The serum steroid signature of PCOS hints at the involvement of novel pathways for excess androgen biosynthesis.

CONTEXT: Polycystic ovary syndrome (PCOS) is defined by androgen excess and ovarian dysfunction in the absence of a specific physiological diagnosis. The best clinical marker of androgen excess is hirsutism, while the best biochemical parameter is still a matter of debate. Current consensus guidelines recommend, among other hormones, serum free testosterone as an important serum parameter to measure androgen excess. Recently, however, novel active androgens and androgen metabolic pathways have been discovered. OBJECTIVE: To assess the contribution of novel androgens and related steroid biosynthetic pathways to the serum steroid pool in PCOS women in comparison to healthy controls. DESIGN: This is a case control study, wherein PCOS was diagnosed according to the AE-PCOS 2009 criteria. Serum steroid profiling was performed by liquid chromatography high-resolution mass spectrometry. SETTING: Yeditepe University and associated clinics in Istanbul, Turkey, together with Bern University Hospital Inselspital, Bern, Switzerland. PARTICIPANTS: 42 PCOS women and 42 matched, healthy control women. MAIN OUTCOME MEASURES: Assessment of 34 steroids compartmentalized in four androgen related pathways: the classic androgen pathway, the backdoor pathway, the C11-oxy backdoor pathway, and the C11-oxy (11ß-hydroxyandrostenedione) pathway. RESULTS: Metabolites of all four pathways were identified in healthy and PCOS women. Highest concentrations were found for progesterone in controls and androstenedione in PCOS. Lowest levels were found for 11-ketotestosterone in controls compared to PCOS, and for 20α-hydroxyprogesterone in PCOS compared to controls. PCOS also had higher serum testosterone levels compared to the controls. PCOS women had overall higher levels of steroid metabolites of all four androgen pathways compared to healthy controls. CONCLUSIONS: Novel alternative pathways contribute to the androgen production in healthy and PCOS women. Hyperandrogenism in PCOS is characterized by an overall increase of serum androgens in the classic, backdoor and C11-oxy pathways. While monogenetic disorders of steroid biosynthesis can be recognized by a specific pattern in the steroid profile, no diagnostic pattern or classifier was found in the serum for PCOS.

The Impact of the COVID-19 Pandemic on Depression and Sexual Function: Are Pregnant Women Affected More Adversely?

OBJECTIVE: To investigate depression and sexual function among pregnant and non-pregnant women throughout the COVID-19 pandemic. METHODS: A total of 188 women, 96 pregnant and 92 non-pregnant were included. The Beck Depression Inventory (BDI) and the Arizona Sexual Experience Scale (ASEX) were applied to the participants after obtaining sociodemographic data. RESULTS: The depression scores of pregnant and non-pregnant women were similar (p = 0.846). We found that the depression scores were significantly higher among the group of participants who have lower economic status (p = 0.046). Moreover, the depression score was significantly higher among women who lost their income during the pandemic (p = 0.027). The score on the ASEX was significantly higher, and sexual dysfunction was more prevalent among women who have lower levels of schooling and income (p < 0.05). Likewise, the ASEX scores were significantly higher (p = 0.019) among the group who experienced greater income loss throughout the pandemic. Upon comparing the pregnant and non-pregnant groups, we detected that sexual dysfunction had a significantly higher rate among pregnant women (p < 0.001). CONCLUSION: In times of global crisis, such as the current pandemic, low-income families have an increased risk of experiencing depression and sexual dysfunction. When we compared pregnant women with non-pregnant women, depression scores were similar, but pregnant women were at a 6.2 times higher risk of developing sexual dysfunction.

OBJETIVO: Investigar a depressão e as funções sexuais de mulheres grávidas e não grávidas durante a pandemia de Covid-19. MéTODOS: Um total de 188 mulheres, 96 grávidas e 92 não grávidas, foram incluídas. O Inventário de Depressão de Beck (Beck Depression Inventory, BDI, em inglês) e a Escala de Experiências Sexuais do Arizona (Arizona Sexual Experience Scale, ASEX, em inglês) foram aplicados aos participantes após a obtenção dos dados sociodemográficos. RESULTADOS: As pontuações de depressão de mulheres grávidas e não grávidas foram semelhantes (p = 0,846). Verificou-se que as pontuações de depressão foram significativamente maiores no grupo de participantes de menor nível econômico (p = 0,046). Além disso, a pontuação de depressão foi significativamente maior em mulheres que perderam sua renda durante a pandemia (p = 0,027). A pontuação na ASEX foi significativamente maior, e a disfunção sexual foi mais prevalente em pessoas com menores escolaridade e nível de renda (p < 0,05). Da mesma forma, as pontuações na ASEX foram significativamente mais altas (p = 0,019) no grupo que experimentou maior perda de renda durante a pandemia. Ao comparar os grupos de gestantes e não gestantes, detectou-se que a disfunção sexual apresentava índice significativamente maior entre as gestantes (p <0,001). CONCLUSãO: Em tempos de crise global, como a atual pandemia, famílias de baixa renda têm um risco maior de sofrer depressão e disfunção sexual. Quando comparamos mulheres grávidas e mulheres não grávidas, as pontuações de depressão foram semelhantes, mas as mulheres grávidas apresentaram um risco 6,2 vezes maior de desenvolver disfunção sexual.

The Impact of the COVID-19 Pandemic on Depression and Sexual Function: Are Pregnant Women Affected More Adversely? / O impacto da pandemia de COVID-19 na depressão e na função sexual: as mulheres grávidas são afetadas de forma mais adversa?

Abstract Objective To investigate depression and sexual function among pregnant and nonpregnant women throughout the COVID-19 pandemic. Methods A total of 188 women, 96 pregnant and 92 non-pregnant were included. The Beck Depression Inventory (BDI) and the Arizona Sexual Experience Scale (ASEX) were applied to the participants after obtaining sociodemographic data. Results The depression scores of pregnant and non-pregnant women were similar (p = 0.846). We found that the depression scores were significantly higher among the group of participants who have lower economic status (p = 0.046). Moreover, the depression score was significantly higher among women who lost their income during the pandemic (p = 0.027). The score on the ASEX was significantly higher, and sexual dysfunction was more prevalent among women who have lower levels of schooling and income (p < 0.05). Likewise, the ASEX scores were significantly higher (p = 0.019) among the group who experienced greater income loss throughout the pandemic. Upon comparing the pregnant and non-pregnant groups, we detected that sexual dysfunction had a significantly higher rate among pregnant women (p < 0.001). Conclusion In times of global crisis, such as the current pandemic, low-income families have an increased risk of experiencing depression and sexual dysfunction. When we compared pregnant women with non-pregnant women, depression scores were similar, but pregnant women were at a 6.2 times higher risk of developing sexual dysfunction.

Resumo Objetivo Investigar a depressão e as funções sexuais de mulheres grávidas e não grávidas durante a pandemia de Covid-19. Métodos Um total de 188 mulheres, 96 grávidas e 92 não grávidas, foram incluídas. O Inventário de Depressão de Beck (Beck Depression Inventory, BDI, em inglês) e a Escala de Experiências Sexuais do Arizona (Arizona Sexual Experience Scale, ASEX, em inglês) foram aplicados aos participantes após a obtenção dos dados sociodemográficos. Resultados As pontuações de depressão de mulheres grávidas e não grávidas foram semelhantes (p = 0,846). Verificou-se que as pontuações de depressão foram significativamente maiores no grupo de participantes de menor nível econômico (p = 0,046). Além disso, a pontuação de depressão foi significativamente maior em mulheres que perderam sua renda durante a pandemia (p = 0,027). A pontuação na ASEX foi significativamente maior, e a disfunção sexual foi mais prevalente em pessoas com menores escolaridade e nível de renda (p < 0,05). Da mesma forma, as pontuações na ASEX foram significativamente mais altas (p = 0,019) no grupo que experimentou maior perda de renda durante a pandemia. Ao comparar os grupos de gestantes e não gestantes, detectou-se que a disfunção sexual apresentava índice significativamente Conclusão Em tempos de crise global, como a atual pandemia, famílias de baixa renda têm um risco maior de sofrer depressão e disfunção sexual. Quando comparamos mulheres grávidas e mulheres não grávidas, as pontuações de depressão foram semelhantes, mas as mulheres grávidas apresentaram um risco 6,2 vezes maior de desenvolver disfunção sexual.

Comparison of Laboratory and Radiological Findings of Pregnant and Non-Pregnant Women with Covid-19.

OBJECTIVE: Covid-19 became a pandemic, and researchers have not been able to establish a treatment algorithm. The pregnant population is also another concern for health care professionals. There are physiological changes related to pregnancy that result in different laboratory levels, radiological findings and disease progression. The goal of the present article is to determine whether the laboratory results and radiological findings were different in non-pregnant women (NPWs) of reproductive age and pregnant women (PWs) diagnosed with the Covid-19 infection. METHODS: Out of 34 patients, 15 (44.11%) PWs and 19 (55.8%) NPWs were included in the study. Age, comorbidities, complaints, vitals, respiratory rates, computed tomography (CT) findings and stages, as well as laboratory parameters, were recorded from the hospital database. RESULTS: The mean age of the PWs was of 27.6 ± 0.99 years, and that of the NPWs was of 37.63 ± 2.00; when age was compared between the groups, a statistically significant difference (p = 0.001) was found. The mean systolic blood pressure of the PWs was of 116.53 ± 11.35, and that of the NPWs was of 125.53 ± 13.00, and their difference was statistically significant (p = 0.05). The difference in the minimum respiratory rates of the patients was also statistically significant (p = 0.05). The platelet levels observed among the PWs with Covid-19 were lower than those of the NPWs (185.40 ± 39.09 × 109/mcL and 232.00 ± 71.04 × 109/mcL respectively; p = 0.05). The mean D-dimer value of the PWs was lower in comparison to that of the NPWs (p < 0.05). CONCLUSION: The laboratory findings and imaging studies may differ between pregnant and non-pregnant populations. It is important to properly interpret these studies. Future studies with a higher number of patients are required to confirm these preliminary data.

Comparison of laboratory and radiological findings of pregnant and non-pregnant women with covid-19

Abstract Objective Covid-19 became a pandemic, and researchers have not been able to establish a treatment algorithm. The pregnant population is also another concern for health care professionals. There are physiological changes related to pregnancy that result in different laboratory levels, radiological findings and disease progression. The goal of the present article is to determine whether the laboratory results and radiological findings were different in non-pregnant women (NPWs) of reproductive age and pregnant women (PWs) diagnosed with the Covid-19 infection. Methods Out of 34 patients, 15 (44.11%) PWs and 19 (55.8%) NPWs were included in the study. Age, comorbidities, complaints, vitals, respiratory rates, computed tomography (CT) findings and stages, as well as laboratory parameters, were recorded from the hospital database. Results Themean age of the PWs was of 27.6 ± 0.99 years, and that of the NPWs was of 37.63 ± 2.00; when agewas compared between the groups, a statistically significant difference (p=0.001) was found. The mean systolic blood pressure of the PWs was of 116.53 ± 11.35, and that of the NPWs was of 125.53 ± 13.00, and their difference was statistically significant (p=0.05). The difference in the minimum respiratory rates of the patients was also statistically significant (p=0.05). The platelet levels observed among the PWs with Covid-19 were lower than those of the NPWs (185.40 ± 39.09 x 109/mcL and 232.00 ± 71.04 x 109/mcL respectively; p=0.05). The mean D-dimer value of the PWs was lower in comparison to that of the NPWs (p<0.05). Conclusion The laboratory findings and imaging studiesmay differ between pregnant and non-pregnant populations. It is important to properly interpret these studies. Future studies with a higher number of patients are required to confirm these preliminary data.

Pregnancy worsens the morbidity of COVID-19 and this effect becomes more prominent as pregnancy advances.

OBJECTIVE: To investigate pregnancy outcomes and compare the clinical characteristics of coronavirus 2019 (COVID-19) disease in pregnant and agematched non-pregnant women. MATERIALS AND METHODS: Hospital records of four tertiary care centers were reviewed retrospectively. The subjects comprised 188 pregnant patients and 799 non-pregnant women who were admitted to these hospitals. RESULTS: Pregnancy significantly affected the clinical severity of COVID-19 and this effect was more prominent in pregnant women at >20 weeks gestation (p<0.001). Rates of oxygen support (10.1% vs 4.8%; p≤0.001), intensive care unit admission (3.2% vs 0.6%; p=0.009), presence of fever (12.8% vs 4.4%; p<0.001), tachypnea (7.0% vs 2.4%; p=0.003) and tachycardia (16.0% vs 1.9%; p<0.001) were significantly more frequent in pregnant women compared with non-pregnant women. Pregnancy was strongly associated with the need for oxygen support [relative risk (RR), 2.125; 95% confidence interval (CI): 1.25-3.60] and admission to the intensive care unit (RR, 5.1; 95% CI: 1.57-16.53) compared with non-pregnant women. Some 14.4% of the pregnant women had co-morbidities. Sixty of the 188 pregnant women (31.9%) delivered during the Severe Acute Respiratory syndrome coronavirus-2 infection, 11 (18.3%) had vaginal deliveries and 49 (81.7%) were by cesarean section. Of these 60 deliveries, 40 (66.7%) were <37 weeks gestation. CONCLUSION: Pregnancy worsens the morbidity of COVID-19 and this effect seems to increase as the pregnancy advances, but not the mortality rate.

The effects of menopausal uterine fibroids on the prognosis of endometrium cancer.

OBJECTIVE: This study aimed to evaluate any potential associations between uterine leiomyomas and endometrial cancer. MATERIALS AND METHODS: This is a retrospective study of 153 female patients who have been operated because of endometrial carcinoma in our hospital between 2012 and 2017. Data were collected from hospital records. Study participants were divided into two groups according to the presence and absence of leiomyomas. These two groups were compared in terms of histopathological adenocarcinoma type, nuclear and histological grades, disease stage, para-aortic lymph node involvement, and myometrial invasion. For data analysis, Statistical Package for Social Sciences 15.0 software package was used. Comparison between the two groups was made using the chi-square test, and each variable was tested with the Student's t-test for statistical significance. RESULTS: No statistically significant differences were found between the groups with respect to age, tumor type, myometrial invasion, nuclear grade, or histological grade (p>0.05 for all). A significant difference was found between leiomyomas presence and lymph node metastases. The lymph node metastases were more common in patients without uterine leiomyomas (20.55%) than in those with them (5%; p=0.004). Analysis using the Federation of Obstetrics and Gynecology stages for the presence of leiomyomas indicated that the mean stages were 1A and 1B in patients with and without uterine leiomyomas, respectively (p=0.002). CONCLUSION: Uterine leiomyomas did not adversely affect the prognosis of patients with endometrial carcinoma. Moreover, lymph node involvement was less common, and stages were lower in patients with leiomyomas.

Translation, cultural adaptation, and validation and reliability of assessment of pelvic floor disorders and their risk factors during pregnancy and postpartum questionnaire in Turkish population.

OBJECTIVES: This study was conducted in order to produce translation, cultural adaptation, and validation of Assessment of Pelvic Floor Disorders and Their Risk Factors During Pregnancy and Postpartum Questionnaire (APFDQ) to Turkish in pregnant and postpartum population. MATERIAL AND METHODS: The study included 80 pregnant women. Internal consistency was tested using Cronbach's alpha. Questionnaires were applied three different times in order to assess for sensitivity. Patients were asked to complete the questionnaire first in the third trimester, secondly in postpartum 6th week and finally in postpartum 6th month after birth. For translation process content, face/content validity, reliability, construct validity and reactivity studies were done. All women had undergone pelvic examination and prolapse was assessed by using Pelvic organ Prolapse Quantification System (POP-Q). Urinary symptoms were also evaluated with Urinary Distress Inventory (UDI-6) questionnaire. RESULTS: The mean age of patients was 27.7 ± 5.5 years. Forty-one (51.25%) of the patients had vaginal delivery and 39 (48.75%) had a cesarean section. Above 96% of the patients had completed the questionnaires. POP-Q assessments and UDI-6 results were used to evaluate construct validity. Cronbach's alpha results were found to be 0.7 for all the subscales of the questionnaire: bladder: 0.702, bowel: 0.744, prolapse: 0.701, sexual function: 0.706 respectively, indicating adequate reliability. The test/retest reliability was studied and Pabak values showed moderate reliability in the bowel, prolapse and sexuality, and good reliability for bladder subscale. The results of the patients were compared between pregnancy and postpartum to assess reactivity and shown to be reactive to changes. Also risk factors of the patients were assessed including, family predisposition, maternal age over 35 years, BMI > 25, nicotine use, subjective inability to contract pelvic floor and sense of postpartum wound pain. CONCLUSIONS: The Turkish version of APFDQ is a reliable and valid tool. It can be used for assessing the risk factors, incidence, assessing degree of PFDs and evaluating the impact on quality of life in pregnant and postpartum women.

Comparison of female sexual function and sexual function of their partners between groups of pregnant and non-pregnant women.

OBJECTIVES: To compare the female sexual function index and sexual function of their partners between groups of pregnant and non-pregnant Turkish women. MATERIAL AND METHODS: This was a cross-sectional study of 321 women, including 252 healthy pregnant and 69 healthy nonpregnant women. Assessment of female sexual function index (FSFI), ARIZONA scores of their partners were compared in relation to some of the sociodemographic characteristics and pregnancy trimesters. RESULTS: Comparison of the groups revealed a significantly higher FSFI score in the non-pregnant group whereas the ARIZONA score was significantly higher in the pregnant group (p < 0.001). Age, gravidity, parity and smoking rate adjusted mean differences of scores remained statistically significant (p < 0.001). Higher ARIZONA (> 11) score rate was significantly higher in pregnant groups (55.6% vs 23.2%, p < 0.001). Pregnancy was a risk factor for high ARIZONA score [OR: 4.1 (95% CI 2.2-7.6, p < 0.001)]. Lower FSFI score rate was significantly higher in the pregnant group (26.4% vs 69.4%, p < 0.001). Pregnancy was a risk factor for low FSFI score [OR: 6.4 (95% CI 3.5-11.7, p < 0.001)]. CONCLUSIONS: Both female sexual function index and ARIZONA scores of their partners were found to be significantly different between groups of pregnant and nonpregnant Turkish women which indicated altered sexual function of couples during pregnancy.

Effects of predisposing factors on the success and treatment period in vaginismus.

OBJECTIVE: There are many predisposing factors associated with vaginismus, but there is lack of data in the literature regarding which and how of these factors influence the success rate of treatment. Our aim is to investigate the effects of factors that are considered as predisposing factors for vaginismus on treatment prognosis and success rate, with cognitive-behavioral therapy and desensitization exercises after sexual therapy. METHODS: Patients with vaginismus were divided into three groups. Group 1: patients who successfully completed vaginal penetration exercises after sexual therapy and experienced vaginal sexual intercourse; Group 2: patients who started penetration exercises but could not reach success; Group 3: patients who discontinued treatment before starting exercises. Demographic and sexual parameters were compared between the groups. RESULTS: There were statistically significant differences between the groups in terms of history of vaginismus in relatives (4.3%, 23% and 35.7%, p=0.047, respectively), the unsuccessful therapy history (69%, 61% and 21.4%, p=0.014, respectively), and anal and/or oral sex ratios (47.8%, 7.7% and 57.1%, p=0.019, respectively). Mean number of sessions were significantly higher in patients saying, "It is my fault" than among those perceiving it as a common problem (10.6±2.9 ve 7.5±5.7, p=0.042, respectively), and in patients with sexual disorder in their male partners than those not having any problem (13.3±3.7 ve 8.2±3.7, p=0.013, respectively). CONCLUSION: Patients are more resistant to treatment if they have a history of vaginismus among relatives or when one of the couple say, it is his or her fault.

Effects of predisposing factors on the success and treatment period in vaginismus.

OBJECTIVE: There are many predisposing factors associated with vaginismus, but there is lack of data in the literature regarding which and how of these factors influence the success rate of treatment. Our aim is to investigate the effects of factors that are considered as predisposing factors for vaginismus on treatment prognosis and success rate, with cognitive-behavioral therapy and desensitization exercises after sexual therapy. METHODS: Patients with vaginismus were divided into three groups. Group 1: patients who successfully completed vaginal penetration exercises after sexual therapy and experienced vaginal sexual intercourse; Group 2: patients who started penetration exercises but could not reach success; Group 3: patients who discontinued treatment before starting exercises. Demographic and sexual parameters were compared between the groups. RESULTS: There were statistically significant differences between the groups in terms of history of vaginismus in relatives (4.3%, 23% and 35.7%, p=0.047, respectively), the unsuccessful therapy history (69%, 61% and 21.4%, p=0.014, respectively), and anal and/or oral sex ratios (47.8%, 7.7% and 57.1%, p=0.019, respectively). Mean number of sessions were significantly higher in patients saying, "It is my fault" than among those perceiving it as a common problem (10.6±2.9 ve 7.5±5.7, p=0.042, respectively), and in patients with sexual disorder in their male partners than those not having any problem (13.3±3.7 ve 8.2±3.7, p=0.013, respectively). CONCLUSION: Patients are more resistant to treatment if they have a history of vaginismus among relatives or when one of the couple say, it is his or her fault.

Investigation of the preventive effects of dehydroepiandrosterone (DHEA) and Caffeic acid phenethyl ester (CAPE) on cisplatin-induced ovarian damage in rats.

To investigate whether Dehydroepiandrosterone (DHEA) and Caffeic acid phenethyl ester (CAPE) had any preventive effect against the ovarian damage caused by cisplatin (CP) (cis-diamminedichloroplatinum) in rats. On the first day ovaries were removed, Anti-Müllerian hormone (AMH) was measured (Group1, n:6), in the other groups 7.5 mg/kg cisplatin was administered intraperitoneally. In Group 2 (n = 6), 0.1 ml saline, in Group 3 (n = 5), 20 umol/kg CAPE, in Group 4 (n = 7), DHEA 6 mg/kg were administered every day. On the 10th day, ovaries were removed, AMH was measured. Ovary reserve (primordial/primary/secondary/tertiary/atretic follicles, AMH), ovarian damage scores (follicular degeneration, congestion, hemorrhage, edema, inflammation) were compared. The number of tertiary follicles were statistically high in the CAPE group (p = .015), the inflammation score in the DHEA group (p = .012), AMH level (p = .009) in the control group. The lowest number of atretic follicles (AF) was in the control group, while the highest number of AF was in the DHEA group (p = .002). Significant decreases in AF were the case in the cisplatin and DHEA groups compared to the control group (p < .008). The AMH values had the highest positive correlation with the number of primordial follicles and the highest negative correlation with the number of AF. The cut off point for AMH was 1.57 ng/ml as an indicator of low ovarian reserve. Cisplatin causes total damage and increased numbers of AF on the ovary. Depending on this, AMH levels fall. These negative effects of cisplatin are not obstructed by CAPE or DHEA, and may even be increased by DHEA.

Comparison of the protective effects of sildenafil, vardenafil and tadalafil treatments in ischemia-reperfusion injury in rat ovary.

OBJECTIVES: The aim of this study was to compare the effects of sildenafil, vardenafil and tadalafil in treatment for ischemia/reperfusion injury which is created experimentally in rat ovaries. MATERIAL AND METHODS: For this study, 30 female Wistar albino rats were used, and the rats were separated randomly intofive groups consisting of six rats each: normal, torsion-detorsion, torsion-detorsion + sildenafil 1.4 mg/kg, torsion-detorsion+ vardenafil 1.7 mg/kg and torsion-detorsion + tadalafil 5.0 mg/kg. The agents were given intraperitoneally 30 minutesbefore detorsion. An ovarian torsion procedure was implemented in all other groups for 3 hours with the exception of thenormal group. Then, a detorsion procedure was implemented to the groups for 3 hours. RESULTS: The sildenafil and vardenafil treatments showed protective effect by preventing significant increase in inflammationparameters. (p = 0.058, 0.138). The tadalafil treatment was only protective for cellular degeneration (p = 0.140). Thevardenafil treatment was protective for edema (p = 0.238), vascular congestion (p = 0.111), inflammation (p = 0.138) andcellular degeneration (p = 0.532). Sildenafil, vardenafil and tadalafil inhibited the increase of atretic follicle. AMH levels werestatistically different between torsion and detorsion and vardenafil group (p = 0.004, 0.004), whereas tadalafil and sildenafilgroups were similar to normal group (p = 0.108, 0.108). CONCLUSIONS: PDE inhibitors were found to be effective in reducing ovarian ischemia/reperfusion injury. Sildenafil andtadalafil seem to be more effective than the vardenafil in protecting the ovarian reserve.

Cervix human papilloma virus positivity: Does it cause sexual dysfunction?

OBJECTIVE: To investigate whether testing positive for human papilloma virus (HPV) in cervical screening has an impact on female sexual functioning. MATERIALS AND METHODS: This study was designed as a single-center, prospective, descriptive-cross-sectional study and 300 women who received HPV testing in our hospital [HPV-positive (n=187) or HPV-negative (n=113)]. The Arizona Sexual Experiences (ASEX) scale and Female Sexual Functioning index (FSFI) were administered to study participants during face-to-face interviews. RESULTS: No significant differences were found between women who were HPV-positive and HPV-negative in sexual functions as assessed using the ASEX and FSFI scales (p=0.343 and p=0.604, respectively). In addition, the analyses addressing whether sexual functioning was affected by a positive test result, at diagnosis or during the follow-up (before 2 weeks, 2 weeks-1 month, 1-3 months, 3-6 months, 6 months-1 year and over 1 year) revealed no significant differences between HPV-positive and HPV-negative women in sexual functioning (p>0.05). Sexual dysfunction was less common in married women than in the ASEX scale (p=0.03), and this difference was not detected when the FSFI scale was applied. The incidence of dysfunction was more frequent in working women than in retirees (p=0.006, p=0.01). CONCLUSION: Educational attainment, socioeconomic status, age, employment status, and marital status were found to have statistically significant effects on sexual functioning. Sexual functioning was affected by neither HPV test results (positive/negative) nor time from diagnosis.

Lipid profile and plasma atherogenic index in postmenopausal osteoporosis.

OBJECTIVE: The goal of this study was to investigate the relationship between the lipid profile, plasma atherogenic index (PAI), and osteoporosis in postmenopausal women. METHODS: The data of age, duration of menopause, height, weight, lipid profile, bone mineral density (BMD) value, and history of oral contraceptive use of 407 postmenopausal women who had not been menstruating for at least 12 months, were between the ages 45 and 80, and presented at the obstetrics and gynecology polyclinic of Kartal Dr. Lutfi Kirdar Tr aining and Research Hospital were reviewed. The patients were divided into 2 groups according to the presence of osteoporosis, and the data compared. The level of significance was accepted as p<0.05. RESULTS: A total of 142 postmenopausal patients with osteoporosis were included in the study. The mean age was 61.7±6.9 years. In the control group, there were 263 postmenopausal women without osteoporosis, with a mean age of 58.3±4.5 years. There was no statistically significant difference with respect to triglyceride level; however, in the osteoporosis group, the level of total cholesterol and low-density lipoprotein (LDL) were lower, and the level of high-density lipoprotein (HDL) was higher (p=0.762, p=0.002, p=0.01, p<0.001, respectively). CONCLUSION: A high level of HDL, and low LDL and PAI values, which are important for the prevention of cardiovascular disease, were found to be negative factors for BMD.

Comparison of the long-term effects of single-dose methotrexate and salpingectomy on ovarian reserve in terms of anti-müllerian hormone levels.

The aim of this study was to compare the effects of single-dose methotrexate (MTX) and salpingectomy on ovarian reserve in women with ectopic pregnancy in the late post-treatment period. A total of 181 patients were included in the study; 56 of them received a single-dose of MTX, 45 of them had undergone salpingectomy treatment for ectopic pregnancy in the previous 12-18 months, and 80 healthy women constituted an age-matched control group. The anti-müllerian hormone (AMH), follicle stimulating hormone (FSH) and oestrogen (E2) levels, as well as antral follicle counts (AFC) of the patients were evaluated. The average age was similar in both groups (p = 0.094) and there was no statistically significant difference in the smoking status of the patients (p = 0.949). None of the three groups displayed a significant difference in terms of AFC (p = 0.528), AMH (p = 0.147), FSH (p = 0.393) and E2 levels (p = 0.117). In the treatment of ectopic pregnancy neither the single-dose MTX application nor the salpingectomy had any permanent detrimental effect on the ovarian reserve; serum AMH levels and AFC are unaltered in the long term following single-dose MTX or salpingectomy.

Diaphragmatic resection preserving and repairing pericardium, splenectomy and distal pancreatectomy for interval debulking surgery of ovarian cancer.

OBJECTIVE: The majority of ovarian cancer patients are initially diagnosed at an advanced-stage [1]. Upper abdominal bulky metastasis cephalad to the greater omentum reported to be present in 42% of patients [2]. Many complex surgical procedures such as splenectomy, pancreatectomy, mobilization and partial resection of liver, porta hepatis dissection, diaphragmatic peritonectomy and resection are frequently performed to achieve complete resection of metastatic disease [3]. Our aim in this surgical film is to show the resection of a left sided diaphragmatic implant located beneath the heart, with dissection from the pericardium after entrance to the pericardial cavity. Additionally, step by step splenectomy with distal pancreatectomy also presented. METHODS: A 67years-old woman referred to our clinic for interval debulking for advanced stage suboptimally debulked high grade serous ovarian carcinoma. The tumor invading distal pancreas, hilum and parenchyma of spleen is clearly seen on magnetic resonance imaging. Another implant was also visible on left side of the diaphragm. We achieved complete cytoreduction with no macroscopic disease at the end of the surgery. RESULTS: She stayed at the intensive care unit for two days and in our clinic for seven days. We did not encounter any grade 3 or 4 adverse event in post-operative period. CONCLUSION: The surgical treatment of ovarian cancer has evolved in time in favor of radical surgery. The surgical team should be highly motivated, skilled and experienced for this complex procedures, since being able to reach complete cytoreduction is the most important predictor of survival in ovarian cancer patients.

The optimal analgesic method in saline infusion sonogram: A comparison of two effective techniques with placebo.

OBJECTIVE: Operations performed with local anesthesia can sometimes be extremely painful and uncomfortable for patients. Our aim was to investigate the optimal analgesic method in saline infusion sonograms. MATERIALS AND METHODS: This study was performed in our Clinic of Obstetrics and Gynecology between March and August 2011. Ninety-six patients were included. Patients were randomly divided into groups that received saline (controls, group 1), paracervical block (group 2), or paracervical block + intrauterine lidocaine (group 3). In all groups, a visual analogue scale score was performed during the tenaculum placement, while saline was administered, and 30 minutes after the procedure. RESULTS: When all the patients were evaluated, the difference in the visual analogue scale scores in premenopausal patients during tenaculum placement, during the saline infusion into the cavity, and 30 minutes following the saline infusion sonography were statistically different between the saline and paracervical block groups, and between the saline and paracervical block + intrauterine lidocaine group. However, there was no statistically significant difference between paracervical block and paracervical block + intrauterine lidocaine groups. CONCLUSION: As a result of our study, paracervical block is a safe method to use in premenopausal patients to prevent pain during saline infusion sonography. The addition of intrauterine lidocaine to the paracervical block does not increase the analgesic effect; moreover, it increases the cost and time that the patient stays in the dorsolithotomy position by 3 minutes.

Interpregnancy interval as a risk factor for postmenopausal osteoporosis.

OBJECTIVE: Bone mass loss associated with pregnancy and lactation is usually regained in the postpartum period. However, it is not known whether the bone loss is completely recovered in women with a shortened interpregnancy interval (IPI). The aim of this study was to analyze the effect of IPI and gynecological history on postmenopausal osteoporosis. STUDY DESIGN: The study was conducted among 537 postmenopausal women who were divided into two groups in accordance with the osteoporosis status. Prior to bone densitometry, the patients were questioned about reproductive history. Dual-energy X-ray absorptiometry was used to measure lumbar spinal, femur neck and total femoral bone mineral density. MAIN OUTCOME MEASURE: Association between IPI and postmenopausal osteoporosis was analyzed. RESULTS: The comparison of both groups according to the total duration of breastfeeding did not reveal a considerable variation (p=0.288). In the osteoporosis group the age and duration of menopause were found to be significantly higher (p<0.001) whereas the age of first pregnancy and IPI were notably lower in comparison to the controls group (p<0.001). Multivariate logistic regression analyses revealed that women who have 0-12 months interpregnancy interval have the highest risk for osteoporosis (OR: 4.306; 95% CI, 1.684-11.01). This analysis confirmed that the occurrence of first pregnancy under 27 years of age conveyed a higher risk for osteoporosis, as well. CONCLUSIONS: Shortened IPI may have a detrimental effect on bone mineral density in postmenopausal age.

Cervical polyps: evaluation of routine removal and need for accompanying D&C.

OBJECTIVE: To estimate prevalence of malignancy and dysplasia in cervical polyps and to judge whether cervical polyps need to be removed routinely. Also to investigate if a cervical polyp is an indicator of endometrial pathology and to assess the necessity of performing dilatation and curettage (D&C). MATERIALS AND METHODS: We retrospectively reviewed hospital records of 4,063 cervical polyp cases. Patients' age, menopausal status and pathological findings were recorded. Descriptive statistics, Pearson's χ(2), Fisher's exact test were used for statistical analysis. P value of ≤ 0.05 was accepted significant. RESULTS: Among 4,063 cervical polyps, only 3 (0.1%) cases of malignancy were encountered which were metastasis from endometrium. There were also dysplastic (0.4%), metaplastic (2.1%), inflammatory (1%) changes. Accompanying endometrial pathologies were: endometrial cancer (0.3%), hyperplasia without atypia (1.3%), endometrial polyp (6.6%). There was statistically significant relation between menopausal status and malignancy of cervical polyps (P = 0.055) malignancy of endometrial cavity (P = 0.0001). CONCLUSION: Routine removal of cervical polyps, although not mandatory, seems clinically prudent because pathological evaluation is needed to confirm the diagnosis and to rule out other possibilities. 10.9% of postmenopausal patients and 7.8% of premenopausal patients were diagnosed with any endometrial pathology accompanying cervical polyp. Therefore, cervical polyps can be a sign of endometrial disease, especially in postmenopausal women with cervical polyp endometrium should be evaluated more carefully.