Sexualidad tras la mutilación genital femenina

La Mutilación Genital Femenina (MGF) incluye cualquier procedimiento que implique la extirpación parcial o total de los genitales externos femeninos por razones no médicas. Es evidente que esta práctica vulnera los derechos humanos y es una forma extrema de discriminación de las niñas y mujeres que la sufren. De este modo, es reconocido internacionalmente por la Organización Mundial de la Salud

¿Hablamos de sexo cuando acudimos a la visita ginecológica?

En la mayoría de las visitas a las consultas de ginecología no se habla de la vida sexual. Este hecho tiene su origen en una serie de barreras, tanto institucionales como personales, que afectan a la estructura del sistema sanitario, al profesional sanitario y a las pacientes. Debemos recordar que las pacientes que visitan las consultas de ginecología tienen un mayor riesgo de ver afectada su vida sexual comparadas con las mujeres de la población general. Esto sucede tanto por la propia patología (ginecológica u obstétrica) como por algunos tratamientos que se indican para tratar estas patologías (cirugía, tratamientos farmacológicos, quimioterapia, radioterapia )

Sexual and gynecological health in women with a history of sexual violence: the role of the gynecologist

Objectives: Sexual violence is defined as any sexual act, attempt to commit a sexual act or unwanted sexual comment or action which, by means of force or coercion, is directed against a person's sexuality, regardless of the relationship with the victim. The global prevalence of sexual violence all over the world is 35.6%; 30% partner-related and 7.2% non-partner sexual violence, being the prevalence of sufferers from both types of sexual violence 1.6%. Sexual violence against girls and women is a global public health problem of epidemic proportions. As a violence free life constitutes a basic human right, actions to prevent sexual violence and to treat and follow-up its victims have to be undertaken. Mechanism: A multidisciplinary approach on these cases should be mandatory to help women in all the potential short-, mid- and long-term consequences, which need to be evaluated. Finding in brief: Consequences after sexual violence can be both physical and psychological, including a potential impact on gynecological, reproductive, obstetric and sexual issues of the individual. For this reason, gynecologists should play an important role in the follow-up of girls and women who have suffered sexual violence. Conclusions: Gynecologists have to participate in both the immediate attention and the follow-up of patients who have suffered sexual violence. Gynecologists have the gold opportunity to introduce sexual health care in their clinical practice and their visits should be the place where the discussion of sexual concerns is permitted and also where the identification, support and treatment of women with sexual violence is provided

Treating genitourinary syndrome of menopause in breast cancer survivors: main challenges and promising strategies

Many breast cancer survivors (BCS) suffer the consequences of antineoplastic treatments that induce a hypoestrogenic state, leading to chronic climacteric symptoms such as genitourinary syndrome of menopause (GSM), arousing significant alteration in their quality of life. Non-hormonal therapies (NHT) are first-line treatments, safe but with mild efficacy. When facing moderate-severe GSM, the options for BCS are limited: local estrogen therapy, considered the 'gold standard' but with concerns about safety; vaginal androgens and prasterone, which seem to trigger an activation of estrogen and androgen receptors of the vaginal epithelium layers, without activating estrogen receptors on other tissues, being potentially safe but still without strong evidence in favor of BCS; vaginal lasers, which appear to improve vascularization of vaginal mucosa by stimulating the remodeling of the underlying connective tissue, but with contradictory results of efficacy in recent randomized clinical trials; and ospemifene, an oral selective estrogen receptor modulator presenting mild vaginal estrogenic potency and anti-estrogenic effect at the endometrial and breast level, but still not recommended for use in BCS in recent North American Menopause Society guidelines. There is a need for further studies evaluating objectively the efficacy and safety of these promising therapeutic options. On the other hand, sexuality must be seen as a multifactorial issue, where GSM is only part of the problem; evidence shows that sexual counseling improves the quality of life of BCS. Finally, there is a need to limit the underdiagnosis and undertreatment of GSM in BCS; the primary goal of physicians treating BCS regarding this issue has to be the provision of information of what to expect regarding genital and sexual symptoms to BCS and to counsel on early first-line treatments that may help prevent more severe GSM

Sexual health in women with female genital mutilation

Objective: Female genital mutilation or cutting (FGM/C) includes all the procedures which involve the partial or total removal of the external female genitalia for non-medical reasons. FGM/C exposes women to short and long-term health risks, such as sexual health impairment. For this reason, we have designed this review with the aim to investigate the impact of FGM/C on female sexual health. Methods: We searched Embase, Medline, and the Cochrane library to identify potentially relevant English publications on the effect of FGM/C on women's sexual health. Results: FGM/C constitutes a violation of sexual rights, including the principle of autonomy, integrity and sexual security of the body, as well as the right to sexual equality. A large proportion of women with FGM/C have female sexual dysfunction. Sexual therapy aims to empower these women to identify their own pleasure, raise their awareness about sensorial perceptions and sensuality, improve their genital image and self-esteem and also the proprioception of their genital area. Reconstructive surgery represents one of the therapeutic alternatives for women with FGM/C. Conclusions: Sexuality in women with FGM/C needs to be evaluated by a multidisciplinary team in order to offer an appropriate and personalized treatment, considering the physical and psychological dimensions of the individua

Assessing vaginal wall thickness by transvaginal ultrasound in breast cancer survivors: A pilot study

Aim: There is need for a straightforward objective measure to evaluate vaginal wall changes related to hypoestrogenism. The aim of this pilot study was to evaluate a transvaginal ultrasound procedure for the quantification of vaginal wall thickness in order to differentiate between healthy premenopausal women and postmenopausal women with genitourinary syndrome of menopause using ultra-low-level estrogen status as a model. Methods: We performed a prospective, two-arm, cross-sectional pilot study comparing vaginal wall thickness measured by transvaginal ultrasound in postmenopausal breast cancer survivors using aromatase inhibitors with genitourinary syndrome of menopause (GSM group) and healthy premenopausal women (control or C group) from October 2020 to March 2022. After intravaginal introduction of 20 cm3 of sonographic gel, vaginal wall thickness was measured by transvaginal ultrasound in the anterior, posterior, and right and left lateral walls (four quadrants). The study methods followed the STROBE checklist. Results: According to the results of a two-sided t-test, the mean vaginal wall thickness of the four quadrants in the GSM group was significantly less than that of the C group (2.25 mm vs 4.17 mm, respectively; p < 0.001). Likewise, the thickness of each of the vaginal walls (anterior, posterior, right and left lateral) statistically differed between the two groups (p < 0.001). Conclusion: Transvaginal ultrasound with intravaginal gel may be a feasible objective technique to assess genitourinary syndrome of menopause, showing clear differences in vaginal wall thickness between breast cancer survivors using aromatase inhibitors and premenopausal women. Possible correlations with symptoms or treatment response should be assessed in future studies

Genitourinary Syndrome of Menopause Assessment Tools

New therapeutic options are being considered to treat genitourinary syndrome of menopause (GSM), such as vaginal laser, ospemifene, or prasterone, but there is no explicit agreement in the scientific community for its use. Some concerns have arisen on how to evaluate the improvement of GSM symptoms. In 2003, the FDA suggested possible end points for this purpose: change in severity of symptoms, change in vaginal pH, and change in vaginal maturation index (VMI). Contrarily, the most common assessment tools used to quantify severity and improvement of GSM nowadays are the visual analog scale of GSM symptoms, the vaginal health index, and the female sexual function index. In our opinion, subjective and objective variables to evaluate GSM can be differentiated, and not many of the considered objective outcomes are used in the recent literature assessing GSM. There is the possibility that some therapies present only subjective improvement, giving place to a possible placebo effect that is not being evaluated. To conclude, there is a demand to evaluate whether vaginal pH and VMI are enough to assess objectively GSM changes or new objective approaches should be audited