Comparative assessment of pelvic floor strength using a perineometer and digital examination.

OBJECTIVE: To determine whether digital assessment of pelvic floor contraction strength is as reliable as vaginal perineometry and to assess the practice of pelvic floor exercises by women. DESIGN: A blinded, two-assessor protocol, prospectively testing a volunteer sample of women. POPULATION: Two hundred and sixty-three women (from a total of 278), aged 16-75 years, attending a general gynaecological clinic with nonurinary symptoms. METHODS: Participants answered a questionnaire regarding urinary symptoms and practice of pelvic floor exercises. History and examination was carried out by the clinician, and pelvic floor strength scored digitally using the Oxford Scale. Pelvic floor strength was then assessed by the physiotherapist, using a PFX perineometer. The physiotherapist was blinded to the woman's history, examination findings and digital assessment score. Both the clinician and physiotherapist were blinded to the questionnaire responses. MAIN OUTCOME MEASURES: Digital pelvic floor contraction assessment, according to the Oxford Scale, was compared with perineometric assessment as the gold standard - examined against the background of the questionnaire findings. RESULTS: Of 263 patients, 53 were nulliparous (20%), and 210 parous (80%). Only 49 women carried out regular pelvic floor exercises (19%), and all were parous and admitted to troublesome urinary symptoms. Stress urinary incontinence was reported by 28% of all women (38.1% of parous women and 10.5% of nulliparous women). For both methods, there was no difference in the range of results when parity was taken into account. Concordance studies showed good agreement between digital and perineometric assessment of pelvic floor strength. The kappa value of 0.73 (95% confidence interval 0.67-0.79) indicated substantial agreement between the two methods. CONCLUSION: There is good agreement between digital assessment of pelvic floor contraction strength and vaginal perineometry. Assessment during gynaecological examination may help to identify women with fascial defects of the pelvic floor, as well as those at risk of genital prolapse or urinary symptoms.

Endocrine changes in women conceiving during treatment with an LHRH agonist.

We report on eight patients who conceived during pituitary desensitization with buserelin in the luteal phase of the menstrual cycle. Pregnancy was diagnosed between day 12 and 21 of buserelin administration. Analysis of serum luteinizing hormone on day 12 showed that pituitary desensitization occurred in conjunction with increasing production of ovarian steroid hormones. Serum concentrations of human chorionic gonadotrophin (HCG) were less than 10 IU/l on day 1 of buserelin administration for seven of the eight patients. The serum concentration of HCG on day 12 showed a median value of 722 IU/l (range 14.6-798 IU/l). Five of the eight patients were given HCG support (10,000 IU) following the diagnosis of pregnancy--three of these patients have ongoing pregnancies and the remaining two had blighted ova on scan. Of the remaining three patients, one had a singleton pregnancy which miscarried at 9 weeks, one had a blighted ovum on scan and bled per vagina shortly after this, and one bled per vagina prior to a scan being carried out. Our results show that pregnancy can occur during pituitary desensitization with buserelin, despite patients being counselled not to have unprotected intercourse in the cycle during which administration commences. An HCG assay on day 1 of buserelin administration is not helpful. Pregnancy should be suspected when ovarian steroid production persists despite complete pituitary down-regulation.