Genitourinary symptoms and sexual function in women with primary ovarian insufficiency

OBJECTIVE

There are limited studies on urogenital symptoms in women who experience menopause before the age of 40 years due to primary ovarian insufficiency (POI) or bilateral oophorectomy (surgical POI). This study aimed to compare the urogenital symptoms, including sexuality, of women with POI to those without the condition.

METHODS

This cross-sectional study conducted was in seven Latin American countries, in which postmenopausal women (with POI and non-POI) were surveyed with a general questionnaire, the Menopause Rating Scale (MRS) and the six-item Female Sexual Function Index (FSFI-6). The association of premature menopause with more urogenital symptoms and lower sexual function was evaluated with logistic regression analysis.

RESULTS

Women with POI experience more urogenital symptoms (MRS urogenital score: 3.54 ± 3.16 vs. 3.15 ± 2.89, p < 0.05) and have lower sexual function (total FSFI-6 score: 13.71 ± 7.55 vs. 14.77 ± 7.57 p < 0.05) than women who experience menopause at a normal age range. There were no significant differences in symptoms when comparing women based on the type of POI (idiopathic or surgical). After adjusting for covariates, our logistic regression model determined that POI is associated with more urogenital symptoms (odds ratio [OR]: 1.38, 95% confidence interval [CI] 1.06-1.80) and lower sexual function (OR: 1.67, 95% CI 1.25-2.25).

CONCLUSION

POI, whether idiopathic or secondary to bilateral oophorectomy, is associated with symptoms that affect vaginal and sexual health.

Establishing urogynecology subspecialty in Armenia: The Armenia project

It is well known that there are many countries in the world where Urogynecology is not an existing subspecialty, and women are not receiving appropriate care for their pelvic floor disorders (PFD). One of these countries is the Republic of Armenia. Given the lack of expertise in the field of Urogynecology in Armenia, we conducted a study on the prevalence of PFDs and the degree of bother among women of all ages across the country, which was published in 2020. This led to the creation of the International Urogynecology Association for Armenia, comprising seven physicians from different countries: five from the USA, one urogynecologist from Lebanon, and one urologist from Russia. We implemented hybrid teaching based on Zoom lectures, case presentations, journal clubs, and live visits of mentors to Armenia on a regular basis to see patients and operate with our five fellows. We introduced our fellows to research and statistics by assigning research topics for different projects. Our fellows presented evidence-based presentations and extensive literature reviews on a regular basis. Our program will continue to grow the next 2-3 years. The success of this project holds significance for governmental, public, and healthcare entities in Armenia and across the world, where this subspecialty is non-existent, in preparing future female pelvic surgeons to care for the growing needs of women with these conditions. Replicating this program in other parts of the world will compound the benefits and successes of Urogynecology care across different societies, cultures, and people around the globe.

Impact of COVID-19 in Female Urology

This review discusses the impact of COVID-19 in Female Urology, revises the most important disorders in this field and how their diagnosis and treatment may be modified due to the current pandemic. The text also discusses new options such as telemedicine and what clinical situations within Female Urology should be of utmost importance for the urologist to be careful about. We also discuss how surgeries are being postponed are resumed according to the local scenario.

[Individual resistance card in health care for patients with urogenital diseases]

Currently, practical health care does not have a means to transfer patients health data when they change the place of residence and employment. In this regard, there was a need to develop a health-related instrument to accompany an individual when he/she changes the place of residence and work. The aim of the study was to develop an "individual resistance card" to use in health care for patients with diseases of the genitourinary system.

MATERIALS AND METHODS

We developed an "individual resistance card" proposed to implement in the practice of health care, as an information document on the state of reactivity and resistance (health) of the organism in terms of urologic diseases.

RESULTS

The degree (index) of relative organism resistance is calculated based on impaired individual reactivity and power (intensity) of the environmental pathogenic factors. Its application allows for significant improvement in the effectiveness of periodic health checks, primary and secondary prevention of diseases, because it takes into account both a primary (genotypic) and secondary (acquired) reactivity.

CONCLUSION

The developed Card can be used to record the state of the organism reactivity and resistance regarding urologic diseases and monitor these indicators when the patients change the place of residence and employment. This e-card (in encrypted form) and paper versions may accompany the individuals throughout their lives and will be used for to effectively organize primary and secondary disease prevention by a general practitioner and an urologist.

The three-year positivity rate of sexually transmitted infections among a group of HIV-infected men attending the Department of Genitourinary Medicine, Edinburgh, UK

The aim of this study was to investigate the prevalence of sexually transmitted infections (STI) among patients at the time of and subsequent to the diagnosis of HIV, and possible immunological or virological features of patients with STI. An observational study was carried out on the results of annual STI screenings conducted on consecutive HIV-infected men in the Department of Genitourinary Medicine, Edinburgh between 1 January 1999 and 1 January 2003. Patients were tested for syphilis, gonococcal, and chlamydial infections.

Among the 79 male patients in the study cohort, the frequencies of all STI rose within the study period. The three-year positivity rates of episodes of gonorrhoea, chlamydia, and syphilis were (42/131) 32%, (21/127) 16%, and (13/150) 9%, respectively. Patients with STI had significantly higher median CD4+ T-cells ( P<0.02) and lower median viral loads ( P<0.0001), and a higher proportion of them were on highly active anti-retroviral therapy (HAART) ( P<0.0002) compared with those without an STI. Routine screening for STI and counselling for safe sex should be part of care for all HIV-infected patients.

Seeking and engaging in internet sex: a survey of patients attending genitourinary medicine clinics in Plymouth and in London

We conducted a survey of patients attending two GUM clinics to evaluate the use of the internet for seeking sexual partners and for seeking on-line sexual health information. Prevalence of internet sex-seeking (ISS) was 11% (57/500) in Plymouth and 21% (50/237) in London. ISS was more common among men who have sex with men (MSM) (43/92 = 47%) than men who have sex with women (MSW) (38/280 = 14%, P < 0.0001) and more common amongst MSW than women who have sex with men (WSM) (25/350 = 7%, P = 0.007). In both samples, accessing sexual health information online was associated with ISS (Plymouth, P = 0.05 and London, P = 0.001), as was reporting more than 10 sexual partners per year (Plymouth and London, P < 0.001). It remains to be seen whether the potential sexual health promotion benefits of the internet could balance potential risks of STI acquisition.

Vulval Crohn's disease – a multi-specialty approach

We report a case of Crohn's disease where the patient initially presented with vulval ulceration to the gynaecology unit. Initial investigations were planned jointly by both the gynaecology and genitourinary medicine staff. An examination under general anaesthetic by both teams was performed and biopsies taken. These showed a chronic inflammatory process with epithelioid granulomas. The teams then referred the case to the dermatology team who made the diagnosis of vulval Crohn's disease and initiated treatment with prednisolone and azathioprine. The case illustrates the need for a multi-speciality approach when dealing with such cases.

The management of Chlamydia trachomatis in genitourinary medicine clinics: a national audit in 2004

The first national audit of the management of Chlamydia trachomatis was undertaken by non-consultant career grade doctors working in genitourinary (GU) medicine clinics in the UK. During the audit period of January–March 2004, 1670 data collection forms were completed (from 830 men and 840 women with chlamydia). In all, 99% (1647) were treated appropriately; 76% (1261) were followed up, of which 12% (154) required re-treatment; 71% (1186) were managed appropriately within four weeks and 942 partners (0.56 per index case) were managed satisfactorily within four weeks of the initial partner notification interview. Partner notification outcomes were significantly more successful when the index patient was followed up ( P<0.0001). Outcome standards were not associated with age, gender or sexuality, but were significantly associated with ethnicity ( P<0.004). GU medicine clinics are delivering high-quality care and evidence-based national outcome standards are being met.

Screening, diagnosis and management of early syphilis in genitourinary medicine clinics in the UK

New diagnoses of syphilis in the UK increased eight-fold between 1997 and 2002. This study, conducted in 2002, demonstrated that 31% of clinics were not confident of their expertise to obtain an adequate specimen for dark ground microscopy (DGM), and 35% were not confident of their expertise to detect treponemes on DGM. In all, 64% of clinics had observed adherence problems in HIV-positive patients treated with parenteral regimens, as against 42% with oral regimens. Also, 51% of clinics waited more than a week for the results of initial serological tests for syphilis, and 88% of clinics waited more than a week for confirmatory test results. Other concerns include the failure to perform syphilis serology consistently whenever HIV-positive patients were at risk, and the widespread use of doxycycline as a therapy for syphilis in HIV-positive patients despite concerns that this is not known to be fully treponemicidal in cerebrospinal fluid.

Risk factors for urogenital disorders during pregnancy and after childbirth

INTRODUCTION

pregnancy and childbirth are the physiological processes, but have a significant impact on both the functions of particular organs, and the woman's body as a whole, and often lead to the emersion of different symptoms, which significantly reduce the quality of life. These are the manifestation of urogenital disorders (MUD) during pregnancy and after childbirth. Mental and physical sufferings of patients stimulate obstetrician-gynecologists and urologists to the joint search for the causes of MUD in women, to the differentiated work out of individual methods of prevention, improving of diagnosis and treatment of this pathology.

AIM

to study the risk factors, including the presence of extragenital pathology in women with MUD.

MATERIALS AND METHODS

preliminary survey has been carried out, 51 women-patient have been defined with complaints for MUD - the main group. The urogynecological questionnaire has been filled in, the diaries have been kept on urination, the results of functional tests have been evaluated as well as of ultrasonography of the lower urinary tract. The comparison group consisted of 50 women who gave birth without any signs of MUD.

RESULTS

the results of conducted resrearch indicate the important role of extragenital pathology, in addition to the burdened obstetric and gynecological history as a risk factor for urogenital disorders during pregnancy and after childbirth.

CONCLUSIONS

the high frequency of somatic diseases, which are the visceral manifestations of the syndrome of undifferentiated connective tissue dysplasia in women of the main group, indicates that a generalized defect of connective tissue is one of the reasons for the manifestation of the symptoms of urogenital disorders during pregnancy and after childbirth in women of reproductive age. The gained results must be taken into account when developing the methodology of forecasting the urogenital disorders in women during pregnancy and after childbirth.

The investigation and treatment of female pelvic floor dysfunction

BACKGROUND

25% of all women report involuntary loss of urine, and 7% may require treatment.

METHODS

This review is based on a selection of pertinent literature, including guidelines and Cochrane reviews.

RESULTS

The assessment of pelvic floor dysfunction in women begins with a basic evaluation that is followed by special diagnostic tests if indicated. The physician taking the clinical history should inquire about the patient's behavior, personality, social and other stressors, and eating and drinking habits, as well as any mental disorders that may be present, including anxiety disorders, depression, somatization disorders, and disorders of adaptation. Conservative treatment consists mainly of lifestyle changes, physiotherapy, and medication. Stress incontinence is most commonly treated with pelvic floor exercises, with a documented success rate of 56.1% vs. 6% without such treatment (relative risk 8.38, 95% confidence interval 3.67-19.07). If incontinence persists, surgery may be indicated ( implantation of suburethral tension-free slings, or colposuspension). Feedback and biofeedback training can be used to treat an overactive bladder. If these techniques and drug therapy are unsuccessful, botulinum toxin injections can be considered.

CONCLUSION

Well-validated treatments for pelvic floor dysfunction are available. Psychosomatic factors must be taken into account and can have a major effect on treatment outcomes.

Revised medical criteria for evaluating genitourinary disorders. Final rules

These final rules revise the criteria in the Listing of Impairments (listings) that we use to evaluate cases involving genitourinary disorders in adults and children under titles II and XVI of the Social Security Act (Act). The revisions reflect our program experience and address adjudicator questions we have received since we last comprehensively revised this body system in 2005.

Extension of expiration dates for two body system listings. Final rule

We are extending the expiration dates of the following body systems in the Listing of Impairments (listings) in our regulations: Genitourinary Impairments and Hematological Disorders. We are making no other revisions to these body systems in this final rule. These extensions will ensure that we continue to have the criteria we need to evaluate impairments in the affected body systems at step three of the sequential evaluation processes for initial claims and continuing disability reviews.

Adequacy of contraception and missed opportunities for provision in a genitourinary medicine setting

BACKGROUND AND METHODOLOGY

Sexually active women presenting to genitourinary medicine (GUM) clinics are at risk of both sexually transmitted infections and unwanted pregnancies. Emergency hormonal contraception is the only contraceptive service provided in our GUM clinic in Birmingham, UK. We wanted to assess whether contraception use was adequate in women attending our clinic and whether we were missing opportunities to provide more reliable contraception. All new female patients attending the clinic in January 2006 had their notes reviewed to determine current contraception, adequacy of use and contraceptive advice given.

RESULTS

A total of 266 women were eligible for contraception. Overall, 148 (56%) of the women used reliable methods. Fifty-five (21%) women were using no contraception and not planning a pregnancy. The under-20s, over-30s and ethnic minorities were more likely to use inadequate or no contraception.

DISCUSSION AND CONCLUSIONS

Almost half (43%) the women attending our GUM clinic had inadequate or no contraception, and in addition documentation of contraceptive advice and further information was poor (5%). Young people and ethnic minorities seem particularly vulnerable and at present we are not addressing their contraceptive needs. We plan to conduct a prospective survey to assess this issue further and address feasibility for an on-site contraceptive service.

The features of patients attending walk-in compared with booked clinics for sexually transmitted infections

Few data are available on the comparison of access of patients at risk of sexually transmitted infections (STIs) to different models of genitourinary (GU) medicine services. The aim of this study was to compare the characteristics and STIs results of patients attending walk-in clinics with those of patients attending booked-in clinics in a department of GU medicine. The study was carried out at the Department of GUM at Walsall Manor Hospital. This was a prospective study on consecutive new patients attending first come first served walk-in and booked clinics between 1 January and 1 April 2006. Patients' demography, sexual behaviour and results of screening for STIs were recorded. During the study period, 346 and 234 patients attended walk-in and booked clinics, respectively. Default rate for booked clinics was 27%. Significantly higher proportions of patients attending walk-in clinics were screened for an STI. All patients with HIV (n = 2) or with trichomonal (n = 4) infections attended walk-in clinics. In regression analysis, patients with genitourinary symptoms were more likely to attend walk-in clinics (odds ratio [OR]: 2.371; [95% confidence interval [CI]: 1.545-3.639; P = 0.0005). There was no difference between the prevalence of STIs among patients attending either service model. In conclusion, there was no significant difference between the proportion of patients with or at-risk of STIs who attended booked and walk-in clinics.

Pathophysiology and therapeutic potential of purinergic signaling

The concept of a purinergic signaling system, using purine nucleotides and nucleosides as extracellular messengers, was first proposed over 30 years ago. After a brief introduction and update of purinoceptor subtypes, this article focuses on the diverse pathophysiological roles of purines and pyrimidines as signaling molecules. These molecules mediate short-term (acute) signaling functions in neurotransmission, mechanosensory transduction, secretion and vasodilatation, and long-term (chronic) signaling functions in cell proliferation, differentiation, and death involved in development and regeneration. Plasticity of purinoceptor expression in pathological conditions is frequently observed, including an increase in the purinergic component of autonomic cotransmission. Recent advances in therapies using purinergic-related drugs in a wide range of pathological conditions will be addressed with speculation on future developments in the field.

Management of recurrent genital herpes: a survey of UK genitourinary medicine clinics in 2003

We carried out a survey of all UK genitourinary (GU) medicine clinics, via postal questionnaire, in order to evaluate the current management of recurrent genital herpes (RGH) in the GU medicine setting. Respondents were invited to answer questions regarding various aspects of herpes simplex virus (HSV) management. There was a 62% response rate. Analysis of the returned surveys revealed that the vast majority of clinics (96%) provided drug treatment for RGH, with 81% having a clinic policy for the management of genital herpes (GH). A majority (64%) of clinics had access to some type of counselling or psychological therapy and 47% encouraged collaboration with primary care for follow-up prescribing. Of the clinics providing drug therapy for RGH, 80% used aciclovir alone with smaller numbers having access to aciclovir, famciclovir and valaciclovir. While many clinics are meeting the British Association of Sexual Health and HIV (BASHH) guidelines, improvements can be made to increase the availability of psychological support to patients with HSV and improve links with primary care.

Non-consultant career grade doctors in genitourinary medicine: as revalidation approaches, are some jobs at risk?

The Genitourinary Medicine Non-Consultant Career Grade Group (GUM NCCG Group) was established for the purpose of looking at training and contractual issues for this heterogeneous group of doctors. In June 2003, 700 questionnaires were posted to NCCG doctors in the UK to enquire about various aspects of working conditions. A summary of the 244 replies (35% response) is presented. Eighty-four (34%) had a job plan and 81 (33%) had had an appraisal. Just over one-third (38%) had time allocated for continuing medical education (CME), audit and administration. The response of employers to attempts by NCCGs to upgrade was poor. In all, 195 (80%) said they were registered for the purpose of continuing professional development (CPD), 43 (18%) were not and six people did not know whether they were registered or not. These results give cause for real concern at this point regarding revalidation pathways. Our survey highlights that NCCGs are disadvantaged in terms of appraisal, CPD and career progression and some jobs will be at risk as revalidation approaches.

Triage criteria in genitourinary medicine

An audit of triage was conducted between June and September 2003 in a district general hospital genitourinary medicine department to evaluate the appropriateness of triage criteria to identify those who require urgent intervention. We selected gonorrhoea (B1), chlamydia (C4a), gential herpes (C10a/b) and epidemiological treatment of contacts of B1 or C4a (C4e/B4) as conditions requiring urgent intervention. Eighty-eight percent met one or more of the criteria and were offered urgent appointments and 69% who did not meet the criteria were offered routine appointments. The incidences of B1, C4a, C10a/b and C4e/B4 were 26.5%, 21.2%, 16.8% and 8% respectively in the urgent group compared with corresponding incidences of 4.4% and 16.2% respectively in the routine group. No cases of C10a/b or C4e/B4 were seen in the latter group. Although triage criteria did not identify asymptomatic infections, efficient contact tracing will improve detection of asymptomatic carriers of infections and should be encouraged. The outcome of the audit informed modifications to the criteria and reinforced the need for staff training in triage. In the United Kingdom, genitourinary medicine must be urgently prioritized and invested in, to improve access to all who need to be seen within 48 h of contacting the service.

Trichomonas vaginalis in a Sheffield genitourinary medicine department

The case-notes of all patients who were diagnosed with a first episode of Trichomonas vaginalis (TV) between 1 October 2002 and 30 September 2003 were reviewed. A total of 78 patients were suitable for inclusion in the study. Analysis of their notes revealed that, although the majority of patients presented with symptoms, 15% (n=12) of cases were asymptomatic. A raised vaginal pH was found in 94% (n=47) of the patients in whom it was measured. In all, 97% (n=76) of patients received treatment in accordance with UK national guidelines and, in those tested, initial treatment was found to be 95% (n=57) successful. Treatment of at least one contact could only be confirmed in 27% (n=21) of cases. The implications for future management of TV are discussed.

Revised medical criteria for evaluating genitourinary impairments. Final rules

We are revising the criteria in the Listing of Impairments (the listings) that we use to evaluate claims involving genitourinary impairments. We apply these criteria when you claim benefits based on disability under title II and title XVI of the Social Security Act (the Act). The revisions reflect advances in medical knowledge, treatment, and methods of evaluating genitourinary impairments.

Treatment of Chlamydia trachomatis in North Thames region 2003

Following on from the survey of techniques used for testing chlamydia, a multi-centre re-audit of the treatment of C. trachomatis in genitourinary clinic attendees in the North Thames region from February to March 2003 was performed. This showed an improvement since our previous audit with a significant increase in the number of centres following national guidelines in antibiotic prescribing and offering test of cure in clinically indicated cases.

Training in genitourinary medicine from the specialist registrar's point of view: opportunities and facilities available across the UK and plans for future working

In recent years training for specialist registrars (SpRs) in GU medicine has undergone a number of changes. In addition, the speciality in general is undergoing modernization and change and issues of workforce planning and consultant job availability have been of particular importance to SpRs. In March 2003 a postal survey of SpRs in the UK was undertaken to evaluate training, future career plans and working patterns. A 59% (69/117) response rate was achieved and overall most SpRs expressed satisfaction with their training. However, a number of concerns were raised with aspects of training, which are discussed in this paper. Nearly half of SpRs will consider working part time in the future and almost two-thirds are interested in job sharing. This is the first survey of its kind in GU medicine and the results are informative to all involved with SpR training programmes and workforce planning in the speciality.

Screening for hepatitis C in genito-urinary medicine clinics: a cost utility analysis

BACKGROUND/AIMS

To estimate the cost utility (cost per QALY) of screening for hepatitis C (HCV) infection in people attending genito-urinary medicine clinics in England.

METHODS

An epidemiological model of screening and diagnosis was combined with a Markov chain model of treatment with combination therapy to estimate cost utility. Parameters for the model were informed by literature review, expert opinion and a survey of current screening practice.

RESULTS

The base case estimate was about pound 85,000 per QALY. Selective screening is more cost effective. If screening is restricted to only 20% or 10% of attenders, cost utility is estimated as pound 39,647 and pound 34,288 per QALY. If screening is restricted only to those with a history of injecting drug use, cost utility would be pound 27,138 per QALY. Estimates are particularly sensitive to acceptance rates for screening and treatment.

CONCLUSIONS

Universal screening for HCV in GUM clinics is unlikely to be cost effective. There is limited evidence to support screening of people other than those with a history of injecting drug use and even this policy should be considered with some care and in the context of further research.

Quality of working life in genitourinary medicine

Quality issues are becoming increasingly relevant to the working lives of health care staff. We sought to assess the perceived work-related quality of life of staff working in a genitourinary medicine (GUM) department using a self-administered anonymous questionnaire focusing on areas from the Trust's staff charter. Over two-thirds (69%) of the staff members participated. Perceptions of working life were generally good within GUM. In particular staff felt valued as a resource with free expression of ideas, involvement in decision making, fair treatment and respect. Weaker areas were identified enabling a plan to be developed to address these. It is important to address quality in working life in order to achieve improvements.

Medical workforce speciality review for genitourinary medicine 2001/2002-England, wales, northern ireland and Scotland

This document addresses medical workforce needs for the speciality of Genitourinary Medicine (GUM) for the next 10 years. Data on current consultant numbers, working patterns and retirement are based on information from the Royal College of Physicians (RCP) Workforce Unit annual census undertaken on 30 September 2000. Information on specialist registrars is from the JCHMT. Senior house officers (SHO) data are from the RCP's General Professional Training department. Data on Non-Consultant Career Grade Doctors is from the Association of Genitourinary Medicine Survey. Data on incidence of Sexually Transmitted Infections (STIs) are from KC60 returns on STIs collected from GUM clinics by CDSC. There is considerable movement of doctors in GUM between countries in the UK both during progression from SpR to consultant and at consultant level. Data are therefore presented as amalgamated UK data and also by country. It is essential that workforce planning takes this lateral movement into consideration when undertaking calculations for future workforce requirements.