Physiotherapeutic Treatment for Levator Ani Avulsion after Delivery: A Transperineal Three-dimensional Ultrasound Assessment.

BACKGROUND: Levator ani avulsion is defined as the interruption of the insertion of this muscle on the pubic bone. It is currently recognized as an important triggering factor for genital prolapse. Although surgical interventions are available, there are no conservative strategies for this muscular injury. DESCRIPTION: A 40-year-old female presented with urinary incontinence and levator ani avulsion, which was confirmed on transperineal three-dimensional ultrasound (3DUS). Upon referral for physiotherapy, she presented with incorrect and weak contractions of the pelvic floor. Her treatment comprised 13 sessions of intravaginal electrotherapy followed by pelvic floor muscle (PFM) exercises in different positions. At the end of the sessions, another transperineal 3DUS was performed, and it revealed rapprochement of the levator ani muscle. The avulsed levator ani muscle can be reinserted using physiotherapeutic interventions, especially a combination of electrotherapy and PFM exercises. CONCLUSION: Transperineal 3DUS is an important approach for the follow-up of conservative treatment until full recovery.

Assessing the impact of twin pregnancies on the pelvic floor using 3-dimensional sonography: a pilot study.

OBJECTIVES: The purpose of this study was to compare the morphologic characteristics of the pelvic floor musculature between women with twin and singleton pregnancies. METHODS: We conducted a cross-sectional case-control study of 40 nulliparous women aged 20 to 38 years to compare women with singleton pregnancies (n = 23) to women with twin pregnancies (n = 17). Biometric measurements of the levator hiatus and the sagittal and coronal diameters were made by transperineal 3-dimensional sonography between the 28th and 38th gestational weeks. Comparisons were statistically assessed by the unpaired Student t test and Mann-Whitney U test. RESULTS: For the women with singleton pregnancies, the mean sagittal diameters at rest, during the Valsalva maneuver, and during pelvic floor contraction were 5.3, 5.7, and 4.5 cm, respectively, and the mean coronal diameters under these conditions were 3.8, 4.1, and 3.6 cm. For the women with twin pregnancies, the corresponding values were as follows: mean sagittal diameters, 5.3, 5.8, and 4.6 cm; and mean coronal diameters, 4.3, 4.3, and 3.8 cm. The differences in coronal diameters were statistically significant at rest (P < .01) and during contraction (P = .04). The mean levator hiatal areas for the women with singleton pregnancies were 14.6, 16.9, and 11.7 cm(2) at rest, during Valsalva, and during contraction, respectively; for the women with twin pregnancies, these values were 16.0, 18.6, and 12.6 cm(2). CONCLUSIONS: Hiatal measurements were higher in twin than in singleton pregnancies, with coronal diameters reaching significance at rest and during contraction, suggesting that pelvic support undergoes greater changes during twin pregnancy.

Urinary incontinence related to perineal muscle strength in the first trimester of pregnancy: cross-sectional study.

Objective To analyze pelvic floor muscle strength (PFMS), urinary continence and quality of life related to urinary incontinence (UI) of women in the first trimester of pregnancy. Method Cross-sectional study with a sample of 500 women who started prenatal care in a complementary healthcare facility in Guarulhos, state of São Paulo, from 2012 and 2013. Pelvic floor muscle strength was evaluated through perineometry. The pregnant women who presented UI answered the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Results It was found that maternal age (OR=1.06; CI95% 1.02-1.11) and prior UI (OR=15.12; 95%CI 8.19-27.92) are the variables that, in tandem, best explain the occurrence of UI at the beginning of pregnancy. The mean score on the ICIQ-SF was 8.2 (SD=3.9), considered a moderate impact on quality of life. Conclusion Older pregnant women with prior UI are more likely to have UI in the first trimester of pregnancy.

EMILIN-3, peculiar member of elastin microfibril interface-located protein (EMILIN) family, has distinct expression pattern, forms oligomeric assemblies, and serves as transforming growth factor ß (TGF-ß) antagonist.

EMILIN-3 is a glycoprotein of the extracellular matrix belonging to a family that contains a characteristic N-terminal cysteine-rich EMI domain. Currently, EMILIN-3 is the least characterized member of the elastin microfibril interface-located protein (EMILIN)/Multimerin family. Using RNA, immunohistochemical, and protein chemistry approaches, we carried out a detailed characterization of the expression and biochemical properties of EMILIN-3 in mouse. During embryonic and postnatal development, EMILIN-3 showed a peculiar and dynamic pattern of gene expression and protein distribution. EMILIN-3 mRNA was first detected at E8.5-E9.5 in the tail bud and in the primitive gut, and at later stages it became abundant in the developing gonads and osteogenic mesenchyme. Interestingly and in contrast to other EMILIN/Multimerin genes, EMILIN-3 was not found in the cardiovascular system. Despite the absence of the globular C1q domain, immunoprecipitation and Western blot analyses demonstrated that EMILIN-3 forms disulfide-bonded homotrimers and higher order oligomers. Circular dichroism spectroscopy indicated that the most C-terminal part of EMILIN-3 has a substantial α-helical content and forms coiled coil structures involved in EMILIN-3 homo-oligomerization. Transfection experiments with recombinant constructs showed that the EMI domain contributes to the higher order self-assembly but was dispensable for homotrimer formation. EMILIN-3 was found to bind heparin with high affinity, a property mediated by the EMI domain, thus revealing a new function for this domain that may contribute to the interaction of EMILIN-3 with other extracellular matrix and/or cell surface molecules. Finally, in vitro experiments showed that EMILIN-3 is able to function as an extracellular regulator of the activity of TGF-ß ligands.

Electromyographic evaluation of pelvic floor muscles in pregnant and nonpregnant women.

INTRODUCTION AND HYPOTHESIS: We compared the maximal voluntary contraction (MVC) and strength of pelvic floor muscles (PFM) of pregnant and nonpregnant women using surface electromyography (SEMG). METHODS: Fifteen pregnant primiparous women and 15 nulliparous nonpregnant women were evaluated. The healthy pregnant women were in the third trimester of pregnancy with a single fetus and did not have any neuromuscular alterations. The nonpregnant women did not present with PF dysfunctions and, as with the pregnant women, did not have any previous gynecological surgeries or degenerative neuromuscular alterations. The evaluation methods used were digital palpation (Oxford Grading Scale, which ranges from 0 to 5) and SEMG. In the EMG exam, MVC activity was evaluated, and the better of two contractions was chosen. Before the evaluation, all women received information about PFM localization and function and how to correctly contract PFM. RESULTS: In the EMG evaluation, MVC was significantly greater in the nonpregnant group (90.7 µv) than in the pregnant group (30 µv), with p < 0.001. The same results were observed after vaginal palpation, measured by the Oxford scale, which presented an average of 2.1 in the pregnant group and 4.5 in the nonpregnant group (p = 0.005). CONCLUSION: In comparison to nulliparous women, pregnant women demonstrated worse PFM function with decreased strength and electrical activity.

Transperineal three-dimensional ultrasound for analyzing the effects of perineal stretching with EPI-NO® in women with multiple pregnancies: a pilot study.

OBJECTIVE: To compare the changes in the pelvic floor of women with twin pregnancies who practiced muscle stretching with the EPI-NO® vaginal dilator, as assessed using transperineal three-dimensional ultrasound (3DUS). METHOD: This prospective cross-sectional case-control study included nulliparous women in the third trimester of their multiple pregnancies and divided them into the control group (CG, n = 9) and EPI-NO® group (EpiG, n = 9). During pretreatment, the women underwent transperineal 3DUS to establish the morphometric measurements of the pelvic floor. The CG received guidance regarding pelvic floor muscles, whereas the EpiG underwent weekly physical therapy sessions with the EPI-NO® dilator for 20 min/day. Following this treatment, all women were reassessed using transperineal 3DUS, and the diameter of the EPI-NO® balloons of the women in the EpiG was measured (epinometry). Paired samples t-test was used for comparative analysis. RESULTS: The EpiG showed improved perineal distensibility, which was evidenced by the increase in sagittal diameter at rest (p < .01). Transperineal 3DUS among women in the EpiG showed a significant increase in the sagittal measurement (p = .02), hiatal circumference at rest (p = .03), and epinometry values (diameter of the EPI-NO® balloon; p < .01). The increase in epinometry values was directly correlated (p = .02) with the number of physical therapy sessions. CONCLUSION: EPI-NO® increased pelvic floor distensibility in women with twin pregnancies, as confirmed using transperineal 3DUS and epinometry. This device promoted an increase in perineal distensibility with a single use; however, better results would be obtained with additional sessions.

Translation of the UK-Birth-Satisfaction-Scale-Revised (BSS-R) into Brazilian (Portuguese) and description of initial measurement properties.

RATIONALE: The concept of birth satisfaction embraces many factors, which include for example perceived quality of care provision, stress experienced, and personal coping strategies. A woman's birth experience has the power to affect her mental health, decisions surrounding future birth planning, and quality of relationships with her partner and family. The UK-Birth-Satisfaction-Scale-Revised (UK-BSS-R) is currently recommended as the tool of choice by the International Consortium for Health Outcome Measures (ICHOM) for measuring women's experiences of childbirth. It was therefore considered important to translate and validate this scale for use in a Brazilian context. OBJECTIVE: To translate and culturally adapt the UK-BSS-R into Brazilian (Portuguese) and validate its key measurement properties. METHODS: A repeated-measures survey was conducted for the purpose of examining factor structure, validity and reliability of the Brazilian (Portuguese)-BSS-R. PARTICIPANTS: Data was gathered from (n = 101) Brazilian Portuguese-speaking postnatal women. RESULTS: The initial measurement characteristics of the Brazilian (Portuguese)-BSS-R in terms of Intraclass Correlational Coefficient, Standard Error of Measurement and minimal detectable change were found to be excellent. CONCLUSION: The Brazilian (Portuguese)-BSS-R is now considered to be a valid and reliable multidimensional psychometric instrument for measuring birth satisfaction in a Brazilian Portuguese population of postnatal women. This translation was found to be conceptually consistent with the original English-language version (UK-BSS-R) and to have an excellent initial measurement characteristics profile. The direction of future research is indicated, specifically to undertake a thorough psychometric evaluation of the Brazilian (Portuguese)-BSS-R in a larger sample.

Pelvic floor muscle and transversus abdominis activation in abdominal hypopressive technique through surface electromyography.

AIMS: The abdominal hypopressive technique (AHT) is performed mainly via transversus abdominis (TrA) activation and has been indicated for pelvic floor muscle (PFM) disorders. In some European countries, this technique has become widely used. This study aimed to investigate PFM and TrA activation during the AHT through surface electromyography. METHODS: Thirty-four nulliparous physical therapists in good general health were asked to participate in the trial. To ascertain a correct PFM contraction, each of the participants was assessed by inspection and digital palpation. Ability to contract the TrA was assessed by surface electromyography and AHT training was given before analysis. TrA and PFM activity was recorded using surface electromyography. RESULTS: The mean age of the volunteers was 28.1 (±6.0) years and the mean body mass index was 23.7 (±3.3) kg/m(2) . More than half of the volunteers were physically active (61.3%) and regularly performed PFM training (52.9%) but not TrA exercises (58.8%). Although the AHT activates the PFM when compared to resting tone (P < 0.001), this method is significantly less effective than PFM alone (P < 0.001). Additionally, the combination of the two techniques (AHT + PFM) was similarly effective as isolated PFM contraction (P = 0.586). Although the AHT activated the TrA significantly more than did PFM alone (P = 0.002), the addition of PFM contraction to the AHT significantly increased the amount of TrA activation (P < 0.001). CONCLUSIONS: Based on our results, the AHT is less effective than PFM contraction alone, and adding PFM contraction to AHT also improves the TrA contraction.

Effects of the Paula method in electromyographic activation of the pelvic floor: a comparative study.

INTRODUCTION AND HYPOTHESIS: To determine if Paula method of circular muscles contraction e.g., those surrounding the eyes, mouth and fingers, could increase pelvic floor muscle (PFM) activity. METHODS: Thirty-four healthy, nulliparous volunteers were included, with an average age of 28 (± 5.9) years and body mass index of 23.8 (± 3.3) kg/m(2). They were assigned to randomly perform the sequence: a PFM maximal voluntary contraction, a contraction of circular muscles, followed by a simultaneous combination of PFM and circular muscle contraction. The PFM were evaluated using surface electromyography. RESULTS: PFM activity at baseline was 22.6 (± 10.9) µv. It was unchanged with Paula method contraction (p=0.322). There were also no differences between values of PFM maximal voluntary contraction alone, 99.8 (± 44.3) µv and in combination with the Paula method, 91.8 (± 35.3) µv (p=0.093). CONCLUSIONS: The Paula method seems not to increase PFM activity in nulliparous women.

Device to predict pelvic floor integrity during vaginal delivery: an intra- and interrater reliability study of the Epi-no distensibility measurement.

OBJECTIVE: To determine the test-retest reliability of the pelvic floor distensibility evaluation with Epi-no® device. METHODS: Prospective, blinded observational study with 32 women pregnant from 35 gestational weeks. An Epi-no® balloon was inflated within the pregnant woman's vagina and the maximum circumference achieved was measured using a standard metric measuring tape. Measurements were performed twice in a day by two physiotherapists in a randomized order. Intraobserver reproducibility was obtained with another evaluation 7-14 d after the initial examination. The intraclass correlation coefficient (ICC) was used to determine the intra and interrater reliability and the respective 95% confidence intervals with an alpha level of 0.05. RESULTS: From a total of 32 included pregnant women, 28 were analyzed; they were 29.3 (±5.97) years old, were at 37 (±1.3) weeks' gestation and presented a mean Epi-no® circumference of 20.4 (±2.4) cm. Regarding the intraobserver analysis, examiner 1 observed a maximum circumference of 20.6 (±2.6) cm in the first evaluation and 20.2 (±2.4) cm in the second evaluation, with good reliability (ICC = 0.85). Examiner 2 observed 19.7 (±2.4) cm in the first evaluation and 21.0 (±2.0) cm in the second one, with moderate reliability (ICC = 0.58). Regarding the interobserver analysis, there was good reliability on two evaluation days, with an ICC of 0.76 and 0.82, respectively. CONCLUSIONS: Epi-no® device is a reliable device for physiotherapists to measure pelvic floor distention during pregnancy.

Quantitative assessment of pelvic floor muscle extensibility in pregnant women with a perineal elasticity meter.

Objective: The objective of this study was to compare measurements of pelvic floor muscle extensibility in pregnant women obtained through the Epi-no® and perineal elasticity meter (PEM) devices.Methods: This was an observational, cross-sectional study with a consecutive sample, conducted in a prenatal care outpatient clinic. The pelvic floors of 62 healthy pregnant women with gestational ages between 35 and 40 weeks were assessed. Perineal extensibility was measured using the Epi-no® and PEM devices. Through the linear regression method, a formula was created to calculate the Epi-no® values from the PEM values. To determine the degree of relationship between both variables, Pearson's correlation coefficient was used.Results: In the comparison of the results for 62 pregnant women using the two perineal extensibility assessment methods, the value obtained in the Pearson correlation coefficient analysis (0.621) indicated a moderate relationship between the variables. This finding was not confirmed by the Kappa correlation test. When the measurements were classified into three groups, a slight correlation was identified (perineum with restrictions, moderate extensibility, and good extensibility).Conclusion: There was a relationship between Epi-no® and PEM from slight to moderate agreement.

Lower urinary tract symptoms and perineal function in women with and without fibromyalgia: a cross-sectional study.

INTRODUCTION AND HYPOTHESIS: Fibromyalgia (FM) studies have focused on pain, but a 2010 review of the diagnostic criteria pointed to other symptoms including urinary incontinence (UI). Women with FM present pain, fatigue, and reduced muscle strength; the research hypothesis was that pelvic floor (PF) muscles would be weaker; therefore, FM could be associated with lower urinary tract symptoms (LUTS) and compromise quality of life (QoL). The aim of this paper was to compare PF function, urinary symptoms, and their impact on QoL in women with and without FM and to verify if there is association between FM and LUTS. METHODS: We performed a cross-sectional study with 126 sexually active women aged between 19 and 65 years old, distributed in two groups, women with FM (FG n = 62) and without FM (NFG n = 64). Perineal function was the primary outcome and was assessed by perineometry and bidigital vaginal palpation (PERFECT Scheme). Presence of LUTS was assessed by interview based on international definition, and the impact of UI on QoL was evaluated by the King's Health Questionnaire (KHQ). RESULTS: FG presented worse PF function on clinical exam (p < 0.001) and perineometry (p = 0.04). LUTS was more frequent among FG (p < 0.001). In terms of QoL, FG obtained lower KHQ scores for general health perception (p < 0.001) and sleep/energy (p < 0.003) domains. The odds of presenting LUTS is 5.03 (95%CI 2.35-10.75) higher in women with FM. CONCLUSION: Women with FM had worse perineal function, had more LUTS, and presented UI more frequently, which negatively impacts on QoL.

5-HT1B receptor subtype and aging in rat resistance vessels.

The effects of 5-hydroxytryptamine (5-HT), 5-carboxamidotryptamine, and sumatriptan on rat caudal arteries were examined, with the goal of finding experimental conditions useful in enhancing the 'silent' 5-HT(1B) receptor subtype. It was shown that both reserpine treatment and K(+) depolarization increased the vasoconstriction by 5-HT receptor agonists. The role of the 5-HT(2A) receptor in vasoconstriction was examined using ritanserin (50 nmol/l), a selective 5-HT(2A) antagonist, whereas that of the 'silent' 5-HT(1B) receptor was examined using SB-224289 (0.2 micromol/l), a selective 5-HT(1B) receptor antagonist. The influence of age on the 'silent' 5-HT(1B) receptor subtype was also investigated; for this, the effect of sumatriptan, a selective 5-HT(1B/1D )agonist, was tested on arterial tissues of both young and old rats which had been either K(+) depolarized or reserpine treated or both. It was found that aging strongly shifted the concentration-vasoconstriction curve generated by sumatriptan to the left, also increasing the maximum contractile response, mainly in reserpine-treated tissues. RT-PCR was used to study the expression of 5-HT(1B) and 5-HT(2A) receptors in both young and old tissues. The results support the idea that reserpine-treated and K(+)-depolarized caudal arteries from old rats can be a pharmacological model which is useful in highlighting the 'silent' 5-HT(1B) receptor subtype.

Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence.

PURPOSE: To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. PATIENTS AND METHODS: One hundred eighteen subjects were randomly selected to receive pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response. RESULTS: In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21% patients were satisfied with the treatment. CONCLUSION: Based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.

Impact of covid-19 on the sexual function and self-esteem of young brazilian undergraduate student / Impacto do covid-19 na função sexual e autoestima de jovens universitárias brasileiras

INTRODUCTION: Satisfactory sexual function contributes considerably to women's physical and mental health and is affected by several factors, including chronic stress. Since the beginning of the COVID-19 pandemic, these stressors have been intensified by fear of contamination and morbidity and mortality, deaths, and long-term social isolation. OBJECTIVE: To evaluate the effect of the COVID-19 pandemic on the sexual function and self-esteem of young women attending university in Brazil and also investigate the importance of social isolation in these conditions. METHODS: This longitudinal study included 90 students with active sexual life who answered questionnaires before (in person) and during (virtually) the pandemic. The instruments used were the Female Sexual Function Index (FSFI) and the Rosenberg Self-Esteem Scale. RESULTS: Only 67 women answered all questionnaires sent during the pandemic and had a mean age of 22.9 (±2.99) years; most of them were eutrophic, healthy students and, had a fixed partner. The total FSFI score allowed us to classify women without sexual dysfunction and was not modified during the pandemic. On the other hand, the self-esteem found was slightly lower than that considered healthy and did not change during the pandemic. Women who maintained social distancing showed a statistically significant reduction in sexual function when compared to those who did not (p=0.003). CONCLUSION: The COVID-19 pandemic did not influence young women's sexual function or self-esteem attending university in Brazil. However, the behavior of social isolation during the pandemic impaired the sexual function of these women.

INTRODUÇÃO: A função sexual satisfatória contribui consideravelmente para a saúde física e mental da mulher e é afetada por diversos fatores, entre eles o estresse crônico. Desde o início da pandemia de COVID-19, esses estressores foram intensificados pelo medo de contaminação e morbimortalidade, mortes e isolamento social prolongado. OBJETIVO: Avaliar o efeito da pandemia de COVID-19 na função sexual e autoestima de jovens universitárias no Brasil e também investigar a importância do isolamento social nessas condições. MÉTODOS: Este estudo longitudinal incluiu 90 estudantes com vida sexual ativa que responderam a questionários antes (presencialmente) e durante (virtualmente) a pandemia. Os instrumentos utilizados foram o Índice de Função Sexual Feminina (FSFI) e a Escala de Autoestima de Rosenberg. RESULTADOS: Apenas 67 mulheres responderam a todos os questionários enviados durante a pandemia e tinham idade média de 22,9 (±2,99) anos; a maioria era eutrófica, estudantes saudáveis ​​e com companheiro fixo. O escore total do FSFI permitiu classificar mulheres sem disfunção sexual e não foi modificado durante a pandemia. Por outro lado, a autoestima encontrada foi um pouco menor do que a considerada saudável e não se alterou durante a pandemia. As mulheres que mantiveram distanciamento social apresentaram redução estatisticamente significativa na função sexual quando comparadas àquelas que não o fizeram (p=0,003). CONCLUSÃO: A pandemia de COVID-19 não influenciou a função sexual ou a autoestima de jovens universitárias no Brasil. No entanto, o comportamento de isolamento social durante a pandemia prejudicou a função sexual dessas mulheres.

EMILIN-1 deficiency induces elastogenesis and vascular cell defects.

EMILINs constitute a family of genes of the extracellular matrix with high structural similarity. Four genes have been identified so far in human and mouse. To gain insight into the function of this gene family, EMILIN-1 has been inactivated in the mouse by gene targeting. The homozygous animals were fertile and did not show obvious abnormalities. However, histological and ultrastructural examination revealed alterations of elastic fibers in aorta and skin. Formation of elastic fibers by mutant embryonic fibroblasts in culture was also abnormal. Additional alterations were observed in cell morphology and anchorage of endothelial and smooth muscle cells to elastic lamellae. Considering that EMILIN-1 is adhesive for cells and that the protein binds to elastin and fibulin-5, EMILIN-1 may regulate elastogenesis and vascular cell maintenance by stabilizing molecular interactions between elastic fiber components and by endowing elastic fibers with specific cell adhesion properties.

Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence.

CONTEXT AND OBJECTIVE: Urinary incontinence is a public health problem that affects more than 200 million people worldwide. Stress incontinence is the most prevalent type. Pelvic floor muscle exercises have been used for treating it, although there is no consensus regarding their application. The aim of this study was to compare the results from treating female stress urinary incontinence with pelvic floor muscle exercises with or without physiotherapist supervision. DESIGN AND SETTING: This was a randomized, prospective, controlled trial in the Urogynecology and Vaginal Surgery Sector, Universidade Federal de São Paulo. METHODS: Forty-four women were randomized to be treated for stress urinary incontinence with pelvic floor exercises for three consecutive months, into two groups: one with and the other without physiotherapist supervision. They were evaluated before and after treatment using a quality-of-life questionnaire, pad test, micturition diary and subjective evaluation. Descriptive analysis was used to evaluate the population. The homogeneity of the two groups was evaluated using the Kruskal-Wallis and Chi-squared tests. The success of the two groups after treatment was evaluated using the Wilcoxon test. RESULTS: The supervised group showed statistically greater improvement in the pad test, micturition diary and quality of life than did the control group. In the subjective evaluation, only 23.8% of the control group patients were satised with their treatment. In the supervised group, 66.8% of patients did not want any other treatment. CONCLUSION: Supervised pelvic floor muscle exercises presented better results in objective and subjective evaluations than did unsupervised exercises.

Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study.

CONTEXT AND OBJECTIVE: Several risk factors are involved in perineal lacerations during vaginal delivery. However, little is known about the influence of perineal distensibility as a protective factor. The aim here was to determine a cutoff value for pelvic floor distensibility measured using the Epi-no balloon, which could be used as a predictive factor for perineal integrity in vaginal delivery. DESIGN AND SETTING: Prospective observational single cohort study conducted in a maternity hospital. METHODS: A convenience sample of 227 consecutive at-term parturients was used. All women had a single fetus in the vertex presentation, with up to 9.0 cm of dilation. The maximum dilation of the Epi-no balloon was measured using a tape measure after it had been inflated inside the vagina up to the parturients' maximum tolerance. The receiver operating characteristic (ROC) curve was used to obtain the Epi-no circumference measurement with best sensitivity and specificity. RESULTS: Among the 161 patients who were included in the study, 50.9% underwent episiotomy, 21.8% presented lacerations and 27.3% retained an intact perineum. Age > 25.9 years; number of pregnancies > 3.4; number of deliveries > 2.2 and circumference measured by Epi-no > 21.4 cm were all directly correlated with an intact perineum. Circumference measurements using the Epi-no balloon that were greater than 20.8 cm showed sensitivity and specificity of 70.5% and 66.7% (area under curve = 0.713), respectively, as a predictive factor for an intact perineum in vaginal delivery. CONCLUSION: Circumferences greater than 20.8 cm achieved using the Epi-no balloon are a predictive factor for perineal integrity in parturients.

Can Abdominal Hypopressive Technique Change Levator Hiatus Area?: A 3-Dimensional Ultrasound Study.

This study aimed to evaluate the levator hiatus area (LHA) at rest and during the performance of maximal pelvic floor muscle (PFM) contractions, during the abdominal hypopressive technique (AHT), and during the combination of PFM contractions (PFMCs) and the AHT. The study included 17 healthy nulliparous women who had no history of pelvic floor disorders. The LHA was evaluated with the patients in the lithotomy position. After a physiotherapist instructed the patients on the proper performance of the PFM and AHT exercises, 1 gynecologist performed the 3-dimensional translabial ultrasound examinations. The LHA was measured with the patients at rest. The PFMC alone, the AHT alone or the AHT in combination with a PFMC with 30 seconds of rest between the evaluations were performed. Each measurement was performed 2 times, and the mean value was used for statistical analysis. The Wilcoxon test was used to test the differences between the 2 maneuvers. Similar values were observed when comparing the LHA of the PFM at rest (12.2 ± 2.4) cm and during the AHT (11.7 ± 2.6) cm (P = 0.227). The AHT+ PFMC (10.2 ± 1.9) cm demonstrated lower values compared with AHT alone (11.7 ± 2.6) cm (P = 0.002). When comparing the PFMC (10.4 ± 2.1) cm with the AHT + PFMC (10.2 ± 1.9) cm, no significant difference (P = 0.551) was observed. During PFMC, the constriction was 1.8 cm; during the AHT, the constriction was 0.5 cm; and during the AHT + PFMC, it was 2 cm. The LHA assessed by 3-dimensional ultrasound did not significantly change with AHT. These results support the theory that AHT does not strengthen PFM.

Impact of an exercise protocol on sexuality and quality of life of climacteric women / Impacto de um protocolo de exercícios na sexualidade e qualidade de vida de mulheres climatéricas

INTRODUCTION: Climacteric is a period of transition between the reproductive and nonreproductive phases of the woman, due to hypoestrogenism. Some symptoms such as vasomotor and urogenital disorders and sexual dysfunctions are characteristics of this period that can interfere negatively in women´s quality of life. However, specific exercises can positively influence the improvement of these conditions. OBJECTIVE: To verify the impact of a physiotherapist supervised exercise protocol on menopausal symptoms, sexuality and quality of life of climacteric women. METHODS: A descriptive study with physiotherapeutic intervention through a specific exercise protocol. Participated in the study 18 women attended to Instituto da Mulher e Gestante, in the city of Santos (SP). RESULTS: The women underwent initial physiotherapeutic evaluation, answered the Sexuality Questionnaire Female Sexual Function Index, Kupperman Menopausal Index and SF-36 quality of life. They were then submitted to health education about climacteric period and also to a physiotherapist supervised exercise group, once a week, lasting 50 minutes, for 12 weeks. The same questionnaires were reapplied at the end of this period. CONCLUSION: The protocol of specific group exercises supervised by physiotherapist did not influence sexual function, but it was effective for better quality of life and decreased significantly climacteric symptomatology.

INTRODUÇÃO: O climatério é um período de transição entre as fases reprodutiva e não reprodutiva da mulher consequente ao hipoestrogenismo. Sintomas vasomotores, alterações do trato urogenital e disfunções sexuais são algumas condições características deste período que podem interferir negativamente na qualidade de vida. Entretanto, exercícios específicos podem influenciar positivamente na melhora dessas condições. OBJETIVO: Verificar o impacto de um protocolo de exercícios supervisionado por fisioterapeuta nos sintomas menopausais, na sexualidade e na qualidade de vida de mulheres no climatério. MÉTODOS: Estudo quase-experimental com intervenção fisioterapêutica por meio de protocolo de exercícios específicos. Participaram do estudo 18 mulheres usuárias do Instituto da Mulher e da Gestante, do município de Santos (SP). RESULTADOS: As mulheres foram submetidas à avaliação fisioterapêutica inicial, responderam aos questionários de sexualidade Female Sexual Function Index, Índice Menopausal de Kupperman e de qualidade de vida SF-36. Foram então submetidas a grupo de exercício supervisionado por fisioterapeuta, uma vez por semana, com duração de 50 minutos, por 12 semanas. Os mesmos questionários foram reaplicados ao final deste período. CONCLUSÃO: O protocolo de exercícios específicos em grupo e supervisionado por fisioterapeuta não influenciou a função sexual, mas foi eficaz para melhor qualidade de vida e enfrentamento da sintomatologia do climatério.