Management of Menstrual and Gynecologic Concerns in Girls with Special Needs

For girls with physical and developmental disabilities and their families/caregivers, puberty and menstruation can present significant problems such as vulnerability, abuse risk, unintended pregnancies, difficulties with managing menstrual hygiene, abnormal uterine bleeding, dysmenorrhea, behavioral difficulties/mood concerns or changes in seizure pattern. Healthcare providers may have an important and positive impact for both the adolescents and their families/caregivers during this stage of life. Whether menstrual manipulation is indicated should be decided after a detailed history is taken from both the patient and the caregivers to determine the impact of current problems on quality of life. It should be explained that complete amenorrhea is difficult to achieve and realistic expectations should be addressed. The goals for the management of menstrual concerns should be a reduction in the amount and total days of menstrual flow, reduction of menstrual pain and suppression of ovulatory or cyclic symptoms, depending on each individual patient's needs. Advantages and disadvantages of available treatment methods should also be discussed

Increased incidence of pelvic organ prolapse in women with acromegaly

Objective: To evaluate gynecological problems of female patients with acromegaly and the relationship of these problems with the activity of the disease

Acromegaly is associated with higher frequency of female sexual dysfunction: experience of a single center

The aim of the study was to assess female sexual dysfunction (FSD), quality of life and depression status in female patients with acromegaly. Fifty-seven sexually active female patients with acromegaly disease (21 controlled, 36 uncontrolled) monitored by Cerrahpasa Medical School, Endocrinology and Metabolism out-patient clinic and age and body mass index-matched 46 healthy female subjects were included in the study. Sexual functions and status of depression in both patient and control groups were evaluated by using the Female Sexual Function Index Form (FSFI) and the Beck Depression Inventory (BDI), respectively. Quality of life was evaluated by using the Acromegaly Quality of Life (AcroQoL) Scale. Hormone levels were studied in the groups. The FSFI total score and desire, arousal, orgasm, and satisfaction domains in patients with acromegaly were significantly lower than in the healthy controls (p <= 0.0001). There was no difference between biochemically controlled and uncontrolled patients with acromegaly with respect to FSFI scores (p= 0.7). AcroQoL total score in female patients with controlled acromegaly and uncontrolled acromegaly were 46.33 +/- 16.5% and 50.13 +/- 18.21%, respectively (p= 0.53). The difference in BDI scores between controlled and uncontrolled acromegaly patients was not significant but they were significantly higher in the control group (p <= 0.0001). In the correlation analysis, a negative correlation was found between FSFI total and BDI score (r= -0.69, p< 0.001), age (r= -0.45, p< 0.001), and IGF-I (r= -0.28, p= 0.006). This study showed that sexual dysfunction and depression rates in female patients with acromegaly are higher than in healthy females

Diagnosis, management, and outcome of obstructed hemivagina and ipsilateral renal agenesis (OHVIRA syndrome): Is there a correlation between MRI findings and outcome?

Aim: To review the experience of a single tertiary center with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA syndrome) and evaluate if MRI findings correlate with outcome

Successful pregnancy after presurgical uterine artery embolization in the management of a very large cervical myoma: A case report

Although fibroids are the most common benign tumors of the uterus in women of reproductive age, cervical fibroids are rarely seen. Since cervical fibroids are located deep in the pelvis, the incidence of complications in surgery is high. Among these complications bleeding is the most common, due to poor access to myoma, difficulty in suturing and repair, and distortion of vital neighboring structures. Each case should be managed individually to minimize bleeding. To decrease bleeding in patients who wish to retain their fertility, intraoperative interventions include vasoconstrictors such as vasopressin and adrenaline, uterotonics such as oxytocin, misoprostol or ergometrines, uterine artery clamping, internal iliac artery balloon occlusion catheters, and tourniquets; preoperative interventions include gonadotropin releasing-hormone analogues and uterine artery embolization. We present a case of a 40-year-old woman who had a large cervical myoma and a desire for future fertility. To overcome technical difficulties and reduce intraoperative bleeding during myomectomy, presurgical uterine artery embolization was performed. The patient conceived spontaneously after the operation and a healthy baby was delivered by cesarean section

Non-invasive diagnosis of endometriosis based on a combined analysis of four plasma biomarkers

Purpose: The objective of the current study was to evaluate whether the analysis of different proinflammatory and angiogenesis-regulating cytokines in a well-defined patient population can be accurate for the diagnosis of endometriosis at different stages

Atypical Presentation of Swyer Syndrome

Background: Swyer syndrome is a rare type of disorder of sex development and typically presents with delayed puberty and primary amenorrhea. We describe an unusual presentation of this condition

Giant Vulvar Condylomata: Two Cases and a Review of the Literature

Introduction. Giant vulvar condyloma is usually associated with the HPV subtypes 6 and 11 and is characterized by excessive growth of verrucous lesions on the genitals and/or perianal region. It may be observed in sexually inactive as well as sexually active women. Immunosuppression plays an important role in the development of the disease. Patients and Methods. We report two cases of giant vulvar condyloma together with the review of the literature. Results. One case was a 21-year old sexually inactive woman with a history of Type 1 Diabetes. Second case was a 20-year-old sexually active woman with a rapidly progressing disease and cervical dysplasia. Both cases were operated; all the condylomatous structures were resected with preservation of the anatomy and clitoral innervation and blood flow. Skin and subcuticular dehiscence was the only complication encountered in the first case. Conclusion. Main treatment of giant vulvar condyloma is surgical resection with maintenance of the vulvar anatomy. Preservation of especially the clitoral innervation as much as possible is very important

Treatment of Vaginal Agglutination Complicating Chronic Graft-Versus-Host Disease: A Rare Case Report

We describe a 34-year old patient with vaginal agglutination, which presented as inability to have sexual intercourse two years after bone marrow transplantation for myelodysplastic syndrome. The vaginal adhesions were freed surgically after local estrogen therapy and tibolone was started. She was able to have sexual intercourse two months after the operation. In this case report, vulvovaginal complications of graft-versus-host disease and their treatment and prevention are discussed

Loss of stromal CD73 expression plays a role in pathogenesis of polypoid endometriosis

Purpose To investigate whether CD73 had a role in the pathogenesis of polypoid endometriosis