To compare rates of dyspareunia in infertile women and healthy controls. Secondary aims are to determine whether demographic characteristics, rates of sexual dysfunction, and baseline depression status differ between the two groups.A case-control study.University-based faculty fertility and OB/GYN generalist clinics.Seventy-five infertile female subjects presenting to the infertility clinic and 210 women presenting to the generalist clinic for their annual exam.Completion of an anonymous survey including demographic information, the Female Sexual Function Index (FSFI), Patient-Health Questionnaire-9 (PHQ-9), and original questions regarding sexual pain.Rate of dyspareunia and sexual dysfunction.There were no significant differences in rates of dyspareunia (37.6% controls vs. 30.7% study) or the rate of sexual dysfunction (31.9% controls vs. 37.3% study). Infertile women had more frequent intercourse than controls and were more likely to be married. There were otherwise no differences in baseline rates of depression, demographic characteristics, or individual domain scores of the FSFI.Women seeking fertility treatment had similar rates of dyspareunia and sexual dysfunction compared with controls.

Pains of various kinds--dysmenorrhea, chronic pelvic pain, and dyspareunia--are the major complaints from women with endometriosis, representing the most debilitating nature of the disease. Despite extensive research, our understanding as how endometriosis causes pain is still fragmentary. In this study, we examined transient receptor potential vanilloid 1 (TRPV1)-positive nerve fibers in ectopic endometrium from women with ovarian endometriomas and in endometrium from women without endometriosis and correlated the density with the severity of dysmenorrhea in cases. We also performed an immunohistochemistry analysis of TRPV1 in ectopic and control endometrium. After finding TRPV1 immunoreactivity in ectopic endometrial cells, we further examined whether TRPV1 is functional in ectopic endometrial stromal cells (EESCs). We found that the density of TRPV1-positive nerve fibers in ectopic endometrial implants is higher than that in control endometrium and correlates positively with the severity of dysmenorrhea in women with endometriosis. In addition, TRPV1 expression was also found to be elevated significantly in EESCs when stimulated with inflammatory mediators such as prostaglandin E2 (PGE(2) ) and tumor necrosis factor-α (TNF-α). Finally, we found that TRPV1 activation can induce the release of nitric oxide (NO) and interleukin 1β (IL-1β) in EESCs. The latter finding appears to be consistent with the reports of increased TRPV1 protein expression following peripheral inflammation. Our results suggest that the increased TRPV1-positive nerve fibers may integrate various stimuli on peripheral terminals or primary sensory neurons and generate hyperalgesia in endometriosis. The expression and functionality of TRPV1 in EESCs also suggest that TRPV1 may have neurosecretory functions that are yet to be elucidated.

: The objective of the study was to assess the effectiveness and complication rates for the transvaginal (TVM) technique in the treatment of pelvic organ prolapse (POP).: Women with symptomatic POP (POP-Q stage II-IV) were invited to participate in this institutional review board-approved 5-year study at 3 US centers. All enrolled patients underwent prolapse repair surgery with GYNEMESH PS Prolene Nonabsorbable Soft Mesh using the TVM technique. Success was defined as International Continence Society (ICS) POP-Q stage I or less. The Prolapse-Specific Inventory and quality-of-life questionnaire was used as a subjective outcome measure.: Eighty-five women were included. Sixty-six patients were available for follow-up at 5 years. Overall anatomic success rates were 88% (90% confidence interval [CI], 80%-93%), 69% (90% CI, 59%-78%), and 67% (95% CI, 56%-76%) at 1, 3, and 5 years, respectively. Anatomic success rates in treated compartments were 89% (90% CI, 82%-94%), 76% (90% CI, 66%-84%), and 77% (90% CI, 67%-85%) at 1, 3, and 5 years, respectively. When defined as treated side leading edge above the hymen, success rates were 89% at 5 years. Five patients required reoperation for prolapse by 5 years. Statistically significant improvements in quality-of-life and Prolapse-Specific Inventory scores were sustained over 5 years. Mesh exposure was observed in 16 of 85 patients over the 5 years. Nine required partial mesh excision. There were 3 patients with some degree of dyspareunia, reported between 3 and 5 years, whereas in 8, preexisting dyspareunia resolved. There was 1 rectovaginal fistula reported and 2 reported ureteral injuries, one of which resulted in a ureteral-vaginal fistula; all resolved after repair.: Five-year results indicated that TVM provided a stable anatomic repair. Improvements in quality of life and associated improvements in specific prolapse symptoms were sustained over the 5-year period. Mesh exposure was the most common complication.

Considering the prevalence of female sexual dysfunction, the lack of education and training in female sexual function and dysfunction (FSF&D) during and obstetrics and gynecology residency highlights a need for greater focus on this topic.To assess understanding and confidence among third and fourth year Ob/Gyn residents with respect to FSF&D.An Internet-based survey was constructed to evaluate third and fourth year residents in American Council for Graduate Medical Education-approved Ob/Gyn programs. Residents were asked about familiarity, knowledge, and confidence in treating various aspects of FSF&D, based on the Council on Resident Education in Obstetrics and Gynecology (CREOG) Educational Objectives for Ob/Gyn training. They were also queried regarding areas of improvement for their education.  Responses to survey instrument.Two hundred thirty-four residents responded. The majority (91.5%) reported attending ≤5 didactic activities on FSF&D. Only 19.6% reported often or always screening women for sexual function problems; most had very little or no knowledge in administering or interpreting screening questionnaires. While many (82.8%) felt confident about obtaining a complete sexual history, only 54.7% felt able to perform a targeted physical exam. Although most residents had cared for women with dyspareunia (55.1%), a minority had managed many women with low desire (18.4%), arousal problems (8.1%), anorgasmia (5.6%), or vaginismus (16.7%). In treating patients, 34-56% reported rarely or never suggesting ancillary therapy such as counseling and medications. However, the majority believed that their confidence would increase through FSF&D lectures (97.9%), FSF&D patient observations (97.4%), rotating with a urogynecologist (94.4%), and online modules (90.6%).Despite CREOG requirements for Ob/Gyn training in female sexuality, most residents feel ill-equipped to address these problems. Additional evidence-based educational and didactic activities would enhance residents' knowledge and confidence in treating these common, quality-of-life issues.

To evaluate the vaginal length and incidence of dyspareunia after total abdominal hysterectomy compared to vaginal hysterectomy.This is a prospective observational study. Sixty-six patients were invited to participate in the study who were already planned to undergo abdominal or vaginal hysterectomy for different benign indications in the OB/GYN department, Sohag University Hospital, during the period from March 2007 till April 2009. Patients were classified into two groups. Thirty-six patients who were planned to undergo total abdominal hysterectomy (TAH) represented the first group, and 30 patients who were planned to undergo vaginal hysterectomy (VH) represented the second group. Vaginal length was obtained just before the operation and three times postoperatively. Pre- and post-operative dyspareunia was reported.The mean pre-operative and post-operative vaginal lengths in the TAH group were nearly the same (10.5+/-2.1cm vs. 10.2+/-1.8 cm) without statistically significant difference. In the VH group, there was a statistically significant difference between pre- and post-operative vaginal length (10.1+/-1.9 cm vs. 8.4+/-1.6 cm). In the TAH group, 2 patients (5%) reported a newly developed post-operative dyspareunia. In VH group, 6 patients (20%) developed dyspareunia after surgery.Postoperative dyspareunia is more common after vaginal hysterectomy compared to abdominal hysterectomy. This may be attributed to postoperative shortening of the vagina secondary to excessive trimming of the vaginal walls especially if VH was done for utero-vaginal prolapse.

Vulvovaginal atrophy (VVA) is reported by one-quarter to one-half of postmenopausal women.We evaluated the prevalence, inconvenience of, and issues surrounding hormone use for VVA symptoms in women who were current, past, and never users of menopausal hormone therapy (MHT), along with the relationship of sexual activity to VVA symptoms.An online survey was sent to 3,471 women >or=45 years old participating in a panel of approximately 43,000 U.S. adults maintained by Knowledge Networks. Respondents were stratified by MHT use (current, past, and never) and sexual activity (sexually active and not sexually active). Final respondent data underwent a poststratification process and Chi-square analysis of hormone use and VVA by sexual activity. Main Outcome Measures. Percent, calculated as the ratio of response over total responding for each survey question for all and stratified respondents.Forty-five percent (1,038/2,290) of respondents (age range 45-89 years; mean 60.7 years) were postmenopausal and currently or previously experienced VVA. Approximately 60% of past or never users of MHT reported vaginal symptoms; >90% found them bothersome. In comparison, 82% of current users reported VVA symptoms prior to use. 85% of all respondents were aware of safety issues associated with MHT. The prevalence and perceived severity of VVA symptoms were substantial but less frequent in nonsexually active women. Analysis of MHT use by past or current hormone use indicated a trend away from oral dosing and towards patch or vaginal hormones.Postmenopausal women have a high rate of VVA symptoms. Those who use MHT do so for multiple reasons-hot flashes, VVA, bone protection, dyspareunia-and most have concerns about long-term safety, despite the fact that the majority of MHT use was for >5 years. Safety concerns and lack of physician recommendation were major reasons for not using or discontinuing MHT.

Interstitial cystitis is a syndrome characterized by pelvic pain, urinary urgency/frequency, nocturia, and dyspareunia, with no other identifiable etiology. The clinical presentation of interstitial cystitis is similar to that of many other conditions commonly seen in female patients, including recurrent urinary tract infections, endometriosis, chronic pelvic pain, vulvodynia, and overactive bladder. In addition, interstitial cystitis may exist concurrently with these conditions. Correct diagnosis is necessary for appropriate treatment and improved outcomes. Tools to assist in the diagnosis of interstitial cystitis, as well as effective therapies for this condition, are available. A diagnosis of interstitial cystitis should be considered in patients with irritative voiding symptoms and/or pelvic pain complaints.

Endometrial ossification is a rare endometrial pathology. Its predisposing factors include history of uterine curettage to metabolic abnormalities. It usually presents in patients with secondary infertility and history of first trimester pregnancy loss, accompanied by severe dysmenorrhea and dyspareunia. The diagnosis is suspected by OB-GYN history and USG findings, therapeutic strategies range from D&C to hysterectomy, we propose diagnosis and management by hysteroscopy in order to preserve future fertility and minimize uterine damage. A review of four cases during 1985-2004 from a large assisted reproduction center in Mexico City is presented.

To assess the efficacy of laparoscopic positioning by ligament investment, fixation and truncation (UPLIFT) in alleviating pain in women with a symptomatic, retroverted uterus, the duration of pain relief, and operative or postoperative complications associated with the procedure.Between May 22, 1998, and November 16, 2000, 62 women with a retroverted uterus, chronic pelvic pain, moderate to severe dysmenorrhea and/or dyspareunia underwent UPLIFT on an outpatient basis. The patients for this prospective, cohort study were recruited from 5 private gynecologic practices. The patients were asked to rate their pelvic pain, dysmenorrhea and dyspareunia on a scale of 0-10, with 0 no pain and 10 the worst pain imaginable, preoperatively and again at 4 weeks and 3, 6 and 12 months postoperatively. The average follow-up time was 10.2 months (range, 0.2-14.9).The mean scores for pelvic pain decreased from 7.3 to 3.7 at 12 months (n = 46). Dysmenorrhea decreased from 7.8 to 4.4 (n = 39), and dyspareunia decreased from 8.0 to 3.3 (n=41). All p values were <0.0001. There were 5 minor intraoperative adverse events. The procedure did not result in any postoperative complications.UPLIFT resulted in significant, long-term pain reduction in women with a symptomatic, retroverted uterus.

This study compares the operative parameters of laparoscopic supracervical hysterectomy, laparoscopically assisted vaginal hysterectomy, total vaginal hysterectomy, and total abdominal hysterectomy in patients in a small suburban medical center.This investigation is a Canadian Classification II-2. It was performed in a 238 bed not-for-profit community general hospital. Charts of 117 patients were reviewed. These patients had undergone the following procedures: laparoscopic supracervical hysterectomy, laparoscopically assisted vaginal hysterectomy, total vaginal hysterectomy, total abdominal hysterectomy; questionnaires completed by the patients were reviewed. All patients had hysterectomies performed by members of the Ob/Gyn department of Alamance Regional Medical Center. Comparisons of intraoperative and postoperative events were made in those patients who consented to the study and who returned their questionnaires. Parameters compared were patient age, weight, preoperative diagnosis, operative time, operative complications, blood loss, uterine weight, length of stay, postoperative complications, return to hospital, return to work, resumption of intercourse, dyspareunia, and bowel or bladder problems.Patient demographics and outcomes are similar. Laparoscopic supracervical hysterectomy showed lower morbidity and quicker return to normal function, but most findings did not reach statistical significance.The results support the conclusion that the patients in each arm of the study are similar. The operative parameters show a longer operating time for the laparoscopic procedures than for total abdominal hysterectomy and total vaginal hysterectomy, respectively. The other indicators of morbidity show slight advantages of laparoscopic supracervical hysterectomy in blood loss, length of stay, and resumption of normal activities.