Himen imperforado con hematocolpos. A propósito de un caso / Imperforate hymen with hematocolpos. Apropos of a case

RESUMEN Los defectos en la canalización de la membrana himeneal causan obstrucción del tracto genital femenino. Como consecuencia aparece hematocolpos, resultante de la acumulación y retención de secreciones cervicovaginales -sangre en útero y vagina-, ante la imposibilidad de su evacuación por la presencia de un himen imperforado. Clínicamente aparece masa abdominal, asociada con malformaciones vaginales congénitas. Se presentó el caso de una adolescente de 13 años que refirió retención urinaria, disuria, dolor y masa en hipogastrio, y ausencia de la menarquía a pesar de un desarrollo puberal en estadio Tanner III. Al realizar ultrasonido se constató sangre en el útero, debido a imperforación himeneal que se resolvió mediante himenotomía. La patología de himen imperforado con hematocolpos debe estar entre los posibles planteamientos sindrómicos de aquellas pacientes con cuadros similares; puede diagnosticarse en la Atención Primaria de Salud a partir de una detallada anamnesis y exploración física, aunque la comprobación requiere ecografía (AU).

ABSTRACT The defects in the channeling of the himeneal membrane cause obstruction in the female genital tract. As consequence hematocolpos appears, resulting from the accumulation and retention of cervicovaginal secretions -blood in the uterus and vagina-, due to the impossibility of its evacuation because of the presence of an imperforate hymen. Clinically, abdominal mass appears associated to congenital vaginal malformations. We presented the case of teenager aged 13 years that referred urine retention, dysuria, pain, had a mass in the hypogastrium, and absence of menarche in spite of a Tanner III pubertal development. An ultrasound showed blood in the uterus due to hymeneal imperforation solved through hymenotomy. The pathology of imperforate hymen with hematocolpos should be among the possible syndrome considerations in those patients with the same characteristics; it can be diagnosed in the primary health care from anamnesis and physical exploration, although the verification requires an ultrasound (AU).

Complete corporeal preservation clitoroplasty: new insights into feminizing genitoplasty

ABSTRACT Introduction: 46,XX Congenital adrenal hyperplasia (CAH) remains the first cause of genital virilization and current surgical techniques aim to restore female aspect of genitalia while preserving dorsal neurovascular bundle but not at the expense of not preserving erectile tissue. We aim to report our experience with a new surgical technique for clitoroplasty, completely preserving corporeal bodies, neurovascular bundles without dismembering the clitoris, in four patients with over a year follow up. Materials and Methods: After IRB approval four patients with 46,XX CAH and Prader 5 and 3 external genitalia, underwent feminizing genitoplasty. Complete preservation of erectile tissue was accomplished without a need to dissect dorsal neurovascular bundle. Glans size allowed no need for glanular reduction and there was no need to dismember the corporeal bodies. Results: Four patients 12 to 24-months-old underwent complete corporeal preservation clitoroplasty (CCPC), mean age was 18.5 months, mean follow up was 10.25 months. Vaginoplasty was performed in all patients with partial urogenital mobilization (PUM) and Urogenital Sinus flap (UF), only one severely virilized patient required a parasagittal pre-rectal approach to mobilize the vagina. We had no complications until last follow up. Conclusion: To our knowledge, we are introducing the concept of CCPC without the need of disassembling the corporeal bodies, neurovascular bundle and glans. It stands as a new alternative for feminizing genitoplasty with complete preservation of erectile tissue and no dissection of neurovascular bundle. Although there is still lacking long-term follow-up, it represents a new step in conservative reconfiguration of the external virilized female genitalia.

Anatomia do sistema reprodutor feminino de Alouatta belzebul (Linnaeus, 1766) / [Anatomy of the female reproductive system of the Alouatta belzebul (Linnaeus, 1766)]

O conhecimento da anatomia de qualquer animal silvestre é de fundamental importância para sua preservação e proteção. Neste contexto, o presente estudo objetivou descrever a morfologia do sistema reprodutor feminino de Alouatta belzebul. Foram utilizados seis espécimes de A. belzebul, fêmeas, adultas, e livres de lesões. Observou-se macroscopicamente que os ovários têm características morfológicas em formato ovoides, com superfície lisa, e, na análise histológica na região de córtex, evidenciou-se folículos ovarianos em diferentes estágios de desenvolvimento. As tubas uterinas anatomicamente são finas e curvilíneas, apresentando uma camada mucosa, uma muscular e outra serosa. O útero possui formato simples, com fundo globoso, com um miométrio altamente vascularizado, sendo organizado em feixes de fibras musculares lisas. A estrutura anatômica da vagina apresentou-se como um tubo muscular longo de paredes finas, onde, na região vestibular, o óstio externo da uretra é marcado por uma papila uretral bilobada e, na região de vulva, em sua porção caudal, contatou-se um clitóris bem desenvolvido. No que concerne à análise histológica da vagina, verificou-se, em região de mucosa vaginal, um extrato basal composto por epitélio estratificado pavimentoso não queratinizado atrófico. As descrições morfológicas fornecem, de forma inédita, informações importantes relativas à anatomia macroscópica e microscópica do sistema reprodutor feminino dessa espécie.(AU)

Knowledge of the anatomy of any wild animal is of fundamental importance for its preservation and protection. In this context the present study aimed to describe the morphology of the female reproductive system of A. belzebul. We used 6 specimens of A. belzebul, female, adult and free of lesions. It was macroscopically observed that the ovaries are ovoid with smooth surface and the histological analysis in cortical region showed ovarian follicles in different stages of development. The fallopian tubes are anatomically thin and curvilinear, with one mucous layer, one muscular and one serous layer. The uterus was presented in a simple format with a globular fundus, with a highly vascularized myometrium, being organized in bundles of smooth muscle fibers. The anatomical structure of the vagina presented itself as a long thin-walled muscular tube where in the vestibular region the external orifice of the urethra is marked by a bilobed urethral papilla and in the caudal portion in its caudal portion a well-developed clitoris. Regarding the histological analysis of the vagina, a basal extract composed of atrophic non-keratinized stratified squamous epithelium was found in the vaginal mucosa region. The morphological descriptions provide important information regarding the macroscopic and microscopic anatomy of the female reproductive system of this species in an unprecedented way.(AU)

Lesions of the sheep reproductive system found in a slaughterhouse in the state of Bahia, Brazil / Lesões do sistema reprodutor em ovelhas de abatedouros frigoríficos no estado da Bahia

The present study aimed to evaluate and diagnose pathologies of the reproductive system of slaughtered sheep in slaughterhouses in the state of Bahia since there are few data on the subject as well as it is important to note the diagnosis of these diseases to apply appropriate control and prophylaxis measures. The research was carried out in slaughterhouses in the state of Bahia according to the "Serviço de Inspeção Federal" and "Serviço de Inspeção Estadual" for sheep slaughter. From July 2018 to February 2019, visits and monitoring of 1,072 slaughtered sheep were carried out. The animals came from 22 municipalities in the state of Bahia, aged from six to 18 months. During slaughter, the sheep reproductive systems were sectioned for evisceration and lesion collection. Additionally, epidemiological surveys related to origin, age, and race were obtained. For bacteriological examination, collections were performed with sterile scalpel slides and swabs in Stuart medium sterile tubes and refrigerated in a thermal box. For histopathological analysis, fragments were fixed in 10% formaldehyde and routinely processed for histology, stained with Hematoxylin and Eosin (HE). A study of the sheep's main pathological changes in slaughterhouses in the state of Bahia was carried out, in which 1.072 genital systems were evaluated, and 211 alterations were identified. The most affected reproductive organs were the ovaries (65.3%), followed by the uterus (29.4%) and uterine tubes (5.3%). In the ovaries, the most frequent lesion was a follicular cyst (34.1%); in the fallopian tubes, the cysts represented 3.3% of the lesions, and in the womb, endometritis was observed in 9% of the animals. Other pathologies identified in the ovaries were: luteinized cyst (2.3%); cystic granulosa cell tumor (0.5%); benign lesion (0.5%); agenesis unilateral (0.5%), in addition to other changes of little clinical significance, such as corpus luteum cysts (11.8%) and paraovarian cysts (15.6%). In the fallopian tubes, hydrosalpinx was observed (1%), as well as adenoma (0.5%), agenesis (0.5%), and cysts (3.3%). Uterine lesions included hydrometra (2.3%); Cystic Endometrial Hyperplasia (CEH), abscess, and pyometra (1.4% each); adenomyosis, womb sera petechiae, and total segmental aplasia (1% each); two pregnant uterus, in early pregnancy, presented pyometra (0.9%), however, no change was observed in the fetuses; and uterine polyp (0.5%). Ectopic pregnancy with fetal maceration (0.5%) was observed; vaginitis occurred in 0.5% of the animals, and endometrial melanosis in 8.5%. The high incidence of follicular cysts and endometritis are characterized as diseases that reduce the reproductive efficiency in herds, causing infertility and economic losses in production.(AU)

O objetivo do presente trabalho foi avaliar e diagnosticar alterações do sistema reprodutor de ovelhas abatidas em abatedouros frigoríficos no estado da Bahia. A pesquisa foi realizada em abatedouros frigoríficos do estado da Bahia com Serviços de Inspeção Federal e Estadual no abate de ovinos. No período de julho de 2018 a fevereiro de 2019 foram realizadas visitas e acompanhamento do abate de 1.072 ovelhas. Os animais eram provenientes de 22 municípios do estado da Bahia, com idade entre 6 a 18 meses. Durante o abate, na evisceração foram seccionados os sistemas reprodutores das ovelhas para avaliação e coleta das lesões. Adicionalmente foram obtidos inquéritos epidemiológicos relacionados à procedência, idade e raça. Para o exame bacteriológico, as coletas foram realizadas com lâminas de bisturi estéreis e swabs em tubos estéreis com meio Stuart e refrigeradas em caixa térmica. Para análise histopatológica, os fragmentos foram fixados em formol a 10% e processados de forma rotineira para histologia e corados pela hematoxilina e eosina (HE). Entre 1.072 sistemas genitais avaliados, identificou-se 211 alterações. Os órgãos do sistema reprodutor mais acometidos foram os ovários (65,3%), útero (29,4%) e tubas uterinas (5,3%). Nos ovários, a lesão mais frequente foi o cisto folicular (34,1%); no útero a endometrite (9%) e nas tubas uterinas, os cistos representaram (3,3%). Outras lesões identificadas nos ovários foram: cisto luteinizado (2,3%); tumor de células da granulosa (0,5%); adenoma (0,5%); agenesia unilateral (0,5%), além de outras alterações de pouco significado clínico, como cistos paraovarianos (15,6%) e corpo lúteo cístico (11,8%). Nas tubas uterinas observou-se, além dos cistos tubo-ovarianos (3,3%), hidrossalpinge (1%), adenoma (0,5%) e agenesia (0,5%). As lesões uterinas foram endometrite (9%), hidrometra (2,3%); hiperplasia endometrial cística, abscesso e piometra (1,4% cada); adenomiose, petéquias na serosa do útero e aplasia segmentar (1% cada); dois úteros gravídicos, em início de gestação, apresentaram piometra (0,9%), porém os fetos não apresentaram alterações; e pólipo uterino (0,5%). Observou-se uma gestação ectópica com maceração fetal (0,5%); a vaginite ocorreu em 0,5%, e melanose endometrial em 8,5%. Destaca-se a elevada incidência de cistos foliculares e endometrite que são doenças que reduzem a eficiência reprodutiva dos rebanhos, provocando infertilidade e perdas econômicas na produção.(AU)

Genital injuries: Are they telling us something about sexual violence?

Abstract Genital injury has a forensic relevance after a sexual assault and it has been discussed and investigated among professionals who work in this field. To analyze the studies published in the last decades, the present review examines different factors that may influence this finding, first clarifying terms of the forensic field, such as the peculiarity of the legal medical examination, and the distinction of the terms "legal" and "anatomical" vagina. Finally, it analyses if it is possible that the existence of these injuries in victims explain the lack of consent in sexual contact, and to clarify the meaning of the absence of injuries.

The influence of genitalis odors to women's life / A influência dos odores de genitais na vida da mulher

Objective: To study current knowledge about genital odors by narrative review and suggest a scientifically validated approach to the problem. Methods: Narrative review taking into account articles published in the last 15 years. Results: Vaginal infections and/or dysbioses are the main causes of bad genital odor, with bacterial vaginosis (BV) being the most frequent finding. The change in the body's smell can be caused by several factors that include everything from food to stress. As the cases of vaginal dysbioses are becoming more and more frequent and the treatments usually recommended do not always solve the problem, the use of vaginal acidifiers has become more recurrent to rebalance the vulvovaginal pH. Despite this, there is not yet a scientifically validated approach to identifying the cause of the odor. Conclusion: Female genital malodor affects women's quality of life and should be investigated and treated accordingly

Objetivo: Estudar por revisão narrativa os conhecimentos atuais sobre odores genitais e sugerir uma forma de abordagem do problema que seja cientificamente validada. Métodos: Revisão narrativa levando em conta artigos publicados nos últimos 15 anos. Resultados: As infecções e/ou disbioses vaginais são as principais causas do mau odor genital, sendo principalmente a vaginose bacteriana (VB) o achado mais frequente. A alteração no cheiro do corpo pode ser provocada por uma série de fatores que incluem desde a alimentação até o estresse. Como a ocorrência de casos de disbioses vaginais vem se tornando cada vez mais frequente e os tratamentos habitualmente recomendados nem sempre resolvem o problema, vem se tornando mais recorrente o uso de acidificantes vaginais com a finalidade de reequilibrar o pH vulvovaginal. Apesar disso, não há ainda um forma de abordagem e de identificação da causa do odor que seja cientificamente validada. Conclusão: O mau odor genital feminino afeta a qualidade de vida das mulheres e deve ser investigado e tratado adequadamente.

Autoimagem genital feminina no processo de envelhecimento: revisão integrativa de literatura / Female genital self-image in the aging process: integrative literature review / Autoimagen genital femenina en el proceso de envejecimiento: revisión bibliográfica integradora

O objetivo deste estudo foi verificar o perfil dos estudos que tratam sobre a autoimagem genital feminina no processo de envelhecimento e os fatores intervenientes nessa questão. Revisão bibliográfica integrativa nas bases de dados SciELO, LILACS, MEDLINE e PubMed. Encontraram-se 28 artigos, sendo a maioria com mulheres na perimenopausa, utilizando-se a escala Female Genital Self Image Scale e tendo, como fatores intervenientes, a função sexual, cirurgias genitais, status do relacionamento, idade, entre outros.

The aim of this study was to verify the profile of studies that deal with female genital self-image in the aging process and the intervening factors in it. Integrative bibliographic review in the SciELO, LILACS, MEDLINE and PubMed databases. 28 articles were found, most of them with women in perimenopause, using the Female Genital Self Image Scale and having as intervening factors sexual function, genital surgeries, relationship status, age, among others.

El objetivo de este estudio fue verificar el perfil de los estudios que abordan la autoimagen genital femenina en el proceso de envejecimiento y los factores que intervienen en él. Revisión bibliográfica integradora en las bases de datos SciELO, LILACS, MEDLINE y PubMed. Se encontraron 28 artículos, la mayoría de ellos con mujeres en perimenopausia, utilizando la Escala de autoimagen genital femenina y teniendo como factores intervinientes la función sexual, cirugías genitales, estado civil, edad, entre otros.

Impact of genital hair removal on female skin microenvironment: barrier disruption and risk of infection, a literature review / Impacto da depilação genital no microambiente da pele feminina: ruptura de barreira e risco de infecção, uma revisão da literatura / Impacto de la depilación genital en el microambiente de la piel femenina: interrupción de la barrera y riesgo de infección, una revisión de la literatura

Abstract Genital hair is one of the secondary sexual traits that marks the beginning of puberty; its removal has been part of human culture since ancient times. This practice may lead to modifications in vaginal microbiome with potential repercussions on skin health and balance. We conducted a narrative review with the purpose of describing normal skin microbiota, its impact under microenvironment changes and genital hair removal. Menses, pathological conditions and pubic hair removal may alter vaginal microbiota, being the latter of special relevance giving the risk of hair microtrauma, irritations and potential spread of infectious agents. MÉD.UIS.2019;32(3):27-33

Resumo O cabelo genital é um dos traços sexuais secundários que marcam o início da puberdade; sua remoção faz parte da cultura humana desde os tempos antigos. Essa prática pode levar a modificações no microbioma vaginal com possíveis repercussões na saúde e equilíbrio da pele. Realizamos uma revisão narrativa com o objetivo de descrever a microbiota normal da pele, seu impacto nas alterações do microambiente e na remoção de pelos genitais. A menstruação, as condições patológicas e a remoção de pelos pubianos podem alterar a microbiota vaginal, sendo esta última de especial relevância dando o risco de microtraumatismo capilar, irritações e potencial disseminação de agentes infecciosos. MÉD.UIS.2019;32(3): 27-33

Resumen El vello genital es uno de los rasgos sexuales secundarios que marca el comienzo de la pubertad; su eliminación ha sido parte de la cultura humana desde la antigüedad. Esta práctica puede conducir a modificaciones en el microbioma vaginal con posibles repercusiones potenciales en la salud y el equilibrio de la piel. Realizamos una revisión narrativa con el propósito de describir la microbiota cutánea normal, su impacto bajo los cambios del microambiente y la depilación genital. La menstruación, las condiciones patológicas y la depilación púbica pueden alterar la microbiota vaginal, siendo esta última de especial relevancia dado el riesgo de microtraumatismos, irritaciones y posible propagación de agentes infecciosos. MÉD.UIS.2019;32(3): 27-33

Análise bioeconômica do farelo de arroz na recria de bezerras de corte em azevém / Bioeconomics analyses of rice brain use for reaning of beef heifers on Italian ryegrass pasture

Objetivou-se avaliar a economicidade, o desempenho produtivo e o desenvolvimento das estruturas corporais relacionadas ao trato reprodutivo de bezerras de corte mantidas exclusivamente em pastagem de azevém (Lolium multiflorum Lam.) ou em pastagem de azevém recebendo 0,5 e 1,0% do peso corporal (PC) de farelo de arroz integral (FAI) como suplemento. O método de pastejo foi o rotativo, e o intervalo entre pastejos foi estabelecido considerando-se a soma térmica necessária para a emissão de 1,5 folha de azevém (187,5ºC). O delineamento experimental foi o inteiramente ao acaso, com medidas repetidas no tempo. O ganho médio diário das bezerras não diferiu entre os sistemas alimentares. A taxa de lotação e o ganho de peso por área foram maiores quando as bezerras receberam 1,0% do PC de farelo de arroz integral. A maior margem bruta foi observada quando as bezerras receberam 0,5% de FAI. O custo variável obtido para os diferentes sistemas alimentares apresentou comportamento crescente em função dos níveis de FAI, superando o uso exclusivo do azevém em 49,4% e 81,8%. O peso corporal final, o escore de condição corporal e o escore do trato reprodutivo não diferiram entre os sistemas alimentares. Considerando-se um animal adulto com peso corporal médio de 450kg, as bezerras ao início do experimento apresentaram 34% do peso corporal adulto e peso corporal final médio de 56% do peso adulto. A utilização de níveis de farelo de arroz integral (FAI) na recria de bezerras de corte sob pastejo rotativo em azevém não modifica o ganho médio diário e o escore do trato reprodutivo. O fornecimento de 1% de FAI mostrou efeito substitutivo, proporcionando um incremento de 31,2% na taxa de lotação e de 38,3% no ganho por área. O sistema alimentar AZ0,5 permitiu uma maior margem bruta; já o retorno financeiro direto foi positivo em todos os sistemas alimentares, com melhor retorno calculado para o uso exclusivo do azevém.(AU)

The experiment was carried out with the objective of evaluating the gross margin, the productive and reproductive performance of beef heifers kept exclusively on ryegrass pasture (Lolium multiflorum Lam.) or ryegrass receiving 0.5 and 1.0% of body weight (BW) of whole rice bran as supplement. The grazing method was the rotational and the interval between grazings was set by the thermal sum required for the appearing of 1.5 ryegrass leaf (187.5ºC). The experimental design was completely randomized with repeated measures. Heifers average daily gain did not differ between the feeding systems. The stocking rate and weight gain per area were higher when heifers received 1.0% BW of whole rice bran. The higher gross margin was observed when heifers received 0.5% BW. The variable cost obtained for the different feeding systems showed increasing behavior depending on the WRB levels, surpassing the exclusive use of ryegrass in 49.4% and 81.8%. The final body weight, body condition score and reproductive tract score did not differ between the feeding systems. Considering an adult animal with an average body weight of 450kg, the heifers at the beginning of the experiment showed 34% of mature body weight and final average body weight of 56% of adult weight. The use of rice bran levels (FAZ) in the rearing of beef heifers under rotational grazing on ryegrass does not change the average daily gain and the reproductive tract score. The supply of 1% FAI showed substitutive effect, providing an increase in capacity of 31,2% and 38.3% rate of the gain per area. The food system AZ0,5 allowed a higher gross margin, as the economic return was positive in all food systems, with better return calculated for the exclusive use of ryegrass.(AU)

Tumor adenomatoide de tubas uterinas, reporte de un caso y revisión de la literatura / Adenomatoid uterine tube tumor, case report and literature review

Resumen Los tumores adenomatoides del tracto genital son neoplasias poco frecuentes, de comportamiento benigno; debido a sus características histológicas se confunden fácilmente con tumores de estirpe vascular. Estudios recientes demuestran que los tumores adenomatoides del tracto genital femenino están genéticamente definidos por la mutación TRAF7 que activa la expresión aberrante de la vía NFkB. Presentamos el caso de una mujer de 27 años, asintomática, a quien se le realiza salpingectomía bilateral como método de anticoncepción definitivo; en el examen macroscópico de la tuba derecha se encuentra formación quística que por sus características microscópicas es diagnosticada como tumor adenomatoide de la tuba uterina. Finalmente se realiza una revisión de la literatura.

Abstract The adenomatoid tumors of the genital tract are rare neoplasms, with benign behavior; due to their histological characteristics, they are easily confused with tumors of vascular origin. Recent studies show that adenomatoid tumors of the female genital tract are genetically defined by the TRAF7 mutation that activates the aberrant expression of the NFkB pathway. We present the case of a 27-year-old woman, asymptomatic, who underwent bilateral salpingectomy as a method of definitive contraception; In the macroscopic examination of the right tuba, cystic formation is found which, due to its microscopic characteristics, is diagnosed as an adenomatoid tumor of the uterine tube. Finally, a review of the literature is made

Female genital tract chronic graft-versus-host disease: A narrative review

Abstract Graft-versus-host disease is one of the main causes of morbidity and mortality in patients submitted to hematopoietic stem cell transplantation. This study reviewed the prevalence of lower female genital tract graft-versus-host disease following hematopoietic stem cell transplantation. A systematic search of the literature for articles published between 1982 and 2015 was performed. A growing number of young women suffering from malignant and benign hematological diseases are receiving allogeneic hematopoietic stem cell transplantation with very satisfactory results in relation to the disease itself. However, these patients face gynecological problems due to graft-versus-host disease. Correct diagnosis and early management are needed to avoid irreversible complications.

Utilidad del cateterismo urinario en labor de parto con parto vaginal: una revisión integrativa / Usefulness of urinary catheterization in labor with vaginal delivery: an integrative review

El objetivo de esta revisión integrativa fue identificar la utilidad de la cateterización urinaria intermitente o permanente en mujeres en labor de parto con parto vaginal y las posibles consecuencias en el postparto inmediato para mejorar la práctica clínica obstétrica. En la metodología se consideró las recomendaciones del Joanna Briggs Institute, partiendo de una pesquiza general para luego redactar una pregunta utilizando el formato PCC (Población, concepto y contexto); luego se estableció una estrategia de búsqueda de información en bases de datos, se llevó a cabo la selección y análisis crítico e interpretración de la evidencia encontrada. Identificados un total de 322 artículos, siendo removidos cinco por duplicación y excluídos 305 por título y resumen, quedando seleccionados 6. Como resultado se destacan cuatro temas los cuales fueron discutidos según la evidencia: 1. Cateterismo vesical en labor de parto; 2. Retención urinaria; 3. Distención vesical y labor de parto; 4. Infección urinaria y cateterismo vesical. Se concluye que enfermería obstétrica debe fomentar el vaciamiento vesical mínimo cada dos horas y estar haciendo valoraciones continuas e integrales durante todo el proceso de parto y postparto para detectar con prontitud cualquier desviación en la función correcta de la vejiga

The objective of this integrative review was to identify the usefulness of intermittent or permanent urinary catheterization in women in labor with vaginal delivery and the possible consequences in the immediate postpartum period to improve obstetric clinical practice. In the methodology the recommendations of the Joanna Briggs Institute were considered, starting from a general survey and then writing a question using the PCC format (Population, concept and context). Then a search strategy for information was established in databases, the selection and critical analysis and interpretation of the evidence found was carried out. Identified a total of 322 articles, being removed five by duplication and excluded 305 by title and summary, being selected 6. As a result four issues stand out which were discussed according to the evidence: 1. Bladder catheterization in labor; 2. Urinary retention; 3. Bladder distention and labor; 4. Urinary infection and bladder catheterization. It is concluded that obstetric nursing should encourage minimal bladder emptying every two hours and be making continuous and comprehensive assessments throughout the birth and postpartum process to detect any deviation in correct bladder function promptly

Cambios histológicos del tracto genital y riesgo de malignidad, en hombres transgénero sometidos a tratamiento androgénico / Histological changes of the genital tract and risk of malignancy in transgender men undergoing androgenic treatment

RESUMEN Introducción y objetivos: La identidad de género es la vivencia interna e individual del género tal como cada persona la siente. En algunos casos, la adquisición de los caracteres sexuales secundarios del otro género es importante en el proceso de reasignación de género, siendo importante el tratamiento endocrinológico. La cuestión es si la administración prolongada de andrógenos es segura en los casos de pacientes transexuales mujer a hombre, ya que es poca la evidencia científica a largo plazo. El objetivo de este estudio es analizar las características clínicas de los pacientes trans de nuestra unidad, y los hallazgos anatomopatológicos de las piezas quirúrgicas de histerectomía y doble anexectomía, para ver la influencia de la androgenoterapia en los genitales internos femeninos. Métodos: Se trata de un estudio descriptivo donde se analizaron datos demográficos y clínicos de los pacientes remitidos para cirugía genital, así como se analizaron los resultados del estudio anatomopatológico de las piezas de histerectomía y anexectomía. Resultados: Se incluyeron 66 pacientes, de los que 59 se intervinieron. No se halló malignidad en ninguna de las piezas quirúrgicas, sí diversos hallazgos benignos como miomas, atrofia/proliferación endometrial, actividad folicular en ovarios u ovarios tipo síndrome de ovario poliquístico. Conclusiones: La exposición a andrógenos a largo plazo no parece producir cambios malignos en la histología uterina ni ovárica, sin embargo, a menudo lleva a cambios en la actividad y la arquitectura ovárica, apreciándose en la mayoría de los casos ovarios funcionales e incluso semejantes a los observados en mujeres con ovario poliquístico.

ABSTRACT Introduction and objectives: Gender identity is the internal and individual experience of the gender as each person feels it. In some cases, the acquisition of secondary sexual characteristics of the other gender is important in the process of gender reassignment, with endocrinological treatment being important. The question is whether prolonged administration of androgens is safe in cases of transsexual women to men, since there is little scientific evidence in the long term. The aim of this study is to analyze the clinical characteristics of trans patients in our unit, and the anatomopathological findings of the surgical pieces of hysterectomy and double adnexectomy, to see the influence of androgen therapy on the female internal genitalia. Methods: This is a descriptive study where demographic and clinical data of the patients referred for genital surgery were analyzed, as well as the results of the anatomopathological study of the hysterectomy and adnexectomy pieces were analyzed. Results: 66 patients were included, of which 59 were intervened. No malignancy was found in any of the surgical pieces, but several benign findings such as myomas, endometrial atrophy / proliferation, follicular activity in ovaries or ovaries like polycystic ovary syndrome. Conclusions: Long-term exposure to androgens does not seem to produce malignant changes in uterine or ovarian histology, however, it often leads to changes in ovarian activity and architecture, with functional ovaries being seen in most cases and even similar ones. those observed in women with polycystic ovary.

Teaching blind women about the anatomy and physiology of the female reproductive system through educational manual / Aprendizado de cegas sobre anatomia e fisiologia do sistema reprodutor feminino mediante manual educativo

Abstract Objectives: to evaluate blind women's learning on the anatomy and physiology of the female reproductive system through the use of an educational material. Methods: methodological development study performed with blind women. The participants responded the pre-test to evaluate their knowledge on sexual and reproductive health and received a manual on anatomy and the reproduction of the physiology After an individual reading, in a period ranging from three to fifteen days, they responded the post-test. Results: there was an increase of correct answers in the post-test in all the items in relation to the categories of The Woman's Body and How One Gets Pregnant becoming significant in the following knowledge of "clitoris increases with the woman excited" (p=0.009), "the function of the vagina in a sexual intercourse "(p<0.001), "How does fertilization occurs"(p<0.001) and "the ovulating period" (p<0.001). Conclusions: the manual enabled the participants to learn about the female anatomy and the physiology of fertilization after educational assistive technology.

Resumo Objetivos: avaliar o aprendizado de cegas sobre anatomia e fisiologia do sistema reprodutor feminino mediante o uso de manual educativo. Métodos: estudo de desenvolvimento metodológico, realizado com mulheres cegas. As participantes responderam o pré-teste para avaliação do conhecimento sobre saúde sexual e reprodutiva, e receberam o manual sobre anatomia e fisiologia da reprodução. Após leitura individual, em prazo que variou entre três e quinze dias, responderam o pós-teste. Resultados: houve aumento de respostas corretas no pós-teste em todos os itens com relação às categorias O Corpo da Mulher e Como se Engravida, sendo significativo os seguintes conhecimentos "clitóris aumenta com a mulher excitada" (p=0,009), "função da vagina na relação sexual" (p<0,001), "como ocorre a fecundação" (p<0,001) e "período da ovulação" (p<0,001). Conclusões: o manual permitiu aprendizado das participantes quanto à anatomia feminina e à fisiologia da fecundação após utilização da tecnologia educativa assistiva.

Descripción histológica del aparato reproductor de avestruz hembra (Strutio camelus var. domesticus) / Histological description of the ostrich female reproductive system (Strutio camelus var. domesticus)

El auge de la producción intensiva del avestruz, comenzó en la década de los noventa impulsada por la calidad de su carne y potencialidad de sus subproductos. La raza empleada para producción por la calidad nutricional y sabor de su carne es el híbrido llamado African black (Struthio camelus var. domesticus). En cuanto a la reproducción, el avestruz hembra alcanza su madurez sexual a partir de los 2,5 años. Es importante considerar el aparato genital en aves de producción, ya que una alteración en él, puede generar deficiencias en la fertilidad que se traducen en un menor número de crías. El estudio histológico del aparato reproductor de la hembra será una herramienta más que permitirá resolver problemas reproductivos. Para este análisis se obtuvo muestras de los diferentes segmentos del aparato reproductor de 6 avestruces hembras en edad reproductiva y se procesaron de acuerdo a las técnicas histológicas de rutina. Los cortes fueron observados, fotografiados y analizados bajo microscopio de luz. Obtenidas las fotografías, se analizó comparativamente su morfología con la descrita en la gallina (Gallus gallus). El aparato reproductor de la hembra tiene la particularidad de tener desarrollado solo el ovario y oviducto izquierdo. El ovario es de gran tamaño y en forma de racimo, el cual varía según la estacionalidad. Presenta folículos primordiales, previtelogénicos, vitelogénicos y atrésicos. Los folículos vitelogénicos presentan células de la granulosa y de la teca interna y externa. El oviducto presenta de cefálico a caudal los siguientes segmentos: infundíbulo, magnum, istmo, útero y vagina, que desemboca en la cloaca a nivel del urodeo. En ellos hay pliegues de variada longitud, grosor y número que comprometen la mucosa y submucosa, con glándulas de secreción mucosa y serosa a excepción de la vagina. El análisis histológico comparativo, permitió establecer que la morfología del aparato reproductor de la hembra es semejante a la observada en la gallina con ciertas diferencias microscópicas (Gallus gallus).

In the 1990's, ostrich production reached a peak in our country, boosted by the special characteristics of its meat and the potential of the derivatives. The breed raised is a hybrid called African Black (Struthio camelus var. domesticus) which has a high quality meat in terms of nutritional factors and flavor. With regard to reproduction, the female ostrich reaches maturity at the age of 2.5 years. Genital organs are very important in fowl's production, because they can generate fertility deficiencies that, in turn can diminish brood number. Histological analysis allows a better understanding of the basic structure of the female's genital organs and is a helpful tool to resolve breeding problems. For this analysis samples were obtained from the different segments of the reproductive system of 6 female ostrich in reproductive age. These samples were processed using standard histological technique. Sections were observed, photographed and analyzed under the light-microscope. Photographs were compared with hen's samples. The ostrich female's reproductive system has the particularity of having just the left ovary and oviduct developed. The ovary has a big size and a cluster shape which varies from season to season. It presents paramount, previtellogenic, vitellogenic and atresic follicles. The vitellogenic follicles have granulosa cells and inner and external theca. The oviduct presents cephalocaudally: infundibulum, magnum, isthmus, uterus and vagina, flowing into the urodeum. It shows long pleats of different length and number, with drusen of mucose and serose secretion, except in the vagina. The comparative histological analysis allowed us to establish that the basic structure of the female reproductive system is similar to that of the hen (Gallus gallus).

Effects on the female reproductive system of air pollution produced by the use of wood combustion for residential heating: challenges and perspectives of morphological studies / Efectos sobre el sistema reproductivo femenino de la contaminación del aire producido por el uso de la combustión de madera para calefacción residencial: retos y perspectivas de los estudios morfológicos

Previous studies have shown that air pollution affects cardio-respiratory function, but its role regarding reproductive processes is unknown. There are few experimental background studies on its effects on the morpho-function in the reproductive system. The use of wood combustion for residential heating (WCRH) in the cities of south-central Chile has increased significantly. As a result, it has become a source of significant emissions of particulate matter suspended (PM) in the air. The possible association between exposure to PM and reproductive problems has been suggested only on the basis of epidemiological studies, most of them carried out in environments where the main source of PM emission is the combustion of oil by motorized vehicles and industries, ignoring the effects produced by the smoke of WCRH. For example, in the city of Temuco-Padre Las Casas, Chile, 93 % of PM emissions correspond to WCRH smoke, thus being considered an urban area with a single PM emission source and the factors that contribute to this type of contamination are reasonably representative of most of the cities in south-central Chile. We therefore suggest this as an adequate setting to evaluate the real effect of the environmental contamination produced by the smoke of WCRH in the reproductive system. The limited number of studies reported on the effects of this type of emission on the female reproductive system, present a challenge for the morphological sciences and also for those who make decisions that affect public health.

Estudios previos han demostrado que la polución del aire afecta la función cardio-respiratoria, pero el rol que tiene ésta respecto a los procesos reproductivos es desconocida. Existen escasos antecedentes experimentales sobre sus efectos sobre la morfo-función en el sistema reproductivo. El uso de la combustión de madera para calefacción residencial (WCRH) en las ciudades del centro-sur de Chile ha aumentado significativamente. Como resultado, se ha convertido en una fuente de emisión importante de material particulado en suspensión (PM) en el aire ambiental. La posible asociación entre exposición a PM y problemas reproductivos ha sido sugerida solo en base a estudios epidemiológicos, la mayoría de ellos realizados en ambientes donde la principal fuente de emisión de PM es la combustión del petróleo por vehículos motorizados e industrias, ignorando los efectos producidos por el humo de WCRH. Por ejemplo, en la ciudad de Temuco-Padre Las Casas, Chile, el 93 % de las emisiones de PM corresponden al humo de WCRH, por lo tanto, es considerada como un área urbana con una fuente de emisión de PM única y los factores que contribuyen a este tipo de contaminación son razonablemente representativos a la mayoría de las ciudades en el centro-sur de Chile, lo que permite sugerirla como un ambiente adecuado para evaluar el efecto de la contaminación ambiental producida por el humo de la WCRH en el sistema reproductivo. Los escasos estudios reportados sobre los efectos de este tipo de emisión sobre el sistema reproductivo femenino constituyen un desafío no tan solo para las ciencias morfológicas, sino que además, para quienes toman decisiones que afectan la salud pública.