Physical therapy in sexually dysfunctional women: a systematic review

The World Health Organization (WHO) considers Female Sexual Dysfunctions (FSDs) to be a public health issue. There are a multitude of disorders such as female sexual arousal disorder, hypoactive sexual desire disorder, orgasmic disorder, dyspareunia, and vaginismus. FSDs are detected in 67.9% of the women in the world and are present in 50% of Asians, in 30-50% of Americans, and in 30% of Brazilians. Objective: To systematically review the literature on the different physiotherapy techniques used in the treatment of FSDs. Methods: A systematic search was conducted in the databases EMBASE, PEDro, and MedLine in data as recent as June 2013, by combining words and descriptors of physical therapy treatments and female sexual dysfunctions. Excluded from review were articles concerning male sexual dysfunction, pilot studies, multicentric papers of projects, and those which were either not available in their entirety or were duplicated in another database. After the selection of studies was complete, the randomized clinical trials were scored on the PEDro Evaluation Scale. Results: Eleven articles were included, six of which went on to be qualitatively evaluated on the PEDro scale. The present study followed the methodological structure of PRISMA (Statement for Reporting Systematic Reviews and Meta-Analyses of Studies). All studies found used questionnaires to assess the effects of physical therapy on FSDs. A total of five different types of interventions were verified: kinesiotherapy (Kegel exercises and pelvic floor muscle training - PFMT), Cognitive behavioral therapy (CBT), biofeedback, electrotherapy (transcutaneous electrical stimulation - TENS, and therapeutic ultrasound - US), and manual therapy. The limitations found in this systematic review were related to the unavailability of the articles in full and the low methodological quality of the studies. Conclusion: All studies showed improvements in sexual function after physical therapy intervention. There is no consensus on any intervention with better results; however, kinesiotherapy using PFMT proved to be advantageous because of its easy application, low cost, easy learning curve, and lasting results achieved in a short period. However, there are methodological shortcomings that still need to be dealt with to determine the most suitable physical therapy treatment for FSDs, as well as defining the best dosage, the protocol to be followed, and the duration of therapy, as well as the best cost-benefitAs disfunções sexuais femininas (DSFs) são consideradas um problema de saúde pública pela Organização Mundial da Saúde (OMS). Consistem em inúmeras desordens, como distúrbio da excitação feminina, distúrbio do desejo sexual hipoativo, transtorno sexual do orgasmo feminino, dispareunia e vaginismo. As DSFs são detectadas em 67,9% das mulheres no mundo e estão presentes em 50% das asiáticas, em 30 a 50% das americanas e em 30% das brasileiras. Objetivo: Revisar sistematicamente a literatura sobre as diferentes técnicas de fisioterapia utilizadas no tratamento das DSFs. Métodos: Realizou-se uma busca sistemática, nas bases de dados EMBASE, PEDro e MedLine, de artigos publicados até junho de 2013, através da combinação entre palavras e descritores de tratamentos fisioterapêuticos e disfunções sexuais femininas. Foram excluídos os artigos sobre disfunção sexual masculina, estudos pilotos, papers ou projetos multicêntricos, que não estivessem disponíveis na íntegra ou duplicados em outra base de dado. Após a seleção final dos estudos, foi verificada a pontuação dos ensaios clínicos randomizados na Escala de Avaliação PEDro. Resultados: 11 artigos foram incluídos e, destes, seis passaram para a avaliação qualitativa na Escala PEDro. Este estudo seguiu a estruturação metodológica do PRISMA (Statement for Reporting Systematic Reviews and Meta-Analyses of Studies). Todos os estudos encontrados utilizaram questionários para avaliar os efeitos da intervenção fisioterapêutica nas DSFs. Foi verificado um total de cinco tipos de intervenções diferentes: cinesioterapia (exercícios de Kegel e treinamento muscular do assoalho pélvico - TMAP), terapia cognitivo-comportamental (CGBT), biofeedback, eletroterapia (TENS - eletroestimulação transcutânea e US - ultrassom terapêutico) e terapia manual. As limitações encontradas nesta revisão sistemática foram referentes a não disponibilização dos artigos na íntegra e à baixa qualidade metodológica dos estudos. Conclusão: Todos os estudos mostraram melhora na função sexual após intervenção fisioterapêutica. Não há um consenso sobre a intervenção com melhores resultados, no entanto, a cinesioterapia através do TMAP mostrou-se vantajosa por ser de fácil aplicação, baixo custo, aprendizado imediato e promover resultados duradouros em um curto período de tempo. No entanto, existem lacunas metodológicas que ainda precisam ser preenchidas para determinar o tratamento fisioterapêutico eletivo para as DSFs, assim como definir a melhor dosagem, o protocolo a ser seguido, a duração desta terapia, aliados ao melhor custo-benefíci

Mapeamento dinâmico da dor aos três, seis e nove meses após a cirurgia do câncer de mama / Dynamic pain mapping at three, six and nine months after breast cancer surgery

Purpose: To map pain frequency and pain intensity according to activities in the physical domain of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), at three, six and nine months after breast cancer surgery. In addition, to verify the correlation between upper limb function and pain intensity. Methods: This is a prospective cohort study, with follow-up at three time points. 22 Brazilian women diagnosed with breast cancer were included at three months after breast surgery. They performed the DASH questionnaire, the Body Pain Diagram and the Visual Analogue Scale. Frequency measures were used to analyze the frequency and intensity of pain in the items of the physical domain of the DASH. Pearson's correlation coefficient between pain intensity and the DASH total score at the three different times was calculated, a 95% confidence interval was set. Results: For twenty-two women at three, six and nine months after surgery, the body area with the highest pain frequency was the upper limb (UL) homolateral to the surgery, although, the contralateral UL was also cited as one of the areas with the highest pain frequency at sixth and ninth month. Pain intensity at three and six months remained mild and moderate in ninth month. The DASH activities with the highest pain frequency were: “putting something on a shelf above your head”, “doing heavy household chores” and “carrying a heavy object”. The correlation between pain intensity and function of the UL contralateral to surgery at nine months was strong (r=0,718; p<0.01). Conclusion: The body area with the highest pain frequency at all three times points of analysis was the UL homolateral to the surgery, although the contralateral UL was also present in sixth and ninth month. There was an increase in pain intensity over time. The most painful activities were those that required large amplitudes in different planes of motion. At the ninth month, pain in the contralateral UL showed a strong correlation with limb dysfunction

Perfil Epidemiológico das Mulheres com Câncer Ginecológico: um estudo multicasos, no Sul do Brasil / Epidemiological Profile of Women with Gynecologic: a multi-case study, in Southern Brazil

Introdução: O câncer ginecológico abrange malignidades do colo de útero, ovários, endométrio, vagina e vulva, sendo considerado um problema de saúde pública. Objetivos: Analisar o perfil epidemiológico das mulheres com diagnóstico de câncer ginecológico. Métodos: Estudo de caráter epidemiológico, retrospectivo com delineamento transversal a partir de dados de prontuários eletrônicos de mulheres com câncer ginecológico atendidas pela equipe de fisioterapia do CEPON/SC, no período de janeiro de 2013 a dezembro de 2018. Foi realizada uma análise descritiva dos dados. Resultados: Foram incluídos 310 pacientes com média de idade de 52,13 anos (±13,2 anos). A maioria das mulheres eram caucasianas (90,4%), casadas ou em união estável (60%), de baixa renda (89,2%) e com até o ensino fundamental completo (59,8%). Grande parte das mulheres eram tabagistas ou ex-tabagistas (46,2%) e não realizavam atividade física (85,5%). Houve predominância de casos de câncer de colo de útero (78,7%) e a braquiterapia foi realizada em 100% das mulheres. Conclusão: As pacientes com câncer ginecológico são, em sua maioria, caucasianas, com parceiro, tabagistas ou ex-tabagistas, diagnosticadas em estádios avançados da doença, principalmente câncer de colo uterino, o que representou maior agressividade terapêutica

Breast cancer surgery effect over professional activities

Introduction: Breast cancer is responsible for 25% of all cancers and is the most prevalent in the female population. Due to treatment advances and early diagnoses, survival rates have improved, however this condition impacts work absenteeism due to the productive age of these women. The main factors responsible for work absenteeism are physical complications due to surgical treatment. Objective: The aim of this study is to investigate the effects of surgical breast cancer treatments on occupation, to characterize the degree of work absenteeism and to investigate the type of relation between surgical technique and absenteeism’s main causes. Method: Cross-sectional study with 74 women diagnosed with breast cancer. A semi-structured interview was used to collect information regarding surgical and clinical aspects, sociodemographic data, work behavior and physical therapy treatments. The data was organized on Microsoft Excel and analyzed by frequency and chi-squared test. The significance level considered was p ≤ 0.05. Results: Breast cancer was most common on the left side (51%), Madden modified radical mastectomy was the most common (50%) and lymph node resection was present in 93.2% of cases. The most frequent post-surgery complications were pain, problems with scarring, sensitivity alterations, ROM limitation, lymphedema and seroma. Only 58% of women were treated with physical therapy and 60% withdrew from professional activities, 23% abandoned work, 26% changed their work role and 14% retired due to the disease. Conclusion: The present study suggests the existence of a direct relation between treatment and work absenteeism

Physical symptoms and working performance in female breast cancer survivors: a systematic review

<p><b>Purpose:</b> The aim of this systematic review was to summarize and systematize the information about physical symptoms and its relation with work activity on female Breast Cancer Survivors (BCS).</p> <p><b>Methods:</b> A systematic search was performed on the databases MEDLINE/PubMed (via National Library of Medicine), SCOPUS (Elsevier), Web of Science (Thomson Reuters Scientific) and CINAHL with full text (EBSCO), including papers about physical impairments experienced by female workers who have had breast cancer.</p> <p><b>Results:</b> The search retrieved 238 studies, and another 5 were identified in the articles’ references, totaling 243 papers. After removing duplicates and applying the inclusion criteria and a full text reading, 13 articles were included for qualitative analysis. Concerning physical limitations, most complaints were related to the elevation of upper limbs, carrying heavy objects, driving and holding manual movements. The most referred symptoms were breast/arm pain, fatigue, lymphedema, reduced range of motion and weakness in the upper limbs, scar tissue adherence in the breast/axilla and paresthesia in the arm/breast.</p> <p><b>Conclusion:</b> These symptoms and physical limitations led to the difficulty or impossibility of performing work tasks, which also diminished work productivity, as well as the increase in time to return to work. The present results suggest higher unemployment rates and the need for modifying work conditions.Implication for Rehabilitation</p><p>Health professionals should include risk assessment at daily routine to identify possible sources of physical impairments for upper limbs.</p><p>Provide the support and orientations according to personal and job characteristics of the patient.</p><p>Focus the aims of treatment over upper limbs impairments, reducing the prevalence and the gravity of symptoms.</p><p></p> <p>Health professionals should include risk assessment at daily routine to identify possible sources of physical impairments for upper limbs.</p> <p>Provide the support and orientations according to personal and job characteristics of the patient.</p> <p>Focus the aims of treatment over upper limbs impairments, reducing the prevalence and the gravity of symptoms.</p