulvodynia patients and we found significant differences on the onset of burning pain, orgasmic capability, and sexual frequency.

  10. Female sexual function and response.

    Science.gov (United States)

    Arcos, Barbara

    2004-01-01

    Although female sexual dysfunction is a problem with low priority, it can have a profound impact on quality of life. In women, the cycle of sexual response begins in the brain, where a memory, an image, a scent, music, or a fantasy acts as a trigger to prompt sexual arousal. Thus, the brain is really the key and starting place for treatment of sexual dysfunction. Decreased libido, altered arousal, inability to achieve orgasm, and dyspareunia are the four broad types of sexual dysfunction in women. Decreased libido, thought to be related to androgenic hormones, results in delayed or altered arousal, decreased vaginal lubrication and dilation, delayed or absent orgasm, and pain or dyspareunia, which can lead to an aversion to sexual experiences.

  11. A Case of Secondary Infertility Due to Retention of Fetal Bones in Cervix

    OpenAIRE

    Alev Ozer

    2014-01-01

    A case of secondary infertility related to prolonged retention of fetal bones in the cervix is presented. A 34-year-old nulliparous woman was admitted to the hospital with chronic pelvic pain, dyspareunia, and 12%u2013year-long secondary infertility following an induced abortion due to fetal demise. Transvaginal ultrasonography (USG) revealed a linear echogenic area around the posterior cervical wall. An hysteroscopic examination confirmed the existence of an irregular calcified mass embedded...

  12. Périnée et Grossesse [Pelvic floor and pregnancy

    OpenAIRE

    Fritel, Xavier

    2010-01-01

    International audience; Congenital factor, obesity, aging, pregnancy and childbirth are the main risk factors for female pelvic floor disorders (urinary incontinence, anal incontinence, pelvic organ prolapse, dyspareunia). Vaginal delivery may cause injury to the pudendal nerve, the anal sphincter, or the anal sphincter. However the link between these injuries and pelvic floor symptoms is not always determined and we still ignore what might be the ways of prevention. Of the many obstetrical m...

  13. Vaginal Atrophy following Long-Term Depot Medroxyprogesterone Acetate Use: A Case Report

    Directory of Open Access Journals (Sweden)

    Christie Walker

    2013-01-01

    Full Text Available Depot medroxyprogesterone acetate (DMPA is a commonly used form of contraception, with noncontraceptive benefits for the user. The mode of action is through the suppression of ovulation. It leads to hypoestrogenism which causes dryness of the vagina and dyspareunia. We present in this paper a patient that was very symptomatic with regard to vaginal atrophic changes determined by vaginal cytology. This side effect may become increasingly more common as we see more long-term use of DMPA.

  14. Identifikasi Spesies Candida pada Flour Albus Pengguna Alat Kontrasepsi Dalam Rahim

    OpenAIRE

    Sihotang, Ayu Sri Astuti

    2016-01-01

    Background: Candida sp. are normal flora in the mucous membranes, gastrointestinal tract, vagina, urethra, skin, and nails. Candida sp. infection of the vulva or vagina is called vaginal candidiasis. The clinical symptoms of vaginal candidiasis is flour albus, dyspareunia, dysuria, vulva and vaginal redness and edema. Intrauterin device (IUD) is one of the predisposing factors that can trigger Candida which is initially asymptomatic becomes active proliferate and cause vagin...

  15. Female urethral syndrome. A female prostatitis?

    OpenAIRE

    1996-01-01

    The cause of the female urethral syndrome has previously been obscure, as it has been associated by definition with a lack of objective findings but a plethora of subjective complaints of retropubic pressure, dyspareunia, urinary frequency, and dysuria. There is now strong evidence that the microscopic paraurethral glands connected to the distal third of the urethra in the prevaginal space are homologous to the prostate. They stain histologically for prostate-specific antigen and, like the pr...

  16. Identifikasi Spesies Candida pada Flour Albus Pengguna Alat Kontrasepsi Dalam Rahim

    OpenAIRE

    2016-01-01

    Background: Candida sp. are normal flora in the mucous membranes, gastrointestinal tract, vagina, urethra, skin, and nails. Candida sp. infection of the vulva or vagina is called vaginal candidiasis. The clinical symptoms of vaginal candidiasis is flour albus, dyspareunia, dysuria, vulva and vaginal redness and edema. Intrauterin device (IUD) is one of the predisposing factors that can trigger Candida which is initially asymptomatic becomes active proliferate and cause vagin...

  17. Recurrent extended-spectrum beta-lactamase-producing Escherichia coli urinary tract infection due to an infected intrauterine device

    OpenAIRE

    2014-01-01

    The use of intrauterine devices (IUDs) have been widespread since the 1960s. In 2002, the World Health Organization estimated that approximately 160 million women worldwide use IUDs. However, IUDs are associated with short-term complications such as vaginal bleeding, pelvic discomfort, dyspareunia and pelvic infection. Herein, we report the case of a woman who had recurrent urinary tract infection (UTI) due to the use of an IUD, even after treatment. The patient developed four episodes of UTI...

  18. Efficacy and Tolerability of Fitostimoline (Vaginal Cream, Ovules, and Vaginal Washing) and of Benzydamine Hydrochloride (Tantum Rosa Vaginal Cream and Vaginal Washing) in the Topical Treatment of Symptoms of Bacterial Vaginosis

    OpenAIRE

    Papa, R; Ascione, L.; Rullo, V.; Campedelli, A; Muzi, M.; Petrella, E.; Boselli, F.; Saponati, G.

    2012-01-01

    Two hundred and 91 patients showing signs and symptoms of bacterial vaginosis (BV) were randomized to receive topical treatment with Fitostimoline (vaginal cream and vaginal ovules + vaginal washing) or benzydamine hydrochloride (vaginal cream + vaginal washing) for 7 days. Signs (leucorrhoea, erythema, oedema, and erosion) and symptoms (burning, pain, itching, vaginal dryness, dyspareunia, and dysuria) (scored 0–3) were evaluated at baseline and at the end of treatment; the total symptoms sc...

  19. Simultaneous measurement of pelvic floor muscle activity and vaginal blood flow: a pilot study.

    Science.gov (United States)

    Both, Stephanie; Laan, Ellen

    2007-05-01

    Dyspareunia, defined as persistent or recurrent genital pain associated with sexual intercourse, is hypothesized to be related to pelvic floor hyperactivity and to diminished sexual arousal. Empirical research to support these hypotheses is scarce and concentrates mostly on the role of either pelvic floor activity or genital arousal in female dyspareunia. Currently, however, there is no measurement device to assess pelvic floor activity and genital response simultaneously. The aim of this study was to investigate the validity of a new device that enables simultaneous measurement of pelvic floor activity and genital response in women. Genital arousal measured as vaginal pulse amplitude, and vaginal surface electromyogram (EMG). Thirty sexually functional women participated. To investigate the accuracy of genital response measurement with the adapted photoplethysmograph, and the sensitivity of the device for involuntary changes in pelvic floor activity, vaginal pulse amplitude and vaginal surface EMG were monitored during exposure to emotional, including erotic, films. In addition, vaginal surface EMG was monitored during instructed pelvic floor contractions. The genital data obtained during emotional films proved accurate measurement of genital response. EMG values during the emotional films indicated limited sensitivity of the device for small, involuntary changes in pelvic floor activity due to emotional state. The EMG measurements during the instructed pelvic floor contractions proved sensitivity of the new probe to voluntary pelvic floor activity. It is concluded that following improvement of the sensitivity of the EMG measurement for small, involuntary changes in pelvic floor activity, the device will be a valuable tool in research on superficial dyspareunia.

  20. Dehydroepiandrosterone intra vaginal administration for the management of postmenopausal vulvovaginal atrophy.

    Science.gov (United States)

    Archer, David F

    2015-01-01

    The effects of intravaginal administration of dehydroepiandrosterone (DHEA) for the management of symptomatic vulvovaginal atrophy are reviewed. A literature search related to vulvovaginal atrophy, vaginal atrophy, atrophic vaginitis, estrogen, dehydroepiandrosterone, vulvar itching, burning, dryness, dyspareunia, and libido was performed. Relevant articles addressing the incidence, management, and outcome of DHEA therapy were identified and used for this Expert Opinion. DHEA compared to a placebo is an effective treatment improving symptoms of vaginal atrophy: dyspareunia, burning, itching, and dryness. Objective parameters of vaginal atrophy, specifically pH, vaginal maturation index (VMI), and investigator-evaluated changes in the vagina: moisture, epithelia integrity and color were improved compared to baseline and placebo. There were significant improvements in libido and dyspareunia with the intravaginal use of DHEA that contribute to improved quality of life for postmenopausal women. Dehydroepiandrosterone administered intravaginally on a daily basis is an effective treatment for symptoms, and signs of vulvovaginal atrophy along with libido in postmenopausal women. This article is part of a Special Issue entitled 'Essential role of DHEA'.

  1. Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis.

    Science.gov (United States)

    Mitchell, Leia; King, Michelle; Brillhart, Heather; Goldstein, Andrew

    2017-09-01

    Desquamative inflammatory vaginitis is a poorly understood chronic vaginitis with an unknown etiology. Symptoms of desquamative inflammatory vaginitis include copious yellowish discharge, vulvovaginal discomfort, and dyspareunia. Cervical ectropion, the presence of glandular columnar cells on the ectocervix, has not been reported as a cause of desquamative inflammatory vaginitis. Although cervical ectropion can be a normal clinical finding, it has been reported to cause leukorrhea, metrorrhagia, dyspareunia, and vulvovaginal irritation. Patients with cervical ectropion and desquamative inflammatory vaginitis are frequently misdiagnosed with candidiasis or bacterial vaginosis and repeatedly treated without resolution of symptoms. We report the case of a 34-year-old woman with a 4-year history of profuse yellowish discharge and dyspareunia. Upon presentation, her symptoms and laboratory results met the criteria for desquamative inflammatory vaginitis, but the standard treatments did not provide long-lasting relief. As a last resort, cryotherapy (cryosurgery) of her cervix was performed for treatment of her cervical ectropion, which provided complete resolution of her symptoms. Mitchell L, King M, Brillhart H, Goldstein A. Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis. Sex Med 2017;5:e212-e214. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  2. Effects of Letrozole Compared with Danazol on Patients with Confirmed Endometriosis: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Navid Koleini

    2010-01-01

    Full Text Available Background: Letrozole is an aromatase inhibitor which can decrease estrogen production inperipheral tissues and endometriosis. Danazol, as an androgen, inhibits estrogen production inovaries and recently has been introduced as an aromatase inhibitor. This study was designed tocompare the effects of Danazol with Letrozole on endometriosis symptom relief.Materials and Methods: This study was a randomized clinical trial in which 105 patients withconfirmed endometriosis were randomly assigned to one of three groups. Group 1 received Letrozoletablets (2.5 mg/day, calcium (1000 mg/day and vitamin D (800 IU/day. Group 2 received Danazoltablets (600 mg/day, calcium (1000 mg/day and vitamin D (800 IU/day. Group 3 (placebo groupwere assigned to take two calcium tablets daily (500 mg/tablet and vitamin D (800 IU/day. Pelvicpain, dysmenorrhea and dyspareunia were assessed in participants at baseline and monthly duringthe study for a total of six months. Data were analyzed via SPSS version 15 software with Freidmanand Wilcoxon tests.Results: Mean age in three groups has no significant difference. Of the 105 participants who wereenrolled in this study, 38 patients were assigned to group 1 (Letrozole group, 37 patients in group 2(Danazol group and 31 patients were placed in group 3 (placebo group. This study showed that themean scores for chronic pelvic pain, dysmenorrhea and dyspareunia for the Letrozole group wereless than the Danazol and placebo groups.Conclusion: This study showed that Letrozole can be more effective than Danazol for reducingchronic pelvic pain, dyspareunia and dysmenorrhea in patients suffering from recurrent endometriosis(Registeration Number: IRCT138812043414N1.

  3. Role of the different sexuality domains on the sexual function of women with premature ovarian failure.

    Science.gov (United States)

    Benetti-Pinto, Cristina Laguna; Soares, Patrícia Magda; Giraldo, Helena Patrícia Donovan; Yela, Daniela Angerame

    2015-03-01

    Women with premature ovarian failure (POF) often manifest complaints involving different aspects of sexual function (SF), regardless of using hormone therapy. SF involves a complex interaction between physical, psychological, and sociocultural aspects. There are doubts about the impact of different complaints on the global context of SF of women with POF. To evaluate the percentage of influence of each of the sexuality domains on the SF in women with POF. Cross-sectional study with 80 women with POF, matched by age to 80 women with normal gonadal function. We evaluated SF through the "Female Sexual Function Index" (FSFI), a comparison between the POF and control groups using the Mann-Whitney test. Component exploratory factor analysis was used to assess the proportional influence of each domain on the composition of the overall SF for women in the POF group. SF was evaluated using FSFI. Exploratory Factor Analysis for components was used to evaluate the role of each domain on the SF of women with POF. The FSFI score was significantly worse for women with POF, with a decrease in arousal, lubrication, orgasm, satisfaction, and dyspareunia. Exploratory factor analysis of SF showed that the domain with greater influence in the SF was arousal, followed by desire, together accounting for 41% of the FSFI. The domains with less influence were dyspareunia and lubrication, which together accounted for 25% of the FSFI. Women with POF have impaired SF, determined mainly by changes in arousal and desire. Aspects related to lubrication and dyspareunia complaints have lower determination coefficient in SF. These results are important in adapting the approach of sexual disorders in this group of women. © 2014 International Society for Sexual Medicine.

  4. The outcome of transobturator anterior vaginal wall prolapse repair using porcine dermis graft: intermediate term follow-up

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    Ayman Mahdy

    2013-07-01

    Full Text Available Introduction and Hypothesis We evaluated the anatomical success and complications of Perigee® with porcine dermis Graft in the repair of anterior vaginal wall prolapse (AVWP Materials and Methods After Institutional Review Board (IRB approval, the charts of all patients who underwent AVWP repair using the Perigee/InteXen® kit from July 2005 to July 2009 were reviewed. Patients who had less than 6-month follow-up were excluded. Preoperative data including patient age, previous AVWP repairs, hysterectomy status, preoperative dyspareunia and pertinent physical findings were collected and recorded. Postoperative success was defined as anatomical stage 0 or I using the Pelvic Organ Prolapse Quantification (POP-Q scoring system. Graft related complications were also recorded. Results Out of 89 patients, 69 completed at least 6-month follow-up. Median follow-up was 13 (6-48 months. Seventeen patients (25% had previous AVWP repair and 32 (46% had previous hysterectomy. Preoperatively, AVWP stage II was found in 9 (13%, stage III in 27 (39% and stage IV in 33 (48% patients. Anatomic success was found in 48 (69% patients, with 23 (33% having stage 0 and 25 (36% stage I AVWP. Intraoperative complications included incidental cystotomy in one patient and bladder perforation in one. Postoperative complications included vaginal exposure and dyspareunia in one case, wound dehiscence in one and tenderness over the graft arm with dyspareunia in one. conclusions The use of porcine dermis in AVWP repair is safe with minimal graft related complications; however, anatomical success is lower than that reported with the use of synthetic grafts.

  5. Self-reported menopausal symptoms, coronary artery calcification, and carotid intima-media thickness in recently menopausal women screened for the Kronos early estrogen prevention study (KEEPS).

    Science.gov (United States)

    Wolff, Erin Foran; He, Yunxiao; Black, Dennis M; Brinton, Eliot A; Budoff, Mathew J; Cedars, Marcelle I; Hodis, Howard N; Lobo, Rogerio A; Manson, Joann E; Merriam, George R; Miller, Virginia M; Naftolin, Fredrick; Pal, Lubna; Santoro, Nanette; Zhang, Heping; Harman, S Mitchell; Taylor, Hugh S

    2013-04-01

    To determine whether self-reported menopausal symptoms are associated with measures of subclinical atherosclerosis. Cross-sectional analysis. Multicenter, randomized controlled trial. Recently menopausal women (n = 868) screened for the Kronos Early Estrogen Prevention Study (KEEPS). None. Baseline menopausal symptoms (hot flashes, dyspareunia, vaginal dryness, night sweats, palpitations, mood swings, depression, insomnia, irritability), serum E2 levels, and measures of atherosclerosis were assessed. Atherosclerosis was quantified using coronary artery calcium (CAC) Agatston scores (n = 771) and carotid intima-media thickness (CIMT). Logistic regression model of menopausal symptoms and E2 was used to predict CAC. Linear regression model of menopausal symptoms and E2 was used to predict CIMT. Correlation between length of time in menopause with menopausal symptoms, E2, CAC, and CIMT were assessed. In early menopausal women screened for KEEPS, neither E2 nor climacteric symptoms predicted the extent of subclinical atherosclerosis. Palpitations and depression approached significance as predictors of CAC. Other symptoms of insomnia, irritability, dyspareunia, hot flashes, mood swings, night sweats, and vaginal dryness were not associated with CAC. Women with significantly elevated CAC scores were excluded from further participation in KEEPS; in women meeting inclusion criteria, neither baseline menopausal symptoms nor E2 predicted CIMT. Years since menopause onset correlated with CIMT, dyspareunia, vaginal dryness, and E2. Self-reported symptoms in recently menopausal women are not strong predictors of subclinical atherosclerosis. Continued follow-up of this population will be performed to determine whether baseline or persistent symptoms in the early menopause are associated with progression of cardiovascular disease. NCT00154180. Published by Elsevier Inc.

  6. Danish sexologists - who are they and what are they doing?

    DEFF Research Database (Denmark)

    Kristensen, Ellids; Giami, Alain

    2006-01-01

    were emotional and relational problems and erectile dysfunction for men, and emotional and relational problems and low desire for women. The non-physicians treated fewer males with erectile dysfunction, fewer females with dyspareunia but more victims of sexual abuse. More than half of the non......-physicians considered that the etiologies of sexual disorders were predominantly psychologically grounded in both genders, whereas less than 25% of the physicians shared this opinion. Most Danish sexologists including physicians have some training in psychotherapy and sexology. There are some differences between...

  7. A case of parasitic myoma 4 years after laparoscopic myomectomy

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    Osman Temizkan

    2014-01-01

    Full Text Available We present a case of parasitic myoma complaining of abdominal pain, constipation, dyspareunia and dysmenorrhea 4 years after laparoscopic myomectomy. We performed laparoscopic myomectomy for multiple parasitic myomas. Three myomas were very firmly attached to bowel and mesentery. Parasitic myoma after laparoscopic surgery is very rare condition there are almost 35 cases in the literature. It is related with variable symptoms or can be asymptomatic. Laparoscopic surgeons should be aware of this situation, and further investigation should be made in case of suspicion. Surgery for parasitic myomas can be difficult in case of bowel and mesentery involvement and patient should be informed about the extensive surgery.

  8. Severe Hemoperitoneum Following Rupture of Uterine Diverticulum due to Pregnancy: a Case Report

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    Yaghmaei Minoo

    2009-06-01

    Full Text Available Uterovaginal malformations, occur in 0.16% of women and contribute to the problems of infertility, recurrent pregnancy loss, dysmenorrhea, dyspareunia, amenorrhea and a poor outcome in pregnancy. True diverticulum is an exceedingly rare anomaly and is like a tubular formation connected to uterine cavity that ends in a cul-de sac and It is not classified as any of mullerian duct anomalies. In this article a case of uterine diverticulum rupture due to pregnancy in a 19 years old woman with nausea, vomiting and abdominal pain is reported. Although rare, in complicated pregnancy we should think to genital tract anomalies.

  9. Cuando el coito produce dolor: una exploración de la sexualidad femenina en el noroeste de México When coitus produce pain: an exploration of female sexuality in northwest Mexico

    Directory of Open Access Journals (Sweden)

    Hilda García-Pérez

    2010-04-01

    Full Text Available OBJETIVO: Determinar la prevalencia de dispareunia y los factores de riesgo asociados en población femenina en edades de 25 a 54 años. MATERIAL Y MÉTODOS: Se analizó información de 1183 mujeres sexualmente activas que participaron en un estudio poblacional de tipo transversal en la ciudad de Hermosillo, Sonora. La asociación entre dispareunia y variables sociodemográficas, antecedentes médicos y violencia sexual se analizó usando regresión logística múltiple. RESULTADOS: La prevalencia de dispareunia durante el año previo a la encuesta fue de 12.3% (IC 95% 10.5-14.4%. Después de controlar por la ocupación, se encontró que la dispareunia estuvo asociada con mujeres jóvenes (25-34 años, antecedentes de enfermedades de transmisión sexual y/o enfermedad inflamatoria de la pelvis, infección urinaria crónica, colitis y violencia sexual. CONCLUSIÓN: Es urgente incrementar el escrutinio y la atención de la dispareunia en el contexto de los programas nacionales de salud sexual y reproductiva y en los servicios de atención primaria a la salud.OBJECTIVE: To determine the prevalence of dyspareunia among women aged 25-54 and its associated risk factors. MATERIAL AND METHODS: A cross-sectional population-based study was carried out in the city of Hermosillo, Sonora and data from 1183 sexually active women were analyzed. A multiple logistic regression was computed to analyze the association between dyspareunia and sociodemographic characteristics, medical conditions and sexual violence. RESULTS: The 12-month prevalence of dyspareunia was estimated to be 12.3% (95% CI 10.5, 14.4. After adjustment for working conditions, dyspareunia was associated with younger ages (25-34 years, history of sexually transmitted diseases/pelvic inflammatory disease, chronic urinary tract infections, colitis and history of sexual violence. CONCLUSION: Increased attention to this condition by reproductive health programs and primary care services is urgently

  10. Endometriosis treated by the method of resolving blood stasis to eliminate obstruction in the lower-jiao.

    Science.gov (United States)

    Wang, D; Wang, Z; Yu, C

    1998-03-01

    48 cases of endometriosis were treated with the Neiyi (ectopic endometrium) No. 2 Pills [symbol: see text] 2 [symbol: see text]) composed of fresh Dahuang (Radix et Rhizoma Rhei), Biejia (Carapax Trionycis) and Taoren Shuang (powdered Semen Persicae). After 3 months of treatment, high effective rates were obtained in menorrhalgia, dyspareunia, proctalgia, hysteromyoma, ovary cyst, and tubercles in the pelvic cavity, with a pregnant rate of as high as 26.7% in sterility. Meanwhile, the levels of plasma PGF2 alpha and PGE2 markedly dropped, while that of 6-keto-PGF1 alpha, beta-EP, and HYP significantly elevated.

  11. Patient Satisfaction of Surgical Treatment of Clitoral Phimosis and Labial Adhesions Caused by Lichen Sclerosus

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    Anne N. Flynn, MD

    2015-12-01

    Conclusions: This study shows high patient satisfaction and low complication risk associated with surgical correction of clitoral phimosis and lysis of vulvar adhesions for VGF caused by LS. Patients reported improvement in clitoral sensation and ability to achieve orgasm, as well as decreased dyspareunia. Surgical correction of vulvar scarring is a viable option to restore vulvar anatomy and sexual function in appropriate candidates with anogenital LS. Flynn AN, King M, Rieff M, Krapf J, and Goldstein AT. Patient satisfaction of surgical treatment of clitoral phimosis and labial adhesions caused by lichen sclerosus. Sex Med 2015;3:251–255.

  12. Acute abdomen in a case with noncommunicating rudimentary horn and unicornuate uterus.

    Science.gov (United States)

    Atmaca, Rusen; Germen, Aysegul Tezcan; Burak, Feza; Kafkasli, Ayse

    2005-01-01

    Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the female genital system, causing many obstetrical and gynecologic complications. The frequency of this pathology is approximately 1/100 000. A rudimentary horn usually develops following insufficient development of mullerian ducts. These patients present with dysmenorrhea, dyspareunia, and chronic pelvic pain because of endometriosis and rarely with acute abdominal symptoms following distention and torsion of the noncommunicating rudimentary horn. The case of a patient referred for acute abdomen after distention of a noncommunicating rudimentary horn is presented herein.

  13. Colostrum in menopause effects on vaginal cytology/symptoms.

    Science.gov (United States)

    Tucci, S; Mancini, R; De Vitis, C; Noto, A; Marra, E; Lukic, A; Giovagnoli, M R; Moscarini, M

    2013-01-01

    The aim of this study was to assess the effects of three weeks of daily colostrum cream on vaginal cytology and local symptoms related to menopause. Genito-urinary symptoms and cell morphology were analyzed at time 0 (T0) and after three weeks (16 +/- days since the end of treatment) at time 1 (T1). Dyspareunia, vaginal dryness, and maturation index (MI) reached a statistically significant difference between T0 and T1. The results proved to be an alternative treatment for vaginal distress caused by lack of hormones in patients in which hormonal treatment is contraindicated.

  14. Vulvar and Vaginal Atrophy: Physiology, Clinical Presentation, and Treatment Considerations.

    Science.gov (United States)

    Lev-Sagie, Ahinoam

    2015-09-01

    Vulvovaginal atrophy is a common condition associated with decreased estrogenization of the vaginal tissue. Symptoms include vaginal dryness, irritation, itching, soreness, burning, dyspareunia, discharge, urinary frequency, and urgency. It can occur at any time in a woman's life cycle, although more commonly in the postmenopausal phase, during which the prevalence is approximately 50%. Despite the high prevalence and the substantial effect on quality of life, vulvovaginal atrophy often remains underreported and undertreated. This article aims to review the physiology, clinical presentation, assessment, and current recommendations for treatment, including aspects of effectiveness and safety of local vaginal estrogen therapies.

  15. Ingvinal endometriose

    DEFF Research Database (Denmark)

    Lajer, Henrik; Kristensen, Jens; Kjer, Jens Jørgen

    2009-01-01

    Inguinal endometriosis is a rare manifestation of endometriosis. Four cases are presented. In three of these cases proper diagnosis was delayed due to differential diagnostic difficulties as the symptoms in these cases were interpreted as hernia. In two cases the patient underwent hernia surgery....... In inguinal lump cases in fertile women, endometriosis should be considered if accompanied by dysmenorrhoea or deep dyspareunia. In such cases MRI (magnetic resonance imaging) scans often yield further diagnostic information. If surgery is needed, it should be performed in a gynaecological setting...

  16. Microablative fractional CO2 laser for the genitourinary syndrome of menopause: power of 30 or 40 W?

    Science.gov (United States)

    Pitsouni, Eleni; Grigoriadis, Themos; Falagas, Matthew; Tsiveleka, Angeliki; Salvatore, Stefano; Athanasiou, Stavros

    2017-08-02

    This retrospective case-control study aimed to compare 30 versus 40 W power of CO2 laser for the therapy of genitourinary syndrome of menopause (GSM). Postmenopausal women with severe intensity of dyspareunia and dryness were eligible to be included in this study. Primary outcomes were dyspareunia and dryness. Secondary outcomes were itching/burning, dysuria, frequency and urgency, Female Sexual Function Index (FSFI), vaginal maturation value (VMV), and Vaginal Health Index Score (VHIS). One laser therapy was applied every month for 3 months. Outcomes were evaluated at baseline and 1 month following the 3rd therapy. Fifty (25 per group) women were included in this study. In the 30-W group, mean improvement of dyspareunia, dryness, itching/burning, FSFI, VMV, and VHIS was 6.1 ± 1.7, 6.0 ± 1.9, 5.9 ± 2.0, 16.6 ± 6.7, 29.9 ± 13.0, and 11.0 ± 2.9, respectively (within group comparisons all p < 0.001). In the 40-W group, mean improvement of dyspareunia, dryness, itching/burning, FSFI, VMV, and VHIS was 6.1 ± 1.7, 6.5 ± 2.0, 5.2 ± 2.5, 14.8 ± 7.1, 25.0 ± 13.4, and 10.5 ± 4.1, respectively (within-group comparisons, all p ≤ 0.001). Comparison between 30 and 40 W revealed that mean improvement or presence of all GSM symptoms and clinical signs was not statistically significant different. CO2 laser therapy may improve GSM symptoms and clinical signs. This improvement did not seem to associate to power of 30 or 40 W.

  17. Chronic adverse events and quality of life after radiochemotherapy in anal cancer patients. A single institution experience and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Fakhrian, K. [Universitaetsklinikum Bochum, Marienhospital Herne (Germany). Dept. of Radiation Oncology; Technische Univ. Muenchen, Klinikum Rechts der Isar (Germany). Dept. of Radiation Oncoalogy; Sauer, T.; Klemm, S.; Molls, M. [Technische Univ. Muenchen, Klinikum Rechts der Isar (Germany). Dept. of Radiation Oncoalogy; Dinkel, A. [Technische Univ. Muenchen, Klinikum Rechts der Isar (Germany). Dept. of Psychosomatic Medicine and Psychotherapy; Schuster, T. [Technische Univ. Muenchen, Klinikum Rechts der Isar (Germany). Inst. of Medical Statistics and Epidemiology; Geinitz, H. [Technische Univ. Muenchen, Klinikum Rechts der Isar (Germany). Dept. of Radiation Oncoalogy; Krankenhaus der Barmherzigen Schwestern, Linz (Austria). Dept. of Radiation Oncology

    2013-06-15

    Purpose: To report on chronic adverse events (CAE) and quality of life (QOL) after radiochemotherapy (RCT) in patients with anal cancer (AC). Patients and methods: Of 83 patients who had received RCT at our department between 1988 and 2011, 51 accepted the invitation to participate in this QOL study. CAE were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) v. 4.0 and QOL was assessed with the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) questionnaire. Results: CAE could be evaluated in 49 patients. There was a tendency toward a higher rate of grade 3 CAE in female patients, i.e. 18 out of 37 (49 %) vs. 2 out of 12 (17 %) male patients (p = 0.089). The most common grade 3 CAE were dyspareunia and vaginal symptoms (itching, burning and dryness) in 35 and 22 % of female patients, respectively, followed by stool incontinence in 13 % of all patients (6 out of 49). Both FACT-C and CAE information were available for 42 patients, allowing evaluation of the impact of CAE on QOL. The median total FACT-C score was 110 (40-132) out of a possible maximum of 136. The absence of grade 3 CAE (115 vs. 94, p = 0.001); an interval of {>=} 67 months after the end of the treatment (111 vs. 107, p = 0.010), no stool incontinence vs. grade 3 stool incontinence (111 vs. 74, p = 0.009), higher education (114 vs. 107, p = 0.013) and no dyspareunia vs. grade 3 dyspareunia (116 vs. 93, p = 0.012) were significantly associated with a higher median FACT-C score. Conclusion: The majority of AC patients treated with RCT have acceptable overall QOL scores, which are comparable to those of the normal population. Patients with grade 3 CAE - particularly dyspareunia and fecal incontinence - have a poorer QOL compared to patients without CAE. In order to improve long-term QOL, future strategies might aim at a reduction in dose to the genitalia and more intensive patient support measures. (orig.)

  18. Pain recurrence after shaving of rectovaginal endometriosis

    DEFF Research Database (Denmark)

    Heide, Mathias Gottschalck; Forman, Axel

    on the bowel with risk of recurrence. This could motivate a change into more radical surgery. In the present study we therefore assessed recurrence of pain after shaving of rectovaginal endometriosis performed 2001-2009. Methods: Retrospective follow-up study. Questionnaires were sent to 212 women of whom 174...... women (82%) responded. Outcomes were correlated to the involvement of the anterior rectal wall and postoperative hormonal treatment. Results: Recurrence (pain unchanged or worse) of menstrual pain was found in 26 %, intermenstrual pain in 29 %, dyspareunia in 42 % and dyschezia in 41 %. Postoperative...

  19. Early-stage cervical carcinoma, radical hysterectomy, and sexual function. A longitudinal study

    DEFF Research Database (Denmark)

    Jensen, Pernille T; Groenvold, Mogens; Klee, Marianne C

    2004-01-01

    BACKGROUND: Limited knowledge exists concerning the impact of radical hysterectomy (RH) alone on the sexual function of patients with early-stage cervical carcinoma. The authors investigated the longitudinal course of self-reported sexual function after RH. METHODS: The current study was comprised...... with an age-matched control group from the general population. RESULTS: Compared with control women, patients experienced severe orgasmic problems and uncomfortable sexual intercourse due to a reduced vaginal size during the first 6 months after RH, severe dyspareunia during the first 3 months, and sexual...

  20. Super Infection of An Ovarian Dermoid Cyst with Actinomyces in An Infertile Woman

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    Saghar Salehpour

    2013-01-01

    Full Text Available We present super infection of an ovarian dermoid cyst with actinomyces in an infertile patient.This is a case-report study for evaluation a couple with male factor infertility, who was a goodcandidate for intracytoplasmic sperm injection (ICSI, while a 10 cm dermoid cyst was foundin the woman’s right ovary. Patient complained of pelvic pain, intermittent fever, dysmenorrhea,and dyspareunia. The cyst was extracted using laparoscopy, whilst in histopathologicalexamination, an actinomycosis super infection was reported. Actinomyc super infection of anovarian dermoid cyst is a very rare incident which can also occur in women with no history ofintrauterine device (IUD usage or previous fertility.

  1. Super infection of an ovarian dermoid cyst with actinomyces in an infertile woman.

    Science.gov (United States)

    Salehpour, Saghar; Akbari Sene, Azadeh

    2013-07-01

    We present super infection of an ovarian dermoid cyst with actinomyces in an infertile patient. This is a case-report study for evaluation a couple with male factor infertility, who was a good candidate for intracytoplasmic sperm injection (ICSI), while a 10 cm dermoid cyst was found in the woman's right ovary. Patient complained of pelvic pain, intermittent fever, dysmenorrhea, and dyspareunia. The cyst was extracted using laparoscopy, whilst in histopathological examination, an actinomycosis super infection was reported. Actinomyc super infection of an ovarian dermoid cyst is a very rare incident which can also occur in women with no history of intrauterine device (IUD) usage or previous fertility.

  2. Super Infection of An Ovarian Dermoid Cyst with Actinomyces in An Infertile Woman

    Science.gov (United States)

    Salehpour, Saghar; Akbari Sene, Azadeh

    2013-01-01

    We present super infection of an ovarian dermoid cyst with actinomyces in an infertile patient. This is a case-report study for evaluation a couple with male factor infertility, who was a good candidate for intracytoplasmic sperm injection (ICSI), while a 10 cm dermoid cyst was found in the woman’s right ovary. Patient complained of pelvic pain, intermittent fever, dysmenorrhea, and dyspareunia. The cyst was extracted using laparoscopy, whilst in histopathological examination, an actinomycosis super infection was reported. Actinomyc super infection of an ovarian dermoid cyst is a very rare incident which can also occur in women with no history of intrauterine device (IUD) usage or previous fertility. PMID:24520476

  3. Desquamative inflammatory vaginitis as a manifestation of vitamin D deficiency associated with Crohn disease: case reports and review of the literature.

    Science.gov (United States)

    Peacocke, Monica; Djurkinak, Erin; Tsou, Hui C; Thys-Jacobs, Susan

    2010-07-01

    Desquamative inflammatory vaginitis (DIV) is a chronic disorder associated with yellow vaginal discharge, vulvovaginal burning and pruritus, and dyspareunia. The cause of DIV is unknown; however, infectious, hormonal, and inflammatory etiologies have been proposed. In this series, we observe the association of DIV and vitamin D deficiency by reporting 4 cases of women with DIV and vitamin D deficiency associated with Crohn disease. We further show that the DIV symptoms resolve when the circulating concentrations of 25-hydroxyvitamin D (25-HD) returned to normal. These data provide further support for the notion that DIV can be associated with vitamin D deficiency and DIV symptoms reflect altered vaginal mucous membrane function.

  4. Complete androgen insensitivity syndrome

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    Tančić-Gajić Milina

    2015-01-01

    Full Text Available Introduction. Androgen insensitivity syndrome (AIS belongs to disorders of sex development, resulting from complete or partial resistance to the biological actions of androgens in persons who are genetically males (XY with normally developed testes and age-appropriate for males of serum testosterone concentration. Case Outline. A 21-year-old female patient was admitted at our Clinic further evaluation and treatment of testicular feminization syndrome, which was diagnosed at the age of 16 years. The patient had never menstruated. On physical examination, her external genitalia and breast development appeared as completely normal feminine structures but pubic and axillary hair was absent. Cytogenetic analysis showed a 46 XY karyotype. The values of sex hormones were as in adult males. The multisliced computed tomography (MSCT showed structures on both sides of the pelvic region, suggestive of testes. Bilateral orchiectomy was performed. Hormone replacement therapy was prescribed after gonadectomy. Vaginal dilatation was advised to avoid dyspareunia. Conclusion. The diagnosis of complete androgen insensitivity is based on clinical findigs, hormonal analysis karyotype, visualization methods and genetic analysis. Bilateral gonadectomy is generally recommended in early adulthood to avoid the risk of testicular malignancy. Vaginal length may be short requiring dilatation in an effort to avoid dyspareunia. Vaginal surgery is rarely indicated for the creation of a functional vagina. [Projekat Ministarstva nauke Republike Srbije, br. 175067

  5. Sexual function in menopausal women in Kelantan, Malaysia.

    Science.gov (United States)

    Dhillon, Hardip Kaur; Singh, Harbindar Jeet; Ghaffar, Nor Aliza Abdul

    2005-01-01

    The aim of the study was to document sexual function in Kelantanese postmenopausal women. A semi-structured questionnaire in Malay language was administered to 326 women (mean age of 57.1+/-6.58 (S.D.) years) residing in Kelantan. The subjects comprised of naturally menopaused, healthy women. Of the total respondents, 70% (n=227) were with a spouse at the time of the study. Of these, more than two-thirds reported a decrease in sexual activity following menopause. Varying degree of dyspareunia was reported by 44% of the women. A small fraction (8.8%) reported inability of the vagina to stretch sufficiently to enable the complete penetration of an erect penis. Of the total married respondents, vaginal secretion during sexual intercourse was decreased in 52.4%, did not change in 31% but increased in 1.3% of the women following menopause. Sexual desire was reportedly decreased or absent in two-thirds of the total respondents (n=326). It appears that sexual function significantly decreases during menopause. This may be due to dyspareunia, poor lubrication, loss of sexual desire, and the spouse's health status and ageing itself. Although declining sexual function was recognised by nearly two-thirds of the women, more than half did not take any action to improve their sexual function. Of those who did, they used hormonal therapy, traditional, alternative medicine or practiced healthy lifestyle or a varied combination of above self-help actions.

  6. Diagnosis, management, and long-term outcomes of rectovaginal endometriosis

    Directory of Open Access Journals (Sweden)

    Moawad NS

    2013-11-01

    Full Text Available Nash S Moawad,1 Andrea Caplin21Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Florida, 2University of Florida College of Medicine, Gainesville, FL, USAAbstract: Rectovaginal endometriosis is the most severe form of endometriosis. Clinically, it presents with a number of symptoms including chronic pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia, and rectal bleeding. The gold standard for diagnosis is laparoscopy with histological confirmation; however, there are a number of options for presurgical diagnosis, including clinical examination, transvaginal/transrectal ultrasound, magnetic resonance imagining, colonoscopy, and computed tomography colonography. Treatment can be medical or surgical. Medical therapies include birth control pills, oral progestins, gonadotropin-releasing hormone agonists, danazol, and injectable progestins. Analgesics are often used as well. Surgery improves up to 70% of symptoms. Surgery is either ablative or excisional, and is conducted via transvaginal, laparoscopic, laparotomy, or combined approaches. Common surgical techniques involve shaving of the superficial rectal lesion, laparoscopic anterior discoid resection, and low anterior bowel resection and reanastomosis. Outcomes are generally favorable, but postoperative complications may include intra-abdominal bleeding, anastomotic leaks, rectovaginal fistulas, strictures, chronic constipation, and the need for reoperation. Recurrence of rectal endometriosis is a possibility as well. Other outcomes are improved pain-related symptoms and fertility. Long-term outcomes vary according to the management strategy used. This review will provide the most recent approaches and techniques for the diagnosis and treatment of rectovaginal endometriosis.Keywords: pelvic pain, dyspareunia, bowel resection, endometriosis, rectovaginal

  7. Evaluation of sexual attitude and sexual function in menopausal age; a population based cross-sectional study

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    Somayeh Hashemi

    2013-01-01

    Full Text Available Background: Menopause and its physical, hormonal and psychosocial changes could affect women’s sexual function. There are controversial results regarding relationship between sexual attitudes and function. Objective: We aimed to evaluate sexual attitudes and sexual function among Iranian menopausal age women. Materials and Methods: This population based cross-sectional study was carried out on 225 menopausal women, aged 45-65 years. Based on a self-made questionnaire data were collected about women’s socio-demographic characteristics, attitudes regarding sexuality and sexual function. Data were analyzed using SPSS and sexual function was compared between three groups of women who had positive, medium and negative attitudes regarding sexuality. Results: The mean age of women was 53.11±4.56 years. Seventy percent of them had at least one sexual problem. Feeling of dyspareunia was significantly different between three categories of attitudes regarding sexuality (p=0.03. Comparing data obtained on their attitudes, sexual desire, orgasm and dyspareunia demonstrated significant differences (p=0.03, 0.04, and 0.04 respectively. Conclusion: Attitude regarding sexual function has a great impact on sexual activity of postmenopausal women that need to be considered in their health care programming.

  8. Safety, Efficiency, and Outcomes of Perineoplasty: Treatment of the Sensation of a Wide Vagina

    Directory of Open Access Journals (Sweden)

    Mustafa Ulubay

    2016-01-01

    Full Text Available Background. The sensation of a wide vagina is a common problem for women after childbirth. As its etiology is unknown, there is no uniform management strategy. We hypothesized that, rather than vaginal laxity, the cause was level 3 pelvic support deficiency. Methods. This retrospective study compared preoperative and postoperative genital hiatus length, perineal length, and total vaginal length in patients treated with perineoplasty for the sensation of a wide vagina. A telephone survey was used to determine postoperative patient and male partner satisfaction rates. Results. Mean age of patients was 48 (26–68 years; mean body mass index (BMI was 25.3 (17.6–33.2; and mean parity was 2.5 (2–5. Preoperative and postoperative genital hiatus, perineal length, and total vaginal length were 4.62 and 3.18 (p<0.01, 3.06 and 4.04 (p<0.01, and 9.43 and 9.43 (p=0.882, respectively. At the 6-month follow-up, the success rate of the perineoplasty procedure was 87.9%; according to a visual analog scale, partner satisfaction rate was 92.6%. Ten percent (n=4 of patients said they experienced dyspareunia during sexual intercourse at the introitus of the vagina. Conclusion. With low dyspareunia rates, low complication rates, high patient satisfaction, and satisfactory anatomical success, perineoplasty can be considered successful for treatment of the sensation of a wide vagina.

  9. Impact of Delivery Types on Women's Postpartum Sexual Health

    Institute of Scientific and Technical Information of China (English)

    Huan-ying WANG; Xiao-yang XU; Zhen-wei YAO; Qin ZHOU

    2003-01-01

    Objective To investigate the impact of childbirth on the sexual health of primiparous women in China and the prevalence of women's postpartum sexual problems Method In this cross-sectional study, obstetric records of 460 primiparous women delivering a live-birth at the First Affiliated Hospital of Chongqing University of Medical Sciences between November 1, 2000 and July 31, 2001 were analyzed together with the data collected from questionnaire survey conducted six months after delivery.Results Totally 460 women participated in the questionnaire survey. Though 94. 74% of the subjects had resumed sexual activity within six months after birth, most of them had experienced postpartum sexual problems, among which dyspareunia was the most common type. There was no significant association between delivery types and women's sexual health status in six months after birth, including their satisfactory degree of sexual intercourse, sexual desire, sex active rate, the incidence of dyspareunia and pubococcygeal muscle strength ( P>0. 05 ). Only 20.80%of women had knowledge of sexual health and 8.02% of them had consulted for sexual problems.Conclusions Women's postpartum sexual health problems were very common, they deserve more attention. There was no significant association between delivery types and women's postpartum sexual problems at the 6th month after delivery.

  10. Concomitant Laparoscopic Burch Urethropexy and Combined Vaginal-Laparoscopic Mesh Sling Removal (x2 for Pain and Persistent Stress Urinary Incontinence

    Directory of Open Access Journals (Sweden)

    Sarah A. Huber

    2016-01-01

    Full Text Available Although midurethral mesh tape slings are considered the standard of care in the treatment of female stress urinary incontinence (SUI, complications such as pain, dyspareunia, or erosion are known to occur in addition to persistent incontinence. The management of these types of mesh sling complications can be very complex, especially when the pain is not just isolated to the vagina but extends into other areas, such as the abdomen which requires a much more extensive dissection. Additionally, if a mesh sling needs to be removed, the patient will most likely have a return of her SUI that often necessitates subsequent treatment. Vaginal and/or laparoscopic removal or revision of mesh tape slings should be considered in patients presenting with complications such as vaginal pain, abdominal pain, dyspareunia, or urinary obstructive symptoms. In those patients who demonstrate persistent SUI, concomitant laparoscopic Burch urethropexy can be considered and can safely be performed at the time mesh removal. In this case report we present a patient who required a dual-approach removal of two painful midurethral slings in addition to concomitant treatment of persistent SUI with a laparoscopic Burch urethropexy procedure.

  11. Reduction in Endometrioma Size with Three Months of Aromatase Inhibition and Progestin Add-Back.

    Science.gov (United States)

    Agarwal, Sanjay K; Foster, Warren G

    2015-01-01

    The purpose of this study was to assess the impact of 3 months of aromatase inhibition together with progestin add-back on ovarian endometrioma size. This prospective cohort study was performed at University Medical Center (UC San Diego). Women trying to conceive were excluded. After informed consent, all women were treated with the aromatase inhibitor letrozole (5 mg/d) with norethindrone acetate (5 mg/d) add-back for 3 months. Pre- and posttreatment assessments of endometrioma sizes were performed by ultrasound. The impact of treatment on pain was determined using the patient assessed endpoints of the Biberoglu and Behrman scale. These included assessing dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain each on a scale from 0 to 3. The primary endpoint of this study was the change in ultrasound documented endometrioma size. Fourteen endometriomas in 8 consecutive women were treated for 3 m. Mean endometrioma diameter decreased 50% from 4.6 ± 1.6 cm to 2.3 ± 1.6 cm (mean ± SD). This represents a 75% decrease in endometrioma volume. Endometriosis symptoms of dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain also improved with treatment. In conclusion, a 3-month course of high dose aromatase inhibition with progestin add-back significantly reduces ovarian endometrioma size and warrants further investigation.

  12. Female sexual function following mid-urethral slings for the treatment of stress urinary incontinence.

    Science.gov (United States)

    Alwaal, A; Tian, X; Huang, Y; Zhao, L; Ma, L; Lin, G; Deng, D

    2016-07-01

    The aim of our study was to describe the impact of mid-urethral sling procedure for the treatment of stress urinary incontinence (SUI) on female sexual function. We used PubMed (updated March 2015) to conduct a literature electronic search that included peer-reviewed English language articles. We analyzed the studies about the impact of mid-urethral slings on female sexual function. There are different and contradictory results of the effects of mid-urethral sling on female sexual function. However, more papers show that women undergoing mid-urethral sling procedures report that their sexual function is improved or remains unchanged. The main mechanism of this improved sexuality is the complete relief from coital incontinence, reduction in anxiety and avoidance of sex, whereas the most common symptom related to worsened sexual activity is dyspareunia. Women undergoing sling procedures for SUI should be informed that their sexual activity is likely to remain unchanged or even improve after the operation, but that dyspareunia may occur.

  13. Negative affect and somatically focused anxiety in young women reporting pain with intercourse.

    Science.gov (United States)

    Meana, Marta; Lykins, Amy

    2009-01-01

    After a long history of privileging psychosexual etiological factors over pain and physiological processes, dyspareunia has enjoyed 1 decade of pointed research focused on the presenting problem of pain. Although it is generally acknowledged that certain affective and cognitive styles may play a role in an individual's experience of pain in general, investigations into these questions specifically as they pertain to pain that occurs during sex are relatively scarce. To add to this growing body of knowledge, 759 women aged 18 to 29 completed questionnaires about current sexual functioning, gynecologic history, expectations about intercourse, and various personality and health-related anxiety measures. One-hundred-one women (14% of the sample) reported pain during intercourse on at least 50% of attempts. This group of women significantly differed from 536 women reporting pain on less than 10% of intercourse attempts on personality constructs related to emotional and relational well-being (e.g., neuroticism, extraversion, agreeableness), as well as anxiety sensitivity, anxiety related to physical health concerns, and the amplification of somatosensory experiences. This affective and cognitive profile is consistent with previous studies that have found an attentional hypervigilance to health and pain-related information in women with dyspareunia, all of which could prove germane to cognitive-behavioral treatments targeting this disorder.

  14. A comparative study of sexual function, behavior, and cognitions of women with lifelong vaginismus.

    Science.gov (United States)

    Cherner, Rebecca A; Reissing, Elke D

    2013-11-01

    Vaginismus is classified as a sexual dysfunction, yet limited research is available on the sexual function and behavior of women with this condition. Comparing women with lifelong vaginismus to women with lifelong dyspareunia and women with no pain during intercourse, this study explored sexual function, anxiety, and behavior along with cognitions related to vaginal penetration. A total of 152 women completed an online survey that included a series of validated questionnaires. Main findings indicated that, relative to both comparison groups, women in the vaginismus group reported a more limited range of sexual behavior across the lifespan and more maladaptive cognitions related to fear of losing control of one's body and the situation during penetration. Compared to the no-pain group, both symptomatic groups reported more difficulties across several indicators of sexual function, more limited sexual behavior in the past year and past month, and more maladaptive cognitions related to vaginal penetration. However, women with vaginismus reported more sexual desire and less difficulty with lubrication compared to women with dyspareunia. Numerous sexual problems extending beyond vaginal penetration difficulties were confirmed, suggesting a need for broader treatment approaches not limited to the experience of vaginal penetration. Results were discussed as they relate to the fear-avoidance model of vaginismus.

  15. Sexual function in females after radiotherapy for rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bruheim, Kjersti; Tveit, Kjell Magne; Guren, Marianne G. (The Cancer Centre, Oslo Univ. Hospital, Ullevaal, Oslo (Norway)), E-mail: Kjersti.bruheim@medisin.uio.no; Fossaa, Sophie D. (Faculty of Medicine, Univ. of Oslo, Oslo (Norway)); Skovlund, Eva (School of Pharmacy, Univ. of Oslo, Oslo (Norway)); Balteskard, Lise (Dept. of Oncology, Univ. Hospital of Northern Norway, Tromsoe (Norway)); Carlsen, Erik (Dept. of Clinical Cancer Research, Oslo Univ. Hospital, The Norwegian Radium Hospital, Oslo (Norway))

    2010-08-15

    Background. Knowledge about female sexual problems after pre- or postoperative (chemo-)radiotherapy and radical resection of rectal cancer is limited. The aim of this study was to compare self-rated sexual functioning in women treated with or without radiotherapy (RT+ vs. RT?), at least two years after surgery for rectal cancer. Methods and materials. Female patients diagnosed from 1993 to 2003 were identified from a national database, the Norwegian Rectal Cancer Registry. Eligible patients were without recurrence or metastases at the time of the study. The Sexual function and Vaginal Changes Questionnaire (SVQ) was used to measure sexual functioning. Results. Questionnaires were returned from 172 of 332 invited and eligible women (52%). The mean age was 65 years (range 42-79) and the time since surgery for rectal cancer was 4.5 years (range 2.6-12.4). Sexual interest was not significantly impaired in RT+ (n=62) compared to RT? (n=110) women. RT+ women reported more vaginal problems in terms of vaginal dryness (50% vs. 24%), dyspareunia (35% vs. 11%) and reduced vaginal dimension (35% vs. 6%) compared with RT? patients; however, they did not have significantly more worries about their sex life. Conclusion. An increased risk of dyspareunia and vaginal dryness was observed in women following surgery combined with (chemo-)radiotherapy compared with women treated with surgery alone. Further research is required to determine the effect of adjuvant therapy on female sexual function

  16. Vaginal erbium laser: the second-generation thermotherapy for the genitourinary syndrome of menopause.

    Science.gov (United States)

    Gambacciani, M; Levancini, M; Cervigni, M

    2015-10-01

    Aim To evaluate the effects of the vaginal erbium laser (VEL) in the treatment of postmenopausal women suffering from genitourinary syndrome of menopause (GSM). Method GSM was assessed in postmenopausal women before and after VEL (one treatment every 30 days, for 3 months; n = 45); the results were compared with the effects of a standard treatment for GSM (1 g of vaginal gel containing 50 μg of estriol, twice weekly for 3 months; n = 25). GSM was evaluated with subjective (visual analog scale, VAS) and objective (Vaginal Health Index Score, VHIS) measures. In addition, in 19 of these postmenopausal women suffering from stress urinary incontinence (SUI), the degree of incontinence was evaluated with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before and after VEL treatments. Results VEL treatment induced a significant decrease of VAS of both vaginal dryness and dyspareunia (p vaginal dryness, dyspareunia and mild to moderate SUI. Further studies are needed to explore the role of laser treatments in the management of GSM.

  17. Effect of ultra-low-dose estriol and lactobacilli vaginal tablets (Gynoflor®) on inflammatory and infectious markers of the vaginal ecosystem in postmenopausal women with breast cancer on aromatase inhibitors.

    Science.gov (United States)

    Donders, G; Bellen, G; Neven, P; Grob, P; Prasauskas, V; Buchholz, S; Ortmann, O

    2015-10-01

    This study was a detailed microscopic analysis of the changes of vaginal microflora characteristics after application of 0.03 mg estriol-lactobacilli combination on the vaginal ecosystem in postmenopausal breast cancer (BC) survivors on aromatase inhibitors (AI) with severe atrophic vaginitis. A total of 16 BC women on AI applied daily one vaginal tablet of Gynoflor® for 28 days followed by a maintenance therapy of three tablets weekly for 8 weeks. During four follow up visits a smear from the upper lateral vaginal wall was analysed by phase contrast microscopy at 400 times magnification in order to classify the lactobacillary grades(LBG), bacterial vaginosis (BV), aerobic vaginitis (AV), vulvovaginal candidosis (VVC), proportional number of leukocytes and evidence of parabasal cells and epitheliolysis. LBG improved from 81% LBG-III at entry to 88% LBG-I&IIa after 2 weeks of initial therapy, which further improved upon follow up (p vaginal use of ultra-low dose estriol and lactobacilli results in rapid and enduring improvement of all markers of the vaginal microflora and epithelial vaginal cell quality in women with breast cancer on AI with dyspareunia. Candida may develop soon after its use, but rapidly disappears again upon their prolonged use. Due to its excellent safety profiles and clinical efficacy we recommend this product as first choice in women on AI with severe dyspareunia.

  18. Sling for correcting uterine prolapse: twelve years experience.

    Science.gov (United States)

    Khanam, R A; Rubaiyat, A; Azam, M S

    2014-01-01

    Pelvic organ prolapse is a common morbidity among Bangladeshi women. Both patient and surgeon prefer vaginal hysterectomy for the treatment of this condition and occasionally they choose Fothergill's operation. Uterine suspension is suitable for the young women to preserve the uterus. This observational study was carried out in three teaching hospitals and two other non government hospitals for the period of 12 years among 280 patients with 1st, 2nd and 3rd degree uterine prolapse. Follow up done at 6th week , 6th month, 1st year, 5th year, 10th year and 12th year for recurrence of prolapse, dragging pain and dyspareunia. Among 280 patients >60% patients were of 26-30 years age group. In last follow up at 12th year 2(0.71%) women complained feeling of some descend of uterus, 1(0.36%) complained dragging pain in abdomen and I (0.36%) complained dyspareunia. All patients expressed satisfaction which indicates psychological well being. Uterine sling is an effective procedure to save uterus in young women to improve their quality of life.

  19. An evaluation of quality of life in women with endometriosis who underwent primary surgery: a 6-month follow up in Sabah Women & Children Hospital, Sabah, Malaysia.

    Science.gov (United States)

    M F, Ahmad; Narwani, Hussin; Shuhaila, Ahmad

    2017-10-01

    Endometriosis is a complex disease primarily affecting women of reproductive age worldwide. The management goals are to improve the quality of life (QoL), alleviate the symptoms and prevent severe disease. This prospective cohort study was to assess the QoL in women with endometriosis that underwent primary surgery. A pre- and post-operative questionnaire via ED-5Q and general VAS score used for the evaluation for endometrial-like pain such as dysmenorrhoea and dyspareunia. A total of 280 patients underwent intervention; 224 laparoscopically and 56 via laparotomy mostly with stage II disease with ovarian endometriomas. Improvements in dysmenorrhoea pain scores from 5.7 to 4.15 and dyspareunia from 4.05 to 2.17 (p improved; 6.66-4.68 post-operatively (p intervention. There was no correlation between the stage of disease and endometrial pain; (p = .289), method of intervention (p = .290) and usage of post-operative hormonal therapy (p = .632). This study concluded that surgical treatment improved the QoL with added hormonal therapy post-intervention, despite not reaching statistical significance, showed a promising result. Impact statement Surgical intervention does improve the QoL for women with endometriosis however post interventional hormonal therapy is remain inconclusive.

  20. The Effect of Vitamin D Suppository on Atrophic Vaginal Mucosa in Menopausal Women

    Directory of Open Access Journals (Sweden)

    M Tadayon

    2012-08-01

    Full Text Available Background & aim: Menopause is accompanied with many problems such as coital discomfort, reduction of endometrial thickness and an increase in pH. Vitamin D is effective on proliferation and repair of epithelial tissue. Therefore, this study was conducted to determine the effect of vitamin D on vaginal atrophy among menopause women. Methods: In the present double-blind clinical trial study, forty-four women were randomly divieded into two groups. Treatment group received the vitamin D vaginal suppository, and the control group received placebo vaginal suppository in an 8 week period. Dyspareunia was assessed in first, 2, 4 and 8 weeks visit. The mean of Ph and maturation index of superficial cells were measured in the begnning of the study and at the end of the eighth week. The mann-whitney test was used for data analysis. Results: The mean of superficial cells and vaginal pH in the treatment group were (69.76±12.4 (1.42±.67 respectively while these figures were 54.66±18.38 and 2.9±0.73 for the control group.. The mean of sexual pain decreased considerably in the treatment group. Conclusion: Vitamin D is effective in maturation index and decreased pH and dyspareunia in menopause women.

  1. Clinical update on the use of ospemifene in the treatment of severe symptomatic vulvar and vaginal atrophy

    Directory of Open Access Journals (Sweden)

    Palacios S

    2016-10-01

    Full Text Available Santiago Palacios,1 María Jesús Cancelo2 1Palacios Institute of Women’s Health, Madrid, Spain; 2Gynecology and Obstetrics Department, Guadalajara University Hospital, University of Alcalá, Spain Abstract: The physiological decrease in vaginal estrogens is accountable for the emergence of vulvar and vaginal atrophy (VVA and its related symptoms such as vaginal dryness, dyspareunia, vaginal and/or vulvar irritation or itching, and dysuria. The repercussion of these symptoms on quality of life often makes it necessary to initiate treatment. Up until now, the treatments available included vaginal moisturizers and lubricants, local estrogens, and hormonal therapy. However, therapeutic options have now been increased with the approval of 60 mg ospemifene, the first nonhormonal oral treatment with an agonist effect on the vaginal epithelium and an endometrial and breast safety profile which makes it unique. This is the first selective estrogen receptor modulator indicated in women with moderate-to-severe vaginal atrophy not eligible for local estrogen treatment. Considering that “local estrogen noneligible women” are those in whom such treatment cannot be administered either because it is contraindicated or due to skill issues, who are averse to the mode and convenience of vaginal products’ administration or to their use on account of potential systemic absorption, or those who demonstrate dissatisfaction in terms of efficacy and safety, it is clear that there is a significant unmet medical need in VVA management. In fact, a great number of women show lack of adherence, dropping out of at least one VVA treatment, including nonhormonal moisturizers and lubricants, which they consider to be ineffective and uncomfortable. If they could choose, many of them may opt for oral treatment. In Phase III studies, ospemifene demonstrated efficacy in vaginal dryness and dyspareunia, regenerating vaginal cells, improving lubrication, and reducing pain

  2. Effect of Surgical Removal of Endometriomas on Cyclic and Non-cyclic Pelvic Pain

    Directory of Open Access Journals (Sweden)

    Murat Api

    2015-07-01

    Full Text Available Background: Endometriosis is a complex disease with a spectrum of pain symptoms from mild dysmenorrhea to debilitating pelvic pain. There is no concrete evidence in the literature whether endometriotic cyst per se, causes pain spectrum related to the disease. The aim of the present study was to evaluate the effect of surgical removal of endometriomas on pain symptoms. Materials and Methods: In this prospective, observational, before-after study, which was conducted between March 2012 and January 2013 in Training and Research Hospital,Adana, Turkey, a total of 23 patients including 16 sexually active and 7 virgin symptomatic women were questioned for non-cyclic pelvic pain (NCPP, intensity of the NCPP, presence of cyclic dysmenorrhea, and dyspareunia before and after the endometrioma operation. Participants who were sonographically diagnosed and later pathologically confirmed as having endometrioma without sign and symptoms of deep infiltrative endometriosis (DIE were also questioned for pain symptoms before and after the laparoscopic removal of cyst wall. Patients with intraabdominal adhesions, history of pelvic inflammatory disease, and pathological diagnosis other than endometrioma were excluded. No ancillary procedures were applied for pain management, but if pain was present, pelvic peritoneal endometriotic lesions were ablated beside the removal of ovarian endometriotic cysts. Results: Out of 23 cases with endometrioma, 91 and 78% reported to have NCPP and dysmenorrhea, respectively, before the operation, while 60 and 48%, respectively, after the operation (McNemar’s test, P=0.016 for both figures. Among the sexually active cases, 31% (5/16 had dyspareunia before the operation and only 1 case reported the pain relief after the operation (McNemar’s test, P=1. Intensity of NCPP were reported to be none (8.7%, moderate (21.7%, severe (56.5% and unbearable (13% before the operation and decreased to none (43.5%, mild (43.5%, moderate (4

  3. Attributes and Barriers to Care of Pelvic Pain in University Women

    Science.gov (United States)

    Mann, Julie; Shuster, Jonathan; Moawad, Nash

    2014-01-01

    Study Objective To describe rates of pelvic pain in university women ages 18 and older and to explore the barriers to adequate health care for pelvic pain in this population. Design A cross-sectional study (Canadian Task Force classification II-2). Setting University of Florida, Gainesville, FL. Patients A total of 2000 female students at the University of Florida were randomly selected for participation. Interventions The 2000 sample members were sent a questionnaire to be completed online. Measurements and Main Results The online questionnaire was hosted through the REDCap electronic data capture tool hosted at the University of Florida. This questionnaire included demographic items, general health and health behavior questions, measures to assess different types of pelvic pain (e.g., dysmenorrheal; dyspareunia; urinary, bowel, and vulvar pain), items regarding barriers to care for pelvic pain problems, and quality of life measures. Data were exported to SAS software (SAS Institute Inc., Cary, NC) for analysis. Of the 2000 subjects who received the questionnaire invitation, 390 filled out the questionnaire, yielding a response rate of 19.5%. Respondents’ ages ranged from 18 to 62 with a mean of 23 years. A total of 72.8% of respondents reported experiencing pelvic pain over the past 12 months. Dysmenorrhea was reported by nearly 80% of participants, over one third of participants noted deep dyspareunia, and a significant proportion of participants reported symptoms related to bowel movements. Vulvar symptoms, including superficial dyspareunia, were reported by 21.5% of participants. Most participants with pelvic pain (78.8%) have not received any diagnosis for their pain, whereas 73.6% reported not yet having visited a doctor. Significant barriers to receiving adequate medical care were reported, including difficulty with insurance coverage and physicians’ lack of time and knowledge or interest in chronic pelvic pain conditions. Conclusion Pelvic pain in

  4. The Effect of Nursing Intervention on the Sex Life of Patients after Total Hysterectomy%护理干预对子宫全切术后患者性生活的影响分析

    Institute of Scientific and Technical Information of China (English)

    赖娟红

    2014-01-01

    目的:探讨护理干预对子宫全切术后患者性生活的影响效果。方法:将本院收治的行子宫全切除术的102例患者均分为试验组和对照组,对照组患者给予常规护理,试验组患者在此基础上给予针对性护理干预,比较两组患者术前、术后3个月和术后6个月性生活频率、性生活满意情况以及性交疼痛、阴道干涩发生情况。结果:试验组患者术后6个月性生活频率逐渐升高至接近术前,与术前比较,差异无统计学意义(P>0.05);试验组患者术后3、6个月性生活频率均明显高于对照组,比较差异具有统计学意义(P0.05). The sexual frequency for the experiment group was higher than that of the control group in postoperative 3 months and postoperative 6 months(P<0.05). The satisfaction of the sexual life of the experiment group in the 6 months after the operation were higher than those of the latter 3 months, the incidence rate of dyspareunia and colpoxerosis of the former was lower than that of the latter 3 months(P<0.05). The satisfaction of the sexual life of the experiment group in the 3 months and 6 months after the operation were higher than those of the control group, the incidence rate of dyspareunia and colpoxerosis of the former was lower than that of the control group(P<0.05). Conclusion: It can increase sexual quality of life, increase the sexual frequency, increase the sex satisfaction and lower the incidence rate of dyspareunia and colpoxerosis after total hysterectomy by nursing intervention. It is valuable in clinical application.

  5. Seksuel dysfunktion i menopausen. Status over forekomst, farmakologiske behandlingsmuligheder og risici

    DEFF Research Database (Denmark)

    Gregersen, Nina; Hilmand, Christina Bjerre; Jensen, Pernille Tine;

    2006-01-01

    , and there is evidence suggesting that systemic hormone therapy, such as estrogen, estrogen/progesterone, estrogen/testosterone and tibolone, has a positive impact on sexual dysfunction in the menopause. There is evidence that local estrogen relieves vaginal dryness and dyspareunia. The recent discoveries of the side...... effects of hormone therapy necessitate careful evaluation of the indication for hormone therapy, and the duration of treatment is recommended to be as short as possible. The long-term side effects of testosterone in women have not yet been fully investigated. Sildenafil has shown a positive effect......The frequency of female sexual dysfunction increases with age, and the menopause has a negative influence on sexual life. Pharmacological treatment options of female sexual dysfunctions in the menopause include hormone therapy and sildenafil. Few randomised controlled studies have been done...

  6. Sexual dysfunction in the peri- and postmenopause. Status of incidence, pharmacological treatment and possible risks. A secondary publication

    DEFF Research Database (Denmark)

    Gregersen, Nina; Jensen, Pernille Tine; Giraldi, Annamaria Elena

    2006-01-01

    of randomized, controlled trials have been conducted and evidence suggests that systemic hormone therapy with estrogen, estrogen/progesterone, estrogen/testosterone and tibolone have a positive impact on sexual dysfunction during the peri- and postmenopause. Further, there is evidence that treatment with local...... estrogen relieves vaginal dryness and dyspareunia. Recent knowledge on side effects related to hormone therapy necessitates careful evaluation of the indication for hormone therapy and the duration of postmenopausal hormone therapy should be as short as possible. Long-term side effects of testosterone have...... in the postmenopause. For the time being the effect of testosterone therapy and tibolone on female sexual dysfunction is being investigated. Sexual dysfunction in women (Female Sexual Dysfunction, FSD) is multi-factorial and influenced by physiological, psychological, social and emotional factors. FSD is defined...

  7. Recurrent extended-spectrum beta-lactamase-producing Escherichia coli urinary tract infection due to an infected intrauterine device.

    Science.gov (United States)

    Hui, Chee-Kin

    2014-02-01

    The use of intrauterine devices (IUDs) have been widespread since the 1960s. In 2002, the World Health Organization estimated that approximately 160 million women worldwide use IUDs. However, IUDs are associated with short-term complications such as vaginal bleeding, pelvic discomfort, dyspareunia and pelvic infection. Herein, we report the case of a woman who had recurrent urinary tract infection (UTI) due to the use of an IUD, even after treatment. The patient developed four episodes of UTI within a seven-month period after IUD insertion. During each episode of UTI, extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) was cultured from the patient’s midstream urine. The IUD was finally removed, and culture of the removed IUD was positive for ESBL-producing E. coli. An infected IUD as a source of recurrent UTI should be considered in women with IUD in situ who develop recurrent UTI even after treatment.

  8. Influences of climacteric in female sexual activity

    Directory of Open Access Journals (Sweden)

    Anthonio Alisancharles Batista de Almeida

    2016-06-01

    Full Text Available Objective: to identify complaints of sexual function related to climacteric symptoms among women in climacteric age. Methods: descriptive study. A sample of 330 women aged from 35 to 65 years old, with three previous Pap tests. We used a questionnaire developed by the researchers. A descriptive statistical analysis was performed having the central tendency of proportion and measure the average as a parameter. Results: it was evidenced that 50% were between 35-45 years, 73% were sexually active, 59.4% had decreased libido, and 58.5% reported dyspareunia. Conclusion: it is necessary that the health services and professionals are aware of the influence of climacteric on women’s health to develop strategies aimed at quality of life.

  9. Influences of climacteric in female sexual activity

    Directory of Open Access Journals (Sweden)

    Anthonio Alisancharles Batista de Almeida

    2016-01-01

    Full Text Available Objective: to identify complaints of sexual function related to climacteric symptoms among women in climacteric age. Methods: this is an descritive study. A sample of 330 women aged from 35 to 65 years old, with three previous Pap tests. We used a semi-structured questionnaire developed by the researchers. A descriptive statistical analysis was performed having the central tendency of proportion and measure the average as a parameter. Results: it was evidenced that 50.0% were between 35-45 years, 73.0% were sexually active, 59.4% had decreased libido, and 58.5% reported dyspareunia. Conclusion: it is necessary that the health services and professionals are aware of the influence of climacteric on women’s health to develop strategies aimed at quality of life.

  10. Alpha 2 Delta (α2δ Ligands, gabapentin and pregabalin: what is the evidence for potential use of these ligands in irritable bowel syndrome

    Directory of Open Access Journals (Sweden)

    Jeremy eGale

    2011-06-01

    Full Text Available Irritable bowel syndrome (IBS is a complex disorder that is characterized by abdominal pain and altered bowel habit, and often associates with other gastrointestinal symptoms such as feelings of incomplete bowel movement and abdominal bloating, and extra-intestinal symptoms such as headache, dyspareunia, heartburn, muscle pain and back pain. It also frequently coexists with conditions that may also involve central sensitization processes, such as fibromyalgia, irritable bladder disorder and chronic cough. This review examines the evidence to date on gabapentin and pregabalin which may supports further and continued research and development of the α2δ ligands in disorders characterized by visceral hypersensitivity, such as IBS. The distribution of the α2δ sub-unit of the voltage-gated calcium channel, possible mechanisms of action, pre-clinical data which supports an effect on motor-sensory mechanisms and clinical evidence that points to potential benefits in these patients with IBS will be discussed.

  11. Obstetric anal sphincter injuries

    Institute of Scientific and Technical Information of China (English)

    Remon Keriakos; Deepa Gopinath

    2015-01-01

    Obstetric anal sphincter injuries can be associated with significant short and long term consequences causing devastating impacts on the quality of lives of young, otherwise healthy women. The major consequence is anal incontinence which may be short or long term and vary in severity. The other consequences include pain, infection, dyspareunia and sexual dysfunction. This may in turn result in considerable economic burden to health care providers and patients. It also has an implication on future deliveries. Although it can never be eliminated, it can be reduced by improving practice, training and provision of high quality multidisciplinary care in order to reduce long-term morbidity. Obstetric anal sphincter injuries are also a source of litigation which can be distressing to both patients and clinicians. The aim of this review article is to explore the available evidence on epidemiology, strategies for preventions, prognosis and also how to deal with governance issues.

  12. Evaluating sexual nursing care intervention for reducing sexual dysfunction in Indonesian cervical cancer survivors

    Directory of Open Access Journals (Sweden)

    Yati Afiyanti

    2016-01-01

    Full Text Available Objective: This study aims to describe the factors affecting successful nursing care intervention on sexuality. Methods: A one-group pre- and post-test design was used. Fifty-three cervical cancer survivors and their spouses were administered with nursing care intervention on sexuality in three sessions and evaluated after 6 weeks. Results: Sexual intervention reduced dyspareunia symptoms, improved vaginal lubrication, improved sexual satisfaction, and enhanced sexual arousal, sexual desire, and orgasm among cancer survivors and their spouses. The other influencing factors also simultaneously contributed to the success of nursing care intervention. Conclusions: Nursing care intervention on sexuality could be a part of supportive nursing care and an important aspect in standard nursing care for cancer patients in Indonesia.

  13. Sexual Function in Women with a History of Intrafamilial Childhood Sexual Abuse

    DEFF Research Database (Denmark)

    Kristensen, Ellids; Lau, Marianne Engelbrecht

    2011-01-01

    analysis were applied. Of the women, 63% were unsatisfied with their current sexual life, 39% felt uncomfortable with physical endearments and 71% were unsatisfied with their body. Only 82% had an active sexual life and, of these, 73% reported at least one sexual problem, 48% orgasmic problems and 45......% dyspareunia. The occurrence of sexual problems was significantly correlated to childhood physical violence, current psychological distress, flashbacks in sexual situations and discomfort with physical endearment. The prevalence of sexual pain disorders were also positively correlated to “no adult support......This study investigated sexual function in women with a history of severe intrafamilial childhood sexual abuse (CSA) and the correlation between sexual problems and the severity of CSA, adult support during childhood and current psychiatric symptoms. The sample consisted of 158 women who...

  14. A Case of Secondary Infertility Due to Retention of Fetal Bones in Cervix

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    Alev Ozer

    2014-12-01

    Full Text Available A case of secondary infertility related to prolonged retention of fetal bones in the cervix is presented. A 34-year-old nulliparous woman was admitted to the hospital with chronic pelvic pain, dyspareunia, and 12%u2013year-long secondary infertility following an induced abortion due to fetal demise. Transvaginal ultrasonography (USG revealed a linear echogenic area around the posterior cervical wall. An hysteroscopic examination confirmed the existence of an irregular calcified mass embedded in the cervix. The mass turned out to be conglomerated fetal bone fragments which probably acted as an intrauterine device. After removal of the cervical mass, the patient conceived spontaneously within four months. The present case report emphasizes the significance of a detailed history and a thorough evaluation by transvaginal USG in the case of secondary infertility following an induced or spontaneous abortion.

  15. Early stage cervical cancer, radical hysterectomy and sexual function: a longitudinal study

    DEFF Research Database (Denmark)

    Jensen, Pernille Tine

    Background: Limited knowledge exists regarding the impact of treatment on the sexual function of early stage cervical cancer patients. We investigated the longitudinal course of self-reported sexual function after radical hysterectomy (RH) alone. Methods: 173 patients with lymph node-negative early......-surgery, the patients completed an extended version of the questionnaire with additional items assessing the patient’s perception of changes in sexual function compared with before the cancer diagnosis. Results: Compared with control women, patients experienced severe orgasmic problems and uncomfortable sexual...... intercourse due to a reduced vaginal size during the first 6 months after RH, severe dyspareunia during the first 3 months, and sexual dissatisfaction during the first 5 weeks after RH. A persistent lack of sexual interest and insufficient vaginal lubrication were reported throughout the first 2 years after...

  16. Ovarian failure and cancer treatment: Incidence and interventions for premenopausal women

    Energy Technology Data Exchange (ETDEWEB)

    Feldman, J.E.

    1989-09-01

    Ovarian failure may be a long-term consequence of cancer treatment for premenopausal women. Caused by several treatments, including radiation therapy and the alkylating agents, it produces signs and symptoms associated with menopause: hot flashes, amenorrhea, dyspareunia, loss of libido, and irritability. Critical factors that determine ovarian functioning after treatment for cancer are the patient's age at the time of therapy, the amount of radiation that the ovaries received, and the dose of the antineoplastic agent(s). Medical interventions, such as hormonal therapy and surgical repositioning of the ovaries, may maintain ovarian function for some women. Nursing intervention includes assessment, education, and counseling. Counseling focuses on how the prematurely menopausal patient feels about herself as indicated by self-esteem, body image, and sexuality.

  17. A 3-year follow-up after anterior colporrhaphy compared with collagen-coated transvaginal mesh for anterior vaginal wall prolapse

    DEFF Research Database (Denmark)

    Rudnicki, Martin; Laurikainen, E; Pogosean, R

    2016-01-01

    conventional anterior colporrhaphy and surgery with a collagen-coated prolene mesh. All patients were evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) assessment before and after surgery. Symptoms related to pelvic organ prolapse were evaluated using the Pelvic Floor Impact Questionnaire (PFIQ...... the groups was observed regarding PFIQ-7, PFDI-20, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores. The number of mesh exposures did not change during the study period and all exposures were minor. CONCLUSION: Our study demonstrates that although the objective outcome......-7) and the Pelvic Floor Distress Inventory (PFDI-20). MAIN OUTCOME MEASURES: Objective cure, defined as POP-Q stage prolapse at the 1- and 3-year follow-ups. Furthermore, mesh exposure and dyspareunia were also recorded. RESULTS: In total, 138 patients (70 from the mesh group versus 68 from...

  18. Laparoscopic management of fallopian tube prolapse masquerading as adenocarcinoma of the vagina in a hysterectomized woman

    Directory of Open Access Journals (Sweden)

    Kucuk Mustafa

    2002-01-01

    Full Text Available Abstract Background Fallopian tube prolapse as a complication of abdominal hysterectomy is a rare occurrence. A case with fallopian tube prolapse was managed by a combined vaginal and laparoscopic approach and description of the operative technique is presented. Case presentation A 39-year-old woman with vaginal prolapse of the fallopian tube after total abdominal hysterectomy presented with an incorrect diagnosis of adenocarcinoma of the vaginal apex. The prolapsed tube and cystic ovary were removed by vaginal and laparoscopic approach. The postoperative course went well. Conclusions Early or late fallopian tube prolapse can occur after total abdominal hysterectomy and vaginal hysterectomy. Symptoms consist of persistent blood loss or leukorrhea, dyspareunia and chronic pelvic pain. Vaginal removal of prolapsed tube with laparoscopic surgery may be a suitable treatment. The abdominal or vaginal approach used in surgical correction of prolapsed tubes must be decided in each case according to the patient's individual characteristics.

  19. A Case of Chronic Abdominal Neuropathic Pain and Burning after Female Genital Cutting

    Directory of Open Access Journals (Sweden)

    Vicky Hadid

    2015-01-01

    Full Text Available Introduction. Female genital cutting is prevalent in the Middle Eastern and African countries. This ritual entails not only immediate complications such as infection, pain, and haemorrhage, but also chronic ones including dysmenorrhea and dyspareunia. However, there is limited data on neuropathic pain secondary to female genital mutilation when searching the literature. Case. This case discusses a 38-year-old female with a history of infibulation who presented with a chronic burning abdominal and anterior vulvar pain including the related investigations and treatment. Discussion. This case brings to light the additional delayed complication of this ritual: sensory neuropathy. Our goal is to educate health professionals to be aware of these complications and to appropriately investigate and treat them in order to find a solution to relieve the patients’ symptoms.

  20. Sexual Function in Women with a History of Intrafamilial Childhood Sexual Abuse

    DEFF Research Database (Denmark)

    Kristensen, Ellids; Lau, Marianne Engelbrecht

    2011-01-01

    % dyspareunia. The occurrence of sexual problems was significantly correlated to childhood physical violence, current psychological distress, flashbacks in sexual situations and discomfort with physical endearment. The prevalence of sexual pain disorders were also positively correlated to “no adult support......This study investigated sexual function in women with a history of severe intrafamilial childhood sexual abuse (CSA) and the correlation between sexual problems and the severity of CSA, adult support during childhood and current psychiatric symptoms. The sample consisted of 158 women who...... subsequently began specialized group psychotherapy for CSA sequellae. Clinical interview and questionnaires (Present Sexual Function, Sexual and Body Satisfaction, Symptom Check List 90-R) were used for data collection in a cross sectional study design. Non-parametric analysis, linear and logistic regression...

  1. Standard Operating Procedures for Female Genital Sexual Pain

    DEFF Research Database (Denmark)

    Fugl-Meyer, Kerstin S; Bohm-Starke, Nina; Damsted Petersen, Christina

    2012-01-01

    Introduction.  Female genital sexual pain (GSP) is a common, distressing complaint in women of all ages that is underrecognized and undertreated. Definitions and terminology for female GSP are currently being debated. While some authors have suggested that GSP is not per se a sexual dysfunction......, but rather a localized genial pain syndrome, others adhere to using clearly sexually related terms such as dyspareunia and vaginismus. Aim.  The aims of this brief review are to present definitions of the different types of female GSP. Their etiology, incidence, prevalence, and comorbidity with somatic...... and psychological disorders are highlighted, and different somatic and psychological assessment and treatment modalities are discussed. Methods.  The Standard Operating Procedures (SOP) committee was composed of a chair and five additional experts. No corporate funding or remuneration was received. The authors...

  2. Sigmoid Colon Migration of an Intrauterine Device

    Directory of Open Access Journals (Sweden)

    Funda Akpinar

    2014-01-01

    Full Text Available Background. Intrauterine devices (IUD are commonly used birth control methods. Colonic perforation is an infrequent but serious complication of IUD. Case. A 34-year-old woman with 2-years history of IUD, inserted at early puerperal period, presented to gynecologist with chronic pelvic pain and dyspareunia. Radiological assessment revealed that there were two copper-T devices: one in uterine cavity and another in the colonic lumen. Attempts of retrieval with colonoscopy and laparoscopy were unsuccessful. Intrauterine device embedded in sigmoid colon wall was removed with resection of the involved segment and primary anastomosis was performed. Conclusion. Although there are cases in literature that are successfully managed with colonoscopy, in chronic cases, formation of granulation tissue complicates retrieval of an IUD by this intervention.

  3. Magnetic resonance imaging in deep pelvic endometriosis: iconographic essay

    Energy Technology Data Exchange (ETDEWEB)

    Coutinho Junior, Antonio Carlos; Coutinho, Elisa Pompeu Dias; Lima, Claudio Marcio Amaral de Oliveira; Ribeiro, Erica Barreiros; Aidar, Marisa Nassar [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil); Clinica Multi-Imagem, Rio de Janeiro, RJ (Brazil); E-mail: cmaol@br.inter.net; Gasparetto, Emerson Leandro [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Dept. de Radiologia

    2008-03-15

    Endometriosis is characterized by the presence of normal endometrial tissue outside the uterine cavity. In patients with deep pelvic endometriosis, uterosacral ligaments, rectum, rectovaginal septum, vagina or bladder may be involved. Clinical manifestations may be variable, including pelvic pain, dysmenorrhea, dyspareunia, urinary symptoms and infertility. Complete surgical excision is the gold standard for treating this disease, and hence the importance of the preoperative work-up that usually is limited to an evaluation of sonographic and clinical data. Magnetic resonance imaging is of paramount importance in the diagnosis of endometriosis, considering its high accuracy in the identification of lesions intermingled with adhesions, and in the determination of peritoneal lesions extent. The present pictorial review describes the main magnetic resonance imaging findings in deep pelvic endometriosis. (author)

  4. Differential diagnosis of sexual pain in women (La diagnosi differenziale del dolore sessuale nella donna

    Directory of Open Access Journals (Sweden)

    Giancarlo Carli, MD

    2013-09-01

    Full Text Available Dyspareunia, a pain that occurs in response to an attempted vaginalentry or to a sexual intercourse, is a clinical entity that recognizes multifactorial etiology. It may be due to organic diseases or to functional disorders suchas Hypoactive Syndrome Desire Disease (HSDD, vaginismus and provoked vulvodynia (PVD. A full history is fundamental for the diagnosis of functional syndromes. For PVD diagnosis, the gynaecologist must also have experience of syndromes of chronic widespread pain of unknownetiology such as fibromyalgia since these syndromes are frequently associated. In PVD local and diffuse hyperalgesia is associated with mechanismsof central sensitization. In PVD there is evidence suggesting local mechanisms of neuropathic nature, although local symptoms consist only in light erythema and oedema.

  5. Ear acupuncture or local anaesthetics as pain relief during postpartum surgical repair: a randomised controlled trial

    DEFF Research Database (Denmark)

    Kindberg, S; Klünder, L; Strøm, J

    2009-01-01

    -hour hands-on training in the use of ear acupuncture. All midwives (n= 36) in the department had previous experience in using acupuncture for obstetric pain relief. Pain and wound healing were evaluated using validated scores. Data collection was performed by research assistants blinded towards...... treatment allocation. Randomisation was computer assisted. A total of 207 women were randomised to receive ear acupuncture (105) and local anaesthetics (102), respectively. Main outcome measures The primary outcome was pain during surgical repair. Secondary outcomes were wound healing at 24-48 hours and 14...... days postpartum, participant satisfaction, revision of wound or dyspareunia reported 6 months postpartum. Results Pain during surgical repair was more frequently reported by participants allocated to ear acupuncture compared with participants receiving local anaesthetics (89 versus 54%, P

  6. Depression, anxiety, hostility and hysterectomy.

    Science.gov (United States)

    Ewalds-Kvist, S Béatrice M; Hirvonen, Toivo; Kvist, Mårten; Lertola, Kaarlo; Niemelä, Pirkko

    2005-09-01

    Sixty-five women (aged 32 - 54 yrs) were assessed at 2 months before to 8 months after total abdominal hysterectomy on four separate occasions. Beck's Depression Inventory (BDI), Taylor's Manifest Anxiety Scale (TMAS), the Buss-Durkee Hostility Inventory (BDHI), Measurement of Masculinity-Femininity (MF), Likert scales and semantic differentials for psychological, somatic and sexual factors varied as assessment tools. High-dysphoric and low-dysphoric women were compared with regard to hysterectomy outcomes. Married nulliparae suffered from enhanced depression post-surgery. Pre-surgery anxiety, back pain and lack of dyspareunia contributed to post-surgery anxiety. Pre-surgery anxiety was related to life crises. Pre- and post-surgery hostility occurred in conjunction with poor sexual gratification. Post-hysterectomy health improved, but quality of sexual relationship was impaired. Partner support and knowledge counteracted hysterectomy aftermath. Post-hysterectomy symptoms constituted a continuum to pre-surgery signs of depression, anxiety or hostility.

  7. Acne tarda and male-pattern baldness unmasking primary ovarian insufficiency: a case and review.

    Science.gov (United States)

    Zouboulis, Christos C; Achenbach, Alexander; Makrantonaki, Eugenia

    2014-01-01

    A 30-year-old woman presented with recurrent acne lesions and progressing male-pattern baldness. Furthermore, she reported amenorrhea, weight loss, mucosal xerosis and dyspareunia since discontinuation of hormonal contraception 6 months earlier in order to conceive. Acne tarda and androgenetic alopecia of female pattern were diagnosed. Hormonal and immunologic serological and ultrasound examinations revealed an autoimmune hypergonadotropic primary ovarian insufficiency (POI) with no ovarian cysts but ovarian fibrosis with marked reduced follicle pool. Immediate ovarian stimulation and in vitro fertilization led to pregnancy and the patient gave birth to a healthy child. Though presenting with clinical findings similar to menopause, 50% of patients with POI exhibit varying and unpredictable ovarian function, and only 5-10% are able to accomplish pregnancy. Genetic disorders affect the X chromosome. In 14-30% of cases POI has been associated with autoimmunity. POI may occur after discontinuation of hormonal contraception, like in our case.

  8. Obstetric anal sphincter injuries

    Directory of Open Access Journals (Sweden)

    Remon Keriakos

    2015-10-01

    Full Text Available Obstetric anal sphincter injuries can be associated with significant short and long term consequences causing devastating impacts on the quality of lives of young, otherwise healthy women. The major consequence is anal incontinence which may be short or long term and vary in severity. The other consequences include pain, infection, dyspareunia and sexual dysfunction. This may in turn result in considerable economic burden to health care providers and patients. It also has an implication on future deliveries. Although it can never be eliminated, it can be reduced by improving practice, training and provision of high quality multidisciplinary care in order to reduce long-term morbidity. Obstetric anal sphincter injuries are also a source of litigation which can be distressing to both patients and clinicians. The aim of this review article is to explore the available evidence on epidemiology, strategies for preventions, prognosis and also how to deal with governance issues.

  9. The urogenital system and the menopause.

    Science.gov (United States)

    Calleja-Agius, J; Brincat, M P

    2015-01-01

    The major cause of urogenital atrophy in menopausal women is estrogen loss. The symptoms are usually progressive in nature and deteriorate with time from the menopausal transition. The most prevalent urogenital symptoms are vaginal dryness, vaginal irritation and itching. The genitourinary syndrome of menopause includes vulvovaginal atrophy and the postmenopausal modifications of the lower urinary tract. Dyspareunia and vaginal bleeding from fragile atrophic skin are common problems. Other urogenital complaints include frequency, nocturia, urgency, stress urinary incontinence and urinary tract infections. Atrophic changes of the vulva, vagina and lower urinary tract can have a large impact on the quality of life of the menopausal woman. However, hormonal and non-hormonal treatments can provide patients with the solution to regain the previous level of function. Therefore, clinicians should sensitively question and examine menopausal women, in order to correctly identify the pattern of changes in urogenital atrophy and manage them appropriately.

  10. Menopausal hormone therapy and, vaginal diseases and vulvar issues%绝经后激素治疗与阴道疾病

    Institute of Scientific and Technical Information of China (English)

    王秀霞; 王义贤

    2011-01-01

    The endocrine function of ovaries decreased in women after menopause, also had low estrogen level, shriveled in lower genital tract, and caused related symptoms progressively, such as vaginal dryness, irritation and itching of vulva and vagina, dyspareunia. Therefore, hormone therapy is necessary to improve the symptoms and the life quality in women after menopause.%绝经后妇女卵巢内分泌功能减退,体内雌激素水平降低,下生殖道出现萎缩,并引起相关症状,即阴道干涩,外阴阴道刺激和瘙痒以及性交困难等,通常是进行性的.因此,需采用激素治疗以改善妇女绝经后症状,提高生活质量.

  11. Topical administration of isoflavones for treatment of vaginal symptoms in postmenopausal women: A systematic review of randomised controlled trials.

    Science.gov (United States)

    Ghazanfarpour, M; Latifnejad Roudsari, R; Treglia, G; Sadeghi, R

    2015-01-01

    Current systematic review evaluated the efficacy of topical isoflavones to relieve vaginal symptoms in menopausal women. MEDLINE (1966 to January 2014), Scopus (1990 to January 2014), and the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2013) were searched using keywords 'isoflavone and vagina'. Relevant studies were reviewed by two independent reviewers. Only randomised controlled trials (RCTs) were included in the systematic review. Out of 115 potentially relevant publications, four studies met the inclusion criteria. Topical isoflavones showed beneficial effects on dyspareunia, vaginal dryness and maturation value. Based on only one trial, the result of conjugated equine oestrogen cream (0.3 mg/day) was similar to use of isoflavone vaginal gel and superior to that of placebo gel. However, drawing any definite conclusion was difficult because of the limited number of RCTs, the small sample sizes, weak methodology and considerable heterogeneity of the included studies.

  12. Experimental treatments of endometriosis.

    Science.gov (United States)

    Attar, Rukset; Attar, Erkut

    2015-08-01

    Endometriosis is defined as the presence of endometrial gland and stroma outside the uterine cavity. It is an estrogen-dependent disease and is associated with chronic pelvic pain, dysmenorrhea, dyspareunia and infertility. The treatment of endometriosis is conservative or radical surgery, medical therapies or their combination. All currently used hormonally active treatments are effective in the treatment of endometriosis; however, the adverse effects of these hormonal treatments limit their long-term use. Moreover, recurrence rates are high after cessation of therapy, and the treatments have no benefit in endometriosis-associated infertility. Therefore, researchers are working on new treatment modalities with improved side effects, mainly focusing on the molecular targets involved in etiopathogenesis of endometriosis. Here we summarized these novel treatments modalities.

  13. [A more and more painful intrauterine device… where it is not enough to see the wires to exclude malposition!].

    Science.gov (United States)

    Nohuz, E; Battista, R; Tamburro, S; Leonenko, M; Bayeh, S; Varga, J; Mage, G

    2014-04-01

    We report a case of a 30-year-old woman with an intrauterine device (IUD) improperly inserted deep within the myometrium, with a muscularis layer injury of the recto-sigmoid colon resulting of a uterine perforation and presented as abdomino-pelvic pain and dyspareunia. The ultrasonographic control of the IUD after the insertion (performed seven months before) was not checked. Cervical examination showed the strings of the IUD. The ultrasonographic exploration identified an intra-myometrial IUD with fundus perforation of the uterus. A laparoscopic exploration permitting the removal of the IUD revealed an insertion through the bowel wall. The lessons to draw of about this case report are discussed through a brief review of the literature.

  14. Aetiology and management of non-specific vaginitis.

    Science.gov (United States)

    Dattani, I M; Gerken, A; Evans, B A

    1982-01-01

    In a study of 100 women with non-specific vaginitis, characterised by a vaginal discharge which was malodorous and pruritic in most cases and caused dyspareunia and dysuria in some, Gardnerella vaginalis was isolated in 46% of patients. When present, G vaginalis was significantly associated with Mycoplasma hominis and Bacteroides species. Isolation of G vaginalis was unrelated to the presenting symptoms. Treatment with povidone-iodine pessaries for two weeks produced no pronounced benefit, either clinically or microbiologically, compared with a placebo. Nevertheless, 68% of all patients followed reported improvement four weeks after the start of treatment. The findings suggest that G vaginalis is one cause of non-specific vaginitis, which is more likely to be seen in women using oral contraceptives and is usually cured spontaneously. PMID:7034858

  15. Desquamative inflammatory vaginitis.

    Science.gov (United States)

    Reichman, Orna; Sobel, Jack

    2014-10-01

    Desquamative inflammatory vaginitis (DIV) is an uncommon form of chronic purulent vaginitis. It occurs mainly in Caucasians with a peak occurrence in the perimenopause. Symptoms and signs are nonspecific; DIV is a diagnosis of exclusion, and other causes of purulent vaginitis should be excluded. The main symptoms include purulent discharge, vestibulo-vaginal irritation, and dyspareunia. Examination of vaginal walls shows signs of inflammation with increased erythema and petechiae. Through microscopy (wet mount) of the vaginal secretions, DIV is defined by an increase in inflammatory cells and parabasal epithelial cells (immature squamous cells). Vaginal flora is abnormal and pH is always elevated above 4.5. Although etiology and pathogenesis remain unknown, the favorable response to anti-inflammatory agents suggests that the etiology is immune mediated. Either local vaginal clindamycin or vaginal corticosteroids are adequate treatment. As a chronic condition, maintenance treatment should be considered as relapse is common. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. [Recurrent cystitis and vaginitis: role of biofilms and persister cells. From pathophysiology to new therapeutic strategies].

    Science.gov (United States)

    Graziottin, A; Zanello, P P; D'Errico, G

    2014-10-01

    Recurrent vaginitis and cystitis are a daily challenge for the woman and the physician. The recurrence worsens the symptoms' severity, increases comorbidities, both pelvic (provoked vestibulodynia, bladder pain syndrome, levator ani hyperactivity, introital dyspareunia, obstructive constipation, chronic pelvic pain) and cerebral (neuroinflammation and depression), increases health costs, worsens the quality of life. Antibiotics increase the risk of bacterial resistences and devastate the ecosystems: intestinal, vaginal and mucocutaneous. Pathogenic biofilms are the (still) neglected etiology of recurrences. Biofilms are structured communities of bacteria and yeasts, protected by a self-produced polymeric matrix adherent to a living or inert structures, such as medical devices. Biofims can be intra or extracellular. Pathogens live in a resting state in the deep biofilm layers as "persister cells", resistant to antibiotics and host defences and ready to re-attack the host. The paper updates the evidence on biofilms and introduces new non-antibiotic strategies of preventing and modulating recurrent vaginitis and cystitis.

  17. Effect of one-month treatment with vaginal promestriene on serum estrone sulfate levels in cancer patients: a pilot study.

    Science.gov (United States)

    Del Pup, L; Postruznik, D; Corona, G

    2012-05-01

    Vaginal promestriene was tested in gynecological cancer patients who suffered from severe vaginal dryness and dyspareunia. This form of estrogen has a low level of vaginal absorption and proved to be effective for vaginal atrophy. 17 patients were treated with a 10mg soft vaginal suppository daily for one month. Plasma levels of estrone sulfate (E1S), used as the marker of overall estrogenicity, were measured by liquid chromatography in combination with mass spectrometry. Mean E1S levels changed from 533 (22-2920) to 374 (81-856) pg/ml (p=0.39). In highly symptomatic gynecological cancer patients the level of circulating estrone sulfate was not significantly affected by vaginal promestriene treatment overall, but a wide range of levels was noted pre and post treatment in individual patients. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Efficacy and tolerability of fitostimoline (vaginal cream, ovules, and vaginal washing) and of benzydamine hydrochloride (tantum rosa vaginal cream and vaginal washing) in the topical treatment of symptoms of bacterial vaginosis.

    Science.gov (United States)

    Boselli, F; Petrella, E; Campedelli, A; Muzi, M; Rullo, V; Ascione, L; Papa, R; Saponati, G

    2012-01-01

    Two hundred and 91 patients showing signs and symptoms of bacterial vaginosis (BV) were randomized to receive topical treatment with Fitostimoline (vaginal cream and vaginal ovules + vaginal washing) or benzydamine hydrochloride (vaginal cream + vaginal washing) for 7 days. Signs (leucorrhoea, erythema, oedema, and erosion) and symptoms (burning, pain, itching, vaginal dryness, dyspareunia, and dysuria) (scored 0-3) were evaluated at baseline and at the end of treatment; the total symptoms score (TSS) was also calculated. In 125 patients, a bacterial vaginosis was confirmed by vaginal swab test. The primary efficacy variable analysis, that is, the percentage of patients with therapeutic success (almost complete disappearance of signs and symptoms), demonstrated that Fitostimoline ovules and vaginal cream were therapeutically equivalent and that pooled Fitostimoline treatment was not inferior to benzydamine hydrochloride. All the treatments were well tolerated, with only minor local adverse events infrequently reported. The results of this study confirmed that gynaecological Fitostimoline is a safe and effective topical treatment for BV.

  19. Validation of a questionnaire for self-assessment of sexual function and vaginal changes after gynaecological cancer

    DEFF Research Database (Denmark)

    Jensen, Pernille T; Klee, Marianne C; Thranov, Ingrid;

    2004-01-01

    of partner, sexual activity, sexual satisfaction, and body image. Seven additional items assessing current levels of sexual and vaginal problems compared to pre-diagnosis are intended to be used only once in longitudinal studies. The SVQ was validated in two ways: first, the comprehensibility of each item...... of agreement between the patients' and the observer's ratings was high (median overall agreement 0.84, range 0.46-1.00; median kappa: 0.80, range 0.52-1.00). From the 10 items applicable to all patients, three scales were hypothesized: intimacy, sexual interest and global sexual satisfaction. For sexually......The Sexual function-Vaginal changes Questionnaire (SVQ), was developed to investigate sexual and vaginal problems in gynaecological cancer patients. The instrument consists of 20 core items, measuring sexual interest, lubrication, orgasm, dyspareunia, vaginal dimensions, intimacy, sexual problems...

  20. INTERESTING CASES OF DIFFERENT TYPES OF CERVICAL FIBROIDS

    Directory of Open Access Journals (Sweden)

    Narmadha

    2014-05-01

    Full Text Available The incidence of cervical fibroids is 0.5-1%. It is usually single; they are usually confined to supravaginal portion of the cervix. Rarely it becomes submucous and polypoidal. So it is usually subserous or interstitial. It can be anterior, posterior or central in position. We had different types of cervical fibroids of which we will describe a few. Usually cervical fibroids cause infertility, difficulty in labor, infections, metrorrhagia, menorrhagia, constipation, retention of urine and dyspareunia. The cervical fibroid distorts the shape of cervix and grows bigger. It pushes the uterus upward giving the appearance of lantern of Saint Paul’s dome in a case of a central cervical fibroid. Most of the patients in the reproductive age get admitted for menorrhagia due to fibroid. Its growth is dependent on estrogen. It does not grow after menopause

  1. Pelvic floor muscle strength in primiparous women according to the delivery type: cross-sectional study

    Directory of Open Access Journals (Sweden)

    Edilaine de Paula Batista Mendes

    Full Text Available ABSTRACT Objectives: to compare the pelvic floor muscle strength in primiparous women after normal birth and cesarean section, related to the socio-demographic characteristics, nutritional status, dyspareunia, urinary incontinence, perineal exercise in pregnancy, perineal condition and weight of the newborn. Methods: this was a cross-sectional study conducted after 50 - 70 postpartum days, with 24 primiparous women who underwent cesarean delivery and 72 who had a normal birth. The 9301 PeritronTM was used for analysis of muscle strength. The mean muscle strength was compared between the groups by two-way analysis of variance. Results: the pelvic floor muscle strength was 24.0 cmH2O (±16.2 and 25.4 cmH2O (±14.7 in postpartum primiparous women after normal birth and cesarean section, respectively, with no significant difference. The muscular strength was greater in postpartum women with ≥ 12 years of study (42.0 ±26.3 versus 14.6 ±7.7 cmH2O; p= 0.036 and in those who performed perineal exercises (42.6±25.4 11.8±4.9 vs. cmH2O; p = 0.010, compared to caesarean. There was no difference in muscle strength according to delivery type regarding nutritional status, dyspareunia, urinary incontinence, perineal condition or newborn weight. Conclusion: pelvic floor muscle strength does not differ between primiparous women based on the type of delivery. Postpartum women with normal births, with higher education who performed perineal exercise during pregnancy showed greater muscle strength.

  2. Pelvic floor muscle strength in primiparous women according to the delivery type: cross-sectional study 1

    Science.gov (United States)

    Mendes, Edilaine de Paula Batista; de Oliveira, Sonia Maria Junqueira Vasconcellos; Caroci, Adriana de Souza; Francisco, Adriana Amorim; Oliveira, Sheyla Guimaraes; da Silva, Renata Luana

    2016-01-01

    ABSTRACT Objectives: to compare the pelvic floor muscle strength in primiparous women after normal birth and cesarean section, related to the socio-demographic characteristics, nutritional status, dyspareunia, urinary incontinence, perineal exercise in pregnancy, perineal condition and weight of the newborn. Methods: this was a cross-sectional study conducted after 50 - 70 postpartum days, with 24 primiparous women who underwent cesarean delivery and 72 who had a normal birth. The 9301 PeritronTM was used for analysis of muscle strength. The mean muscle strength was compared between the groups by two-way analysis of variance. Results: the pelvic floor muscle strength was 24.0 cmH2O (±16.2) and 25.4 cmH2O (±14.7) in postpartum primiparous women after normal birth and cesarean section, respectively, with no significant difference. The muscular strength was greater in postpartum women with ≥ 12 years of study (42.0 ±26.3 versus 14.6 ±7.7 cmH2O; p= 0.036) and in those who performed perineal exercises (42.6±25.4 11.8±4.9 vs. cmH2O; p = 0.010), compared to caesarean. There was no difference in muscle strength according to delivery type regarding nutritional status, dyspareunia, urinary incontinence, perineal condition or newborn weight. Conclusion: pelvic floor muscle strength does not differ between primiparous women based on the type of delivery. Postpartum women with normal births, with higher education who performed perineal exercise during pregnancy showed greater muscle strength. PMID:27533267

  3. A new device for simultaneous measurement of pelvic floor muscle activity and vaginal blood flow: a test in a nonclinical sample.

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    Both, Stephanie; van Lunsen, Rik; Weijenborg, Philomeen; Laan, Ellen

    2012-11-01

    Dyspareunia in women, defined as persistent or recurrent genital pain associated with sexual intercourse, is hypothesized to be related to (fear associated) pelvic floor hyperactivity and to diminished sexual arousal. Psychophysiological research to support these hypotheses is scarce and concentrates mostly on the role of either pelvic floor activity or sexual arousal. To investigate both factors, a measurement device that enables simultaneous assessment of pelvic floor muscle activity and genital sexual arousal would be most optimal. The aim of this study was to test a new vaginal device0-a vaginal photoplethysmograph with build-in surface electromyography (EMG)--that allows simultaneous assessment of pelvic floor muscle activity and vaginal blood flow. Genital arousal measured as vaginal pulse amplitude (VPA) and vaginal surface EMG. Thirty-six sexually functional women participated. To investigate the sensitivity of the device for changes in genital blood flow and involuntary changes in pelvic floor activity, VPA and vaginal surface EMG were monitored during exposure to sexual and anxiety-evoking film clips. In addition, vaginal surface EMG was monitored during voluntary flick and hold contractions. VPA increased in response to the sexual film, and EMG values were significantly higher in response to the anxiety-evoking film. Higher EMG values in response to the anxiety film were associated with lower VPA. EMG during the instructed 3-second hold pelvic floor contractions showed, as expected, higher values during pelvic floor contractions with support of surrounding muscle groups, compared with pelvic floor muscles alone. The device is sensitive to changes in vaginal blood flow in response to sexual stimuli, and it is able to pick up small, involuntary changes in pelvic floor activity associated with anxiety. Also, the device is able to record changes in pelvic floor activity during voluntary pelvic floor contractions. This new device will be a valuable tool in

  4. Factors predisposing women to chronic pelvic pain: systematic review

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    Latthe, Pallavi; Mignini, Luciano; Gray, Richard; Hills, Robert; Khan, Khalid

    2006-01-01

    Objective To evaluate factors predisposing women to chronic and recurrent pelvic pain. Design, data sources, and methods Systematic review of relevant studies without language restrictions identified through Medline, Embase, PsycINFO, Cochrane Library. SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results. Exposure to risk factors was compared between women with and without pelvic pain. Results were pooled within subgroups defined by type of pain and risk factors. Results There were 122 studies (in 111 articles) of which 63 (in 64 286 women) evaluated 54 risk factors for dysmenorrhoea, 19 (in 18 601 women) evaluated 14 risk factors for dyspareunia, and 40 (in 12 040 women) evaluated 48 factors for non-cyclical pelvic pain. Age < 30 years, low body mass index, smoking, earlier menarche (< 12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhoea. Younger age at first childbirth, exercise, and oral contraceptives were negatively associated with dysmenorrhoea. Menopause, pelvic inflammatory disease, sexual abuse, anxiety, and depression were associated with dyspareunia. Drug or alcohol abuse, miscarriage, heavy menstrual flow, pelvic inflammatory disease, previous caesarean section, pelvic pathology, abuse, and psychological comorbidity were associated with an increased risk of non-cyclical pelvic pain. Conclusion Several gynaecological and psychosocial factors are strongly associated with chronic pelvic pain. Randomised controlled trials of interventions targeting these potentially modifiable factors are needed to assess their clinical relevance in chronic pelvic pain. PMID:16484239

  5. COMPARATIVE STUDY OF ROUTINE VERSUS RESTRICTED USE OF EPISIOTOMY IN PRIMIGRAVIDAS

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    Apurva

    2016-06-01

    Full Text Available OBJECTIVES To compare maternal morbidity in routine versus selective episiotomy in primigravidae. STUDY DESIGN Prospective case control study. SETTING AND DURATION OF STUDY Obstetrics and gynaecology ward of Krishna Institute of Medical Sciences, Karad, from November 2013 to June 2015. METHODOLOGY Deliveries managed with routine use of episiotomy formed the Control Group, while those managed with restricted use of episiotomy formed the Study Group. Exclusion Criteria of our study was multigravida, multiple pregnancies, assisted breech deliveries, non-vertex presentations including malposition, instrumental deliveries and associated systemic diseases, maternal exhaustion, preterm deliveries, foetal macrosomia, PROM and VBAC. Perineal Pain Score was measured in the post-partum period by 100 mm VAS (visual analog scale. The main outcome measures which causes maternal morbidity was severe perineal trauma (3rd and 4th degree tears. Other outcomes which cause the maternal morbidity in terms of 1st and 2nd perineal tears, presence of perineal pain, haematoma formation and wound dehiscence were also recorded on proforma. RESULTS This study included 200 patients of routine episiotomy and 200 patients of restricted episiotomy. In the study group, 75% of women had first degree of tear and 22.5% women had second degree tear without any post-partum haemorrhage and in the control group; 95% pregnant women had episiotomy without any extension, 10 pregnant women had third degree of tear. During followup, only 2 patients reported dyspareunia in study group, while 3 patients reported faulty wound healing, 1 patient each reported urinary incontinence and anorectal incontinence, also 4 patients reported dyspareunia among control group. CONCLUSION As perineal pain, perineal tears and wound dehiscence and infections were all less frequent in study group, as compared to routine group, also pelvic muscle strength was better in study group, so overall maternal morbidity

  6. Vaginal pH-balanced gel for the control of atrophic vaginitis among breast cancer survivors: a randomized controlled trial.

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    Lee, Yoo-Kyung; Chung, Hyun Hoon; Kim, Jae Weon; Park, Noh-Hyun; Song, Yong-Sang; Kang, Soon-Beom

    2011-04-01

    To estimate the effects of vaginal pH-balanced gel on vaginal symptoms and atrophy in breast cancer survivors treated with chemotherapy or endocrine therapy. This was a randomized, double-blind, placebo-controlled study. Breast cancer survivors who experienced menopause after chemotherapy or endocrine therapy were voluntarily enrolled and randomly administered vaginal topical pH-balanced gel or placebo three times per week for 12 weeks. Vaginal dryness and dyspareunia were measured by visual analog scale, vaginal health index, and vaginal pH. The endometrium and ovary were evaluated by transvaginal ultrasonography. Among 98 enrolled women, 86 completed the treatment (n=44 and n=42 for the pH-balanced gel group and placebo group, respectively). Vaginal dryness and dyspareunia improved more in the pH-balanced gel group than in the placebo group (baseline mean 8.20 compared with end-point mean 4.23 [P=.001] and 8.23 compared with 5.48 [P=.040], respectively). Vaginal pH-balanced gel reduced the vaginal pH (gel: baseline mean 6.49 compared with end-point mean 5.00; placebo: 6.22 compared with 5.69 [Pvaginal maturation index (gel: 45.5 compared with 51.2; placebo: 46.4 compared with 47.9 [Pvaginal health index (gel: 15.8 compared with 21.1; placebo 14.3 compared with 16.98 [P=.002]). There was no significant difference in adverse effects between the two groups except for mild irritation at the early time of pH-balanced gel administration. Vaginal pH-balanced gel could relieve vaginal symptoms and improve vaginal health in breast cancer survivors who have experienced menopause after cancer treatment. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00607295. I.

  7. Evaluation of Risk Factors Associated with Endometriosis in Infertile Women

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    Ashrafi, Mahnaz; Sadatmahalleh, Shahideh Jahanian; Akhoond, Mohammad Reza; Talebi, Mehrak

    2016-01-01

    Background Endometriosis affects women’s physical and mental wellbeing. Symptoms include dyspareunia, dysmenorrhea, pelvic pain, and infertility. The purpose of this study is to assess the correlation between some relevant factors and symptoms and risk of an endometriosis diagnosis in infertile women. Materials and Methods A retrospective study of 1282 surgical patients in an infertility Institute, Iran between 2011 and 2013 were evaluated by laparoscopy. Of these, there were 341 infertile women with endometriosis (cases) and 332 infertile women with a normal pelvis (comparison group). Chi-square and t tests were used to compare these two groups. Logistic regression was done to build a prediction model for an endometriosis diagnosis. Results Gravidity [odds ratio (OR): 0.8, confidence interval (CI): 0.6-0.9, P=0.01], parity (OR: 0.7, CI: 0.6-0.9, P=0.01), family history of endometriosis (OR: 4.9, CI: 2.1-11.3, Pgalactorrhea (OR: 2.3, CI: 1.5-3.5, P=0.01), history of pelvic surgery (OR: 1.9, CI: 1.3-2.7, P0.05). Fatigue, diarrhea, constipation, dysmenorrhea, dyspareunia, pelvic pain and premenstrual spotting were more significant among late-stage endometriosis patients than in those with early-stage endometriosis and more prevalent among patients with endometriosis than that of the comparison group. In the logistic regression model, gravidity, family history of endometriosis, history of galactorrhea, history of pelvic surgery, dysmenorrhoea, pelvic pain, dysparaunia, premenstrual spotting, fatigue, and diarrhea were significantly associated with endometriosis. However, the number of pregnancies was negatively related to endometriosis. Conclusion Endometriosis is a considerable public health issue because it affects many women and is associated with the significant morbidity. In this study, we built a prediction model which can be used to predict the risk of endometriosis in infertile women. PMID:27123195

  8. Evaluation of Risk Factors Associated with Endometriosis in Infertile Women

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    Mahnaz Ashrafi

    2016-05-01

    Full Text Available Background: Endometriosis affects women’s physical and mental wellbeing. Symptoms include dyspareunia, dysmenorrhea, pelvic pain, and infertility. The purpose of this study is to assess the correlation between some relevant factors and symptoms and risk of an endometriosis diagnosis in infertile women. Materials and Methods: A retrospective study of 1282 surgical patients in an infertility Institute, Iran between 2011 and 2013 were evaluated by laparoscopy. Of these, there were 341 infertile women with endometriosis (cases and 332 infertile women with a normal pelvis (comparison group. Chi-square and t tests were used to compare these two groups. Logistic regression was done to build a prediction model for an endometriosis diagnosis. Results: Gravidity [odds ratio (OR: 0.8, confidence interval (CI: 0.6-0.9, P=0.01], parity (OR: 0.7, CI: 0.6-0.9, P=0.01, family history of endometriosis (OR: 4.9, CI: 2.1-11.3, P0.05. Fatigue, diarrhea, constipation, dysmenorrhea, dyspareunia, pelvic pain and premenstrual spotting were more significant among late-stage endometriosis patients than in those with early-stage endometriosis and more prevalent among patients with endometriosis than that of the comparison group. In the logistic regression model, gravidity, family history of endometriosis, history of galactorrhea, history of pelvic surgery, dysmenorrhoea, pelvic pain, dysparaunia, premenstrual spotting, fatigue, and diarrhea were significantly associated with endometriosis. However, the number of pregnancies was negatively related to endometriosis. Conclusion: Endometriosis is a considerable public health issue because it affects many women and is associated with the significant morbidity. In this study, we built a prediction model which can be used to predict the risk of endometriosis in infertile women.

  9. Does a history of bullying and abuse predict lower urinary tract symptoms, chronic pain, and sexual dysfunction?

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    Nault, Tori; Gupta, Priyanka; Ehlert, Michael; Dove-Medows, Emily; Seltzer, Marlene; Carrico, Donna J; Gilleran, Jason; Bartley, Jamie; Peters, Kenneth M; Sirls, Larry

    2016-11-01

    To investigate associations of bullying and abuse with pelvic floor symptoms, urogenital pain, and sexual health characteristics of women presenting to a multidisciplinary women's urology center. Retrospective review of a prospective database. Patients completed questions about bullying, abuse, sexual health and validated questionnaires including the Pelvic Floor Dysfunction Inventory (PFDI-20), Overactive Bladder Questionnaire (OAB-q), and visual analog scale (VAS 0-10) for genitourinary pain. Statistical analyses included Chi-squared and t tests, which compared victims of bullying and/or abuse to non-victims. Three hundred and eighty patients were reviewed. Three hundred and thirty-eight had data on bullying and abuse history. Out of 380, 94 (24.7 %) reported that they were victims of bullying. Out of 380, 104 (27.4 %) reported that they were victims of abuse. Women with a history of bullying and abuse had increased overall pain scores compared to those without a history of either. Women with a history of abuse and bullying had increased PFDI-20, POPDI, and UDI-6 scores compared to women who were not bullied or abused. There was no difference in being sexually active or in sexual satisfaction between the groups. Patients with a history of abuse and bullying had the greatest percentage of dyspareunia (p = 0.009). Women with a history of bullying, abuse, or both predict increased pelvic floor distress, urological symptoms, increased urogenital pain, and increased dyspareunia. Clinicians should screen for exposure to bullying or abuse in order to provide comprehensive resources to address these psychosocial issues.

  10. Development of chronic pain after episiotomy.

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    Turmo, M; Echevarria, M; Rubio, P; Almeida, C

    2015-10-01

    To analyze the incidence of chronic pain 5 months after episiotomy, as well as potential prognostic factors. A prospective cohort observational study was conducted on pregnant women age≥18 years who had undergone an episiotomy. The presence of pain was evaluated in the area of episiotomy at 24 and 48 h of delivery using a structured face-to-face questionnaire, and by telephone questionnaire at 5 months. The primary endpoint was the presence of persistent pain at 5 months. A record was made of the presence of pain at delivery, and its intensity, the presence or absence of epidural analgesia, instrumental delivery, perineal tear, and pain when episiotomy was performed, as well as the presence of dyspareunia and urinary incontinence at 5 months post-episiotomy. A total of 87 parturient patients were included, of whom 78 completed the study. Of the patients who completed the study, 12.8% reported chronic episiotomy pain. Epidural analgesia was associated with a higher incidence of instrumental delivery and less pain at the time of episiotomy and expulsion (P<.0005, P<.02, and P<.01, respectively). Chronic pain is associated with operative delivery (P<.017), and with the presence of pain at rest at 24 and 48 h (P<.01), of wound complications (P<.026), and of dyspareunia (P<.001). An incidence of 12.8% of women developing chronic pain after delivery with episiotomy suggests a health problem. More studies are needed to confirm our results. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Anatomical distribution of pelvic deep infiltrating endometriosis and its relationship with pain symptoms

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    DAI Yi; LENG Jin-hua; LANG Jing-he; LI Xiao-yan; ZHANG Jun-ji

    2012-01-01

    Background Endometriosis is a controversial and enigmatic disease.Deep infiltrating endometriosis (DIE) is responsible for painful symptoms and is the least understood type of endometriosis.Little work has been devoted to define the location of DIE lesions and its relationships with pain.The aim of the study was to investigate the relationship between the anatomical distribution of DIE lesions and pain symptoms.Methods Clinical data from 354 patients between May 2003 and December 2007 with laparoscopically diagnosed endometriosis were collected including 177 DIE patients and 177 non-DIE patients.The pain symptoms,including dysmenorrhea (DM),chronic pelvic pain (CPP,defined as intermittent or permanent pelvic pain,not related to the menstruation and longer than 6 months),deep dyspareunia (pelvic pain at intercourse) and dyschezia (pelvic pain with defecation),were recorded for every patient before operation.Endometriotic lesions were recorded by their anatomical distributions,the depth of infiltration and lesion colors.And the relationship between the anatomical distribution of DIE lesions and pain symptoms was analyzed.Pearson's chi-square test or Fisher's exact test,one-way analysis of variance (ANOVA) and linear regression and binary Logistic regression were used for statistical analysis.Results The duration ((13.79±3.94) years) of pain suffering in DIE patients was much longer than that of non-DIE patients (P <0.01).In DIE patients,60.7% of the uterosacral ligament (USL) nodules were bilateral (P <0.01); 44.6% of the cul-de-sacs were completely blocked.Rectum invasion was observed in 19.9% of DIE patients (P=0.03); pelvic adhesion was also more common.Up to 98.41% of the deep infiltrative lesions were located in the posterior pelvic compartment.DIE lesions were also found in bladder (1.58%),USL (67.08%),cul-de-sac (12.02%),recto-vaginal septum (12.66%),rectum and rectosigmoid junction (2.85%) and ureter (3.80%).The odds ratio of USL

  12. Interest of retro-anal levator plate myorrhaphy in selected cases of descending perineum syndrome with positive anti-sagging test

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    Beco Jacques

    2008-07-01

    Full Text Available Abstract Background Levator plate sagging (LPS, usually called descending perineum syndrome, is one of the main defects encountered in perineology. This defect is classically associated with colo-proctologic functional troubles (dyschesia and anal incontinence but can also induce perineodynia, gynaecological and lower urinary tract symptoms. Methods A retrospective case series of nine female patients (mean age: 44.3 underwent an isolated retro-anal levator plate myorrhaphy (RLPM to treat symptomatic LPS confirmed by rectal examination and/or Perineocaliper®. An anti-sagging test (support of the posterior perineum must significantly improve the symptoms that were resistant to conservative treatment. The effect of the procedure on the symptoms of the 3 axes of the perineum (urological, colo-proctologic and gynecological and on perineodynia was evaluated during a follow up consultation more than 9 months after surgery. The effect of RLPM on the position of the anal margin and on the levator plate angle was studied using rectal examination, Perineocaliper® and retro-anal ultrasound. Results Before surgery, anti-sagging tests were positive for dyschesia, urinary urgency and pain. After a mean follow-up of 16.1 months, RLPM resolved or improved 2/2 cases of stress urinary incontinence, 3/5 of urinary urgency, 3/4 of dysuria, 3/3 of anal incontinence, 7/8 of dyschesia, 3/4 of cystocele, 4/5 of rectocele, 5/8 of dyspareunia and 6/7 of perineodynia. Rectal examination showed a complete suppression of sagging in 4 patients and an improvement in the 5 others. The mean reduction of perineal descent was 1.08 cm (extremes: 0–1.5. Using retro-anal ultrasound of the levator plate, the mean reduction of sagging was 12.67 degrees (extremes: 1 – 21. Conclusion Anti-sagging tests can be used before surgery to simulate the effect of RLPM. This surgical procedure seems to improve stress urinary incontinence, frequency, nocturia, urgency, dysuria, anal

  13. Anxiety and depression in patients with endometriosis: impact and management challenges

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    Laganà AS

    2017-05-01

    Full Text Available Antonio Simone Laganà,1 Valentina Lucia La Rosa,2 Agnese Maria Chiara Rapisarda,3 Gaetano Valenti,3 Fabrizio Sapia,3 Benito Chiofalo,1 Diego Rossetti,4 Helena Ban Frangež,5 Eda Vrtačnik Bokal,5 Salvatore Giovanni Vitale1 1Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G Barresi”, University of Messina, Messina, 2Unit of Psychodiagnostics and Clinical Psychology, 3Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, 4Department of Maternal and Child Health, Gavardo Hospital, Brescia, Italy; 5Department of Reproduction, University Medical Center Ljubljana, Ljubljana, Slovenia Abstract: Endometriosis is one of the most common gynecological diseases and affects ~10% of women in reproductive age. The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain (CPP, dysmenorrhea, dyspareunia and infertility. Symptoms of endometriosis often affect psychological and social functioning of patients. For this reason, endometriosis is considered as a disabling condition that may significantly compromise social relationships, sexuality and mental health. Considering this point, the aim of this narrative review is to elucidate the impact of anxiety and depression in the management of women with endometriosis. Psychological factors have an important role in determining the severity of symptoms, and women who suffer from endometriosis report high levels of anxiety, depression and other psychiatric disorders. In addition, endometriosis is one of the most important causes of CPP; women with endometriosis suffer from a wide range of pelvic pain such as dysmenorrhea, dyspareunia, nonmenstrual (chronic pelvic pain, pain at ovulation, dyschezia and dysuria. Several studies have underlined the influence of CPP on quality of life and psychological well-being of women with endometriosis. Data suggest that the experience of pelvic pain is an

  14. Examining the sexual function and related attitudes among aged women: A cross- sectional study

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    Safieh Jamali

    2016-01-01

    Full Text Available Background: Sexual function and its subsequent satisfaction are among the most important aspects of women’s life. However, this instinct could be influenced by some factors such as diseases, drug using, aging, and hormonal and physiologic changes associated with menopause, and sexual behavior. Objective: The aim of this study was to describe the prevalence rates of sexual dysfunction, and related attitudes among aged women in Jahrom, Iran. Materials and Methods: This cross-sectional study was conducted on 746 postmenopausal women aged between 50 and 89 years old who had referred to obstetric and gynecologic clinic in Jahrom, from April to October 2014. Female Sexual Function Index questionnaire was used order to assess the sexual function. The cases were classified into three categories according to the attitude scores: negative (17-32, medium (33-38, and positive (39-48. One-way ANOVA test was used to determine the relationship between FSFI and attitude scores. Results: The participants’ mean±SD age was 60.10±6.89 years and the total mean score of FSFI was 19.31±8.5. In addition, 81.5% of the women had sexual dysfunction (FSFI 26.55. Almost 62.1% the women displayed a negative attitude towards sexuality and only 18.8% women had positive attitude. Feeling of dyspareunia (p= 0.02, lubrication (p< 0.0001, orgasm (p= 0.002 and satisfaction (p= 0.002 were significantly different between three categories of attitudes regarding sexuality, respectively Conclusion: Our data showed that sexual disorders were highly prevalent among postmenopausal women. The most affected problems were arousal, dyspareunia, and lubrication. More than half of the women had negative attitude towards sexual function consequently this could affect their sexual function. So, it seems screening of sexual dysfunction for finding the causes in women should be the main sexual health program. Also, it would be important to emphasis the role of physicians and experts on

  15. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity

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    Gülmezoglu Metin

    2006-07-01

    Full Text Available Abstract Background 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. Methods 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. Results 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. Meta-regression 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%. Conclusion 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

  16. A comparative study of continuous versus interrupted suturing for repair of episiotomy or second degree perineal tear

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    Lopamudra Jena

    2015-02-01

    Full Text Available Background: This study has been taken up to assess the effects of continuous versus interrupted suturing methods on the incidence of short and long term postpartum maternal morbidity experienced by women following repair of episiotomy or second-degree perineal tears after vaginal birth. Methods: This comparative prospective study was conducted in department of obstetrics and gynaecology of S.C.B. medical college, Cuttack, Odisha to compare continuous suturing technique with interrupted method for the repair of episiotomy and second degree perineal tear following vaginal delivery in 211 women. One group was repaired with continuous non-locking sutures involving the vaginal mucosa, perineal muscles and subcutaneous tissue for skin and other group had continuous locking stitch of vaginal mucosa, interrupted sutures in perineal muscles and interrupted transcutaneous stitches for skin. Identical suture material (catgut supplied by the government was used for both the groups. The mothers were interviewed on the 2nd, 10th and 42nd day following repair regarding pain perception with lying, walking and sitting posture using Visual Analogue Scale (VAS. Results: The pain score measured by VAS on 2nd day showed mild to moderate pain in continuous group compared to moderate and severe pain in interrupted group (P = 0.008 in lying position and (P = 0.000 in sitting and walking position. On 10th day no difference in perception in lying position (P = 0.571 but more subjects of interrupted group had pain in sitting and walking position (P = 0.05. On 42nd day no difference in pain perception in both groups was seen (P = 1.000. There was no difference in wound dehiscence in both the groups (P = 0.361. Subjects in the interrupted group had greater complains of dyspareunia compared to subjects in continuous group (P = 0.009. Less length of suture were required in the continuous group (P = 0.000. Conclusions: Continuous suturing technique for repair of episiotomy and

  17. [Hysteroscopy to relieve IUD-related symptoms].

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    de Groot, Pieter C M; Kapiteijn, Kitty; Siemans, Frederike C

    2010-01-01

    A levonorgestrel-releasing intrauterine device (LNG-IUD) had been placed in 4 patients, aged 33, 27, 46 and 27 years. They subsequently experienced symptoms that were possibly related to the IUD, such as haemorrhagic discharge, pain and dyspareunia. Patients who have persistent symptoms after IUD placement need to be examined. If a malpositioned IUD is suspected, outpatient vaginoscopic hysteroscopy should be considered. Hysteroscopy can reveal the cause of the symptoms. Furthermore, an IUD that is incorrectly positioned can be repositioned during the same procedure. One advantage to this is that unnecessary removal of an IUD may be prevented. The first patient referred to in this article had lost confidence in the IUD and requested its removal. In the second patient, the IUD had perforated the anterior wall of the uterus and it was removed as well. In the third patient, the IUD had perforated the posterior wall of the uterus, but it was repositioned during the hysteroscopy. In the last patient, hysteroscopy showed the IUD to be in a transverse position, but this could be corrected immediately.

  18. Research Progress of Prostaglandin in Endometriosis%前列腺素在子宫内膜异位症中的研究进展

    Institute of Scientific and Technical Information of China (English)

    徐燕颖

    2013-01-01

    子宫内膜异位症(EMs)是育龄期妇女的常见疾病,发病率为5% ~10%,是引起女性不孕的主要原因.患者多出现慢性盆腔痛、痛经、性交困难等症状,严重影响生活质量.EMs的病因复杂,其确切发病机制目前仍不明确.前列腺素E2(PGE2)是一种不稳定型的类花生四烯酸化合物,越来越多的证据表明,PGE2在EMs的病理生理过程中发挥关键作用,如细胞增殖、抗凋亡、免疫抑制和血管生成等.%Endometriosis is the primary cause of infertility in women,with a prevalence ranging from 5% to 10% .Women with endometriosis suffer from symptoms such as chronic pelvic pain,dysmenorrhea and dys-pareunia, which significantly reduce the quality of life.The etiology of Ems is complex,and the exact patho-genesis is still unclear.Prostaglandin E2( PGE2 )is an unstahle eicosanoid.A growing body of evidence demonstrates that PGE2 regulates many pathophysiological processes including cell proliferation, antiapoptosis, immune suppression and angiogenesis.

  19. The Prevalence of Trichomoniasis and Metronidazole Susceptibility of the Isolates in Ghorveh City, Year 2015

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    Mohammad Matini

    2016-11-01

    Full Text Available Introduction: Trichomoniasis is one of the most common non-viral sexually transmitted diseases caused by Trichomonas vaginalis. The aim of this study was to determine the prevalence of the infection and to consider the metronidazole susceptibility of the T. vaginalis isolates. Methods:This cross sectional study was conducted on 670females attending gynecology clinics of Qorveh city, Kurdistan province, during year 2015. Diagnosis of trichomoniasis was performed using Dorset culture medium and wet mount methods. In vitro drug susceptibility testing was done aerobically after establishment of the isolates in an axenic culture medium, diamond. Results: From 670vaginal samples, eight %1.2(and four %0.6(were positive for T. vaginalis by wet mount and culture methods, respectively. Fifty percent of the infected individuals were aged from 35to 44years old and were illiterate P < 0.05(. Clinical signs and symptoms of trichomoniasis were vaginal discharge, itching, burning sensation, dyspareunia, abdominal pain and greenish discharge. All of the parasites were sensitive to metronidazole with mean minimum inhibitory concentration MIC(and standard deviation of 1.9and 0.85µg/mL, respectively. Conclusions:Although, the prevalence of trichomoniasis is relatively low in the studied population but due to the importance of sexually transmitted diseases in public health, strategic measurements are necessary to prevent and control the infection.

  20. Aromaterapi Lavender dapat Menurunkan Intensitas Nyeri Perineum pada Ibu Post Partum

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    Wiwin Widayani

    2017-01-01

    Full Text Available Perineals pain affects  woman ability to mobilize so that it can cause complications such as post-partum haemoragik. Trauma to the perineum also cause discomfort and dyspareunia, therefore, perineal pain management is important. Currently the handling used to relieve pain is complementary therapy aromatherapy with essential oils of lavender, because lavender has the properties of anticonvulsant, antidepressant, anxiolytic, and also soothing. Aromatherapy stimulates the hypothalamus to secrete chemical mediators that serve as pain relievers and give rise to feelings of happiness. The purpose of this study was to determine the effect of lavender aromatherapy to the perineal pain intensity in post partum women. This study is a quasy experiment pre and post non random control in postpartum women at Bidan Praktik Mandiri in Bandung. Sampling this study using consecutive sampling technique. The data taken using the instrument in the adaptation of a Visual Analog Scale (VAS and analyzed by using the wilcoxon signed rank test. The result is there was a decrease in pain intensity before and after the administration of inhaled lavender aromatherapy (Z=-3.77 with p-value 0.001. Lavender aromatherapy can be a complementary alternative therapy to reduce pain in postpartum women but more research necessary is needed with more respondents.

  1. Women's sexual behavior, body image and satisfaction with surgical outcomes after hysterectomy: a comparison of vaginal and abdominal surgery.

    Science.gov (United States)

    Gütl, P; Greimel, E R; Roth, R; Winter, R

    2002-03-01

    The aim of this study was to investigate the impact of vaginal and abdominal hysterectomy on women's sexual behavior, sexual dysfunction, body image and satisfaction with surgery. A prospective study was conducted on 90 women to evaluate the outcomes of hysterectomy. Data were collected prior to surgery, three months and two years after surgery, using self-report questionnaires. The results showed significant differences in women's sexual behavior and sexual dysfunction before and after hysterectomy, independent of the surgical procedure performed. Women in both groups reported improvements in sexual desire, sexual activity and sexual intercourse three months and two years after surgery. Sexual dysfunction such as dyspareunia, vaginismus, lack of orgasm and loss of sexual interest diminished significantly after surgery. Regression analyses revealed that postmenopausal status, severity of gynecological complaints and frequency of sexual intercourse were the most important factors for improved sexual outcomes. Women in the abdominal group were dissatisfied with their body image because of the abdominal scar, experienced more pain and had a longer period of recovery from surgery compared to women in the vaginal group. According to the results, sexual behavior alone is not an important factor in choosing vaginal or abdominal hysterectomy. However, sexual behavior was important in both groups when evaluating outcomes after hysterectomy.

  2. Etiology, diagnosis, and clinical management of vulvodynia

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    Sadownik LA

    2014-05-01

    Full Text Available Leslie A Sadownik University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, BC, Canada Abstract: Chronic vulvar pain or discomfort for which no obvious etiology can be found, ie, vulvodynia, can affect up to 16% of women. It may affect girls and women across all age groups and ethnicities. Vulvodynia is a significant burden to society, the health care system, the affected woman, and her intimate partner. The etiology is multifactorial and may involve local injury or inflammation, and peripheral and or central sensitization of the nervous system. An approach to the diagnosis and management of a woman presenting with chronic vulvar pain should address the biological, psychological, and social/interpersonal factors that contribute to her illness. The gynecologist has a key role in excluding other causes for vulvar pain, screening for psychosexual and pelvic floor dysfunction, and collaborating with other health care providers to manage a woman's pain. An important component of treatment is patient education regarding the pathogenesis of the pain and the negative impact of experiencing pain on a woman's overall quality of life. An individualized, holistic, and often multidisciplinary approach is needed to effectively manage the woman's pain and pain-related distress. Keywords: vulvodynia, diagnosis, treatment, etiology, sexual pain disorder, dyspareunia, vestibulodynia, assessment, treatment, multidisciplinary

  3. Apigenin induces ROS-dependent apoptosis and ER stress in human endometriosis cells.

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    Park, Sunwoo; Lim, Whasun; Bazer, Fuller W; Song, Gwonhwa

    2017-06-15

    Apigenin is a plant-derived flavonoid having antiproliferative, anti-inflammatory, and anti-angiogenic properties in chronic and metabolic diseases, and cancers. However, the functional role of apigenin remains to be identified in human endometriosis that is a benign inflammatory disease causing infertility, dysmenorrhea, dyspareunia, and chronic abdominal or pelvic pain. In the present study, we determined the effects of apigenin on two well-established human endometriosis cell lines (VK2/E6E7 and End1/E6E7). Apigenin reduced proliferation and induced cell cycle arrest and apoptosis in the both endometriosis cell lines. In addition, it disrupted mitochondrial membrane potential (MMP) which was accompanied by an increase in concentration of calcium ions in the cytosol and in pro-apoptotic proteins including Bax and cytochrome c in the VK2/E6E7 and End1/E6E7 cells. Moreover, apigenin treated cells accumulated excessive reactive oxygen species (ROS), and experienced lipid peroxidation and endoplasmic reticulum (ER) stress with activation of the unfolded protein response (UPR) regulatory proteins. Furthermore, the apigenin-induced apoptosis in endometriosis cells was regulated via the ERK1/2, JNK, and AKT cell signaling pathways. Taken together, apigenin is a potential novel therapeutic agent to overcome current limitations in the treatment to endometriosis. © 2017 Wiley Periodicals, Inc.

  4. Contraception and endometriosis: challenges, efficacy, and therapeutic importance

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    Weisberg E

    2015-07-01

    Full Text Available Edith Weisberg,1 Ian S Fraser2 1Family Planning NSW, 2School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia Abstract: Endometriosis is a benign gynecological condition that is estimated to affect 10% of women in the general population and appears to be increasing in incidence. It is an estrogen-dependent inflammatory disease, and is primarily characterized by dysmenorrhea, deep dyspareunia, chronic pelvic pain, and variable effects on fertility. The symptoms may greatly affect quality of life, and symptom control may be the primary aim of initial management, while contraceptive effect is often secondary. It is estimated that 30%–50% of women with endometriosis have an infertility problem, so a considerable number of endometriosis sufferers will require effective, planned contraception to maximize “protection of fertility” and prevent progression of the endometriotic condition. Ideally, this contraception should also provide symptom relief and improvement of physical, mental, and social well-being. At the present time, long-term progestogens appear to be the most effective choice for meeting all of these requirements, but other options need to be considered. It is becoming increasingly recognized that hormonal contraceptive systems are necessary for prevention of disease recurrence following surgical treatment of endometriosis. The personal preferences of the woman are an integral part of the final contraceptive choice. This article discusses the advantages and disadvantages of the contraceptive options available to women with endometriosis. Keywords: pelvic pain, disease recurrence, progestogens, delivery systems, long-acting

  5. Laser-induced interstitial thermotherapy (LITT) with the KTP 532 laser for the treatment of uterine adenomyosis

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    Chapman, Roxana; Chapman, Kenneth

    1997-05-01

    Adenomyosis is a condition in which the myometrium is infiltrated by endometrial glands and stroma. This results in myometrial hyperplasia, uterine enlargement and causes menorrhagia, dysmenorrhoea and dyspareunia for which there is no known cure other than hysterectomy. The success of LITT in the treatment of uterine leiomyomata suggested that this might also be effective for the treatment of adenomyosis. Initially LITT was carried out on patients with adenomyosis prior to hysterectomy, then on patients who had completed child-bearing and finally on those who desired a family. Not only were symptoms relieved but pregnancies occurred spontaneously. The KTP 532 nm component of the KTP/YAG laser, which is absorbed by red pigment, was used with a 600 micrometer fiber with a bare tip via a needle microstat at laparoscopy. Holes were drilled in the abnormal tissue 3 cm apart and the laser fiber then slowly withdrawn, the object being to coagulate the surrounding blood vessels and adenomyotic tissue. The number of joules required depended on the volume of tissue treated.

  6. Clinical signs, symptoms and serum level of interleukin-6 and tumor necrosis factor in women with or without endometriosis

    Institute of Scientific and Technical Information of China (English)

    Wachyu Hadisaputra

    2013-01-01

    Objective: To evaluate clinical signs and symptoms and serum levels of interleukin-6 ( IL-6), tumor necrosis factor-α (TNF-α), matrix metalloproteinase-2 (MMP-2), and vascular endothelial growth factor (VEGF) as non-invasive methods to diagnose endometriosis. Methods: Eighty women scheduled to laparoscopy underwent blood sampling for measurement of IL-6, TNF-α, MMP-2, and VEGF. The diagnosis of endometriosis was established by laparoscopy using The American Fertility Society visual diagnosis. The presence or absence of endometriosis was correlated with clinical signs and symptoms and with serum levels of those substances. Results:The sensitivity and specificity to detect endometriosis of infertility (OR 134.3) were 78 % and 98%, dysmenorrhoea (OR 11.7) were 63 % and 88 %, and chronic pelvic pain (OR 13.0) were 28 % and 100 %. The presence of rectovaginal nodules had a sensitivity 25 % and specificity 100 %. (OR 11.3, 95 %). The sensitivity and specificity of biologic markers IL-6 (OR 2.5) were 68 % and 53%, and TNF-α (OR 28.1) were 68% and 60 %. Conclusions: History of infertility, dysmenorrhea, chronic pelvic pain, dyspareunia, cervical tenderness and rectovaginal nodule are clinical signs and symptoms suggesting endometriosis. IL-6 and TNF-α appears to be best serum markers for endometriosis.

  7. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development.

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    Vervoort, A J M W; Uittenbogaard, L B; Hehenkamp, W J K; Brölmann, H A M; Mol, B W J; Huirne, J A F

    2015-12-01

    Caesarean section (CS) results in the occurrence of the phenomenon 'niche'. A 'niche' describes the presence of a hypoechoic area within the myometrium of the lower uterine segment, reflecting a discontinuation of the myometrium at the site of a previous CS. Using gel or saline instillation sonohysterography, a niche is identified in the scar in more than half of the women who had had a CS, most with the uterus closed in one single layer, without closure of the peritoneum. An incompletely healed scar is a long-term complication of the CS and is associated with more gynaecological symptoms than is commonly acknowledged. Approximately 30% of women with a niche report spotting at 6-12 months after their CS. Other reported symptoms in women with a niche are dysmenorrhoea, chronic pelvic pain and dyspareunia. Given the association between a niche and gynaecological symptoms, obstetric complications and potentially with subfertility, it is important to elucidate the aetiology of niche development after CS in order to develop preventive strategies. Based on current published data and our observations during sonographic, hysteroscopic and laparoscopic evaluations of niches we postulate some hypotheses on niche development. Possible factors that could play a role in niche development include a very low incision through cervical tissue, inadequate suturing technique during closure of the uterine scar, surgical interventions that increase adhesion formation or patient-related factors that impair wound healing or increase inflammation or adhesion formation.

  8. Sexual functions of Turkish women with gynecologic cancer during the chemotherapy process.

    Science.gov (United States)

    Akkuzu, Gulcihan; Ayhan, Ali

    2013-01-01

    The negative effects of gynecologic cancer on women's health is multidimensional. Sexual problems arising after chemotherapy are decreased interest and vaginal lubrication, lack of orgasm and dyspareunia and sense of reduction in sexual attractiveness in general. The purpose of this study was to evaluate changes that patients who receive chemotherapy for a gynecologic oncology disorder experience in their sexual functions. A descriptive/cross-sectional and qualitative study was performed. The Female Sexual Function Index (FSFI) was used in order to collect data on sexual capacity. The quantitative data obtained were evaluated with frequency and percentage calculations while content analysis was performed for the qualitative data. All of the information related to sexuality was provided by the physician. Chemotherapy treatment affected sexuality negatively in 55.9%. Since receiving the diagnosis, 52.9% of women had experienced no sexual intercourse at all. Those who had an FSFI score of 30 and below made up 75% of the women. After the content analysis of data obtained during in in-depth interviewing, we focused on three main themes: desire for sexual intercourse, problems experienced during sexual intercourse, and coping with problems. An integrated system where sexual problems can be handled professionally should be present during gynecological cancer treatment.

  9. Family planning services in developing countries: an opportunity to treat asymptomatic and unrecognised genital tract infections?

    Science.gov (United States)

    Wilkinson, D; Ndovela, N; Harrison, A; Lurie, M; Connolly, C; Sturm, A W

    1997-12-01

    This is a study of 189 women attending a family planning clinic in rural South Africa to determine the prevalence of asymptomatic and unrecognized genital tract infections. Genital samples were taken from these women to diagnose infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, Treponema pallidum, and HIV, and to diagnose bacterial vaginosis. Among the 189 women, 41 (22%) reported having had an STD treated in the preceding 12 months. By direct questioning, 74 women stated the following symptoms: genital itch -- 38 (20%); vaginal discharge -- 56 (30%); dysuria -- 33 (18%); dyspareunia -- 22 (12%); and genital ulcers -- 4 (2%). 45 (24%) women had more than one symptom. 119 (63%) women had at least one genital infection, and 49 (26%) had multiple infections. Most of the infections were asymptomatic; while those that were symptomatic, were unrecognized or not reported. Results showed a high prevalence of genital tract infection among the participating women, with most of their infections remaining asymptomatic or unrecognized. Thus, strategies to detect and treat genital tract infections in rural South Africa need to be developed.

  10. [Chlamydia trachomatis genital infections and contraception].

    Science.gov (United States)

    Aloisio, T; Rullo, F; Smeraglia, R; Giorgio, A; Lettieri, G; Sannino, F; Martinelli, A

    1988-01-01

    330 women with a median age of 30.15 (+- 9.5) years sought gynecological consultation for advice on contraception and for cervical carcinoma screening. Anamnesis explored the presence of dysuria, dyspareunia, secretions, and pelvic pain, the number of partners, and type of contraceptive used. Endocervical samples were collected by means of tampon and the specimens were analyzed for 48 to 120 hours to find antigens of Chlamydia trachomatis (C.T.) by a solid phase immunoenzymatic test. Peripheral blood samples were also taken from all women to look for antibodies of C.T. and also the indirect immunoperoxidase test was used to search for specific antibodies of C.T. (IgM, IgA, IgE, IgG). The chi-square test was applied for statistical analysis. None of the women who used oral hormonal contraceptives or condoms were infected (presence of antigens and positivity for IgM and/or IgE and/or IgA), however, 36 of 90 IUD users (40%) were infected, 18 of 132 women who used no contraceptives whatsoever (13.7%) were also infected. 91% of the subjects had a single partner. In view of these findings the use of the condom and oral contraceptives is recommended with proper instruction about their potential side effects.

  11. Oral contraceptives after myomectomy: a short term trial.

    Science.gov (United States)

    Luisi, Stefano; Ciani, Valentina; Gabbanini, Massimo; Sollazzi, Sofia; Torricelli, Michela; Calonaci, Francesco; Petraglia, Felice

    2009-01-01

    Following myomectomy the rate of fertility is restored and pregnancy may be attempted with a good outcome. In the present study a 3 month treatment with OCs in a group of women after a myomectomy was evaluated. The drug compliance and side effects, the benefits of OC in order to reduce symptoms, to increase post-surgical hemoglobin levels and to avoid an early pregnancy after myomectomy were analyzed. A group of women (n = 55) each with myoma >/=5 cm was recruited: they presented menorrhagia, pelvic pain, dyspareunia and dysmenorrhae. After laparotomic myomectomy the women were divided into 3 groups. Group 1: women (n = 16) treated with pill A (15 mcg of ethynilestradiol + 60 mcg of gestodene); group 2: women (n = 23) treated with pill B (20 mcg of ethynilestradiol + 100 mcg of levonorgestrel); group 3: women (n = 16) treated with a placebo (oral calcium). After three months from myomectomy and treatment patients in each group reported a reduced menorrhagia, dismenorrhea and pelvic pain. Serum haemoglobin levels increased in all women (P < .05). No pregnancy occurred in any group and the compliance was good. A post surgery treatment by using oral contraceptives guarentees pregnancy prevention, associated with reduction of pain, and improvement of haematologic conditions.

  12. The impact of pelvic floor surgery on female sexual function: a mixed quantitative and qualitative study.

    Science.gov (United States)

    Roos, A M; Thakar, R; Sultan, A H; de Leeuw, J W; Paulus, A T G

    2014-01-01

    To assess whether the current condition-specific sexual function questionnaire provides full insight into sexual function following pelvic floor surgery. Prospective, mixed quantitative and qualitative study. Urogynaecology clinic in a large university hospital. Thirty-seven women undergoing surgery for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI). Women were seen before surgery and 3 months postoperatively. At both visits the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ) was completed and a qualitative face-to-face semi-structured interview was conducted. PISQ total and domain scores, as well as the change in the preoperative and postoperative score, were calculated and analysed using Wilcoxon signed rank test and one-sample t-test. The qualitative data were systematically analysed using data-matrices. The impact of pelvic floor surgery on female sexual function. Significant improvement was seen for PISQ total score (P = 0.003) as well as Physical (P qualitative data showed that improvement in sexual function was a result of cure of POP and SUI symptoms. Deterioration of sexual function was due to dyspareunia, fear of causing damage to the surgical result, new symptoms and a disappointing result of surgery. Our qualitative data show that PISQ is limited in the assessment of sexual function after pelvic floor surgery as it does not assess most surgery-specific negative effects on sexual function. © 2013 Royal College of Obstetricians and Gynaecologists.

  13. Study of epidemiological features of health problems in perimenopausal and postmenopausal women in an urban community

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    Manjusha K Deotale

    2015-04-01

    Full Text Available Introduction: Menopause is said to be universal reproductive phenomenon. Menopause although not a disease is associated with annoying physiological changes and varied symptoms such as hot flushes, night sweats, urinary and genital changes, dyspareunia, insomnia and many psychological dysfunctions such as anxiety, depression, lack of concentration and decreased self-esteem. Every woman's experience of the menopause is unique; she may experience all of the symptoms or none of them. Some find the transition barely noticeable while others find it life altering. Materials and Methods: A cross-sectional study was conducted among peri and postmenopausal women aged 40-60 years residing at Government colony, Bandra, Mumbai, Maharashtra for a period of 1-year. A predesigned and pretested questionnaire was used for collecting data. A booklet on "care during menopause" was used for giving health education. Results: In this study, mean age at natural menopause was 45.32 years (standard deviation ±2.79. Our study participants reported mostly muscular and joint pain (44.86%, urological symptoms (23.43%, vasomotor symptoms (21.14%, vulvovaginal symptoms (19.43%, psychological symptoms (15.14%, weight gain (14.86%, psychosexual symptoms (11.43% and hirsutism (1.43%. Conclusions: There is a necessity of a multidisciplinary approach to the problems of menopause with more stress on promotive and preventive interventions. There should be provision of relevant health services, health education and promotional activities to cope up with the health needs of women in their postmenopausal years.

  14. Advantages of implantation of acellular porcine-derived mesh in the treatment of human rectocele – Case report

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    Tomasz Kościński

    2016-09-01

    Full Text Available Introduction. A rectocele is a hernation of the rectum into the vaginal lumen developing as a consequence of weakness of the rectovaginal septum. It affects about 18% of women after childbearing age. Symptoms associated with a rectocele include constipation, vaginal fullness or heaviness, feeling of a bulging mass within vagina, incomplete stool evacuation and dyspareunia. Current methods of surgical treatment of a rectocele often require implantation of a mesh graft. In most of cases, synthetic and non-absorbable meshes are used. Although implantation of a synthetic and non-absorbable mesh is effective in the treatment of rectocele, a high rate of mesh erosion has been reported. Case report. This study presents a surgical technique and case report for the treatment of a rectocele in a 46-year-old women by implantation of a porcine-derived absorbable collagen mesh (Pelvicol® by transvaginal approach, with six year follow-up. A review of the literature concerning implantation of Pelvicol® for the treatment of rectocele was also undertaken. Conclusions. The clinical experience and review of the literature by the authors suggest that a porcine-derived acellular mesh is non-cytotoxic, pyrogenic or allergenic, and the application of a biomesh in the management of rectocele is effective and safe, and the risk of mesh erosion is very low.

  15. Non-hormonal topical treatment of vulvovaginal atrophy: an up-to-date overview.

    Science.gov (United States)

    Sinha, A; Ewies, A A A

    2013-06-01

    Vulvovaginal atrophy-related symptoms exert a negative impact on the quality of life of up to 50% of postmenopausal women. Many of them decline to use topical vaginal estrogen, which is the standard effective therapy, due to the adverse publicity over recent years, and seek for alternatives. Further, there are no safety studies to support the use of topical vaginal estrogen in breast cancer survivors, and it is considered as contraindicated by many health-care professionals. Vaginal moisturizers and lubricants as well as regular sexual activity may be helpful to such women. Vaginal moisturizers may have an equivalent efficacy to topical vaginal estrogen and should be offered to women wishing to avoid the use of hormonal therapy. Lubricants are usually used during sexual intercourse to provide temporary relief from vaginal dryness and dyspareunia; however, they have no long-term therapeutic effects. We provide in this systematic review up-to-date information, for women and health-care professionals, about the use, safety and efficacy of the available vaginal moisturizers and lubricants.

  16. Prevalence of sexual dysfunction in women seeking services at family planning centers in Tehran.

    Science.gov (United States)

    Shokrollahi, P; Mirmohamadi, M; Mehrabi, F; Babaei, G

    1999-01-01

    In the present study, a modified standardized sexual function questionnaire, along with a test of knowledge about and attitude toward sexuality, was administered to 300 healthy women, ages 16 through 53, who sought services at family planing centers in Tehran, Iran. All participants were married. The greatest percentages had two children (35%) and were housewives (69%). Some 72% were well educated, and 1% were illiterate; 74% of the women had moderate knowledge about sexuality, and 53% had a conservative attitude toward sexuality. The study revealed the prevalence of inhibited desire (15%), inhibited orgasm (26%), lack of lubrication (15%), vaginismus (8%), and dyspareunia (10%); 38% of the women had at least one sexual dysfunction. The most common sexual difficulties reported were "too little foreplay before intercourse" and "partner chooses inconvenient time" (8% each). Despite these difficulties, 51% of the sample reported that their overall sexual relationship was satisfactory. Knowledge about sexuality was significantly correlated with orgasm experience, higher knowledge being associated with more orgasm experience. There were significant correlations between attitude toward sexuality and sexual function (orgasm, desire, lubrication); a conservative attitude was associated with more sexual dysfunction. Spousal sexual dysfunction had a significant negative correlation with sexual function in the woman.

  17. Anatomy and physiology of genital organs - women.

    Science.gov (United States)

    Graziottin, Alessandra; Gambini, Dania

    2015-01-01

    "Anatomy is destiny": Sigmund Freud viewed human anatomy as a necessary, although not a sufficient, condition for understanding the complexity of human sexual function with a solid biologic basis. The aim of the chapter is to describe women's genital anatomy and physiology, focusing on women's sexual function with a clinically oriented vision. Key points include: embryology, stressing that the "female" is the anatomic "default" program, differentiated into "male" only in the presence of androgens at physiologic levels for the gestational age; sex determination and sex differentiation, describing the interplay between anatomic and endocrine factors; the "clitoral-urethral-vaginal" complex, the most recent anatomy reading of the corpora cavernosa pattern in women; the controversial G spot; the role of the pelvic floor muscles in modulating vaginal receptivity and intercourse feelings, with hyperactivity leading to introital dyspareunia and contributing to provoked vestibulodynia and recurrent postcoital cystitis, whilst lesions during delivery reduce vaginal sensations, genital arousability, and orgasm; innervation, vessels, bones, ligaments; and the physiology of women's sexual response. Attention to physiologic aging focuses on "low-grade inflammation," genital and systemic, with its impact on women sexual function, especially after the menopause, if the woman does not or cannot use hormone replacement therapy.

  18. Integrative treatment in endometriosis

    Institute of Scientific and Technical Information of China (English)

    Yu Jin; Yu Chao-qin

    2006-01-01

    Objective: To study the effectiveness of Yu's Neiyi Recipe on endometriosis.Methods: Yu's Neiyi Recipe was administrated in 48 patients with endometriosis (including 20 infertile cases). The clinical manifestations, ultrasonography, basal body temperature (BBT) and hormonal levels were observed before and 3 months after the treatment. The pregnancy outcome was followed up within 2 years.Results: Efficacy of Yu's Neiyi Recipe in the 48 cases was 93.75% within 3 months of treatment, 15 of the 20 infertile women become pregnant (80%) within 2 years. After the treatment, scores of dysmenorrhea, chronic pelvic pain or dyspareunia, and the size of ovarian endometrioma obviously decreased (P<0.01, P<0.01, P<0.01), meanwhile, the BBT type and high phase score (HPS) significantly improved (P<0.05). During herbal treatment, serum high PRL levels significantly dropped (P<0.05), and serum LH and E2 levels elevated significantly (P<0.05).Conclusions: Yu's Neiyi Recipe not only relieves the symptoms and signs of patients with endometriosis significantly, but also shows a good regulation on patients' ovarian function to improve the rate of ovulation and pregnancy.

  19. Tarlov cysts: clinical evaluation of an italian cohort of patients.

    Science.gov (United States)

    Marino, D; Carluccio, M A; Di Donato, I; Sicurelli, F; Chini, E; Di Toro Mammarella, L; Rossi, F; Rubegni, A; Federico, A

    2013-09-01

    Tarlov cyst syndrome is a rare, often asymptomatic disorder, characterised by isolated or multiple nerve-root cysts, usually occurring in the sacral spine, near the dorsal root ganglion, between the perineurium and endoneurium. The cysts may cause lower back pain, sacral radiculopathy, dyspareunia and urinary incontinence. There is little data in the literature on the relationship between Tarlov cysts and symptoms. Here, we report further details on the clinical impact of Tarlov cysts and investigate their pathogenesis and role as a cause of lumbosacral symptoms. We examined 157 patients with MRI evidence of symptomatic Tarlov cysts. Patients underwent complete neurological examination and were scored by the Hamilton Depression Rating Scale and the Visual Analogue Scale. Complete lower limb electromyography was performed in 32 patients. Clinical picture was correlated with size and number of cysts detected by MRI. Family history was recorded for signs of genetic inheritance. Almost all patients suffered perineal or lower back pain; 34 complained of sphincter and 46 of sexual disorders. Hamilton scores were abnormal, and family history was positive in a few cases. The scanty literature on Tarlov cysts mainly regards therapy by a neurosurgical approach. Our results provide new data on clinical impact and possible pathogenetic mechanisms.

  20. Management of urogenital atrophy in breast cancer patients: a systematic review of available evidence from randomized trials.

    Science.gov (United States)

    Mazzarello, Sasha; Hutton, Brian; Ibrahim, Mohammed F K; Jacobs, Carmel; Shorr, Risa; Smith, Stephanie; Ng, Terry; Clemons, Mark

    2015-07-01

    Symptoms of urogenital atrophy are common in breast cancer survivors. Its optimal management is currently unknown. A systematic review of randomized controlled trials (RCTs) evaluating treatments for urogenital atrophy in breast cancer patients was performed. EMBASE, Ovid Medline and the Cochrane Library were searched from 1946 to November 2014. Outcomes included improvements in both vaginal symptoms (e.g., dryness, pain, dyspareunia and itching) and vaginal hormone response measured by validated scales [e.g., Vaginal Health Index (VHI) and Vaginal Maturation Index (VMI)]. Of 430 unique citations identified, 4 studies (n = 196) met inclusion criteria. Interventions included pH-balanced gel, Replens(®), lidocaine, Estring(®) and Vagifem(®). Sample sizes ranged from 7 to 98 patients. Given the heterogeneity of the studies, a narrative synthesis of results was performed. One study of 98 patients suggested that vaginal pH-balanced gel (mean VHI 5.00 ± 0.816, mean VMI 51.18 ± 3.753) was more efficient than placebo (VHI 16.98 ± 3.875, p VMI 47.87 ± 2.728, p VMI in a study of seven patients. Treatment of urogenital atrophy remains a challenging issue and there is a paucity of RCT evidence addressing this knowledge gap. It is evident that more prospective trials are needed.

  1. Diagnosis of Female Diverticula Using Magnetic Resonance Imaging

    Directory of Open Access Journals (Sweden)

    Sima Porten

    2008-01-01

    Full Text Available We investigate the ability of physical exam to diagnose urethral diverticula with or without magnetic resonance imaging (MRI and exclusive of invasive modalities. A retrospective chart review of all women undergoing urethral diverticulectomy at our institution since 1999 was performed. We identified 28 female patients with a mean age at diagnosis of 42.6 years (range 18–66. Common presenting symptoms included dyspareunia, urgency, and frequency. Physical exam revealed a suspected urethral diverticulum in 26 (92.9% patients, which was confirmed postoperatively in 17 of the 20 (85% women who underwent surgical resection. Noninvasive imaging modalities (MRI or CT were available for review in 20 (71% cases and made the correct diagnosis of urethral diverticulum (presence or absence in 19 (95% patients. In those patients with symptoms of stress or urge incontinence (11, 39%, voiding cystourethrogram (VCUG was performed. Urethral diverticula are often easily diagnosed on physical exam. MRI can be a useful adjunct for defining diverticular extent in surgical planning, especially for proximal and complex diverticula, and should be the modality of choice if clinical suspicion is high based on patient symptoms and physical exam.

  2. Extramammary Paget’s Disease Versus Lichen Sclerosus

    Directory of Open Access Journals (Sweden)

    Pappova T.

    2016-12-01

    Full Text Available Burning, itching and dyspareunia are typical symptoms of many genital diseases. These subjective complaints can be misdiagnosed because of different clinical presentations. We present a case report of a postmenopausal woman treated for genital warts over a period of three years followed by the development of leukoplastic lesions in the whitish area clinical classified as Lichen sclerosus (LS. Histology of this lesion revealed carcinoma in situ. After radical surgical removal, vulvar Paget’s disease was histologically verified. LS and extramammary Paget's disease (EMPD belong to a group of uncommon dermatoses which mainly affect the skin of the genitals in postmenopausal women. Ulceration, erosions and leukoplastic lesions can signalize the development of squamous cell carcinoma in association of lichen sclerosus, on the other hand, they can be the sign of EMPD after a long period of time using different topical agents. The importance of reaching the correct diagnosis is essential and can influence current patient investigations and invasive or non-invasive treatment.

  3. [Pelvic floor and pregnancy].

    Science.gov (United States)

    Fritel, X

    2010-05-01

    Congenital factor, obesity, aging, pregnancy and childbirth are the main risk factors for female pelvic floor disorders (urinary incontinence, anal incontinence, pelvic organ prolapse, dyspareunia). Vaginal delivery may cause injury to the pudendal nerve, the anal sphincter, or the anal sphincter. However the link between these injuries and pelvic floor symptoms is not always determined and we still ignore what might be the ways of prevention. Of the many obstetrical methods proposed to prevent postpartum symptoms, episiotomy, delivery in vertical position, delayed pushing, perineal massage, warm pack, pelvic floor rehabilitation, results are disappointing or limited. Caesarean section is followed by less postnatal urinary incontinence than vaginal childbirth. However this difference tends to disappear with time and following childbirth. Limit the number of instrumental extractions and prefer the vacuum to forceps could reduce pelvic floor disorders after childbirth. Ultrasound examination of the anal sphincter after a second-degree perineal tear is useful to detect and repair infra-clinic anal sphincter lesions. Scientific data is insufficient to justify an elective cesarean section in order to avoid pelvic floor symptoms in a woman without previous disorders.

  4. Posthysterectomy vault prolapse of vaginal walls: Choice of operating procedure

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    Argirović Rajka

    2012-01-01

    Full Text Available Post-hysterectomy vaginal vault prolapse is a common complication following different types of hysterectomy with a negative impact on the woman’s quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanisms for the uterus and vagina is important in order to make the right choice of the corrective procedure and also to minimize the risk of posthysterectomy occurrence of vault prolapse. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced in hysterectomy to prevent vault prolapse. Vaginal vault repair can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures. The vaginal approach for vault prolapse is superior to the abdominal approach in terms of complication rates, blood loss, postoperative discomfort, length of hospital stay and costeffectiveness. Moreover, it allows the simultaneous repair of all coexistent pelvic floor defects, such as cystocele, enterocele and rectocele. Abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. Other less commonly performed procedures include uterosacral ligament suspension and illeococcygeal fixation with a high risk of ureteric injury. Surgical mesh of non-absorbent material is gaining in popularity and preliminary data from vaginal mesh procedures is encouraging.

  5. Final report on position of female circumcision in Nigeria.

    Science.gov (United States)

    Adelaja, O A

    1981-01-01

    Survey data reveal that female genital mutilation (FGM) is being practiced in most Nigerian states, usually on babies and young girls but occasionally during wedding preparations or 7 months into the first pregnancy. Among the few tribes that mutilate women after marriage, husbands carry out the deed. Usually, FGM is performed on a group of girls, but it can also be performed on one girl in her home. The mutilator, who is paid a token fee, uses a knife or a razor. Post-mutilation treatment includes application of a variety of traditional methods. The most usual immediate complication is bleeding but other complications include tearing, septicemia, fistula development, stenosis, delayed second-stage labor, tetanus, urinary obstruction, and dyspareunia. Reasons cited for FGM include tradition, the belief that FGM curbs female promiscuity, and the belief that a baby whose head touches a clitoris during delivery will die. A prominent 1981 newspaper article on the subject reported the view of a physician that the practice ought to be eradicated and the view of a mutilator that it is not likely to be stopped.

  6. [Impact of aging on sexuality].

    Science.gov (United States)

    Degauquier, C; Absil, A-S; Psalti, I; Meuris, S; Jurysta, F

    2012-01-01

    Numerous authors on sexual behaviors have studied the link between the persistence of a sexually active life and progressive aging. The knowledge of sexual health in the elderly has shown that biological sexual aging is extremely diverse and heterogeneous in men as well as in women, and contradicts the stereotype of age that would inevitably alter the sexual biological response in each human. Sexual diseases (lubrication, dyspareunia, erectile dysfunction, inability to achieve orgasm) and diseases of aging that impact sexual function have a growing incidence but don't never touch 100% of individuals. There is a decline in sexual interest correlated with the life-span, but the negative effects of age on desire are related to health problems. Moreover, sexual desire is more correlated with personal attitudes toward sexuality than with biological factors and diseases. Several predictors account for the pursuit of an active sexuality (including the presence of a partner, good health, having good sexual self-esteem, enjoyable past experience, an attitude that values the importance of sex in couple relationship), but the most decisive factor to successfully face the specific markers of aging is the ability to adapt to a more sensory sexuality, less focused on performance and coitus.

  7. The effect of hormones on the lower urinary tract.

    Science.gov (United States)

    Robinson, Dudley; Toozs-Hobson, Philip; Cardozo, Linda

    2013-12-01

    The female genital and lower urinary tracts share a common embryological origin, arising from the urogenital sinus and both are sensitive to the effects of the female sex steroid hormones throughout life. Estrogen is known to have an important role in the function of the lower urinary tract and estrogen and progesterone receptors have been demonstrated in the vagina, urethra, bladder and pelvic floor musculature. In addition estrogen deficiency occurring following the menopause is known to cause atrophic change and may be associated with lower urinary tract symptoms such as frequency, urgency, nocturia, urgency incontinence and recurrent infection. These may also co-exist with symptoms of urogenital atrophy such as dyspareunia, itching, vaginal burning and dryness. Epidemiological studies have implicated estrogen deficiency in the aetiology of lower urinary tract symptoms with 70% of women relating the onset of urinary incontinence to their final menstrual period. Whilst for many years systemic and vaginal estrogen therapy was felt to be beneficial in the treatment of lower urinary and genital tract symptoms this evidence has recently been challenged by large epidemiological studies investigating the use of systemic hormone replacement therapy as primary and secondary prevention of cardiovascular disease and osteoporosis. The aim of this paper is to examine the effect of the sex hormones, estrogen and progesterone, on the lower urinary tract and to review the current evidence regarding the role of systemic and vaginal estrogens in the management of lower urinary tract symptoms and urogenital atrophy.

  8. Treatments for invasive carcinoma of the cervix: what are their impacts on the pelvic floor functions?

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    Alessandra Ferreira de Noronha

    2013-01-01

    Full Text Available Aims: Describe the impact of surgery, radiotherapy and chemoradiation in the pelvic floor functions in cervical cancer patients. Materials and Methods: A prospective study with women submitted to radical hysterectomy (RH (n = 20, exclusive radiotherapy (RT (n = 20 or chemoradiation (CT/RT (n = 20 for invasive cervical cancer. Urinary, intestinal and sexual function, as well as vaginal length and pelvic floor muscle contraction were evaluated. Comparisons between groups were performed by Kruskal-Wallis and Chi-square tests (p < 0.05. Results: The groups were similar in stress urinary incontinence incidence (p = 0.56, urinary urgency (p = 0.44, urge incontinence (p = 0.54, nocturia (p = 0.53, incomplete bowel emptying (p = 0.76, bowel urgency (p = 0.12 and soilage (p = 0.43. The CT/RT group presented a higher urinary frequency (p < 0.001 and diarrhea (p = 0.025. Patients in the RH group were more sexually active (p = 0.01 and experienced less dyspareunia (p = 0.021. Vaginal length was shorter in RT group (5.5 ± 1.9cm and CT/RT(5.3 ± 1.5 cm than in the RH group (7.4 ± 1.1 cm (p < 0.001. Pelvic floor muscle contraction was similar (p = 0.302. Conclusions: RT and CT/RT treatment for cervical carcinoma are more associated to sexual and intestinal dysfunctions.

  9. An unusual cause of urinary incontinence: Urethral coitus in a case of Mayer-Rokitansky-Kuster-Hauser syndrome.

    Science.gov (United States)

    Sharifiaghdas, Farzaneh; Daneshpajooh, Azar; Sohbati, Samira; Mirzaei, Mahboubeh

    2016-09-01

    Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare anomaly in women and is characterized by congenital aplasia of the uterus and vagina, with normal development of secondary sexual characteristics and a normal karyotype. We report a case of a 38-year-old women with MRKH syndrome that had experienced urethral sex for many years. She presented with urinary incontinence and dyspareunia. The patient's secondary sexual characteristics were normal, and examination revealed a widely open incompetent megalourethra and an absent vagina. Laboratory studies confirmed a 46, XX karyotype. Imaging included ultrasonography and magnetic resonance imaging, which indicated bilateral normal ovaries and a rudimental bicornuate uterus. After confirming the diagnosis of MRKH, the patient underwent urethroplasty by urethral plication, antiincontinence surgery by autologous fascial sling of the bladder neck, and the creation of a neo-vagina using a urethral flap. After 3 months, voiding cystourethrography and uroflowmetry confirmed normal voiding. There were no postoperative symptoms of urinary incontinence, and the patient was completely satisfied.

  10. Chronic vulvovaginal candidiasis: what we know and what we have yet to learn.

    Science.gov (United States)

    Fischer, Gayle

    2012-11-01

    Vulvovaginal candidiasis (VVC) is defined as vulvovaginitis, causally associated with Candida species in the vagina. It is seen commonly in vulval clinics as a cause of persistent vulvovaginitis and yet this chronic condition is yet to be formally defined and explained. The classic symptom complex of chronic itch, pain and dyspareunia exacerbating premenstrually and remitting during menstruation associated with an erythematous vulval eruption is well described but the exact aetiology remains elusive. Research in recent years has suggested that VVC is not an opportunistic infection or an immunodeficiency but a hypersensitivity response to a commensal organism that may be genetically determined. Further, it is apparent on clinical grounds that oestrogen plays an essential permissive role and that, in healthy non-diabetic patients, VVC does not occur in the absence of oestrogen whether endogenous or exogenous. The nature of this relationship has not been established. In this article I discuss the diagnostic features of VVC, its management and what is currently understood of its aetiology.

  11. Directory of Open Access Journals (Sweden)

    Alessandra Ferreira de Noronha

    2013-01-01

    Full Text Available Aims:Describe the impact of surgery, radiotherapy and chemoradiation in the pelvic floor functions in cervical cancer patients.Materials and Methods:A prospective study with women submitted to radical hysterectomy (RH (n = 20, exclusive radiotherapy (RT (n = 20 or chemoradiation (CT/RT (n = 20 for invasive cervical cancer. Urinary, intestinal and sexual function, as well as vaginal length and pelvic floor muscle contraction were evaluated. Comparisons between groups were performed by Kruskal-Wallis and Chi-square tests (p < 0.05.Results:The groups were similar in stress urinary incontinence incidence (p = 0.56, urinary urgency (p = 0.44, urge incontinence (p = 0.54, nocturia (p = 0.53, incomplete bowel emptying (p = 0.76, bowel urgency (p = 0.12 and soilage (p = 0.43. The CT/RT group presented a higher urinary frequency (p < 0.001 and diarrhea (p = 0.025. Patients in the RH group were more sexually active (p = 0.01 and experienced less dyspareunia (p = 0.021. Vaginal length was shorter in RT group (5.5 ± 1.9cm and CT/RT(5.3 ± 1.5 cm than in the RH group (7.4 ± 1.1 cm (p < 0.001. Pelvic floor muscle contraction was similar (p = 0.302.Conclusions:RT and CT/RT treatment for cervical carcinoma are more associated to sexual and intestinal dysfunctions.

  12. Fertility and Symptom Relief following Robot-Assisted Laparoscopic Myomectomy

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    Michael C. Pitter

    2015-01-01

    Full Text Available Objective. To examine success of robot-assisted laparoscopic myomectomy (RALM measured by sustained symptom relief and fertility. Methods. This is a retrospective survey of 426 women who underwent RALM for fibroids, symptom relief, or infertility at three practice sites across the US. We examined rates of symptom recurrence and pregnancy and factors associated with these outcomes. Results. Overall, 70% of women reported being symptom-free, with 62.9% free of symptoms after three years. At >3 years, 66.7% of women who underwent surgery to treat infertility and 80% who were also symptom-free reported achieving pregnancy. Factors independently associated with symptom recurrence included greater time after surgery, preoperative dyspareunia, multiple fibroid surgeries, smoking after surgery, and preexisting diabetes. Factors positively correlated with achieving pregnancy included desiring pregnancy, prior pregnancy, greater time since surgery, and Caucasian race. Factors negatively correlated with pregnancy were advanced age and symptom recurrence. Conclusions. This paper, the first to examine symptom recurrence after RALM, demonstrates both short- and long-term effectiveness in providing symptom relief. Furthermore, RALM may have the potential to improve the chance of conception, even in a population at high risk of subfertility, with greater benefits among those who remain symptom-free. These findings require prospective validation.

  13. Classification of Hypertrophy of Labia Minora: Consideration of a Multiple Component Approach.

    Science.gov (United States)

    González, Pablo I

    2015-11-01

    Labia minora hypertrophy of unknown and under-reported incidence in the general population is considered a variant of normal anatomy. Its origin is multi-factorial including genetic, hormonal, and infectious factors, and voluntary elongation of the labiae minorae in some cultures. Consults with patients bothered by this condition have been increasing with patients complaining of poor aesthetics and symptoms such as difficulty with vaginal secretions, vulvovaginitis, chronic irritation, and superficial dyspareunia, all of which can have a negative effect on these patients' sexuality and self esteem. Surgical management of labial hypertrophy is an option for women with these physical complaints or aesthetic issues. Labia minora hypertrophy can consist of multiple components, including the clitoral hood, lateral prepuce, frenulum, and the body of the labia minora. To date, there is not a consensus in the literature with respect to the classification and definition of varying grades of hypertrophy, aside from measurement of the length in centimeters. In order to offer patients the most appropriate surgical technique, an objective and understandable classification that can be used as part of the preoperative evaluation is necessary. Such a classification should have the aim of offering patients the best cosmetic and functional results with the fewest complications.

  14. Diagnosis of endometriosis with imaging: a review

    Energy Technology Data Exchange (ETDEWEB)

    Kinkel, Karen [Clinique et fondation des Grangettes, Institut de Radiologie, Chene-Bougeries/Geneva (Switzerland); Frei, Kathrin A. [University Hospital Bern, Department of Obstetrics and Gynaecology, Bern (Switzerland); Balleyguier, Corinne [Institut Gustave Roussy, Radiology Department, Villejuif (France); Chapron, Charles [Hopitaux de Paris, Service de Gynecologie Obstetrique II, Unite de Chirurgie, Paris (France)

    2006-02-01

    Endometriosis corresponds to ectopic endometrial glands and stroma outside the uterine cavity. Clinical symptoms include dysmenorrhoea, dyspareunia, infertility, painful defecation or cyclic urinary symptoms. Pelvic ultrasound is the primary imaging modality to identify and differentiate locations to the ovary (endometriomas) and the bladder wall. Characteristic sonographic features of endometriomas are diffuse low-level internal echos, multilocularity and hyperchoic foci in the wall. Differential diagnoses include corpus luteum, teratoma, cystadenoma, fibroma, tubo-ovarian abscess and carcinoma. Repeated ultrasound is highly recommended for unilocular cysts with low-level internal echoes to differentiate functional corpus luteum from endometriomas. Posterior locations of endometriosis include utero-sacral ligaments, torus uterinus, vagina and recto-sigmoid. Sonographic and MRI features are discussed for each location. Although ultrasound is able to diagnose most locations, its limited sensitivity for posterior lesions does not allow management decision in all patients. MRI has shown high accuracies for both anterior and posterior endometriosis and enables complete lesion mapping before surgery. Posterior locations demonstrate abnormal T2-hypointense, nodules with occasional T1-hyperintense spots and are easier to identify when peristaltic inhibitors and intravenous contrast media are used. Anterior locations benefit from the possibility of MRI urography sequences within the same examination. Rare locations and possible transformation into malignancy are discussed. (orig.)

  15. Essure Surgical Removal and Subsequent Resolution of Chronic Pelvic Pain: A Case Report and Review of the Literature

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    Isamarie Lora Alcantara

    2016-01-01

    Full Text Available Background. Hysteroscopic tubal sterilization (Essure is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. A small percentage of these women subsequently choose to have the tubal inserts removed due to regret or perceived side effects such as late-onset pelvic pain secondary to placement of the Essure device. Case. A twenty-nine-year-old woman G4P4014 presented with a two-year complaint of chronic pelvic pain and dyspareunia after the hysteroscopic placement of an Essure device for sterilization. On reviewing the images of the HSG, it was noted that although tubal occlusion was confirmed, the left Essure coil appeared curved on itself in an elliptical fashion and did not seem to follow the expected anatomic trajectory of the fallopian tube. The patient reported resolution of chronic pelvic pain following laparoscopic removal of Essure device. Conclusion. A misplaced Essure device should be considered in the differential diagnosis of chronic pelvic pain in women who had difficult placement of the device. In addition to demonstrating tubal occlusion, careful examination of the configuration of the Essure microinserts on HSG examination provides valuable information in patients with pelvic pain after Essure placement.

  16. Perbandingan Sensasi Nyeri 48 Jam dan 42 Hari Pascasalin Menggunakan Benang Chromic Catgut dengan Fast Absorbing Polyglactin 910

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    Benny Hasan Purwara

    2011-06-01

    Full Text Available Perineal pain due to tears that occur during delivery can be felt immediately after birth or several months later, causing dyspareunia. Episiotomy as a prophylactic to protect the integrity of the pelvic floor is a straight and neat surgical incision will replace rough lacerations. Pain sensation due to episiotomy wound suturing can be reduced by using thread that quickly absorbed. The purpose of this study was to compare perineal pain sensation after suturing episiotomy wound using chromic catgut with using fast absorbing polyglactin 910. The perineal pain of both groups were evaluated 48 hours and 42 days post episiotomy using visual analog scale (VAS. This study was conducted at the Obstetrics and Gynecology Department, Faculty of Medicine Padjadjaran University/Dr. Hasan Sadikin Hospital period December 2009–March 2010. Fifty out of 100 subjects were sutured using chromic catgut and 50 were using fast-absorbing polyglactin 910. Chi-square test analysis at 48 hours postpartum, showed no significant perineal pain difference (p=0.645 of both groups but at 42 days the analysis showed a significant difference (p<0.001 between both groups, incidence of perineal pain free better with fast absorbing sutures using polyglactin 910 (46 cases or 92% compared with the use of chromic catgut (29 cases or 58%. In conclusion, suturing perineal wound using fast-absorbing polyglactin 910 provide free events perineal pain better than chromic catgut in 42 days.

  17. [Routine episiotomy--a five year practice at University Hospital "Majchin Dom"].

    Science.gov (United States)

    Nalbanski, A; Nikolov, A

    2009-01-01

    Episiotomy continues to be a frequently used procedure in obstetrics despite little scientific support for its routine use. The rationale for routine episiotomy is based on two foundation arguments: that episiotomy reduces perineal trauma and that it prevents subsequent pelvic relaxation. A careful review finds little evidence to support these arguments. Although episiotomy does decrease the occurrence of anterior lacerations, it fails to accomplish the majority of goals stated as reasons for its use. Episiotomy does not decrease damage to the perineum but rather increases it. The midline episiotomy increases the risk for third-degree and fourth-degree lacerations. Episiotomy fails to prevent the development of pelvic relaxation and its attendant complications. Rather than decreasing maternal morbidity, episiotomy increases blood loss and is related to greater initial postpartum pain and dyspareunia. The claims of a protective effect on the fetus in shortening the second stage of labor, improving Apgar scores, and preventing perinatal asphyxia have not been borne out. Efforts should be directed to determine whether episiotomy is beneficial. It is now very important to improve new birthing techniques that maintain the integrity of the perineum and do not involve surgical procedures. More trials are necessary to clarify which are the real indications to use episiotomy. Meanwhile, without the proper scientific evidence, the most correct attitude seems to be a careful use of episiotomy, with decisions on a case-by-case basis.

  18. Lavender-thymol as a new topical aromatherapy preparation for episiotomy: A randomised clinical trial.

    Science.gov (United States)

    Marzouk, T; Barakat, R; Ragab, A; Badria, F; Badawy, A

    2015-01-01

    The objective of this study was to evaluate the effectiveness of topical lavender-thymol in promoting episiotomy healing. This placebo-controlled, single-blinded, randomised clinical trial involved 60 primiparous women. REEDA score was used to evaluate the outcome of the trial. On the 7th post-partum day, women in Placebo-treated group had worse Redness, Edema, Ecchymosis, Discharge and Approximation (REEDA) score of 3.93 ± 3.65 compared with those in Lavender-thymol-treated group (2.03 ± 1.7) with significant difference (P = 0.013). Visual analogue Scale (VAS) score for pain at episiotomy in Lavender-thymol-treated group was 3.5 ± 1.9, whereas in Placebo-treated group it was 2.1 ± 2.2 (p = 0.011) for dyschezia, 3.8 ± 1.7 and 2.8 ± 1.6 in Placebo- and Lavender-thymol-treated women, respectively (p = 0.023). At 7th post-partum week, dyspareunia was more severe in Placebo-treated group compared with that in Lavender-thymol-treated group (5.3 ± 2.7 vs 2.7 ± 1.5 and p episiotomy wound care with little or no expected side effects compared with that using placebo.

  19. The Use of Tutomesh for a Tension-Free and Tridimensional Repair of Uterovaginal and Vaginal Vault Prolapse: Preliminary Report

    Directory of Open Access Journals (Sweden)

    Danilo Dodero

    2015-01-01

    Full Text Available Objective. To evaluate efficacy in terms of vaginal capacity, coital function, and recurrence prevention of a new biological mesh of bovine pericardium (Tutomesh in the repair of severe POP. Methods. Thirty cases of patients suffering from stage III uterine or apical prolapse undergone surgical repair by means of a modified sacrospinous ligament suspension combined with mesh attachment to both the cardinal ligaments, posterior and anterior colporrhaphy, and perineal body fixation. The mesh was replaced inside the pelvis with the goal of reconstructing the tridimensional fascial disposition of the structures sustaining the correct axis of vagina. Follow-up was done at 12 months with POPIQ analysis. Results. One total mesh failure occurred early after surgery due to marked deficiency of anatomy. Two cystoceles were observed at 12 months in two patients treated for apical prolapse where anterior repair was not performed. Two other patients developed a de novo SUI at 12 months. No reported abnormalities of coital function or dyspareunia were ever found after surgery. Conclusions. It is possible that the utilization of a tension-free and tridimensional placement of Tutomesh might favor a more physiologic reconstruction of the vaginal axis as compared with traditional sacrospinous ligament suspension.

  20. Sexual dysfunction in patients with alcohol and opioid dependence

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    Sandeep Grover

    2014-01-01

    Full Text Available There are limited numbers of studies which have evaluated the sexual dysfunction (SD in patients with alcohol and opioids dependence. This article reviews the existing literature. Electronic searches were carried out using the PubMed, Google Scholar, and ScienceDirect to locate the relevant literature. Subjects addicted to heroin or on methadone maintenance treatment (MMT or buprenorphine maintenance treatment (BMT show higher rates of SD in comparison to the general population. SD rates have ranged 34-85% for heroin addicts, 14-81% for MMT, 36-83% for BMT, and 90% for naltrexone maintenance. The rates of SD in alcohol-dependent population have ranged 40-95.2%, with rates being consistently much higher in alcohol-dependent population than in the healthy controls or social drinkers. The common SDs reported have been erectile dysfunction followed by premature ejaculation, retarded ejaculation and decreased sexual desire among men, and dyspareunia and vaginal dryness among women. This review suggests that long-term use of alcohol and opioids are associated with SD in almost all domains of sexual functioning. There is a need to increase the awareness of clinicians about this association as many times SD in patients with substance abuse lead to poor treatment compliance and relapse. Further, there is a need to carry out more number of studies to understand the relationship in a better way.

  1. Acute mucocutaneous and systemic adverse effects of Etretinate

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    "Mortazavi H

    2003-06-01

    Full Text Available This cross sectional study was carried out between 1993 to 1998 at Razi Skin Hospital, the affiliated Dermatology Department of Tehran University of Medical Sciences. Eight hundred patients receiving etretinate for various skin diseases took part in this study. Among them, 457 patients with first admission to dermatologic clinic who had at least four regular sequential visits and responding to our questionnaire were selected to enter the study for evaluating acute toxicity of etretinate. Cheilitis with a frequency of 88 percent was the most frequent side effect. Hair loss (22.97%, dry mouth with thirst (15.09%, dryness of mucous membranes (13.12%, xerosis with pruritus (11.15%, nose bleeding (8.31%, paronychia (5.47%, facial dermatitis (3.06%, conjunctivitis (2.84% and in addition to mucocutaneous ones, chills (2.63%, headache (2.19%, mental depression (2.19%, urinary frequency (1.53% and papilledema (0.44% were among the other observed toxicities, The relationship between mucocutaneous side effect with dosage of etretinate, sex and, age of the patients was evaluated. The association between mucoctaneous toxicities and sex was significant, sex and, age of the patients was evaluated. The association between mucocutaneous toxicities and sex was significant (P<0.05. We observed four rare side effect in the patients including hair color lightening appering as whitening or blondness, hair waving, dyspareunia and gynecomastia. In conclusion, females were more to acute mucocutaneous toxicities of etretinate.

  2. [Practice of reconstructive plastic surgery of the clitoris after genital mutilation in Burkina Faso. Report of 94 cases].

    Science.gov (United States)

    Ouédraogo, C M R; Madzou, S; Touré, B; Ouédraogo, A; Ouédraogo, S; Lankoandé, J

    2013-06-01

    To describe and evaluate the results of reconstructive plastic surgery of the clitoris in order to promote reproductive health. We conducted a retrospective study from 2007 to 2010. Ninety-four women were included in our study. The mean age was 32.3 years. The evaluation of the experience of sexuality before reconstruction showed that 41.5 % of patients had never had a sexual desire before surgery, more than half did not have a clitoral orgasm and dyspareunia was experienced by about a third of them. The main reason for consultation in our series was related to sexual dysfunction in more than half of our study population. All patients were operated using the technique of Dr Pierre Foldès. Evaluation with a decline of at least 6 months after surgery showed us a massive restoration of the clitoris at 89.7 %. There was a significant difference between sexual desire before and after surgery. A significant improvement in sexuality was observed in 83.6 % of patients. However, there was no significant difference between orgasm before and after surgery. This showed us that getting an orgasm is multifactorial and it is not enough to have a clitoris to have an orgasm, you have to use it. Regardless of the anatomical and functional results, all women were satisfied with respect to body found. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  3. Impact of vulvovaginal health on postmenopausal women: a review of surveys on symptoms of vulvovaginal atrophy

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    Parish SJ

    2013-07-01

    Full Text Available Sharon J Parish,1 Rossella E Nappi,2 Michael L Krychman,3 Susan Kellogg-Spadt,4 James A Simon,5 Jeffrey A Goldstein,6 Sheryl A Kingsberg7 1Albert Einstein College of Medicine, Bronx, NY, USA; 2Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo University, University of Pavia, Pavia, Italy; 3Southern California Center for Sexual Health and Survivorship Medicine and Clinical Faculty University of California Irvine, Newport Beach and Irvine, CA, USA; 4Pelvic and Sexual Health Institute, Philadelphia, PA, USA; 5Obstetrics and Gynecology, George Washington University, Washington, DC, USA; 6Novo Nordisk Inc, Princeton, NJ, USA; 7Departments of Reproductive Biology and Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA Abstract: Several recent, large-scale studies have provided valuable insights into patient perspectives on postmenopausal vulvovaginal health. Symptoms of vulvovaginal atrophy, which include dryness, irritation, itching, dysuria, and dyspareunia, can adversely affect interpersonal relationships, quality of life, and sexual function. While approximately half of postmenopausal women report these symptoms, far fewer seek treatment, often because they are uninformed about hypoestrogenic postmenopausal vulvovaginal changes and the availability of safe, effective, and well-tolerated treatments, particularly local vaginal estrogen therapy. Because women hesitate to seek help for symptoms, a proactive approach to conversations about vulvovaginal discomfort would improve diagnosis and treatment. Keywords: health care professional, hypoactive sexual desire disorder, local vaginal estrogen therapy, quality of life, urinary tract infection, vulvovaginal atrophy

  4. A comparative study of vaginal estrogen cream and sustained-release estradiol vaginal tablet (Vagifem in the treatment of atrophic vaginitis in Isfahan, Iran in 2010-2012

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    Pardis Hosseinzadeh

    2015-01-01

    Full Text Available Background: Atrophic vaginitis is a disease, which affects up to 50% of postmenopausal women. This study compared the effectiveness and user-friendliness of Vagifem (an estradiol vaginal tablet and vaginal estrogen cream in the treatment of atrophic vaginitis. Materials and Methods: One hundred and sixty postmenopausal women with symptoms of atrophic vaginitis were randomly divided into two groups of treatment with Vagifem or with vaginal estrogen cream for 12 weeks. Patients used the medication daily for the first 2 weeks of the study, and twice weekly. Severity of vaginal atrophy and four main symptoms of atrophic vaginitis including dysuria, dyspareunia, vaginal itching, and dryness were evaluated and compared before and after treatment. In addition, patients were asked regarding user-friendliness and hygienic issues of medications. Results: Both vaginal estrogen cream and Vagifem significantly improved symptoms of atrophic vaginitis but in terms of effectiveness for the treatment symptoms of atrophic vaginitis, there was no significant difference between the two medications. Vagifem compared to estrogen cream resulted in significantly lower rate of hygienic problems (0% versus 23%, P < 0.001, and was reported by the patients as a significantly easier method of treatment (90% versus 55%, P < 0.0001. Conclusion: This investigation showed that Vagifem is an appropriate medication for the treatment of atrophic vaginitis, which is as effective as vaginal estrogen creams and is more user-friendly.

  5. EFEK SUSU SKIM YANG DISUPLEMENTASI ISOFLAVON KEDELAI DAN Zn (

    Directory of Open Access Journals (Sweden)

    Hery Winarsi

    2004-12-01

    Full Text Available Premenopause is part of natural aging process in women indicated by the decrease of ovarial estrogen production, and usually followed by development of menopausal syndrome. Susumeno, skim milk fortified with 100 mg of soy isoflavone and 8 mg of Zn was given to premenopausal women for decreasing menopausal syndrome. This research aimed to evaluate the effect of susumeno on menopausal syndrome in premenopausal women. About 33 premenopausal women aged 43-52 years old in Purwokerto were choosen as respondent. Their menopausal syndrome were identified by using questioner. The answers were scored from 1 to 5 ; i.e., 1 = not detected; 2 = less detected; 3 = mildly detected; 4 = detected; 5 = much detected. It was revealed that some of menopausal syndromes had significantly decreased, especially vaginal dryness from less detected to not detected (p=0,01; fatigue from mildly detected to not detected (p=4,07E-05; mindless from mildly detected to not detected (p=0,022; and dyspareunia from less detected to not detected (p=0,036

  6. Atrophic Vaginitis in Breast Cancer Survivors: A Difficult Survivorship Issue

    Directory of Open Access Journals (Sweden)

    Joanne Lester

    2015-03-01

    Full Text Available Management of breast cancer includes systematic therapies including chemotherapy and endocrine therapy can lead to a variety of symptoms that can impair the quality of life of many breast cancer survivors. Atrophic vaginitis, caused by decreased levels of circulating estrogen to urinary and vaginal receptors, is commonly experienced by this group. Chemotherapy induced ovarian failure and endocrine therapies including aromatase inhibitors and selective estrogen receptor modulators can trigger the onset of atrophic vaginitis or exacerbate existing symptoms. Symptoms of atrophic vaginitis include vaginal dryness, dyspareunia, and irritation of genital skin, pruritus, burning, vaginal discharge, and soreness. The diagnosis of atrophic vaginitis is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Lifestyle modifications can be helpful but are usually insufficient to significantly improve symptoms. Non-hormonal vaginal therapies may provide additional relief by increasing vaginal moisture and fluid. Systemic estrogen therapy is contraindicated in breast cancer survivors. Continued investigations of various treatments for atrophic vaginitis are necessary. Local estrogen-based therapies, DHEA, testosterone, and pH-balanced gels continue to be evaluated in ongoing studies. Definitive results are needed pertaining to the safety of topical estrogens in breast cancer survivors.

  7. Ultra-low-dose vaginal estrogen tablets for the treatment of postmenopausal vaginal atrophy.

    Science.gov (United States)

    Simon, J A; Maamari, R V

    2013-08-01

    Vaginal atrophy is a common chronic condition affecting up to 57% of postmenopausal women. The decrease in estrogen following cessation of menses can lead to bothersome symptoms that include vaginal dryness and irritation, pain and burning during urination (dysuria), urinary tract infections, and pain (dyspareunia) and bleeding during sexual activities. These symptoms can be safely and effectively managed with the use of local estrogen therapy, which reduces the risks associated with long-term systemic hormone therapy. The ultra-low-dose 10 μg estradiol vaginal tablet is the lowest approved dose available and has an annual estradiol exposure of only 1.14 mg. Its development addresses recommendations from regulatory agencies and women's health societies regarding the use of the lowest hormonal dose. The 10 μg vaginal tablet displays minimal estradiol absorption, causes no increased risk of endometrial hyperplasia or carcinoma, and provides significant symptom relief. The clinical evidence presented here may offer greater reassurance to health-care professionals and postmenopausal women that vaginal atrophy can be treated safely and effectively.

  8. The Use of Human Adipose-Derived Stem Cells in the Treatment of Physiological and Pathological Vulvar Dystrophies

    Directory of Open Access Journals (Sweden)

    Maria Giuseppina Onesti

    2016-01-01

    Full Text Available “Vulvar dystrophy” is characterized by chronic alterations of vulvar trophism, occurring in both physiological (menopause and pathological (lichen sclerosus, vulvar graft-versus-host disease conditions. Associated symptoms are itching, burning, dyspareunia and vaginal dryness. Current treatments often do not imply a complete remission of symptoms. Adipose-Derived Stem Cells (ADSCs injection represents a valid alternative therapy to enhance trophism and tone of dystrophic tissues. We evaluated efficacy of ADSCs-based therapy in the dystrophic areas. From February to April 2013 we enrolled 8 patients with vulvar dystrophy. A biopsy specimen was performed before and after treatment. Digital photographs were taken at baseline and during the follow-up. Pain was detected with Visual Analogue Scale and sexual function was evaluated with Female Sexual Function Index. All patients received 2 treatments in 3 months. Follow-up was at 1 week , 1 and 3 months, and 1 and 2 years. We obtained a significant vulvar trophism enhancement in all patients, who reported pain reduction and sexual function improvement. Objective exam with speculum was easy to perform after treatment. We believe ADSCs-based therapy finds its application in the treatment of vulvar dystrophies, since ADSCs could induce increased vascularization due to their angiogenic properties and tissue trophism improvement thanks to their eutrophic effect.

  9. Treatment of postmenopausal vaginal atrophy with 10-μg estradiol vaginal tablets.

    Science.gov (United States)

    Panay, Nick; Maamari, Ricardo

    2012-03-01

    Postmenopausal estrogen deficiency can lead to symptoms of urogenital atrophy. Individuals with urogenital atrophy have symptoms that include vaginal dryness, vaginal and vulval irritation, vaginal soreness, pain and burning during urination (dysuria), increased vaginal discharge, vaginal odour, vaginal infections, recurrent urinary tract infections, pain associated with sexual activity (dyspareunia) and vaginal bleeding associated with sexual activity. Despite the frequency and effects of vaginal atrophy symptoms, they are often under-reported and, consequently, under-treated. Therefore, care of a menopausal woman should include a physical assessment of vaginal atrophy and a dialogue between the physician and the patient that explores existing symptoms and their effect on vulvovaginal health, sexuality and quality-of-life issues. The development of the ultra-low-dose 10-µg estradiol vaginal tablets is in line with the requirements of regulatory agencies and women's health societies regarding the use of the lowest effective hormonal dose. Because of its effectiveness and safety profiles, in addition to its minimal systemic absorption, the 10-µg estradiol vaginal tablet can offer greater reassurance to health-care providers and postmenopausal women with an annual estradiol administration of only 1.14 mg.

  10. Non-hormonal treatment of vulvo-vaginal atrophy-related symptoms in post-menopausal women.

    Science.gov (United States)

    Tersigni, C; Di Simone, N; Tempestilli, E; Cianfrini, F; Russo, R; Moruzzi, M C; Amar, I D; Fiorelli, A; Scambia, G; Villa, P

    2015-01-01

    In post-menopausal period vulvo-vaginal atrophy (VVA)-related symptoms may seriously affect women's quality of life. Hormonal replacement therapy effectively relieves these symptoms but it is not always safe or accepted, and a non-hormonal treatment is often needed instead. Over a period of 12 weeks, we tested the effect of a twice-a-week vulvo-vaginal application of a hyaluronic acid, AC collagen, isoflavones and vitamins-based cream (Perilei Pausa) on 35 women in post-menopausal period, reporting VVA-related symptoms. After 12 weeks of treatment with Perilei Pausa a significant improvement in vaginal dryness, vulvo-vaginal itching, dyspareunia (P vaginal paleness and petechiae was also reduced (P = 0.037, P = 0.016 and P = 0.032, respectively). No significant difference in terms of maturation value of cervico-vaginal epithelium was observed. In conclusion, Perilei Pausa may represent an effective and safe alternative treatment of symptomatic VVA in post-menopausal women.

  11. Effects of low dose estrogen therapy on the vaginal microbiomes of women with atrophic vaginitis.

    Science.gov (United States)

    Shen, Jian; Song, Ning; Williams, Christopher J; Brown, Celeste J; Yan, Zheng; Xu, Chen; Forney, Larry J

    2016-01-01

    Atrophic vaginitis (AV) is common in postmenopausal women, but its causes are not well understood. The symptoms, which include vaginal itching, burning, dryness, irritation, and dyspareunia, can usually be alleviated by low doses of estrogen given orally or locally. Regrettably, the composition of vaginal bacterial communities in women with AV have not been fully characterized and little is known as to how these communities change over time in response to hormonal therapy. In the present intervention study we determined the response of vaginal bacterial communities in postmenopausal women with AV to low-dose estrogen therapy. The changes in community composition in response to hormonal therapy were rapid and typified by significant increases in the relative abundance of Lactobacillus spp. that were mirrored by a decreased relative abundance of Gardnerella. These changes were paralleled by a significant four-fold increase in serum estradiol levels and decreased vaginal pH, as well as nearly a two-fold increase in the Vaginal Maturation Index (VMI). The results suggest that after menopause a vaginal microbiota dominated by species of Lactobacillus may have a beneficial role in the maintenance of health and these findings that could lead to new strategies to protect postmenopausal women from AV.

  12. Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection

    Science.gov (United States)

    Jhang, Jia-Fong; Kuo, Hann-Chorng

    2015-01-01

    Chronic pelvic pain (CPP) is defined as pain in the pelvic organs and related structures of at least 6 months’ duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A), known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment. PMID:26094697

  13. Applications and Therapeutic Actions of Complementary and Alternative Medicine for Women with Genital Infection

    Science.gov (United States)

    Liu, Chenfang; Zhang, Yuehui; Yu, Yang; Han, Fengjuan

    2014-01-01

    Genital infection is a common worldwide disease among females with clinical features such as bilateral lower abdominal tenderness, abnormal vaginal or cervical discharge, fever, abnormal vaginal bleeding, dyspareunia, vaginal itching, and adnexal tenderness, which can significantly impair women's health and quality of life. Genital infection is commonly treated with antibiotics, leading to an imbalance in gut flora due to prolonged use of antibiotics. Therefore, it is necessary to discover safe and efficacious alternative treatment strategies for patients with genital infection. Complementary and alternative medicine (CAM) is becoming increasingly prevalent among women with genital infection. CAM has interested the western mainstream medical community because of its less invasive, safe, effective, economical, and convenient therapies. CAM focuses on the prevention and treatment of disease and has become an important force in treating chronic disease. During the last few decades, the popularity of CAM has gradually increased. To further understand the efficacy of CAM in treating genital infection, our paper will review the current progress of treating genital infection including vulvitis, vaginitis, cervicitis, and pelvic inflammatory disease (PID) with CAM therapies. Several CAM strategies including traditional Chinese medicine (TCM), acupuncture, Psychology interference, and physical therapy are introduced in this review. PMID:24648850

  14. [The voice of women subjected to female genital mutilation in the Region of Murcia (Spain)].

    Science.gov (United States)

    Ballesteros Meseguer, Carmen; Almansa Martínez, Pilar; Pastor Bravo, María del Mar; Jiménez Ruiz, Ismael

    2014-01-01

    To explore the perceptions of a group of women who underwent female genital mutilation on the impact of this practice on their sexual and reproductive health. We performed a phenomenological qualitative study in a sample of 9 sub-Saharan Africa women, whose mean age was 30 years old and who had lived in Spain for 1 to 14 years. These women underwent genital mutilation in their countries of origin. Data was collected using a socio-demographic survey and an in-depth, structured personal interview. Subsequently, we performed a thematic discourse analysis. The discourses were grouped into four categories related to participants' perceptions of female genital mutilation. These categories were intimate relationships, pregnancy, childbirth, and social impact. The practice of female genital mutilation is maintained due to social and family pressure, transmitted from generation to generation and silenced by women themselves. This practice affects their sexual and reproductive health, as demonstrated by anorgasmia and dyspareunia. The women were satisfied with the healthcare received during pregnancy and childbirth. Nevertheless, most of them were not satisfied with family planning. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  15. Visual attention to erotic images in women reporting pain with intercourse.

    Science.gov (United States)

    Lykins, Amy D; Meana, Marta; Minimi, Jillian

    2011-01-01

    The coupling of sex and pain creates an interesting theoretical conundrum of clinical significance: Are women with dyspareunia distracted from sexual stimuli, or are they hypervigilant to sexual stimuli because these stimuli elicit thoughts and expectations of pain? This study measured attention to sexual stimuli in women reporting persistent pain with intercourse, women reporting low sexual desire, and women reporting no sexual problems. Participants viewed a series of erotic images, each containing an object intended to distract from the erotic scene regions, while an eye tracker recorded their eye movements. Women with pain looked for shorter periods of time and fewer times at the sexual scene region than did both women with low sexual desire (p = .024 and p = .018, respectively) and the no-dysfunction control group (p < .001 and p = .003, respectively). Women with pain also looked at the context (nonsexual) scene region significantly more times and for longer periods than did the no-dysfunction control women (p = .013 and p = .042, respectively). Results are interpreted to be potentially supportive of the cognitive distraction hypothesis associated with sexual dysfunction, with an additional component of cognitive avoidance of sexual stimuli for the women reporting sexual pain.

  16. The Use of Tutomesh for a Tension-Free and Tridimensional Repair of Uterovaginal and Vaginal Vault Prolapse: Preliminary Report

    Science.gov (United States)

    Dodero, Danilo; Bernardini, Luca

    2015-01-01

    Objective. To evaluate efficacy in terms of vaginal capacity, coital function, and recurrence prevention of a new biological mesh of bovine pericardium (Tutomesh) in the repair of severe POP. Methods. Thirty cases of patients suffering from stage III uterine or apical prolapse undergone surgical repair by means of a modified sacrospinous ligament suspension combined with mesh attachment to both the cardinal ligaments, posterior and anterior colporrhaphy, and perineal body fixation. The mesh was replaced inside the pelvis with the goal of reconstructing the tridimensional fascial disposition of the structures sustaining the correct axis of vagina. Follow-up was done at 12 months with POPIQ analysis. Results. One total mesh failure occurred early after surgery due to marked deficiency of anatomy. Two cystoceles were observed at 12 months in two patients treated for apical prolapse where anterior repair was not performed. Two other patients developed a de novo SUI at 12 months. No reported abnormalities of coital function or dyspareunia were ever found after surgery. Conclusions. It is possible that the utilization of a tension-free and tridimensional placement of Tutomesh might favor a more physiologic reconstruction of the vaginal axis as compared with traditional sacrospinous ligament suspension. PMID:26425731

  17. Genetic polymorphisms of cytochrome P450cl7alpha (CYP17) and progesterone receptor genes (PROGINS) in the assessment of endometriosis risk.

    Science.gov (United States)

    De Carvalho, Cristina Valleta; Nogueira-De-Souza, Naiara Correa; Costa, Ana Maria Massad; Baracat, Edmund Chada; Girão, Manoel J B C; D'Amora, Paulo; Schor, Eduardo; da Silva, Ismael D C G

    2007-01-01

    We designed the present study in order to evaluate the eventual role of polymorphisms in the genes encoding cytochrome P450c17alpha (CYP17) and the progesterone receptor (PROGINS) as risk factors for endometriosis development. Eligible cases consisted of 121 women with surgically confirmed endometriosis who underwent treatment in a hospital in São Paulo, Brazil during the period from September 2003 to September 2005. The 281 controls were participants with normal gynecological as well as pelvic ultrasound evaluation, who did not have any gynecological conditions during their reproductive lives such as pelvic pain and/or dyspareunia nor infertility history. Genomic DNA was obtained from buccal cells and processed for DNA extraction using the GFX DNA extraction kit (GE Healthcare). The CYP17 (-34T-->C) polymerase chain reaction-restriction fragment length polymorphism assay has been described previously, as has the progesterone receptor polymorphism (PROGINS) detection assay. PROGINS heterozygosis genotype frequencies were shown to be statistically higher in endometriosis cases compared with controls. On the other hand, differences in the CYP17 polymorphism (-34T-->C) frequencies were not even close to significance (p = 0.278) according to our findings.

  18. Applications and Therapeutic Actions of Complementary and Alternative Medicine for Women with Genital Infection

    Directory of Open Access Journals (Sweden)

    Chenfang Liu

    2014-01-01

    Full Text Available Genital infection is a common worldwide disease among females with clinical features such as bilateral lower abdominal tenderness, abnormal vaginal or cervical discharge, fever, abnormal vaginal bleeding, dyspareunia, vaginal itching, and adnexal tenderness, which can significantly impair women’s health and quality of life. Genital infection is commonly treated with antibiotics, leading to an imbalance in gut flora due to prolonged use of antibiotics. Therefore, it is necessary to discover safe and efficacious alternative treatment strategies for patients with genital infection. Complementary and alternative medicine (CAM is becoming increasingly prevalent among women with genital infection. CAM has interested the western mainstream medical community because of its less invasive, safe, effective, economical, and convenient therapies. CAM focuses on the prevention and treatment of disease and has become an important force in treating chronic disease. During the last few decades, the popularity of CAM has gradually increased. To further understand the efficacy of CAM in treating genital infection, our paper will review the current progress of treating genital infection including vulvitis, vaginitis, cervicitis, and pelvic inflammatory disease (PID with CAM therapies. Several CAM strategies including traditional Chinese medicine (TCM, acupuncture, Psychology interference, and physical therapy are introduced in this review.

  19. Relationship between delivery modes and genitourinary syndrome among postmenopausal women.

    Science.gov (United States)

    Yaralizadeh, M; Abedi, P; Salehinejad, P

    2017-08-01

    Many postmenopausal women suffer from genitourinary syndrome of menopause (GSM) due to the lack of estrogen. This study aimed to evaluate the relationship between mode of delivery and GSM among postmenopausal women. We performed a case-control study of women who had had either vaginal delivery or Cesarean section. Data were collected through a sociodemographic questionnaire and a check list for assessing signs and symptoms of GSM. Subjective symptoms of vaginal atrophy (dryness, dyspareunia, itching, burning and paleness), pH of the vagina and maturation index were assessed and recorded. Data were analyzed using the χ(2) test and independent t-test. A total of 125 postmenopausal women were recruited (65 with a history of normal vaginal delivery (NVD) and 60 with a history of Cesarean section). Vaginal pH was more commonly lower (pH 5-5.49) in the NVD group (50.8% vs. 40%) (p women with a history of normal vaginal delivery were less likely to have GSM compared to the women with a history of Cesarean section. Other prospective studies can explore this relationship better.

  20. Aromatase inhibitors in the treatment of deep endometriosis

    Directory of Open Access Journals (Sweden)

    Simone Ferrero

    2009-09-01

    Full Text Available Recent case reports and pilot studies suggested that aromatase inhibitors might be effective in treating pain symptoms related to the presence of endometriosis. We present the case of a 32-year-old woman who suffered dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia caused by rectovaginal endometriosis. Pain symptoms recurred after treatment with the oral contraceptive pill; the patient refused surgery. Therefore a double-drug regimen including letrozole (2.5 mg/day and norethisterone acetate (2.5 mg/day was offered to the patient. The scheduled length of treatment was six months. This double-drug regimen determined a quick and significant improvement in all pain symptoms. During treatment, the patient complained mild arthralgia. After the interruption of treatment, pain symptoms quickly recurred and at 6-month follow-up their intensity was similar to baseline values. Operative laparoscopy was performed, the presence of rectovaginal endometriosis was confirmed and all visible endometriotic lesions were excised. Aromatase inhibitors might be offered when pain symptoms caused by endometriosis persist during the administration of other hormonal therapies and the patient refuses surgery. However, women must be informed that these drugs determine only a temporary relief of pain symptoms and might cause adverse effects (such as arthralgia.

  1. Atrophic Vaginitis in Breast Cancer Survivors: A Difficult Survivorship Issue

    Science.gov (United States)

    Lester, Joanne; Pahouja, Gaurav; Andersen, Barbara; Lustberg, Maryam

    2015-01-01

    Management of breast cancer includes systematic therapies including chemotherapy and endocrine therapy can lead to a variety of symptoms that can impair the quality of life of many breast cancer survivors. Atrophic vaginitis, caused by decreased levels of circulating estrogen to urinary and vaginal receptors, is commonly experienced by this group. Chemotherapy induced ovarian failure and endocrine therapies including aromatase inhibitors and selective estrogen receptor modulators can trigger the onset of atrophic vaginitis or exacerbate existing symptoms. Symptoms of atrophic vaginitis include vaginal dryness, dyspareunia, and irritation of genital skin, pruritus, burning, vaginal discharge, and soreness. The diagnosis of atrophic vaginitis is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Lifestyle modifications can be helpful but are usually insufficient to significantly improve symptoms. Non-hormonal vaginal therapies may provide additional relief by increasing vaginal moisture and fluid. Systemic estrogen therapy is contraindicated in breast cancer survivors. Continued investigations of various treatments for atrophic vaginitis are necessary. Local estrogen-based therapies, DHEA, testosterone, and pH-balanced gels continue to be evaluated in ongoing studies. Definitive results are needed pertaining to the safety of topical estrogens in breast cancer survivors. PMID:25815692

  2. A comparative study of vaginal estrogen cream and sustained-release estradiol vaginal tablet (Vagifem) in the treatment of atrophic vaginitis in Isfahan, Iran in 2010-2012.

    Science.gov (United States)

    Hosseinzadeh, Pardis; Ghahiri, Atallah; Daneshmand, Freshteh; Ghasemi, Mojdeh

    2015-12-01

    Atrophic vaginitis is a disease, which affects up to 50% of postmenopausal women. This study compared the effectiveness and user-friendliness of Vagifem (an estradiol vaginal tablet) and vaginal estrogen cream in the treatment of atrophic vaginitis. One hundred and sixty postmenopausal women with symptoms of atrophic vaginitis were randomly divided into two groups of treatment with Vagifem or with vaginal estrogen cream for 12 weeks. Patients used the medication daily for the first 2 weeks of the study, and twice weekly. Severity of vaginal atrophy and four main symptoms of atrophic vaginitis including dysuria, dyspareunia, vaginal itching, and dryness were evaluated and compared before and after treatment. In addition, patients were asked regarding user-friendliness and hygienic issues of medications. Both vaginal estrogen cream and Vagifem significantly improved symptoms of atrophic vaginitis but in terms of effectiveness for the treatment symptoms of atrophic vaginitis, there was no significant difference between the two medications. Vagifem compared to estrogen cream resulted in significantly lower rate of hygienic problems (0% versus 23%, P vaginitis, which is as effective as vaginal estrogen creams and is more user-friendly.

  3. A very large leiomyoma of the urethra: a case report.

    Science.gov (United States)

    Fedelini, Paolo; Chiancone, Francesco; Fedelini, Maurizio; Fabiano, Marco; Persico, Francesco; Di Lorenzo, Domenico; Meccariello, Clemente

    2017-02-28

    Leiomyomas are benign mesenchymal tumours of smooth muscle origin. They are the most common uterine masses in women of reproductive age group and may be related to the hormonal status. Urethral leiomyomas are very rare. According to the literature, the mean diameter of the urethral leiomyomas is 3.7 cm. We report a case of a very large leiomyoma of the urethra. A 40-year-old women woman was admitted to our department for a giant vaginal mass. She complained of haematuria, dysuria, recurrent urinary tract infections and dyspareunia. The physical evaluation demonstrated a 6 × 5.5 cm neoformation involving the distal tract of the urethra. The patient underwent an ultrasonography and then a magnetic resonance that suggested the diagnosis of leiomyoma. The neoformation was excised through a suburethral incision. The patient was discharged after 3 days and no intraoperative and postoperative complications occurred. The Foley catheter was removed after a week. The patient was continent to urine, and at 6 months follow-up, the patient was symptom free and no recurrences occurred.

  4. Septate uterus with cervical duplication and a longitudinal vaginal septum: an unclassified mullerian anomaly

    Directory of Open Access Journals (Sweden)

    Ruchika Mangla

    2016-02-01

    Full Text Available Uterine anomalies are the result of disturbances in the development, formation or fusion of the mullerian ducts during foetal life with an incidence of 0.001%-10% in general population. These patients most often present with amenorrhoea, dysmenorrhoea, dyspareunia and infertility. Women with these anomalies are more prone to poor foetal outcomes such as first trimester losses or preterm labour. We report a case of a 35 years old female with septate uterus with cervical duplication and a longitudinal vaginal septum. Diagnosis was obtained by physical examination, ultrasound imaging, hysterosalphingography and magnetic resonance imaging and hysterolaproscopy. The clinical presentation of such a case and surgical options available were studied, and the excision of the vaginal septum was done. This case of congenital uterine anomaly does not fit into the current classification system of mullerian anomalies by American fertility society, which is based on the traditional caudal to cranial, unidirectional developmental pattern. This strongly indicates the possibility of an alternative mechanism of mullerian development. [Int J Reprod Contracept Obstet Gynecol 2016; 5(2.000: 536-538

  5. The relationship between female genital cutting and sexual problems experienced in the first two months of marriage.

    Science.gov (United States)

    Abdel-Aleem, Mahmoud A; Elkady, Magdy M; Hilmy, Yaser A

    2016-03-01

    To examine the relationship between female genital cutting (FGC) and sexual problems experienced by couples in the first 2 months of marriage ("honeymoon distress"). A multicenter cross-sectional study was conducted at centers in Assiut and Sohag, Egypt, between March 1, 2011, and March 31, 2014. Eligible couples presented with sexual problems during the first 2 months of marriage. Couples were interviewed and asked to complete a pre-designed questionnaire, and a genital examination was performed. The primary outcomes of the study were the contribution of FGC to honeymoon distress and the effect of FGC on quality of life. Overall, 430 couples enrolled in the study. FGC was present in 376 (87.4%) women. The main presenting feature of honeymoon distress was superficial dyspareunia, which affected 291 (77.4%) women with FGC versus 16 (29.6%) of 54 without FGC (hazard ratio 8.13, 95% confidence interval 4.32-15.30). Women with FGC were more likely to have a poor quality of life during the first 2 months of marriage than were those without FGC (279 [74.2%] vs 13 [24.1%]; odds ratio 9.07, 95% confidence interval 4.66-17.64). FGC was found to be a contributing factor to honeymoon distress. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  6. Managing irritable bowel syndrome in primary care.

    Science.gov (United States)

    Corsetti, Maura; Whorwell, Peter J

    2015-06-01

    The classic symptoms of irritable bowel syndrome (IBS) are abdominal pain, bloating and some form of bowel dysfunction. The pain is typically colicky in nature and can occur at any site although most commonly it is on the left side. The abdomen feels flat in the morning and then gradually becomes more bloated as the day progresses reaching a peak by late afternoon or evening. It then subsides again over night. Traditionally IBS is divided into diarrhoea, constipation or alternating subtypes. IBS patients frequently complain of one or more non-colonic symptoms, these include constant lethargy, low backache, nausea, bladder symptoms suggestive of an irritable bladder, chest pain and dyspareunia in women. The traditional view that IBS is a largely psychological condition is no longer tenable. Rectal bleeding, a family history of malignancy and a short history in IBS should always be treated with suspicion. Both pain and bowel dysfunction are often made worse by eating. It is recommended that a coeliac screening test is undertaken to rule out this condition. Other routine tests should include inflammatory markers such as CRP or ESR. Calprotectin is a marker for leukocytes in the stools and detects gastrointestinal inflammation. A negative test almost certainly rules out inflammatory bowel disease, especially in conjunction with a normal CRP. Fermentable carbohydrates can have a detrimental effect on IBS and this has led to the introduction of the low FODMAP diet.

  7. Standardized modified colposuspension – mid-term results of prospective studies in one centre

    Directory of Open Access Journals (Sweden)

    Grzegorz Surkont

    2015-05-01

    Full Text Available Introduction. Burch colposuspension is still estimated as a ‘gold standard’ by the Cochrane Collaboration Group in the treatment of operative stress urinary incontinence (SUI Some urogynecologists agree with this statement, some argue that Burch colposuspension should no longer be used. Objective. The aim of this study was to evaluate mid-term effects and patient’s satisfaction with standardized modified colposuspension performed in one centre. Material and methods. Modified colposuspension was performed after standardization by 2 trained gynaecologists in 354 women. Data collected from 227 women were added to the final analysis of mid-term results. Average time from the operation to mid-term visit was 19 months (range 9–36 months. Results. At mid-term visit, 86.3% of patients were cured. There was no case of post-void urine residual over 100 ml. Pain near the operated region was reported by 1 woman from agricultural region. No one reported negative impact of modified colposuspension on sexual activity or dyspareunia. Conclusions. Modified colposuspension according to the E. Petri technique seems to be an operation that is safe and well-tolerated by women with preoperative stress urinary incontinence and paravaginal defect without urodynamic signs of ISD in mid-term observation.

  8. Systematic review of sexual function and satisfaction following the management of vaginal agenesis.

    Science.gov (United States)

    McQuillan, Sarah K; Grover, Sonia R

    2014-10-01

    Historically, sexual satisfaction following the management of vaginal agenesis was assessed subjectively. Standardized sexual function questionnaires are being used more frequently as instruments to accurately and more objectively assess the subjective nature of sexual outcomes as part of a more holistic approach to the care of women with vaginal agenesis. Articles concerning the management of vaginal agenesis were systematically reviewed, with specific focus on those that discussed functional outcomes, sexual satisfaction and psychosomatic outcomes, and in particular attempted to measure these outcomes. A total of 6,691 articles on vaginal agenesis were identified, with 106 of these reporting sexual satisfaction and psychosomatic outcomes. Only 1 randomized control trial (RCT) was identified, the remaining articles being made up of case series or case reports. Only 17 articles used standardized objective assessment of sexual satisfaction. While the bowel technique had the longest vaginal length at 12.87 cm, it had the most number of complaints of dyspareunia (4.8%), stenosis (10.5%) and the lowest average subjective sexual satisfaction. The Davydov method used standardized sexual function assessments most frequently. This technique had a higher average score than both the bowel vaginoplasty technique in the only RCT and the Vecchietti method in a prospective assessment. Overall, the management of vaginal agenesis requires a multidisciplinary approach to fully support these patients from initial diagnosis, through management decision-making and long-term follow-up, through transition to adulthood.

  9. Clinicopathological correlation of infective vaginal discharges in non pregnant sexually active women of reproductive age group in a tertiary care centre of Western UP

    Directory of Open Access Journals (Sweden)

    Aruna Verma

    2013-06-01

    Full Text Available Background: The aim was to study the etiology of infective vaginal discharges prevalent in our area and to study its association with PID. Methods: A total of 500 patients were recruited for study attending Gynae OPD and presenting with vaginal discharge. After detailed history taking and physical examination three sterile vaginal swabs were taken from the posterior fornix and sent for culture of Candida and Trichomonas on Saborauds Dextrose Agar and Kufperberg media respectively and one was used for smear for gram’s staining to diagnose Bacterial vaginosis by Nugent’s scoring. Results: In this study, prevalence of BV, Candida and Trichomonas vaginalis was found to be 146 (29.2%, 106 (21.2% and 15(3% respectively out of 24 cases had mixed infections while no organism was found in 257 cases (51.4%. Candida infection was found to be significantly associated with presence of other complaints such as itching, burning micturition, dyspareunia etc (p1 abortions(p=0.015, presence of urogenital complaints (p5 (p5 (p=0.004. Conclusions: Bacterial vaginosis and candidiasis are the most common causes of infective vaginal discharges in our community than trichomoniasis. [Int J Reprod Contracept Obstet Gynecol 2013; 2(3.000: 349-354

  10. Newly developed vaginal atrophy symptoms II and vaginal pH: a better correlation in vaginal atrophy?

    Science.gov (United States)

    Tuntiviriyapun, P; Panyakhamlerd, K; Triratanachat, S; Chatsuwan, T; Chaikittisilpa, S; Jaisamrarn, U; Taechakraichana, N

    2015-04-01

    The primary objective of this study was to evaluate the correlation among symptoms, signs, and the number of lactobacilli in postmenopausal vaginal atrophy. The secondary objective was to develop a new parameter to improve the correlation. A cross-sectional descriptive study. Naturally postmenopausal women aged 45-70 years with at least one clinical symptom of vaginal atrophy of moderate to severe intensity were included in this study. All of the objective parameters (vaginal atrophy score, vaginal pH, the number of lactobacilli, vaginal maturation index, and vaginal maturation value) were evaluated and correlated with vaginal atrophy symptoms. A new parameter of vaginal atrophy, vaginal atrophy symptoms II, was developed and consists of the two most bothersome symptoms (vaginal dryness and dyspareunia). Vaginal atrophy symptoms II was analyzed for correlation with the objective parameters. A total of 132 naturally postmenopausal women were recruited for analysis. Vaginal pH was the only objective parameter found to have a weak correlation with vaginal atrophy symptoms (r = 0.273, p = 0.002). The newly developed vaginal atrophy symptoms II parameter showed moderate correlation with vaginal pH (r = 0.356, p atrophy score (r = 0.230, p atrophy symptoms and the objective parameters. Vaginal pH was significantly correlated with vaginal atrophy symptoms. The newly developed vaginal atrophy symptoms II was associated with a better correlation. The vaginal atrophy symptoms II and vaginal pH may be better tools for clinical evaluation and future study of the vaginal ecosystem.

  11. Laser therapy for the restoration of vaginal function.

    Science.gov (United States)

    Gambacciani, Marco; Palacios, Santiago

    2017-05-01

    Laser therapy has a therapeutic role in various medical conditions and most recently has gained interest as a non-hormonal treatment for genitourinary syndrome of menopause (GSM) and as a non-invasive option for stress urinary incontinence (SUI). Several therapies are available to alleviate GSM symptoms, including hormonal and non-hormonal products. Both microablative fractional CO2 laser and the non-ablative vaginal Er:YAG laser (VEL) induce morphological changes in the vaginal tissues, and data from non-randomized clinical trials suggest that laser therapy can alleviate vaginal dryness and dyspareunia. VEL has been reported to improve SUI as well as vaginal prolapse. Although large randomized trials have not been reported, the evidence suggests that VEL can be offered as a safe and efficacious alternative to hormone replacement therapy (HRT) for GSM, as well as a first-line treatment for mild to moderate SUI, before surgical procedures are resorted to. Randomized studies are needed to compare laser treatments with other therapies, as well as to assess the duration of the therapeutic effects and the safety of repeated applications. Research is presently evaluating both an automated robotic probe for VEL treatments and an intraurethral probe for the treatment of severe and type III SUI. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. A Rare Case of Retroperitoneal Leiomyoma

    Science.gov (United States)

    Mahendru, Rajiv; Gaba, Geetinder; Yadav, Shweta; Gaba, Gurmeet; Gupta, Chinky

    2012-01-01

    Introduction. Leiomyoma uteri is one of the most common benign conditions for which women undergo hysterectomy every year. Fibroids found retroperitoneally are a rare entity, especially, primary retroperitoneal fibroid. Case Presentation. We report a case of 42-year-old para 1 who presented to our hospital with recurring retention of urine, lower abdominal and pelvic pain, and dyspareunia . Provisional diagnosis on the basis of examination and imaging was large subserosal fibroid with mild right-sided hydroureteronephrosis, due to pressure effect of the fibroid. Abdominal hysterectomy was done for the patient, and intraoperatively, a bulky uterus was found with multiple small fibroids on anterior and posterior walls, and a large fibroid approx. 10 × 8 cm was found arising from the posterior surface at the level of internal os retroperitoneally, which was confirmed by histopathology as leiomyoma. Conclusion. Retroperitoneal fibroids are rare neoplasms and treatment is surgical removal. Preoperative imaging can only give provisional diagnosis and can be misguiding. Final diagnosis of retroperitoneal fibroid can be made only intraoperatively. PMID:22900220

  13. A Rare Case of Retroperitoneal Leiomyoma

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    Rajiv Mahendru

    2012-01-01

    Full Text Available Introduction. Leiomyoma uteri is one of the most common benign conditions for which women undergo hysterectomy every year. Fibroids found retroperitoneally are a rare entity, especially, primary retroperitoneal fibroid. Case Presentation. We report a case of 42-year-old para 1 who presented to our hospital with recurring retention of urine, lower abdominal and pelvic pain, and dyspareunia . Provisional diagnosis on the basis of examination and imaging was large subserosal fibroid with mild right-sided hydroureteronephrosis, due to pressure effect of the fibroid. Abdominal hysterectomy was done for the patient, and intraoperatively, a bulky uterus was found with multiple small fibroids on anterior and posterior walls, and a large fibroid approx. 10×8 cm was found arising from the posterior surface at the level of internal os retroperitoneally, which was confirmed by histopathology as leiomyoma. Conclusion. Retroperitoneal fibroids are rare neoplasms and treatment is surgical removal. Preoperative imaging can only give provisional diagnosis and can be misguiding. Final diagnosis of retroperitoneal fibroid can be made only intraoperatively.

  14. [Complications associated with the use of polypropylene mesh in women under colposacropexy].

    Science.gov (United States)

    Aguilera-Maldonado, Lizzete Verónica; Jiménez-Vieyra, Carlos Ramón; Solís-Moreno, Tania Kristal

    2015-10-01

    There have been numerous surgical procedures and modi fied in the hope of obtaining a lasting cure for pelvic organ prolapse These surgeries were performed using the traditionally native tissues of the patient. In an effort to reduce morbidity, improve surgical outcomes and reduce the complexity of these operations, we used a growing number of synthetic mesh repairs and biomaterials used tissue from cadaver or animal. To evaluate the frequency of complications associated with the use of polypropylene mesh in women undergoing colposacropexy. Retrospective, observational and descriptive study conducted at the Hospitalde Ginecología y Obstetricia 3 IMSS (Mexico) between 1 January 2006 and 15 February 2013. The main risk factors associated with pelvic organ prolapse were considered, comorbidity and complications directly linked to the procedure. With respect to the related complications colposacropexy procedure using polypropylene mesh were documented in 20 of 67 patients which corresponded to 30%. A number of complications have been associated with the use of meshes between these include: extrusion, erosion, pelvic pain, dyspareunia, bladder or bowel condition, but one aspect is poorly evaluated sexual dysfunction without to definitely plays an important role in the field bio-psychosocial.

  15. [Lesion of pelvic organs in secondary varicose veins of the small pelvis].

    Science.gov (United States)

    Tsukanov, Yu T; Tsukanov, A Yu; Levdansky, E G

    2015-01-01

    The authors studied peculiarities of pelvic organs lesions in patients presenting with secondary small pelvic varicose veins (SPVV) induced by endured thrombosis of iliac veins. The study included a total of 70 patients after endured thrombosis of iliac veins verified by radiodiagnostic methods. The average duration of thrombosis amounted to 3.8 years. The patients were subdivided into two groups. The Study Group comprised 48 patients presenting with small pelvic varicose veins revealed by duplex scanning; the Control Group was composed of 22 patients with no varicose pelvic veins. It was determined that characteristic features of patients with secondary SPVV having developed after iliac veins thrombosis included chronic pelvic pain, dilatation of cavernous veins of the rectum, inguinal vein varicosity and varicose veins of the groin and anterior abdominal wall. Formation of secondary SPVV after endured iliac vein thrombosis leads to disorders of pelvic organs, similar to those in primary varicosity, but more often being functional. Endured iliac veins thrombosis in formation of secondary SPVV leads to urination impairments with prevalence of moderately pronounced symptomatology. Small pelvic organs dysfunction in women with secondary SPVV due to endured iliac veins thrombosis manifests itself in dyspareunia, leukorrhea, and dysmenorrhea.

  16. A unique case of pica of adult onset with interesting psychosexual aspects

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    Suddhendu Chakraborty

    2011-01-01

    Full Text Available Pica has been considered as the ingestion of inedible substances or atypical food combinations. Pica has been reported widely in pediatric age group and often found to be co existing with obsessive compulsive or major depressive disorder. Reports of pica in elderly age group are relatively uncommon and rarely does it have an adult onset. In this article we present a case of adult onset pica. A young lady with unusual sensation in her abdomen was found to consume iron nails over years and there was history of dyspareunia since her marriage three months back. On query it was known that the lady is having same sex relationship over years. There unique conglomeration of cultural, psychodynamic and physiological determinants which together is responsible for this unusual habit of this lady. Moreover the onset of the disease at a late age and different psychodynamic issues make the case all the more interesting. Whether the pica is an eating disorder or obsessive compulsive disorder is still controversial. Pica has been mentioned in Diagnostic and Statistical Manual IV TR. The present case report warrants the need to look into this entity more closely with regards to its occurrence and etiology.

  17. Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection

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    Jia-Fong Jhang

    2015-06-01

    Full Text Available Chronic pelvic pain (CPP is defined as pain in the pelvic organs and related structures of at least 6 months’ duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A, known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment.

  18. 影响妇女产后性健康的相关因素%Women's sexual health after delivery and its related influential factors

    Institute of Scientific and Technical Information of China (English)

    徐晓阳; 王焕英; 苏立; 彭彬; 姚珍薇

    2007-01-01

    BACKGROUND: The postnatal sexual health of women is crucial in reproductive health, due to lack of sexual knowledge and sexual heath care service as well as conventional idea, the medical staff and postnatal women themselves pay little attention and discussion on the sexual health after childbirth.OBJECTIVE; To investigate the prevalence and types of women's sexual problems after childbirth, identify the factors associated with dyspareunia and investigate the status quo of postnatal sexual health care service. DESIGN: Cross-sectional study and follow-up survey within six months after delivery.SETTING: Department of Reproductive Medicine, Chongqing University of Medical Sciences. PARTICIPANTS: A total of 798 primiparous women delivering a live birth in Department of Obstetrics at the First Affiliated Hospital of Chongqing University of Medical Sciences between November 2000 and July 2001, and 79 husbands who accompanied their wives during the follow-ups were adopted in this study.METHODS: The primiparous women after 6 months of childbirth and husbands conducted routine postnatal follow-ups and were informed of the follow-up content. The interview was used in this cross-sectional study and the questionnaires were finished under the help of health professional. And some advice, consultations and treatments can be given in time. MAIN OUTCOME MEASURES; ①main change of postnatal sexual life;②postnatal sexual problems and related factors. RESULTS: Totally 460 out of 798 primiparous women in accordance with the inclusive and exclusive criterions received follow-up surveys after telephone or letter notification. ①Main change of postnatal sexual life: Of the 460 respondents, 94.74% had resumed sexual activity within six months after delivery. Compared with one year pre-pregnancy, the number of sexual activity decreased obviously within 3-6 months after delivery, and 66.0% of postnatal women decreased the sexual desire.②Postnatal sexual problems and related factors

  19. Analysis on the related factors of female orgasmic dysfunction%女性性高潮障碍相关因素分析

    Institute of Scientific and Technical Information of China (English)

    张鹤鹏; 潘连军; 张爱霞; 雷雨; 阚延静

    2012-01-01

    目的:探讨女性性高潮障碍的相关危险因素,为女性性高潮障碍的防治提供依据.方法:采用回顾性调查方法,对2009年3月~12月在南京医科大学附属南京市妇幼保健院进行健康体检的20岁以上女性及其女性陪护人进行问卷调查,应用女性性功能指数(FSFI)问卷评估性功能,性高潮评分<4.0分为性高潮障碍的诊断标准,采用多因素Logistic回归进行多因素分析.结果:共发放问卷2 658份,有1 856例女性完成问卷,问卷回收率69.8%.剔除性唤起障碍者602例,其余性唤起正常的855例中性高潮障碍者298例,占34.9% (298/855).Logistic多因素分析表明,年龄(≥40岁)、难产、对居所不满意、绝经、性交疼痛、配偶性功能障碍等是女性性高潮障碍的独立危险因素(P<0.05).结论:女性性高潮障碍的发生与年龄(≥40岁)、难产、对居所满意度、绝经、性交疼痛、配偶性功能障碍多种因素相关.%Objective: To explore the related risk factors of female orgasmic dysfunction, provide a basis for prevention and treatment of female orgasmic dysfunction. Methods: A retrospective investigation method was used to survey the women more than 20 years who received physical examination in the hospital from March to December in 2009 and the women who accompanied them by a questionnaire, female sexual function index (FSFI) questionnaire was applied to assess their sexual function, orgasm score 40 years) , dystocia, being unsatisfied with residence, menopause, dyspareunia, and sexual dysfunction of partners were the independent risk factors of female orgasmic dysfunction (P <0. 05) . Conclusion: The occurrence of female orgasmic dysfunction is related to age ( ^40 years) , dystocia, being unsatisfied with residence, menopause, dyspareunia, and sexual dysfunction of partners.

  20. Sexual function in adult patients with classic bladder exstrophy: A multicenter study.

    Science.gov (United States)

    Park, Weon; Zwink, Nadine; Rösch, Wolfgang H; Schmiedeke, Eberhard; Stein, Raimund; Schmidt, Dominik; Noeker, Meinolf; Jenetzky, Ekkehart; Reutter, Heiko; Ebert, Anne-Karoline

    2015-06-01

    The bladder exstrophy-epispadias complex (BEEC) comprises a spectrum of congenital anomalies that represents the severe end of urorectal malformations, and has a profound impact on continence as well as sexual and renal functions. The relation between severity of BEEC and its associated functional impairments, on one hand, and the resulting restrictions in quality of life and potential psychopathology determine the patients' outcome. It is important for improving further outcome to identify BEEC-related sources of distress in the long term. Genital function and sexuality becomes an important issue for adolescent and adult BEEC individuals. Hence, the present study focused on sexual function and psychological adaption in patients with BEEC. In a multicenter study 52 patients (13 females, 39 males) with classic bladder exstrophy (BE) with their bladders in use were assessed by a self-developed questionnaire about sexual function, and psychosexual and psychosocial outcome. The patients were born between 1948 and 1994 (median age 31 years). Twelve of 13 (92%) females and 25 of 39 (64%) males with classic BE had answered the questions on sexual function. Of these, 50% females and 92% males answered that they masturbated. Females had sexual intercourse more frequently. Six (50%) females affirmed dyspareunia whereas only two (8%) males reported pain during erection. Eight (67%) females specified having orgasms. Eighteen (72%) males were able to ejaculate. Two males and none of the females lived in a committed partnership (Figure). Two (15%) females and 13 (33%) males answered all psychosocial questions. The majority of these patients had concerns about satisfactory sexuality and lasting, happy partnerships. A minority of patients of both sexes were willing to answer psychosocial questions. Sexual activity and relationships of many adult BE patients seems to be impaired. Not surprisingly, sexual activity and awareness were different in males and females even in a multi

  1. 不孕症妇女子宫内膜异位症危险因素对照研究分析%Controlled Study and Analysis of the Risk Factors of Infertile Women with Endometriosis

    Institute of Scientific and Technical Information of China (English)

    方明珠; 丁书贵; 郭华峰

    2014-01-01

    endometriosis, dysmenorrhea extent, menstrual volume, dyspareunia, oral contraceptives, pregnancy history, pelvic pain, and other factors (P<0.05). Multi-factor logistic regression analysis showed that age, duration of infertility, body mass index, dysmenorrhea, pelvic pain, dyspareunia, and the family history of endometrio-sis are the risk factors related to endometriosis. Conclusion Low BMI value,a family history of endometriosis, menstrual history and pelvic pain are high risk factors of the infertile women with endometriosis, whereas multi-pregnancy is a protective factor of en-dometriosis.

  2. Is vaginal hyaluronic acid as effective as vaginal estriol for vaginal dryness relief?

    Science.gov (United States)

    Stute, Petra

    2013-12-01

    In a multicenter, randomized, controlled, open-label, parallel- group trial hyaluronic acid vaginal gel (Hyalofemme) was compared to estriol vaginal cream (Ovestin) in women with vaginal dryness due to various causes. A total of 144 supposedly postmenopausal women below age 70 years were randomized in a 1:1 ratio to either receive hyaluronic acid vaginal gel (5 g per application) or estriol vaginal cream (0.5 g cream per application = 0.5 mg estriol) every 3 days for a total of ten applications, respectively. Exclusion criteria included vaginal infections, conventional contraindications to estrogens, use of vaginal products other than the investigational compounds, being unmarried, pregnant, or breastfeeding. The aim of the study was to test for non-inferiority of hyaluronic acid vaginal gel compared to estriol vaginal cream. The primary efficacy end point was the percentage (%) improvement in vaginal dryness, with the secondary end points being the percentage (%) improvements in vaginal itching, burning, and dyspareunia. Efficacy was assessed by using a visual analog scale (VAS) (0-10; 0 = absent, 10 = intolerable) at baseline (V0), during telephone contact after the third administration (V1), and at the final visit after the tenth administration (V2). Safety parameters included vaginal pH, endometrial thickness, and a vaginal smear for vaginal microecosystem assessment. Adverse events were recorded according to international guidelines. 133 women completed the study. At baseline, participants' characteristics did not differ significantly. Mean age was 54 years, time since menopause was 5 years on average, and cause of menopause was mostly natural. However, mean menstrual cycle days were also reported, although according to inclusion criteria only postmenopausal women were eligible for the study. At V1, an improvement in vaginal dryness was reported by about 49 % of women using hyaluronic acid vaginal gel, and by 53 % of women using estriol vaginal cream (p = 0

  3. Treatment complications among long-term survivors of cervical cancer: treated by surgery or radiotherapy

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    Kamal A. Elghamrawi

    2011-11-01

    Full Text Available This study assesses the morbidity and complications of treatment among long-term survivors of cervical cancer. Ninety-eight female patients who were diagnosed and treated from invasive carcinoma of the cervix uteri 5 years or more are included in this study. All the cases were free of disease and had survived up to December 2010. Forty-one cases were treated with radical hysterectomy with removal of the lymph nodes (Wertheim’s surgery (42%. Radical radiation therapy was given to 57 cases (58% according to our treatment protocol; weekly cisplatin was given concomitantly with radiation. Although urinary adverse effects were more prevalent among the radiation group, the difference was not statistically significant. Bowel dysfunction was more prevalent and statistically significant (p\\0.001 among the radiotherapy arm. Dysfunctions recorded included change in bowel habit, diarrhea, constipation, tenesmus, soiling of clothes and or flatulence. However, their severity was grade 1–2 only. The frequency of small intestinal obstruction was comparable in both arms. Pelvic vein thromboses had a tendency to occur among the surgical group especially in obese females (p value 0.005. The frequency of sexual dysfunction was comparable in both groups with no statistical difference. It was age related. The younger the patients’ ages, the more was the sexual complaint irrespective to the treatment modality. Sexual problems included dyspareunia from vaginal stenosis shortening or dryness, vulval soreness from itching and dryness. Bearing in mind that many patients had more than one health complaint. The remaining cases denied the presence of any complications and stated that they had a normal life style.

  4. Sexual dysfunction among female patients of reproductive age in a hospital setting in Nigeria.

    Science.gov (United States)

    Fajewonyomi, Benjamin A; Orji, Ernest O; Adeyemo, Adenike O

    2007-03-01

    Although sexual dysfunction is an important public-health problem in Nigeria, little research has been conducted on this topic in Nigeria. This cross-sectional study was conducted to determine the prevalence of sexual dysfunction and their correlates among female patients of reproductive age using a questionnaire. Respondents were recruited from the out-patients clinics of a teaching hospital setting in Ile-Ife/ Ijesa administrative health zone, Osun State, Nigeria. Of 384 female patients interviewed, 242 (63%) were sexually dysfunctional. Types of sexual dysfunction included disorder of desire (n=20; 8.3%), disorder of arousal (n=l 3; 5.4%), disorder of orgasm (n=154; 63.6%), and painful coitus (dyspareunia) (n=55; 22.7%). The peak age of sexual dysfunction was observed among the age-group of 26-30 years. Women with higher educational status were mostly affected. The reasons for unsatisfactory sexual life mainly included psychosexual factors and medical illnesses, among which included uncaring partners, present illness, excessive domestic duties, lack of adequate foreplay, present medication, competition among wives in a polygamous family setting, previous sexual abuse, and guilt-feeling of previous pregnancy termination among infertile women. The culture of male dominance in the local environment which makes women afraid of rejection and threats of divorce if they ever complain about sexually-related matters might perpetrate sexual dysfunction among the affected individuals. Sexual dysfunction is a real social and psychological problem in the local environment demanding urgent attention. It is imperative to carry out further research in society at large so that the health and lifestyles of affected women and their partners could be improved.

  5. Surgical Treatment After Failed Primary Correction of Urogenital Sinus in Female Patients with Virilizing Congenital Adrenal Hyperplasia.

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    Maria Helena Palma Sircili

    2016-10-01

    Full Text Available Purpose: Genital reconstruction in female patients with virilizing congenital adrenal hyperplasia (CAH is very challenging. Our aim was to evaluate the techniques employed to treat complications after failure of primary urogenital sinus (UGS surgery, as well as the result of these reoperations.Patients and Methods: Twenty girls with virilizing CAH who were previously submitted to genitoplasty in our service and elsewhere had recurrent UGS stenosis and vaginal introitus stenosis that required surgical treatment. The main symptoms were recurrent urinary tract infection (UTI in nine, dyspareunia in six and hematocolpos in three (two associated with sepsis. The anatomical findings were the persistence of UGS with stenosis in 17 patients and vaginal introitus stenosis in three. The mean age at procedure was 15.2 yrs., averaging 13.1 yrs. after the first surgery. The surgical techniques employed were: isolated perineal flap in 17 patients and perineal flap with partial mobilization of UGS in three. The mean follow-up after the procedure was 4.8 years (varying from 1 to 17yrs.Results: Vaginal dilations were performed after surgery in 15 patients. Good functional and anatomical results were obtained in 15 patients, with vaginal introitus amenable to dilators of 3.0 cm in diameter. Five patients with high vaginal insertion had recurrent vaginal stenosis and required a surgical revision. No patients presented menstrual obstruction or UTI after surgery. Eight of the 15 adult patients are sexually active. Conclusion: The reoperation to treat failed primary UGS treatment using Y-V flap and partial mobilization techniques associated to vaginal dilations, promoted good anatomical and functional results with low morbidity in 75% of the patients.□

  6. Dying for love: Perimenopausal degeneration of vaginal microbiome drives the chronic inflammation-malignant transformation of benign prostatic hyperplasia to prostatic adenocarcinoma.

    Science.gov (United States)

    Reece, Albert Stuart

    2017-04-01

    Prostatic carcinoma is the second commonest cancer in males and is so common as to become almost holoendemic with advancing age. The recent demonstration that far from being benign, "benign" prostatic hypertrophy is a likely a reaction of the prostate to chronic untreated lower genital tract infection, and that this chronic inflammation is likely the usual precursor to the frequent occurrence of prostatic carcinoma has far reaching implications. The obvious source for the chronic inflammatory stimulus in the prostate is the documented dramatically altered lower female genital microbiota associated with the menopause. Hence the major hypothesis is that prostatic cancer may arise due to chronic infection and inflammation in the prostate gland consequent upon the altered microbiome of the menopausal female genital tract. This has implications for testing and diagnosis, treatment, population health and personal hygiene practices. It suggests that male dyspareunia, although almost never encountered in clinical practice may in fact be relatively common in older males, and in particular if diagnosed, represents a critical opportunity for therapeutic intervention to interrupt the chronic inflammation - cancer transformation and progression which has been well documented in other tissues. It implies that the coordinated application of next generation sequencing to the microbiome of the lower genital tracts of male and female couples, including seminal fluid, will have both research applications to further explore this sequence, as well as finding application as a potential population level screening procedure as is presently done for the "Thin Prep" cervical screening for human papillomavirus in females. Moreover this insight opens up new opportunities for chemointervention and chemoprevention for this important clinicopathological progression. These considerations give rise to the exciting possibility that prostatic malignancy may be preventable by various methods of local

  7. Application of Robotic Surgery in the treatment of endometriosis: View point of an Indian OBGYN fellow in USA

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    Krishna Kavita Ramavath

    2015-02-01

    Full Text Available Background: This article is an observational experience of robotic surgery in USA by an Indian Obgyn fellow. Primary objective is to analyze retrospectively peri operative outcomes in stage 2 and 3 Endometriosis treated with robot assisted laparoscopy. Secondary objective is to report an Indian Obgyn, Physician observer fellows experience in USA with Robotic surgery. Methods: 29 women underwent robotic surgery at in the department of gynecology at Doctor's hospital, Baptist health, Miami. Pre-op time, console time, total operative time, blood loss, peri-operative complications noted. Results: Mean age is 42 +/- 8 years with BMI of 26.2 +/- 8 kg/m2. Eighteen patients (62% were age 40 and above. Twenty patients (69% presented with chronic pelvic pain. Dyspareunia in 16 (55.2%, bloating in five (17.2% and pelvic mass in thirteen (44.8% Unilateral pelvic mass in nine patients (31 % and bilateral in four patients (13.8%. CA 125 levels are elevated in nine patients (31% and significantly higher with endometriomas (76.1 +/- 49.2 U/ml. 38% underwent robot assisted laparoscopic hysterectomy and BSO. 14.8% underwent robot assisted laparoscopic hysterectomy with Robot (LSO/RSO. Mean operative time 64.7 min. Mean blood loss 40 ml. Conclusions: Robotic surgery is safe, with minimal blood loss and shorter hospital stay. Alike in the surgical techniques, though diverse in the work infrastructure and technology, East and West have common scenarios which can be tackled with exchange of training opportunities. This interchange of knowledge and skills will benefit patients with increased surgeon's efficiency. [Int J Reprod Contracept Obstet Gynecol 2015; 4(1.000: 202-209

  8. Improving accuracy of intraoperative diagnosis of endometriosis: Role of firefly in minimal access robotic surgery

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    John R Lue

    2016-01-01

    Full Text Available Endometriosis continues to be a major primary gynecologic etiology of chronic pelvic pain. The symptom profile, which includes cyclic pelvic pain, dysmenorrhea, and dyspareunia or dyschezia, is nonspecific and does not correlate with the extent or severity of disease. Trans-vaginal or trans-rectal ultrasound, as well as magnetic resonance imaging, can help visualize endometriomas and deeply infiltrating endometriosis. Additionally, there have been no serum marker tests available so far. However, even intraoperatively, the diagnosis may be missed, leading to under diagnosis and delayed or noninitiation of treatment. There are thought to be three distinct endometriotic lesions of the pelvis that are seen laparoscopically. The first is that which is visible on the pelvic peritoneal surface or the surface of the ovary, which is commonly termed peritoneal endometriosis. Second, endometriotic lesions that occur within the ovary and form cysts that are often lined with endometrioid mucosa are termed endometriomas. Lastly, rectovaginal endometriomas are endometriotic lesions that contain a mixture of adipose and fibrous tissue located between the rectum and vagina. All of these lesions can be singular or multiple and the pelvis may contain one or all three types of lesions. The shared histologic feature with all three lesions is the presence of endometrial epithelial cells or endometrial stroma. During a diagnostic procedure, the da-Vinci robot and its firefly mode allow for three dimensional visualization and seven degrees of instrument articulation for meticulous dissection of fibrotic areas of peritoneum that may contain deep infiltrating lesions of endometriosis. This case report describes a relatively new and innovative technique for effectively diagnosing and successfully treating endometriosis when other less invasive methods have failed.

  9. Relationship Analysis between Pelvic Pain and Pathological Changes of Patients with Endometriosis%子宫内膜异位症患者盆腔疼痛与病变的关系分析

    Institute of Scientific and Technical Information of China (English)

    于翠革

    2015-01-01

    目的:分析子宫内膜异位症患者盆腔疼痛与病变之间的关系。方法:选取2013年2月~2015年2月100例子宫内膜异位症患者进行治疗,主要对患者的病变发生位置、盆腔粘连、类型、浸润程度等进行分析,探讨其盆腔疼痛与病变的关系。结果:轻度粘连者性交疼痛、排便痛/肛门坠胀发生率及痛经程度均显著优于中、重度粘连者(P<0.05)。结论:子宫内膜异位症盆腔疼痛与粘连程度相关,因此将病灶完全切除才能有效解决疼痛问题。%Objective:To analyze the relationship between pelvic pain and pathological changes of patients with endometriosis. Methods:100 cases of patients with endometriosis selected from February 2015 to February 2013 were treated, the location of lesions, pelvic adhesion, type and degree of invasion were mainly analyzed, to explore the relationship between pelvic pain and pathological changes. Results:Dyspareunia, incidence of defeca-tion pain or anus bulge and dysmenorrhea degree of mild adhesion were significantly superior to those of moderate and severe adhesions (P<0.05). Conclusion:Pelvic pain of endometriosis is associated with adhesion degree, so only lesions completely removed can effectively solve the problem of pain.

  10. Breast cancer treatment and sexual dysfunction: Moroccan women's perception

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    Ismaili Nabil

    2011-06-01

    Full Text Available Abstract Background This exploratory prospective study evaluated women's responses to questions that asked them to describe how their body image and sexual functioning had changed since their breast cancer diagnosis to treatment. Methods A questionnaire concerning body image scale and various sexual problems experienced after diagnosis and treatment was anonymously completed by 120 women in the outpatient clinic of our hospital's Division of medical Oncology. To be eligible, subjects had to be sexually active and had histology proven breast cancer. They also had to have received treatment for breast cancer. Results 100% of participants have never spoken with their doctor about this subject. 84% of the participants continued sexual activity after treatment, but there was an increase in the incidence of sexual functioning problems which resulted in a slight reduction in the quality of their sex lives. 65% of the women experienced dyspareunia followed by lubrication difficulties (54% and the absence or reduction of sexual desire (48% and 64%, respectively while, 37% had lack of satisfaction (37%. Female orgasmic disorder and brief intercourse and arousal were reported respectively by 40% and 38% of the subjects. The sexual dysfunctions were absent before diagnosis and management of breast cancer in 91.5% subjects and of these 100% subjects complained of a deterioration of the symptomatology after the various treatments. 90% of the dysfunctions were observed after chemotherapy, 9% after surgery and 3% after radiotherapy; none of the subjects indicated the onset of dysfunctions to have been associated with hormonotherapy. 100% expressed not having received sufficient information about how the disease and treatment (including surgery might affect their sexual life. Conclusion Breast cancer and its treatment may result in significant difficulties with sexual functioning and sexual life. Addressing these problems is essential to improve the quality of

  11. Sexual dysfunctions among people living with aids in Brazil

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    Marco de Tubino Scanavino

    2010-01-01

    Full Text Available INTRODUCTION: Sexual dysfunction symptoms in patients with HIV have not been fully investigated in Brazil. OBJECTIVES: To investigate the association between sexual dysfunction symptoms and AIDS among participants in the Brazilian Sex Life Study. METHODS: The Brazilian Sex Life Study is a cross-sectional population study. The participants answered an anonymous self-responsive inquiry. It was applied to a population sample in 18 large Brazilian cities. Answers given by those who reported having AIDS (75 were compared with those who reported not having AIDS (control; 150. This was a case-control study nested in a cross-sectional population study. RESULTS: In females, AIDS was associated with "sexual inactivity over the last 12 months" and "does not maintain sexual arousal until the end of the sex act" (P < 0.05 after adjusting for race and thyroid disease. Compared to the control group, men with AIDS had more difficulty becoming sexually aroused (they required more help from their partner to begin the sex act, they required longer foreplay than they wished, they reported losing sexual desire before the end of the sex act, and they required longer to ejaculate than they desired (P < 0.05. After adjusting for sexual orientation, sex hormone deficiency, depression, and alcoholism, only "does not have sexual desire," "have longer foreplay," and dyspareunia were associated with AIDS. DISCUSSION AND CONCLUSIONS: The results support the hypothesis that sexual dysfunctions are associated with AIDS. Men with AIDS need more time and stimulation to develop a sexual response, and a significant portion (37% of women with AIDS reported sexual inactivity over the last 12 months.

  12. Prognostic factors for long-term quality of life after adjuvant radiotherapy in women with endometrial cancer.

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    Foerster, Robert; Schnetzke, Lara; Bruckner, Thomas; Arians, Nathalie; Rief, Harald; Debus, Juergen; Lindel, Katja

    2016-12-01

    Adjuvant radiotherapy (RT) for endometrial cancer (EC) may affect patients' quality of life (QoL). There is a paucity of data on prognostic factors for long-term QoL and sexual functioning. This study aimed to investigate such factors and assess the role of the vaginal dilator (VD). QoL was assessed in 112 EC patients 6 years (median) after RT. QoL was compared to normative data, and the influence of age, tumor characteristics, lymphadenectomy, RT, and acute toxicities was assessed. VD use and its effect on subjective vaginal shortening/tightness was analyzed. QoL was reduced, particularly in younger patients. Vaginal brachytherapy only and intensity-modulated RT (IMRT) were associated with better global health status and reduced chronic gastrointestinal (GI) symptoms. Higher acute GI toxicity was associated with increased chronic GI symptoms, particularly diarrhea, and reduced role functioning. Higher acute urinary toxicity was associated with increased chronic urological symptoms, muscular/pelvic pain, and chronic GI symptoms, as well as with reduced emotional/social functioning and reduced global health status. Sexual interest/activity was increased despite vaginal dryness and dyspareunia. Sexual interest/activity increased with age. Only few, mainly younger patients used the VD. VD use >1 year was found in women with higher sexual interest/activity. Acute vaginal toxicity and chronic pain prevented VD use. Subjective vaginal shortening/tightness was not reduced in VD users. RT technique and acute toxicities are prognostic for the extent of chronic symptoms and long-term QoL. Sexuality is important even at a higher age. Few patients use the VD and a reduction of subjective vaginal shortening/tightness was not achieved.

  13. Research Advances of Endometriosis Relative Genes%子宫内膜异位症相关基因研究进展

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    张春斌; 常春艳; 刘爽; 谈西满; 胡玉红; 张金波; 罗佳滨

    2009-01-01

    Endometriosis is a chronic recurrent and progressive disease characterized by the presence of functional endometrial glandular epithelium and stroma outside the uterine cavity that affects up to 15% of women of child-bearing age. It can cause dyspareunia, pelvic pain, dysmenorrhea, and infertility. Although the etiology of endometriosis is unknown, several hypotheses have been proposed to explain its origin. Recently,genetic factors are thought to contribute to the development of this disease, and polygene/multiple factor theory has been accepted generally. This article presents an overview of research advancement of genes related to endometriosis, including gene polymorphism and abnormal expression of gene product. We try to explain the developmental mechanism of endometriosis from the angle of molecular genetics.%子宫内膜异位症(内异症)是一种易复发并具有侵袭性的慢性疾病,特点是有生长功能的子宫内膜腺上皮腺体和间质细胞出现在正常子宫体腔内膜以外,可以影响约15%生育年龄的妇女,引起性交痛、盆腔疼痛、痛经和不孕.目前内异症病因不清,已经提出几种假说解释它的发生机制,研究认为遗传因素在内异症的发生发展中起作用,多基因/多因素理论已经被广泛接受.本文对内异症相关基因多态性和基因产物异常表达的研究加以分析,试图从分子遗传学角度解释内异症发生发展的机制.

  14. Sexuality in Nigerian older adults

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    Olatayo, Adeoti Adekunle; Kubwa, Ojo Osaze; Adekunle, Ajayi Ebenezer

    2015-01-01

    Introduction Oftentimes the older adults are assumed to be asexual as few studies explore into the sexuality of this age group worldwide and even in Nigeria. It is an important aspect of quality of life which is often neglected by people in this age group, attending physicians and the society as a whole. The study was aimed at determining the perception of older adults about sexuality, identify the factors that could militate against sexuality and fill any void in information in this regard. Methods Descriptive study conducted in one hundred older adults. A semi-structured questionnaire was administered to consenting participants between 1st of September 2013 and 31st of March 2014. Results Mean age of respondents was 66.42± 5.77 years. Seventy-eight percent of the male respondents considered engaging in sexual activity as safe compared to 45.8% of the female respondents. More of the women (33.3%) regarded sexuality in the older adults as a taboo when compared to the men (5.4%). However, the men were more favourably disposed to discussing sexual problems than the women with their spouses (42% vs 20%) and Physicians (23.2% vs 0.0%). Major factors responsible for sexual inactivity were participants’ medical ailments (65%), partners’ failing health (15%) as well as anxiety about sexual performance (25%) in the men and dyspareunia (25%) in women. Conclusion There is an urgent need to correct the misconception about sexuality in this age group especially among the women and for the physicians to explore the sexual history of every patient. PMID:26977224

  15. Sexual activity and function assessment in middle-aged Chinese women using the female sexual function index.

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    Zhang, Caiyun; Cui, Liping; Zhang, Lizhi; Shi, Chang; Zang, Hong

    2017-06-01

    To assess sexual activity, sexual function, and their correlation with vaginal maturation status among middle-aged Chinese women. A cross-sectional study with comparisons across age groups was carried out. In all, 120 women aged 45 to 60 years were recruited into three groups: 45 to 50 (youngest group), 51 to 55 (intermediate group), and 56 to 60 years old (eldest group). Sexual function was assessed through the Female Sexual Function Index (FSFI); vaginal maturation status was determined through the Vaginal Maturation Index (VMI) and pH value. Sexual activity was recorded with self-administered questionnaires. Low sexual frequency was present in a higher proportion of women, but sexual distress was identified within a lower proportion of women in the eldest group. The total FSFI score was significantly lower in the eldest group than in the youngest and intermediate groups (P VMI (P VMI was positively correlated with the total FSFI score, the domain score for sexual desire, and lubrication (r = 0.26, 0.25, 0.34; P < 0.05, 0.05, 0.01), but the opposite associations were demonstrated for pH value (r = -0.47, -0.37, -0.38; P < 0.01, respectively), especially with vaginal pain (r = -0.44, P < 0.01). Among middle-aged Chinese women, sexual desire is lower in 56 to 60-year-old women, compared with those aged 45 to 55 years, whereas vaginal dryness and dyspareunia become more prevalent with age. Importantly, sexual function is associated with vaginal maturation status in women at midlife.

  16. Subpubic Cartilaginous Pseudocyst: Orthopedic Feature with Urological Consequences

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    Fawzy Farag

    2014-01-01

    Full Text Available Introduction. Masses arising from structures adjacent to the female urethra can cause obstructive urinary symptoms. Subpubic cartilaginous pseudocyst is a rare degenerative lesion of pubic symphysis that may cause these symptoms. Materials and Methods. A 61-year- and 57-year-old women presented with symptoms of difficult micturition and dyspareunia. Physical examination revealed a painless smooth, rounded, firm, and cystic mass, at the anterior vaginal wall of about 4 cm width. The mass caused inward deviation of the external urethral meatus. Cystoscopy and MRI were done. Results. Cystoscopy of case 1 (61 y demonstrated anterior external urethral compression with normal urethral mucosa. Cystoscopy was not possible in case 2 (57 y because the urethra could not be entered under local anesthesia. MRI showed almost the same findings in both cases: midline, rounded, and cystic mass ~3×3×4 cm, anterosuperior to the urethra, and posteroinferior to the pubic symphysis, with normal features of the urinary bladder. Open surgical excision of theses lesions was performed in both patients. Histopathologic assessment of the specimen obtained from both patients showed degenerated hyaline with areas of fibrinous and mucoid degeneration, a picture suggestive of cartilaginous subpubic pseudocyst. After 11-month and 4-month followup of patients numbers 1 and 2, respectively, there is no evidence of local recurrence of the lesion, either clinically or radiologically and both patients void empty. Conclusions. Subpubic cartilaginous pseudocysts are rare benign lesions with only 13 cases were reported in the literature. Patients present with a spectrum of gynecological and/or urological manifestations. Sizable lesions severely compressing the urethra need surgical excision to restore the voiding function.

  17. Correlates of sexual satisfaction among Iranians women attending South Tehran health centers: A cross-sectional study

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    Zeinab Tavakol

    2014-08-01

    Full Text Available Introduction: Sexual activity not only is a crucial physiologic need, but also it has been associated with religious, mystical, and historical concepts. The aim of this study was to assess Iranian women’s sexual satisfaction and its correlating factors. Methods: This was a cross-sectional study at South Tehran health centers (STHCs, which were affiliated to Tehran University of Medical Sciences (Tehran, Iran. A convenience sample consist of 405 women who were married, had at least sixth-grade literacy level, were not addicted to opioids or alcohol, had no history of infertility, psychiatric, and physical disorders, and referred to STHCs to receive Primary Health Care services. Main outcome measures were women’s demographics, sexual function, and sexual satisfaction were assessed by a questionnaire. Results: Most women (58.2% had moderate sexual satisfaction. A significant direct association was shown between sexual satisfaction and couple’s educational level (P < 0.001, partner’s higher income (P = 0.037, regular menstruation (P = 0.005, and degree of woman’s love toward her partner (P < 0.001. There was a significant indirect association between sexual satisfaction and gravidity number (P = 0.029, and number of offspring (P = 0.006. Having sexual intercourse at least once a week (P = 0.003, equal sex request (P = 0.028, accepting partner’s request pleasingly (P < 0.001, experiencing sexual arousal (P < 0.001, and lubrication (P < 0.001 was directly associated with sexual satisfaction. Dyspareunia (P < 0.001 and difficulty to reach orgasm (P < 0.001 showed significant indirect association. Conclusion: Women sexual satisfaction associates with interpersonal and sexual factors. Creating opportunity for midwives in health centers to consult with couples, assess their quality of sexual function, educate them, and refer them to specialists if needed, is strongly recommended for healthcare systems of Iran.

  18. Female Urethral Diverticulum: Presentation, Diagnosis, and Predictors of Outcomes After Surgery

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    El-Nashar, Sherif A.; Singh, Ruchira; Bacon, Melissa M.; Kim-Fine, Shunaha; Occhino, John A.; Gebhart, John B.; Klingele, Christopher J.

    2017-01-01

    Introduction and Hypothesis To report on clinical presentation, diagnosis, and outcomes after treatment of female urethral diverticulum (UD). Methods Using a record linkage system, women with a new diagnosis of UD at Mayo Clinic from January 1, 1980, through December 31, 2011, were identified. The presenting symptoms, clinical characteristics, diagnosis, and management of women presenting with UD were recorded. Outcomes after surgery were assessed using survival analysis. All statistical analyses were 2-sided and P values less than 0.05 were considered significant. Statistical analysis was done using SAS version 9.2 and JMP version 9.0 (SAS Institute Inc.). Results A total of 164 cases were identified. Median age at diagnosis was 46 years (range, 21–83). The most common presenting symptom was recurrent urinary tract infection (98, 59.8%), followed by urinary incontinence (81, 49.4%), dysuria (62, 37.8%), dyspareunia (37, 22.6%), and hematuria (15, 9.1%). Examination revealed vaginal mass in 55 (33.5%) of the women. A significant trend was noted toward an increase in use of both magnetic resonance imaging and computed tomography (P < 0.001) along with a progressive decrease in use of urethrogram (P < 0.001) for diagnosis of UD over the years. Among 114 women who underwent surgical treatment for UD, 14(12.3%) women presented with recurrent UD and the 5-year recurrence rate after surgery for UD was 23.4% (95% confidence interval, 13.9–37.0) and a reoperation rate of 17.0% (95% confidence interval, 8.8–30.2) at 5 years. Conclusions Female UD is a rare and unique condition. Clinical presentation is usually nonspecific, and magnetic resonance imaging is commonly used for confirming the diagnosis. Recurrence is not uncommon, and repeat surgical intervention might be needed. PMID:27636213

  19. Complications associated with transobturator sling procedures: analysis of 233 consecutive cases with a 27 months follow-up

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    Dubuisson Jean-Bernard

    2009-09-01

    Full Text Available Abstract Backround The transobturator tape procedure (TOT is an effective surgical treatment of female stress urinary incontinence. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions. Methods It was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris®, Obtape®, TVT-O®. Follow-up information was available for 225 (96.6% women. Results There were few per operative complications. Forty-eight women (21.3% reported late complications including de novo or worsening of preexisting urgencies (10.2%, perineal pain (2.2%, de novo dyspareunia (9%, and vaginal erosion (7.6%. The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris®, Obtape® and TVT-O® respectively (P = 0.001. The overall proportion of women satisfied by the procedure was 72.1%. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4% compared to women who did not (78.4% (RR 0.14, 95% CI 0.05-0.38, P Conclusion Late post operative complications are relatively frequent after TOT and can impair patient's satisfaction. Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Choice of the safest sling material is crucial as it is a risk factor for erosion.

  20. Acute and late vaginal toxicity after adjuvant high-dose-rate vaginal brachytherapy in patients with intermediate risk endometrial cancer: is local therapy with hyaluronic acid of clinical benefit?

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    Delishaj, Durim; Fabrini, Maria Grazia; Gonnelli, Alessandra; Morganti, Riccardo; Perrone, Franco; Tana, Roberta; Paiar, Fabiola; Gadducci, Angiolo

    2016-01-01

    Purpose The aim of the present study was to evaluate the effectiveness of hyaluronic acid (HA) in the prevention of acute and late vaginal toxicities after high-dose-rate (HDR) vaginal brachytherapy (BT). Material and methods Between January 2011 and January 2015, we retrospectively analyzed 126 patients with endometrial cancer who underwent extrafascial hysterectomy with or without lymphadenectomy and adjuvant HDR-vaginal BT +/– adjuvant chemotherapy. The total dose prescription was 21 Gy in 3 fractions (one fraction for week). Vaginal ovules containing 5 mg of HA were given for whole duration of vaginal BT and for the two following weeks. Acute and late toxicities were evaluated according to CTCAE vs 4.02. Results According to the revised FIGO 2009 classification, most tumors were in stage IA (30.9%) and in stage IB (57.9%). Thirty-three patients (26.2%) received adjuvant chemotherapy before vaginal BT. Five-year disease-free survival (DFS) and five-year overall survival (OS) were 88% and 93%, respectively. The most common grade 1-2 acute toxicities were vaginal inflammation (18 patients, 14.3%) and dyspareunia (7 patients, 5.5%). Two patients (1.6%) had more than one toxicity. Late toxicity occurred in 20 patients (15.9%). Grade 1-2 late toxicities were fibrosis (14 patients, 11.1%) and telangiectasias (7 patients, 5.5%). Six patients (4.8%) had more than one late toxicity. No grade 3 or higher acute or late toxicities were observed. Conclusions These results appear to suggest that the local therapy with HA is of clinical benefit for intermediate risk endometrial cancer patients who receive adjuvant HDR-vaginal BT after surgery. A randomized trial comparing HA treatment vs. no local treatment in this clinical setting is warranted to further evaluate the efficacy of HA in preventing vaginal BT-related vaginal toxicity. PMID:28115957

  1. Brain processing of visual stimuli representing sexual penetration versus core and animal-reminder disgust in women with lifelong vaginismus.

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    Charmaine Borg

    Full Text Available It has been proposed that disgust evolved to protect humans from contamination. Through eliciting the overwhelming urge to withdraw from the disgusting stimuli, it would facilitate avoidance of contact with pathogens. The physical proximity implied in sexual intercourse provides ample opportunity for contamination and may thus set the stage for eliciting pathogen disgust. Building on this, it has been argued that the involuntary muscle contraction characteristic of vaginismus (i.e., inability to have vaginal penetration may be elicited by the prospect of penetration by potential contaminants. To further investigate this disgust-based interpretation of vaginismus (in DSM-5 classified as a Genito-Pelvic Pain/Penetration Disorder, GPPPD we used functional magnetic resonance imaging (fMRI to examine if women with vaginismus (n = 21 show relatively strong convergence in their brain responses towards sexual penetration- and disgust-related pictures compared to sexually asymptomatic women (n = 21 and women suffering from vulvar pain (dyspareunia/also classified as GPPPD in the DSM-5, n = 21. At the subjective level, both clinical groups rated penetration stimuli as more disgusting than asymptomatic women. However, the brain responses to penetration stimuli did not differ between groups. In addition, there was considerable conjoint brain activity in response to penetration and disgust pictures, which yield for both animal-reminder (e.g., mutilation and core (e.g., rotten food disgust domains. However, this overlap in brain activation was similar for all groups. A possible explanation for the lack of vaginismus-specific brain responses lies in the alleged female ambiguity (procreation/pleasure vs. contamination/disgust toward penetration: generally in women a (default disgust response tendency may prevail in the absence of sexual readiness. Accordingly, a critical next step would be to examine the processing of penetration stimuli following

  2. Prevalence, Risk Factors, and Clinical Findings of Candidiasis and Trichomoniasis in Women Supported by Selected Health Centers of Tabriz, Iran

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    Sehhatie-Shafaie Fahimeh

    2014-10-01

    Full Text Available Objective: Vulvovaginitis candidiasis and trichomoniasis constitute at least 50% of infectious vaginitis cases. The aim of this study was to determine the prevalence, risk factors, and clinical findings of candidiasis and trichomoniasis in women supported by selected health centers of Tabriz, Iran. Materials and Methods: This was a cross-sectional study, in which 1000 women who had the study criteria were selected by random sampling. In addition, 12 health centers of Tabriz were selected for this study. A questionnaire was used to obtain their personal and reproductive information, checklist for clinical observations, and culture methods (sabouraud dextrose agar and diamond for diagnose vaginal infections. Results: The prevalence of candidiasis and trichomoniasis were 25.2 and 9.2%, respectively. Findings showed that candidiasis infection, history of diseases, vaginal pH, number of coitus, number of delivery, and number of vaginal delivery, breast feeding status, method of last delivery, and contraceptive methods are risk factors for candidacies. Moreover, age at marriage, personal health, sexual hygiene, and vaginal pH are risk factors for trichomoniasis. A statistically significant relationship was observed between candidiasis and clinical findings, such as pruritus, pruritus during coitus, burning sensation with coitus, dysuria in woman and her husband, dyspareunia, low abdominal pain, urinal symptoms, vaginal status, amount of discharge, consistency appearance, and color of discharges. Furthermore, a significant relationship was observed between trichomoniasis and dysuria, and appearance and color of vaginal discharge. Conclusion: Due to the high prevalence of candidiasis, trichomoniasis infections, and infected women as asymptomatic carriers, it seems necessary to pay more attention to these infections and make efforts for their prevention.

  3. Development of conjugated estrogens/bazedoxifene, the first tissue selective estrogen complex (TSEC) for management of menopausal hot flashes and postmenopausal bone loss.

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    Komm, Barry S; Mirkin, Sebastian; Jenkins, Simon N

    2014-11-01

    Conjugated estrogens (CE) combined with the selective estrogen receptor modulator (SERM) bazedoxifene (BZA) is a new option for alleviating menopausal symptoms and preventing postmenopausal bone loss. The rationale for developing the tissue selective estrogen complex (TSEC) CE/BZA was to combine CE's benefits with the SERM's tissue-specific properties to offset estrogenic stimulation of endometrial and breast tissue. TSECs provide a progestin-free alternative to traditional estrogen-progestin therapy (EPT) in women with a uterus. Preclinical studies supported bazedoxifene as the SERM of choice and demonstrated that CE/BZA provided an optimal balance of estrogen receptor agonist/antagonist activity compared with other potential TSEC pairings. Initial clinical development of CE/BZA focused on determining the appropriate dose ratio that would demonstrate efficacy with minimal to no stimulation of the breast or endometrium. Clinical studies confirmed the efficacy of the selected doses for maintaining bone mass; relieving vasomotor symptoms, vulvar-vaginal atrophy, and dyspareunia; and improving sexual function in postmenopausal women. Reduction of hot flashes also translated into improved menopause-specific quality of life and sleep. Unlike EPT, the FDA-approved dose of CE 0.45 mg/BZA 20mg does not cause a change in breast density or the endometrium, or increase breast pain compared with placebo. In clinical trials up to 2 years, CE 0.45 mg/BZA 20 mg has a favorable tolerability profile and rates of coronary heart disease, venous thromboembolism, and amenorrhea similar to placebo. Therefore, CE 0.45 mg/BZA 20 mg is an effective, well-tolerated alternative to EPT for menopausal symptom relief and osteoporosis prevention for postmenopausal women with a uterus.

  4. Profile of bazedoxifene/conjugated estrogens for the treatment of estrogen deficiency symptoms and osteoporosis in women at risk of fracture.

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    Rossini, Maurizio; Lello, Stefano; Sblendorio, Ignazio; Viapiana, Ombretta; Fracassi, Elena; Adami, Silvano; Gatti, Davide

    2013-01-01

    Decreasing levels of estrogens during menopause are associated with reduced bone density and an increased risk of osteoporosis. Many women also experience bothersome vasomotor and vaginal symptoms during the menopausal transition. Results of systematic reviews and meta-analyses of randomized controlled trials have shown that both systemic estrogen therapy or hormone therapy (estrogen combined with a progestin) are useful to prevent bone loss, and they are the most effective treatment for such climacteric symptoms as hot flushes, sweating, vaginal dryness, and dyspareunia. Unfortunately, estrogen therapy and hormone therapy increase the risk of endometrial and breast cancer, respectively. The selective estrogen receptor modulators (SERMs) result in positive estrogenic effects on bone, with no negative effects on the endometrium and breast but do not provide relief from postmenopausal symptoms. The combination of a SERM with estrogen as a tissue selective estrogen complex (TSEC) is a new strategy for the prevention of bone loss and the treatment of climacteric symptoms. This combination is particularly interesting from a clinical point of view, taking into account that estrogen alone did not increase breast cancer risk by the Women's Health Initiative. TSEC is hypothesized to provide the benefits of estrogen-alone therapy, with an improved tolerability profile because the SERM component can make possible the elimination of progestin. The objective of this review was to critically evaluate the evidence from the reports published to date on the use of bazedoxifene (a third-generation SERM) in combination with conjugated estrogens in postmenopausal women. The conclusion is that effectively, the combination of bazedoxifene and conjugated estrogens may be a promising alternative to hormone therapy for the prevention of osteoporosis and the treatment of postmenopausal symptoms in non-hysterectomized postmenopausal women.

  5. [Sarcoidosis of the female genital tract].

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    Šefčíková, A; Turková, M; Žurková, M

    To present the findings of sarcoidosis on female genital tract. Review. Department of Obstetric and Gynecology, Silesian Hospital Opava. Overview of published findings from case studies. Sarcoidosis is a multisystem granulomatous disorder of unclear cause. It typically involves the lymph nodes of mediastinum, predominantly billateral and/or pulmonary infiltrates. We find extrapulmonary involvement in 30-50% of cases. Sarcoidosis of the female reproductive system is a rare, it represent less than 1% cases of sarcoidosis. Lesions there may affect any organ, including the vulva, vagina, cervix, uterus, fallopian tube and ovary, but also for example placenta and breast. There is also recorded the incidence of multiple localization on female genitalia. Since sarcoidosis of this area is so rare, often proceeds asymptomatic and recognized only as an incidental finding, there are mention only the case histories in literature yet.Clinical symptoms may be non-specific, often imitating a tumor, or tend to be specific, depending on the localization of disability such as perineal pain, pain in the scar after the previous birth trauma, persistent pruritus, itching, irritation, dyspareunia, menstrual cycle disorders, menorrhagia, metrorrhagia, postmenopausal bleeding, amenorrhoe, abdominal pain, endometrial polypoid lesions, recurrent or persistent serometra or discharge. The diagnosis is made up of histologically - we are demonstrating noncaseating granulomas.The therapy is difficult, there are no available official guidelines. If the lesions are clinically silent, we can observed them because they may spontaneously disappear. If we are embarking on medical therapy, we start from a local application, and if this is unsuccessful then we approach the systemic administration. Corticosteroids are the drug of choice. If we diagnose the sarcoidosis of the female genital organs we must exclude systemic disease of sarcoidosis. The prognosis of disease is good.

  6. High prevalence of chronic pelvic pain in women in Ribeirão Preto, Brazil and direct association with abdominal surgery

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    Gabriela Pagano de Oliveira Goncalves da Silva

    2011-01-01

    Full Text Available INTRODUCTION: Chronic pelvic pain is a disease that directly affects the social and professional lives of women. OBJECTIVE: To estimate the prevalence of this clinical condition and to identify independent factors associated with it in women living in Ribeirão Preto, Brazil. METHODS: A one-year cross-sectional study was conducted in a population sample of 1,278 women over the age of 1,278 women over the age of 14 years. The target population was predominantly composed of women who are treated by the public health system. The questionnaire was administered by interviewers who were not linked to the city health care programs. The prevalence of the morbidity was estimated. First, we identified the significant variables associated with pelvic pain (p<0.10 and then we attributed values of 0 or 1 to the absence or presence of these variables. Logistic regression analysis was used to identify and estimate the simultaneous impact of the independent variables. The results were expressed by odds ratio and their 95% confidence interval with p<0.05. RESULTS: The disease was found in 11.5% (147/1,278 of the sample. The independent predictors were dyspareunia, previous abdominal surgery, depression, dysmenorrhea, anxiety, current sexual activity, low back pain, constipation, urinary symptoms, and low educational level. CONCLUSION: The prevalence of chronic pelvic pain in Ribeirão Preto is high and is associated with conditions that can usually be prevented, controlled, or resolved by improvement of public health policies and public education.

  7. Prevalence and conditions associated with chronic pelvic pain in women from São Luís, Brazil

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    L.S.C. Coelho

    2014-09-01

    Full Text Available The objective of the present study was to estimate the prevalence of chronic pelvic pain in the community of São Luís, capital of the State of Maranhão, Northeastern Brazil, and to identify independent conditions associated with it. A cross-sectional study was conducted, including a sample of 1470 women older than 14 years predominantly served by the public health system. The interviews were held in the subject's home by trained interviewers not affiliated with the public health services of the municipality. The homes were visited at random according to the city map and the prevalence of the condition was estimated. To identify the associated conditions, the significant variables (P=0.10 were selected and entered in a multivariate analysis model. Data are reported as odds ratio and 95% confidence interval, with the level of significance set at 0.05. The prevalence of chronic pelvic pain was 19.0%. The independent conditions associated with this diagnosis were: dyspareunia (OR=3.94, premenopausal status (OR=2.95, depressive symptoms (OR=2.33, dysmenorrhea (OR=1.77, smoking (OR=1.72, irregular menstrual flow (OR=1.62, and irritative bladder symptoms (OR=1.90. The prevalence of chronic pelvic pain in Sao Luís is high and is associated with the conditions cited above. Guidelines based on prevention and/or early identification of risk factors may reduce the prevalence of chronic pelvic pain in São Luís, Brazil.

  8. 子宫颈抹片检查常规筛选宫颈组织、癌前病变或癌变 在发展中国家门诊中的运用%Screening of premalignant and malignant cervical lesions in underdeveloped countries by using Pap smear as routine investigation in outpatient department

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    Rubina Mukhtar; Maham Munir; Allah Rakha; Abdul Mateen; Rab Nawaz Maken; Muhammad Arif

    2011-01-01

    Objective: Papanicolou (Pap) smear screening has dramatically reduced the incidence of invasive cervical can-cer worldwide. Pap smear screening is still not widely available in developing countries and therefore cannot be used as mass screening tool. This study was designed to establish the role of Pap smear as a routine investigation for females presented to gynecological department. Methods: It was a hospital based study. Patients attending with complaints including irregular vagi-nal bleeding, vagina discharge, dyspareunia, low backache or lower abdominal pain and primary or secondary infertility were included in the study. All these patients underwent pap smear. Results: Age of females was 25 to 60 years. Ninety females had dysplasia. Mild to moderate dysplasia was positive in 84 females. Six patients had severe dysplasia suspicious for squa-mous cell carcinoma (SCC) which was confirmed as invasive SCC on biopsy. All patients with mild to moderate dysplasia were regularly followed at 4 to 6 months. Thirty patients were lost during follow up. Forty had negative smear at 6 months, while fourteen having persistent dysplasia on repeated pap smears were referred for biopsies. Histopathology confirmed invasive SCC in five patients while chronic cervicitis was reported in nine patients. Only two of screened patients with high suspicion for cancer showed false negative results. Directed biopsies done in these confirmed invasive SCC. Conclusion: Pap smear is a useful, simple, non-invasive and reliable screening tool for cervical cancer. It may be practiced as a routine investigation in outpatients in developing countries, where mass screening is not available.

  9. Sexual Anatomy and Function in Women With and Without Genital Mutilation: A Cross-Sectional Study.

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    Abdulcadir, Jasmine; Botsikas, Diomidis; Bolmont, Mylène; Bilancioni, Aline; Djema, Dahila Amal; Bianchi Demicheli, Francesco; Yaron, Michal; Petignat, Patrick

    2016-02-01

    Female genital mutilation (FGM), the partial or total removal of the external genitalia for non-medical reasons, can affect female sexuality. However, only few studies are available, and these have significant methodologic limitations. To understand the impact of FGM on the anatomy of the clitoris and bulbs using magnetic resonance imaging and on sexuality using psychometric instruments and to study whether differences in anatomy after FGM correlate with differences in sexual function, desire, and body image. A cross-sectional study on sexual function and sexual anatomy was performed in women with and without FGM. Fifteen women with FGM involving cutting of the clitoris and 15 uncut women as a control group matched by age and parity were prospectively recruited. Participants underwent pelvic magnetic resonance imaging with vaginal opacification by ultrasound gel and completed validated questionnaires on desire (Sexual Desire Inventory), body image (Questionnaire d'Image Corporelle [Body Image Satisfaction Scale]), and sexual function (Female Sexual Function Index). Primary outcomes were clitoral and bulbar measurements on magnetic resonance images. Secondary outcomes were sexual function, desire, and body image scores. Women with FGM did not have significantly decreased clitoral glans width and body length but did have significantly smaller volume of the clitoris plus bulbs. They scored significantly lower on sexual function and desire than women without FGM. They did not score lower on Female Sexual Function Index sub-scores for orgasm, desire, and satisfaction and on the Questionnaire d'Image Corporelle but did report significantly more dyspareunia. A larger total volume of clitoris and bulbs did not correlate with higher Female Sexual Function Index and Sexual Desire Inventory scores in women with FGM compared with uncut women who had larger total volume that correlated with higher scores. Women with FGM have sexual erectile tissues for sexual arousal, orgasm

  10. Treatment of Postmenopausai Colpoxerosis by Fufan Jingxuegui:A Clinical Observation of 32 Cases%复方精血归治疗绝经后阴道干涩症32例疗效观察

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    武权生; 唐怡; 陈红

    2001-01-01

    Objective:To explore the curative effect of Fufan Jingxuegui (FJG) on postmenopausal colpoxerosis.Methods:32 cases of postmenopausal colpoxerosis were treated by FJG,and the clinical symptoms scoring and level of sexual hormones were observed.Results:FJG can markedly relieve vaginal dryness and dyspareunia,decrease the Kuppermen score value of comprehensive symptoms,improve the status and atrophie index of,vagina,increase the blood flow of ovarian artery,and tends to raise serum E2,the total effective rate being 96.7%.Conclusion:FJG is effective for postmenopausal colpoxerosis,and influence on ovarian function may be its chief mechanism.%目的:探讨中药复方精血归治疗绝经后妇女阴道干涩症的临床疗效。方法:对32例绝经后阴道干涩症患者应用复方精血归治疗,观察临床症状、积分及性激素改善情况。结果:精血归能明显消除、缓解阴道干涩、性交疼痛等主症,降低综合症状kuppermen评分值,可改善阴道健康状态和萎缩指数,增加卵巢动脉血流量,并有升高血清E2的趋势,总有效率96.7%。结论:复方精血归治疗绝经后阴道干涩症确有较好的疗效,作用机制主要是通过影响卵巢功能来实现的。

  11. Effective Factors on Urinary Incontinence in Natural Menopausal Women

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    Shohani

    2015-10-01

    Full Text Available Background Urinary tract infections and urinary incontinence are common urogenital problems affecting 7 - 10% of menopausal women. Objectives The primary objective of this study was to quantify effective factors on urinary incontinence in a cohort of menopausal women. Patients and Methods A sample of 150 menopausal women (natural menopause for at least 12 months were recruited from 13 healthcare centers in Ilam, Iran. Data regarding diagnosis, medical history and clinical symptoms were collected using a structured questionnaire and screening patient medical records. Logistic regression models were used to examine associations between urinary incontinence and other variables. Results Multiple atrophic urogenital changes were identified including vaginal dryness (42%, decreased libido (41.3%, dyspareunia (16%, vaginal itching (11.3% and vaginal discharge and burning (10.7%. The prevalence of urinary frequency, stress urinary incontinence, nocturia and urge urinary incontinence were 33.3%, 28.7%, 22.7% and 17.3%, respectively. A multivariate logistic model found that urinary infection (OR 5.6; 95% CI: 2.6 - 11.58, cystocele (OR 1.73; 95% CI: 1.29 - 2.33 and rectocele (OR 1.47; 95% CI: 1.20 - 1.80 were potential risk factors for incontinence. A significant association was observed between marital status and vaginal atrophy, body mass index and urinary incontinence and parity type and urinary incontinence (P < 0.05 for all. Conclusions Multiple associations existed between atrophic urogenital changes and urinary incontinence. The most significant interaction was between urinary tract infections and urinary incontinence in menopausal women, with urinary tract infections increasing the risk of incontinence by 5.6 fold. We recommend health professionals to focus on early screening of these issues and implement educational programs for women as part of standard practice.

  12. Comparison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopause Women: A Randomized Controlled Clinical Trial

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    Azam Jokar

    2016-01-01

    Full Text Available Background: Vaginal atrophy is a common complication in menopause which does not improve with time and, if untreated, can affect the quality of life for women. The aim of this study was to compare the effectiveness of the vaginal cream of hyaluronic acid and conjugated estrogen (Premarin in treatment of vaginal atrophy. Methods: This study was a randomized controlled clinical trial on 56 menopausal women with symptoms of vaginal atrophy; they were randomly allocated to two groups (recipient conjugated estrogen and hyaluronic acid. The severity of each sign of atrophy was evaluated by visual analog signals (VAS and on the basis of a four point scale. Also to recognize the cellular maturation with pap smear and the maturation degree were calculated according to the formula and scores 0-100. As to the vaginal PH, we used PH marker band, the rate of which was divided into 4 degrees. Data were analyzed using SPSS, version 20, and P≤0.05 was considered as significant. Results: The results of this study showed that the symptoms of vaginal atrophy compared with the baseline level were relieved significantly in both groups. Dryness, itching, maturation index, PH and composite score of the vaginal symptoms were relieved significantly in both groups (P<0.001. Dyspareunia in Premarin (P<0.05 and hyaluronic acid (P<0.001 decreased compared with pre-treatment. Urinary incontinence only showed improvement in the hyaluronic acid group (P<0.05. Improvement in urinary incontinence, dryness, maturation index (P<0.05 and composite score of vaginal symptoms (P<0.001 in the hyaluronic acid group was better than those in the Premarin group. Conclusion: According to the results of the present study, hyaluronic acid and conjugated estrogen improved the symptoms of vaginal atrophy. But hyaluronic acid was more effective and this drug is suggested for those who do not want to or cannot take local hormone treatment.

  13. Management of vesicovaginal fistula: An experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach

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    Rakesh Kapoor

    2007-01-01

    Full Text Available Purpose: We aim to present our experience for the repair of vesicovaginal fistula (VVF with special reference to surgical approach. Materials and Methods: From January 1999 to June 2005, 52 VVF patients with mean age of 32 years underwent operative treatment. Fistulas were divided into two groups, simple and complex, depending on site, size, etiology and associated anomalies. Simple VVFs were approached through the vaginal route and complex VVFs via the transabdominal route. Patients were evaluated at two to three weeks initially, three-monthly twice and later depending on symptoms. Results: Thirty-two (61.5% had simple fistulas and 20 (38.5% complex fistulas. The most common etiology was obstetric trauma in 31 (59.6% patients, while the second most common cause was post hysterectomy VVF. Thirty-two (61.5% patients were managed by transvaginal route, of which 17 had supratrigonal and 15 trigonal fistulas. Twenty (38.5% patients with complex fistulas were managed by abdominal route. The mean blood loss, postoperative pain and mean hospital stay were shorter in transvaginal repair. Eleven (21.2% patients required ancillary procedures for various other associated anomalies at the time of fistula repair. Three patients failed repair giving a success rate of 94.2%. At a mean follow-up of three years 48 women were sexually active, of these 10 (19.2% complained of mild to moderate dyspareunia. Conclusion: Most of the simple fistulas irrespective their locations are easily accessible transvaginally while in complex fistulas we recommend the transabdominal approach. Depending on the clinical context both the approaches achieved comparable success rates.

  14. Sexuality in Nigerian older adults.

    Science.gov (United States)

    Olatayo, Adeoti Adekunle; Kubwa, Ojo Osaze; Adekunle, Ajayi Ebenezer

    2015-01-01

    Oftentimes the older adults are assumed to be asexual as few studies explore into the sexuality of this age group worldwide and even in Nigeria. It is an important aspect of quality of life which is often neglected by people in this age group, attending physicians and the society as a whole. The study was aimed at determining the perception of older adults about sexuality, identify the factors that could militate against sexuality and fill any void in information in this regard. Descriptive study conducted in one hundred older adults. A semi-structured questionnaire was administered to consenting participants between 1(st) of September 2013 and 31(st) of March 2014. Mean age of respondents was 66.42 ± 5.77 years. Seventy-eight percent of the male respondents considered engaging in sexual activity as safe compared to 45.8% of the female respondents. More of the women (33.3%) regarded sexuality in the older adults as a taboo when compared to the men (5.4%). However, the men were more favourably disposed to discussing sexual problems than the women with their spouses (42% vs 20%) and Physicians (23.2% vs 0.0%). Major factors responsible for sexual inactivity were participants' medical ailments (65%), partners' failing health (15%) as well as anxiety about sexual performance (25%) in the men and dyspareunia (25%) in women. There is an urgent need to correct the misconception about sexuality in this age group especially among the women and for the physicians to explore the sexual history of every patient.

  15. Short- and Long-Term Quality of Life and Bowel Function in Patients With MRI-Defined, High-Risk, Locally Advanced Rectal Cancer Treated With an Intensified Neoadjuvant Strategy in the Randomized Phase 2 EXPERT-C Trial

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    Sclafani, Francesco; Peckitt, Clare [The Royal Marsden NHS Foundation Trust, London (United Kingdom); Cunningham, David, E-mail: david.cunningham@rmh.nhs.uk [The Royal Marsden NHS Foundation Trust, London (United Kingdom); Tait, Diana [The Royal Marsden NHS Foundation Trust, London (United Kingdom); Giralt, Jordi [Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Department of Medical Oncology, Barcelona (Spain); Glimelius, Bengt [University of Uppsala, Uppsala (Sweden); Keränen, Susana Roselló [Biomedical Research Institute INCLIVA, Department of Hematology and Medical Oncology, University of Valencia (Spain); Bateman, Andrew [Southampton General Hospital, Cancer Sciences Unit, University of Southampton (United Kingdom); Hickish, Tamas [Poole Hospital NHS Foundation Trust, Department of Medical Oncology, Bournemouth University (United Kingdom); Tabernero, Josep [Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Department of Medical Oncology, Barcelona (Spain); Thomas, Janet; Brown, Gina; Oates, Jacqueline; Chau, Ian [The Royal Marsden NHS Foundation Trust, London (United Kingdom)

    2015-10-01

    Objective: Intensified preoperative treatments have been increasingly investigated in locally advanced rectal cancer (LARC), but limited data are available for the impact of these regimens on quality of life (QoL) and bowel function (BF). We assessed these outcome measures in EXPERT-C, a randomized phase 2 trial of neoadjuvant capecitabine combined with oxaliplatin (CAPOX), followed by chemoradiation therapy (CRT), total mesorectal excision, and adjuvant CAPOX with or without cetuximab in magnetic resonance imaging-defined, high-risk LARC. Methods and Materials: QoL was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR29 questionnaires. Bowel incontinence was assessed using the modified Fecal Incontinence Severity Index questionnaire. Results: Compared to baseline, QoL scores during preoperative treatment were better for symptoms associated with the primary tumor in the rectum (blood and mucus in stool, constipation, diarrhea, stool frequency, buttock pain) but worse for global health status, role functioning, and symptoms related to the specific safety profile of each treatment modality. During follow-up, improved emotional functioning and lessened anxiety and insomnia were observed, but deterioration of body image, increased urinary incontinence, less sexual interest (men), and increased impotence and dyspareunia were observed. Cetuximab was associated with a deterioration of global health status during neoadjuvant chemotherapy but did not have any long-term detrimental effect. An improvement in bowel continence was observed after preoperative treatment and 3 years after sphincter-sparing surgery. Conclusions: Intensifying neoadjuvant treatment by administering induction systemic chemotherapy before chemoradiation therapy improves tumor-related symptoms and does not appear to have a significantly detrimental effect on QoL and BF, in both the short and the long term.

  16. Pelvic inflammatory disease: Contemporary diagnostic and therapeutic approach

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    Terzić Milan

    2010-01-01

    Full Text Available Pelvic inflammatory disease (PID is polymicrobial infection in women characterized by inflammation of the upper genital tract, including endometritis, salpingitis, pelvic peritonitis, occasionally leading to the formation of tubo-ovarian abscess (TOA. PID primarily affects young, sexually active women, and it is highly correlated with having several sexual partners, intrauterine contraceptive device and sexually transmited diseases. The spectrum of disease is caused most commonly by Chlamydia trachomatis and Neisseria gonorrhoeae in 30-50% of cases. PID is responsible for severe acute morbidity and significant long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. The following clinical features are suggestive of a diagnosis of PID: bilateral lower abdominal tenderness, abnormal vaginal or cervical discharge, fever (higher than 38°C, abnormal vaginal bleeding, dyspareunia, cervical motion tenderness and adnexal tenderness, with or without a palpable mass. In laboratory findings, there is presence of excess leucocytes, elevated erythrocyte sedimentation rate or C-reactive protein. Transvaginal ultrasound scanning may be helpful, and its sensitivity is up to 85%. It can identify inflamed and dilated tubes and tubo-ovarian masses. Magnetic resonance imaging can be helpful in a final diagnosis in 95% of cases. In 15-30% of suspected cases, there is no laparoscopic evidence of disease. Treatment regimens for PID include broadspectrum antibiotics, including coverage for Neisseria gonorrhoeae and Chlamydia trachomatis. The usage of parenteral or oral therapy, inpatient or outpatient regimens, depends on the patient’s clinical condition. Considering the potential complications of disease, there is a need for good health educational programmes in reproductive period.

  17. Clinical and psychological repercussions of videolaparoscopic tubal ligation: observational, single cohort, retrospective study

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    Daniel Spadoto Dias

    Full Text Available CONTEXT AND OBJECTIVE: Tubal ligation is one of the most commonly used contraceptive methods worldwide. Since the controversy over the potential effects of tubal sterilization still continues, this study aimed to evaluate the clinical and psychological repercussions of videolaparoscopic tubal ligation.DESIGN AND SETTING: Observational, single cohort, retrospective study, conducted in a tertiary public hospital.METHODS: A questionnaire was applied to 130 women aged 21-46 years who underwent videolaparoscopic tubal ligation by means of tubal ring insertion or bipolar electrocoagulation and sectioning, between January 1999 and December 2007. Menstrual cycle interval, intensity and duration of bleeding, premenstrual symptoms, dysmenorrhea, dyspareunia, noncyclic pelvic pain and degree of sexual satisfaction were assessed in this questionnaire. Each woman served as her own control, and comparisons were made between before and after the surgical procedure and between the two techniques used.RESULTS: The clinical and psychological repercussions were significant, with increases in bleeding (P = 0.001, premenstrual symptoms (P < 0.001, dysmenorrhea (P = 0.019 and noncyclic pelvic pain (P = 0.001; and reductions in the number of sexual intercourse occurrences per week (P = 0.001 and in libido (P = 0.001. Women aged ≤ 35 years at the time of sterilization were more likely to develop menstrual abnormalities. The bipolar electrocoagulation method showed greater clinical and psychological repercussions.CONCLUSION: Regardless of the technique used, videolaparoscopic tubal ligation had repercussions consisting of increased menstrual flow and premenstrual symptoms, especially in women aged ≤ 35 years, and also had a negative influence on sexual activity.

  18. Evaluation of long-term pelvic floor symptoms after an obstetric anal sphincter injury (OASI) at least one year after delivery: A retrospective cohort study of 159 cases.

    Science.gov (United States)

    Desseauve, D; Proust, S; Carlier-Guerin, C; Rutten, C; Pierre, F; Fritel, X

    2016-01-01

    The aim of this study was to assess long-term pelvic floor symptoms after an obstetric anal sphincter injury (OASI). This retrospective cohort study included 237 cases of OASI (0.86% of deliveries) identified at Poitiers University Hospital between 2000 and 2011. Symptoms were assessed using validated self-administered questionnaires, including Female Pelvic Floor Questionnaire, Pescatori anal incontinence score, EuroQoL five-dimension score, and pain visual analogue scale (VAS). One hundred and sixty women (67%) filled out the questionnaires, on average 46 months after delivery (8-152). Among them, 93 (54%) reported at least one symptom occurring "frequently" (the most common being dyspareunia), and 45 (28%) a symptom occurring "daily" (the most common being flatus incontinence). Anal incontinence was reported by 32 (20%) women, flatus incontinence "frequently" or "daily" by 28 (18%), and stool incontinence "frequently" or "daily" by 9 (6%). Urinary incontinence was reported "frequently" or "daily" by 27 women (17%) at stress, 17 (11%) at urge, and 11 (7%) at mixed circumstances. Prolapse symptoms were reported "frequently" or "daily" by 6 women (4%). Pain during intercourse was reported "frequently" or "daily" by 17 women (11%). Twenty-four women (18%) reported chronic pelvic pain (VAS score≥4/10). Ninety-five percent of women reported a normal quality of life for mobility, self-care, and usual activities; however, alterations in pain/discomfort (32%) and anxiety/depression (33%) domains were frequently reported. Pelvic floor symptoms 4 years after OASI were highly prevalent. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  19. [Place of vulvovaginal candidiasis in the lower genital tract infections and associated risk factors among women in Benin].

    Science.gov (United States)

    Ogouyèmi-Hounto, A; Adisso, S; Djamal, J; Sanni, R; Amangbegnon, R; Biokou-Bankole, B; Kinde Gazard, D; Massougbodji, A

    2014-06-01

    Determine the place of vulvo-vaginal candidiasis (VVC) in the lower genital infections and seek risk factors among women in Benin. The study was conducted in the laboratory of mycology of Hôpital de la Mère et de l'Enfant Lagune (Homel) from 1st March to 31st July, 2013. It involved all the women who were asked a vaginal swab and gave their consent in written form. After administration of a questionnaire, the vaginal samples were collected with sterile cotton swabs for a test with potassium hydroxide, an estimation of vaginal pH, direct microscopic examination, fresh, and after a Gram stain and culture on Sabouraud-chloramphenicol, ordinary agar and fresh blood agar. One hundred and thirty-one women were included in the study period. Clinical signs were dominated by vaginal discharge (74.8%), followed by vulvar pruritus (51.9%) and dyspareunia (36.6%). Culture on Sabouraud was positive in 51 cases or 38.9%. Candida albicans was isolated in 96.1% of cases, against 3.9% of Candida glabrata. The risk factors involved were: pregnancy, antibiotics, synthetic underclothing and frequent wearing tight pants. In addition of Candida, Gardnerella vaginalis was found in 36.6% of samples with an association with C. albicans in 28.2% of cases. This study showed that vulvovaginal candidiasis is the leading cause of lower genital tract infections in women in Benin with involvement of several risk factors which research is needed to develop appropriate preventive measures. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  20. Sexual and Reproductive Outcomes in Early Stage Cervical Cancer Patients after Excisional Cone as a Fertility-sparing Surgery: An Italian Experience

    Science.gov (United States)

    Fanfani, Francesco; Landoni, Fabio; Gagliardi, Maria Lucia; Fagotti, Anna; Preti, Eleonora; Moruzzi, Maria Cristina; Monterossi, Giorgia; Scambia, Giovanni

    2014-01-01

    Background The purpose of this study was to analyze the quality of life in terms of sexual and reproductive outcome in patients suffering from early stage cervical cancer, submitted to an excisional cone as fertility-sparing treatment. Methods A multicenter retrospective analysis about specific dimensions of physical, psychological, reproductive and sexual functions after a cold-knife conization plus pelvic laparoscopic lymphadenectomy was conducted at Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome-Italy and at Division of Gynecology, European Institute of Oncology, Milan-Italy. The aim of this study was twofold. It aimed to analyze the quality of life in patients submitted to minimally invasive surgery and to compare these data with radical trachelectomy. Results Twenty-three patients with an average age of 30 years decided to participate in this study. After the treatment, all women (100%) had regular menstruation, 7 (30.4%) had increased not invalidating dysmenorrhea; 1 (4.4%) experienced a cervical stenosis; 6 among 10 patients that tried to conceive (60%) obtained one spontaneous pregnancy; 4 more (40%) underwent in vitro fertilization and embryo transfer and only 1 of them (25%) was successful. About sexual assessment, 1 patient (4.4%) had trouble in lubricating, 3 (13%) had anxiety about performance, 6 (26.1%) complained of dyspareunia which was resolved within 3 subsequent months. All patients (100%) obtained a complete psychological and physical recovery. Conclusion This study demonstrated preliminary encouraging data about sexual and reproductive outcome after excisional conization. A comparison with trachelectomy surely needs longer follow-ups, more cases and prospective analyses. PMID:24696793

  1. Climacteric and menopause in seven South-east Asian countries.

    Science.gov (United States)

    Boulet, M J; Oddens, B J; Lehert, P; Vemer, H M; Visser, A

    1994-10-01

    The menopause is universal, but what about the climacteric? In an attempt to answer this question, a study was conducted in seven south-east Asian countries, namely, Hong Kong, Indonesia, Korea, Malaysia, the Philippines, Singapore and Taiwan. Samples of approximately 400 women in each country were questioned about a number of climacteric complaints, incontinence and dyspareunia, consultation of a physician, menopausal status and several background characteristics. Special care was taken to overcome linguistic and cultural problems, and the data collected were kept as objective as possible. From the results obtained we were able to show that the climacteric was indeed experienced in south-east Asian countries, although in a mild form. The prevalence of hot flushes and of sweating was lower than in western countries, but was nevertheless not negligible. The percentages of women who reported the more psychological types of complaint were similar to those in western countries. The occurrence of climacteric complaints affected perceived health status. A physician was consulted for climacteric complaints by 20% of the respondents, although this was most frequently associated with the occurrence of psychological complaints and less so with that of hot flushes and sweating. The median age at menopause (51.09) appeared to be within the ranges observed in western countries. Ethnic background and age at menarche were found to have a significant influence on age at menopause. The study clearly demonstrated that climacteric complaints occur in south-east Asia. The findings suggest, however, that vasomotor-complaint-related distress might be 'translated' into psychological complaints, which are more frequently considered to warrant consulting a physician.

  2. Reparo transperineal de retocele: avaliação do grau de satisfação, dispareunia e recidiva pós-operatória Transperineal repair for rectocele: grade of satisfaction and postoperatory dispareunia and recurrence

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    Sinara Mônica de Oliveira Leite

    2009-12-01

    Full Text Available A retocele é uma disfunção pélvica pobremente diagnosticada, apesar de sua prevalência significativa. Seu reconhecimento é essencial para o tratamento de determinados casos, como constipação refratária. A sintomatologia é vaga, e nem sempre associada ao prolapso. O tratamento clínico é ineficaz quando utilizado isoladamente. Existem várias técnicas, e dentre elas a abordagem transperineal pode ser considerada uma opção adequada na correção do prolapso. Nas 12 pacientes objetos de nosso estudo, houve melhora significativa do padrão evacuatório, uma resposta aceitável no tratamento da dispareunia, com índice de recidiva tolerável e alto grau de satisfação pós-operatória. A comparação com as demais técnicas ainda exige estudos comparativos mais significativos, com amostras mais expressivas. Até o momento, qualquer análise comparativa entre as técnicas cirúrgicas utilizadas pode ser falha.Rectocele is a poorly diagnosed pelvic dysfunction, despite its significant prevalence. Its recognition is essential for the treatment of certain cases as refractory constipation. The symptoms are vague and not always associated with prolapse. Clinical treatment is ineffective when used alone. There are several techniques, being the transperineal approach an appropriate option for the correction of prolapse. The target of this data is a group of 12 female patients with rectocele: they experienced significant improvement in the defecation standard, an acceptable response in the treatment of dyspareunia, with acceptable recurrence rate and high degree of satisfaction after surgery. The comparison with other techniques still requires significant further comparative studies with samples more expressive. To date, any comparative analysis between the surgical techniques used may be failure.

  3. Clinical and treatment factors associated with vaginal stenosis after definitive chemoradiation for anal canal cancer.

    Science.gov (United States)

    Mirabeau-Beale, Kristina; Hong, Theodore S; Niemierko, Andrzej; Ancukiewicz, Marek; Blaszkowsky, Lawrence S; Crowley, Elizabeth M; Cusack, James C; Drapek, Lorraine C; Kovalchuk, Nataliya; Markowski, Meghan; Napolitano, Brian; Nyamwanda, Jacqueline; Ryan, David P; Wolfgang, John; Kachnic, Lisa A; Wo, Jennifer Y

    2015-01-01

    We sought to evaluate the incidence of vaginal stenosis (VS) and identify clinical and treatment factors that predict for VS in female patients with anal cancer treated with definitive chemoradiation. The cohort included 95 consecutive women receiving definitive chemoradiation between 2003 and 2012. All but 1 received intensity modulated radiation therapy; median primary tumor dose 50.4 Gy (range, 41.4-60). A modified National Cancer Institute Common Terminology Criteria for Adverse Events version 4 was used to score VS based on the medical record description of dyspareunia, pain with dilator use, vaginal dryness, or difficult pelvic examination. Ordered logistic regression was performed to assess VS predictors. Median age was 60.4 years (range, 19-97). With median follow-up of 2.5 years, 70 women (74%) had adequate information to assess VS. Of these, VS grade distribution was 21.4% grade 0, 14.3% grade 1, 27.1% grade 2, and 37.1% grade 3. By multivariable ordered logistic regression, younger age (P = .02), higher tumor dose (P = .06), and earlier treatment year (P = .04) were associated with higher grade of VS. VS is a common late complication in women treated definitively with chemoradiation for anal canal cancer. Younger age, higher tumor dose, and earlier year of treatment were associated with a higher grade of stenosis. Prospective investigation into patient reported outcomes is warranted, including sexual function and VS prevention strategies to better understand its effect on long-term survivorship. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  4. Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis.

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    de Oliveira, Sofia Andrade; Fonseca, Marcelo C M; Bortolini, Maria A T; Girão, Manoel J B C; Roque, Matheus T; Castro, Rodrigo A

    2017-08-05

    The efficacy and safety of removing or preserving the uterus during reconstructive pelvic surgery is a matter of debate. We performed a systematic review and meta-analysis of studies that compared hysteropreservation and hysterectomy in the management of uterine prolapse. PubMed, Medline, SciELO and LILACS databases were searched from inception until January 2017. We selected only randomized controlled trials and observational cohort prospective comparative studies. Primary outcomes were recurrence and reoperation rates. Secondary outcomes were: operative time, blood loss, visceral injury, voiding dysfunction, duration of catheterization, length of hospital stay, mesh exposure, dyspareunia, malignant neoplasia and quality of life. Eleven studies (six randomized and five non-randomized) were included involving 910 patients (462 in the hysteropreservation group and 448 in the hysterectomy group). Pooled data including all surgical techniques showed no difference between the groups regarding recurrence of uterine prolapse (RR 1.65, 95% CI 0.88-3.10; p = 0.12), but the risk of recurrence following hysterectomy was lower when the vaginal route was used with native tissue repair (RR 10.61; 95% CI 1.26-88.94; p = 0.03). Hysterectomy was associated with a lower reoperation rate for any prolapse compartment than hysteropreservation (RR 2.05; 95% CI 1.13-3.74; p = 0.02). Hysteropreservation was associated with a shorter operative time (mean difference -12.43 min; 95% CI -14.11 to -10.74 ; p uterine prolapse was not lower but the rate of reoperation for prolapse was lower following hysterectomy, while operative time was shorter and blood loss was less with hysteropreservation. The limitations of this analysis were the inclusion of nonrandomized studies and the variety of surgical techniques. The results should be interpreted with caution due to potential biases.

  5. Effect of continuous nursing care on the life quality of patients with hysterectomy%延续护理对子宫全切术后患者性生活质量的影响

    Institute of Scientific and Technical Information of China (English)

    张宝英

    2015-01-01

    目的:探讨延续护理在提高子宫全切术后患者性生活质量中的作用。方法将85例子宫全切术后患者随机分为观察组(41例)、对照组(44例),2组患者出院时均按常规给予出院指导,观察组在出院后1,3,4,5个月再给予延续护理,比较2组患者出院后6个月的性生活质量。结果观察组患者性生活满意度、性交痛及阴道干涩的发生率均明显优于对照组(P<0.01或P<0.05)。结论延续护理可有效提高子宫切除术后患者性生活质量。%Objective To investigate the effect of continuing nursing care in improving sexual life quality of patients with hysterectomy.Methods 85 cases of hysterectomy patients were randomly divided into observation group (41 cases) and control group (44 cases). Two groups of patients were conventionally given discharge guidance. The continue nursing care was provided to the observation group in 1, 3, 4, 5 months after discharge, then make comparision of sexual life of two groups in this 6 months.Results Compared with control group, the level of sexual life satisfaction is higher, the complaints of dyspareunia and vaginal dryness were significantly less (P<0.01 or P<0.05). Conclusion Continuing nursing care can effectively improve the quality of sexual life of patients after hysterectomy.

  6. Trichomoniasis: How do we diagnose in a resource poor setting?

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    R Sivaranjini

    2013-01-01

    Full Text Available Background: Diagnosis of Trichomonas vaginalis vaginalis infection based solely on clinical symptoms and signs is unreliable because the spectrum of infection is broad and other sexually transmitted pathogens cause similar signs and symptoms. Aims: Our study was undertaken to study the frequency of T. vaginalis infection in women presenting with vaginal discharge, to characterize the clinical features, and to study the sensitivity and specificity of microbiological investigations in the diagnosis of the same. Materials and Methods: This was a hospital-based descriptive study done on 400 female patients with vaginal discharge attending the Gynecology out-patient department (OPD of JIPMER, Puducherry, from May 2010 to July 2011. Women of age between 20 years and 50 years presenting with vaginal discharge irrespective of marital status, were included, and detailed history was elicited and thorough examination was performed. Results: In 400 women presenting with vaginal discharge from Gynecology out-patient department (OPD included in the study, T. vaginalis infection was found in 27 (6.75% women. The risk factors for trichomoniasis included history of pre- or extramarital sexual contact in the woman or her partner, symptomatic partner, and alcohol consumption. A positive association with pelvic inflammatory disease was also observed. The most frequent symptoms included lower abdominal pain, dysuria, and dyspareunia. Combining of Whiff test, pH > 4.5, and pus cells in Gram-stained smear, the specificity in diagnosing the infection (97.3% approached that of the reference standard, i.e., culture. On combining wet mount with Papanicolaou smear, the sensitivity increased to 92.6%, which was higher than that individually done. Conclusion: To conclude, diagnosis of T. vaginalis infection based solely on clinical symptoms and signs is unreliable, and combination of simple laboratory tests increases the diagnostic performance close to the reference standard

  7. Sexual Dysfunction in Women with Type 2 Diabetes Mellitus

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    Forouzan Elyasi

    2015-05-01

    Full Text Available Background: Sexual dysfunction (SD is one of the important problems in diabetic patients. The present study aimed to determine the prevalence of sexual problems in Iranian women with type 2 diabetes mellitus. Methods: A cross-sectional study was conducted among type 2 diabetic women who visited two outpatient endocrine clinics, namely Imam Hospital and Tuba clinic (Sari, Iran in 2012. Patients were asked to complete two validated questionnaires: Female Sexual Function Index (FSFI and The Hospital Anxiety and Depression Scale (HADS as well as a demographic questionnaire. Analysis was performed using descriptive and analytical tests. P<0.05 was considered to be significant. Results: One hundred and fifty women with type 2 diabetes were investigated. Most of the cases aged 40-44 years old. The mean of the total score of the FSFI questionnaire was 22. The prevalence of sexual dysfunction was 78.7% (CI: 71.4-84.4; among these, 58% (CI: 50.0-65.6 reported problems in lubrication, 50% (CI: 42.1-57.9 complained of decreased sexual desire, 50% (CI: 42.1-57.9 had problems with arousal, 47.3% (CI: 39.5-55.3 had dyspareunia, 32.7% (CI: 25.7-40.5 complained of orgasmic dysfunction and 42.7% (CI: 35.0-50.7 reported problems in sexual satisfaction. With regard to the results of the HADS questionnaire, 58.7% (CI: 50.7-66.2 of the patients had depression and 96.7% (CI: 92.4-98.6 had anxiety. Conclusion: This study showed the high prevalence of sexual dysfunction in diabetic women, especially among those complaining of depression. Health care professionals dealing with diabetic patients should be aware of possible presence of sexual dysfunction in female patients.

  8. Sexuality and quality of life in women with a prior diagnosis of breast cancer after risk-reducing salpingo-oophorectomy.

    Science.gov (United States)

    Tucker, Paige E; Saunders, Christobel; Bulsara, Max K; Tan, Jason Jit-Sun; Salfinger, Stuart G; Green, Helena; Cohen, Paul A

    2016-12-01

    To investigate the prevalence of sexual dysfunction in women with a history of breast cancer following risk-reducing salpingo-oophorectomy (RRSO). A secondary objective was to examine the effect of a prior diagnosis of breast cancer, and other factors, on sexuality and quality of life (QoL) outcomes. Cross-sectional study of 119 women who underwent RRSO between 2009 and 2014. Data were collected via a questionnaire comprising demographic information and validated measures of sexual function, sexual distress, relationship satisfaction, body image, psychological stress, menopause symptoms and general quality of life. Sixty out of 119 participants who underwent RRSO had a history of breast cancer. Eighty percent of women with breast cancer had female sexual dysfunction (FSD) and 82% had hypoactive sexual desire disorder (HSDD) after RRSO. Bilateral mastectomy was associated with higher rates of HSDD (p = 0.028) and higher body image self-consciousness (BISC) during sexual activity (p = 0.011). Breast reconstruction was associated with higher relationship satisfaction (RAS) scores (p = 0.004). Compared to Tamoxifen, aromatase inhibitors (AI) were significantly associated with reduced lubrication (p = 0.041), arousal (p = 0.004), orgasm (p = 0.002) and greater dyspareunia (p = 0.027). Prior diagnosis of breast cancer was not associated with the prevalence of FSD (p = 0.532). High rates of FSD and HSDD occur in women with breast cancer following RRSO. Low relationship satisfaction, bodily pain, bilateral mastectomy and the use of aromatase inhibitors were associated with poorer sexual function. Women had similar sexual outcomes and QoL after RRSO, regardless of breast cancer history. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Prevalence of symptoms suggestive of reproductive tract infections/sexually transmitted infections in women in an urban area of Ludhiana

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    Preethi S Philip

    2013-01-01

    Full Text Available Background: RTIs/STIs present a huge burden of disease, adversely impact reproductive health, and cause suffering for both men and women with consequences more devastating and widespread among women. These infections often go undiagnosed and untreated. Objectives: 1 To identify the most common reported symptoms of RTI/STI among married women aged 15-44 years in an urban population of Ludhiana. 2 To identify important risk factors associated with symptoms of RTI/STI in the study population. Materials and Methods: A cross-sectional study was carried out among married women aged 15-44 years in an urban area in Ludhiana, using the WHO-Syndromic Approach for diagnosis and management of RTIs/STIs. The sample consisted of 260 eligible women obtained by systematic random sampling, from amongst those residing in the population served by one MPHW (F. Results: The prevalence of symptoms suggestive of RTIs/STIs in the study population was found to be 17.3%. The most common symptoms reported by the women sufferers were urinary (dysuria 57.8%, frequent urination 53.3%, followed by dyspareunia (26.7%, unusual vaginal discharge (24.4% and vaginal itching (22.2%. Age 35-44 years, gravidity >4, education high school/above, joint families, history of abortion, and using ordinary cloth during menstruation were found to be significant risk factors. 64.4% of those with symptoms were untreated, 68.7% of those treated reported partial relief, most of those treated preferred private doctors, and the partners were not treated.

  10. Women's sexual health and contraceptive needs after a severe obstetric complication ("near-miss": a cohort study in Burkina Faso

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    Ganaba Rasmané

    2010-08-01

    Full Text Available Abstract Background Little is known about the reproductive health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect reproductive events in the first year postpartum. Methods Data were collected from a prospective cohort of women who either experienced life threatening (near-miss pregnancy-related complications or an uncomplicated childbirth, followed from the end of pregnancy to one year postpartum or post-abortum. Documented outcomes include menses resumption, sexual activity resumption, dyspareunia, uptake of contraceptives, unmet needs for contraception and women's reproductive intentions. Participants were recruited in seven hospitals between December 2004 and March 2005 in six towns in Burkina Faso. Results Reproductive events were associated with pregnancy outcome. The frequency of contraceptive use was low in all groups and the method used varied according to the presence or not of a live baby. The proportion with unmet need for contraception was high and varied according to the time since end of pregnancy. Desire for another pregnancy was highest among near-miss women with perinatal death or natural abortion. Women in the near-miss group with induced abortion, perinatal death and natural abortion had significantly higher odds of subsequent pregnancy. Unintended pregnancies were observed mainly in women in the near-miss group with live birth and the uncomplicated delivery group. Conclusions Considering the potential deleterious impact (on health and socio-economic life of new pregnancies in near-miss women, it is important to ensure family planning coverage includes those who survive a severe complication.

  11. An epidemiological study of sexual disorders in south Indian rural population.

    Science.gov (United States)

    Sathyanarayana Rao, T S; Darshan, M S; Tandon, Abhinav

    2015-01-01

    Sexuality is an important aspect of the personality of an individual and influences psychological, physical and social well-being of both men and women. It is a paradox, that in the country where 'kamasutra' (by Vatsyayana) took birth, there is a lack of research publications and sexuality related literature; hence the current study was conducted, to estimate the prevalence and association of sexual disorders with various socio-demographic variables, in the selected rural population. Subjects who were sexually active and fulfilled the study criteria were administered Arizona Sexual Experience Scale as screening tool for the presence of sexual problems. Those who were found to be having sexual problems were interviewed further using appropriate questionnaires. 21.15% of the male subjects were diagnosed to have one (or more) sexual disorder. Prevalence of erectile dysfunction was found to be 15.77%, male hypoactive sexual desire disorder (HSDD) 2.56%; premature ejaculation was found to be prevalent in 8.76% of the male subjects. Around 14% of the female subjects were diagnosed to have female sexual disorders. Prevalence of female arousal dysfunction was found to be 6.65%, female HSDD 8.87%, female anorgasmia 5.67%, female dyspareunia 2.34% and female sexual aversion disorder was found to be prevalent in 0.37% of the female subjects. This study concluded that one in five males and one in seven females were suffering from one (or more) sexual disorder. Improving the training of undergraduate medical and nursing students in sexuality related issues, increasing trained individuals in sexual medicine by starting new courses, providing sex education to the general population using media and merging sexual health care with primary care, are likely to play a significant role in addressing the increasing sexual health morbidity.

  12. Correlation between pelvic adhesions and pain symptoms of endometriosis%子宫内膜异位症患者盆腔粘连与疼痛的相关性

    Institute of Scientific and Technical Information of China (English)

    郝敏; 赵卫红; 王永红

    2009-01-01

    目的 探讨子宫内膜异位症(内异症)患者中盆腔粘连的发生率及其与疼痛症状的相关性. 方法 分析2003年1月至2007年12月间480例内异症患者盆腔粘连及痛经、慢性盆腔痛(CPP)、性交痛与排便痛的发生情况,评价内异症患者的盆腔粘连与疼痛症状之间的相关性.根据美国生育学会1985年修订的内异症分期标准(r-AFS)分为Ⅰ期155例,Ⅱ期33例,Ⅲ期108例,Ⅳ期184例. 结果 (1)480例内异症患者中,72.3%(347/480)存在盆腔粘连;Ⅰ期25.2%(39/155),Ⅱ期78.8%(26/33),Ⅲ期90.7%(98/108),Ⅳ期100.0%(184/184),且盆腔粘连程度与内异症的临床期别间呈正相关关系(rs=0.870,P<0.01);(2)480例内异症患者中,伴痛经者占61.0%(293/480),其中轻、中、重度痛经分别为52.2%(153/293)、26.6%(78/293)、21.2%(62/293);伴CPP者占23.8%(114/480),伴性交痛者占15.4%(74/480),伴排便痛者占7.1%(34/480);(3)卵巢粘连与痛经和CPP呈正相关关系(rs=0.367、0.267,P<0.01);子宫底后壁粘连与痛经和CPP呈正相关关系(rs=0.336、0.164,P<0.01);输卵管粘连与痛经、CPP和排便痛均呈显著正相关关系(rs=0.283、0.225、0.159, P<0.01);直肠粘连与痛经呈正相关关系(rs=0.101,P<0.05).除性交痛外,内异症患者的盆腔粘连程度与其痛经、CPP及排便痛均呈正相关关系(rs=0.470、0.273、0.132、P<0.01).结论 盆腔粘连是内异症的特征性病变,粘连部位及程度与疼痛症状密切相关.%Objective To study the incidence of pelvic adhesions in endometriosis(EM) and the relationship between pelvic adhesions and pain symptoms. Methods The incidence of pelvic adhesions, dysmenorrhea, chronic pelvic pain, dyspareunia, dyschizia in 480 patients with EM were studied retrospectively to evaluate the correlation between pelvic adhesions and the degree of pain symptoms. In accordance with the revised American Fertility Society classification (r-AFS), it was observed that 155 cases were in Stage Ⅰ,33 cases

  13. Neovaginoplastia com membrana amniótica na síndrome de Mayer-Rokitansky-Küster-Hauser Neovaginoplasty using amniotic membrane in Mayer-Rokitansky-Küster-Hauser syndrome

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    Bruno Ramalho de Carvalho

    2007-12-01

    neovagina de aspecto adequado.PURPOSE: to evaluate the results of neovaginoplasty with the use of a human amniotic graft in patients with the Mayer-Rokitansky-Küster-Hauser (MRKH syndrome. METHODS: the study was a retrospective analysis of a series of 28 patients with the MRKH syndrome conducted from 1990 to 2003. The patients were attended and treated at the Ambulatório de Ginecologia Infanto-Puberal (AGIP of the Hospital Universitário of the Faculdade de Medicina de Ribeirão Preto of the Universidade de São Paulo (FMRP-USP, being submitted to neovaginoplasty by the technique of McIndoe and Bannister, modified by the use of a human amniotic membrane graft. Epithelization, amplitude and depth of the neovaginas were evaluated 7 and 40 days after the procedure. Patient satisfaction was determined during the late postoperative period in terms of the presence of discomfort and dyspareunia during sexual relations. RESULTS: postoperatively, seven patients (25% presented vaginal stenosis and six of them were submitted to a new surgical intervention, one had shortening of the neovagina, corrected with the use of exercises with a vaginal mold, three (10.7% developed a rectovaginal fistula, one (3.6% a uterovesical fistula, and one (3.6% excess skin in the vaginal introitus - all successfully corrected with surgery. Four patients (14.3% presented urinary tract infection. Two months after surgery, 11/19 patients (57.8% presented satisfactory sexual activity and 42% dyspareunia, and within a maximum period of four years, 20/21 patients (95.2% had satisfactory sexual activity and 4.8% dyspareunia. CONCLUSIONS: an amniotic membrane graft is a good option for the treatment of vaginal agenesis. Perioperative follow-up involves educational guidance regarding the use of the mold and regarding patient sexuality in order to reduce the complaints of dysfunctional coitus in the presence of a favorable surgical evolution and a neovagina of adequate aspect.

  14. Surgery for women with apical vaginal prolapse.

    Science.gov (United States)

    Maher, Christopher; Feiner, Benjamin; Baessler, Kaven; Christmann-Schmid, Corina; Haya, Nir; Brown, Julie

    2016-10-01

    -quality evidence). If 3% of women require repeat surgery for SUI after sacral colpopexy, between 2% and 16% are likely to do so after vaginal procedures. Recurrent prolapse is probably more common after vaginal procedures (RR 1.89, 95% CI 1.33 to 2.70; 4 RCTs, n = 390; I(2) = 41%, moderate-quality evidence). If 23% of women have recurrent prolapse after sacral colpopexy, about 41% (31% to 63%) are likely to do so after vaginal procedures.The effect of vaginal procedures on bladder injury was uncertain (RR 0.57, 95% CI 0.14 to 2.36; 5 RCTs, n = 511; I(2) = 0%, moderate-quality evidence). SUI was more common after vaginal procedures (RR 1.86, 95% CI 1.17 to 2.94; 3 RCTs, n = 263; I(2) = 0%, moderate-quality evidence). Dyspareunia was also more common after vaginal procedures (RR 2.53, 95% CI 1.17 to 5.50; 3 RCTs, n = 106, I(2) = 43%, low-quality evidence). Vaginal surgery with mesh versus without mesh (6 RCTs, n = 598, 1-3 year review). Awareness of prolapse - There may be little or no difference between the groups for this outcome (RR 1.08 95% CI 0.35 to 3.30 1 RCT n = 54, low quality evidence). The confidence interval was wide suggesting that if 18% of women are aware of prolapse after surgery without mesh, between 6% and 59% will be aware of prolapse after surgery with mesh. Repeat surgery for prolapse - There may be little or no difference between the groups for this outcome (RR 0.69, 95% CI 0.30 to 1.60; 5 RCTs, n = 497; I(2) = 9%, low-quality evidence). If 4% of women require repeat surgery for prolapse after surgery without mesh, 1% to 7% are likely to do so after surgery with mesh.We found no conclusive evidence that surgery with mesh increases repeat surgery for SUI (RR 4.91, 95% CI 0.86 to 27.94; 2 RCTs, n = 220; I(2) = 0%, low-quality evidence). The confidence interval was wide suggesting that if 2% of women require repeat surgery for SUI after vaginal colpopexy without mesh, 2% to 53% are likely to do so after surgery with mesh.We found no clear evidence that surgery

  15. 雌激素对绝经妇女性行为的临床分析%Clinical Analyse of Estrogen in Sex Behaviour After Menopause

    Institute of Scientific and Technical Information of China (English)

    赖爱鸾; 李天锡

    2000-01-01

    Objective:to assess the effects on sexual function with Estrogen in postmenopausai women.Methods:35 postmenopausal women received oral conjugated estrogen/medroxyprogesterone acetate(treatment group)and 15 others taked only Calcium (control group)for 3 months.FSH and E2 levels were measured in both of group and sexual behaviour score were investigate before and after treatment.Relusts:the level of estrogen was significantly higher in treatment group(P<0.01) than that control group(P>0.05),the sexual behaviour score showed a significantl differance in treatment group(P<0.01),and no differance in control group(P>0.05) after treatment for 3 months.Conclusion:Hormone replacement therapy improves postmenopausal symtome of vaginal dryness and dyspareunia,shows the benefits of sexual desire and enjoyment in postmenopausal women.%目的:观察性激素补充疗法对于改善绝经妇女性功能的作用.方法:对35例绝经妇女(治疗组)予结合雌激素0.625 mg/d,安宫黄体酮2?mg/d;另外15例(对照组)服用碳酸钙500 mg/d,共计3个月.,用药前后对两组的雌激素水平进行测定,同时对性行为进行评分,评价用药效果.结果:治疗组用药后雌激素水平明显增加(P<0.01),用药前后性行为评分比较有显著性差异(P<0.01);对照组用药前后雌激素水平及性行为评分比较无显著性差异(P>0.05).结论:雌激素能够明显改善绝经妇女阴道萎缩性症状,显示出对性愉快及性兴趣的益处.

  16. 经闭孔吊带手术治疗女性压力性尿失禁46例临床观察%TOT for surgical treatment of female stress urinary incontinence in 46 cases

    Institute of Scientific and Technical Information of China (English)

    周晨曦; 丁俊; 李国波; 朱旭明; 陈国栋; 陈怡芳

    2015-01-01

    目的:观察经闭孔吊带( transobturator tape ,TOT)尿道中段悬吊术治疗女性压力性尿失禁( stress urinary inconti-nence,SUI)的近期疗效。方法女性SUI患者46例,采取TOT手术治疗,对比手术前后国际尿失禁咨询委员会尿失禁问卷(ICI-Q-SF)评分、1 h尿垫试验和最大尿流率变化,以判定疗效。结果随访6~18个月,治愈33例(71.7%),有效11例(23.9%),无效2例(4.3%)。 ICI-Q-SF评分、1 h尿垫试验显著优于术前,最大尿流率无变化。结论 TOT手术是治疗女性SUI安全、有效的微创手术方法。%Objective To evaluate the recent efficacy of applying outside-in transobturator tape ( TOT) tension-free mid-ure-thral suspension in the treatment of female stress urinary incontinence ( SUI) .Methods A total of 46 female inpatients with SUI were enrolled using Italy Herniamesh sling .Preoperative and postoperative data were recorded and compared , including International Consulta-tion on Incontinence Questionnaire-Short Form (ICI-Q-SF), 1-hour pad weight test and maximum urinary flow rates (Qmax).Results All patients have been followed up for 6 to 12 months.The cure, improvement and failure rates were 33 patients (71.7%), 11 (23.9%) and 2 (4.3%), respectively.The differences were significant when compared ICI-Q-SF and 1-hour pad weight test (P<0.05).Postop-erative complications included 2 cases of vulva hematoma , 1 case of dyspareunia , 2 cases of groin pain and 1 case of de novo detrusor overactivity .No case recorded with bladder perforation , urine retention and mesh erosion .Conclusion Transobturator tape procedure is an effective minimally invasive method for the surgical treatment of female SUI with low rate of complication and good primary outcome .

  17. Pelvic organ prolapse (POP) surgery: the evidence for the repairs.

    Science.gov (United States)

    Gomelsky, Alex; Penson, David F; Dmochowski, Roger R

    2011-06-01

    What is known on the subject? and What does the study add? Substantial experience of the outcomes has been gathered regarding the acute and sub-acute experience with various types of corrective procedures for POP. These include long-term POP correction as well as more recent recognition of improvement in functional disorders associated with POP such as UI, colorectal dysfunction, and sexual dysfunction. Long-term follow-up is available for some of the older types of interventions and current multicentre trials are being accrued with longer term follow-up for new interventions including mesh-type repairs. The study adds a condensed and summarized version of the current literature regarding the various interventions for POP and also provides an overview of the current controversies and areas where knowledge is incomplete and in need of further elaboration for definitive answers regarding optimization of surgical care for POP. Our aim is to summarise the available data on the transvaginal placement of synthetic mesh for pelvic organ prolapse (POP) repair, with a focus on the outcomes and complications of commercial POP-repair kits. As the stability and durability of autologous tissues may be questionable, nonabsorbable, synthetic materials are an attractive alternative for providing additional support during POP surgery. These materials are not novel, and most have been used for many years in surgical applications, e.g. hernia repairs. While theoretically appealing, the implantation of synthetic mesh in the pelvis may be associated with inherent adverse consequences, such as erosion, extrusion, and infection. Additionally, the routine use of these materials may carry potential long-term complications, such as dyspareunia, chronic pelvic pain, and vaginal distortion. The success and failure of mesh-augmented POP repair is related not only to the synthetic material itself, but also to patient- and surgeon-related factors. Recent warnings by the USA Food and Drug

  18. Endometriose de septo retovaginal: doença de diagnóstico e tratamento específicos Rectovaginal septum endometriosis: a disease with specific diagnosis and treatment

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    Mauricio Simões Abrão

    2003-09-01

    Full Text Available RACIONAL: O envolvimento do septo retovaginal, reto e sigmóide pela endometriose pode causar sintomas intensos como dismenorréia, dor pélvica, dispareunia de profundidade, tenesmo e proctorragia cíclicos, em mulheres em idade reprodutiva. O diagnóstico pode ser suspeitado diante da história clínica típica e exame ginecológico adequado, ou ainda através de exame retal, enema opaco ou colonoscopia, entre outros. As indicações cirúrgicas, em geral, estão relacionadas à intensidade dos sintomas e falha no tratamento conservador. No entanto, o tratamento de escolha, para este tipo de endometriose, é a ressecção cirúrgica do tecido acometido, a fim de aliviar os sintomas e evitar progressão da doença. A localização correta assim como a avaliação da presença de extensão do processo em direção ao reto, ligamentos uterossacros ou septo retovaginal é extremamente importante para se garantir um tratamento cirúrgico eficaz. OBJETIVO: Descrever os principais aspectos relacionados à endometriose de septo retovaginal e fornecer aos cirurgiões gerais algumas informações específicas sobre esta enigmática doença. CONCLUSÃO: A endometriose de septo retovaginal é doença freqüente, de diagnóstico e tratamento específicos.BACKGROUND: The involvement of the rectovaginal septum, of rectum and sigmoid by endometriosis leads to intense symptoms as dysmenorrhea, pelvic pain, deep dyspareunia, tenesmus and hematochezia in young and middle aged women during periods. The diagnosis can be made by tipycal history and vaginal examination, rectal examination, barium enema, proctoscopy and so on. The indications of operation include severe clinic symptoms and failed conservative therapy. The treatment of choice for this type of endometriosis is the surgical resection of affected tissue, in order to relieve patient symptoms, and avoid disease progression. The correct assessment as to the presence and extension of the endometriosis

  19. Ressonância magnética na endometriose pélvica profunda: ensaio iconográfico Magnetic resonance imaging in deep pelvic endometriosis: iconographic essay

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    Antonio Carlos Coutinho Junior

    2008-04-01

    Full Text Available A endometriose caracteriza-se pela presença de tecido endometrial funcionante heterotópico. Em pacientes com endometriose pélvica profunda pode haver acometimento dos ligamentos útero-sacros, reto, septo retovaginal, vagina ou bexiga. Os sintomas podem ser variados e incluem dor pélvica, dismenorréia, dispareunia, sintomas urinários e infertilidade. O padrão-ouro para o tratamento é a ressecção completa dessas lesões. Assim, é muito importante a avaliação pré-operatória dessas pacientes, sendo esta avaliação, em geral, limitada em relação aos dados clínicos e ultra-sonográficos. A ressonância magnética tem grande importância no diagnóstico da endometriose, principalmente por permitir a identificação das lesões de permeio a aderências e a avaliação da extensão das lesões subperitoneais. Neste estudo são ilustrados, na forma de ensaio iconográfico, os principais achados da endometriose pélvica profunda à ressonância magnética.Endometriosis is characterized by the presence of normal endometrial tissue outside the uterine cavity. In patients with deep pelvic endometriosis, uterosacral ligaments, rectum, rectovaginal septum, vagina or bladder may be involved. Clinical manifestations may be variable, including pelvic pain, dysmenorrhea, dyspareunia, urinary symptoms and infertility. Complete surgical excision is the gold standard for treating this disease, and hence the importance of the preoperative work-up that usually is limited to an evaluation of sonographic and clinical data. Magnetic resonance imaging is of paramount importance in the diagnosis of endometriosis, considering its high accuracy in the identification of lesions intermingled with adhesions, and in the determination of peritoneal lesions extent. The present pictorial review describes the main magnetic resonance imaging findings in deep pelvic endometriosis.

  20. Laparoscopic Management of Huge Cervical Myoma.

    Science.gov (United States)

    Peker, Nuri; Gündoğan, Savaş; Şendağ, Fatih

    To demonstrate the feasibility of laparoscopic management of a huge cervical myoma. Step-by-step video demonstration of the surgical procedure (Canadian Task Force classification III-C). Uterine myoma is the most common benign neoplasm of the female reproductive tract, with an estimated incidence of 25% to 30% at reproductive age [1,2]. Patients generally have no symptoms; however, those with such symptoms as severe pelvic pain, heavy uterine bleeding, or infertility may be candidates for surgery. The traditional management is surgery; however, uterine artery embolization or hormonal therapy using a gonadotropin-releasing hormone agonist or a selective estrogen receptor modulator should be preferred as the medical approach. Surgical management should be performed via laparoscopy or laparotomy; however, the use of laparoscopic myomectomy is being debated for patients with huge myomas. Difficulties in the excision, removal, and repair of myometrial defects, increased operative time, and blood loss are factors keeping physicians away from laparoscopic myomectomy [1,2]. A 40-year-old gravida 0, para 0 woman was admitted to our clinic with complaints of chronic pelvic pain, dyspareunia, and infertility. Her health history was unremarkable. Ultrasonographic examination revealed a 14 × 10-cm myoma in the cervical region. On bimanual examination, an immobile solid mass originating from the uterine cervix and filling the pouch of Douglas was palpated. The patient was informed of the findings, and laparoscopic myomectomy was recommended because of her desire to preserve her fertility. Abdominopelvic examination revealed a huge myoma filling and enlarging the cervix. Myomectomy was performed using standard technique as described elsewhere. A transverse incision was made using a harmonic scalpel. The myoma was fixed with a corkscrew manipulator and enucleated. Once bleeding was controlled, the myoma bed was filled with Spongostan to prevent possible bleeding from leakage

  1. Microbial and cytopathological study of intrauterine contraceptive device users

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    Agarwal Krishna

    2004-09-01

    Full Text Available CONTEXT: Intrauterine contraceptive device (IUCD is a commonly used birth-spacing method which is fitted into maternal system. Clinical, microbial and cytopathological monitoring of women using these devices are important for ascertaining their side effects, risk of genital tract infection and carcinogenic potential. AIMS: To study clinical, microbial and cytopathological changes in IUCD users in a tertiary care hospital. DESIGN: Prospective analytic. SETTING: Tertiary hospital. MATERIAL AND METHODS: women visiting Family Planning clinic for follow up (IUCD users, n=100 or for IUCD insertion (controls, n=50 were enrolled in the study. Each subject underwent detailed history, general physical, systemic, and per local examination. Vaginal discharge was subjected to pH testing, KOH and wet mount examination, gram staining, and for culture and sensitivity. Bacterial vaginosis was defined using Nugent criteria. Cervical smears were examined and reported as per Bethesda system. STATISTICAL ANALYSIS: The information was entered into Microsoft Excel spreadsheet. The results were analyzed using EPI Info version-6 and Stata statistical software version 7 packages. Two-tailed t-test, chi2 test with Yates correction and two-tailed Fisher Exact tests were applied. RESULTS: Most women used CuT 200 (92%. Median duration of use was 2 years. Chief complaints of IUCD users included backache (54%, vaginal discharge (46%, pain lower abdomen (34%, dyspareunia (22%, menorrhagia (18% and dysmenorrhea (14%. Mean hemoglobin was lower in IUCD users than controls (11.2±1.7 versus 11.9±1.8 g/dL, p 0.02. Proportion of women with anemia was higher in IUCD users than in controls (29% versus 16%, p 0.12. Cervical erosion was significantly increased in study group as compared the controls (20% versus 0%, p=0.00 whereas only insignificant increase in vaginitis (6% versus 0%, p=0.17. Trichomonas vaginalis and fungal hyphae positivity and gram stain findings and bacterial

  2. Post tubal ligation syndrome or iatrogenic hydrosalpinx.

    Science.gov (United States)

    Gregory, M G

    1981-10-01

    The purpose of this case report is as follows: to attempt to establish an association between the observed increase in hydrosalpinx and the phenomenal increase in surgical sterilization; to present a credible etiology for iatrogenic hydrosalpinx; and to discuss the pathogenesis of a disease process henceforth referred to as post tubal ligation syndrome. A 36-year-old white woman was admitted to Park View Hospital in Nashville, Tennessee on January 7, 1981 for evaluation of continuous lower abdominal pain, abdominal pressure, and dyspareunia for several months. The woman had 2 children who were delivered vaginally. An abdominal tubal ligation was performed for sterilization when she was 27, and vaginal hysterectomy, with anterior and posterior colporrhaphy, was done for symptomatic pelvic relaxation at age 33. Physical examination showed tenderness without palpable masses in the pelvic adnexal areas. Laboratory studies were within normal limits. On January 9, 1981, the patient underwent exploratory laparotomy, and bilateral salpingo-oophorectomy. She was found to have bilateral hydrosalpinx. Historically, hydrosalpinx has been considered an intermediary step in pelvic inflammatory disease. Iatrogenic hydrosalpinx is, in essence, initiated by an initial insult, e.g., tubal ligation, fulguration, or application of a mechanical clip or band. Theoretically, single point interruption of a fallopian tube should produce no ill effects. The popularity and success of tubal ligation attest to single point interruption of an otherwise normal fallopian tube as an innocuous procedure. A schematic drawing is provided of the same tube insulted a 2nd time and consequently the situation is prefactory to development of hydrosalpinx, i.e., a tube lined with secretory epithelium is closed at both ends. Secretion within this closed system will produce dilatation. This "2nd" insult to the normal fallopian tube, post tubal ligation, may take 1 of several forms. The symptoms of iatrogenic

  3. Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review

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    Venturini Pier L

    2011-06-01

    Full Text Available Abstract This systematic review aims to assess the efficacy of aromatase inhibitors (AIs in treating pain symptoms caused by endometriosis. A comprehensive literature search was conducted to identify all the published studies evaluating the efficacy of type II nonsteroidal aromatase inhibitors (anastrozole and letrozole in treating endometriosis-related pain symptoms. The MEDLINE, EMBASE, PubMed, and SCOPUS databases and the Cochrane System Reviews were searched up to October 2010. This review comprises of the results of 10 publications fitting the inclusion criteria; these studies included a total of 251 women. Five studies were prospective non-comparative, four were randomized controlled trials (RCTs and one was a prospective patient preference trial. Seven studies examined the efficacy of AIs in improving endometriosis-related pain symptoms, whilst three RCTs investigated the use of AIs as post-operative therapy in preventing the recurrence of pain symptoms after surgery for endometriosis. All the observational studies demonstrated that AIs combined with either progestogens or oral contraceptive pill reduce the severity of pain symptoms and improve quality of life. One patient preference study demonstrated that letrozole combined with norethisterone acetate is more effective in reducing pain and deep dyspareunia than norethisterone acetate alone. However, letrozole causes a higher incidence of adverse effects and does not improve patients' satisfaction or influence recurrence of symptoms after discontinuation of treatment. A RCT showed that combining letrozole with norethisterone acetate causes a lower incidence of adverse effects and lower discontinuation rate than combining letrozole with triptorelin. Two RCTs demonstrated that, after surgical treatment of endometriosis, the administration of AIs combined with gonadotropin releasing hormone analogue for 6 months reduces the risk of endometriosis recurrence when compared with gonadotropin

  4. Female genital mutilation: an injury, physical and mental harm.

    Science.gov (United States)

    Utz-Billing, I; Kentenich, H

    2008-12-01

    This article gives an overview over the huge topic of 'female genital mutilation' (FGM). FGM means non-therapeutic, partial or complete removal or injury of each of the external female genitals. It concerns about 130 million women around the world. FGM is performed in about 30 countries, most of which are located in Africa. Four types of FGM are distinguished: type I stands for the removal of the clitoral foreskin, type II means the removal of the clitoris with partial or total excision of the labia minora. Type III is the extreme type of FGM. Not only the clitoris but also the labia minora and majora were removed. The orificium vaginae is sewn up, leaving only a small opening for urine or menstruation blood. Other types like pricking, piercing of clitoris or vulva, scraping of the vagina, etc. were defined as type IV of FGM. The mentioned reasons for FGM are: encouragement of the patriarchal family system, method for birth control, guarantee of moral behaviour and faithfulness to the husband, protection of women from suspicions and disgrace, initiation ritual, symbol of feminity and beauty, hygienic, health and economic advantages. Acute physical consequences of FGM include bleeding, wound infections, sepsis, shock, micturition problems and fractures. Chronic physical problems like anemia, infections of the urinary tract, incontinence, infertility, pain, menstruation problems and dyspareunia are frequent. Women also have a higher risk for HIV infections. During pregnancy and delivery, examinations and vaginal application of medicine are more difficult. Women have a higher risk for a prolonged delivery, wound infections, a postpartum blood loss of more than 500 mL, perineal tears, a resuscitation of the infant and an inpatient perinatal death. Mental consequences after FGM include the feelings of incompleteness, fear, inferiority and suppression. Women report chronic irritability and nightmares. They have a higher risk for psychiatric and psychosomatic diseases

  5. Aspectos epidemiológicos e clínicos da endometriose pélvica: uma série de casos Epidemiological and clinical aspects of pelvic endometriosis: series of cases

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    Patrick Bellelis

    2010-01-01

    Full Text Available OBJETIVO: Descrever aspectos clínicos e epidemiológicos das pacientes portadoras de endometriose pélvica operadas em nosso serviço. MÉTODOS: Estudo retrospectivo de 892 pacientes submetidas a videolaparoscopia com confirmação histológica do diagnóstico de endometriose. RESULTADOS: A média de idade foi de 33,2 ± 6,3 anos, sendo 78,7% brancas. Observamos 76,9% de mulheres com 2º ou 3º graus completos; 56,5% das pacientes eram nulíparas e 62,2% relataram dismenorreia como principal queixa. A dor pélvica crônica foi o sintoma mais prevalente, seguido pela dispareunia de profundidade, sendo referidos por 56,8% e 54,7% das pacientes, respectivamente. A infertilidade foi referida por 39,8% das 892 pacientes. CONCLUSÃO: A endometriose é uma doença geralmente diagnosticada na 4º década da vida das pacientes, as quais apresentam queixas clínicas relacionadas com frequência à dor pélvica e infertilidade, que devem sempre ser questionadas para orientar a hipótese diagnóstica.OBJECTIVE: To describe clinical and epidemiological aspects of patients with pelvic endometriosis who were operated in our service. METHODS: A retrospective study was made of 892 patients submitted to laparoscopy with histological confirmation of diagnosis of endometriosis. RESULTS: The mean age was 33.2 ± 6.3 years and 78.7% were Caucasian. We found that 76.9% of women had higher education. 56.5% of patients were nulliparous and 62.2% reported dysmenorrhea as the main complaint. Chronic pelvic pain was the most prevalent symptom, followed by deep dyspareunia, mentioned by 56.8% and 54.7% of patients, respectively. Infertility was reported by 39.8% of the 892 patients. CONCLUSION: Endometriosis is a disease diagnosed in the 4th decade of life, of patients who have multiple complaints . They must always be questioned to properly orient diagnosis and monitor results of treatment.

  6. Mucosal versus muscle pain sensitivity in provoked vestibulodynia

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    Witzeman K

    2015-08-01

    highest level of pain.Results: The lower vestibule’s mucosa 5.81 (standard deviation =2.83 was significantly more sensitive than the upper vestibule 2.52 (standard deviation =2.6 (P<0.01 on exam. However, mucosal sensitivity was not associated with intercourse pain, while muscle sensitivity was moderately associated with both average and highest intensity of intercourse pain (r=-0.46, P=0.01 and r=-0.42, P=0.02, respectively.Conclusion: This preliminary study suggests that mucosal measures alone may not sufficiently capture the spectrum of clinical pain report in women with PVD, which is consistent with the empirical success of physical therapy in this population.Keywords: vulvodynia, provoked vestibulodynia, pain sensitivity, pelvic floor muscle pain, vulvar pain, pressure pain threshold, dyspareunia

  7. Profile of bazedoxifene/conjugated estrogens for the treatment of estrogen deficiency symptoms and osteoporosis in women at risk of fracture

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    Rossini M

    2013-07-01

    Full Text Available Maurizio Rossini,1 Stefano Lello,2 Ignazio Sblendorio,3 Ombretta Viapiana,1 Elena Fracassi,1 Silvano Adami,1 Davide Gatti11Department of Medicine, Rheumatology Unit, University of Verona, Italy; 2Endocrinological Gynecology, Pathophysiology of Menopause and Osteoporosis, Dermopathic Institute of Immacolata, Roma, Italy; 3Medical Coach Italia Center, Bari, ItalyAbstract: Decreasing levels of estrogens during menopause are associated with reduced bone density and an increased risk of osteoporosis. Many women also experience bothersome vasomotor and vaginal symptoms during the menopausal transition. Results of systematic reviews and meta-analyses of randomized controlled trials have shown that both systemic estrogen therapy or hormone therapy (estrogen combined with a progestin are useful to prevent bone loss, and they are the most effective treatment for such climacteric symptoms as hot flushes, sweating, vaginal dryness, and dyspareunia. Unfortunately, estrogen therapy and hormone therapy increase the risk of endometrial and breast cancer, respectively. The selective estrogen receptor modulators (SERMs result in positive estrogenic effects on bone, with no negative effects on the endometrium and breast but do not provide relief from postmenopausal symptoms. The combination of a SERM with estrogen as a tissue selective estrogen complex (TSEC is a new strategy for the prevention of bone loss and the treatment of climacteric symptoms. This combination is particularly interesting from a clinical point of view, taking into account that estrogen alone did not increase breast cancer risk by the Women's Health Initiative. TSEC is hypothesized to provide the benefits of estrogen-alone therapy, with an improved tolerability profile because the SERM component can make possible the elimination of progestin. The objective of this review was to critically evaluate the evidence from the reports published to date on the use of bazedoxifene (a third

  8. Th1 and Th2 immune responses related to pelvic endometriosis Resposta imunológica Th1 e Th2 relacionada à endometriose pélvica

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    Sergio Podgaec

    2010-01-01

    Full Text Available OBJECTIVE: This study analyzed the relationship between clinical characteristics of endometriosis and Th1/Th2 immune response patterns. METHODS: A prospective study was performed with 65 patients with endometriosis (Group A and 33 without the disease (Group B. Measurement of IL 2, 4 and 10, TNF-alpha and IFN-gamma was carried out in peripheral blood and peritoneal fluid. RESULTS: Serum TNF-alpha was higher in patients with endometriosis who had deep dyspareunia compared to controls (mean 4.5 pg/ml and 2.3 pg/ml, pOBJETIVO: Este estudo analisa a relação entre as características clínicas da endometriose e os padrões da resposta imune Th1/Th2. MÉTODOS: Estudo prospectivo realizado com 65 pacientes com endometriose (Grupo A e 33 pacientes sem a doença (Grupo B. Foram realizadas avaliação no fluido peritoneal e sangue periférico de IL 2, 4 e 10, TNF-alfa e IFN-gama. A significância foi estabelecida em p < 0,05. RESULTADOS: TNF-alfa encontrava-se elevado em pacientes com endometriose que apresentavam dispareunia de profundidade comparado com controle (média 4,5 pg/ml e 2,3 pg/ml, p< 0,05. Dentre essas pacientes (n=32, 65,5% apresentavam endometriose profunda. Pacientes com endometriose e infertilidade apresentavam concentrações maiores de IL-2 no fluido peritoneal quando comparadas com controle (média 5,9 pg/ml e 0,2 pg/ml, p< 0,05, sendo que neste grupo, 63,5% (n=14 apresentavam endometriose profunda. Foi observada também maior concentração de IL-10 nas pacientes que apresentavam endometriose ovariana quando comparadas às sem esse tipo de endometriose, assim como quando comparadas às pacientes do grupo controle (média 50pg/ml, 18,7pg/ml e 25,7pg/ml, p<0,05. CONCLUSÃO: Estes resultados sugerem que quando dados clínicos específicos associam-se a uma produção elevada de certas citocinas, ocorre um padrão de resposta Th1 que pode estar associado à endometriose profunda.

  9. Demonstration of Cutaneous Allodynia in Association with Chronic Pelvic Pain

    Science.gov (United States)

    Jarrell, John

    2009-01-01

    Pelvic pain is a common condition that is associated with dysmenorrhea and endometriosis. In some women the severe episodes of cyclic pain change and the resultant pain becomes continuous and this condition becomes known as Chronic Pelvic Pain. This state can be present even after the appropriate medical or surgical therapy has been instituted. It can be associated with pain and tenderness in the muscles of the abdomen wall and intra-pelvic muscles leading to severe dyspareunia. Additional symptoms of irritable bowel and interstitial cystitis are common. A common sign of the development of this state is the emergence of cutaneous allodynia which emerges from the so-called viscero-somatic reflex. A simple bedside test for the presence of cutaneous allodynia is presented that does not require excessive time or special equipment. This test builds on previous work associated with changes in sensation related to gall bladder function and the viscera-somatic reflex(1;2). The test is undertaken with the subject s permission after an explanation of how the test will be performed. Allodynia refers to a condition in which a stimulus that is not normally painful is interpreted by the subject as painful. In this instance the light touch associated with a cotton-tipped applicator would not be expected to be painful. A positive test is however noted by the woman as suddenly painful or suddenly sharp. The patterns of this sensation are usually in a discrete pattern of a dermatome of the nerves that innervate the pelvis. The underlying pathology is now interpreted as evidence of neuroplasticity as a consequence of severe and repeating pain with changes in the functions of the dorsal horns of the spinal cord that results in altered function of visceral tissues and resultant somatic symptoms(3). The importance of recognizing the condition lies in an awareness that this process may present coincidentally with the initiating condition or after it has been treated. It also permits the

  10. Lichen Sclerosus

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    Şeniz Ergin

    2012-06-01

    Full Text Available Lichen sclerosus is a progressive, inflammatory dermatosis characterized with porcelain white sclerotic plaques most commonly in the anogenital area of postmenopausal women. Children and men can also be affected. Extragenital involvement may occur. Even though the etiology is unknown; autoimmune, genetic, hormonal and infectious factors are suggested. Lichen sclerosus is associated with autoimmune diseases such as thyroid disease, alopecia areata, vitiligo, diabetes and pernicious anemia. An increased incidence of autoantibodies to the extracellular matrix protein 1 is shown in sera of patients with lichen sclerosus. Familial occurence and an association with HLA DQ7 supports the presence of genetic factors in its etiology. However, the role of estrogen and androgens could not be demonstrated as etiologic factors. Clinical similarity with acrodermatitis chronica atrophicans led researches to be held for the detection of Borrelia burgdorferi antibodies ended with conflicting results. Disease may be triggered with trauma in the presence of genetic predisposition. Pruritus is the main symptom. Pain, burning and dysesthesia may occur. Lichen sclerosus may be confused with sexual abuse in girls. Furthermore, it is more severe in the presence of sexual abuse. If not treated it leads to permanent anatomical disorders in the anogenital region. It is one of the most common cause of acquired phimosis in boys. Meatal stenosis and urinary obstruction may develop. Erectile dysfunction and dyspareunia due to introital stenosis may cause psychosexual problems in men and women. Perianal involvement causes constipation in women and girls. Long-standing anogenital lesions have the risk of developing squamous cell carcinoma. Verrucous carcinoma rarely occurs. Extragenital symptoms do not have similar risks. Ultra-potent topical corticosteroids are used as the first line therapy. In the case of unresponsiveness to corticosteroids the alternative approaches are

  11. Lichen Sclerosus

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    Şeniz Ergin

    2012-06-01

    Full Text Available Lichen sclerosus is a progressive, inflammatory dermatosis characterized with porcelain white sclerotic plaques most commonly in the anogenital area of postmenopausal women. Children and men can also be affected. Extragenital involvement may occur. Even though the etiology is unknown; autoimmune, genetic, hormonal and infectious factors are suggested. Lichen sclerosus is associated with autoimmune diseases such as thyroid disease, alopecia areata, vitiligo, diabetes and pernicious anemia. An increased incidence of autoantibodies to the extracellular matrix protein 1 is shown in sera of patients with lichen sclerosus. Familial occurence and an association with HLA DQ7 supports the presence of genetic factors in its etiology. However, the role of estrogen and androgens could not be demonstrated as etiologic factors. Clinical similarity with acrodermatitis chronica atrophicans led researches to be held for the detection of Borrelia burgdorferi antibodies ended with conflicting results. Disease may be triggered with trauma in the presence of genetic predisposition. Pruritus is the main symptom. Pain, burning and dysesthesia may occur. Lichen sclerosus may be confused with sexual abuse in girls. Furthermore, it is more severe in the presence of sexual abuse. If not treated it leads to permanent anatomical disorders in the anogenital region. It is one of the most common cause of acquired phimosis in boys. Meatal stenosis and urinary obstruction may develop. Erectile dysfunction and dyspareunia due to introital stenosis may cause psychosexual problems in men and women. Perianal involvement causes constipation in women and girls. Long-standing anogenital lesions have the risk of developing squamous cell carcinoma. Verrucous carcinoma rarely occurs. Extragenital symptoms do not have similar risks. Ultra-potent topical corticosteroids are used as the first line therapy. In the case of unresponsiveness to corticosteroids the alternative approaches are

  12. [The use of restorative medicine technologies for the rehabilitation of the patients presenting with endometriosis of external genitalia].

    Science.gov (United States)

    Makarenko, L V; Krutova, V A; Gordon, K V

    2012-01-01

    This paper reports the results of analysis of the psycho-emotional status and pain syndrome in the women presenting with endometriosis of external genitalia treated with a combination of hormonal preparations and balneotherapy. A total of 216 infertile patients were involved in the study. The duration of the infertility period varied from 1.5 to 19 years. All the patients underwent surgical intervention. The influence of rehabilitative therapy on the quantitative vital indices (psycho-emotional adaptation to the social environment and pain intensity) was estimated before and after the treatment. The patients were divided into 3 groups. Those of group 1 received an oral contraceptive (30 mcg of ethinylestradiol plus 2 mg dienogest) as a continuous three-cycle course (63 tablets) followed by its discontinuation for the 7 day menstrual period and the final three-cycle course (total duration of therapy 6 months). The patients of group 2 were treated with injections of agonists of gonadotropin releasing hormone (GnRH) at a dose of 3.75 mg once every 4 weeks (total duration 6 months). In group 3, the injections of GnRH agonists (3.75 mg once every 4 weeks, total duration 6 months) were combined with a course of balneotherapy using radon. All the three rehabilitative modalities produced a well-apparent positive effect. Chronic pelvic pain before treatment was reported by 90,3% of the patients. After the treatment, the number of such women in groups 1, 2, and 3 decreased to 20,8%, 12,5%, and 30,6% respectively Dyspareunia in the pre-treatment period was diagnosed in 66,7% of the patients. After treatment, this pathology persisted only in 23,6%, 18,1%, and 31,9% of the patients in groups 1, 2, and 3 respectively. Psycho-emotional disorders before treatment were documented in 90,3% of the patients compared with 27,8%, 25%, and 30,6% after therapy. It is concluded that all the three therapeutic modalities markedly improved health conditions of the patients presenting with

  13. [Piriformis muscle syndrome: etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy].

    Science.gov (United States)

    Grgić, Vjekoslav

    2013-01-01

    The term 'piriformis syndrome' (PS), introduced by Robinson in 1947, implies a group of signs and symptoms caused by piriformis muscle (PM) disorders. Since PM disorders lead to irritation/compression of the anatomic structures passing under its belly, the main clinical PS signs and symptoms are actually the clinical signs and symptoms of irritation/ compression of neural and vascular structures passing through the infrapiriform foramen: sciatic nerve/SN, inferior gluteal nerve, posterior femoral cutaneous nerve, pudendal nerve, inferior gluteal artery and vein and inferior pudendal artery and vein. The clinical picture is usually dominated by signs and symptoms of irritation/compression of SN (SN irritation --> low back and buttock pain, sciatica,paresthesias in distribution of SN; SN compression --> low back and buttock pain,sciatica, paresthesias and neurologic deficit in distribution of SN). Irritation/compression of other structures can result in the following signs and symptoms: inferior gluteal nerve --> atrophy of gluteal muscles; posterior femoral cutaneous nerve --> pain, paresthesias and sensory disturbances in the posterior thigh; pudendal nerve --> pudendal neuralgia, painful sexual intercourse (dyspareunia), sexual dysfunction, urination and defecation problems; inferior gluteal artery --> ischemic buttock pain; inferior pudendal artery --> ischemic pain in the area of external sex organs, perineum and rectum, sexual dysfunction, urination and defecation problems; inferior gluteal vein --> venous stasis in gluteal area; inferior pudendal vein --> venous stasis in external sex organs and rectum. Functional/non-organic and organic PM disorders can cause PS: spasm, shortening, hypertrophy, anatomic variations, edema, fibrosis, adhesions, hematoma, atrophy, cyst, bursitis, abscess, myositis ossificans, endometriosis, tumors (functional disorders: PM spasm and shortening). The most common causes for PS are PM spasm, shortening and hypertrophy and anatomic

  14. Prolapso de tuba uterina após histerectomia vaginal: relato de caso Fallopian tube prolapse after vaginal hysterectomy: a case report

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    Maurício B. Noviello

    2003-12-01

    Full Text Available O prolapso de tuba uterina é complicação rara após histerectomia, com aproximadamente 80 casos descritos na literatura. A sintomatologia é inespecífica, podendo incluir sangramento genital, dispareunia e dor pélvica crônica. O diagnóstico diferencial deve ser feito com granuloma de cúpula vaginal e carcinoma de vagina. O tratamento deve ser individualizado, podendo ser realizado por via vaginal, abdominal ou laparoscópica. Relatamos o caso de uma paciente, 47 anos, com miomatose uterina, submetida a histerectomia vaginal, evoluindo com prolapso de tuba uterina após 11 meses de pós-operatório. O exame especular evidenciava lesão vegetante, friável e sangrante localizada na cúpula vaginal. Esses achados clínicos sugeriam o diagnóstico de prolapso de tuba uterina. A paciente foi submetida a nova intervenção cirúrgica, com ressecção da tuba uterina por via vaginal. O exame natomopatológico confirmou o diagnóstico e a paciente evoluiu com remissão completa da sintomatologia.Fallopian tube prolapse is a rare complication after hysterectomy, with approximately 80 cases described in the literature. The symptoms are nonspecific including vaginal bleeding, dyspareunia and chronic pelvic pain. The differential diagnosis must be done with granulation tissue of the vaginal cuff and vaginal carcinoma. The treatment should be individualized, and is possible to be done by vaginal, abdominal or laparoscopic approach. We report a case of a 47-year-old woman with myoma who was submitted to a vaginal hysterectomy and evolved with fallopian tube prolapse 11 months after surgery. Specular examination showed a fungating, friable and bleeding lesion at the vaginal cuff. The clinical findings suggested the diagnosis of fallopian tube prolapse. The patient was submitted to a new surgical intervention with resection of the left fallopian tube. The histologic examination confirmed the diagnosis and the patient evolved with complete remission of

  15. Vaginal Testosterone Cream vs Estradiol Vaginal Ring for Vaginal Dryness or Decreased Libido in Women Receiving Aromatase Inhibitors for Early-Stage Breast Cancer: A Randomized Clinical Trial.

    Science.gov (United States)

    Melisko, Michelle E; Goldman, Mindy E; Hwang, Jimmy; De Luca, Amy; Fang, Sally; Esserman, Laura J; Chien, Amy J; Park, John W; Rugo, Hope S

    2017-03-01

    Aromatase inhibitors (AI) are associated with significant urogenital atrophy, affecting quality of life and drug compliance. To evaluate safety of intravaginal testosterone cream (IVT) or an estradiol-releasing vaginal ring (7.5 μg/d) in patients with early-stage breast cancer (BC) receiving an AI. Intervention was considered unsafe if more than 25% of patients had persistent elevation in estradiol (E2), defined as E2 greater than 10 pg/mL (to convert to pmol/L, multiply by 3.671) and at least 10 pg/mL above baseline after treatment initiation on 2 consecutive tests at least 2 weeks apart. Postmenopausal (PM) women with hormone receptor (HR)-positive stage I to III BC taking AIs with self-reported vaginal dryness, dyspareunia, or decreased libido were randomized to 12 weeks of IVT or an estradiol vaginal ring. Estradiol was measured at baseline and weeks 4 and 12 using a commercially available liquid chromatography and tandem mass spectrometry assay; follicle-stimulating hormone levels were measured at baseline and week 4. Gynecologic examinations and sexual quality-of-life questionnaires were completed at baseline and week 12. This randomized noncomparative design allowed safety evaluation of 2 interventions concurrently in the same population of patients, reducing the possibility of E2 assay variability over time and between the 2 interventions. The primary objective of this trial was to evaluate safety of IVT or an estradiol vaginal ring in patients with early-stage BC receiving an AI; secondary objectives included evaluation of adverse events, changes in sexual quality of life using the Cancer Rehabilitation Evaluation System sexuality subscales, changes in vaginal atrophy using a validated 4-point scale, and comparison of E2 levels. Overall, 76 women signed consent (mean [range] age, 56 [37-78] years), 75 started treatment, and 69 completed 12 weeks of treatment. Mean (range) baseline E2 was 20 (10 pg/mL) in 28 of 76 women (37%). Persistent E2 elevation was

  16. [Quality of life and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension].

    Science.gov (United States)

    Ye, Shuang; Yang, Jiaxin; Cao, Dongyan; Zhu, Lan; Lang, Jinghe; Shen, Keng

    2014-08-01

    disorder [88% (52/59)], orgasm dysfunction [72% (28/39)] and low enjoyment or relaxation after sex [51% (20/39)], which was not statistically significant (P > 0.05). Reduced vagina size and shorter vagina was more prominent in control group (12/18) than that in study group [19% (4/21)] with statistical significance (P vaginal lubrication, dyspareunia and sexual enjoyment (P > 0.05). Patients with peritoneovaginoplasty following RH had much longer vagina and less self-perceived short vagina. Vaginal extension following RH does not worsen the pelvic floor symptoms.

  17. Diabetes and the impairment of reproductive function: possible role of mitochondria and reactive oxygen species.

    Science.gov (United States)

    Amaral, Sandra; Oliveira, Paulo J; Ramalho-Santos, João

    2008-02-01

    Diabetes Mellitus (DM), a state of chronic hyperglycemia, is a major cause of serious micro and macrovascular diseases, affecting, therefore, nearly every system in the body. Growing evidence indicates that oxidative stress is increased in diabetes due to overproduction of reactive oxygen species (ROS) and decreased efficiency of antioxidant defences, a process that starts very early and worsens over the course of the disease. During the development of diabetes, oxidation of lipids, proteins and DNA increase with time. Mitochondrial DNA mutations have also been reported in diabetic tissues, suggesting oxidative stress-related mitochondrial damage. Diabetes-related oxidative stress may also be the trigger for many alterations on sexual function, which can also include decreased testicular mitochondrial function. Although sexual disorders have been extensively studied in diabetic men, possible changes in the sexual function of diabetic women have only recently received attention. The prevalence of sexual dysfunction in diabetic men approaches 50%, whereas in diabetic women it seems to be slightly lower. Testicular dysfunction, impotence, decreased fertility potential and retrograde ejaculations are conditions that have been described in diabetic males. Diabetes is also the most common cause of erectile dysfunction in men. Poor semen quality has also been reported in diabetic men, including decreased sperm motility and concentration, abnormal morphology and increased seminal plasma abnormalities. In addition, diabetic men may have decreased serum testosterone due to impaired Leydig cell function. Among diabetic women neuropathy, vascular impairment and psychological complaints have been implicated in the pathogenesis of decreased libido, low arousability, decreased vaginal lubrication, orgasmic dysfunction, and dyspareunia. An association between the production of excess radical oxygen species and disturbed embryogenesis in diabetic pregnancies has also been suggested

  18. Meta-analysis of efficacy and safety of application of adjuvant materials in the repair of anterior vaginal wall prolapse%应用辅助材料行修补术治疗阴道前壁脱垂的有效性及安全性的Meta分析

    Institute of Scientific and Technical Information of China (English)

    胡敏; 李秉枢; 程艳香; 吴德斌; 闵洁; 丁文娟; 洪莎莎; 洪莉

    2012-01-01

    vaginal wall anatomy failure rate,operative duration,intraoperative bleeding volume,postoperative visceral injury,pelvic pain,urinary infection,material exposure,material erosion,de novo urinary incontinence and de novo dyspareunia in the adjuvant materials repair and repair without adjuvant materials groups.Results A total of 20 randomized controlled trials including 2313 participants were retrieved.The shortest average follow-up period was 3 months and the longest 36 months.Compared with repair without adjuvant materials,the application of adjuvant materials in anterior vaginal wall repair reduced vaginal front wall prolapse anatomy failure rate lower anatomy failure rate,had a longer operating duration,more peri-operative bleeding and lower urinary tract infection rate.The comprehensive effects were as follows:P<0.01,RR =0.51,95%CI:0.41-0.64;P <0.01,weighted mean differenece (WMD) =16.25,95% CI:8.07-24.43;P =0.01,WMD =35.00,95% CI:6.90-63.11 ;P =0.03,RR =0.51,95% CI:0.28-0.93,respectively,but the comparison of two groups around in visceral injury,postoperative pain,de novo stress urinary incontinence and de novo dyspareunia had no significant differences (P =0.07,0.58,0.54 and 0.67) and the average materiale exposure and rosion rate were 4.37% (27/618) and 7.69% (24/312) respectively.Conclusions The application of adjuvant materials in anterior vaginal wall repair can improve the postoperative recurrence.But no obvious differences exist in the incidence of complications in anterior repair with adjuvant materials and repair without adjuvant materials.

  19. Clinical analysis of efficacy and quality of life of segmental bowel resection for bowel endometriosis%节段性肠切除术治疗肠道子宫内膜异位症患者的临床疗效及生命质量分析

    Institute of Scientific and Technical Information of China (English)

    刘多; 沈慧敏; 梁炎春; 王伟; 刘田雨; 尚春亮; 姚书忠

    2016-01-01

    Objective To evaluate the efficacy and quality of life of segmental bowel resection for bowel endometriosis. Methods Totally 62 symptomatic patients with bowel endometriosis undergoing segmental bowel resection were recruited. A visual analogue scale (VAS) and the 36-item short form health survey (SF-36) questionnaire were administered before and at least 1 year after surgery, respectively. Pregnancy rates were also recorded. Results Sixty-two patients in total underwent follow-up ranging from 12 to 74 months. All patients complained of obvious pain symptoms, including dysmenorrhea, dyspareunia, pain on defecation and chronic pelvic pain. The relief of dysmenorrhea (2.9 ± 2.2 versus 7.5 ± 2.9), dyspareunia (0.7 ± 0.5 versus 4.3 ± 2.2) and pain on defecation (1.6 ± 0.7 versus 7.3 ± 1.9) after surgery was statistically significant (all P<0.01). The scores for all 8 domains of the SF-36 questionnaire were significant improved after segmental bowel resection (all P<0.01). The complication rate was 45% (28/62), including 18 cases of urinary retention, 4 rectovaginal fistulas, 2 cases of vaginal dehiscence, and 1 case each of thrombogenesis, pelvic abscess and general peritonitis. All of the patients with complications recovered well throughout follow-up. The postoperative pregnancy rate of the previous infertile patients was 6/10. Among the 6 gestational cases, 2 had labour, 2 underwent caesarean sections, one had a spontaneous natural abortion, and one underwent uterine curettage. Conclusion Segmental bowel resection could significantly relieve pain and improve quality of life for patients with bowel endometriosis.%目的:探讨节段性肠切除术治疗肠道子宫内膜异位症患者的临床疗效并分析其生命质量。方法收集2008年1月1日至2013年12月31日于中山大学附属第一医院妇产科行节段性肠切除术治疗的肠道子宫内膜异位症患者62例,所有患者分别于术前及术后至少12个月完成视觉模拟评

  20. Pelvic floor muscle strength in primiparous women according to the delivery type: cross-sectional study.

    Science.gov (United States)

    Mendes, Edilaine de Paula Batista; Oliveira, Sonia Maria Junqueira Vasconcellos de; Caroci, Adriana de Souza; Francisco, Adriana Amorim; Oliveira, Sheyla Guimaraes; Silva, Renata Luana da

    2016-08-15

    to compare the pelvic floor muscle strength in primiparous women after normal birth and cesarean section, related to the socio-demographic characteristics, nutritional status, dyspareunia, urinary incontinence, perineal exercise in pregnancy, perineal condition and weight of the newborn. this was a cross-sectional study conducted after 50 - 70 postpartum days, with 24 primiparous women who underwent cesarean delivery and 72 who had a normal birth. The 9301 PeritronTM was used for analysis of muscle strength. The mean muscle strength was compared between the groups by two-way analysis of variance. the pelvic floor muscle strength was 24.0 cmH2O (±16.2) and 25.4 cmH2O (±14.7) in postpartum primiparous women after normal birth and cesarean section, respectively, with no significant difference. The muscular strength was greater in postpartum women with ≥ 12 years of study (42.0 ±26.3 versus 14.6 ±7.7 cmH2O; p= 0.036) and in those who performed perineal exercises (42.6±25.4 11.8±4.9 vs. cmH2O; p = 0.010), compared to caesarean. There was no difference in muscle strength according to delivery type regarding nutritional status, dyspareunia, urinary incontinence, perineal condition or newborn weight. pelvic floor muscle strength does not differ between primiparous women based on the type of delivery. Postpartum women with normal births, with higher education who performed perineal exercise during pregnancy showed greater muscle strength. comparar a força muscular do assoalho pélvico em primíparas no pós-parto normal e cesariana, relacionando-a às características sociodemográficas, estado nutricional, incontinência urinária, dispareunia, exercício perineal na gestação, condição perineal e peso do recém-nascido. estudo transversal realizado entre 50 e 70 dias de pós-parto, com 24 primíparas submetidas à cesariana e 72 ao parto normal. Utilizou-se PeritronTM 9301 para análise da força muscular. Comparou-se as médias da força muscular entre os

  1. 女性系统性红斑狼疮患者性功能障碍状况及影响因素研究%Sexual Dysfunction Status and Influencing Factors of Female Patients With Systemic Lupus Erythematosus

    Institute of Scientific and Technical Information of China (English)

    秦毅; 顾志峰; 李立人; 桑燕

    2016-01-01

    function in SF - 36( P < 0. 05);the scores of sexual desire were correlated with age,years of marriage,menopause or not,combining with heart disease,presence of vasculitis,dimensional scores of physical function and physical role function in SF - 36(P < 0. 05);the scores of sexual arousal were correlated with age,years of marriage,menopause or not,combining with heart disease,presence of vasculitis and pyuria,dimensional scores of physical function,physical role function and emotional function in SF - 36( P < 0. 05);the scores of vaginal lubrication degree were correlated with age,years of marriage,age at menarche,menopause or not,number of pregnancy,combining with heart disease,taking nonsteroidal antiinflammatory drugs,presence of vasculitis,pyuria and mucosal ulcer,dimensional scores of physical function,physical role function and emotional function in SF - 36(P < 0. 05);the scores of orgasm were correlated with age,years of marriage,menopause or not,combining with heart disease,taking nonsteroidal antiinflammatory drugs, presence of vasculitis and pyuria,physical function,dimensional scores of physical function,physical role function and emotional function in SF - 36( P < 0. 05);the scores of satisfaction degree of sexual life were correlated with age,years of marriage,menopause or not,age at menopause,combining with heart disease,presence of vasculitis and pleurisy,dimensional scores of physical function,physical role function and emotional function in SF - 36(P < 0. 05);the scores of dyspareunia were correlated with age,years of marriage,age at menarche,menopause or not,combining with heart disease,taking nonsteroidal antiinflammatory drugs,presence of vasculitis and pyuria,the dimensional scores of physical function,physical role function, body pain and emotional function( P < 0. 05). Multiple linear regression analysis results showed that combining with heart disease was the influencing factor of scores of sexual desire,sexual arousal,vaginal lubrication and

  2. Adhesion prevention agents for gynaecological surgery: an overview of Cochrane reviews.

    Science.gov (United States)

    Hindocha, Akshay; Beere, Lawrence; Dias, Sofia; Watson, Andrew; Ahmad, Gaity

    2015-01-06

    Intraperitoneal adhesions are associated with considerable co-morbidity and have large financial and public health repercussions. They have secondary effects that include chronic pelvic pain, dyspareunia, subfertility and bowel obstruction. In women with adhesions, subsequent surgery is more difficult, often takes longer, and is associated with a higher complication rate (Broek 2013). The significant burden of adhesions has led to the development of several anti-adhesion agents, although there is disagreement as to their relative effectiveness. To summarise evidence derived from Cochrane systematic reviews on the clinical safety and effectiveness of solid agents, gel agents, liquid agents and pharmacological agents, used as adjuvants to prevent formation of adhesions after gynaecological pelvic surgery. The Cochrane Database of Systematic Reviews was searched using the keyword 'adhesion' up to August 2014. The Cochrane information management system was also searched for any titles or protocols of reviews in progress. Two review authors independently extracted information from the reviews, with disagreements being resolved by a third review author. The quality of the included reviews was described in a narrative manner, and the AMSTAR tool was used to formally assess each review included in this overview. The quality of evidence provided in the original reviews was described using GRADE methods. We included two reviews, one with 18 studies comparing solid agents (oxidised regenerated cellulose expanded polytetrafluoroethylene, sodium hyaluronate and carboxymethylcellulose, and fibrin sheets) with control or with each other. The other review included 29 studies which compared liquid agents (4% icodextrin, 32% dextran, crystalloids), gel agents (carboxymethylcellulose and polyethylene oxide, polyethylene glycol gels, hyaluronic acid based gel, 0.5% ferric hyaluronate gel, sodium hyaluronate spray) and pharmacological agents (gonadotrophin-releasing hormone agonist

  3. Avaliação da sexualidade em mulheres submetidas à histerectomia para tratamento do leiomioma uterino Sexuality evaluation in women submitted to hysterectomy for the treatment of uterine leiomyoma

    Directory of Open Access Journals (Sweden)

    Imacolada Marino Tozo

    2009-10-01

    the SQF results before and after hysterectomy (χ2= 0.6; degree of freedom=12; p=0.05. The mean scores obtained after the application of the SSIF have shown significant deterioration in the following parameters: sexual satisfaction (p=0.03; expression of feminine sensuality (p=0.01; vaginismus/dyspareunia (p=0.02 and anorgasmia (p=0.04. CONCLUSIONS: it seems that hysterectomy has a negative impact on women's sexual life, with reports of decreased libido, arousal and orgasmic capacity.

  4. Evaluation of pelvic varicose veins using color Doppler ultrasound: comparison of results obtained with ultrasound of the lower limbs, transvaginal ultrasound, and phlebography Avaliação de varizes pélvicas por Doppler colorido: comparação dos resultados obtidos com ultrassom dos membros inferiores, ultrassom transvaginal e flebografia

    Directory of Open Access Journals (Sweden)

    Fanilda Souto Barros

    2010-06-01

    Full Text Available Introduction: Pelvic varicose veins, one of the main causes of chronic pelvic pain and dyspareunia, are an important source of reflux for lower limb varicose veins, especially in recurrent cases. Color Doppler ultrasound of the lower limbs and transvaginal ultrasound are the noninvasive diagnostic methods most commonly used to assess pelvic venous insufficiency, whereas phlebography is still considered as the gold standard. Objectives: To determine the prevalence of lower limb varicose veins originating from the pelvis in a group of female patients and to determine the agreement between results obtained via color Doppler ultrasound of the lower limbs, transvaginal ultrasound, and phlebography. Methods: The sample comprised female patients referred to a vascular laboratory for lower limb screening. Patients diagnosed with deep venous thrombosis were excluded. Data analysis included kappa coefficient of agreement, McNemar's test, sensitivity and specificity values. Results: Of a total of 1,020 patients, 124 (12.2% had findings compatible with reflux of pelvic origin. Among these patients, 51 (41.2% were recurrent cases. A total of 249 were submitted to transvaginal ultrasound. There was significant agreement between lower limb ultrasonographic findings and transvaginal findings. Phlebography was performed in 54 patients. The comparison between transvaginal ultrasound and phlebography was associated with a 96.2% sensitivity and 100% specificity. Conclusions: The authors draw attention to the relatively high prevalence of lower limb varicose veins originating from the pelvis, suggesting an important but underdiagnosed cause of recurrent varicose veins.Introdução: AS VARIZES Pélvicas, uma das principais causas de dor pélvica crônica e dispareunia, são uma importante fonte de refluxo para as varizes dos membros inferiores, especialmente em casos recorrentes. O Doppler colorido dos membros inferiores e o ultrassom transvaginal são os m

  5. The clinical application and the effect of PROSIMA repair system in treating pelvic organ prolapse%PROSIMA修复系统在盆腔器官脱垂患者中的应用及疗效分析

    Institute of Scientific and Technical Information of China (English)

    纪妹; 史惠蓉; 苏玥辉; 赵曌; 王琳; 张孝艳

    2012-01-01

    recovered sexual activity didn't complain of dyspareunia, no de novo urgency incontinence and stress urinary incontinence occurred. The scores for PFIQ- 7 and PISQ-12 were significantly improved, the scores of before treatment were lower than those after treatment (P <0.05). Conclusions PROSIMA pelvic floor reconstruction is an effective surgical method for treating POP with less invasive. The long-term effect and life quality after this procedure need further followed-up.

  6. Meta-analysis of clinical efficacy of TVT-S versus TVT-O/TOT in the treatment of stress urinary incontinence%单切口经阴道和闭孔路径无张力尿道中段悬吊术治疗压力性尿失禁的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    周全; 宋岩峰; 陈杰; 邱琳琳; 袁晓东

    2012-01-01

    Objective To assess the current evidence of effectiveness and safety of Single-incision mini-slings (TVT-S) versus transobturator tension-free vaginal tapes (TVT-O/TOT) in the management of female stress urinary incontinence (SUI).Methods Literature searches were conducted for all randomized controlled trials (RCTs) comparing TVT-S and TVT-O/TOT from CNKI,CBM,VIP,MEDLINE,OVID,FMJS and Cochrane Library between November 1996 and November 2011.The Revman 5.1.0 software was used for Meta-analysis according to Cochrane system evaluation method.Results A total of 1545 females in 7 RCTs were included.Meta-analysis showed that no statistical differences existed in the rate of postoperative voiding dysfunction and dyspareunia between TVT-S and TVT-O/TOT (P > 0.05).But the rate of objective cure,re-operation,inner thigh and groin pain and de novo urgency were statistically significant (P < 0.05).Conclusion As compared with TVT-O/TOT,TVT-S procedure is associated with less postoperative inner thigh and groin pain,but a lower objective cure rate and relatively higher rates of de novo urgency and reoperation.%目的 系统评价单切口经阴道尿道中段悬吊术(TVT-S)与闭孔路径无张力尿道中段悬吊术(TVT-O/TOT)治疗压力性尿失禁的临床疗效和安全性.方法 计算机配合手工检索万方数据库、CNKI、CBM、VIP、MEDLINE、OVID、FMJS、Cochrane Library中,从1996年11月到2012年3月TVT-S和TVT-O/TOT的随机对照试验文献.按Cochrane系统评价方法,采用Revman5.1.0进行荟萃分析.结果 共纳入7项研究,共1545例患者.荟萃分析结果显示TVT-S与TVT/TOT相比,术后排空障碍[RR =0.68,95% CI(0.37 ~ 1.26),P>0.05]和性交疼痛[RR =2.60,95% CI(0.88 ~7.68),P>0.05]发生率差异无统计学意义,但客观治愈率[RR=0.86,95% CI(0.78 ~0.93),P<0.05]、再次手术率[RR =2.51,95% CI (1.51 ~4.17),P<0.05]、术后大腿内侧及腹股沟区疼痛[RR =0.06,95% CI(0.02 ~0.20),P<0.05]

  7. Endometriose de cicatriz cirúrgica: estudo retrospectivo de 72 casos Scar endometriosis: a retrospective study of 72 patients

    Directory of Open Access Journals (Sweden)

    Nilo Sérgio Nominato

    2007-08-01

    Full Text Available OBJETIVO: avaliar a freqüência e fatores associados à endometriose de cicatriz cirúrgica. MÉTODOS: foi realizado estudo observacional, tipo coorte retrospectivo, a partir da revisão de prontuários de pacientes do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG com diagnóstico anatomopatológico de endometriose de cicatriz cirúrgica, no período de maio de 1978 a dezembro de 2003. RESULTADOS: foram encontrados 72 pacientes com diagnóstico de endometriose de cicatriz. A incidência de endometriose de cicatriz após cesariana foi significativamente maior do que após parto normal (0,2 e 0,06%, respectivamente; pPURPOSE: to identify the incidence and associated factors of surgical scar endometriosis. METHODS: a retrospective cohort observational study performed from the medical records of female patients attended at the Clinical Hospital of Univesidade Federal de Minas Gerais (UFMG with histopathological diagnosis of scar endometriosis from May 1978 to December 2003. RESULTS: a total of 72 patients were included in the study. The incidence of scar endometriosis after cesarean section was significantly higher than after episiotomy (0.2% and 0.06%, respectively; p<0.00001 with relative risk of 3.3. The women’s age, when diagnosed, ranged from 16 to 48 years old, (mean=30.8 years old. The scar location varied according to the previous surgery: 46 scars after cesarean sections, one after hysterectomy and one after abdominal surgery (48 lesions in the abdominal wall; 19 scars after episiotomy, one because of relapse and two after pelvic floor surgeries (22 pelvic wounds; two women had not been submitted to previous gynecological surgery (one umbilical endometrioma and one lesion in the posterior vaginal wall. Pain was the most frequent symptom (80%, followed by a node (79% and, in more than 40%, the pain and the node suffered modification with menstruation. Other less frequent complaints were: dyspareunia, secondary

  8. Gravidez e Diabetes Gestacional: uma combinação prejudicial à função sexual feminina? Pregnancy and Gestational Diabetes: a prejudicial combination to female sexual function?

    Directory of Open Access Journals (Sweden)

    Meireluci Costa Ribeiro

    2011-05-01

    illicit drugs or use of medications that can interfere with sexual function. Eighty-seven patients fulfilled the selection criteria and were included in the study. The Sexual Quotient . Feminine Version (QS-F questionnaire was used to assess sexual function. Student's t and X² tests were used to compare differences between groups and p<0.05 was considered significant. RESULTS: The mean gestational age of the participants was 34 weeks. There were no significant differences in the mean QS-F scores between groups (62.5 healthy vs 62.8 GDM women, p=0.9. Approximately half the participants (47 and 47.5% of the healthy and GDM women, respectively, p=0.9 had total scores up to 60, indicative of dysfunction in one of the assessed domains (desire, sexual satisfaction, arousal, orgasm, dyspareunia and vaginismus. CONCLUSIONS: The prevalence of sexual dysfunction was high among women in the third trimester of pregnancy and did not differ significantly between healthy women and women with GDM.

  9. 雌激素联合盆底康复治疗对绝经后女性泌尿生殖道萎缩的疗效分析%Vaginal estrogen combined with pelvic floor rehabilitation for urogenital atrophy in postmenopausal women

    Institute of Scientific and Technical Information of China (English)

    马明妍

    2015-01-01

    Objective To investigate the treatment effect of vaginal estrogen in the combination of pelvic floor rehabilitation for urogenital atrophy in postmenopausal women.Methods 197 postmenopausal women with urogenital atrophy treated at our hospital from February, 2014 to February, 2015 were selected and were randomly divided into an observation group and a control group.The control group were vaginally smeared with promestriene cream, 1 g: 0.01 g, 1 g once, once a day;when the symptoms were improved,promestriene cream was used twice a week, 1 g once, for 2 months.In addition, the observation group were treated with pelvic floor rehabilitation therapy for 2 months.The treatment effect were compared between these two groups.Results The symptoms of vaginal atrophy were much better after than before the treatment in both groups, with statistical differences (P<0.01).Urinary incontinence, vaginal dryness,dyspareunia, bacteriuria positiveness etc.were improve much more in the observation group than in the control group, with statistical differences (P<0.01).Conclusions Vaginal estrogen in the combination of pelvic floor rehabilitation for urogenital atrophy in postmenopausal women is effective and worth being clinically generalized.%目的 探讨阴道雌激素联合盆底康复对绝经后女性泌尿生殖道萎缩的治疗效果.方法 选取2014年2月至2015年2月于我院接收治疗的197例泌尿道萎缩绝经后女性,以随机分组法分为观察组与对照组,对照组患者采用普罗雌烯乳膏行阴道涂抹治疗,1g/次,1次/d,症状好转后用药改为2次/周,1g/次,治疗周期为2个月;观察组在对照组基础上,加以联合盆底康复治疗法,治疗周期为2个月.比较两组治疗效果.结果 两组患者阴道萎缩症状有明显好转,前后比较,差异有统计学意义(P<0.01);观察组患者尿失禁、阴道干涩、性交困难、菌尿阳性各顶指标好转情况均优于对照组,差异有统计学意义(P< 0.01).结论 阴

  10. 经阴道子宫骶骨韧带高位悬吊术对重度盆腔器官脱垂的临床治疗探究%Clinical effect of transvaginal high uterosacral ligament suspension on severe pelvic organ prolapse

    Institute of Scientific and Technical Information of China (English)

    曾敏; 谷霞

    2014-01-01

    Objectives:To investigate the clinical treatment effect of transvaginal high uterosacral ligament suspension (HUS)on severe pelvic organ prolapsed (POP).Methods:The 53 severe POP patients in our hospital from March 2010 to March 2012 received transvaginal HUS treatment.Stage changes in the pelvic organ prolapse quantification system (POP-Q)and quality of life was recorded.Results:The average operation time,amount of bleeding,hospitalization time and cost of treatment was (125.7 ±39.5)min,(122.9 ±13)mL,(5.9 ±1.2)d and (9733.7 ±1107.9)Yuan respectively,without ureteral injury,postoperative infection,nerve injury and other complications.All the 53 patients were effectively followed up,with mean follow -up time of (1 1 .7 ±0.8 ) months.There were 52 cases effective,1 cases ineffective,no recurrence,an efficiency of 98.1%;the POP-Q stage of the last follow-up had significantly decreased compared with before,while quality of life was significantly improved (P<0.05 ),no dyspareunia.Conclusion:Transvaginal HUS therapy is safe and reliable and of various other advantages in the treatment of severe POP,which is conducive to the early recovery of patients and can im-prove their quality of life,hereby worthy of clinical application.%目的:探讨经阴道子宫骶骨韧带高位悬吊术(high uterosacral ligament suspension,HUS)对重度盆腔器官脱垂(pelvic organ prolapse,POP)的临床治疗效果。方法:对我院2010年3月至2012年3月收治的53例重度POP患者采取经阴道HUS治疗,观察其盆腔器官脱垂定量系统(POP-Q)分期变化及生活质量评分变化。结果:患者平均手术时间(125.7±39.5)min,术中出血量(122.9±13.0)mL,住院时间(5.9±1.2)d,治疗费用(9733.7±1107.9)元,未见术中输尿管损伤,未见术后感染、神经损伤等并发症,恢复良好;53例患者均获得有效随访,平均随访时间(11.7±0.8)个月,有效52例,无效1

  11. Avaliação do impacto da correção cirúrgica de distopias genitais sobre a função sexual feminina Impact of surgery for pelvic organ prolapse on female sexual function

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    Daniela Siqueira Prado

    2007-10-01

    partners after the surgery. Quality of sexual life improved significantly (p=0.03. Symptoms such as dyspareunia (25.6% before versus 17.1% after surgery, discomfort (27.9 versus 0%, embarrassment (20.9% versus 0% and fear (2.3% versus 0% significantly improved (p<0.001. Analogical scales scores regarding desire (5 versus 7, p=0.001, arousal (6 versus 8, p<0.001 and satisfaction with sexual life (5 versus 7, p<0.001 also improved. There was a statistically significant improvement (p<0.001 of the POP-Q stages after the surgery. However, there was no statistically significant correlation between changes in vaginal dimensions and changes in sexual function. CONCLUSIONS: after pelvic reconstructive surgery, there was a significant improvement in the quality of sexual life and of the POP-Q stages. However, there was no correlation between them.

  12. EFFECTIVENESS AND SAFETY OF MIFEPRISTONE IN DIFFERENT DOSE (10 MG AND 25 MG FOR THE TREATMENT OF UTERINE FIBROIDS AND TO EVALUATE QUALITY OF LIFE

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    Pratibha Rai

    2016-07-01

    Full Text Available BACKGROUND Mifepristone is Selective Progesterone Receptor Modulators (SPRMS and is emerging as a best medical treatment increasing the quality of life as well as saving the patient from surgery. This drug has shown great effectiveness, e.g.: 2.5 mg, 5 mg and 10 mg, but with less reduction in uterine volume as well as reduction in fibroids size. Ref. 1 Yang Y et al. AIM The aim of this study was to evaluate the safety and improvement of life pattern using 10 mg and 25 mg daily doses of Mifepristone for six months with a nine month follow-up period for the regress of fibroids as well as uterine volume to improve quality of life without any surgery in premenopausal women with complaint of menorrhagia, dysmenorrhoea, abdominal discomfort, dyspareunia, rectal pain, urinary problem and weakness due to anaemia. DESIGN The research was a randomized double blind clinical study undertaken at Patliputra Medical College Hospital, Dhanbad (Jharkhand. SEARCH METHOD I had searched a number of international journals, reference lists, databases and ongoing trails and the internet. Also searched the specialised register of Cochrane menstrual disorders and subfertility (Cochrane menstrual disorder and subfertility. The Cochrane central register of control trails (Central. The Cochrane library 2011, Issue 4. METHODOLOGY The trial was done on 100 patients. Patients were divided into two equal groups (All were with symptomatic uterine fibroids to evaluate safety as well as quality of life. Dose decided was 10 mg (A and 25 mg (B of Mifepristone. Subjects were taken from Gynaecological outdoor of Patliputra Medical College Hospital, Dhanbad, (Jharkhand, after taking their consent. All women were between the age group of 35 to 48 years with symptomatic multiple fibroids of various sizes and site. At enrolment patients of both groups underwent clinical assessment, Per Abdomen (P/A and Per Vaginal (P/V examination, USG for uterine volume and size of fibroid. Endometrial

  13. [Investigation of the prevalence of Trichomonas vaginalis among female Syrian refugees with the complaints of vaginitis aged between 15-49 years].

    Science.gov (United States)

    Yentür Doni, Nebiye; Aksoy, Mustafa; Şimşek, Zeynep; Gürses, Gülcan; Hilali, Neşe Gül; Yıldız Zeyrek, Fadile; Özek, Behire; Yıldırımkaya, Gökhan

    2016-10-01

    Since the Syrian civil war began in 2011, most of the Syrian refugees have immigrated to Turkey due to its open gate policy and the width of the border. By the end of 2015, it was estimated that there were 2.5 million Syrian refugees in Turkey. Many of the Syrian refugees live in Sanliurfa due to its location on the border with Syria. Trichomonas vaginalis, apart from viral agents is the most common parasite among sexually transmitted infection agents. The aim of this study was to determine the prevalence of T.vaginalis among female married Syrian refugees living outside of the camps in Sanliurfa city center, aged between 15-49 years with complaints of vaginitis. This multi-purpose survey was carried out between February and March of 2015, in collaboration with the United Nations Population Fund and Harran University. This study was approved under the heading of "General Health Status of Female Syrian Refugees" by the Ethics Committee of Harran University Faculty of Medicine. A total of 460 Syrian refugees house were selected using the probability cluster sampling method, with a 95% confidence level and a 5% confidence interval with a design effect. Two women refused to participate in the study, and the response rate was 99.6%. Two Syrian nurses, one laboratory technician, and one interpreter who knew Kurdish and Arabic were hired for the field survey. A structured questionnaire written in Turkish was translated to Arabic and used to collect the sociodemographic data during face to face interviews. According to the questionnaire data, the women with the complaints of vaginal discharge, unusual vaginal bleeding and/or dyspareunia were invited to the Gynecology Department of Harran University Research and Training Hospital for a medical examination. During gynecological examination, swab samples obtained from posterior fornix were evaluated by direct microscopy and Giemsa staining methods for the presence of T.vaginalis trophozoites. Of 458 women who have

  14. Prognostic factors for long-term quality of life after adjuvant radiotherapy in women with endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Foerster, Robert; Schnetzke, Lara; Arians, Nathalie; Rief, Harald; Debus, Juergen; Lindel, Katja [University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg (Germany); Bruckner, Thomas [University Hospital Heidelberg, Department of Medical Biometry, Heidelberg (Germany)

    2016-12-15

    Adjuvant radiotherapy (RT) for endometrial cancer (EC) may affect patients' quality of life (QoL). There is a paucity of data on prognostic factors for long-term QoL and sexual functioning. This study aimed to investigate such factors and assess the role of the vaginal dilator (VD). QoL was assessed in 112 EC patients 6 years (median) after RT. QoL was compared to normative data, and the influence of age, tumor characteristics, lymphadenectomy, RT, and acute toxicities was assessed. VD use and its effect on subjective vaginal shortening/tightness was analyzed. QoL was reduced, particularly in younger patients. Vaginal brachytherapy only and intensity-modulated RT (IMRT) were associated with better global health status and reduced chronic gastrointestinal (GI) symptoms. Higher acute GI toxicity was associated with increased chronic GI symptoms, particularly diarrhea, and reduced role functioning. Higher acute urinary toxicity was associated with increased chronic urological symptoms, muscular/pelvic pain, and chronic GI symptoms, as well as with reduced emotional/social functioning and reduced global health status. Sexual interest/activity was increased despite vaginal dryness and dyspareunia. Sexual interest/activity increased with age. Only few, mainly younger patients used the VD. VD use >1 year was found in women with higher sexual interest/activity. Acute vaginal toxicity and chronic pain prevented VD use. Subjective vaginal shortening/tightness was not reduced in VD users. RT technique and acute toxicities are prognostic for the extent of chronic symptoms and long-term QoL. Sexuality is important even at a higher age. Few patients use the VD and a reduction of subjective vaginal shortening/tightness was not achieved. (orig.) [German] Eine adjuvante Radiotherapie (RT) kann die Lebensqualitaet von Patientinnen mit Endometriumkarzinom (EC) beeinflussen. Daten zu prognostischen Faktoren fuer die langfristige Lebensqualitaet (QoL) und die Sexualfunktion sind

  15. Tratamento laparoscópico de 98 pacientes com endometriose intestinal Laparoscopic treatment of 98 women with bowel endometriosis

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    Luciana Maria Pyramo Costa

    2010-03-01

    sigmoidectomy (n 1; 1% e segmental right colon resection (n 1, 1%. The most frequent concomitant surgery performed was the removal of ovarian endometriomas (n 45. Operative morbity was observed in 9.2% and major complications were rectovaginal fistula (1% and anastomosis dehiscence (1%. After a mean followup of 14 months that included 42 patients , recurrence of clinical symptoms (pelvic pain and dyspareunia was observed in 8 cases as well as 4 cases of asymptomatic intestinal wall endometriosis recurrence which was identified by ultrasonography. CONCLUSION: Laparoscopic treatment of bowel endometriosis is feasible, safe and presents a low recurrence rate.

  16. Investigation of perimenopausal symptoms of middle-aged women in Xuhui region of Shanghai%上海徐汇区中年妇女围绝经期症状调查

    Institute of Scientific and Technical Information of China (English)

    朱晓璐; 李萍; 孙东梅; 陶敏芳; 滕银成

    2016-01-01

    Objective To discuss the occurrence and influencing factors of perimenopaual symptoms by investigating the perimenopausal symptoms in middle-aged women in Xuhui Region of Shanghai .Methods From August 1, 2012 to December 31, 2013, women aged 40-60 years taking health examination in Shanghai Jiaotong University Affiliated Sixth People ’ s Hospital were investigated .Modified Kupperman Index ( KMI) and general questionnaires were used to do the investigation and the data was analyzed .Results A total of 2 046 women were recruited in the investigation with mean age of 51.23 ±7.00 years.The occurrence of perimenopausal syndrome was 66.9%( KMI>6) .The occurrence rate of perimenopausal syndrome increased with the growth of age and menopausal status .The most common symptoms were fatigue (83.38%), dyspareunia (55.67%), bone pain (50.29%), insomnia (48.29%) and mood swing (40.71%) in order.Regression analysis revealed that growth of age , poor education, low income, late menarche, frequent induced abortion and complicating coronary heart disease were the risk factors of perimenopausal symptom aggravation (t value was 22.533, -4.055, -2.088, 2.709, 5.522 and 4.203, respectively, all P<0.05).Conclusion The occurrence of pe-rimenopausal symptoms in middle-aged women in Xuhui Region of Shanghai is high .Therefore, health and medical institutions should take more health care measures based on perimenopausal symptoms in Shanghai middle-aged women .%目的:通过对上海徐汇区中年妇女围绝经期症状的调查,探讨上海中年妇女围绝经期症状发生情况及其影响因素。方法采用改良Kupperman评分量表( KMI)及一般情况调查表对2012年8月1日至2013年12月31日在上海交通大学附属第六人民医院体检中心进行正常体检的年龄在40~60岁的中年妇女进行问卷调查,并分析调查结果。结果本次研究中,共纳入符合标准的妇女2046例。受试者平均年龄51.23±7.00岁。中年妇女

  17. 藏红花加温胆汤对子宫内膜异位症患者外周血基质金属蛋白酶9水平的影响%Effect of Wendan Decoction plus Saffron on serum MMP-9 in endometriosis of uterus

    Institute of Scientific and Technical Information of China (English)

    杨慧君; 赵鲜

    2016-01-01

    for 24 weeks.The serum estradiol, MMP-9 and matrix metalloproteninases inhibitor-1(TIMP-1) were detected before and after treatment, the degree of pain and clinical efficacy were compared.Results Compared with before treatment, levels of estradiol(E2),progesterone(P) and luteotropic hormone(LH) decreased in two groups(P<0.01), the levels of MMP-9, MMP-9/TIMP-1 decreased(P<0.01), levels of TIMP-1 increased(P<0.01), levels of CA125 decreased(P <0.01), and the maximum diameter of pelvic mass line decreased(P<0.01), dysmenorrhea pelvic pain, dyspareunia and VAS score decreased(P<0.01).Compared with the control group, levels of E2, P and LH in the research group were lower(P<0.01), the levels of MMP-9, MMP-9/TIMP-1 were lower(P<0.01), levels of TIMP-1 were higher(P<0.01), levels of CA125 were lower(P<0.01), the maximum diameter of pelvic mass line were lower(P<0.01), dysmenorrhea and pelvic pain and VAS scores were lower(P<0.01), and the effective rate of research group was higher(P<0.05).Conclusion Wendan Decoction plus Saffron in the treatment of endometriosis of uterus was effective, and it can reduce endometriosis, dysmenorrhea and pelvic pain degree, reduce pelvic mass, and may reduce the level of serum MMP-9 related.

  18. Irritable bowel syndrome in women with chronic pelvic pain in a Northeast Brazilian city Síndrome do intestino irritável em mulheres com dor pélvica crônica em uma cidade do Nordeste Brasileiro

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    Lígia Maria Montenegro Lessa

    2013-02-01

    Full Text Available PURPOSES: To determine the prevalence of irritable bowel syndrome (IBS in women with chronic pelvic pain (CPP and its associated features; to determine whether IBS and CPP constitute the same syndrome. METHODS: Cross-sectional population survey with systematic sequential sampling according to census districts in which 1470 women were interviewed with respect to the sample calculation. The participants resided in their own homes, were at least 14 years of age, experienced menarche and presented CPP according to the American College of Obstetrics and Gynaecology. The dependent variable was IBS based on Rome III criteria in women with CPP, and the following independent variables were possibly associated with IBS: age, schooling, duration of pain, sedentary lifestyle, migraine, depression, insomnia, back pain, dysmenorrhea, dyspareunia, depression, history of violence, and intestinal symptoms. The sample was subdivided into groups with and without IBS. After the descriptive analysis of the variables was performed, the respective frequencies were evaluated using GraphPad Prism 5 software. To evaluate the association between the dependent variable and the independent variables, the χ² test was used with a significance level of 5%. RESULTS: The prevalence of IBS in women with CPP was 19,5%. Pain duration (p=0.03, back pain (p=0.002, history of physical or sexual abuse (p=0.002, and intestinal complaints were more prevalent in the group with IBS and CPP. There was no difference between the groups regarding other criteria. CONCLUSION: The data confirmed the literature, identified several aspects that were shared between the pathologies and supported the hypothesis that both pathologies can constitute the same syndrome.OBJETIVOS: Verificar a prevalência da síndrome do intestino irritável (SII em mulheres com dor pélvica crônica (DPC e as características associadas; analisar se SII e DPC constituem a mesma síndrome. MÉTODOS: Estudo transversal do

  19. Treinamento dos músculos do assoalho pélvico nas disfunções sexuais femininas Pelvic floor muscle training in female sexual dysfunctions

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    Virginia Pianessole Piassarolli

    2010-05-01

    Full Text Available OBJETIVO: avaliar o efeito do treinamento dos músculos do assoalho pélvico (TMAP sobre as disfunções sexuais femininas. MÉTODOS: para esse ensaio clínico com abordagem antes e depois, foram incluídas 26 mulheres que apresentavam diagnóstico de disfunção sexual (transtorno de desejo sexual, de excitação, orgástico e/ou dispareunia. As participantes foram avaliadas antes, na metade (após cinco sessões e ao final do tratamento (após dez sessões, por meio da palpação vaginal bidigital (avaliação da força dos músculos do assoalho pélvico-MAP, eletromiografia (EMG intravaginal (captação das amplitudes de contração dos MAP e Female Sexual Function Index (FSFI, questionário de avaliação da função sexual. As mulheres foram submetidas ao TMAP em diferentes posições, por dez sessões (uma ou duas vezes na semana. Para análise estatística, utilizou-se frequências absolutas e relativas para características clínicas e força dos MAP. Empregou-se teste de Friedman para comparação dos escores dos domínios do FSFI e valores da EMG, t de Student para associação entre esses valores e características das mulheres e Wilcoxon para modificação percentual da EMG. O teste Mann-Whitney permitiu comparar esses valores com características clínicas. Para correlacionar os valores da EMG com escore total médio, utilizou-se teste de correlação de Spearman. Adotou-se nível de significância de pPURPOSE: to evaluate the effect of pelvic floor muscle training (PFMT on female sexual dysfunctions. METHODS: twenty-six women with a diagnosis of sexual dysfunction (sexual desire, arousal, orgasmic disorders and/or dyspareunia were included in a clinical trial with a before/after approach . The assessment was carried out before, during (after five sessions and at the end of the treatment (after ten sessions by two-digit palpation (assessment of pelvic floor muscle, PFM, strength, intravaginal electromyography (EMG (capture of PFM

  20. Selective Estrogen Receptor Modulators – an Updatebr (Joint Statement by the German Society for Gynecological Endocrinology and Reproductive Medicine [DGGEF] and the German Professional Association of Gynecologists [BVF

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    Rabe T

    2015-01-01

    (with at least 12 months since the last menses for whom treatment with progestin-containing therapy is not appropriate.br Clomifene (Triphenylethylene derivative: Treatment of ovarian dysfunction (infertility. Ospemifene: FDA registration for treatment of moderate or severe dyspareunia, a symptom of vulvar and vaginal atrophy, due to menopause; EU-registration for moderate or severe symptoms of vulvo-vaginal atrophy.br Ormeloxifene used in India for contraception and treatment of dysfunctional uterine bleeding. Raloxifene (Benzothiophene derivative used for treatment and prevention of osteoporosis in postmenopausal women and in some countries (including the USA for breast cancer prevention in high risk women. Raloxifene has no marketing authorization for this indication in Europe. The VTE risk is increased, similar to HRT. Death due to stroke was increased in the RUTH study (secondary prevention study, but not in the MORE or CORE studies (osteoporosis treatment and extension studies.br Tamoxifene (triphenylethylene derivative is licensed for adjuvant use in women with primary or metastasized breast cancer and in some countries for the primary prevention of breast cancer. Tamoxifene is an antiestrogen, used (20 mg/day in women who have estrogen receptor-positive (ER+ breast cancer. Unfortunately, resistance to tamoxifene is common in women with metastatic disease. Possible side effects include an increased risk of endometrial cancer and, like with all SERMs, an increased risk of VTE. An increased risk of stroke has been observed in the NSABP-1 study (RR1.42, but this was not statistically significant. Some antidepressants (SSRIs abolish the effect of tamoxifene.br Toremifene (citrate (also a triphenylethylene derivative has EU marketing authorization for first line endocrine treatment of hormone-dependent meta static breast cancer in postmenopausal patients. Fareston is not recommended for patients with estrogen receptor negative tumors. According to the US license

  1. LONGITUDINAL PREPUTIAL PEDICLED FLAP URETHROPLASTY FOR CHORDEE OF Donnahoo TYPE Ⅳ%纵行带蒂包皮瓣卷管尿道间置矫治先天性Donnahoo Ⅳ型阴茎下曲畸形

    Institute of Scientific and Technical Information of China (English)

    曾莉; 单伟; 袁淼; 黄桂珍; 黄鲁刚

    2012-01-01

    angle was 0-10° (mean, 1.2°). All patients were followed up 6 months to 12 years (mean, 33 months). No recurrence, stabbing pain of the balanus, or foreign body sensation occurred during follow-up. Of them, 4 patients (13.33%) had urinary fistular, they had satisfactory results after the second operation; 2 patients (6.67%) had urethral stricture 1 month after operation, they also had satisfactory results after arethral dilatation. The other patients showed no scattering urinary flow and good direction without complication. Six patients had satisfactory sexual function after puberty without erection disorder, pain, or dyspareunia. Conclusion Longitudinal preputial pedicled flap urethroplasty can achieve maximum utilization of prepuce and aesthetic and functional improvement with less complication, so it is a relatⅣely ideal mean for treating chordee of Donnahoo type Ⅳ.

  2. Síndrome do climatério: inquérito populacional domiciliar em Campinas, SP Climacteric syndrome: a population-based study in Brazil

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    Adriana Orcesi Pedro

    2003-12-01

    prevalence of climacteric, urogenital and sexual symptoms in a population of Brazilian women. METHODS: A cross-sectional descriptive population-based study was conducted. The selection of 456 women aged 45-60 years, living in Campinas, SP, in 1997, was done through area cluster sampling, according to data from the Brazilian Institute of Geography and Statistics. Data were collected via home interviews, using structured pretested questionnaires. Data were analyzed using the chi-squared test and the nonparametric Kruskal-Wallis test; a probability of <0.05 was considered statistically significant. The degree of climacteric symptoms was analyzed through circulatory and psychological indices. Analysis of the main components was used to determine symptom interrelationships. RESULTS: The most prevalent symptoms were nervousness (82%, hot flushes (70%, headache (68%, irritability (67% and sweating (59%. Hot flushes, sweating and insomnia were significantly more prevalent in the peri and postmenopausal phases. The frequency (severity of vasomotor and psychological symptoms did not vary according to the menopause phase. The prevalence of urinary incontinence was 27.4%. Complaints of dyspareunia and vaginal dryness were infrequent. Decreased libido was the most frequent sexual complaint. It was observed that some climacteric complaints were interrelated. The first cluster included hot flushes and sweating (vasomotor cluster. The second cluster included nervousness, depression and irritability (psychological cluster. The third cluster included dizziness and palpitation (atypical cluster. CONCLUSION: Climacteric symptoms in this population were highly prevalent and similar to those described in developed Western countries.

  3. Sexual problems during early postpartum period and awareness in postpartum sexual health: a retrospective study%女性产后早期性问题及产后性健康知识知晓状况分析

    Institute of Scientific and Technical Information of China (English)

    折瑞莲; 魏晓萍; 王芳; 汪杨; 苏放明

    2011-01-01

    目的 探讨女性产后早期的性问题及对产后性健康知识的知晓情况.方法 选择在我院住院分娩,且于2010年10月至11月在我院产科门诊行产后检查的产妇109例,以自行设计的产后性健康情况调查表,由专人负责调查填表,分析其产后性问题发生情况及对产后性健康知识的知晓情况.结果 产后妇女首次行产后检查的时间为6~12周;产后6周内,有5.50%(6/109)的产妇恢复性生活;产后6~8周时,有15.60%(17/109)的产妇恢复性生活;产后12周时,42.20%(46/109)的产妇恢复了性生活.产后出现的性问题有:性交疼痛占76.09%(35/46)、阴道干涩占63.04%(29/46)、性欲低下占54.35%(25/46)、高潮缺失占23.91%(11/46),其中性交疼痛、阴道干涩、性欲低下为常见;产后性生活采取避孕措施的占10.87%(5/46).21.10%(23/109)的产妇知道产后恢复性生活的时间,12.84%(14/109)的产妇知道产后可能出现的性问题,13.76%(15/109)产妇知道产后避孕知识,6.42%(7/109)的产妇表示愿意在出现产后性问题时主动就医,9.17%(10/109)产妇其丈夫愿意了解产后性保健知识.结论 产后早期性问题较为普遍,应当引起医务人员的重视;产妇性健康知识普遍薄弱,应大力加强产前产后宣教,提高产后性保健知识的知晓率.%Objective To investigate the sexual problems during early postpartum period and the awareness of postpartum sexual health. Methods A questionnaire survey was carried out in 109 women who received routine postpartum check-up in our outpatient department between October and November 2010 to identify postpartum sexual problems and the awareness of postpartum sexual health. Results The first postpartum check-up was received 6 to 12 weeks after the delivery. Of 109 participants,6 (5.5%), 17(15.6%) and 46 (42.2%) resumed sexual activity within 6,6 to 8,and 12 weeks after the delivery,respectively. Postpartum sexual problems included dyspareunia (35/46,76. 09

  4. 门诊抑郁障碍患者的性功能状况%Sexual function in outpatients with depressive disorder

    Institute of Scientific and Technical Information of China (English)

    王平; 张志珺; 潘集阳; 司天梅; 于欣; 邓红; 王刚; 刘哲宁; 李晓白; 李惠春; 陆峥

    2011-01-01

    Objective: To investigate the occurrence, manifestations of sexual problems in outpatiersts with depressive disorders before and after the medical treatment, and the doctors’understanding and management of the sexual problems related to the depressive disorders.Methods: This was a multicenter, retrospective, and self-compared survey.A total of 171 outpatients meeting the criteria for depressive disorder of Diagnostic and Statistical Manual Of Mental Disorder, Fourth Edition (DSM-Ⅳ) and 200 psychiatrists were investigated from 9 university affiliated psychiatric hospitals.The self-designed questionnaires were used to assess the sexual problems of patient during the pre-disease, depressive episode and after the medical treatment and to assess the doctors’understanding and management of the sexual problems related to the depressive disorders.Results: The data of 143 patients were analyzed.It showed that patients with depressive disorders manifested much sexual dysfunctions, such as lower sexual desire (hypoactive sexual desire and sexual disgust), female sexual arousal disorder and male erectile disorder, orgasmic inhibition, dyspareunia and dissatisfaction with sexual intercourse and sexual relationship.After treatment with antidepressants, the patients’self rated severity of disease improved about 53.7%, and most of the sexual dysfunction remained abnormal.The female satisfaction with sexual relationship improved significantly after the treatment.The depresive episode of ≥2 was risk factor to male ejaculation problem in the normal state (B= 1.983, P =0.043),while decline in the ability of thinking was protective factor ( B= - 1.878, P= 0.027).The depresive episode of ≥ 2 was risk factor for female vaginal lubrication problem in the normal state (B= 0.864, P= 0.011), falling asleep problem was risk factor for intercourse satisfaction decline for female after illness (B= -0.965, P= 0.007).Although 79.5% doctors considered sexual problems were of

  5. [Post-partum: Guidelines for clinical practice--Short text].

    Science.gov (United States)

    Sénat, M-V; Sentilhes, L; Battut, A; Benhamou, D; Bydlowski, S; Chantry, A; Deffieux, X; Diers, F; Doret, M; Ducroux-Schouwey, C; Fuchs, F; Gascoin, G; Lebot, C; Marcellin, L; Plu-Bureau, G; Raccah-Tebeka, B; Simon, E; Bréart, G; Marpeau, L

    2015-12-01

    circumstances, it may be performed in the delivery unit provided safety rules are maintained and regulatory authorities are informed (Professional consensus). An analgesic multimodal protocol developed by the medical team should be available and oral way should be favored (Professional consensus) (grade B). For every cesarean delivery, thromboprophylaxis with elastic stockings applied on the morning of the surgery and kept for at least 7 postoperative days is recommended (Professional consensus) with or without the addition of LMWH according to the presence or not of additional risk factors, and depending on the risk factor (major, minor). Early postoperative rehabilitation is encouraged (Professional consensus). Postpartum visit should be planned 6 to 8 weeks after delivery and can be performed by an obstetrician, a gynecologist, a general practitioner or a midwife, after normal pregnancy and delivery (Professional consensus). Starting effective contraception later 21 days after delivery in women who do not want closely spaced pregnancy is recommended (grade B), and to prescribe it at the maternity (Professional consensus). According to the postpartum risk of venous thromboembolism, the combined hormonal contraceptive use before six postpartum weeks is not recommended (grade B). Rehabilitation in asymptomatic women in order to prevent urinary or anal incontinence in medium or long-term is not recommended (Expert consensus). Pelvic-floor rehabilitation using pelvic-floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months postpartum (grade A), regardless of the type of incontinence. Postpartum pelvic-floor rehabilitation is recommended to treat anal incontinence (grade C). Postpartum pelvic-floor rehabilitation is not recommended to treat or prevent prolapse (grade C) or dyspareunia (grade C). The optimal time for maternity discharge for low risk newborn depends more on the organisation of the post-discharge follow up (Professional

  6. Total Laparoscopic Hysterectomy Versus Total Abdominal Hysterectomy:a Retrospective Comparison of Clinical Effects and Sexual Functions%腹腔镜与开腹全子宫切除术的临床疗效和对性功能影响的比较

    Institute of Scientific and Technical Information of China (English)

    周莹莹; 应小燕

    2014-01-01

    Objective To investigate two different hysterectomy ( total abdominal hysterectomy and total laparoscopic hysterectomy ) on short-term efficacy and influence on sexual functions . Methods The retrospective records of 100 cases of total laparoscopic hysterectomy ( TLH) and 100 cases of total abdominal hysterectomy ( TAH) from January 2009 to December 2012 were reviewed.The operation time, intraoperative blood loss, postoperative hospital stay, and sexual satisfaction at 12 months postoperatively were compared between the two groups . Results The operation time was longer in the TLH Group than that in the TAH Group [(128 ±11) min vs.(87 ±33) min, t=-11.787, P=0.000].The intraoperative blood loss was less in the TLH Group than that in the TAH Group [(108 ±37) ml vs.(155 ±28) ml, t=-10.129, P=0.000].The hospital stay was shorter in the TLH Group than that in the TAH Group [(5.5 ±1.9) d vs.(8.2 ±1.6) d, t =-10.870, P =0.000].There were no significant differences between the two groups in sexual frequency (Z=-1.300, P=0.193), libido (Z=-0.564, P=0.573), achievement of orgasm (Z =-1.591, P=0.112), sexual intercourse disorder (Z =-0.478, P =0.633), and the overall satisfaction (Z=-0.083, P=0.934).Extent of dyspareunia was worse in the TLH Group than in the TAH Group (Z=-3.752, P=0.000). Conclusions TLH has less blood loss and shorter hospitalization time than TAH .Hysterectomy has a certain influence on sex functions .Differences in the sexual satisfaction are not statistically significant between the two procedures .%目的:比较腹腔镜下全子宫切除术( total laparoscopic hysterectomy ,TLH)和开腹全子宫切除术( total abdominal hysterectomy ,TAH)的临床效果及对性功能的影响。方法回顾性分析2009年1月~2012年12月TLH和TAH各100例的临床资料,比较2组手术时间、术中出血量、住院时间及术后12个月性生活满意度等。结果 TLH手术时间明显长于TAH组[(128±11)min vs.(87±33

  7. Inclusão dos sintomas na discriminação entre tumores anexiais benignos e malignos Inclusion of symptoms in the discrimination between benign and malignant adnexal masses

    Directory of Open Access Journals (Sweden)

    Caio Augusto Hartman

    2012-11-01

    .56, and postmenopausal bleeding (PR=2.91; 95%CI 1.55 - 5.44. The presence of pelvic pain, constipation, dyspareunia, fatigue, abdominal pain, nausea or vomiting, menstrual irregularity, weight loss, diarrhea, and bleeding after intercourse was similar in both groups. CONCLUSIONS: In women with adnexal tumors including indication of surgical treatment, the preoperative evaluation of symptoms may help predicting malignancy.

  8. 早期子宫颈癌患者行子宫广泛性切除联合阴道延长术后的生命质量和性生活状态的评估%Quality of life and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension

    Institute of Scientific and Technical Information of China (English)

    叶双; 杨佳欣; 曹冬焱; 朱兰; 郎景和; 沈铿

    2014-01-01

    difficulty emptying bladder,incomplete emptying and constipation were most commonly reported.Both group presented with hypoactive sexual desire disorder [88% (52/59)],orgasm dysfunction [72%(28/39)] and low enjoyment or relaxation after sex [51%(20/39)],which was not statistically significant (P>0.05).Reduced vagina size and shorter vagina was more prominent in control group (12/18) than that in study group [19% (4/21)] with statistical significance (P<0.05),while no difference in sexual desire,vaginal lubrication,dyspareunia and sexual enjoyment (P>0.05).Conclusions Patients with peritoneovaginoplasty following RH had much longer vagina and less self-perceived short vagina.Vaginal extension following RH does not worsen the pelvic floor symptoms.