The evaluation and management of female sexual dysfunction.

Female sexual dysfunction has complex physiologic and psychological components that require a detailed screening, history, and physical examination. Our goal in this review is to provide family physicians with insights and practical advice to help screen, diagnose, and treat female sexual dysfunction, which can have a profound impact on patients' most intimate relationships.

A novel approach to mesh revision after sacrocolpopexy.

Pelvic organ prolapse (POP) is the herniation of pelvic organs to or beyond the vaginal walls. POP affects 50% of parous women; of those women, 11% will need surgery based on bothersome symptoms. Transvaginal mesh has been used for vaginal augmentation since the 1990s. Complications from mesh use are now more prominent, and include chronic pelvic pain, dyspareunia, vaginal mesh erosion, and urinary and defecatory dysfunction. Presently, there is no consensus regarding treatment of these complications. Reported herein are two cases of women with defecatory dysfunction and pain after sacrocolpopexy who underwent mesh revision procedures performed with both urogynecologic and colorectal surgery.

A case of pelvic organ prolapse in the setting of cirrhotic ascites.

Ascites is commonly found in patients with liver cirrhosis. Although conservative therapy is often the ideal choice of care with these patients who also have symptomatic pelvic organ prolapse, this may fail and surgical methods may be needed. Literature is limited regarding surgical repair of prolapse in the setting of ascites. The authors present the surgical evaluation and management of a 63-year-old woman with recurrent ascites from liver cirrhosis who failed conservative therapy. With adequate multidisciplinary care and medical optimization, this patient underwent surgical therapy with resolution of her symptomatic prolapse and improved quality of life.

Early Revision of Suburethral Sling for Persistent Stress Incontinence.

BACKGROUND: Midurethral slings are an effective treatment method for stress urinary incontinence (SUI). Although success rates can be as high as 90%, the remaining patients with disappointing results may require further surgical intervention. In particular, those patients with persistent SUI may need further revision of the existing sling. Literature is limited in the optimal treatment of these patients. CASE SERIES: Five patients who underwent midurethral slings for SUI and had subsequent sling revision were included in this analysis. The technique of revision is outlined in this article. Subsequently, these patients had greatly improved continence. CONCLUSIONS: Our patients did benefit from this method of sling revision. Further information on sling revisions with increased patient populations would allow us to make appropriate recommendations.

Complementary and alternative medical therapies for interstitial cystitis: an update from the United States.

The diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) has shifted from organ-specific to a multifactorial, multidisciplinary and individualized approach. Patients with refractory and debilitating symptoms may respond to complementary and alternative medical treatments (CAM). Through CAM therapies, practitioners assist the patient to be at the center of their care, empowering them to be emotionally and physically involved. Multi-disciplinary care, including urology, gynecology, gastroenterology, neurology, psychology, physiotherapy and pain medicine, is also identified to be the crux of adequate management of patients with chronic pelvic pain because of its variable etiology. The purpose of this review is to emphasize these changes and discuss management strategies.