Speculum self-insertion: an alternative method for gynaecological examination?

BACKGROUND: Speculum examination is an intrusive practice in the clinical care of women. It requires privacy and patients may experience discomfort or anxiety related to the procedure, which can result in delays or avoidance of necessary healthcare. Speculum self-insertion originated in the United States in the 1970s as part of the self-help movement. However, this clinical practice is largely unknown among healthcare providers and has rarely been assessed. AIM: This study investigates the women's views and healthcare providers' experiences of the self-insertion method. METHOD: A qualitative study was conducted between December 2021 and October 2022, including fieldwork combining semi-structured interviews (10 women) and focus groups associated with individual interviews of 13 healthcare providers. The data collected were independently coded by 2 authors and analysed using an inductive approach and grounded theory method. RESULTS: Speculum self-insertion was described as a way to decrease discomfort and facilitate speculum insertion. Self-insertion was proposed as a means of allowing women to participate in the examination, reducing their vulnerability against power imbalances in the doctor-patient relationship. Both patients and healthcare providers have reported that speculum self-insertion is a method that can contribute to improving trust and communication during the examination. CONCLUSION: The practice of speculum self-insertion during the consultation is an alternative to traditional practitioner insertion and may be offered to all women by any practitioner who wishes to use this technique.

The use of a speculum is common in gynaecological consultations and most women are likely to encounter this tool during a medical examination. Several studies have already shown that this examination can cause pain and anxiety. Speculum self-insertion is not widely used and consists of allowing the woman to insert the speculum herself while being assisted by the practitioner. A study was conducted with 10 women and 13 healthcare providers to evaluate this technique and its impact on women's healthcare. This technique reduces the discomfort that can be felt during the examination. The woman will regain control of her body during the examination and this technique will reduce the hierarchical relationship felt by some women. A discussion about the gynaecological examination and women's healthcare is created during the consultation. Even if this technique does not seem to be suitable for all women, routinely offering self-insertion allows the healthcare provider to adapt to each woman and to her choice. The proposal of speculum self-insertion is an alternative technique that can improves women's feelings and their overall health.

Sexual and Gender Minority Patients' First Pelvic Examination Experiences: What Clinicians Need to Know.

STUDY OBJECTIVE: The aim of this study was to identify factors that influence the first pelvic exam experiences of sexual and gender minority (SGM) adolescents and young adults who were assigned female at birth (AFAB). METHODS: Using purposive sampling, we recruited SGM AFAB individuals, ages 18-24, who had had at least 1 pelvic examination. Semi-structured interviews and an iterative approach allowed for the emergence of factors influencing the first pelvic exam experience. Items included in the final code directory had a Krippendorff's alpha intercoder reliability score greater than 0.7. Interviews were analyzed using ATLAS.ti. RESULTS: Thirty participants completed interviews. Fourteen participants identified as bisexual, 2 as gay, 1 as lesbian, 3 as pansexual, 8 as queer, and 2 as straight/heterosexual. Sixteen participants identified as cisgender, 9 as genderqueer/gender nonconforming, and 5 as transgender. Factors influencing the first pelvic exam experience were organized as patient- or clinician-level factors. The patient-level factors of gender identity, sexual orientation, history of sexual trauma, and participant's relationship to their body were central factors influencing the exam experience. Speculum insertion during the exam induced anxiety and pain for some. The clinician-level factors of gender, age, and race or ethnicity influenced the exam experience. Most participants preferred detailed communication. Participants offered recommendations to ensure gender-affirming, patient-centered care during the first pelvic exam. CONCLUSION: SGM AFAB individuals identified patient- and clinician-level factors influencing their first pelvic exam experiences. This study underscores the need for changes in medical education and health systems to ensure that SGM AFAB individuals have their needs met and feel comfortable in reproductive health settings.

Factors that Affect Performance of Clinical Breast Examination and Mammography Screening among Brazilian Women.

BACKGROUND: In the Brazilian health system, community health facilities consist of multidisciplinary teams that focus on family health, whereas health centers treat mainly illnesses of registered patients. In the present study we compared socio-economic factors and performance of mammography screening (MS) and clinical breast exam (CBE),  respectively, among women who used both types of public health service centers. METHODS: The present study included 180 women aged ≥40 years, who used different health service centers within the same municipal district. Of all 180 women, 110 (41.1%) and 70 (38.9%) used a health center and a community health facility. Logistic regression analysis was performed to calculate odds ratios (ORs) and confidence intervals (CIs) of variables. RESULTS: Regression modeling indicated that women who used the community health facility, performed annual MS 9.52 (OR= 0.105; 95%CI: 0.03- 0.36) times more often (p <0.001). In this model retirement and gynecological service use ≤ each second year, increased annual MS performance 8.16 (95%CI: 1.55- 54.32) and 7.78 (95%CI: 2.54- 23.79) times (p <0.001; p <0.001). Among 113 (62.8%) women who reported strong fear of MS, the chance of its performance was 35.71 (OR= 0.028; 95%CI: 0.02- 0.32) times decreased (p= 0.05). In a second model use of gynecological service ≤ each second year, increased chance of annual CBE performance 7.92 (95%CI: 3.25- 19.29) times (p <0.001). Women who used the community health facility performed annual and bi-annual CBE 2.90 (OR= 0.345; 95%CI: 0.14- 0.86) and 2.97 (OR= 0.337; 95%CI: 0.12- 0.92) times more often, compared to women who used the health center (p =0.030). CONCLUSIONS: Performance of MS and CBE varied both considerable among women who used different types of health service centers. Gynecological service use, fear and socioeconomic variables, additionally influenced regular performance of MS and CBE.

Danish women's preferences regarding gynecological examination support international recommendations: A cross-sectional study.

OBJECTIVE: Gynecological examinations (GEs) are challenging for many women. Several recommendations and guidelines have emerged, partly based on common sense and clinicians' consensus. However, there is a lack of knowledge regarding women's opinions. Therefore, this study aimed to describe women's preferences and experiences in relation to GEs and investigate whether they are dependent on their socioeconomic status. METHODS: In Denmark, GEs are typically performed by general practitioners or resident specialists in gynecology (RSGs) in gynecological hospital departments. This cross-sectional questionnaire and register study included approximately 3000 randomly selected patients who visited six RSGs from January 1, 2020, to March 1, 2021. The main outcome measurement involved women's preferences and experiences regarding GEs. RESULTS: Overall, 37% of the women thought that a changing room was important, 20% preferred a garment to cover themselves, 18% preferred a separate examination room, and 13% thought that the presence of a chaperone was important. Compared with working and retired women, more women outside the workforce felt insufficiently informed, considered their experience with RSGs unprofessional, and found GEs painful. CONCLUSION: Our results support existing recommendations regarding GEs and the related environment, confirming that privacy and modesty are factors to take into consideration as they are of concern for a relatively large group of women. Thus, providers should focus on women outside the workforce, because this group appears to feel vulnerable in this environment.

[Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. / Examen pelvien en gynécologie et obstétrique : recommandations pour la pratique clinique.

OBJECTIVE: To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS: A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS: The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS: The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS: The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.

Clinical Conundrum: Spontaneous Paravaginal Venous Plexus Thrombosis Presenting as Acute Lower Pelvic Pain.

Acute pelvic pain due to venous thrombosis can be encountered in the context of pelvic congestion syndrome. Some vascular anomalies such as nutcracker syndrome or May-Thurner syndrome may cause left ovarian vein or left iliofemoral vein thrombosis. Smaller parametrial or paravaginal vein thrombi have rarely been reported as aetiologies of acute pelvic pain. We present a case of spontaneous paravaginal venous plexus thrombosis presenting as acute lower pelvic pain in which thrombophilia was diagnosed. Small vein thrombosis or an unusual location of thrombus should prompt vascular studies and a thrombophilia work-up.

Atitudes e crenças de médicos ginecologistas- -obstetras e de pacientes do Hospital Universitário de Brasília sobre o rastreamento cervical e o exame pélvico / Attitudes and beliefs of obstetrician-gynecologists and patients at the University Hospital of Brasília about cervical screening and pelvic examination

Objetivo: Avaliar as atitudes e crenças de pacientes e médicos ginecologistas-obstetras sobre o rastreamento cervical e o exame pélvico no Hospital Universitário de Brasília (HUB). Métodos: Foram realizadas entrevistas com pacientes que aguardavam por uma consulta previamente agendada no ambulatório de ginecologia e com médicos ginecologistas-obstetras que atuavam no HUB. Cada grupo respondeu a um questionário que enfocava a realização do rastreamento cervical e do exame pélvico (EP). Resultados: No total, 387 pacientes responderam ao questionário. Dessas, apenas 4,13% sabiam que, de acordo com as diretrizes brasileiras, o rastreamento cervical deveria ser iniciado aos 25 anos de idade, 5,17% sabiam que ele deveria ser encerrado aos 64 anos e 97,93% esperavam um intervalo menor do que o trienal recomendado. Após serem informadas sobre as diretrizes, 66,93% acreditavam que o início aos 25 anos é tardio, 61,5%, que o encerramento aos 64 anos é precoce, 88,37%, que o intervalo trienal é muito longo e 94,06% ficaram com receio de que problemas de saúde pudessem aparecer nesse intervalo. Dos 44 médicos que responderam ao questionário, embora a maioria concordasse com as diretrizes, somente 31,82%, 38,64% e 34,1% as seguia com relação à frequência, à idade de início e à idade de encerramento, respectivamente. Quanto ao EP, aproximadamente metade dos participantes de cada grupo considerava que o exame deveria ser realizado nas consultas regulares com o ginecologista. Conclusão: Foi observada uma discrepância entre as expectativas das pacientes e as diretrizes para o rastreamento de câncer cervical. A maior parte das pacientes não as conhecia e, quando informadas, não concordava com elas. Quanto aos médicos ginecologistas- obstetras, a maioria não as seguia, apesar de conhecê-las. Quanto ao EP, grande parte dos médicos e pacientes considerava-o importante e acreditava que ele deveria ser realizado de forma rotineira nas consultas ginecológicas.

Objective: Evaluate the attitudes and beliefs of patients and obstetrician-gynecologists about cervical screening and pelvic examination in the University Hospital of Brasília (HUB). Methods: Face-to-face interviews with patients waiting for a previously scheduled consultation at the gynecology outpatient clinics and attending obstetrician-gynecologists at the HUB. Each group answered a questionnaire addressing cervical screening and pelvic examination (PE). Results: 387 patients answered the questionnaire. Of these, only 4.13% were aware that, according to Brazilian guidelines, cervical screening should begin at age 25, 5.17% that it should stop at age 64 and 97.93% expected a shorter interval than the recommended triennial. After being informed of the guidelines, 66.93% believed that starting at age 25 is late, 61.5% that stopping at 64 is early, 88.37% that the triennial interval is too long, and 94.06% would be afraid that health problems could appear during the interval. Of the 44 participating physicians, although most agreed with the guidelines, only 31.82%, 38.64% and 34.1% followed them regarding frequency, starting and stopping age, respectively. As for EP, approximately half of the participants in each group believed that it should be performed in regular consultations with the gynecologist. Conclusion: There was a discrepancy between patients' expectations and cervical screening guidelines. Most patients didn't know and, when informed, didn't agree with them. As for Ob-Gyn physicians, most did not follow these guidelines, despite knowing them. As for pelvic exam, most physicians and patients considered it important and believed it should be routinely performed during gynecological consultations.

Bacterial vaginosis and trichomoniasis: prevalence, associated factors, and performance of diagnostic tests

Introduction: Bacterial vaginosis and vaginal trichomoniasis are frequent causes of health care demand. Objective: To estimate the prevalence, identify associated factors, and investigate the performance of diagnostic tests for bacterial vaginosis and trichomoniasis. Methods: Cross-sectional study with participants over 18 years old. All of them were submitted to an interview and gynecological examination with evaluation of vaginal secretion, pH verification, collection of material for Pap smear, wet mount test, Whiff test, bacterioscopy, and polymerase chain reaction for trichomoniasis detection. Logistic regression analysis was applied to identify associated factors with bacterial vaginosis. Diagnostic performance for bacterial vaginosis was evaluated following Amsel criteria, the Ison and Hay score, and the Pap smear, considering the Nugent score as the gold standard. As for trichomoniasis, diagnostic performance was evaluated through the Pap smear and the wet mount test, using the polymerase chain reaction as the gold standard. Results: The prevalence of bacterial vaginosis was 33.7%, and for trichomoniasis, 0.5%. The complaint of abnormal vaginal secretion was associated with the diagnosis of bacterial vaginosis (odds ratio 2.2). The diagnostic accuracy by Amsel criteria, the Ison and Hay score, and the Pap smear was 35.6, 97.0, and 84.2%, respectively. The sensitivity for trichomoniasis through wet mount test was 0.0%, and through the Pap smear, 100%. Conclusion: The prevalence of bacterial vaginosis was high, and trichomoniasis was low. The only associated factor with bacterial vaginosis was the report of abnormal vaginal secretion. The methods with the most accurate diagnostic performance for bacterial vaginosis were the Ison and Hay score and the Pap smear and, for trichomoniasis, the Pap smear

Percepção dos enfermeiros frente à realização do exame citopatológico em mulheres com deficiência física / Nurse perception regarding cytopathological exams in physically disabled women

RESUMO Objetivo compreender a ótica dos enfermeiros sobre as barreiras enfrentadas pelas mulheres com deficiência física no que concerne à realização do exame citopatológico. Métodos estudo qualitativo, realizado com 11 enfermeiras das Unidades Básicas de Saúde, incluindo zona urbana e rural. O processamento e a análise dos dados utilizaram o software IRAMUTEQ - acrônimo de Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados as classes 1 e 5 foram aglutinadas na classe "Inadequação da infraestrutura"; a classe 2 foi "Resultados dos exames coletados"; a 3, "Sentimentos na realização do exame"; e a 4, "Capacitação das equipes". Conclusão desvelaram-se sentimentos negativos vivenciados pelas mulheres na realização do exame, falta de capacitação dos profissionais, ausência de estratégias de manejo na unidade, e estrutura física inapta para as necessidades das usuárias. Contribuições para a prática comprovou-se a necessidade de atenção às mulheres com deficiência física e de realização do exame de rotina. Ademais, mostrou-se necessário fomentar estratégias para a adequação e melhoria dos conhecimentos dos profissionais que realizam os atendimentos.

ABSTRACT Objective to understand the perspective of nurses regarding the obstacles faced by physically disabled women in regard to cytopathological examinations. Methods qualitative study with 11 nurses from Basic Health Units, including urban and rural areas. Data was processed and analyzed using the software IRAMUTEQ (R pour les Analyses Multidimensionnelles de Textes et de Questionnaires). Results classes 1 and 5 were grouped into the class "Inadequate infrastructure"; class 2 was "Results of the collected exams"; class 3, "Feelings at the time of examination"; and 4 "Team training". Conclusion we revealed that women presented negative feelings during the examination, professionals lacked further training, there were no strategies to deal with the situation in the unit, and facilities were inadequate to attend the needs of the users. Contributions to practice: we demonstrated that it is essential to provide care to physically disabled women and carry out routine exams in this population. Furthermore, this study can give support to strategies to adapt and improve the knowledge of the workers who provide care.

Teratoma de ligamento redondo, reporte de caso y revisión de la bibliografía / Round ligament teratoma, case report and literature review

Resumen ANTECEDENTES: El teratoma es un tumor casi siempre benigno, con una amplia variabilidad en su localización, extremadamente rara, en el ligamento redondo. CASO CLÍNICO: Paciente de 30 años, con antecedente de un embarazo a término. En la revisión ecográfica se reportó una lesión quística paraovárica izquierda de 46 x 35 mm, sin componente sólido, graso ni calcificaciones. En el examen ginecológico se palpó una masa por encima del útero, orientada hacia el lado izquierdo, no dolorosa. El resto del examen físico trascurrió sin otras alteraciones. La impresión diagnóstica inicial fue de teratoma abdominopélvico sustentada en la ecografía transvaginal en la que los ovarios se observaron normales, con una masa de ecogenicidad mixta de 50 x 40 x 46 mm, con áreas ecolúcidas y ecogénicas de intensidad variable hacia la fosa iliaca izquierda superior, sin contacto con el ovario. El ligamento redondo se seccionó a ambos lados de la masa y se extrajo sin complicaciones; el reporte histopatológico fue de: teratoma quístico maduro. CONCLUSIONES: El ligamento redondo es una localización infrecuente de los quistes dermoides que debe considerarse en los diagnósticos diferenciales de las masas pélvicas; es susceptible de tratamiento quirúrgico por vía laparoscópica.

Abstract BACKGROUND: Teratoma is an almost always benign tumor, with a wide variability in its location; its location in the round ligament is extremely rare. CLINICAL CASE: 30-year-old patient, with a history of a full-term pregnancy. On routine ultrasound examination, a 46 x 35 mm left paraovarian cystic lesion was reported, with no solid, fatty component or calcifications. In the gynecological examination a mass was palpated above the uterus, oriented to the left side, non-painful. The rest of the physical examination passed without other alterations. The initial diagnostic impression was of abdomino-pelvic teratoma supported by transvaginal ultrasound in which the ovaries were normal, with a mass of mixed echogenicity of 50 x 40 x 46 mm, with echolucent and echogenic areas of variable intensity towards the left superior iliac fossa, without contact with the ovary. The round ligament was sectioned on both sides of the mass and removed without complications; the histopathologic report was: mature cystic teratoma. CONCLUSIONS: The round ligament is an infrequent location of dermoid cysts that should be considered in the differential diagnoses of pelvic masses; it is amenable to surgical treatment laparoscopically.

Técnica modificada de colporrafia anterior por ausencia de fascia prevesical: reporte de caso / Modified technique of anterior colporraphy due to absence of prevesical fascia: case report

Resumen ANTECEDENTES: El prolapso de órganos pélvicos es frecuente en pacientes posmenopáusicas. El tratamiento definitivo, cuando el compartimiento anterior está afectado, es el quirúrgico (colporrafia anterior). Aquí se describen los desenlaces clínicos derivados de la aplicación de una técnica modificada de colporrafia anterior en una paciente con ausencia de fascia prevesical, con una estadificación POP-Q estadio II, con afectación en el compartimiento anterior. CASO CLÍNICO: Paciente de 64 años, con antecedentes de una colporrafia anterior a los 56 años, prolapso de órgano pélvico con afectación del compartimiento anterior. En el examen ginecológico se evidenció la afectación del compartimiento anterior, específicamente en el nivel II conforme a la nueva clasificación POP-Q. Debido a los antecedentes quirúrgicos se optó por la colporrafia anterior, con punto de poliglactina 910 y colpopexia por vía vaginal, con puntos de polipropileno aplicados con un dispositivo de captura de sutura para reparación de tejido nativo. El desenlace quirúrgico fue satisfactorio. CONCLUSIÓN: En el contexto de la colporrafia es importante tener en cuenta las diferentes estrategias quirúrgicas, cada vez menos invasivas, con correcciones sitio-específicas que permitan reparar el defecto anatómico, desaparecer los síntomas, disminuir el riesgo y la probabilidad de recidivas.

Abstract BACKGROUND: Pelvic organ prolapse is common in postmenopausal women. The definitive treatment when the anterior compartment is involved is surgical (anterior colporrhaphy). Here we describe the clinical results obtained using a modified anterior colporrhaphy technique in a patient with absence of prevesical fascia, POP-Q stage II, with involvement of the anterior compartment. CLINICAL CASE: 64-year-old female patient with a history of a previous colporrhaphy at the age of 56, pelvic organ prolapse with involvement of the anterior compartment. Gynaecological examination revealed anterior compartment involvement, specifically level II according to the new POP-Q classification. Based on the surgical history, anterior colporrhaphy with polyglactin 910 suture and vaginal colpopexy with polypropylene sutures using a suture capture device for native tissue repair was chosen. Surgical outcome was satisfactory. CONCLUSION: In the context of colporrhaphy, it is important to take into account the different surgical strategies, increasingly less invasive, with site-specific corrections that allow repair of the anatomical defect, disappearance of symptoms, reducing the risk and probability of recurrence.

Gynecological patients differ from prenatal patients in appraisals of medical student participation in outpatient clinics / Pacientes ginecológicas diferem de pacientes do pré-natal na apreciação da participação de estudantes de medicina nos atendimentos ambulatoriais

Abstract Introduction: The participation of students in clinical consultations is essential for their medical education. This experience allows for the acquisition of technical skills and the transmission of ethical and professional values. Objective: To evaluate how differences in outpatient conditions (gynecological or prenatal care), appraisal of previous experience, and sociodemographic profiles influence women's willingness to accept student participation in their consultations. Methods: We selected 743 cases (45.1% prenatal) with previous experience in student participation of 893 women attending outpatient gynecological (52.6%) or prenatal (47.4%) clinics at Brasilia University Hospital from 2016 to 2019. Scales were adopted for women's appraisal of student interpersonal communication, willingness to accept, and unwillingness to accept student participation. We used t tests to assess differences, chi-square statistics to compare proportions between outpatient groups, correlations between key variables, and linear regression to estimate variables predicting the willingness outcome. Results: Odds ratios over 1 (p< 0.01) emerged for age older than 35 years, not married, less than higher education, multiparity, discomfort with students, and lower acceptance of gender equality in relation to the Ob-Gyn gender for the gynecological group. Women in the gynecological group offered a better appraisal (from one to five) of interpersonal communication (4.75 vs. 4.43, effect size g= 0.605), showed more willingness (4.58 vs. 4.26, g= 0.625), and conveyed less unwillingness to accept student participation (2.35 vs. 2.47, g= 0.143) than women in the prenatal group. In the linear regression analysis (N= 743), a higher willingness to accept student participation was significantly related (in decreasing impact) to better appraisal of student interpersonal communication (p< 0.001), lower unwillingness (p< 0.001), gynecological group (p< 0.001), tolerance to pelvic examination by a student (p= 0.017), and age older than 35 years (p= 0.016). Conclusions: The experience of supportive interpersonal communication, especially regarding the gynecological group, had a predominant impact on the patient's willingness to accept the participation of students in consultations. Overall, the willingness to accept this participation differs depending on the patient's (reason for consultation, lower unwillingness, age) and student's (communication, gender) factors. Hopefully, the findings can contribute to fostering student-patient partnerships from the perspective of the articulation between service and teaching in medicine.

Resumo Introdução: A participação de estudantes nas consultas clínicas é essencial para a educação médica deles. Tal experiência permite a aquisição de habilidades técnicas e a transmissão de valores ético-profissionais. Objetivo: Este estudo teve como objetivo avaliar como diferenças na condição ambulatorial (atendimento ginecológico ou pré-natal), na apreciação de experiências anteriores e nos perfis sociodemográficos influenciariam a disposição das mulheres em aceitar a participação de estudantes em suas consultas. Método: De um total de 893 mulheres atendidas no ambulatório de ginecologia (52,6%) e de pré-natal (47,4%) do Hospital Universitário de Brasília de 2016 a 2019, foram selecionadas 743 (45,1% pré-natal) que referiam experiência prévia com a participação de estudantes em suas consultas. Foram adotadas escalas para avaliar a apreciação das mulheres sobre a comunicação interpessoal dos estudantes e a disposição e a falta dela em aceitar a participação deles. Foram utilizados o teste t para avaliar as diferenças, as estatísticas qui-quadrado para comparar as proporções entre os grupos, as correlações entre variáveis-chave e a regressão linear para estimar as variáveis associadas à boa vontade das pacientes quanto aos estudantes. Resultado: Razões de chance acima de 1 (p < 0,01) para mulheres do grupo ginecológico emergiram quanto à idade acima de 35 anos, não casadas, escolaridade aquém da educação terciária, multíparas, desconfortáveis com estudantes e menor aceitação de equidade de gênero dos médicos ginecologistas obstetras. Mulheres no grupo ginecológico apresentaram melhor apreciação da comunicação interpessoal, de um a cinco (4,75 versus 4,43, tamanho do efeito g = 0,605), maior disposição (4,58 versus 4,26, g = 0,625) e menor indisposição (2,35 versus 2,47, g = 0,143) em aceitar a participação de estudantes do que mulheres do grupo pré-natal. Na análise de regressão linear (n = 743), maior disposição em aceitar estudantes foi significativamente associada (em impacto decrescente), com melhor apreciação da comunicação interpessoal destes (p < 0,001), menor indisposição (p < 0,001), grupo ginecológico (p < 0,001), tolerância ao exame pélvico realizado por estudante (p = 0,017) e idade maior que 35 anos (p = 0,016). Conclusão: A experiência de comunicação interpessoal de suporte, principalmente no que concerne ao grupo ginecológico, teve impacto predominante na disposição das pacientes em aceitar a participação de estudantes nas consultas. No geral, a vontade de aceitar essa participação difere dependendo dos fatores da paciente (motivo da consulta, menor indisposição, idade) e do estudante (comunicação, gênero). Espera-se que os achados possam contribuir para fomentar parcerias estudante-paciente na perspectiva da articulação entre serviço e ensino em medicina.

A case of intestinal schwannoma initially suspected by transvaginal ultrasound.

Schwannomas are peripheral nerve sheath tumors. Due to their low incidence, few cases of colorectal schwannomas have been published, which increases the diagnostic challenge. The aim of this case report is to discuss the role of transvaginal ultrasound in different areas than the gynecological disorders, when on hands of properly trained professionals that perform systematized procedures. A 56-year-old woman consulted for postmenopausal genital bleeding. During transvaginal ultrasound, a colonic solid, hypervascularized mass of 23 × 26 mm was visualized. As a result of this incidental finding, the patient underwent a sigmoidectomy, with a final diagnosis of intestinal schwannoma. Transvaginal ultrasound is today one of the most useful and accurate diagnostic tools in the assessment of gynecological disorders. However, the proximity of other pelvic structures makes it possible to evaluate the presence of nongynecological conditions. This fact should encourage gynecologists to systematize the transvaginal ultrasound procedure.

Comparing Self-Reported Pain During Intercourse and Pain During a Standardized Gynecological Exam at 12- and 24-Month Postpartum.

BACKGROUND: There is limited information about the physical indicators and biopsychosocial predictors of self-reported pain during intercourse and pain during a gynecological examination at 12- and 24-month following childbirth. AIM: This longitudinal study aimed to (i) Compare the findings from gynecological exams at 12- and 24-month postpartum for women with minimal vs clinically significant pain during intercourse; (ii) Assess the biomedical and psychosocial correlates of self-reported pain during intercourse and the vestibular pain index (VPI) from the cotton-swab test at 12- and 24-month postpartum; (iii) Establish the relationship between self-reported pain during intercourse and the cotton-swab test. METHODS: Women (N = 97 at 12 months postpartum and N = 44 at 24-month postpartum) recruited from a local women's hospital completed online surveys in their first trimester of pregnancy and at 12- and 24-month postpartum to assess pain during intercourse and biopsychosocial variables. Those with clinically significant (pain ≥4/10 on a visual analogue scale) were matched with those reporting minimal pain (pain <3/10) and underwent a gynecological exam including a cotton-swab test. Descriptive analyses, multiple regressions, and bivariate correlations were conducted to address each of the study aims, respectively. MAIN OUTCOME MEASURES: (i) Findings from the gynecological examination (ii) Numerical rating scale for the VPI; (iii) Visual analogue scale of pain during intercourse. RESULTS: The majority of women in both pain groups had normal physical findings in the gynecological exam. Greater sexual distress and pain catastrophizing at 12- and 24-month postpartum were significantly associated with greater pain during intercourse at each time-point, respectively. Greater pain catastrophizing at 12 months postpartum was significantly associated with greater pain during the cotton-swab test at that time-point. Lower relationship satisfaction at 12 months postpartum was associated with greater VPI ratings at 24 months postpartum. Pain during intercourse and the VPI were moderately and positively correlated. CLINICAL IMPLICATIONS: Addressing psychosocial variables may interrupt the maintenance of postpartum pain. Following an initial assessment, self-reported pain intensity may be a suitable proxy for repeated examinations. STRENGTHS & LIMITATIONS: This study is the first to describe the physical findings and psychosocial predictors of pain during intercourse and the VPI at 12- and 24-month postpartum. The homogenous and small sample may limit generalizability. CONCLUSION: There were no observable physical indicators of clinically significant postpartum pain during intercourse. Psychosocial variables were linked to women's greater postpartum pain during intercourse and VPI ratings. Rossi MA, Vermeir E, Brooks M, et al. Comparing Self-Reported Pain During Intercourse and Pain During a Standardized Gynecological Exam at 12- and 24-Month Postpartum. J Sex Med 2022;19:116-131.

Risk of Endometrial Cancer and Frequencies of Invasive Endometrial Procedures in Young Breast Cancer Survivors Treated With Tamoxifen: A Nationwide Study.

BACKGROUND: Although the guidelines recommend gynecological assessment and close monitoring for symptoms of endometrial cancer in postmenopausal breast cancer survivors taking tamoxifen (TAM), the risk of endometrial cancer in young breast cancer survivors has not yet been fully assessed. This study aimed to investigate the risk of developing endometrial cancer and the frequencies of gynecological examinations in young breast cancer survivors taking TAM in South Korea. METHODS: A nationwide retrospective cohort study was conducted using the Health Insurance Review and Assessment Service claims data. Kaplan-Meier analyses and log-rank tests were used to assess the probability of endometrial cancer, benign endometrial conditions, and the probability of invasive endometrial procedure. To analyze the risk of endometrial cancer and benign endometrial conditions, we used a multivariable Cox proportional hazards regression model. RESULTS: Between 2010 and 2015, 60,545 newly diagnosed female breast cancer survivors were included. The total person-years were 256,099 and 140 (0.23%) patients developed endometrial cancer during the study period. In breast cancer survivors aged ≥60 years [hazard ratio (HR), 5.037; 95% confidence interval (CI), 2.185-11.613], 50-59 years (HR, 4.343; 95% CI, 2.122-8.891), and 40-49 years (HR, 2.121; 95% CI, 1.068-4.213), TAM was associated with an increased risk of endometrial cancer. In subjects aged below 40 years, TAM did not significantly increase the risk of endometrial cancer. However, among the TAM subgroups, breast cancer survivors aged below 40 years [1.61 per 1,000 person-years (PY); HR, 12.460; 95% CI, 2.698-57.522] and aged 40-49 years (2.22 per 1,000 PY; HR, 9.667; 95% CI, 4.966-18.819) with TAM-related endometrial diseases showed significantly increased risks of endometrial cancer. Among the TAM subgroup with benign endometrial conditions, the ratios of the frequency of invasive diagnostic procedures to the incidence of endometrial cancer were higher in subjects under 40 than subjects aged 60 or more. CONCLUSION: Young breast cancer survivors with TAM-related benign endometrial diseases are at a higher risk of developing endometrial cancer. Gynecological surveillance should be tailored to the risk of endometrial cancer in young breast cancer survivors to improve the early detection of endometrial cancer and avoid unnecessary invasive procedures.

The relationship between body privacy and anxiety in women having gynecological examination.

Protection of privacy during gynecological examination is one of the important ethical principles and invasion of body privacy can cause anxiety. This study was conducted in order to determine the relationship between the level of importance women attach to privacy and the level of anxiety. This descriptive-correlational study consisted of 349 women who applied to the obstetrics outpatient clinic of a university hospital to have gynecological examination. Data were collected using Body Privacy Scale for Gynecology and Obstetrics and State Anxiety Inventory. Before the gynecological examination, the high importance women attach to privacy in rights and all of them experienced anxiety. A positive relationship was found between the importance women attach to privacy and their anxiety levels. It was determined that the importance women attach to body privacy in these areas explained 16.3% of the total variance at the level of anxiety.IMPACT STATEMENTWhat is already known on this subject? Gynecological examination is one of the basic examination methods in the protection of women's health. Protection of body privacy during gynecological examination is one of the most important ethical principles. Failure to exercise due care to ensure body privacy during gynecological examination causes anxiety in women.What do the results of this study add? In our study, it was found that women having gynecological examination place a high degree of emphasis on body privacy. It was determined that all women experienced anxiety before gynecological examination. It was determined that the importance women attach to body privacy was an important determinant in the increasing level of anxiety.What are the implications of these findings for clinical practice and/or further research? Not giving importance to body privacy, increases the level of anxiety before gynecological examination.

Evaluation of human papillomavirus self-collection offered by community health workers at home visits among under-screened women in Brazil.

OBJECTIVE: To explore the acceptability of high-risk human papillomavirus self-testing, involving community health workers, for never/under-screened Brazilian women. Cervical cancer is the most common cause of cancer-related death among adult women in a large number of low-income and lower-middle-income countries, where it remains a major public health problem. High-risk human papillomavirus persistence is required for the development of cervical neoplasia. METHODS: The target population was all women aged 30+ from the list of families available in healthcare centre data, who had never been screened or were not screened in the previous 3 years (under-screened women), and who were living in the 17 cities included in this study. RESULTS: Of the 377 women included, 16.9% (n = 64) had never had a pap smear. Of all samples included in the study, 97.1% (n = 366) were considered adequate for evaluation, as 2.9% (n = 11) were considered invalid for all high-risk human papillomavirus types. Analysing these 366 samples, 9.6% (n = 35) of the women were infected by at least one high-risk human papillomavirus type and 90.4% (n = 331) had no infection with any high-risk type of the virus. CONCLUSIONS: Vaginal self-sampling is an adequate strategy to improve the effectiveness of the cervical cancer program by increasing screening in a high-risk group.

Desigualdades regionais e sociais na realização de mamografia e exame citopatológico nas capitais brasileiras em 2019: estudo transversal / Desigualdades regionales y sociales en la realización de mamografías y exámenes citopatológicos en las capitales brasileñas en 2019: un estudio transversal / Regional and social inequalities in mammography and Papanicolaou tests in Brazilian state capitals in 2019: a cross-sectional study

Objetivo: Analisar desigualdades regionais e sociais na realização de mamografia e exame citopatológico. Métodos: Estudo transversal, com dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel), de 2019. As variáveis de desfecho foram realização de mamografia e exame citopatológico; e as variáveis de exposição, raça/cor da pele, escolaridade e macrorregião nacional de residência. Medidas de desigualdades absolutas foram apresentadas por meio do slope index of inequality (SII) e equiplots. Resultados: Foram incluídas 23.339 mulheres. A realização de mamografia foi 5,2 pontos percentuais maior naquelas com maior escolaridade, e de exame citopatológico, 5,3 pontos percentuais menor nas mulheres de raça/cor da pele preta. A realização de mamografia e exame citopatológico foram 3,9 e 11,2 pontos percentuais maiores na região Sul, respectivamente. Conclusão: Desigualdades sociais e regionais persistem no país e afetam, principalmente, mulheres de raça/cor da pele preta, de baixa escolaridade e residentes no Nordeste brasileiro.

Objetivo: Analizar las desigualdades regionales y sociales en la realización de mamografías y exámenes citopatológicos. Métodos: Estudio transversal con datos de la Vigilancia de Factores de Riesgo y Protección de Enfermedades crónicas por encuesta telefónica de 2019. Las variables de resultado fueron mamografía y examen citopatológico. Las variables de exposición fueron raza/color de piel, nivel de educación y macrorregión nacional de residencia. Las desigualdades absolutas se presentaron utilizando el slope index of inequality y el equiplots. Resultados: Se estudiaron 23.339 mujeres. La realización de mamografía fue 5,2 puntos porcentuales más alta en las mujeres con educación superior y la citopatología fue 5,3 puntos porcentuales más baja en mujeres de raza /piel negra. La mamografía y la citopatología fueron 3,9 y 11,2 puntos porcentuales más altos, respectivamente, en la Región Sur. Conclusión: Las desigualdades sociales y regionales persisten en Brasil y afectan principalmente a mujeres de piel negra, con baja escolaridad y residentes en la región Nordeste del país.

Objective: To assess regional and social inequalities in mammography and Papanicolaou tests. Methods: This was a cross-sectional study with data from the 2019 Chronic Disease Risk and Protective Factors Surveillance Telephone Survey (Vigitel). The outcome variables were mammography and cytopathology test. The exposure variables were race/skin color, schooling and region of residence in Brazil. Absolute inequality measurements were presented using the slope index of inequality (SII) and equiplots. Results: 23,339 women were included in this study. Having a mammography was 5.2 percentage points higher in women with higher levels of education, while having a cytopathology test was 5.3 percentage points lower in women of Black race/skin color. Having mammography and cytopathology tests was 3.9 and 11.2 percentage points higher, respectively, in the Southern region. Conclusion: Social and regional inequalities persist in Brazil and affect mainly women of Black race/skin color, with low education levels and living in the Northeast region of the country.