Resultados Da Colpofixação Sacroespinal Associada A Colporrafia Anterior Para O Tratamento Do Prolapso De Cúpula Vaginal

To evaluate the results of sacrospinous colpopexy surgery associated with anterior colporrhaphy for the treatment of womeN with post-hysterectomy vaginal vault prolapse. Methods This prospective study included 20women with vault prolapse, PelvicOrgan Prolapse Quantification System (POP-Q) stage ≥ 2, treated between January 2003 and February 2006, and evaluated in a follow-up review (more than one year later). Genital prolapse was evaluated qualitatively in stages and quantitatively in centimeters. Prolapse stage < 2 was considered to be the cure criterion. Statistical analysis was performed using the Wilcoxon test (paired samples) to compare the points and stages of prolapse before and after surgery. Results Evaluation of the vaginal vault after one year revealed that 95% of subjects were in stage zero and that 5% were in stage 1. For cystocele, 50% were in stage 1, 10% were in stage 0 (cured) and 40% were in stage 2. For rectocele, three women were in stage 1 (15%), one was in stage 2 (5%) and 16 had no further prolapse. The most frequent complication was pain in the right buttock, with remission of symptoms in all three cases three months after surgery. Conclusions In this retrospective study, the surgical correction of vault prolapse using a sacrospinous ligament fixation technique associatedwith anterior colporrhaphy proved effective in resolving genital prolapse. Despite the low complication rates, there was a high rate of cystocele, which may be caused by posterior vaginal shifting due to either the technique or an overvaluation by the POP-Q system. © 2016 by Thieme Publicações Ltda, Rio de Janeiro, Brazil.382778

Cirurgia Com Tela Para Correção De Prolapso De Parede Anterior: Metanálise

Purpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6–8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used, with or without the use of vaginal meshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: ‘anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)’ in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score ( > 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07–1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72–82,25]), longer surgery time (MD = 15,08 [0,48–29,67]), but less prolapse recurrence (OR = 0,22 [01,3–0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence. © 2016 by Thieme Publicações Ltda, Rio de Janeiro, Brazil.38735636

Cirurgia com tela para correção de prolapso de parede anterior: metanálise

Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6–8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used, with or without the use of vaginal meshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: ‘anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)’ in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score ( > 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07–1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72–82,25]), longer surgery time (MD = 15,08 [0,48–29,67]), but less prolapse recurrence (OR = 0,22 [01,3–0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence.387356364Prolapso de órgãos pélvicos é problema de saúde públicas, sendo o mais comum o anterior. Para tratamento são utilizadas cirurgias, com ou sem telas. O uso de telas é para diminuir recidivas, mas não h á consenso. Métodos: Foi realizada revisão da literatura e metanálise, sobre uso de telas na correção do prolapso anterior. Base de dados foi PUBMED , com termos (MESH): “Anterior Pelvic Organ OR Cystocele AND Surgery AND (Mesh or Colporrhaphy)”. Critérios de exclusão foram: seguimento menor que 1 ano, telas biológicas ou absorvíveis. Resultados: foram avaliados 115 artigos. Após revisão dos títulos, 70 estudos foram descartados e 18 após leitura de resumos. Após critérios de Jadad (>2), 12 estudos foram incluídos. Análise estatística foi razão de risco ou diferença entre médias dos grupos, e as análises com grande heterogeneidade foram avaliadas através de análise de efeito aleatório. Resultados: Cura objetiva foi superior no grupo com tela - OR 1,28 (1,07-1,53, p ≤ 0,00001), maior perda sanguínea - diferença média (MD) 45,98 (9,72-82,25, p = 0,01), tempo cirúrgico mais longo - MD 15,08 (0,48-29,67, p = 0,04), porém menor recorrência - OR 0,22 (0,13-0,38, p = 0,00001), não apresentando maior resolução dos sintomas - OR 1,93 (0,83-4,51, p = 0,15). Dispareunia e taxa de reoperação também não foram diferentes entre grupos. Qualidade de vida não apresentou diferença. Conclusões: Cirurgia com tela para prolapso vaginal anterior apresenta melhor taxa de cura anatômica e menor recorrência, sem diferenças cura subjetiva, reoperação e qualidade de vida. Há maior tempo cirúrgico e perda sanguínea. Uso de telas deve ser individualizado

Vaginal hysterectomy with bilateral sacrospinous fixation plus an anterior mesh versus abdominal sacrocervicopexy for the treatment of primary apical prolapse in postmenopausal women: a randomized controlled study

Introduction and hypothesis: We compared vaginal hysterectomy with bilateral sacrospinous fixation plus an anterior polyvinylidene fluoride mesh versus abdominal sacrocolpopexy for the treatment of primary apical prolapse in postmenopausal women. Methods: A prospective, randomized, single-blind, parallel study [Registro Brasileiro de Ensaios Clinicos (REBEC) trial register code RBR-7t6rg2] was performed from October 2015 to May 2016. A total of 71 postmenopausal women with advanced pelvic organ prolapse (POP) and undergoing surgery were randomized to the abdominal sacrocolpopexy (ASC) (n = 36) or the vaginal sacrospinous fixation with anterior mesh (VSF-AM) (n = 35) groups. Pelvic Organ Prolapse Quantification (POP-Q) system classification was performed for objective assessment, and the International Consultation on Incontinence Questionnaire–Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) questionnaires were filled out for subjective evaluation by women before and 1 year after surgery. All procedures were performed by a single surgeon. Results: Both groups had improvement in almost POP-Q points (except for vaginal length in the VSF-AM group) and all ICIQ scores. The ASC group had a longer operative time (129 versus 117 min, p = 0.0038) and duration for return to activities (103 versus 57 days, p <.05). Four women (11%) in the VSF-AM group were reoperated versus none from the ASC group (p = .05). Conclusions: Although the study did not achieve the planned recruitment, after 12 months of follow-up, ASC did not differ from VSF-AM in objective and subjective scores (ICIQ questionnaires; POP-Q measurements). Recovery time was longer after open abdominal surgery.31236537

Severity of urinary incontinence is associated with prevalence of sexual dysfunction

Introduction and hypothesis: Urinary incontinence (UI) affects overall health-related and sexual quality of life (QoL) in women. There is no consensus on the impact of severity and type of UI on the prevalence of sexual dysfunction (DS). The aim of this study was to evaluate the association between types and severity of UI and DS. Methods: A cross-sectional study of women with UI. Inclusion criteria: women complaining of UI and > 18 years old. Women with a history of previous treatment for UI, recurrent urinary tract infections, renal lithiasis, previous radiation therapy or pelvic organ prolapse above stage 2 in the Pelvic Organ Prolapse Quantification (POP-Q) system were excluded. Clinical and epidemiological data were collected, and the following questionnaires were applied: ICIQ-SF, ICIQ-OAB, King’s Health Questionnaire (KHQ) and Female Sexual Function Index (FSFI). Results: Concerning the type of UI, the majority of women had MUI (69.1%) and 56.8% reported having coital UI. The mean score was 20.81 ± 8.45 in the FSFI questionnaire. There was a prevalence of SD in 71.6% of women, with no difference in types of UI (p = 0.753) and loss during sexual intercourse (p = 0.217). There was a correlation between severity of UI (ICIQ-SF) and arousal (r = −0.26; p = 0.008), lubrication (r = −0.25; p = 0.009), orgasm (r = −0.25; p = 0.009), pain (r = −0.26; p = 0.007) and total (r = −0.28; p = 0.004) domain scores. Conclusions: There is a high prevalence of SD in women with urinary incontinence, irrespective of the type of UI and urine leakage during sexual intercourse. However, the greater the severity of UI is, the worse the sexuality questionnaire scores

Evaluation Of Sexual Function In Brazilian Women With Recurrent Vulvovaginal Candidiasis And Localized Provoked Vulvodynia

Introduction. Recurrent vulvovaginitis is an important trigger for inflammatory processes that in many cases may result in vulvovaginal pain. Vulvodynia, a vulvar disorder, can also cause a lot of pain in the female genitals. The sexual function in women with vulvodynia or recurrent vulvovaginitis will possibly be negatively affected and therefore should be evaluated. Aim. To assess sexual function in women with recurrent vulvovaginal candidiasis (RVVC) and localized provoked vulvodynia (LPV) in comparison with women without lower genital tract dysfunction. Methods. A 1-year cross-sectional study evaluated sexual function in 58 women (11 with RVVC, 18 with LPV, and 29 controls) seen at a university outpatient clinic. Sexual function was assessed by taking into account the results obtained from the application of the Female Sexual Function Index (FSFI) questionnaire. Kruskal-Wallis, Mann-Whitney, chi-square, and Fisher's tests were used for statistical analysis. Main Outcome Measure. FSFI, a validated questionnaire in Portuguese. Results. There were no significant differences in the three groups with respect to age, marital status, schooling, race, body mass index, contraceptive method, and parity. The FSFI questionnaire total score found was 25.51 (±5.12), 21.17 (±5.15), and 29.56 (±3.87) for the RVVC, LPV, and control groups, respectively. The scores were significantly statistically lower in the study groups compared with the control group (P<0.05). Women with RVVC and LPV also had lower total scores compared with 26.55 values, considered a cutoff score for sexual dysfunction in literature. The LPV group showed a significant difference and scored worse in the domains of arousal, lubrication, orgasm, satisfaction, and pain but not in the domain of sexual desire. The same occurred with the RVVC group but only for the domains of orgasm and satisfaction. Conclusion. Women with RVVC and LPV had significantly more symptoms of sexual dysfunction than women without lower genital tract diseases. © 2011 International Society for Sexual Medicine.93805811Stewart, D., Whelan, C., Fong, I., Tessler, K., Psychosocial aspects of chronic, clinically unconfirmed vulvovaginitis (1990) Obstet Gynecol, 76, pp. 852-856Masheb, R., Lozano-Blanco, C., Kohorn, E., Minkin, M., Kerns, R., Assessing sexual function and dyspareunia with the Female Sexual Function Index (FSFI) in women with vulvodynia (2004) J Sex Marital Ther, 30, pp. 315-324Abdo, C., Fleury, H., Aspectos diagnósticos e terapêuticos das disfunções sexuais femininas (2006) Rev. psiquiatr. Clín, 33, pp. 162-167Development of the World Health Organization Quality of Life Assessment instrument (the WHOQOL) (1994) Quality of life assessment: International perspectives, pp. 41-69. , The WHOQOL Group. Orley J, Kuyken W, eds. Heidelberg: Springer VerlagNyirjesy, P., Peyton, C., Weitz, M., Mathew, L., Culhane, J., Causes of chronic vaginitis: Analysis of a prospective database of affected women (2006) Obstet Gynecol, 108, pp. 1185-1191Geiger, A., Foxman, B., Sobel, J., Chronic vulvovaginal candidiasis: Characteristics of women with Candida albicans, C glabrata and no candida (1995) Genitourin Med, 71, pp. 304-307Sobel, J.D., Candidal vulvovaginitis (1993) Clin Obstet Gynecol, 36, pp. 153-165Eckert, L.O., Hawes, S.E., Stevens, C.E., Koutsky, L.A., Eschenbach, D.A., Holmes, K.K., Vulvovaginal candidiasis: Clinical manifestations, risk factors, management algorithm (1998) Obstet Gynecol, 92, pp. 757-765van Lankveld, J.J.D.M., Granot, M., Weijmar Schultz, W.C.M., Binik, Y.M., Wesselmann, U., Pukall, C.F., Bohm-Starke, N., Achtrari, C., Women's sexual pain disorders (2010) J Sex Med, 7, pp. 615-631Haefner, H., Report of the International Society for the Study of Vulvovaginal Disease terminology and classification of vulvodynia (2007) J Low Genit Tract Dis, 11, pp. 48-49Harlow, B., Stewart, E., A population-based assessment of chronic unexplained vulvar pain: Have we underestimated the prevalence of vulvodynia? (2003) J Am Med Womens Assoc, 58, pp. 82-88Meana, M., Binik, Y.M., Khalifé, S., Cohen, D., Dyspareunia: Sexual dysfunction or pain syndrome? (1997) J Nerv Ment Dis, 185, pp. 561-569Giesecke, J., Reed, B., Haefner, H., Giesecke, T., Clauw, D., Gracely, R., Quantitative sensory testing in vulvodynia volunteers and increased peripheral pressure pain sensitivity (2004) Obstet Gynecol, 104, pp. 126-133Tympanidis, P., Terenghi, G., Dowd, P., Increased innervation of the vulval vestibule in patients with vulvodynia (2003) Br J Dermatol, 148, pp. 1021-1027Jantos, M., Vulvodynia: A psychophysiological profile based on electromyographic assessment (2008) Appl Psychophysiol Biofeedback, 33, pp. 29-38Glazer, H., Jantos, M., Hartmann, E., Swencionis, C., Electromyographic comparisons of the pelvic floor in women with dysesthetic vulvodynia and asymptomatic women (1998) J Reprod Med, 43, pp. 959-962Boardman, L.A., Stockdale, C.K., Sexual pain (2009) Clin Obstet Gynecol, 52, pp. 682-690Ponte, M., Klemperer, E., Sahay, A., Chren, M., Effects of vulvodynia on quality of life (2009) J Am Acad Dermatol, 60, pp. 70-76Gates, E.A., Galask, R.P., Psychological and sexual functioning in women with vulvar vestibulitis (2001) J Psychosom Obstet Gynaecol, 22, pp. 221-228Ehrström, S., Kornfeld, D., Rylander, E., Bohm-Starke, N., Chronic stress in women with localized provoked vulvodynia (2009) J Psychosom Obstet Gynaecol, 30, pp. 73-79Spoelstra, S.K., Diijkstra, J.R., van Driel, M.F., Weijmar Schultz, W.C., Long-term results of an individualized, multifaceted, and multidisciplinary therapeutic approach to provoked vestibulodynia (2011) J Sex Med, 8, pp. 489-496Abdo, C.H., Oliveira Jr, W.M., Moreira Jr, E.D., Fittipaldi, J.A., Prevalence of sexual dysfunctions and correlated conditions in a sample of Brazilian women-results of the Brazilian Study on Sexual Behavior (BSSB) (2004) Int J Impot Res, 16, pp. 160-166Laumann, E.O., Paik, A., Rosen, R.C., Sexual dysfunction in the United States. Prevalence and predictors (1999) JAMA, 281, pp. 537-544Fugl-Meyer, K.S., Female sexual disorders: Psychiatric aspects (2002) Can J Psychiatr, 47, pp. 419-425Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., Ferguson, D., D'Agostino Jr, R., The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function (2000) J Sex Marital Ther, 26, pp. 191-208Thiel, R.R., Dambros, M., Palma, P., Thiel, M., Riccetto, C., Ramos, M.F., Translation into Portuguese, cross-national adaptation and validation of the Female Sexual Function Index (2008) Rev Bras Ginecol Obstet, 30, pp. 504-510Wiegel, M., Meston, C., Rosen, R., The Female Sexual Function Index (FSFI): Cross-validation and development of clinical cutoff scores (2005) J Sex Marital Ther, 31, pp. 1-20Jeremias, J., Ledger, W.J., Witkin, S.S., Interleukin 1 receptor antagonist gene polymorphism in women with vulvar vestibulitis (2000) Am J Obstet Gynecol, 182, pp. 283-285Graziottin, A., Serafini, A., Palacios, S., Aetiology, diagnostic algorithms and prognosis of female sexual dysfunction (2009) Maturitas, 63, pp. 128-134Ramage, M., Female sexual dysfunction (2006) Psychiatry, 6, pp. 105-110Donaldson, R.L., Meana, M., Early dyspareunia experience in young women: Confusion, consequences, and help-seeking barriers (2011) J Sex Med, 8, pp. 814-82

Prospective Evaluation Of Bone Mass In Women With Gonadal Dysgenesis Undergoing Hormone Therapy - A 5-year Analysis

[No abstract available]341152154NIH consensus development panel on osteoporosis prevention, diagnosis, and therapy, March 7-29, 2000: Highlights of the conference (2001) South Med J, 94 (6), pp. 569-573. , JunAlbright, F., Smith, P.H., Richardson, A.M., Postmenopausal osteoporosis: Its clinical features (1940) J Am Med Assoc, 116, pp. 2465-2474De Cherney, A., Physiologic and pharmacologic effects of estrogen and progestin on bone (1993) J Reprod Med, 38, pp. 1007-1013Lindsay, R., Estrogen therapy in the prevention and management of osteoporosis (1987) American Journal of Obstetrics and Gynecology, 156 (5), pp. 1347-1351Tobias, J.H., Chambers, T.J., Effect of sex hormones on bone resorption by rat osteoclasts (1991) Acta Endocrinol, 124, pp. 121-127Lindsay, R., Estrogens, bone mass, and osteoporotic fracture (1991) Am J Med, 91 (5 SUPPL. B), pp. 115-135Dempster, D.W., Lindsay, R., Pathogenesis of osteoporosis (1993) Lancet, 341 (8848), pp. 797-801. , DOI 10.1016/0140-6736(93)90570-7Oldenhave, A., Netelenbos, C., Pathogenesis of climacteric complaints: Ready for the change? (1994) Lancet, 343 (8898), pp. 649-653. , DOI 10.1016/S0140-6736(94)92641-7Manolagas, S.C., Jilka, R.L., Bone marrow, citokines and bone remodeling (1995) New Engl J Med, 332, pp. 335-341Prior, J.C., Progesterone as a bone-trofic hormone (1990) Endocr Rev, 11, pp. 386-398Odell, W.D., Heath III, H., Osteoporosis: Pathophysiology, prevention, diagnosis and treatment (1993) Dis Month, 39, pp. 789-867Dhuper, S., Warren, M.P., Brooks-Gunn, J., Fox, R., Effects of hormonal status on bone density in adolescent girls (1990) J Clin Endocrinol Metab, 71, pp. 1083-1088Fernandes, C.E., Wehba, S., Melo, N.R., Osteoporose pósmenopausica (1996) Femina, 24 (1 SUPPL.), pp. 3-26Bahner, F., Schwartz, G., Heinz, H.H., Turner's syndrome with fully developed secondary sex characteristics and fertility (1969) Acta Endocrinol, 35, p. 379Nakashima, I., Robison, A., Fertility in 45X female (1971) Pediatrics, 47, pp. 770-775Baracat, E.C., Rodrigues, L.G., Brunoni, D., Gênese dos órgãos da reprodução. Estados intersexuais (1995) Ginecologia Endócrina, pp. 179-195. , São Paulo: Editora AtheneuSing, R.P., Carr, D.H., The anatomy and histology of XO human embryos and fetuses (1966) Ann Rec, 155, pp. 369-373Speroff, L., Glass, R.H., Kase, N., Normal and abnormal sexual developmment (1994) Clinical Gynecologic Endocrinology and Infertility, pp. 321-360. , Speroff L, Glass RH, Kase N, Fifth Edition. Baltimore, Willians & WilkinsMcDonough, P.G., Genetic determinants of premature ovarian failure (1994) Ovarian Endocrinopathies, pp. 263-277. , Schats R, Schoemaker J. eds-, London, The Parthenon PublishingBonduki, C.E., Haiddar, M.A., Da Motta, E.L.A., Nunes, M.G., Lima, G.R., Baracat, E.C., Densidade óssea em pacientes com gonadal dysgenesis (1996) Reprod Climat, 11, pp. 43-44Preger, L., Steinbach, H.L., Moskowitz, P., Scully, A.L., Goldberg, M.B., Roentgenographic abnormalities in phenotypic females with gonadal dysgenesis (1968) AJR, 104, pp. 899-910Brown, D.M., Jowsey, J., Bradford, D.S., Osteoporosis in ovarian dysgenesis (1974) J Pediatr, 84, pp. 816-820Ross, J.L., Long, L.M., Feuillan, P., Cassorla, F., Cutler Jr., G.B., Normal bone density of the wrist and spine and increased wrist fractures in girls with Turner's syndrome (1991) Journal of Clinical Endocrinology and Metabolism, 73 (2), pp. 355-359Cann, C.E., Martin, M.C., Genant, H.K., Jaffe, R.B., Decreased spinal mineral content in amenorrheic women (1984) Journal of the American Medical Association, 251 (5), pp. 626-629. , DOI 10.1001/jama.251.5.626White, C.M., Hergenroeder, A.C., Klish, W.J., Bone mineral density in 15 to 21 year-old eumenorrheic and amenorrheic subjects (1992) Am J Dis Child, 146, pp. 31-3

Factors associated with the prescription of vaginal pessaries for pelvic organ prolapse

To identify the factors associated with the prescription of vaginal pessaries (VPs) as a conservative treatment for pelvic organ prolapse (POP). A cross-sectional study was performed during two annual urogynecology and general obstetrics and gynecology meetings in 2017 (São Paulo, SP, Brazil). A 19-item deidentified questionnaire regarding experiences and practices in prescribing VPs for POP patients was distributed among gynecologists. Our primary outcome was the frequency of prescribing VPs as a conservative treatment for POP. The reasons for prescribing or not prescribing VPs were also investigated. Univariate and multivariate analyses with crude and adjusted odds ratios (ORs) were performed for variables associated with the prescription of pessaries. RESULTS: Three hundred forty completed surveys were analyzed. Half of the respondents (53.53%) were between 30-49 years old; most of them were female (73.53%), were from the Southeast Region (64.12%), were trained in obstetrics and gynecology (80.24%) or urogynecology (61.18%) and worked in private offices (63.42%). More than one-third (36.48%) attended four or more POP cases/week, and 97.65% (n=332) had heard or knew about VPs for POP; however, only 47.06% (n=160) prescribed or offered this treatment to patients. According to the multivariate analysis, physicians aged 18-35 years (OR=1.97[1.00-3.91]; p=0.04), those who participated in a previous urogynecology fellowship (OR=2.34[1.34-4.09]; p<0.01), those with relatively high volumes of POP cases (4 or +) (OR=2.23[1.21-4.47]; p=0.01) and those with PhD degrees (OR=2.75[1.01-7.54]; p=0.05) prescribed more pessaries. Most gynecologists did not prescribe VPs. Younger physician age, participation in a previous urogynecology fellowship, a PhD degree, and a relatively high volume of POP cases were associated with increased VP prescription rates7

Polycystic Ovary Syndrome And Chronic Autoimmune Thyroiditis

Introduction: Polycystic ovary syndrome (PCOS) has been associated with an autoimmune origin, either per se or favoring the onset of autoimmune diseases, from a stimulatory action on the inflammatory response. Thus, autoimmune thyroiditis (AIT) could be more prevalent among women with PCOS. Objective: To evaluate the prevalence of AIT in women with PCOS. Study design: It was a cross-sectional study, in a tertiary center, including 65 women with PCOS and 65 women without this condition. Clinical and laboratory parameters were evaluated and a thyroid ultrasound scan was performed. Levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), anti-thyroid peroxidase (anti-TPO) antibodies, anti-thyroglobulin (anti-TG) antibodies, and thyroid ultrasound findings were evaluated. Results: The prevalence of subclinical hypothyroidism (SCH) in women with PCOS was 16.9% and 6.2% in the non-PCOS group. AIT was more common in the PCOS group compared with the non-PCOS group (43.1% versus 26.2%). But, when it was adjusted by weight and insulin resistance, the difference in the thyroiditis risk was not observed (OR 0.78, CI 0.28-2.16). Conclusion: AIT risk was similar in the PCOS and the non-PCOS group. SCH are more common in women with PCOS, highlighting a need for periodic monitoring of thyroid function.3114851Dunaif, A., Insulin resistance and the polycystic ovary syndrome: Mechanism and implications for pathogenesis (1997) Endocr Rev, 18, pp. 774-800Gleicher, N., Barad, D., Weghofer, A., Functional autoantibodies, a new paradigm in autoimmunity? (2007) Autoimmun Rev, 7, pp. 42-45Mueller, A., Schöfl, C., Dittrich, R., Thyroid-stimulating hormone is associated with insulin resistance independently of body mass index and age in women with polycystic ovary syndrome (2009) Hum Reprod, 24, pp. 2924-2930Janssen, O.E., Mehlmauer, N., Hahn, S., High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome (2004) Eur J Endocrinol, 150, pp. 363-369Benetti-Pinto, C.L., Berini Piccolo, V.R., Garmes, H.M., Teatin Juliato, C.R., Subclinical hypothyroidism in young women with polycystic ovary syndrome: An analysis of clinical, hormonal, and metabolic parameters (2013) Fertil Steril, 99, pp. 588-592Cooper, D.S., Biondi, B., Subclinical thyroid disease (2012) Lancet, 379, pp. 1142-1154Dayan, C.M., Daniels, G.H., Chronic autoimmune thyroiditis (1996) N Engl J Med, 335, pp. 99-107Garelli, S., Masiero, S., Plebani, M., High prevalence of chronic thyroiditis in patients with polycystic ovary syndrome (2013) Eur J Obstet Gynecol Reprod Biol, 169, pp. 248-251Anaforoglu, I., Topbas, M., Algun, E., Relative associations of polycystic ovarian syndrome vs metabolic syndrome with thyroid function, volume, nodularity and autoimmunity (2011) J Endocrinol Invest, 34, pp. e259-e264Kachuei, M., Jafari, F., Kachuei, A., Keshteli, A.H., Prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome (2012) Arch Gynecol Obstet, 285, pp. 853-856Ganie, M.A., Marwaha, R.K., Aggarwal, R., Singh, S., High prevalence of polycystic ovary syndrome characteristics in girls with euthyroid chronic lymphocytic thyroiditis: A case-control study (2010) Eur J Endocrinol, 162, pp. 1117-1122Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (pcos (2004) Hum Reprod, 19, pp. 41-47. , Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop GroupTreloar, A.E., Boynton, R.E., Behn, B.G., Brown, B.W., Variation of the human menstrual cycle through reproductive life (1967) Int J Fertil, 12, pp. 77-126Archer, J.S., Chang, R.J., Hirsutism and acne in polycystic ovary syndrome (2004) Best Pract Res Clin Obstet Gynaecol, 18, pp. 737-754Babson, A.L., The immulite automated immunoassay system (1991) J Clin Immunoassay, 14, pp. 83-88Matthews, D.R., Hosker, J.P., Rudenski, A.S., Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man (1985) Diabetologia, 28, pp. 412-419Surks, M.I., Ortiz, E., Daniels, G.H., Subclinical thyroid disease: Scientific review and guidelines for diagnosiSand management (2004) Jama, 291, pp. 228-238Pedersen, O.M., Aardal, N.P., Larssen, T.B., The value of ultrasonography in predicting autoimmune thyroid disease (2000) Thyroid, 10, pp. 251-259Sheth, S., Role of ultrasonography in thyroid disease (2010) Otolaryngol Clin North Am, 43, pp. 239-255Pocock, S.J., Clinical trials with multiple outcomes: A statistical perspective on their design, analysis, and interpretation (1997) Control Clin Trials, 18, pp. 530-545Ganie, M.A., Laway, B.A., Wani, T.A., Association of subclinical hypothyroidism and phenotype, insulin resistance, and lipid parameters in young women with polycystic ovary syndrome (2011) Fertil Steril, 95, pp. 2039-2043Petríková, J., Lazúrová, I., Ovarian failure and polycystic ovary syndrome (2012) Autoimmun Rev, 11, pp. A471-A478Petríková, J., Lazúrová, I., Yehuda, S., Polycystic ovary syndrome and autoimmunity (2010) Eur J Intern Med, 21, pp. 369-37

Electromyography And Vaginal Pressure Of The Pelvic Floor Muscles In Women With Recurrent Vulvovaginal Candidiasis And Vulvodynia

Objective: To evaluate the electrical potentials and pressure exerted by the pelvic floor muscles in women with recurrent vulvovaginal candidiasis (RVVC) or vulvodynia as compared to control women. Study Design: A crosssectional study performed in the Female Outpatient Clinic of Genital Infections in the Department of Obstetrics and Gynecology of the Universidade Estadual de Campinas analyzed and compared electromyography (EMG) and vaginal pressure of the pelvic floor muscles in 61 women. Of these 61 women, 19 had vulvodynia, 12 had RVVC and 30 women had no disorder (control group). For data collection, the instrument used was the Miotool Uro device and its software Biotrainer (Miotec Ltd., Porto Alegre, Rio Grande do Sul, Brazil). Results: The EMG evaluation of the pelvic floor muscles showed significantly lower values in the vulvodynia group (tonic contractions) and RVVC group (phasic and tonic contractions) when compared to the control group. No significant differences in basal tone EMG and vaginal pressure values at rest or during pelvic floor muscle contractions were found among groups. The maximum time of sustained contraction in patients with RVVC or vulvodynia was significantly lower (p < 0.0001) than in controls. Conclusion: Women with vulvodynia and RVVC have more frequent pelvic floor muscle dysfunction than controls when observed by EMG evaluation. © Journal of Reproductive Medicine®, Inc.57141147Haefner, H.K., Report of the International Society for the Study of Vulvovaginal Disease terminology and classification of vulvodynia (2007) J Low Genit Tract Dis, 11, pp. 48-49Nyirjesy, P., Peyton, C., Weitz, M.V., Causes of chronic vaginitis: Analysis of a prospective database of affected women (2006) Obstet Gynecol, 108, pp. 1185-1191Geiger, A.M., Foxman, B., Sobel, J.D., Chronic vulvovaginal candidiasis: Characteristics of women with Candida albicans, C glabrata and no candida (1995) Genitourin Med, 71, pp. 304-307Sobel, J.D., Candidal vulvovaginitis (1993) Clin Obstet Gynecol, 36, pp. 153-165Giraldo, P.C., Ribeiro Filho, A., Simões, J., Vulvovaginites: Aspectos habitualmente não-considerados (1997) J Bras Ginec, 107, pp. 89-93Stewart, D.E., Whelan, C.I., Fong, I.W., Psychosocial aspects of chronic, clinically unconfirmed vulvovaginitis (1990) Obstet Gynecol, 76, pp. 852-856Glazer, H.I., Jantos, M., Hartmann, E.H., Electromyographic comparisons of the pelvic floor in women with dysesthetic vulvodynia and asymptomatic women (1998) J Reprod Med, 43, pp. 959-962Witkin, S.S., Gerber, S., Ledger, W.J., Differential characterization of women with vulvar vestibulitis syndrome (2002) Am J Obstet Gynecol, 187, pp. 589-594Sobel, J.D., Vulvovaginitis: When Candida becomes a problem (1998) Dermatol Clin, 16, pp. 763-768Reissing, E.D., Brown, C., Lord, M.J., Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome (2005) J Psychosom Obstet Gynaecol, 26, pp. 107-113Moyal-Barracco, M., Lynch, P.J., 2003 ISSVD terminology and classification of vulvodynia: A historical perspective (2004) J Reprod Med, 49, pp. 772-777Harlow, B.L., Stewart, E.G., A population-based assessment of chronic unexplained vulvar pain: Have we underestimated the prevalence of vulvodynia? (2003) J Am Med Womens Assoc, 58, pp. 82-88Nunns, D., Mandal, D., Byrne, M., Guidelines for the management of vulvodynia (2010) Br J Dermatol, 162, pp. 1180-1885Glazer, H.I., Marinoff, S.C., Sleight, I.J., Web-enabled Glazer surface electromyographic protocol for the remote, real-time assessment and rehabilitation of pelvic floor dysfunction in vulvar vestibulitis syndrome: A case report (2002) J Reprod Med, 47, pp. 728-730Zolnoun, D., Hartmann, K., Lamvu, G., A conceptual model for the pathophysiology of vulvar vestibulitis syndrome (2006) Obstet Gynecol Surv, 61, pp. 395-401Bachmann, G.A., Rosen, R., Pinn, V.W., Vulvodynia: A state-of-the-art consensus on definitions, diagnosis and management (2006) J Reprod Med, 51, pp. 447-456Reed, B.D., Haefner, H.K., Edwards, L., A survey on diagnosis and treatment of vulvodynia among vulvodynia researchers and members of the International Society for the Study of Vulvovaginal Disease (2008) J Reprod Med, 53, pp. 921-929Haefner, H.K., Collins, M.E., Davis, G.D., The vulvodynia guideline (2005) J Low Genit Tract Dis, 9, pp. 40-51Payne, K.A., Binik, Y.M., Amsel, R., When sex hurts, anxiety and fear orient attention towards pain (2005) Eur J Pain, 9, pp. 427-436Piassarolli, V.P., Hardy, E., Andrade, N.F., Pelvic floor muscle training in female sexual dysfunctions [Article in Portuguese] (2010) Rev Bras Ginecol Obstet, 32, pp. 234-240Pagano, R., Value of colposcopy in the diagnosis of candidiasis in patients with vulvodynia (2007) J Reprod Med, 52, pp. 31-34Mann, M.S., Kaufman, R.H., Brown Jr., D., Vulvar vestibulitis: Significant clinical variables and treatment outcome (1992) Obstet Gynecol, 79, pp. 122-125Sobel, J.D., Wiesenfeld, H.C., Martens, M., Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis (2004) N Engl J Med, 351, pp. 876-883Graven-Nielsen, T., Arendt-Nielsen, L., Peripheral and central sensitization in musculoskeletal pain disorders: An experimental approach (2002) Curr Rheumatol Rep, 4, pp. 313-321Frawley, H.C., Galea, M.P., Phillips, B.A., Reliability of pelvic floor muscle strength assessment using different test positions and tools (2006) Neurourol Urodyn, 25, pp. 236-242Bø, K., Sherburn, M., Evaluation of female pelvic-floor muscle function and strength (2005) Phys Ther, 85, pp. 269-282Nappi, R.E., Ferdeghini, F., Abbiati, I., Electrical stimulation (ES) in the management of sexual pain disorders (2003) J Sex Marital Ther, 29, pp. 103-110Jantos, M., Vulvodynia: A psychophysiological profile based on electromyographic assessment (2008) Appl Psychophysiol Biofeedback, 33, pp. 29-38White, G., Jantos, M., Glazer, H., Establishing the diagnosis of vulvar vestibulitis (1997) J Reprod Med, 42, pp. 157-160Bergeron, S., Brown, C., Lord, M.J., Physical therapy for vulvar vestibulitis syndrome: A retrospective study (2002) J Sex Marital Ther, 28, pp. 183-192Rosenbaum, T.Y., Physiotherapy treatment of sexual pain disorders (2005) J Sex Marital Ther, 31, pp. 329-340Danielsson, I., Torstensson, T., Brodda-Jansen, G., EMG biofeedback versus topical lidocaine gel: A randomized study for the treatment of women with vulvar vestibulitis (2006) Acta Obstet Gynecol Scand, 85, pp. 1360-1367Butrick, C.W., Pelvic floor hypertonic disorders: Identification and management (2009) Obstet Gynecol Clin North Am, 36, pp. 707-722Murina, F., Bernorio, R., Palmiotto, R., The use of amielle vaginal trainers as adjuvant in the treatment of vestibulodynia: An observational multicentric study (2008) Medscape J Med, 10, p. 2