Influence of the Menstrual Cycle Phase on Pain Perception and Analgesic Requirements in Young Women Undergoing Gynecological Laparoscopy.

CONTEXT: The influence of the gonadal hormones on some aspects of the human physiology has been studied with uncertain results. Still a confusion exists in relation to the real effects of the female hormones on the perception of pain. The existing data refer mainly to experimental studies and have provided results not always useful in the clinical practice. DATA SOURCE: This study was designed to detect whether there are differences in the perception of the postoperative pain in women, during two clearly defined phases of hormonal asset: luteal and follicular phases. CONCLUSION: The results of this study have demonstrated that in postoperative female patients pain is perceived significantly more in the luteal phase of the menstrual period, than in the follicular phase. This could suggest that female in child-bearing age should be scheduled for elective surgery preferentially during the follicular phase, unless differently necessary. It would guarantee a more comfortable postoperative period, with reduced necessity of analgesics.

Perinatal mental illness and autoimmune diseases: a qualitative sistematic review.

INTRODUCTION: The term "perinatal mental illness" refers to the set of psychiatric disorders that occur during pregnancy and up to one year after childbirth. The disorders that occurred before pregnancy along with the disorders that emerge during pregnancy or in the postpartum period are all considered perinatal mental illnesses. The causes of prenatal mental illness are still unknown. However, recent studies have shown a major risk in patients with autoimmune diseases (AIDs). EVIDENCE ACQUISITION: We performed a comprehensive search of relevant studies from February 2000 to December 2021 to ensure all possible studies were captured. A systematic search of PubMed databases was conducted. We selected "autoimmune disease" as the search term, combining with "perinatal mental illness," "perinatal depression" or "postpartum anxiety" or "postpartum psychosis" or "bipolar disorder" or "postpartum blues." EVIDENCE SYNTHESIS: The results of our review show that patients with perinatal mental illness have higher risks of subsequent AIDs. In fact, when a woman develops perinatal mental illness, accurate counseling can be employed: on the one hand, the woman should be send to the psychiatrist, on the other hand she has to be informed about the increased risk of a future developement of AID. CONCLUSIONS: As described in the literature, correlation between perinatal mental illness and AID could bring new diagnostic opportunities, relevant for practical decisions. Further studies need to confirm the correlation between perinatal mental illness and AID.

Sex ratio at birth: causes of variation and narrative review of literature.

INTRODUCTION: The human sex ratio at birth (SRB) is the parameter which reflects the relationship between males and females at birth. It is not 50:50, but approximately 0.515 in favor of males. There are many factors that can influence SRB and its variations are not easily demonstrable. EVIDENCE ACQUISITION: Our aim was to investigate the environmental and human agents capable of causing variations in the SRB by providing a narrative review of the scientific literature. EVIDENCE SYNTHESIS: Studies demonstrated that male and female embryos/fetuses' response to stress in different way and the male ones show less resistance. This phenomenon seems to persist for approximately six months after a stressful event, suggesting a purpose of reproductive regulation and protection of the perpetuation of the species. Although the relationship of dependence with parenting decisions, thanks to prenatal diagnosis and assisted fertility techniques is easily understood, it is more complex to correlate its variations with environmental pressures that act through secondary mechanisms. The Covid-19 pandemic, natural catastrophes, terroristic attacks, economic crises are some of the difficulties encountered in recent times. CONCLUSIONS: The impact of all the factors reported is not explained only with a possible a priori determination of sex at conception, but also with secondary effects in the pregnancy outcomes. Thus, the determination of sex appears to be a complex and multifactorial mechanism, besides a matter of genetics. The pandemic and climate changes are the present important opportunities of research for possibly reaching more certain answers.

Waiting time and pain during office hysteroscopy.

STUDY OBJECTIVE: To find a correlation between the waiting time between counseling about and performance of office hysteroscopy and the perception of pain. DESIGN: Observational study (Canadian Task Force classification II-2). SETTING: Academic environment. PATIENTS: Two hundred eighty-four women undergoing hysteroscopy. INTERVENTIONS: Diagnostic hysteroscopy with endometrial biopsy. MEASUREMENTS AND MAIN RESULTS: Before examination, patients were asked to complete 2 forms, the STAI-S (State-Trait Anxiety Inventory, State) and STAI-T (State-Trait Anxiety Inventory, Trait) anxiety scales, for evaluation of their usual anxiety state and their state of anxiety during the examination. Patients were asked to quantify on a visual analog scale the pain felt during the examination. A statistically significant positive correlation, even if weak, was demonstrated between pain and waiting time (r = 0.45; p < .01) but not with the values for the anxiety state (r = 0.06; p = .56) and anxiety trait (r = -0.05; p = .66). Pain (≥4) was significantly associated with waiting time (≥60 minutes) (odds ratio [OR], 5.21; 95% confidence interval [CI], 1.29-35.50), age (OR, 1.57; 95% CI, 0.40-5.87) and menopause (OR, 2.81; 95% CI, 1.10-7.40) but not with STAI-S level (≥34) (OR, 0.87; 95% CI, 0.26-3.12) or STAI-T level (≥34) (OR, 0.65; 95% CI, 0.19-2.32). CONCLUSION: Office hysteroscopy is associated with a level of anxiety that can affect patient tolerability of the procedure. However, factors such as reducing waiting time may have a positive effect on patient compliance, making hysteroscopy easier and thereby increasing its diagnostic and therapeutic potential.

Office hysteroscopic-guided selective tubal chromopertubation: acceptability, feasibility and diagnostic accuracy of this new diagnostic non-invasive technique in infertile women.

The aim of this study was to evaluate accuracy, tolerability and side effects of office hysteroscopic-guided chromoperturbations in infertile women without anaesthesia. Forty-nine infertile women underwent the procedure to evaluate tubal patency and the uterine cavity. Women with unilateral or bilateral tubal stenosis at hysteroscopy with chromoperturbation, and women with bilateral tubal patency who did not conceive during the period of six months, underwent laparoscopy with chromoperturbation. The results obtained from hysteroscopy and laparoscopy in the assessment of tubal patency were compared. Sensitivity, specificity, accuracy, positive-predictive value and negative-predictive value were used to describe diagnostic performance. Pain and tolerance were assessed during procedure using a visual analogue scale (VAS). Side effects or late complications and pregnancy rate were also recorded three and six months after the procedure. The specificity was 87.8% (95% CI: 73.80-95.90), sensitivity was 85.7% (95% CI 57.20-98.20), positive and negative predictive values were 70.6% (95% CI: 44.00-89) and 94.7% (95% CI: 82.30-99.40), respectively. Pregnancy rate (PR) within six months after performance of hysteroscopy with chromoperturbation was 27%. Office hysteroscopy-guided selective chromoperturbation in infertile patients is a valid technique to evaluate tubal patency and uterine cavity.