Women's sexual health improvement: sexual quality of life and pelvic floor muscle assessment in asymptomatic women.

Introduction: Problems related to the quality of sexual life in gynecological practice are usually neglected. This study aimed to highlight the significance of this area of concern and evaluate the usefulness of tools, such as patient-reported outcomes (PROs) and pelvic floor examination, to improve women's sexual wellbeing and to identify predictors of poor quality of sexual life during the well-woman annual visit. Methods: A cross-sectional study was designed to examine 300 healthy women to determine whether the sexual quality of life (SQOL) questionnaire (on electronic devices) and pelvic floor muscle assessment (the vulva, anus, muscles, and periurethral (VAMP) protocol) of asymptomatic women during the annual bimanual examination (BME) help differentiate patients who would benefit from discussing sexual problems with a gynecologist. Dyspareunia was an exclusion criterion. Results: The majority of subjects experienced high sexual wellbeing (82.0% with SQOL score of ≥84), with a mean of 85.7 points. SQOL scores were lower for psychiatric disorders or symptoms (37.0% of subjects), although they did not correlate with age, BMI, parity, contraception use, history of vulvovaginal symptoms, neurosurgical/orthopedic problems, and rectal, bowel, or bladder symptoms. Patients with dyspareunia (16.0% of participants, although they denied it during the face-to-face consultation) had a 3.6 times higher prevalence of low or moderate quality of sexual life. The VAMP protocol score was low in asymptomatic women, 33.0% met positive criteria (VAMP+, NRS ≥3) for pelvic floor dysfunction (overactivity), although at borderline levels. VAMP+ was positively correlated with chronic pain and genitourinary symptoms, but neither with dyspareunia nor incontinence, and was unrelated to the SQOL score (p = 0.151). Conclusion: Women's sexual health is a global health priority. Finding a way to start a discussion with an asymptomatic patient is crucial to increasing patients' interest in disclosing a sexual health problem to be resolved. PROs or simple questions about sexual wellbeing direct the discussion mainly toward the at-risk group for sexual deterioration: those with mental health problems and women with dyspareunia. Dyspareunia is considered a predictor of decreased quality of sexual life, a major sexual disorder that should not be overlooked. Gynecological consultation should resolve concerns, identify the problem, and refer for professional sexual care if still needed.

Vulvodynia in prepubertal girls: diagnosis.

OBJECTIVES: To identify specific features of vulvodynia in prepubertal girls, highlight potential triggers and concomitant diseases, outline diagnostic criteria is neglected problem in adolescent gynecology. MATERIAL AND METHODS: A retrospective study, based on medical records of an outpatient clinic, a cohort of 54 vulvodynia cases was evaluated, aged 3-10 years, seen between January 2016 and July 2018. RESULTS: The study cohort presented with pain (61%), sometimes aggravated at night, pruritus (44%) and a range of other varied and unusual vulvar complaints (26%). Concomitant diseases and/or psychological problems were present in 61% of cases. Overactive pelvic muscles accompanying symptoms like urological or gastrological problems were noted in half of children. Several potential triggers were identified in a third of the cases that were emotionally stressful to the children. From the commencement of symptoms, 93% of the girls have consulted more than one doctor with 43% seeing more than three doctors, without receiving a diagnosis of vulvodynia. CONCLUSIONS: A diagnosis of vulvodynia needs to be considered in the absence of vulva pathology with wide range of vulvar pain, pruritus and discomfort. All persistent or recurrent vulvar discomfort must be taken into consideration as a vulvodynia symptom, also various non-specific, worrisome complaints. Comorbid urological and gastrological symptoms associated with overactive pelvic muscles should not be overlooked. Chronic pain can be triggered by the psychological distress in some prepubertal girls. Proper diagnosis may prevent long-term negative sequelae, what emphasizes the need for professional education of healthcare providers in adolescent vulvar pain and discomfort.

Pilot study of testing a clinical tool for pelvic physical examination in patients with vulvodynia.

OBJECTIVES: Vulvodynia diagnosis is based on medical history and physical examination. The study is aimed to evaluate the clinical usefulness of a pelvic floor physical examination (VAMP protocol) for vulvodynia diagnosis, applied during gynecological examination, proposed as educational and diagnostic tool. MATERIAL AND METHODS: Pelvic physical examinations were performed for 650 non-pregnant female patients. A study group of 449 cases met the vulvodynia diagnostic criteria (120 with provoked, 104 with spontaneous, and 121 with mixed subtype) and were compared with those of 201 healthy individuals. Four anatomical regions were examined: the vulva (V) and anus (A) with a cotton swab, the internal pelvic muscles (M) with a digital examination of the levator ani, and the paraurethral (P) area with digital pressure. Only the maximum pain score for a given area was recorded, using a Numerical Rating Scale. The four anatomical regions were recorded under the VAMP acronym. RESULTS: Differences in mean scores VAMP protocol were statistically between vulvodynia and comparison group for V = 6.48 vs 0.98; M = 6.29 vs 1.05; and P = 6.89 vs 1.33, with exception of A = 0.03 vs 0.08. Patient age, weight, way of delivery, other concomitant diseases (e.g., dysuria, anal and bowel symptoms), vulvodynia subtype, and pain duration did not influence VAMP scores in patients with vulvodynia and comparison group. CONCLUSIONS: Pelvic examination according to VAPM protocol can be applied in vulvar pain patients for diagnostic purposes. Besides of vulvodynia symptoms any other analyzed variables did not influence on scores of VAMP protocols. We found that cut-off score ≥ 3 even in one of V, M or P component of VAMP protocol can be considered as diagnostic criterium for vulvodynia. Component A (anus area) was not useful for vulvodynia diagnosis.

Genitourinary syndrome of menopause treatment using lasers and temperature-controlled radiofrequency.

Perimenopausal changes caused by oestrogen deficiency are accompanied by a decrease in the content of collagen and elastin in the tissues, leading to thinning of the epithelium and the resultant disappearance of the superficial layer, which leads to smooth muscle dysfunction as well as connective tissue degradation. This aetiopathogenetic chain results in a set of symptoms experienced by approximately 50% of women in the peri- and postmenopausal period. Symptoms of dryness, burning, dyspareunia and urgency contribute to a significant reduction in the quality of sexual function and general comfort of life due to recurrent infections of the vagina, vulva and urinary tract. Different therapeutic methods may benefit genitourinary syndrome of menopause (GSM), while innovative methods such as lasers or radiofrequency deserve further study in this area.