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- Dyspareunia and pelvic floor muscle function before and during pregnancy and after childbirth. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Apr 1.
There is limited knowledge on dyspareunia during pregnancy and postpartum and the role of the pelvic floor muscles (PFM) in women with dyspareunia. Aims of the study were to investigate the presence of dyspareunia before and during pregnancy and postpartum, and to compare vaginal resting pressure (VRP), PFM strength, and endurance between women with and those without dyspareunia. It was hypothesized that there is no difference in PFM variables between women with and those without dyspareunia.Three hundred nulliparous women participated in this prospective cohort and answered questions about dyspareunia and the level of bother at gestational weeks 22 and 37, 6 and 12 months postpartum, and retrospectively prior to their pregnancies using ICIQ-FLUTSsex. PFM variables were assessed by manometer at gestational week 22, and 6 and 12 months postpartum. Comparisons between groups were analyzed using independent samples t test.Twenty-eight and 30 % of the women reported dyspareunia at pre-pregnancy and at gestational week 22 respectively. At gestational week 37, and 6 and 12 months postpartum, the percentages were 40, 45, and 33 respectively. No difference in PFM variables was found between women with and those without dyspareunia. Level of bother was higher postpartum than before and during pregnancy.Symptoms of dyspareunia were common at all time points. No link could be made between PFM function and dyspareunia. Women suffering from dyspareunia postpartum reported it as being bothersome. Our findings suggest that women should be asked about symptoms of dyspareunia related to pregnancy, and that future research should aim for preventative and therapeutic strategies.
- Antidepressants and sexual dysfunction: mechanisms and clinical implications. [Journal Article]
- Postgrad Med 2014 Mar; 126(2):91-9.
Introduction: Depression is one of the more prevalent mental disorders in the United States, with estimates as high as 6.7% of Americans affected annually. Consequently, antidepressant use in the United States is also widespread. Both depression and its treatments are associated with sexual dysfunction (SD) in men and women, including orgasm and arousal problems, hypoactive sexual desire, premature ejaculation, erectile difficulties, and dyspareunia. Sexual dysfunction is frequently cited as a reason for nonadherence or discontinuation of treatment for depression.
Aim:The objective of our review is to aid physicians, including primary care physicians, psychiatrists, and urologists/gynecologists, in the multidisciplinary approach to treating patients with SD and depression.
Methods:Our review focuses on articles published within the last 10 years on SD and depression in adults, with an emphasis on the relationship of treatments for depression on SD.
Summary:Different classes of antidepressants vary in their ability to cause sexual side effects.
Results:Treatment with selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) is associated with SD. Use of other antidepressants, such as bupropion, mirtazapine, nefazodone, and vilazodone, have been associated with less SD compared with SSRIs; furthermore, some of the mentioned antidepressants have been used in the treatment of SD induced by SSRIs and SNRIs.
- Short-term Outcomes of Vaginal Mesh Placement Among Female Medicare Beneficiaries. [Journal Article]
- Urology 2014 Apr; 83(4):768-73.
To compare short-term outcomes between prolapse repairs with and without mesh using a national data set. Mesh use in surgical treatment of pelvic organ prolapse has gained wide popularity. However, mesh complications have increased concomitantly with its use.Public Use File data were obtained for a 5% random national sample of female Medicare beneficiaries aged 65 years and older. Women who underwent prolapse surgery were identified using Current Procedural Terminology Coding System, Fourth Edition (CPT-4) codes. Because the code for mesh placement was effected in 2005, we separated patients into 3 cohorts as follows: those who underwent prolapse repairs from 1999 to 2000 (presumably without mesh), those who underwent repairs from 2007 to 2008 (presumably without mesh), and those with mesh (based on CPT-4 code 57267) from 2007 to 2008. One-year outcomes were identified using International Classification of Diseases, Ninth Revision diagnosis and procedure codes and CPT-4 procedure codes.A total of 9180 prolapse repairs without mesh were performed from 1999 to 2000, 7729 without mesh from 2007 to 2008, and 1804 prolapse repairs with mesh from 2007 to 2008. Prolapse reoperation within 1 year of surgery was higher in nonmesh vs mesh cohorts (6%-7% vs 4%, P <.02). Mesh removal rates were higher in mesh vs nonmesh group (4% vs 0%-1%, P <.001). Mesh use was associated with more dyspareunia, mesh-related complications, and urinary retention, even when controlling for concomitant sling.Mesh to treat pelvic organ prolapse and stress urinary incontinence was associated with a small decrease in early reoperation for prolapse. This decrease came at the expense of increased rates of pelvic pain, retention, mesh-related complications, and mesh removal.
- Ospemifene, a non-oestrogen selective oestrogen receptor modulator for the treatment of vaginal dryness associated with postmenopausal vulvar and vaginal atrophy: A randomised, placebo-controlled, phase III trial. [JOURNAL ARTICLE]
- Maturitas 2014 Mar 12.
To evaluate the efficacy and safety of ospemifene, a novel selective oestrogen receptor modulator, in the treatment of vaginal dryness in postmenopausal women with vulvovaginal atrophy (VVA).A 12 week, multicentre, randomised, double-blind, parallel-group phase III study of women (40-80 years) with VVA and self-reported vaginal dryness as their most bothersome symptom.The co-primary efficacy endpoints were the change from baseline to Week 12 in (1) percentage of parabasal cells in the maturation index (MI), (2) percentage of superficial cells in the MI, (3) vaginal pH, and (4) severity of vaginal dryness. Safety assessments included physical examination, cervical Papanicolaou test and clinical laboratory analyses. Endometrial thickness and histology was also assessed.A total of 314 women were randomised to once-daily ospemifene 60mg/day (n=160) or placebo (n=154). Significant improvements in the percentages of parabasal and superficial cells in the MI and vaginal pH were observed with ospemifene compared with placebo (p<0.001 for all parameters). The mean change from baseline in severity score of vaginal dryness reported by women receiving ospemifene compared with those receiving placebo approached statistical significance (p=0.080). Improvements in each of the four co-primary endpoints with ospemifene were statistically significant compared to placebo in the per protocol population. The majority of treatment-emergent adverse events were considered mild to moderate in severity.Once-daily oral ospemifene 60mg was effective for the treatment of VVA in postmenopausal women with vaginal dryness.
- Long-term followup of a large cohort of patients with ovotesticular disorder of sex development. [Journal Article]
- J Urol 2014 May; 191(5 Suppl):1532-6.
We present the followup of a large cohort of patients with ovotesticular disorder of sex development treated at a single tertiary center.We reviewed the records of 20 patients with ovotesticular disorder of sex development. We retrospectively evaluated clinical and surgical characteristics. A prospective study was also performed, including evaluation of surgical results, gonadal function, sexual activity and voiding symptoms of these patients during adulthood.All patients had ambiguous genitalia, including 18 with a 46,XX karyotype and 2 with a 46,XX/46,XY karyotype. Gender assignment at birth was male in 13 patients and female in 7. Three females were later reassigned to the male gender. Bilateral gonadectomy was performed in 10 patients. Testicular tissue was preserved in 8 males and ovarian tissue was preserved in 2 females. Average followup was 25 years (range 4 to 46). Puberty started spontaneously in 14 patients between ages 11 and 14 years. Seven patients showed spontaneous puberty after conservative gonadal surgery and 4 required hormonal replacement during adulthood. The most frequent complications in males were urethral fistula in 6 and late urethral stenosis in 3. Two patients with urethral stenosis had symptoms 10 years postoperatively. One female presented with temporary dyspareunia. In adulthood 8 males and 2 females reported sexual activity. All male patients reported orgasm and 2 reported ejaculation.Male gender assignment was more prevalent. Long-term followup revealed adequate pubertal development and sexual activity. Complications involving the urethra developed frequently in male patients.
- [The voice of women subjected to female genital mutilation in the Region of Murcia (Spain).] [JOURNAL ARTICLE]
- Gac Sanit 2014 Mar 24.
To explore the perceptions of a group of women who underwent female genital mutilation on the impact of this practice on their sexual and reproductive health.We performed a phenomenological qualitative study in a sample of 9 sub-Saharan Africa women, whose mean age was 30 years old and who had lived in Spain for 1 to 14 years. These women underwent genital mutilation in their countries of origin. Data was collected using a socio-demographic survey and an in-depth, structured personal interview. Subsequently, we performed a thematic discourse analysis.The discourses were grouped into four categories related to participants' perceptions of female genital mutilation. These categories were intimate relationships, pregnancy, childbirth, and social impact.The practice of female genital mutilation is maintained due to social and family pressure, transmitted from generation to generation and silenced by women themselves. This practice affects their sexual and reproductive health, as demonstrated by anorgasmia and dyspareunia. The women were satisfied with the healthcare received during pregnancy and childbirth. Nevertheless, most of them were not satisfied with family planning.
- Study of menopausal symptoms, and perceptions about menopause among women at a rural community in Kerala. [Journal Article]
- J Midlife Health 2013 Jul; 4(3):182-7.
Menopausal health demands priority in Indian scenario due to increase in life expectancy and growing population of menopausal women. Most are either unaware or do not pay adequate attention to these symptoms.To find the prevalence of menopausal symptoms and perceptions regarding menopause among menopausal women of Kerala.A community based cross-sectional house to house survey was conducted at Anjarakandy a field practice area under Kannur Medical College, Anjarakandy.The study was conducted among 106 postmenopausal women staying more than 6 months at Anjarakandy with the help of pretested questionnaire administered by a trained social worker from January to October 2009. Before that a pilot study was conducted and required sample size of 100 was calculated. Random sampling of houses was done.Data was coded, entered, and analyzed using SPSS 15. Chi-square test, proportions, and percentages were used.The mean age of attaining menopause was 48.26 years. Prevalence of symptoms among ladies were emotional problems (crying spells, depression, irritability) 90.7%, headache 72.9%, lethargy 65.4%, dysuria 58.9%, forgetfulness 57%, musculoskeletal problems (joint pain, muscle pain) 53.3%, sexual problems (decreased libido, dyspareunia) 31.8%, genital problems (itching, vaginal dryness) 9.3%, and changes in voice 8.4%. Only 22.4% of women knew the correct cause of menopause.Thus study stated that all the ladies were suffering from one or more number of menopausal symptoms. Ladies should be made aware of these symptoms, their causes and treatment respectively.
- Spontaneous hymeneal endometriosis: a rare cause of dyspareunia. [Journal Article]
- BMJ Case Rep 2014.
Vulvar endometriosis can occur after surgery or trauma and cause dyspareunia. A 30-year-old woman presented with orificial dyspareunia lasting for 5 months. Her history was marked by a vaginal birth without perineal injury and the removal of a cyst from the left Bartholin's gland. On examination, we observed a selectively painful, superficial and retractile lesion, 5 mm in diameter at the junction of the hymen at some distance from the bartholinitis scar. Endometriosis was suspected due to the exacerbation of pain during menses. The surgery consisted of excision of the hymenal area of the painful lesion. Pathological examination confirmed the presence of endometrial tissue. The painful symptoms resolved and no additional treatment was administered. Any vulvar lesion, regardless of its appearance and location, can be related to endometriosis. Surgical resection is recommended to relieve the symptoms and provide histological proof.
- Third and fourth degree perineal injury after vaginal delivery: does race make a difference? [Journal Article]
- Hawaii J Med Public Health 2014 Mar; 73(3):80-3.
Severe perineal injury (third and fourth degree laceration) at the time of vaginal delivery increases the risk of fecal incontinence, chronic perineal pain, and dyspareunia.1-5 Studies suggest the prevalence of severe perineal injury may vary by racial group.6 The purpose of the current study was to examine rates of severe perineal injury in different Asian and Pacific Islander subgroups. A retrospective cohort study was performed among all patients who had a vaginal delivery at Queens Medical Center in Honolulu, Hawai'i between January 1, 2002 and December 31, 2003. Demographic and health related variables were obtained for each participant. Maternal race/ethnicity (Japanese, Filipino, Chinese, other Asian, Part-Hawaiian/Hawaiian, Micronesian, other Pacific Islander, Caucasian, multiracial [non-Hawaiian], and other) was self-reported by the patient at the time admission. The significance of associations between racial/ethnic groups and demographic and health related variables was determined using chi-square tests for categorical variables and analysis of variance for continuous factors. Multiple logistic regression was performed to adjust for potential confounders when examining severe laceration rates. A total of 1842 subjects met inclusion criteria. The proportion of severe perineal lacerations did not differ significantly between racial groups. In the multiple logistic regression analysis, operative vaginal delivery was related to both race and severe perineal laceration. However, despite adjusting for this variable, race was not associated with an increased risk of having a severe laceration (P = .70). The results of this study indicate the risk of severe perineal laceration does not differ based on maternal race/ethnicity.
- Applications and Therapeutic Actions of Complementary and Alternative Medicine for Women with Genital Infection. [REVIEW]
- Evid Based Complement Alternat Med 2014.:658624.
Genital infection is a common worldwide disease among females with clinical features such as bilateral lower abdominal tenderness, abnormal vaginal or cervical discharge, fever, abnormal vaginal bleeding, dyspareunia, vaginal itching, and adnexal tenderness, which can significantly impair women's health and quality of life. Genital infection is commonly treated with antibiotics, leading to an imbalance in gut flora due to prolonged use of antibiotics. Therefore, it is necessary to discover safe and efficacious alternative treatment strategies for patients with genital infection. Complementary and alternative medicine (CAM) is becoming increasingly prevalent among women with genital infection. CAM has interested the western mainstream medical community because of its less invasive, safe, effective, economical, and convenient therapies. CAM focuses on the prevention and treatment of disease and has become an important force in treating chronic disease. During the last few decades, the popularity of CAM has gradually increased. To further understand the efficacy of CAM in treating genital infection, our paper will review the current progress of treating genital infection including vulvitis, vaginitis, cervicitis, and pelvic inflammatory disease (PID) with CAM therapies. Several CAM strategies including traditional Chinese medicine (TCM), acupuncture, Psychology interference, and physical therapy are introduced in this review.