Associated factors of vaginal laxity and female sexual function: a cross-sectional study.

BACKGROUND: Female sexual dysfunction (FSD), including vaginal laxity (VL), can lead to a decrease in quality of life and affect partner relationships. AIM: We aimed to investigate the associated factors of VL and FSD and their relationship with other pelvic floor disorders in a female population. METHODS: This cross-sectional study was conducted at Chelsea and Westminster Hospital from July to December 2022. All women referred to clinical care at the urogynecology clinic were included. Participants were assessed according to sociodemographic and clinical aspects, the Pelvic Organ Prolapse Quantification system, sexual function, VL, sexual attitudes, sexual distress, sexual quality of life, vaginal symptoms, and pelvic floor disorders. Unadjusted and adjusted associated factors of VL and FSD were analyzed. OUTCOMES: The primary outcome was the identification of the associated factors of VL and FSD in a female population, and secondary outcomes included the association between VL and pelvic organ prolapse (POP) with the questionnaire scores. RESULTS: Among participants (N = 300), vaginal delivery, multiparity, perineal laceration, menopause, and gel hormone were significantly more frequent in those reporting VL (all P < .05). When compared with nulliparity, primiparity and multiparity increased the odds of VL by approximately 4 and 12 times, respectively (unadjusted odds ratio [OR], 4.26 [95% CI, 2.05-8.85]; OR, 12.77 [95% CI, 6.53-24.96]). Menopause and perineal laceration increased the odds of VL by 4 and 6 times (unadjusted OR, 4.65 [95% CI, 2.73-7.93]; OR, 6.13 [95% CI, 3.58-10.49]). In multivariate analysis, menopause, primiparity, multiparity, and POP remained associated with VL. CLINICAL IMPLICATIONS: Parity, as an obstetric factor, and menopause and staging of POP, as clinical factors, were associated with VL. STRENGTHS AND LIMITATIONS: The investigation of associated factors for VL will contribute to the understanding of its pathophysiology. The study design makes it impossible to carry out causal inference. CONCLUSION: Menopause, primiparity, multiparity, and POP were highly associated with VL complaints in multivariate analysis.

Laser and Pelvic Floor Muscle Training for Urinary Incontinence: A Randomized Clinical Trial.

IMPORTANCE: Pelvic floor muscle training (PFMT) is considered the first option as a conservative treatment for female stress urinary incontinence (SUI). However, there is still debate whether energy-based devices are effective for treating SUI. OBJECTIVE: The objective of this study was to assess whether PFMT and fractional CO2 laser therapy may improve symptoms in women with SUI. STUDY DESIGN: A parallel, randomized, nonblinded, noninferiority trial included 94 of 144 women 18 years or older with SUI randomized into 2 groups. The CO2 laser group (n = 47) received 3 vaginal applications at monthly intervals. The PFMT group (n = 47) underwent 2 weekly sessions. Primary outcome was the mean difference of International Consultation on Incontinence Questionnaire-Urinary Incontinence Short-Form (ICIQ-UI-SF) total scores between groups after 3 and 6 months. Main secondary outcomes were questionnaires for assessment of pelvic floor symptoms (Pelvic Floor Impact Questionnaire-Short Form 7 [PFIQ-7]), sexual function (Female Sexual Function Index [FSFI]), and improvement after treatment (Patient Global Impression of Improvement [PGI-I]). RESULTS: A reduction in the ICIQ-UI-SF total score, PFIQ total score, and the Urinary Impact Questionnaire score was perceived between baseline and 3-6 months in both groups. CO2 laser did not reach the noninferiority margin when compared with PFMT in both follow-up periods and analyses. Pelvic floor muscle training has improved the FSFI desire domain between baseline and 3-6 months, whereas CO2 laser improved the FSFI orgasm, pain, and total score after 3 months and FSFI orgasm and total score after 6 months. PGI-I assessment has shown an improvement in both groups. CONCLUSION: Fractional CO2 laser therapy was noninferior to PFMT after 3-6 months of treatment. Both groups presented a reduction in the ICIQ-UI-SF scores, and both methods could be considered for women with SUI.

Treatment of women with vaginal laxity: systematic review with meta-analysis.

BACKGROUND: Despite several treatments that have been used for women reporting vaginal laxity (VL), to our knowledge no systematic review is available on the topic so far. AIM: In this study, we sought to summarize the best available evidence about the efficacy and safety of interventions for treating VL, whether conservative or surgical. METHODS: A comprehensive search strategy was performed in Medline, Embase, Scopus, Web of Science, and Cochrane Library for reports of clinical trials published from database inception to September 2022. Studies selected for inclusion were in the English language and were performed to investigate any type of treatment for VL, with or without a comparator, whether nonrandomized studies or randomized controlled trials (RCTs). Case reports and studies without a clear definition of VL were excluded. OUTCOMES: The outcomes were interventions (laser, radiofrequency, surgery, and topical treatment), adverse effects, sexual function, pelvic floor muscle (PFM) strength, and improvement of VL by the VL questionnaire (VLQ). RESULTS: From 816 records, 38 studies remained in the final analysis. Laser and radiofrequency (RF) were the energy-based treatment devices most frequently studied. Pooled data from eight observational studies have shown improved sexual function assessed by a Female Sexual Function Index score mean difference (MD) of 6.51 (95% CI, 5.61-7.42; i2 = 85%, P < .01) before and after intervention, whether by RF (MD, 6.00; 95% CI, 4.26-7.73; i2 = 80%; P < .001) or laser (MD, 6.83; 95% CI, 5.01-8.65; i2 = 92%; P < .01). However, this finding was not shown when only 3 RCTs were included, even when separated by type of intervention (RF or laser). When RF treatment was compared to sham controls, VLQ scores did not improve (MD, 1.01; 95% CI, -0.38 to 2.40; i2 = 94%; P < .001). Patient PFM strength improved after interventions were performed (MD, 4.22; 95% CI, 1.02-7.42; i2 = 77%; P < .001). The ROBINS-I (Risk Of Bias In Nonrandomized Studies of Interventions) tool classified all non-RCTs at serious risk of bias, except for 1 study, and the risk of bias-1 analysis found a low and unclear risk of bias for all RCTs. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) certainty of the evidence was moderate for sexual function and the VLQ questionnaire and low for PFM strength. CLINICAL IMPLICATIONS: Sexual function in women with VL who underwent RF and laser treatment improved in observational studies but not in RCTs. Improvement in PFM strength was observed in women with VL after the intervention. STRENGTHS AND LIMITATIONS: Crucial issues were raised for the understanding of VL, such as lack of standardization of the definition and for the development of future prospective studies. A limitation of the study was that the heterogeneity of the interventions and different follow-up periods did not make it possible to pool all available data. CONCLUSIONS: Vaginal tightening did not improve sensation in women with VL after intervention, whereas RF and laser improved sexual function in women with VL according to data from observational studies, but not from RCTs. PFM strength was improved after intervention in women with VL.

VDR, CXCR1, CXCR2, PSCA Polymorphisms and Recurrent Urinary Tract Infections in Women: Genetic Association Study.

INTRODUCTION AND HYPOTHESIS: Urinary tract infection (UTI) is one of the most common human infections. Evidence suggests that there might be a genetic predisposition to UTI. Previous small candidate gene studies have suggested that common variants in genes involved in the immune response to UTI could increase susceptibility to the development of recurrent UTI (rUTI). The objective was to conduct a gene association study to replicate previous gene association studies identifying single nucleotide polymorphisms (SNPs) putatively associated with rUTI in adult women. METHODS: Women with a history of rUTI and healthy controls were recruited (n = 1,008) from gynaecology outpatient clinics. Participants completed a signed consent form and questionnaire for phenotyping. DNA was extracted from blood or saliva samples for each participant. Putative associated SNPs were identified from a comprehensive systematic review of prior gene association studies. Primers for each selected SNP were designed, and genotyping was conducted using a competitive polymerase chain reaction (PCR) method. The Chi-squared test was used to assess the association between each variant and rUTI. Genotyping quality was assessed by checking for deviation from Hardy-Weinberg equilibrium. RESULTS: We found no association between SNPs tested in the VDR (p = 0.16, p = 0.09, p = 0.36), CXCR1 (p = 0.09), CXCR2 (p = 0.39), PSCA (p = 0.74) genes, and rUTI in adult women. CONCLUSIONS: To our knowledge, this is the largest study to date, finding no significant associations. Previously reported positive associations may have been due to type 1 error, or genotyping errors. Future studies should adjust for confounders and employ adequate sample sizes. A greater understanding of the genetic components associated with rUTI may influence future treatment guidelines and screening for susceptible patients.

Transobturator Versus Minisling for Urinary Incontinence: A Randomized Controlled Trial.

IMPORTANCE: The comparison between single-incision slings (SISs) and midurethral slings has been documented in the literature, but results vary according to the SIS device. OBJECTIVES: The purpose of this study is to assess whether SIS (Solyx) is noninferior to transobturator (TOT) (Obtryx) sling for treating women with confirmed stress-predominant urinary incontinence. STUDY DESIGN: A prospective, parallel, nonblinded, multicenter, noninferiority, randomized controlled study with 114 patients were randomized and followed 6 and 12 months after surgery. Interventions were midurethral TOT sling (Obtryx-halo; n = 58) or SIS (Solyx; n = 56). The primary outcome was improvement in the Patient Global Impression of Improvement (PGI-I). Secondary outcomes were the Kings Health Questionnaire (KHQ) instruments after treatment, subjective improvement, and surgical outcomes. RESULTS: Both groups were homogeneous ( P = NS) regarding sociodemographic and clinical variables. There was improvement in the PGI-I after 6 ( P = 0.001) and 12 months ( P = 0.001) of treatment for women who underwent TOT sling. After 6 months, KHQ scores improved in the TOT group for the following domains: role limitations ( P = 0.026) and physical limitations ( P = 0.006). After 12 months, the TOT group presented better KHQ scores that were statistically significant from the SIS group in incontinence impact ( P = 0.012), physical limitations ( P = 0.001), and severity measures ( P = 0.017). Moreover, the TOT group presented higher subjective improvement after 6 months ( P = 0.006) than the SIS group. Mesh erosion was higher in the SIS group ( P = 0.006). Reoperations were not statistically different between groups. CONCLUSION: There were higher scores in the PGI-I score and higher subjective improvement for the TOT sling after 6 and 12 months of treatment when compared with the SIS group.

PEOPLE: Lifestyle and comorbidities as risk factors for pelvic organ prolapse-a systematic review and meta-analysis PEOPLE: PElvic Organ Prolapse Lifestyle comorbiditiEs.

INTRODUCTION AND HYPOTHESIS: The literature is scarce regarding the effects of comorbidities, clinical parameters, and lifestyle as risk factors for pelvic organ prolapse (POP). This study was performed to systematically review the literature related to body mass index (BMI), waist circumference, diabetes mellitus (DM), hypertension (HT), dyslipidemia, chronic constipation, smoking, chronic cough, occupation, and striae and varicose veins as determinants for POP. METHODS: Search terms in accordance with Medical Subject Headings were used in PubMed, Embase, LILACS, and the Cochrane Library. Clinical comparative studies between women with and without POP and containing demographic and/or clinical raw data related to lifestyle and/or comorbidities were included. The ROBINS-I (risk of bias in non-randomized studies of interventions) instrument was used. Fixed-effects and random-effects models were used for homogeneous and heterogeneous studies, respectively. RESULTS: Forty-three studies were included in the meta-analysis. BMI < 25 kg/m2 was found to be a protective factor for POP [OR 0.71 (0.51, 0.99); p = 0.04], and BMI > 30 kg/m2 was a risk factor for POP [OR 1.44 (1.37, 1.52); p < 0.00001]. Waist circumference (≥ 88 cm) was reported as a risk factor for POP [OR 1.80 (1.37, 2.38); p < 0.00001], along with HT [OR 1.18 (1.09, 1.27); p = 0.04], constipation [OR 1.77 (1.23, 2.54); p < 0.00001], occupation [OR 1.86 (1.21, 2.86); p < 0.00001], persistent cough [OR 1.52 (1.18, 1.94); p < 0.0001]), and varicose veins [OR 2.01 (1.50, 2.70); p = 0.12]. CONCLUSIONS: BMI < 25 kg/m2 is protective while BMI > 30 kg/m2 is a risk factor for POP. Large waist circumference, dyslipidemia, HT, constipation, occupation, persistent cough, and varicose veins are also determinants for POP.

Implementing telemedicine in urogynecology: A feasibility study.

INTRODUCTION AND HYPOTHESIS: Telemedicine has been recommended for the management of urogynecological conditions during the coronavirus (COVID 19) pandemic. This study aimed to evaluate the feasibility of telemedicine for urogynecology at a Brazilian public hospital. METHODS: A descriptive observational study was performed at a urogynecology outpatient clinic. The primary outcome was the desire to continue with telemedicine. Secondary outcomes were appointment resolvability, technical aspects of the appointment, and patient satisfaction. The participants had in-person appointments that were canceled because of the COVID-19 pandemic. We collected data on sociodemographic characteristics and clinical and technical aspects of the appointments. The participants responded to satisfaction questionnaires 7-15 days post-procedure. The categorical variables were evaluated based on absolute and relative frequency. The continuous variables were described as the mean and standard deviation. A chi-square test was performed to determine the association between variables. RESULTS: In total, 225 patients had appointments canceled due to the COVID-19 pandemic, of which 171 were eligible for the study. Telemedicine appointments were agreed upon by 48% of the participants and 85.5% responded to the satisfaction survey. We found that 57.7% of the participants desired to continue with telemedicine. The appointment resolvability rate was 76.1%, 63.4% of the appointments met the technical criteria, and the satisfaction rate was 93%. The only variable associated with the desire to continue telemedicine was overall patient satisfaction (p=0.02). CONCLUSIONS: Telemedicine in urogynecology is feasible and can be implemented in the studied population. However, actions are essential to adequately support patient preference and improve the acceptance of telemedicine.

Perceived racism or racial discrimination and the risk of adverse obstetric outcomes: a systematic review

ABSTRACT BACKGROUND: Racial disparities are differences among distinct subgroups of the human species; biologically, there are no scientifically proven reasons for them to exist. OBJECTIVE: To assess the impact of racism or racial discrimination on obstetric outcomes. DESIGN AND SETTING: Systematic review conducted at a tertiary/academic hospital. METHODS: The Cochrane Library, SCOPUS/EMBASE, PubMed, Web of Science and ClinicalTrials.gov databases were searched from inception to June 2020. Studies presenting any type of racial discrimination, or any manifestation of racism that was perceived by women of any age in an obstetric scenario were included. Studies that only assessed racial disparities without including direct racism were excluded. The secondary outcomes evaluated included quality of antenatal care, intra and postpartum care, preterm birth and birthweight. The Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I) scale was used to assess the quality of evidence from non-randomized studies. RESULTS: A total of 508 records were retrieved and 29 were selected for qualitative synthesis. No meta-analysis could be performed due to the high heterogeneity across studies. Perceived racism was associated as a risk factor in 7/10 studies focusing on pregnancy and postpartum maternal outcomes, five studies on preterm birth, one study on small for gestational age and two studies on low birthweight. Overall, among the 29 studies, the risk of bias was classified as moderate. CONCLUSIONS: Perceived racism presented an association with poor obstetric outcomes. Anti-racist measures are needed in order to address the problems that are causing patients to perceive or experience racism. SYSTEMATIC REVIEW REGISTRATION: PROSPERO database, CRD42020194382

Perceived racism or racial discrimination and the risk of adverse obstetric outcomes: a systematic review.

BACKGROUND: Racial disparities are differences among distinct subgroups of the human species; biologically, there are no scientifically proven reasons for them to exist. OBJECTIVE: To assess the impact of racism or racial discrimination on obstetric outcomes. DESIGN AND SETTING: Systematic review conducted at a tertiary/academic hospital. METHODS: The Cochrane Library, SCOPUS/EMBASE, PubMed, Web of Science and ClinicalTrials.gov databases were searched from inception to June 2020. Studies presenting any type of racial discrimination, or any manifestation of racism that was perceived by women of any age in an obstetric scenario were included. Studies that only assessed racial disparities without including direct racism were excluded. The secondary outcomes evaluated included quality of antenatal care, intra and postpartum care, preterm birth and birthweight. The Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I) scale was used to assess the quality of evidence from non-randomized studies. RESULTS: A total of 508 records were retrieved and 29 were selected for qualitative synthesis. No meta-analysis could be performed due to the high heterogeneity across studies. Perceived racism was associated as a risk factor in 7/10 studies focusing on pregnancy and postpartum maternal outcomes, five studies on preterm birth, one study on small for gestational age and two studies on low birthweight. Overall, among the 29 studies, the risk of bias was classified as moderate. CONCLUSIONS: Perceived racism presented an association with poor obstetric outcomes. Anti-racist measures are needed in order to address the problems that are causing patients to perceive or experience racism. SYSTEMATIC REVIEW REGISTRATION: PROSPERO database, CRD42020194382.

Patient Acceptance of Telemedicine in Urogynecology Consultations - A Cross-Sectional Study Performed at a Brazilian Public Institution / Aceitação de telemedicina em consultas de uroginecologia: Estudo transversal em uma instituição pública brasileira

Abstract Objective To evaluate the acceptance of telemedicine and determine its associated factors in an urogynecology outpatient clinic of a public hospital in Brazil. Methods The present was a cross-sectional study performed between June and November 2020. The included patients had their elective appointments postponed due to the coronavirus disease 2019 (COVID-19) pandemic. The variables considered regarding the acceptance of telemedicine were: urogynecologic diagnosis, age, level of schooling, place of residence, access to the internet, type of device used, frequency of internet use, and use of social media platforms. The categorical variables were described by their absolute and relative frequencies. The association among variables was evaluated through the Fisher exact test, and univariate and multivariate analyses, considering the acceptance of telemedicine as the dependent variable. Results A total of 225 patients were listed, and 182 agreed to participate. The mean age was 59 years old, 81.3% of the patients had access to the internet, and 87.3% of them accepted telemedicine. There were statistically significant associations regarding the acceptance of telemedicine and high levels of schooling (p< 0.01), internet access (p< 0.01), daily use of the internet (p< 0.01), access through personal mobile phone (p< 0.01), and access through the participant's own residence (p< 0.01). In the univariate and multivariate analyses, only high levels of schooling were associated with the acceptance of telemedicine (Adjusted odds ratio: 4.82; 95% confidence interval = 1.59-14.65). Conclusion Most of the urogynecology patients of a public hospital in a developing country accepted telemedicine. Internet access and level of schooling were the factors associated with the acceptance of telemedicine in urogynecology.

Resumo Objetivo Avaliar aceitação da telemedicina e determinar seus fatores associados em uma clínica de uroginecologia de um hospital público brasileiro. Métodos Trata-se de estudo transversal realizado entre junho e novembro de 2020. Foram recrutadas pacientes que tiveram seus atendimentos eletivos adiados devido à pandemia de doença do coronavírus 2019 (coronavirus disease 2019, COVID-19, em inglês). As variáveis consideradas para a aceitação da telemedicina foram: diagnóstico uroginecológico, idade, escolaridade, local de residência, acesso à internet, tipo de dispositivo, frequência do uso da internet, e uso de plataformas de redes sociais. As variáveis categóricas foras descritas na forma de suas frequências absoluta e relativa. A associação entre essas variáveis foi avaliada por meio do teste exato de Fisher e análises uni e multivariada, e a aceitação da telemedicina foi considerada a variável dependente. Resultados Um total de 225 pacientes foram listadas, e 182 concordaram em participar. A idade média das participantes foi de 59 anos; 81,3% delas tinham acesso à internet, e 87,3% aceitaram a telemedicina. Observaram-se associações estatisticamente significativas entre a aceitação e maior escolaridade (p< 0,01), acesso à internet (p< 0,01), uso diário da internet (p< 0,01), acesso por celular próprio (p< 0,01), e acesso da própria residência (p< 0,01). Nas análises uni e multivariada, somente alto nível de escolaridade esteve associado à aceitação da telemedicina (razão de probabilidades ajustada: 4,82; intervalo de confiança de 95% = 1,59-14,65). Conclusão A maioria das pacientes atendidas em um hospital público de um país em desenvolvimento concordaram com a telemedicina. Acesso à internet e nível de escolaridade foram fatores associados à aceitação da telemedicina nessa população.

Risk factors for mediolateral episiotomy at a tertiary hospital: a cross-sectional study.

OBJECTIVE: The main aim of this study was to assess the associated factors for selective mediolateral episiotomy at a tertiary, academic hospital. METHODS: A retrospective cohort analysis between 2017 and 2019 was performed. The primary outcome was the prevalence of selective mediolateral episiotomy. Independent variables were maternal, intrapartum, and neonatal characteristics. A significance level of 5% was established, and univariate and multivariate analyses with logistic regression models were performed. RESULTS: From 2,761 vaginal deliveries eligible for inclusion during this period, the prevalence of selective mediolateral episiotomy was 18.7%. Univariate analysis has shown that non-white women were protective factors (OR=0.77 [0.63-0.96]; p=0.02) for episiotomy; primiparity (OR=2.61 [2.12-3.21]; p<0.01), number of vaginal examinations between 6-10 repetitions (OR=3.16 [2.48-4.01]; p<0.01) and 11-20 repetitions (OR=5.40 [3.69-7.90]; p<0.01), longer second stage duration (OR=1.01 [1.00-1.02]; p<0.01), and women with gestational age more than 37 weeks were risk factors. Multivariate analysis reported that second stage duration (AOR=1.01 [1.00-1.03]; p<0.01), primiparity (AOR=2.03 [1.34-3.06]; p<0.01), and number of vaginal examinations between 6-10 repetitions (AOR=2.36 [1.50-3.70]; p<0.01) and 11-20 repetitions (AOR=3.29 [1.74-6.20]; p<0.01) were remained as risk factors for selective mediolateral episiotomy. CONCLUSION: A higher number of vaginal examinations during labor (over six repetitions), longer duration of second stage labor, and primiparity were risk factors associated with selective mediolateral episiotomy.

Patient Acceptance of Telemedicine in Urogynecology Consultations - A Cross-Sectional Study Performed at a Brazilian Public Institution.

OBJECTIVE: To evaluate the acceptance of telemedicine and determine its associated factors in an urogynecology outpatient clinic of a public hospital in Brazil. METHODS: The present was a cross-sectional study performed between June and November 2020. The included patients had their elective appointments postponed due to the coronavirus disease 2019 (COVID-19) pandemic. The variables considered regarding the acceptance of telemedicine were: urogynecologic diagnosis, age, level of schooling, place of residence, access to the internet, type of device used, frequency of internet use, and use of social media platforms. The categorical variables were described by their absolute and relative frequencies. The association among variables was evaluated through the Fisher exact test, and univariate and multivariate analyses, considering the acceptance of telemedicine as the dependent variable. RESULTS: A total of 225 patients were listed, and 182 agreed to participate. The mean age was 59 years old, 81.3% of the patients had access to the internet, and 87.3% of them accepted telemedicine. There were statistically significant associations regarding the acceptance of telemedicine and high levels of schooling (p < 0.01), internet access (p < 0.01), daily use of the internet (p < 0.01), access through personal mobile phone (p < 0.01), and access through the participant's own residence (p < 0.01). In the univariate and multivariate analyses, only high levels of schooling were associated with the acceptance of telemedicine (Adjusted odds ratio: 4.82; 95% confidence interval = 1.59-14.65). CONCLUSION: Most of the urogynecology patients of a public hospital in a developing country accepted telemedicine. Internet access and level of schooling were the factors associated with the acceptance of telemedicine in urogynecology.

OBJETIVO: Avaliar aceitação da telemedicina e determinar seus fatores associados em uma clínica de uroginecologia de um hospital público brasileiro. MéTODOS: Trata-se de estudo transversal realizado entre junho e novembro de 2020. Foram recrutadas pacientes que tiveram seus atendimentos eletivos adiados devido à pandemia de doença do coronavírus 2019 (coronavirus disease 2019, COVID-19, em inglês). As variáveis consideradas para a aceitação da telemedicina foram: diagnóstico uroginecológico, idade, escolaridade, local de residência, acesso à internet, tipo de dispositivo, frequência do uso da internet, e uso de plataformas de redes sociais. As variáveis categóricas foras descritas na forma de suas frequências absoluta e relativa. A associação entre essas variáveis foi avaliada por meio do teste exato de Fisher e análises uni e multivariada, e a aceitação da telemedicina foi considerada a variável dependente. RESULTADOS: Um total de 225 pacientes foram listadas, e 182 concordaram em participar. A idade média das participantes foi de 59 anos; 81,3% delas tinham acesso à internet, e 87,3% aceitaram a telemedicina. Observaram-se associações estatisticamente significativas entre a aceitação e maior escolaridade (p < 0,01), acesso à internet (p < 0,01), uso diário da internet (p < 0,01), acesso por celular próprio (p < 0,01), e acesso da própria residência (p < 0,01). Nas análises uni e multivariada, somente alto nível de escolaridade esteve associado à aceitação da telemedicina (razão de probabilidades ajustada: 4,82; intervalo de confiança de 95% = 1,59­14,65). CONCLUSãO: A maioria das pacientes atendidas em um hospital público de um país em desenvolvimento concordaram com a telemedicina. Acesso à internet e nível de escolaridade foram fatores associados à aceitação da telemedicina nessa população.

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Female Sexual Distress Scale-Revised questionnaire for women with vaginal laxity.

INTRODUCTION AND HYPOTHESIS: Vaginal laxity (VL) can impair women´s quality of life and there are not many tools aimed at quantitatively addressing this complaint. Sexual distress can be present within this group of patients. The aim of our study is to carry out the cross-cultural adaptation/translation and validation of the Female Sexual Distress Scale-Revised (FSDS-R) for Brazilian Portuguese women with VL. METHODS: Women age ≥ 18 years, with VL (n=82), and without VL (n=53) were included. Continuous variables were described in the form of mean/standard deviation or median/range, and Student's t test was used. The Chi-squared test was used for dichotomous variables. Cronbach's alpha coefficient was used for internal consistency and Spearman's correlation was used to assess construct validity (FSDS-R, Female Sexual Function Index [FSFI], and Incontinence Questionnaire Vaginal Symptoms [ICIQ-VS]). A significance level of 5% was established using a two-tailed test. RESULTS: Women with VL presented more anal/vaginal sexual intercourse than women without VL (p=0.030). All three instruments (FSDS-R, FSFI, and ICIQ-VS) presented discriminant validity between women with and without VL (p<0.001). A high internal consistency (Cronbach´s alpha =0.887) was found in women with VL and without VL (0.917). Regarding construct validity (n=82), there was a strong positive correlation between FSDS-R score and ICIQ-VS scales, except for a weaker correlation between the ICIQ-VS vaginal symptoms subscale (r: +0.2788; p=0.013). A moderate negative correlation was found between FSDS-R and all FSFI domains (p<0.001), except for pain (p<0.062). CONCLUSIONS: The Brazilian version of the FSDS-R showed adequate internal consistency and discriminant validity, and a correlation was found with other instruments such as FSFI and ICIQ-VS.

Measurement of the vaginal wall thickness by transabdominal and transvaginal ultrasound of women with vaginal laxity: a cross-sectional study.

INTRODUCTION AND HYPOTHESIS: An objective diagnostic method to understand vaginal laxity (VL) is still missing. The aim of our study is to determine whether vaginal wall thickness (VWT) measured by ultrasound may differ according to the abdominal or vaginal techniques and to assess whether clinical variables are associated with vaginal measurements of women with VL. METHODS: A cross-sectional study conducted at a tertiary hospital included 82 women aged ≥ 18 years with VL complaints assessed by the Vaginal Laxity Questionnaire. Women who reported severe comorbidities or vulvovaginal disorders, previous treatment for VL, and use of vaginal estrogen in the last 6 months were excluded. Participants reporting VL underwent transabdominal (TAUS) and transvaginal ultrasound (TVUS) and physical examination and answered validated questionnaires. Descriptive data were given as mean and standard deviation, median (range), and absolute and relative frequency. The significance level adopted for this study was 5%. Sample size calculation was not performed for the present study. RESULTS: Mean age was 41.20 ± 8.64 years, and most participants were multiparous, with previous vaginal delivery and having vaginal intercourse. A statistically significant difference (up to 3 mm) between TAUS and TVUS measurements of the VWT was found in the proximal, middle-third, and distal compartments. A significant correlation was found between VWT and TAUS or TVUS in the mid-third and distal compartments. CONCLUSION: A significant correlation was found between the VWT measurements in TVUS and TAUS. Our findings might give the health professional more possibilities for investigating VWT according to patient characteristics.

Risk factors for mediolateral episiotomy at a tertiary hospital: a cross-sectional study

SUMMARY OBJECTIVE: The main aim of this study was to assess the associated factors for selective mediolateral episiotomy at a tertiary, academic hospital. METHODS: A retrospective cohort analysis between 2017 and 2019 was performed. The primary outcome was the prevalence of selective mediolateral episiotomy. Independent variables were maternal, intrapartum, and neonatal characteristics. A significance level of 5% was established, and univariate and multivariate analyses with logistic regression models were performed. RESULTS: From 2,761 vaginal deliveries eligible for inclusion during this period, the prevalence of selective mediolateral episiotomy was 18.7%. Univariate analysis has shown that non-white women were protective factors (OR=0.77 [0.63-0.96]; p=0.02) for episiotomy; primiparity (OR=2.61 [2.12-3.21]; p<0.01), number of vaginal examinations between 6-10 repetitions (OR=3.16 [2.48-4.01]; p<0.01) and 11-20 repetitions (OR=5.40 [3.69-7.90]; p<0.01), longer second stage duration (OR=1.01 [1.00-1.02]; p<0.01), and women with gestational age more than 37 weeks were risk factors. Multivariate analysis reported that second stage duration (AOR=1.01 [1.00-1.03]; p<0.01), primiparity (AOR=2.03 [1.34-3.06]; p<0.01), and number of vaginal examinations between 6-10 repetitions (AOR=2.36 [1.50-3.70]; p<0.01) and 11-20 repetitions (AOR=3.29 [1.74-6.20]; p<0.01) were remained as risk factors for selective mediolateral episiotomy. CONCLUSION: A higher number of vaginal examinations during labor (over six repetitions), longer duration of second stage labor, and primiparity were risk factors associated with selective mediolateral episiotomy.

Age and/or postmenopausal status as risk factors for pelvic organ prolapse development: systematic review with meta-analysis.

INTRODUCTION AND HYPOTHESIS: Age is named as a risk factor for pelvic organ prolapse (POP), despite not being the primary outcome for many observational studies. Postmenopausal status is another associated factor but has many confounders. We aimed to systematically review the role of age and/or postmenopausal status in POP development. METHODS: Systematic review addressing age and hormones, more specifically by postmenopausal status, from inception to March 2020 in four databases (PubMed, Embase, WOS, Cochrane Library). Quality of evidence was classified by the ROBINS-I classification for non-randomized studies. Experimental studies, animal studies, studies linking age with recurrent POP and case series were excluded. Effect estimates were collected from adjusted odds ratio plus 95% confidence intervals. Significance level was 5%. A discussion exploring mechanistic factors was also included. RESULTS: Nineteen studies (11 cross sectional, 6 cohort and 2 case control) were included for quantitative analysis. Only two studies presented a low overall risk of bias for age; most of the domains were of moderate risk. Every additional year was responsible for a 10% increase in the risk to develop POP (OR = 1.102 [1.021-1.190]; i2 = 80%, random analysis, p = 0.012). This trend was confirmed when age was dichotomized into a cutoff of 35 (p = 0.035) and 50 (p < 0.001) years. Although an increase in the risk for POP was noted in postmenopausal women, this did not reach statistical significance (OR = 2.080 [0.927-4.668], i2 = 0%, p = 0.076). CONCLUSION: Age is a risk factor for POP; postmenopausal status was not statistically associated with POP, prompting the need for further studies addressing this factor.

Cross sectional study on assessment of ring pessary cleaning and removal every six months: adverse events and complications.

INTRODUCTION AND HYPOTHESIS: Despite its frequent use, there is little evidence of adequate management of pessaries for treating pelvic organ prolapse (POP). Thus, the aims the study were to assess the rate of complications in women using ring-type pessaries with cleaning and monitoring every 6 months and to correlate the time of use of the pessary with possible complications. METHODS: This is a cross-sectional study including women diagnosed with stage 3 or 4 genital prolapse, who were already in outpatient follow-up and who used a ring pessary. We excluded patients using another type of pessary, with severe comorbidities and with POP-Q ≤ 2 staging. The chi-square test or Fisher exact test was applied for categorical variables, the t-test for continuous variables with normal distribution and Mann-Whitney test for non-parametric variables. RESULTS: A total of 83 women using a ring pessary were assessed. The mean in months of pessary use was 31.8 ± 14.9 months. Vaginal discharge was the most frequent complaint representing 26.5%, followed by foul smell in 13.3%. No significant correlation was found between length of pessary use and clinical variables. However, a significant correlation was found between immediate complications and the length of pessary use (21.3 ± 5.9 months; p < 0.0044). CONCLUSION: There was no increase in complication rate in the continuous use of a ring pessary with cleaning and monitoring every 6 months. Determining a follow-up time that reduces the risk of complications is necessary not only for the organization of the attendance services, allowing a greater number of monitored patients, but also for the access of patients who need regular monitoring.

Effect of radiofrequency and pelvic floor muscle training in the treatment of women with vaginal laxity: A study protocol.

BACKGROUND: Vaginal laxity is an underreported condition that negatively affects women's sexual function and their relationships. Evidence-based studies are needed to better understand this complaint and to discuss its treatment options. Thus, we present a study protocol to compare the effect of radiofrequency and pelvic floor muscle training in the treatment of women with complaints of vaginal laxity. METHODS/DESIGN: This is a prospective, parallel-group, two-arm, randomized clinical trial (Registry: RBR-2zdvfp-REBEC). Participants will be randomly assigned to one of the two groups of intervention (Radiofrequency or Pelvic Floor Muscle Training). The study will be performed in the Urogynecology outpatient clinic and in the physiotherapy outpatient clinic at the State University of Campinas-UNICAMP and will include women aged ≥ 18 years and with self-reported complaints of vaginal laxity. Participants will be assessed at baseline (pre-intervention period) and will be followed up in two periods: first follow-up (30 days after intervention) and second follow-up (six months after intervention). EXPECTED RESULTS: The results of this randomized clinical trial will have a positive impact on the participants' quality of life, as well as add value to the development of treatment options for women with complaints of vaginal laxity. TRIAL REGISTRATION: Registry: RBR-2zdvfp-Registro Brasileiro de Ensaios Clínicos-REBEC (19/02/2020).

Interventional treatment for myofascial pelvic floor pain in women: systematic review with meta-analysis.

INTRODUCTION AND HYPOTHESIS: Female myofascial pain (MFP) of the pelvic floor muscles (PFM) is a subtype of chronic pelvic pain associated with urinary, anorectal, and sexual symptoms, such as dyspareunia. Treatment remains poorly discussed, and we hypothesized that different treatments could improve outcomes versus placebo or no treatment. METHODS: A systematic review (CRD 42020201419) was performed in June 2020 using the following databases: PubMed, Cochrane Library, Web of Science, Embase, Scopus, BVSalud, Clinicaltrials.gov , and PEDro, including randomized clinical trials related to MPF of PFM. Primary outcome was pain after treatment, and secondary outcomes were quality of life and sexual function. Risk of bias and quality of evidence (GRADE criteria) were evaluated. Meta-analysis for continuous variables was performed (mean difference between baseline and treatment and post-treatment mean between groups). RESULTS: Five studies were included (n = 218). Final mean VAS score (GRADE: very low) after 4 weeks of treatment (p = 0.14) and the mean difference from baseline and 4 weeks (p = 0.66) between groups were not different between the intervention and control groups. Quality of life according to the SF-12 questionnaire (GRADE: very low) followed the same pattern. However, sexual function (GRADE: low) according to the total FSFI score (MD = -5.07 [-8.31, -1.84], p < 0.01, i2 = 0%) and the arousal, orgasm, and pain domains improved in the intervention groups when the mean difference from baseline and 4 weeks was compared with controls. CONCLUSION: Pain and quality of life after 4 weeks of heterogeneous intervention differed between the intervention and control groups in sexual function: FSFI in studies improved in almost all domains. VAS (in three studies) and SF-12 (in two studies) failed to demonstrate differences.

Severe Perineal Trauma in a Brazilian Southeastern Tertiary Hospital: A Retrospective Cohort Study.

OBJECTIVE: This study aimed to investigate the prevalence of severe perineal trauma (obstetric and anal sphincter injury [OASIS]) in a tertiary high-risk pregnancy facility and the associated factors. METHODS: A retrospective electronic chart review on perineal lacerations was performed from the period of April 2017 to February 2019. Obstetric and anal sphincter injury was diagnosed by a rectal examination. Primary outcome was the prevalence of OASIS (third- and fourth-degree perineal tear). Independent variables were maternal, intrapartum, and neonatal characteristics. Univariate and multivariate analyses with logistic regression models were performed. A P value lower than 0.05 was considered significant. RESULTS: The prevalence of OASIS (third/fourth-degree laceration) was 1.51% (43/2846) in our population. Our population was mostly white (66.3%) and mostly primiparous (52.1%). By comparison, the prevalence of first/second-degree laceration was 43% (1223/2846). Selective episiotomy occurred in 18.73% (517/2761) of patients, and it was not associated with OASIS (P = 0.211). Advanced maternal age (P = 0.196), higher number of vaginal examinations (P = 0.169), fetal presentation (P = 0.533), and duration of second stage (P = 0.757) were not associated with OASIS. Univariate analysis has found that forceps delivery (odds ratio [OR], 3.68 [1.74-7.79]; P = 0.001), neonatal macrossomy (OR, 3.42 [1.02-11.43]; P = 0.045), and larger head circumference (OR, 1.15 [1.02-1.32]; P = 0.026) were risk factors for OASIS, whereas higher gravidity reduced the risk (OR, 0.61 [0.42-0.91] for OASIS. However, after multivariate analysis, only head circumference (OR, 1.86 [1.10-3.14]; P = 0.020) remained as a risk factor. CONCLUSIONS: Larger neonatal head circumference increased in 86% the risk for severe perineal trauma in this cohort of women.