1
|
Li L, Adeyemi-Fowode O, Bercaw-Pratt JL, Hakim J, Dietrich JE. Surgical Management of OHVIRA and Outcomes. J Pediatr Adolesc Gynecol 2024; 37:198-204. [PMID: 38070700 DOI: 10.1016/j.jpag.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/12/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023]
Abstract
STUDY OBJECTIVE Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) includes uterine didelphys, unilateral obstructed hemivagina, and ipsilateral renal anomaly. Surgical management of this condition relies on accurate diagnosis to excise the obstructed longitudinal vaginal septum (OLVS). Vital considerations involve identifying the side affected, ipsilateral renal anomaly (IRA), thickness of the septum (TS), septal axis (SA), and distance of the septum to perineum (DSP). The study aimed to evaluate the preoperative characteristics, imaging findings, and surgical outcomes of OHVIRA. METHODS Institutional review board approval was obtained for this retrospective chart review. ICD-10 codes identified OHVIRA cases between 2012 and 2019 at a single children's hospital. Patient demographic characteristics, magnetic resonance imaging findings, surgical management, outcomes, and complications were reviewed. Descriptive statistics were utilized. RESULTS Twenty-six patients met inclusion criteria. Most were diagnosed at puberty (92%). Abdominal pain (50%) was the most common presenting complaint. The mean age of diagnosis was 13.2 years overall and 11.2 years for those with regular cycles vs 13.4 years for those with irregular cycles. Preoperative imaging showed predominant right-sided OLVS (50%), IRA (77%), and oblique SA (65%). All patients underwent vaginoscopy, septum resection, and vaginoplasty, except 1 who was managed with an abdominal drain as a neonate. Four required postoperative vaginal stent or Foley, with DSP greater than 5 cm in all cases. One intraabdominal abscess complication occurred. No instances of hematocolpos re-accumulation or reoperation were observed during the 3-year follow-up period. CONCLUSION This study demonstrates that detailed preoperative planning and a systematic surgical approach lead to favorable outcomes in OHVIRA irrespective of the OLVS laterality, TS, SA, or DSP.
Collapse
Affiliation(s)
- Lucy Li
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Oluyemisi Adeyemi-Fowode
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Jennifer L Bercaw-Pratt
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Julie Hakim
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Division of Pediatrics, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
2
|
|
3
|
Perkins N. Vaginal atrophy and genital pain in women on depot medroxyprogesterone acetate contraceptive injection. Aust N Z J Obstet Gynaecol 2024; 64:160-164. [PMID: 37817446 DOI: 10.1111/ajo.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
Depot medroxyprogesterone acetate causes a hypo-estrogenic state in over half of users although clinical vaginal atrophy causing superficial dyspareunia is thought rarely to occur. This is a case series of ten women using depot medroxyprogesterone acetate who presented with superficial dyspareunia and clinical vaginal atrophy. The women were treated with vaginal estriol cream and their contraception was discontinued or changed. All patients had either a complete resolution of symptoms or a substantial improvement at follow-up, and the clinical and laboratory findings of vaginal atrophy had resolved. This case series demonstrates that vaginal atrophy may occur more frequently than previously thought.
Collapse
Affiliation(s)
- Nicky Perkins
- Auckland Sexual Health Service, Te Whatu Ora/Te Toka Tumai, Auckland, New Zealand
| |
Collapse
|
4
|
Florez N, Kiel L, Meza K, Wei Z, Mazzola E, Velazquez AI, Franco I, Fidler MJ, Elkins I, Feldman J, Seaborne L, Heisler C, King JC, Moore A, Wiens J, Kushner D. Sexual Health Assessment in Women with Lung Cancer study: Sexual health assessment in women with lung cancer. Cancer 2024; 130:375-384. [PMID: 37843054 DOI: 10.1002/cncr.35057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Sexual health is understudied and underreported in patients with lung cancer, and most data precede the approval of widely used targeted therapies and immune checkpoint inhibitors. The authors sought to evaluate the prevalence of sexual dysfunction in women with lung cancer in our current clinical environment. METHODS This cross-sectional survey study was administered online to 249 women via the GO2 for Lung Cancer (GO2) Registry, using the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction Measures questionnaire. Participants were recruited between June 2020 to June 2021. Eligibility criteria included age >18 years, self-identifying as a woman, fluency in English, and a lung cancer diagnosis within 10 years. RESULTS Most (67%) had stage IV lung cancer and 47% were receiving targeted therapy; 66% were undergoing active treatment. Despite 54% of participants reporting "recent" sexual activity, most (77%) indicated having little to no interest in sexual activity and 48% reported recent minimal satisfaction with their sex life. The most common reasons negatively affecting participants' satisfaction with their sex life included fatigue (40%) and feeling sad/unhappy (28%). Common reasons for lack of recent sexual activity included lack of interest (68%) and vaginal dryness or pain (30%). Compared to pre-diagnosis, women were significantly less likely to have recent interest in sexual activity. In multivariable logistic-regression, vaginal dryness showed a significant negative association with recent interest in sexual activity. CONCLUSIONS Sexual dysfunction is prevalent in women with lung cancer. Sexual health should be integrated into routine care for patients with lung cancer.
Collapse
Affiliation(s)
- Narjust Florez
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lauren Kiel
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kelly Meza
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Zihan Wei
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Ana I Velazquez
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Idalid Franco
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | | | | - Amy Moore
- LUNGevity Foundation for Lung Cancer, Bethesda, Maryland, USA
| | | | | |
Collapse
|
5
|
Sartore A, Scalia MS, Mangino FP, Savastano G, Magni E, Ricci G. Pelvic floor function after third and fourth degree perineal lacerations: a case-control study on quality of life. BMC Womens Health 2024; 24:12. [PMID: 38172805 PMCID: PMC10765914 DOI: 10.1186/s12905-023-02739-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 10/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The primary aim of this study was to compare the quality of life between women with obstetric anal sphincter injury (OASI) and women with intact perineum or minor vaginal tears following their first vaginal birth through a validated urogynaecological questionnaire. As a secondary aim, we wanted to identify the specific symptoms for pelvic floor dysfunction after a vaginal birth. METHODS One hundred thirty-three cases (III- and IV-degree vaginal tears) and 133 controls (intact perineum or I- and II-degree vaginal tear) were asked to fill the PFDI-20 condition-specific and quality of life survey at three and 12 months after vaginal delivery. The survey evaluates pelvic floor dysfunction symptoms through three subsections: the Pelvic Organ Prolapse Distress Inventory (POPDI), the Colorectal-Anal Distress Inventory (CRADI), and Urinary Distress Inventory, (UDI). The scoring system ranges from 0 (no distress) to 100 (maximum distress) for each subsection, subsequently summed up to obtain the summary score (0 to 300). The patients recruited were asked to complete the survey at 3- and 12-months follow-up visit. Accordingly, data collection started. Categorical variables were subjected to Chi-square test or Fisher's Exact test. Quantitative variables were compared through Student's t-test or Mann-Whitney test. RESULTS All surveys have shown statistically significant differences when comparing the cases to the control group. Consequently, PFDI-20 has shown a strong correlation between III- and IV-grade lacerations and pelvic floor dysfunction persistence at 12 months after delivery. Intestinal symptoms were the most reported disturbances among women with previous OASI. CONCLUSIONS Major vaginal tears have demonstrated to have a strong impact on women's quality of life up to a follow-up of 12 months. The use of PFDI-20 questionnaire is a useful and valid tool in the diagnosis and follow-up of genital prolapse, fecal and urinary incontinence in primiparous women with a history of OASI. Thus, its application in clinical practice can help offering the most adequate rehabilitative treatment.
Collapse
Affiliation(s)
- Andrea Sartore
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137, Trieste, Italy
| | - Maria Sole Scalia
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137, Trieste, Italy.
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127, Trieste, Italy.
| | | | - Giulia Savastano
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127, Trieste, Italy
| | - Elena Magni
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127, Trieste, Italy
| |
Collapse
|
6
|
Bevilacqua F, Selk A, Stockdale C, Vieira-Baptista P, Adedipe T, Bohl T, Marozio L, Borella F, Gallio N, Pollano B, Robba E, Barbierato I, Benedetto C, Preti M. The International Society for the Study of Vulvovaginal Disease (ISSVD) Vulvar Awareness Day Campaign: Knowledge of Vulvo vaginal Diseases Among Italian Obstetrics and Gynecology Residents. J Low Genit Tract Dis 2024; 28:91-94. [PMID: 37906606 DOI: 10.1097/lgt.0000000000000777] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVES The objective of this study is to investigate vulvovaginal disease (VVD) awareness in Italian obstetrics and gynecology (Ob/Gyn) residents. MATERIALS AND METHODS A 25-question survey on VVD basic knowledge (17 questions) and willingness to improve it (8 questions) was distributed through Ob/Gyn resident online group chats, from different Italian Universities in January 2023. A total number of 250 residents were invited to participate; 124 responses were obtained (response rate: 50%). Data were collected and analyzed using descriptive statistics through REDCap. RESULTS Overall, 87 of the 124 respondents (70%) fully completed the questionnaire and represented the study group. Residents were distributed among years of residency: 15% first year, 31% second year, 23% third year, 11% fourth year, and 20% fifth year. Most (60%) never attended a VVD clinic during residency, with an increasing percentage of attendance in later residency years (15% at first year vs 65% at fifth).Participants reported low knowledge of vulvar precancerous lesions and vulvoscopy but better knowledge of vaginitis, vulvar self-examination, and lichen sclerosus. Of the respondents, 50% were not satisfied with the education provided during residency, and more than 60% lacked confidence in managing VVD.All participants expressed a strong desire to improve their knowledge and skills, with 100% agreeing that every gynecologist should know the "basics" and 98% wanting to improve their knowledge through webinars (45%), lessons (34%), newsletters, and videos (19%). CONCLUSION Our findings indicate a significant need to improve VVD knowledge among Italian Ob/Gyn residents. Further efforts are necessary to provide information about VVD and comprehensive training programs in Italian Universities.
Collapse
Affiliation(s)
| | - Amanda Selk
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Tolu Adedipe
- Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
| | - Tanja Bohl
- Vulva Clinic, Jean Hailes Medical Centre, Clayton, Victoria, Australia
| | - Luca Marozio
- Department of Surgical Sciences University of Torino, Torino, Italy
| | - Fulvio Borella
- Department of Surgical Sciences University of Torino, Torino, Italy
| | - Niccolò Gallio
- Department of Surgical Sciences University of Torino, Torino, Italy
| | | | - Eleonora Robba
- Department of Surgical Sciences University of Torino, Torino, Italy
| | | | - Chiara Benedetto
- Department of Surgical Sciences University of Torino, Torino, Italy
| | - Mario Preti
- Department of Surgical Sciences University of Torino, Torino, Italy
| |
Collapse
|
7
|
Shao Y, Sun K, Yang M, Chang J. Vulvar-vaginal-gingival-otic syndrome. Exp Dermatol 2024; 33:e14912. [PMID: 37612855 DOI: 10.1111/exd.14912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/23/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Abstract
In order to retrospectively analyse the multi-site involvement pattern of erosive lichen planus patients, we retrospectively reported the clinical and medical data of three patients with erosive lichen planus which involving their vulva, vagina, gingiva, and ear canal. We confirmed the existence of otic lichen planus, and found that it is more common in patients with vulvovaginal-gingival syndrome of erosive lichen planus. Therefore, we propose 'vulvovaginal-gingival-otic syndrome' to further describe this rare compound pattern of lichen planus.
Collapse
Affiliation(s)
- Yakun Shao
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Kailv Sun
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Min Yang
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianmin Chang
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
8
|
Han L, Wang Z, Shi G, Zheng A, Ruan J. Minimally Invasive Surgery for Transverse Vaginal Septum in an Adolescent Girl. J Minim Invasive Gynecol 2023; 30:774-775. [PMID: 37369344 DOI: 10.1016/j.jmig.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Ling Han
- Department of Obstetrics and Gynecology (all authors), West China Second Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China (all authors)
| | - Zhaowei Wang
- Department of Obstetrics and Gynecology (all authors), West China Second Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China (all authors); West China Xiamen hospital of Sichuan University, Xiamen Fujian, China (Wang)
| | - Gang Shi
- Department of Obstetrics and Gynecology (all authors), West China Second Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China (all authors)
| | - Ai Zheng
- Department of Obstetrics and Gynecology (all authors), West China Second Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China (all authors)
| | - Jiaying Ruan
- Department of Obstetrics and Gynecology (all authors), West China Second Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China (all authors).
| |
Collapse
|
9
|
Day T, Selim MA, Allbritton JI, Scurry J. Nonsclerotic Lichen Sclerosus: Definition of a Concept and Pathologic Description. J Low Genit Tract Dis 2023; 27:358-364. [PMID: 37467474 PMCID: PMC10545066 DOI: 10.1097/lgt.0000000000000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Nonsclerotic lichen sclerosus (NSLS) refers to the clinicopathologic situation of examination findings consistent with lichen sclerosus (LS) but without dermal sclerosis on microscopy. This review aims to describe the features of NSLS and provide a classification framework. METHODS The International Society of the Study of Vulvovaginal Diseases tasked the Difficult Pathologic Diagnoses Committee with development of consensus documents for conditions with problematic histopathology. The Difficult Pathologic Diagnoses Committee reviewed the literature on NSLS and formulated descriptions and diagnostic criteria, then approved by the International Society of the Study of Vulvovaginal Diseases membership. RESULTS Nonsclerotic LS may be categorized into 4 histopathologic subtypes: lichenoid dermatitis, hypertrophic lichenoid dermatitis, dermal fibrosis without acanthosis, and dermal fibrosis with acanthosis. Each has a pathologic differential diagnosis of 1 or more entities, so clinical correlation is required for final diagnosis of LS. There is no evidence to support a reliable association between absent sclerosis and clinical appearance, duration, or oncogenic potential of LS. CONCLUSIONS Pathologists and clinicians should be familiar with the concept of NSLS and its implications for patient management. Use of the term "early LS" to indicate a lack of sclerosis in presumed LS should be abandoned. Clinical correlation is required to confirm LS from among the differential diagnoses.
Collapse
Affiliation(s)
- Tania Day
- University of Newcastle, Newcastle, New South Wales, Australia
- John Hunter Hospital, Newcastle, New South Wales, Australia
| | | | | | - James Scurry
- University of Newcastle, Newcastle, New South Wales, Australia
- New South Wales Health Pathology, Hunter New England, Newcastle, New South Wales, Australia
| |
Collapse
|
10
|
Forret A, Mares P, Delacroix C, Chevallier T, Potier H, Fatton B, Masia F, Ripart S, Letouzey V, de Tayrac R, Salerno J. [Photobiomodulation and vulvovaginal disorders after anticancer treatments]. Bull Cancer 2023; 110:883-892. [PMID: 37183056 DOI: 10.1016/j.bulcan.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 05/16/2023]
Abstract
Anticancer treatments induce vulvovaginal complications that alter the quality of life and sexuality of patients. New technologies, such as photobiomodulation, could address this problem, for which few effective therapeutic solutions exist. The objective of this study was to describe the characteristics of patients seeking treatment and to observe the effects of photobiomodulation. This is a prospective cohort of patients treated for cancer, in failure of first-line medical treatment, managed at the University Hospital of Nîmes. The history, symptoms and impact of the disorders on their quality of life were collected. At follow-up, improvement was assessed using the PGI-I and FSFI questionnaires. Twenty-eight patients were treated. They were all menopausal, half of them after anticancer treatments [chemotherapy (78%), radiotherapy (36%), hormone therapy (36%)]. The main symptom reported was vaginal dryness (72%). Seventy-one percent of patients (n=20) felt that their daily life was affected≥8/10. All patients had sexual dysfunction. Twenty-two patients received at least 6 sessions of photobiomodulation. Seventy-two percent (n=18) of patients felt better or much better after treatment (PGI-I≤2). The median improvement estimated by the patients was 65% (Q1=50%; Q3=72.5%). There was also a significant clinical improvement. No serious adverse events were reported. Due to the small number of patients in a heterogeneous population with no control group, we cannot extrapolate our results. However, the objective was to assess the status of these pathologies and the contribution of photobiomodulation in patients who have failed first-line treatment; and these results are encouraging.
Collapse
Affiliation(s)
- Amaury Forret
- CHU Amiens-Picardie, service de gynécologie-obstétrique, 1, rue du Professeur-Christian-Cabrol, 80000 Amiens, France.
| | - Pierre Mares
- CHU de Nîmes, service de gynécologie-obstétrique, 4, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | - Charlotte Delacroix
- CHU de Nîmes, service de gynécologie-obstétrique, 4, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | - Thierry Chevallier
- CHU de Nîmes, service BESPIM, 4, rue du Professeur-Robert-Debré, 30900 Nîmes, France; Université de Montpellier, Institut Desbrest d'épidémiologie et de santé publique, UMR 1302, UMR Inserm, Montpellier, France
| | - Hugo Potier
- CHU de Nîmes, service BESPIM, 4, rue du Professeur-Robert-Debré, 30900 Nîmes, France; Université de Montpellier, Institut Desbrest d'épidémiologie et de santé publique, UMR 1302, UMR Inserm, Montpellier, France
| | - Brigitte Fatton
- CHU de Nîmes, service de gynécologie-obstétrique, 4, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | - Florent Masia
- CHU de Nîmes, service de gynécologie-obstétrique, 4, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | - Sylvie Ripart
- CHU de Nîmes, service de gynécologie-obstétrique, 4, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | - Vincent Letouzey
- CHU de Nîmes, service de gynécologie-obstétrique, 4, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | - Renaud de Tayrac
- CHU de Nîmes, service de gynécologie-obstétrique, 4, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | - Jennifer Salerno
- CHU de Nîmes, service de gynécologie-obstétrique, 4, rue du Professeur-Robert-Debré, 30900 Nîmes, France; Service de chirurgie gynécologique, Clinique Beau-Soleil, 119, avenue de Lodeve, 34070 Montpellier, France
| |
Collapse
|
11
|
Barbero M, Villasco A, Villa M, Badellino E, Marello E, Botta G. Conjugate treatment with high concentration normobaric oxygen and hyaluronic acid for vaginal atrophy: a prospective study. Eur Rev Med Pharmacol Sci 2023; 27:2011-2017. [PMID: 36930500 DOI: 10.26355/eurrev_202303_31567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Vulvovaginal atrophy is a condition closely related to low circulating estrogen levels, with post-menopause being the main cause. However, patients of childbearing age may also present with these symptoms due to treatments that reduce estrogen production. Local estrogen therapy is the causal treatment of local symptoms, but it is not always accepted and is often abandoned by patients. In recent years, alternative therapies have been proposed: fractional CO2 laser or the conjugate treatment with normobaric oxygen and hyaluronic acid, the latter being the subject of this study. The study aimed to evaluate the effectiveness of conjugate topical treatment with normobaric oxygen and hyaluronic acid. PATIENTS AND METHODS 50 patients were evaluated and treated with 5 applications of 15 minutes each, every 15 days, with Caressflow®. All patients presented at least one of the symptoms related to vulvovaginal atrophy: dryness, burning, and dyspareunia. In all cases, vulvoscopy, colposcopy, and cervicovaginal cytology were performed. The patients were interviewed with an analogic scale (VAS) concerning the severity of symptoms before and after the treatment. Colposcopy and PAP-smear were assessed by mean of Vaginal Health Index Score (VHI) at baseline and at the end of the treatment. RESULTS All patients completed the treatment scheme and presented with a significant improvement in subjective symptoms. The colposcopy and PAP-smear performed 10 days after the end of the last treatment showed a significant improvement in the appearance and elasticity of the vaginal epithelium and the cytological picture, which showed, in the sample taken after treatment, hyaluronic acid vesicles within the cell cytoplasm. CONCLUSIONS This study corroborates the data presented in the latest published papers on the effectiveness of treatment with normobaric O2 and hyaluronic acid on vaginal atrophy. Efficacy has been confirmed both in terms of subjective symptoms reported by the patients and objective improvement at colposcopy and PAP-smear cytology.
Collapse
Affiliation(s)
- M Barbero
- Obstetrics and Gynaecology Complex Unit, Cardinal Massaia Hospital, ASL AT, Asti, Italy.
| | | | | | | | | | | |
Collapse
|
12
|
Fallahipour L, Nazari M, Karimi M, Zare E. Effectiveness of Educational Intervention Based on Transtheoretical Model on Physical Activity and Menopausal Symptoms. Biomed Res Int 2022; 2022:1791445. [PMID: 36560963 PMCID: PMC9767743 DOI: 10.1155/2022/1791445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022]
Abstract
Introduction Menopause is an inevitable part of women's lives. Physical activity as nonhormonal therapy can decrease the symptoms of menopause. This study is aimed at investigating the effect of educational intervention based on the transtheoretical model (TTM) on physical activity and menopausal symptoms of female clients of the health center in Pasargad City, Iran. Methods This quasi-experimental study was performed on 140 females admitted to health center of Pasargad City, Fars Province, Iran (intervention = 70 and control = 70). The data collection tool consisted of demographic data, menopause rating scale, international physical activities questionnaire, and TTM questionnaire (stages of change, processes of change, decision-making balance, and self-efficacy) that were completed before and two months after intervention. For intervention group, the educational program was implemented during 5 sessions of 50-55 min. Data were analyzed by SPSS 25 and by using Chi-square test, independent t-test, and paired t-test. Results After intervention, the mean scores of physical symptoms are sleep problems, muscle problems and discomfort, psychological symptoms, depression, irritability, and anxiety of intervention group decreased significantly post intervention (p < 0.001). Analysis showed that psychological symptoms, mental fatigue, somatic, and urogenital symptoms, and vaginal dryness increased 2 months after the intervention. Also, the mean score of cons, pros, decision balance, self-efficacy, consciousness raising, dramatic relief, environmental reevaluation, and self-reevaluation have significant changed in intervention group (p < 0.05). In addition, the top percent of progress can be seen in contemplation (31. 5%). Conclusion This study showed the effectiveness of educational intervention based on TTM to reduce menopausal symptoms and promote physical activity in postmenopausal women.
Collapse
Affiliation(s)
- Leila Fallahipour
- Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahin Nazari
- Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Karimi
- Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elahe Zare
- Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
13
|
Ayyash M, Miller M, Hijaz M. Evaluation of a microperforate hymen leading to the incidental diagnosis of a borderline ovarian tumour. BMJ Case Rep 2022; 15:e252017. [PMID: 36319036 PMCID: PMC9628543 DOI: 10.1136/bcr-2022-252017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Microperforate hymens are rare anatomical variants with an unknown incidence and very few reported cases. Borderline ovarian tumours are similarly uncommon, with an incidence of approximately 0.002%-0.006%. The concurrent presence of a microperforate hymen and a borderline ovarian tumour is therefore exceedingly unique with no documented cases to date. In this report, we review the case of a nulliparous woman in her late 20s who initially presented with an inability to have penetrative intercourse. A subocclusive hymenal variant was noted on examination and further imaging work-up resulted in the incidental discovery of a large ovarian mass subsequently noted to be a borderline ovarian tumour. Herein, we review contemporary approaches to the diagnosis and management of both hymenal variants and borderline ovarian tumours, and discuss fertility-sparing strategies for young women diagnosed with ovarian neoplasms.
Collapse
Affiliation(s)
- Mariam Ayyash
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Madison Miller
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Miriana Hijaz
- Department of Women's Health, Division of Gynecologic Oncology, Henry Ford Health System, Detroit, Michigan, USA
| |
Collapse
|
14
|
Thomas MA, Morlock R, Dart C, Howard B. Sexual Satisfaction Results With the Vaginal pH Modulator From the Phase 3 AMPOWER Study. J Sex Med 2022; 19:975-982. [PMID: 35418329 DOI: 10.1016/j.jsxm.2022.03.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/22/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The novel vaginal pH modulator (VPM; Phexxi) is a non-hormonal, woman-controlled, on-demand, water-based, surfactant-free contraceptive vaginal gel; VPM has also been cleared by the Food and Drug Administration for use as a personal lubricant. AIM The aim of this study is to report on sexual satisfaction results from the phase 3 AMPOWER study. METHODS AMPOWER was a single-arm, open-label, multicenter study to assess the safety and efficacy of VPM in preventing pregnancy. Women were enrolled who were healthy, age 18-35 years, and sexually active with regular cyclic menses. OUTCOMES Women's satisfaction (including sexual satisfaction) was an exploratory endpoint measured at Baseline and Visits 3-5; sexual satisfaction-related patient reported outcomes (PROs) were assessed via 3 different questions: (i) a question related to the impact on a woman's sex life; (ii) a question from the Sexual Function Questionnaire (SFQ) related to the frequency of ten sexual problems; and (iii) a question from the Female Sexual Function Index (FSFI) related to lubrication. RESULTS For sexual satisfaction-related PRO measures with baseline assessments, the majority of women reported the same or improved scores at Visit 5 (ranging from 85.8% to 98.4%). The percentage of women who reported that their sex life was improved and/or maintained was higher in Visit 3, 4, and 5 (95.4%, 95.1%, and 93.6%, respectively) compared to Baseline (87.6%). The mean impact on sex life score significantly improved at Visit 5 compared to Baseline (P < .001). In the SFQ, the mean score significantly improved (P < .005) at Visit 5 vs Baseline in 7 of the 10 variables measured (vaginal dryness, lack of sexual interest and/or desire, vaginal tightness, pain, anxiety, unable to orgasm, and vaginal bleeding or irritation). In women who reported sexual activity in the last 4 weeks, the mean FSFI score also significantly improved from Baseline to Visit 5 (P = .037). CLINICAL IMPLICATIONS In this post-hoc analysis of the phase 3 AMPOWER study, the PRO results demonstrate a high level of sexual satisfaction with VPM. STRENGTHS AND LIMITATIONS The primary strength of this analysis was the large study size of 1,330 women. Limitations included the non-randomized study design, the post-hoc nature of the analysis, and the fact that sexual satisfaction was an exploratory endpoint. CONCLUSION As a non-hormonal, woman-controlled, on-demand, lubricating contraceptive gel, VPM offers women a unique set of benefits with positive impacts on their sexual health. Thomas MA, Morlock R, Dart C, Howard B. Sexual Satisfaction Results With the Vaginal pH Modulator From the Phase 3 AMPOWER Study. J Sex Med 2022;19:975-982.
Collapse
|
15
|
Liu Y, Yuan Y, Day AJ, Zhang W, John P, Ng DJ, Banov D. Safety and efficacy of compounded bioidentical hormone therapy (cBHT) in perimenopausal and postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Menopause 2022; 29:465-482. [PMID: 35357369 DOI: 10.1097/gme.0000000000001937] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022]
Abstract
IMPORTANCE More information is needed about the efficacy and safety of compounded bioidentical hormone therapy (cBHT) in the published literature. A thorough synthesis of existing data is not currently available. OBJECTIVE To provide a systematic review and meta-analysis of the existing evidence related to the safety and efficacy of commonly prescribed cBHT preparations in perimenopausal and postmenopausal women. EVIDENCE REVIEW PubMed, ClinicalTrials.gov, and The Cochrane Central Register of Controlled Trials were searched. Randomized controlled trials (RCTs) comparing cBHT with a placebo or FDA-approved products in perimenopausal or postmenopausal women were eligible. The risk of bias was assessed by the Cochrane risk of bias tool. The primary safety outcome was changes in lipid profile and glucose metabolism, and the primary efficacy outcome was the change of vaginal atrophy symptoms. The secondary outcomes included the change of endometrial thickness, risk of adverse events, vasomotor symptoms, change of serum hormone levels, and change of bone mineral density. FINDINGS A total of 29 RCTs reported in 40 articles containing 1,808 perimenopausal and postmenopausal women were included. Two risk factors of cardiovascular disease, lipid profile, and glucose metabolism, were evaluated with cBHT. The results showed that compounded androgen was not associated with change of lipid profile or glucose metabolism. There was no change in endometrial thickness or serious adverse events. There were more androgenic side effects with compounded dehydroepiandrosterone compared with placebo as expected. Other safety measures including clinical cardiovascular events, endometrial biopsy, and risk of breast cancer were not studied. cBHT in the form of compounded vaginal androgen was found to significantly improve vaginal atrophy symptoms (SMD -0.66 [95% CI, -1.28 to -0.04]; I2 = 86.70%). This finding was supported by the association between compounded vaginal androgen and improved female sexual function scores. The changes of serum hormone levels were also evaluated. Despite the variations in absorption from different types of compounded hormones, routes, and strengths, the trends were consistent with published data from FDA-approved products. CONCLUSIONS AND RELEVANCE This review found that cBHT used in primarily short-term RCTs is not associated with adverse changes in lipid profile or glucose metabolism. cBHT in the form of vaginal androgens appears beneficial for vaginal atrophy symptoms. There are insufficient RCTs of cBHT to assess clinical risk of breast cancer, endometrial cancer, or cardiovascular disease. Long-term studies with clinical endpoints are needed.
Collapse
Affiliation(s)
- Yi Liu
- Professional Compounding Centers of America (PCCA), Houston, TX
| | - Ying Yuan
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - A J Day
- Professional Compounding Centers of America (PCCA), Houston, TX
| | - Wen Zhang
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Princy John
- Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX; and
| | - Danielle J Ng
- College of Pharmacy, University of Houston, Houston, TX. Funding/support: None reported
| | - Daniel Banov
- Professional Compounding Centers of America (PCCA), Houston, TX
| |
Collapse
|
16
|
Chen R, Wang JY, Lv K. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women. JAMA 2022; 327:283. [PMID: 35040891 DOI: 10.1001/jama.2021.22305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rong Chen
- Department of Gynecology and Obstetrics, Tenth People's Hospital, Shanghai, China
| | - Jing Yan Wang
- Department of Plastic Surgery, Xinhua Hospital, Shanghai, China
| | - Kaiyang Lv
- Department of Plastic Surgery, Xinhua Hospital, Shanghai, China
| |
Collapse
|
17
|
Ngenda N. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women. JAMA 2022; 327:283. [PMID: 35040892 DOI: 10.1001/jama.2021.22302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Neroli Ngenda
- Royal Brisbane & Women's Hospital, University of Queensland, Brisbane, Australia
| |
Collapse
|
18
|
Li FG, Nesbitt-Hawes E, Abbott JA. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women-Reply. JAMA 2022; 327:284-285. [PMID: 35040889 DOI: 10.1001/jama.2021.22308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Fiona G Li
- School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - Jason A Abbott
- School of Women's and Children's Health, Sydney, New South Wales, Australia
| |
Collapse
|
19
|
Veron L, Wehrer D, Uzan C. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women. JAMA 2022; 327:283-284. [PMID: 35040893 DOI: 10.1001/jama.2021.22299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lucie Veron
- Cancer Medicine Department, Gustave Roussy Institute, Villejuif, France
| | - Delphine Wehrer
- Cancer Medicine Department, Gustave Roussy Institute, Villejuif, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
20
|
Aboueddahab Z, Guelzim K, Kouach J. Familial occurrence of concomitant imperforate hymen and transverse vaginal septum: a case report. Pan Afr Med J 2022; 42:207. [PMID: 36284573 PMCID: PMC9547026 DOI: 10.11604/pamj.2022.42.207.33418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/07/2022] [Indexed: 11/19/2022] Open
Abstract
The imperforate hymen and transverse vaginal septum are female reproductive tract abnormalities. Their concurrent occurrence is rare. So far, no manifestation of both anomalies within the same family has been reported in the literature. We report the first familial case of two sisters having both mentioned abnormalities. Our patient was the youngest sister of a 14-year-old, who presented with cyclic lower abdominal pain. Clinical and imaging examinations showed an imperforate hymen with hematometrocolpos. In addition, the surgery confirmed a low transverse vaginal septum, which was resected using a virginity-preserving procedure. In conclusion, the presence of both mentioned abnormalities between siblings reflects a potential genetic etiology, also in order to avoid late diagnostics of such anomalies, the imperforate hymen must be screened in the birth room.
Collapse
Affiliation(s)
- Zineb Aboueddahab
- Department of Gynecology and Obstetrics, Military Instruction Hospital Mohammed V, Rabat, Morocco
- Corresponding author: Zineb Aboueddahab, Department of Gynecology and Obstetrics, Military Instruction Hospital Mohammed V, Rabat, Morocco.
| | - Khalid Guelzim
- Department of Gynecology and Obstetrics, Military Instruction Hospital Mohammed V, Rabat, Morocco
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V university, Rabat, Morocco
| | - Jaouad Kouach
- Department of Gynecology and Obstetrics, Military Instruction Hospital Mohammed V, Rabat, Morocco
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V university, Rabat, Morocco
| |
Collapse
|
21
|
Affiliation(s)
- Marisa Adelman
- Department of Obstetrics and Gynecology, The University of Utah School of Medicine, Salt Lake City
| | - Ingrid E Nygaard
- Department of Obstetrics and Gynecology, The University of Utah School of Medicine, Salt Lake City
| |
Collapse
|
22
|
Frishman GN. A septum is not always a septum: diagnosis and management of vaginal longitudinal septums via a video presentation. Fertil Steril 2020; 114:768. [PMID: 32854932 DOI: 10.1016/j.fertnstert.2020.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Gary N Frishman
- Division of Reproductive Endocrinlogy and Infertility, Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| |
Collapse
|
23
|
Abstract
OBJECTIVE The objective of this study was to estimate the importance of risk factors affecting sexual function in sexually active midlife women. MATERIALS AND METHODS A cohort of 780 women undergoing the menopausal transition was surveyed each year for up to 7 years. Data were collected from sexually active women on sexual function, including frequencies of enjoyment, arousal, orgasm, passion for partner, satisfaction with partner, pain, lack of lubrication, fantasizing, and sexual activity. Data were also collected on a large number of potential risk factors for sexual dysfunction, including behaviors (smoking and alcohol use), health status (overall and frequency of different disorders), and demographic information (race, education, income, etc.). Height and weight were measured at an annual clinic visit; serum hormone concentrations were assayed using blood samples donated annually. Data on individual outcomes were examined with ordinal logistic regression models using individual as a random effect. An overall sexual function score was constructed from individual outcome responses, and this score was examined with linear regression. All factors with univariate associations of p < 0.1 were considered in multivariate model building with stepwise addition. RESULTS A total of 1,927 women-years were included in the analysis. Women with much more physical work than average had higher sexual function scores and higher rates of enjoyment, passion, and satisfaction. Higher family income was associated with lower sexual function score and more frequent dry sex. Married women had significantly lower sexual function scores, as did those with frequent irritability or vaginal dryness. A higher step on the Ladder of Life was associated with a higher sexual function score and higher frequency of sexual activity. CONCLUSIONS The factors associated with sexual outcome in menopausal women are complex and vary depending on the sexual outcome.
Collapse
Affiliation(s)
- Rebecca L. Smith
- Department of Pathobiology, University of Illinois College of Veterinary Medicine, Urbana, Illinois
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Jodi A. Flaws
- Department of Comparative Biomedicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois
| |
Collapse
|
24
|
Leibaschoff G, Izasa PG, Cardona JL, Miklos JR, Moore RD. Transcutaneous Temperature Controlled Radiofrequency (TTCRF) for the Treatment of Menopausal Vaginal/Genitourinary Symptoms. Surg Technol Int 2016; 29:149-159. [PMID: 27608749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of non-ablative, monopolar transcutaneous temperature controlled radiofrequency (TTCRF) technology in the treatment of postmenopausal women suffering from genuine stress urinary incontinence (SUI) related to menopause and to evaluate histological changes vaginally associated with the treatment. MATERIALS AND METHODS Subjective and objective symptoms of SUI were assessed in study subjects before and after TTCRF, (1 treatment every 30 days, for 3 months; n=10) and compared with the effects of a placebo treatment on a control group of demographically similar women (n =10). SUI was subjectively evaluated with subjective Urogenital Distress Inventory (UDI-6) and with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before and after TTCRF treatments and objectively with cough stress test. Vaginal health was evaluated with the Vaginal Health Index (VHI) score and visual analogue score (VAS) for dyspareunia and dryness. Punch biopsies were obtained at the urethra-vesical junction in the anterior compartment, before and at the end of the treatment protocol. Basic and histochemical staining methods were used. RESULTS In subjects suffering SUI, TTCRF treatment was associated with a significant (p<0.01) improvement of ICIQ-SF and UDI-6 scores. Seven of 10 patients (70%) had a negative cough stress test after the treatment protocol. Improvements were maintained up to the 12th week of follow-up. The results were supported by the positive histologic changes seen vaginally in women suffering from postmenopausal vaginal atrophy. TTCRF was well tolerated with no complications reported in study patients. CONCLUSION TTCRF treatment in postmenopausal women suffering from SUI showed significant improvement in both objective and subjective symptoms. Vaginal health scores also improved as did VAS for dryness and dyspareunia. We feel these improvements were related to histological changes related to improvement in vaginal atrophy that were not observed in placebo patients.
Collapse
Affiliation(s)
- Gustavo Leibaschoff
- ynecology and Obstetrics Department, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Pablo Gonzalez Izasa
- Gynecology and Obstetrics Department, Military University of Colombia,Urogynecology Department, Hospital Universitario San Jorge, Pereira, Colombia
| | | | - John R Miklos
- Female Pelvic Medicine and Reconstructive Surgery Department, International Urogynecology Associates of Atlanta, Beverly Hills, California and Dubai, United Arab Emirates, Obstetrics and Gynecology Department, Emory University, Atlanta, Georgia
| | - Robert D Moore
- Female Pelvic Medicine and Reconstructive Surgery, International Urogynecology Associates of Atlanta, Beverly Hills, California and Dubai, United Arab Emirates, Obstetrics and Gynecology Department, Emory University, Atlanta, Georgia
| |
Collapse
|
25
|
New guidelines for treating vaginal atrophy. Harv Womens Health Watch 2013; 21:8. [PMID: 27024851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
26
|
Buvat J. [Congress reports]. Gynecol Obstet Fertil 2013; 41:188-189. [PMID: 23474246 DOI: 10.1016/j.gyobfe.2013.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- J Buvat
- ETARP, 3, rue Carolus, 59000 Lille, France
| |
Collapse
|
27
|
Sasso K. Vaginal support pessaries. Urol Nurs 2012; 32:235. [PMID: 23472526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
28
|
Baker J. Vaginal support pessaries. Urol Nurs 2012; 32:235. [PMID: 23472525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
29
|
Robb-Nicholson C. Ask the doctor. Do vaginal estrogens that are used for vaginal dryness have the same risks as estrogen taken orally or by skin patch? Harv Womens Health Watch 2011; 19:8. [PMID: 27024316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
30
|
10 symptoms not to ignore. What to take seriously, when to seek care. Mayo Clin Womens Healthsource 2008; 12:1-2. [PMID: 18836393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
31
|
Proceedings of the XIXth World Congress of the International Society for the Study of Vulvovaginal Disease. Vancouver, British Columbia, Canada. July 28-August 4, 2007. J Reprod Med 2008; 53:383-435. [PMID: 19058344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
32
|
Hoffstetter S, Leong FC, LeFevre C. Vulvodynia. Mo Med 2007; 104:522-525. [PMID: 18210918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Vulvar pain and discomfort are common conditions which can truly make the patient's life miserable. It is relatively common, but can be a difficult condition to evaluate and treat. This article serves to give the primary care physician a basic framework with which to begin treatment for such patients.
Collapse
|
33
|
|
34
|
|
35
|
Berman L, Berman J, Felder S, Pollets D, Chhabra S, Miles M, Powell JA. Seeking help for sexual function complaints: what gynecologists need to know about the female patient's experience. Fertil Steril 2003; 79:572-6. [PMID: 12620442 DOI: 10.1016/s0015-0282(02)04695-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To further explore the patient experience of seeking help for a sexual function complaint. DESIGN Survey administered on a Web-based instrument. SETTING Healthy volunteers visiting an online Website. PATIENT(S) The majority of participants were married (73%), Caucasian (88%), and premenopausal (67%). Most commonly reported sexual complaints included low desire (77%), low arousal (62%), and difficulty achieving orgasm (56%). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Patient experience survey on a women's sexual health website. RESULT(S) Although 40% of the women reported that they did not seek help from a physician for sexual function complaints, 54% reported that they would like to. Although only a minority of the women internalized their experience with extremely negative emotions like shame, devaluation, or disgust, the experience was not a particularly emotionally positive one along the lines of relief, optimism, or confidence, and a great deal of frustration and anxiety about treatment was reported. CONCLUSION(S) The extent to which health professionals currently receive exposure to training in human sexuality as well as the way in which female sexual complaints are handled in the medical setting remain ambiguous. The inflow of patients with sexual function complaints only will increase, and it is time for physicians to start to acknowledge women's sexuality with the same importance their patients do.
Collapse
Affiliation(s)
- Laura Berman
- Department of Urology and Psychiatry, University of California, Los Angeles School of Medicine, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Komesaroff PA, Kafanelis B, Black C, Cable V, Sudhir K, Daly J. Experiences at menopause of women in a non-English-speaking community: a qualitative study. Climacteric 2002; 5:78-86. [PMID: 11974562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
CONTEXT It is important that clinicians appreciate the link between physiological disturbances and cultural meanings. The community surrounding the Baker Medical Research Institute in Melbourne, Australia includes a substantial number of women from a Greek-speaking background who attend the Menopause Clinic. OBJECTIVE To demonstrate how qualitative methodologies can assist with the development of clinical services by employing them to elucidate the role of cultural variables in the ways in which Greek women view menopause, aging, illness and medicine. DESIGN This was a qualitative study employing in-depth interviews on five separate occasions over 2 years, analyzed with thematic and ethnographic content analysis. PATIENTS Subjects were 40 Greek-speaking women attending the Clinic, aged 45-60 years. RESULTS There is an intricate association between experiences of the menopause and family relationships, problems raised by immigration and the cultural dislocation caused by it, beliefs and theories of the body, religion, and traditional approaches to healing and medicine. Many women had experienced unfavorable or unsatisfactory encounters with medicine in the past, reflecting lack of understanding of the women's experiences and failures of communication about clinical assessments and recommended treatments. Traditional therapies were often used without advising doctors. CONCLUSIONS The study emphasizes the potential utility of qualitative research methods for improving clinical practice by elaborating the specific requirements of particular groups, and thereby allowing doctors to deliver services that are more acceptable to patients from both a cultural and an ethical point of view, and also more effective. The process established for the evolution of our clinic may serve as a model for other clinics seeking to direct themselves to the needs of particular social groups or communities.
Collapse
Affiliation(s)
- P A Komesaroff
- Baker Medical Research Institute, PO Box 6492, St. Kilda Central, Melbourne 8008, Australia
| | | | | | | | | | | |
Collapse
|
37
|
Abstract
BACKGROUND The normal life expectancy of survivors of early-stage breast cancer (BCS) underscores the need to address long-term quality of life issues in these women. Sexual dysfunction persists after breast cancer treatment, despite recovery in other domains. OBJECTIVE To examine associations between a broad array of characteristics and sexuality in BCS. PARTICIPANTS Sixty-one postmenopausal BCS who were participants in a randomized, controlled trial of nonhormonal interventions for menopause symptoms and who had a partnered, intimate relationship. METHODS Cross-sectional analysis of baseline trial data. Outcomes were standardized scales of sexual interest, dysfunction, and satisfaction. Candidate predictors included demographic, anatomical, medical, psychological, sociocultural, and hormonal characteristics. Forward, stepwise regression was used. RESULTS Relationship quality, vaginal discomfort, education, and hot flashes were each associated with two of the three domains of sexuality assessed. Ten other factors entered predictive models: age, time since diagnosis, breast conservation, comorbidity, urinary incontinence, perceived health, body image, bioavailable testosterone, luteinizing hormone, and sex hormone binding globulin. Each of these 10 factors was associated with only one sexuality domain. CONCLUSIONS In this small sample of BCS, we found multiple correlates of sexuality. Most seem to impact uniquely on individual domains of sexual function. Several characteristics are modifiable and could be targets for intervention.
Collapse
Affiliation(s)
- G A Greendale
- Division of Geriatrics, UCLA School of Medicine, Los Angeles, CA 90095-1687, USA
| | | | | | | |
Collapse
|
38
|
Abstract
This paper reviews the history of infiltrating recto-vaginal endometriosis, its clinical and histological diagnosis, together with discussion of treatment options available. Important new work demonstrates significant serious symptomatology which patients suffer, and the relief that can be obtained by radical surgical excision. However this treatment is only available in certain specialist centres. The appropriate methods of management are yet to be subject to a proper randomized control trial, and results of treatment can only be assessed by meticulous recording of patient signs and symptomatology pre- and post-operation associated with histological confirmation of the disease.
Collapse
Affiliation(s)
- J T Wright
- Centre for Endometriosis and Pelvic Pain, Woking Nuffield Hospital, Surrey, UK.
| |
Collapse
|
39
|
Abstract
OBJECTIVES To analyze attitude to menopause from women's own accounts and to examine whether psychosocial factors and attitude are associated with symptom reporting. METHODS The data form part of a population-based longitudinal study of a cohort of women who have been followed annually for 5 years using psychological interviews and rating scales, health screening and hormonal characterization. The data reported here were collected at the fourth follow-up when the women (n = 148) were 53 years old. RESULTS Women were classified as perimenopausal (27%), postmenopausal (15%), hormone replacement therapy (HRT) users (52%) and hysterectomized (6%), based on self-reports. More than half the women (51%) had a positive attitude to menopause, 24% had a negative attitude and 25% had a neutral attitude. Menopausal status was not associated with attitude to menopause. Factor analysis of symptom ratings yielded ten independent factors comprising negative mood, vasomotor symptoms, decreased sexual desire, memory problems, sleep-related symptoms, vaginal dryness, urogenital problems, joint pain, vitality and increased sexual desire. Only vasomotor symptoms and joint pain were associated with menopausal status. The other symptoms were more strongly related to psychosocial factors, life-style and attitude to menopause. CONCLUSIONS The results support the view of the menopause as a developmental phase associated with an increased self-awareness and a stronger personal identity. More than half the women held a positive view of the menopause, whereas the remaining proportion of women had either a negative or a neutral attitude. Only vasomotor symptoms and joint pain were associated with postmenopausal status. Other symptoms were significantly related to psychosocial factors, life-style and attitude to menopause.
Collapse
Affiliation(s)
- A S Olofsson
- Department of Clinical Neuroscience, Karolinska Hospital, Stockholm, Sweden
| | | |
Collapse
|
40
|
Abstract
Menopause is diagnosed after 12 months of amenorrhoea resulting from the permanent cessation of ovarian function. The mean age at menopause is 51 years. The perimenopause, a time of changing ovarian function, precedes the final menses by several years. The physiology and clinical manifestations of this transition to menopause are not well understood; however, some symptoms, such as hot flashes, certainly begin in the perimenopause. Causal associations between menopause and several symptoms and diseases are proposed. The evidence for these associations varies and is reviewed. Hormone replacement therapy can be directed at symptom relief or at prevention or treatment of chronic diseases. Doses and routes of hormone replacement therapy vary by indication. Complications of hormone replacement therapy depend on the regimen used. Knowing the expected vaginal bleeding pattern for each hormone replacement therapy regimen is important, since unexpected bleeding may signal endometrial hyperplasia. Postmenopausal hormone therapy is a complex intervention that produces positive and negative specific health effects. Overall, based on observational studies, postmenopausal women who use hormones have a 30-50% lower all-cause mortality rate than those who do not use hormones. It is important to recognise that the value that individual women place on various health outcomes associated with hormone replacement therapy may differ. Thus, the decision to use hormone replacement therapy should be made jointly by each woman and her health-care provider, after careful consideration of possible benefits, risks, and her personal preferences.
Collapse
Affiliation(s)
- G A Greendale
- Division of Geriatrics, School of Medicine, Center for Health Sciences, University of California, Los Angeles 90095-1687, USA
| | | | | |
Collapse
|
41
|
|
42
|
|
43
|
|
44
|
Abstract
OBJECTIVES To review the literature on the role of oral sex in the transmission of non-viral sexually transmitted infections (STIs). METHOD A Medline search was performed using the keywords oro-genital sex, and those specific to each infection. Further references were then taken from each article read. CONCLUSIONS Oral sex is a common sexual practice between both heterosexual and homosexual couples. Oro-genital sex is implicated as a route of transmission for gonorrhoea, syphilis, Chlamydia trachomatis, chancroid, and Neisseria meningitidis. Other respiratory organisms such as streptococci, Haemophilus influenzae, and Mycoplasma pneumoniae could also be transmitted by this route. Fellatio confers risk for acquisition of infection by the oral partner. Cunnilingus appears to predispose to recurrent vaginal candidiasis although the mechanism for this is unclear, while a link between oro-genital sex and bacterial vaginosis is currently being studied. Oro-anal sex is implicated in the transmission of various enteric infections. In view of the increased practice of oral sex this has become a more important potential route of transmission for oral, respiratory, and genital pathogens.
Collapse
Affiliation(s)
- S Edwards
- Department of Genitourinary Medicine, Addenbrooke's Hospital, Cambridge
| | | |
Collapse
|
45
|
Abstract
Vaginal trichomoniasis poses a difficult therapeutic challenge when metronidazole is ineffective or contraindicated. We conducted a retrospective study of 6.25% paromomycin cream in the treatment of nine women referred with cases of vaginal trichomoniasis where metronidazole resistance or allergy was present. Results obtained immediately and 1 month after treatment were reviewed. The median age of the patients was 46 years; four women were nulliparous. The median symptom duration was 1 year. Five women were allergic to metronidazole. In four cases, resistance to high doses of metronidazole was demonstrated. Smears or cultures were positive immediately after treatment for three patients; a fourth relapsed 2 weeks later. Of these patients for whom treatment failed, one was cured with a 3-week course of paromomycin cream, and another was successfully treated with paromomycin cream and oral tinidazole. Three patients developed vaginal ulcerations that resolved spontaneously. Adverse effects may be a result of local formulation. Paromomycin cream was useful for treatment of cases of trichomonas infection where metronidazole resistance or allergy was encountered.
Collapse
Affiliation(s)
- P Nyirjesy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA
| | | | | | | | | |
Collapse
|
46
|
Knezevich S, Torch M. Streptococcal toxic shocklike syndrome leading to bilateral lower extremity compartment syndrome and renal failure. Report of a case. Clin Orthop Relat Res 1990:247-50. [PMID: 2323138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Compartment syndrome is considered a true emergency in orthopedic practice. To reduce morbidity and mortality from this condition, prompt diagnosis and appropriate treatment are absolutely essential. An unusual bilateral lower extremity compartment syndrome leading to renal failure and crush syndrome occurred in a 13-year-old girl with Streptococcal toxic shocklike syndrome. This situation seems not to have been previously reported. Early diagnosis and expeditious treatment produced minimal sequelae of the condition.
Collapse
Affiliation(s)
- S Knezevich
- Department of Orthopaedic Surgery, Columbus Children's Hospital, Ohio
| | | |
Collapse
|
47
|
Rapuoda BA, Chunge CN, Chunge RN, Ngindu AM. Urogenital myiasis: a case report. East Afr Med J 1986; 63:672-5. [PMID: 3816635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
48
|
El'tsov-Strelkov VI, Chervakova TV, Tokhiian AA. [Role of group B streptococci in perinatal pathology]. Akush Ginekol (Mosk) 1984:6-10. [PMID: 6391240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
49
|
Horejsí J, Zuntová A, Zelenka A. [Uro-copro-lithiasis of the vagina]. Cesk Gynekol 1980; 45:492-3. [PMID: 7418035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
50
|
Schneider GT. Sexually transmissible vaginal infections in pregnancy. 2. Less common infections. Postgrad Med 1979; 65:185-8. [PMID: 218182 DOI: 10.1080/00325481.1979.11715122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|