Association between Physical Activity and Menstrual Cycle Disorders in Young Athletes.

Our study aims to evaluate clinical predictors of menstrual cycle disorders in female athletes who compete in running disciplines. This is a prospective observational study. Women were recruited between January and May 2022. Fifty-three patients were enrolled and completed a questionnaire about menstrual cycle, physical activity, and food habit characteristics. Of the women in our population, 39.6% had menstrual irregularities and reported a significantly higher number of kilometers run per week (67 vs. 35, p:0.02). The number of kilometers run per week was associated with menstrual irregularities (for 10 km, OR 1.35; IC95% 1.05-1.73; p: 0.02) after adjusting for BMI, age, level of sport and caloric intake. The variable of "km run per week" appeared as a diagnostic indicator of irregular menstrual cycle with statistical significance (AUC ROC curve 0.71, IC95% 0.54-0.86, p-value=0.01) and the cut-off of 65 km run per week is a good indicator of the presence of irregular menstrual cycle (sensitivity (SE) and specificity (SP) of 55% and 81.48%). Menstrual cycle disorders are very frequent in female athletes, and the variable of km run per week may play a role in screening endurance athletes at high risk for these disorders.

Superinfection of Rectovaginal Endometriosis: Case Report and Review of the Literature.

BACKGROUND: A peculiar complication of endometriosis is a superinfection. However, the superinfection of extra-ovarian endometriosis is anecdotal, and only a few cases have been described. We wanted to present the first cases of the superinfection of rectovaginal endometriosis and to perform a literature review of the superinfection of extra-ovarian endometriosis. METHODS: We present a case of a 24-year-old woman who was referred to our Pelvic Floor Unit for rectal-perineal pain, dyspareunia, and recurrent episodes of dense purulent vaginal discharge for one year, in which the superinfection of rectovaginal endometriosis was diagnosed. Moreover, we performed a systematic search of the literature indexed on PubMed up to 31 January 2023. RESULTS: Laparoscopic drainage was successful in managing this condition. In the literature, clinical presentation and instrumental and microbiological findings are very heterogeneous. However, the gold standard of management is represented by surgical or percutaneous drainage. CONCLUSIONS: In the case of a pelvic abscess, the superinfection of endometriosis lesions should be suspected, and this can represent the onset symptom of endometriosis. Ultrasonography may show nodular or flat hypoechoic lesions with hyperechoic debris and peripheral positive color/power Doppler intensities. The goal of management is to drain the abscess, either percutaneously or via traditional surgery, followed by proper hormonal therapy to reduce recurrence.

Major post-partum hemorrhage rate in a I level hospital: data analysis of substandard care and near-miss cases.

BACKGROUND: Post-partum hemorrhage continues to be a leading cause of maternal mortality and morbidity. The aim of this study was to estimate the prevalence of major hemorrhage, near-miss cases and substandard care in a I level hospital. METHODS: We conducted a retrospective cohort study of pregnant women between 2003 and 2018 who had a blood loss ≥1500 mL or who required one or more blood transfusions. We assessed near-miss cases and substandard care. RESULTS: Over the 16 years, there were 14,523 births: 156 women (1.07%) had a blood loss ≥1500 mL or required one or more blood transfusions. There were 16 near-miss cases and no maternal deaths. Twenty-three cases required transfer to the Intensive Care Unit (11.5%), in 3.5% of non near-miss cases and in 81.2% of near-miss cases (P<0.001). We identified substandard care in 36.4% of low risk women, and in 62.5% of near-miss cases (P=0.04). CONCLUSIONS: After dividing the cases in a first period (2003-2010) and a second period (2011-2018), we highlighted 11.6% near-miss cases in the first period and 8.8% in the second period (P=NS). The procedures adopted following the failure of the pharmacological therapy changed over the two periods: uterine packs with sterile gauzes went from 17.9% in the 2003-2010 timeframe, to 2.4% in the 2011-2018 (P=0.01). While the use of uterine balloon went from 12.8% (2003-2010) to 64.3% (2011-2018) (P<0.001).

Pelvic organ prolapse and vaginal cancer: A systematic literature review.

BACKGROUND: Primary vaginal cancer is a rare gynecologic malignancy. Few cases describing the concurrence of a vaginal tumor with advanced genital prolapse are reported in the literature and there is no consensus on optimal treatment. OBJECTIVES: To investigate available evidence on presentation, treatment, and outcomes of these concurrent conditions. SEARCH STRATEGY: We performed a systematic search of literature indexed on PubMed, Scopus, ISI Web of Science, and Cochrane using a combination of keywords and text words represented by "pelvic organ prolapse", "genital prolapse", and "vaginal cancer", "vaginal carcinoma". SELECTION CRITERIA: No article type restrictions were applied. DATA COLLECTION AND ANALYSIS: Twenty-one studies (case reports and two small case series) were incorporated into the review process, for a total of 27 patients. MAIN RESULTS: Management usually involved surgery or primary external beam radiation therapy. External beam radiation therapy was reported to be highly associated with the development of vesicovaginal fistula. A surgical approach was the treatment of choice in most cases. Exclusive interstitial brachytherapy was rarely performed. CONCLUSION: A multidisciplinary approach considering risks and benefits is of the utmost importance to provide counseling and tailor treatment strategy in these complex cases.

Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women.

Vaginal health is an essential component of active and healthy aging in women at midlife and beyond. As a consequence of hormonal deprivation and senescence, the anatomy and function of urogenital tissues are significantly affected and vulvovaginal atrophy (VVA) may occur. In a high proportion of postmenopausal women, progressive and chronic VVA symptoms have a strong impact on sexual function and quality of life. The new definition of genitourinary syndrome of menopause (GSM) comprises genital symptoms (dryness, burning, itching, irritation, bleeding), sexual symptoms (dyspareunia and other sexual dysfunctions) and urinary symptoms (dysuria, frequency, urgency, recurrent urinary infections). Many variables (age, sexual activity and partnership status) influence the clinical impact VVA/GSM symptoms and attitudes of elderly women to consult for receiving effective treatments. Psychosocial factors play a critical role in sexual functioning, but the integrity of the urogenital system is as well important affecting many domains of postmenopausal women's health, including sexual function. Several international surveys have extensively documented the need to improve VVA/GSM management because of the strong impact on women's daily life and on couple's intimacy. Health care providers (HCPs) need to be proactive in the early recognition of VVA/GSM in order to preserve urogenital and sexual longevity, by using hormonal and non-hormonal strategies. The clinical diagnosis is based on genital examination to identify objective signs and on the use of subjective scales to rate most bothersome symptoms (MBS), especially vaginal dryness. Recent studies point to the importance of addressing VVA/GSM as a potential early marker of poor general health in analogy with vasomotor symptoms. Therefore, a standard of VVA/GSM care in elderly women is desirable to enhance physical, emotional and mental well-being.