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- Role of the Different Sexuality Domains on the Sexual Function of Women with Premature Ovarian Failure. [JOURNAL ARTICLE]
- J Sex Med 2014 Nov 6.
Women with premature ovarian failure (POF) often manifest complaints involving different aspects of sexual function (SF), regardless of using hormone therapy. SF involves a complex interaction between physical, psychological, and sociocultural aspects. There are doubts about the impact of different complaints on the global context of SF of women with POF.To evaluate the percentage of influence of each of the sexuality domains on the SF in women with POF.Cross-sectional study with 80 women with POF, matched by age to 80 women with normal gonadal function. We evaluated SF through the "Female Sexual Function Index" (FSFI), a comparison between the POF and control groups using the Mann-Whitney test. Component exploratory factor analysis was used to assess the proportional influence of each domain on the composition of the overall SF for women in the POF group.SF was evaluated using FSFI. Exploratory Factor Analysis for components was used to evaluate the role of each domain on the SF of women with POF.The FSFI score was significantly worse for women with POF, with a decrease in arousal, lubrication, orgasm, satisfaction, and dyspareunia. Exploratory factor analysis of SF showed that the domain with greater influence in the SF was arousal, followed by desire, together accounting for 41% of the FSFI. The domains with less influence were dyspareunia and lubrication, which together accounted for 25% of the FSFI.Women with POF have impaired SF, determined mainly by changes in arousal and desire. Aspects related to lubrication and dyspareunia complaints have lower determination coefficient in SF. These results are important in adapting the approach of sexual disorders in this group of women. Benetti-Pinto CL, Soares PM, Giraldo HPD, and Yela DA. Role of the different sexuality domains on the sexual function of women with premature ovarian failure. J Sex Med **;**:**-**.
- Nutcracker syndrome. [Journal Article, Review]
- World J Nephrol 2014 Nov 6; 3(4):277-81.
The nutcracker phenomenon [left renal vein (LRV) entrapment syndrome] refers to compression of the LRV most commonly between abdominal aorta and superior mesenteric artery. Term of nutcracker syndrome (NCS) is used for patients with clinical symptoms associated with nutcracker anatomy. LRV entrapment divided into 2 types: anterior and posterior. Posterior and right-sided NCSs are rare conditions. The symptoms vary from asymptomatic hematuria to severe pelvic congestion. Symptoms include hematuria, orthostatic proteinuria, flank pain, abdominal pain, varicocele, dyspareunia, dysmenorrhea, fatigue and orthostatic intolerance. Existence of the clinical features constitutes a basis for the diagnosis. Several imaging methods such as Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography and retrograde venography are used to diagnose NCS. The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension. The treatment options are ranged from surveillance to nephrectomy. Treatment decision should be based on the severity of symptoms and their expected reversibility with regard to patient's age and the stage of the syndrome.
- Newly developed vaginal atrophy symptoms II and vaginal pH: a better correlation in vaginal atrophy? [JOURNAL ARTICLE]
- Climacteric 2014 Nov 6.:1-21.
ABSTRACT Objectives: The primary objective of this study was to evaluate the correlation among symptoms, signs, and the number of lactobacilli in postmenopausal vaginal atrophy. The secondary objective was to develop a new parameter to improve the correlation. Study design: A cross-sectional descriptive study Methods: Naturally postmenopausal women aged 45-70 years with at least one clinical symptom of vaginal atrophy of moderate to severe intensity were included in this study. All of the objective parameters [vaginal atrophy score (VAS), vaginal pH, the number of lactobacilli, vaginal maturation index (VMI), and vaginal maturation value (VMV)] were evaluated and correlated with vaginal atrophy symptoms. A new parameter of vaginal atrophy, vaginal atrophy symptoms II, was developed and consists of the two most bothersome symptoms (vaginal dryness and dyspareunia). Vaginal atrophy symptoms II was analyzed for correlation with the objective parameters. Results: One hundred and thirty two naturally postmenopausal women were recruited for analysis. Vaginal pH was the only objective parameter found to have a weak correlation with vaginal atrophy symptoms (r = 0.273, p = 0.002). The newly developed vaginal atrophy symptoms II parameter showed moderate correlation with vaginal pH (r = 0.356, p < 0.001) and a weak correlation with the vaginal atrophy score (r = 0.230, p < 0.001). History of sexual intercourse within 3 months was associated with a better correlation between vaginal atrophy symptoms and the objective parameters. Conclusion: Vaginal pH was significantly correlated with vaginal atrophy symptoms. The newly developed vaginal atrophy symptoms II was associated with a better correlation. The vaginal atrophy symptoms II and vaginal pH may be better tools for clinical evaluation and future study of the vaginal ecosystem.
- Interventions for women in subsequent pregnancies following obstetric anal sphincter injury to reduce the risk of recurrent injury and associated harms. [JOURNAL ARTICLE]
- Cochrane Database Syst Rev 2014 Nov 6.:CD010374.
Perineal damage occurs frequently during childbirth, with severe damage involving injury to the anal sphincter reported in up to 18% of vaginal births. Women who have sustained anal sphincter damage are more likely to suffer perineal pain, dyspareunia (painful sexual intercourse), defaecatory dysfunction, and urinary and faecal incontinence compared to those without damage. Interventions in a subsequent pregnancy may be beneficial in reducing the risk of further severe trauma and may reduce the risk of associated morbidities.To examine the effects of Interventions for women in subsequent pregnancies following obstetric anal sphincter injury for improving health.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014).Randomised controlled trials, cluster-randomised trials and multi-arm trials assessing the effects of any intervention in subsequent pregnancies following obstetric anal sphincter injury to improve health. Quasi-randomised controlled trials and cross-over trials were not eligible for inclusion.No trials were included. In future updates of this review, at least two review authors will extract data and assess the risk of bias of included studies.No eligible completed trials were identified. One ongoing trial was identified.No relevant trials were included. The effectiveness of interventions for women in subsequent pregnancies following obstetric anal sphincter injury for improving health is therefore unknown. Randomised trials to assess the relative effects of interventions are required before clear practice recommendations can be made.
- Resumption of intercourse after childbirth in southwest Nigeria. [JOURNAL ARTICLE]
- Eur J Contracept Reprod Health Care 2014 Nov 5.:1-8.
Objective To determine the history of resumption of intercourse after childbirth and associated contraceptive practices among women in the southwest region of Nigeria. Methods A cohort of 181 women with live births was followed up for 6 months after delivery. Enquiry about the time of first intercourse after childbirth, associated dyspareunia, use of contraception, etc was made during the postnatal clinic visits and/or by telephone contact. Results Fifty (27.6%) had coitus within six weeks of childbirth, it increased to 115 (63.3%) at three months and 127 (70.2%) by six months post-delivery. Prevalence of dyspareunia was 36.2%. Eighty three (65.4%) of sexually active women practiced contraception which was predominantly use of male condom and withdrawal method. Co-habitation with husband (adjusted OR: 6.30; 95% CI: 2.56-17.01; p = 0.001) and mode of delivery (adjusted OR: 2.45; 95% CI: 1.30-4.73; p = 0.006) were strong predictors of commencement of sexual intercourse within six months postpartum. Significantly fewer women who had Caesarean section resumed coitus within six months when compared with those who had vaginal deliveries (59.2% versus 78.4%). Perineal injury did not predict resumption of coitus or experience of dyspareunia. Conclusion In contrast to the norm, more women in southwest Nigeria are resuming coitus soon after childbirth. It is imperative to scale up counselling on postpartum sexuality and contraception within the maternal health services in this region.
- What you should know about dyspareunia. [Journal Article]
- Am Fam Physician 2014 Oct 1; 90(7):Online.
- Dyspareunia in women. [Journal Article]
- Am Fam Physician 2014 Oct 1; 90(7):465-70.
Dyspareunia is recurrent or persistent pain with sexual activity that causes marked distress or interpersonal conflict. It affects approximately 10% to 20% of U.S. women. Dyspareunia can have a significant impact on a woman's mental and physical health, body image, relationships with partners, and efforts to conceive. The patient history should be taken in a nonjudgmental way and progress from a general medical history to a focused sexual history. An educational pelvic examination allows the patient to participate by holding a mirror while the physician explains normal and abnormal findings. This examination can increase the patient's perception of control, improve self-image, and clarify findings and how they relate to discomfort. The history and physical examination are usually sufficient to make a specific diagnosis. Common diagnoses include provoked vulvodynia, inadequate lubrication, postpartum dyspareunia, and vaginal atrophy. Vaginismus may be identified as a contributing factor. Treatment is directed at the underlying cause of dyspareunia. Depending on the diagnosis, pelvic floor physical therapy, lubricants, or surgical intervention may be included in the treatment plan.
- Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women. [Journal Article, Review]
- Sex Med 2013 Dec; 1(2):44-53.
Vaginal atrophy, which may affect up to 45% of postmenopausal women, is often associated with one or more urinary symptoms, including urgency, increased frequency, nocturia, dysuria, incontinence, and recurrent urinary tract infection.To provide an overview of the current literature regarding cellular and clinical aspects of vaginal atrophy and response to treatment with local vaginal estrogen therapy.PubMed searches through February 2012 were conducted using the terms "vaginal atrophy," "atrophic vaginitis," and "vulvovaginal atrophy." Expert opinion was based on review of the relevant scientific and medical literature.Genitourinary symptoms and treatment of vaginal atrophy from peer-reviewed published literature.Typically, a diagnosis of vaginal atrophy is made based on patient-reported symptoms, including genitourinary symptoms, and an examination that reveals signs of the disorder; however, many women are hesitant to report vaginal-related symptoms, primarily because of embarrassment.Physicians in various disciplines are encouraged to initiate open discussions about vulvovaginal health with postmenopausal women, including recommended treatment options. Goldstein I, Dicks B, Kim NN, and Hartzell R. Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women. Sex Med 2013;1:44-53.
- [Quality of life and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension]. [English Abstract, Journal Article]
- Zhonghua Fu Chan Ke Za Zhi 2014 Aug; 49(8):609-15.
To investigate the quality of life and sexual function of cervical cancer patients following radical hysterectomy (RH) and vaginal extension.Case-control and questionnaire- based method was employed in this study. Thirty-one patients of early-stage (I b1-I b2) cervical cancer who had undergone vaginal extension following classic RH in Peking Union Medical College Hospital from December 2008 to September 2012 were included in study group, while 28 patients with matching factors and RH only during the same period were allocated to control group. There was no significant difference between two groups in terms of clinical and demographic variables including age at diagnosis, tumor stage and follow-up time (P > 0.05). Patients were assessed retrospectively by validated self-reported questionnaires the European Organization for Research and Treatment of Cancer Cervix Cancer Module Questionnaire (EORTC QLQ-CX24) mainly for quality of life and sexual function for cervical cancer patients; the Sexual Function and Vaginal Changes Questionnaire (SVQ) further investigates sexual function and vaginal changes of patients with gynecologic malignancy at least 6 months after treatment.Vaginal length acquired by pelvic examination by gynecologic oncologists during follow-up visits was (10.0 ± 1.3) cm and (5.9 ± 1.0)cm in study group and control group respectively (P = 0.000). Sixty-eight percent (21/31) of cases in study group and 64% (18/28) of cases in control group had resumed sexual activity at the time of interview, and the time interval between treatment and regular sexual activity was mean 6 months (range 3-20 months) and mean 5 months (range 1-12 months) in study and control group respectively, in which there was not statistical significance (P > 0.05). No difference was observed regarding pelvic floor symptoms (P > 0.05) while difficulty emptying bladder, incomplete emptying and constipation were most commonly reported. Both group presented with hypoactive sexual desire disorder [88% (52/59)], orgasm dysfunction [72% (28/39)] and low enjoyment or relaxation after sex [51% (20/39)], which was not statistically significant (P > 0.05). Reduced vagina size and shorter vagina was more prominent in control group (12/18) than that in study group [19% (4/21)] with statistical significance (P < 0.05), while no difference in sexual desire, vaginal lubrication, dyspareunia and sexual enjoyment (P > 0.05).Patients with peritoneovaginoplasty following RH had much longer vagina and less self-perceived short vagina. Vaginal extension following RH does not worsen the pelvic floor symptoms.
- [Significance of symptom and physical sign to diagnosis of deeply infiltrating endometriosis]. [English Abstract, Journal Article]
- Zhonghua Fu Chan Ke Za Zhi 2014 Aug; 49(8):599-603.
To study the significance of pain symptoms and physical signs to diagnosis of deeply infiltrating endometriosis (DIE).Totally 500 patients with laparoscopic diagnosis of endometriosis were studied retrospectively and divided into two groups depending on the existance of DIE. The pain symptoms and gynecological physical signs were recorded detail, and the correlation with diagnose of DIE were analyzed.(1) The significance of pain symptoms: the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and OR, 95% CI of each pain symptom were: dysmenorrhae (90.5%, 37.2%, 59.6%, 79.3%, 5.66, 3.46-9.28), chronic pelvic pain (35.2%, 82.6%, 67.4%, 55.4%, 2.58, 1.70-3.91), dyspareunia (46.2%, 80.6%, 70.7%, 59.6%, 3.56, 2.39-5.32), dyschezia (51.0%, 73.7% , 66.5% , 59.5%, 2.91, 2.00- 4.24), respectively. (2) Pelvic physical examination: the sensitivity, specificity, PPV and NPV of each physical sign were: fixed uterine: 73.6%, 71.2%, 79.5%, 64.0%; fixed ovarian cyst: 94.1%, 20.3%, 63.3%, 70.0%; uterosacral ligaments nodule: 47.1%, 97.5%, 96.6%, 54.9%; uterosacral ligaments nodule with tenderness: 81.7%, 75.0%, 83.1%, 73.2%; rectovaginal septum nodule: 32.2%, 100.0%, 100.0%, 49.4%; rectovaginal septum nodule with tenderness: 32.2%, 100.0%, 100.0%, 49.4%; blue nodule in posterior vaginal forni: 14.9%, 100.0%, 100.0%, 43.7%.In the symptoms, the dysmenorrheal has the highest sensitivity and NPV for the diagnosis. And chronic pelvic pain has the highest specificity, and dysparaunia has the highest PPV for the diagnosis. In pelvic vaginal examination, fixed uterine, fixed ovarian cyst and the nodule on uretosarcal ligment and rectovaginal septum with tenderness, the blue lesion on posterior fornix have the strong significance for DIE. So record the symptom detail and careful digital vaginal examination, especially the vaginal-recto-abdominal examination could improve the diagnosis DIE obviously before procedure.