Peripartum dissociation, sense of control, postpartum posttraumatic stress disorder and emotional adjustment to motherhood in adult survivors of childhood maltreatment.

Survivors of childhood maltreatment (CM) may experience difficulties in the peripartum period and in adjustment to motherhood. In this study we examined a model wherein CM is associated with maternal self-efficacy and maternal bonding three months postpartum, through mediation of peripartum dissociation and reduced sense of control during childbirth and postpartum-posttraumatic-stress disorder (P-PTSD). Women were recruited in a maternity ward within 48 h of childbirth (T1, N = 440), and contacted three-months postpartum (T2, N = 295). Participants completed self-report questionnaires: peripartum dissociation, sense of control (T1), and CM, P-PTSD, postpartum-depression, maternal self-efficacy and bonding (T2). Obstetrical data were collected from medical files. Structural equation modeling was conducted to test the hypothesized model, controlling for mode of delivery and postpartum-depression. Reported CM included child emotional neglect (CEN; 23.5%), child emotional abuse (CEA; 16.3%), child sexual abuse (CSA; 12.9%) and child physical abuse (CPA; 7.1%). CM was positively associated with peripartum dissociation and P-PTSD (p < .001). Peripartum dissociation was positively associated with P-PTSD (p < .001). P-PTSD was negatively associated with maternal self-efficacy (p < .001) and maternal bonding (p < .001). Association between CM and maternal self-efficacy and bonding was serially mediated by peripartum dissociation and P-PTSD, but not by sense of control. Findings remained significant after controlling for mode of delivery and postpartum-depression. CM is a risk factor for adjustment to motherhood, owing to its effects on peripartum dissociation and P-PTSD. Implementation of a trauma-informed approach in obstetric care and recognition of peripartum dissociative reactions are warranted.

Iron deficiency and sexual dysfunction in women.

INTRODUCTION: Sexual dysfunction negatively affects approximately 40% to 50% of adult women across various stages of life. Common risk factors include sexual traumas, relationship problems, chronic conditions, medication side effects, and poor physical health, including iron deficiency. OBJECTIVES: This review summarizes a presentation from a symposium that discussed the types and causes of sexual dysfunction at key times in women's lives, focusing on the relationship between iron deficiency and sexual dysfunction. METHODS: The symposium was held at the XV Annual European Urogynaecological Association Congress, Antibes, France, in October 2022. Symposium content was identified through literature searches of PubMed. Original research, review articles, and Cochrane analyses discussing sexual dysfunction in association with iron deficiency/anemia were included. RESULTS: Iron deficiency in women is commonly caused by abnormal uterine bleeding, but women may develop iron deficiency anemia (IDA) because of increased iron needs or reduced iron intake/absorption. Treatment with oral iron supplementation has been shown to improve sexual function in women with IDA. Ferrous sulphate is considered as a standard of care for oral iron treatment; prolonged-release iron formulations have improved tolerability, enabling lower doses and better tolerability. CONCLUSION: IDA and sexual dysfunction are related, so the identification of sexual dysfunction or iron deficiency in a woman should prompt an investigation of the other condition. Testing for iron deficiency is an inexpensive and simple step that can be routinely included in the workup of women with sexual dysfunction. Once identified, IDA and sexual dysfunction in women should be treated and followed to optimize quality of life.

Obstetric outcome and emotional reactions to childbirth in women with dyspareunia: A cross-sectional study.

OBJECTIVE: To assess obstetrical outcomes, perceptions of childbirth experience and emotional adjustment, in women with dyspareunia. STUDY DESIGN: In this cross-sectional study, 440 women were recruited within 48 h postpartum in the maternity ward of a large medical center, during the period of April 2018- August 2020. Self-report questionnaires were administered which addressed demographic and reproductive background, dyspareunia, perceptions of control during labor (Labor Agentry Scale), perceived professional support (Intrapartum Care Scale), and maternal adjustment, implicated in perinatal dissociation (Peritraumatic Dissociative Experiences Questionnaire), acute stress disorder (ASD) symptoms (Stanford Acute Stress Reaction Questionnaire), bonding (Mother-to-Infant Bonding Scale), anticipated maternal self-efficacy (Maternal Self-Efficacy Scale) and well-being (Positive and Negative Affect Schedule, Edinburgh Postnatal Depression Scale). Obstetrical information was retrieved from clinical files and included pregnancy complications, week and mode of delivery, nature of labor onset, analgesia during delivery, birthweight, perineal tears. RESULTS: The dyspareunia group included 71 women (18.3%) and the comparison group 317 (81.7%). Demographic data were similar among groups. No difference was observed in nature of labor onset, type of analgesia, route of delivery, perineal tears. More participants with dyspareunia had premature delivery versus comparisons (14.1% vs 5.6%, p = 0.02). Women with dyspareunia reported lower levels of control (p = 0.01) and perceived support during childbirth (p < 0.001), higher levels of perinatal dissociation (p < 0.001) ASD symptoms (p < 0.001), depression (p = 0.02), negative affect (p < 0.001), and reported lower levels of maternal bonding (p < 0.001) and anticipated maternal self-efficacy (p = 0.01). CONCLUSION: Dyspareunia was associated with more premature deliveries, parameters of emotional distress during childbirth and poorer maternal adjustment following childbirth. Perinatal caregivers should be cognizant of such cognitive and emotional reactions in women with dyspareunia, so as to assess for a history of dyspareunia in pregnant women and provide adequate support during pregnancy and delivery.

Permanent or absorbable suture material for sacrospinous ligament fixation: Does it matter?

OBJECTIVE: To evaluate success and safety of sacrospinous ligament fixation (SSLF) using permanent versus absorbable suture materials 12 months following surgery. STUDY DESIGN: Following IRB approval, the electronic medical records of women who underwent SSLF in the gynecology department of a university-affiliated medical center from November 2012 to September 2021 were retrospectively reviewed. SSLF was carried out using Capio®and Digitex™, with either absorbable (polyglactin-910 or polydioxanone) sutures (group 1), or permanent (polypropylene) sutures (group 2), Pre-operative and post-operative assessment included prolapse staging using the pelvic organ prolapse quantification system and validated quality of life questionnaires (Pelvic Floor Distress Inventory and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12). Patients with postoperative information on objective and subjective outcome at 12 months were included in final analysis. Anatomical success was defined as POP stage < 2 at 12-months following surgery. For statistical analysis, the Mann-Whitney test was used for continuous variables, Fisher's exact test for dichotomous variables, and Chi-squared test of independence for variables with>2 categories. RESULTS: During the study period, 234 women underwent SSLF. One-hundred and forty-two patients (60.7 %) returned at the 12-month follow-up and were included in final analysis. Seventy-two (50.7 %) patients had absorbable suture and 70 patients (49.3 %) had permanent suture. Estimated blood loss was significantly higher in group 1 [100 (50-150) cc vs 50 (50-100) cc respectively, p =.016]. Moderate to severe pain on POD-1 was significantly higher in group 2 [VAS: 2.00 (0.00-4.00) vs 4.00 (3.00-5.75) respectively, p =.001]. Anatomical success, defined as POP ≤ stage 2 at 12 months, was similar between groups: 69 % in group 1 vs 67 % in group 2 (p =.77). Subjective cure was similar between groups, 97.2 % in group 1 vs 94.3 % in group 2 (p =.44). At the 12-month follow-up, none of the patients had gluteal pain. The rate of de-novo dyspareunia was similar between groups: 4 women (5.9 %) in the absorbable suture group versus 2 women (3.3 %) in the permanent suture group (p =.49). CONCLUSIONS: Our findings suggest that absorbable or permanent suture material does not affect outcome of SSLF. Permanent sutures may be related to increased immediate postoperative pain.

Predictors of persistent overactive bladder following surgery for advanced pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: Reliable risk factors for persistent urgency following pelvic organ prolapse (POP) surgery are still unclear. We aimed to identify preoperative parameters related to persistent postoperative urgency in a cohort of women following surgery for POP stage 3-4 with concomitant overactive bladder (OAB). METHODS: In this retrospective analysis, women with POP stage 3-4 and OAB who underwent POP repair during November 2012-December 2020 were included. Preoperative evaluation included history, Pelvic Organ Prolapse Quantification (POP-Q), multi-channel urodynamic studies and Pelvic Floor Distress Inventory (PFDI-20). Surgical procedures included: anterior and posterior colporrhaphy, sacrospinous ligament suspension, anterior vaginal wall mesh repair and robotic-assisted laparoscopic sacrocolpopexy. At the 12-month follow-up, urogynecological history, POP-Q evaluation, cough stress test and the PFDI-20 questionnaire were repeated. RESULTS: One hundred seventy-three patients were included in the analysis. Resolution of urgency was observed in 56% of women. Variables associated with persistent postoperative urgency included body mass index (BMI) (27 kg/m2 vs 25.7 kg/m2, p = 0.04), preoperative increased daytime frequency (46.39% vs 61.84%, p = 0.05), urgency urinary incontinence (UUI) (51.46% vs 80.26%, p = 0.0001), detrusor overactivity (DO) (40.2% vs 61.84%, p = 0.009) and lower maximum flow rate on UDS (13.9 ml/s vs 15 ml/s, p = 0.04). Multivariate analysis confirmed preoperative DO (OR: 12.2 [95% CI: 1.4-16.6]; p = 0.01), preoperative UUI (OR 3.8 [95% CI: 1.3-11.0]; p = 0.008) and BMI > 25 kg/m2 (OR 1.8 [95% CI: 1.1-7.2]; p = 0.04) as predictive factor for persistent urgency. CONCLUSIONS: In women with advanced POP and OAB, being overweight, preoperative UUI and DO are related to persistent postoperative urgency. These findings will guide our future preoperative counseling and reinforce the role of UDS in POP management.

[OBSTETRIC VIOLENCE - SINCE WHEN AND WHERE TO: IMPLICATIONS AND PREVENTIVE STRATEGIES].

INTRODUCTION: Obstetric violence has recently gained wide recognition and is defined as inappropriate or disrespectful treatment given by medical staff to women throughout the antepartum period, delivery and postpartum. It includes verbal violence, denial of patient autonomy, the practice of unconsented or unnecessary medical procedures, discrimination based on race or ethnic background, and physical violence. The source of obstetric violence has been vastly studied by psycho-sociologists who have conceptualized it as stemming back to ancient gender role theories. In the medical literature, obstetric violence has been devoted increasing attention only in recent years. Clinical studies show it is a widespread phenomenon and reports indicate that up to 30% of women, both from low- and high-income regions, claim to have experienced a subtype of obstetric violence during childbirth. Obstetric violence may have a profound psychological impact: post-partum acute stress disorder (ASD), post-traumatic stress disorder (PTSD), and post-partum depression (PPD) are all well-documented mental health consequences of maternal mistreatment. Reactivation of past PTSD may also occur, as obstetric violence may be experienced as re-victimization by post-traumatic women. Currently, obstetric violence is defined with legislative backing only in a few countries in Latin America and medical research on the topic is still scarce. Both worldwide and at a local level, effective prevention and management of obstetric violence requires multidisciplinary cooperation and organizational changes. Those include greater social awareness, adjusted treatment protocols, improved training of healthcare professionals in the field of trauma-sensitive care, focused clinical research and targeted legislation.

Surgical treatment of advanced anterior wall and apical vaginal prolapse using the anchorless self-retaining support implant: long-term follow-up.

INTRODUCTION AND HYPOTHESIS: Following health notification by the FDA in 2008 of serious complications with transvaginal mesh for anterior pelvic organ prolapse, there has been a return to native tissue repairs. Earlier work with a self-retaining support (SRS) implant showed a high anatomical success rate with minimal implant-related complications over a medium-term follow-up. It is proposed that post-implant complications are more a consequence of the method of mesh anchoring rather than the implant itself. Our system incorporates an ultralight mesh with a frame that provides level I, II, and III support without the need for fixation. The first long-term outcomes of SRS implantation are presented. METHODS: A prospective multicenter trial was conducted using two consecutive identical protocols of the use of the SRS implant in women with symptomatic anterior compartment prolapse extending their follow-up to 36 months. Anatomical success (Pelvic Organ Prolapse Quantification stage 0 or 1 or a Ba ≤ -2) was recorded along with subjective success as defined by regular quality-of-life (PFDI-20 and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire) assessments. RESULTS: Sixty-seven patients completed 36 months of follow-up. Mean Ba measurements improved from 3.1 (-1 to 6) cm to -2.8 (-1 to -3) cm and C point from 0.4 (-8 to 6) cm to -6.9 (-10 cm to 1) cm. accumulating to a significant anatomical success rate of 94.3%. Subjective success based on question #3 of the PFDI-20, analyzed for the index surgical compartment, reached 95.7%. Post-operative complications included 2 cases of urinary retention, 1 minor frame exposure, 1 case of delayed voiding dysfunction, and 2 cases of de novo stress urinary incontinence. Untreated pre-operative second-degree Bp measurements had increased in 27% at follow-up. CONCLUSION: The long-term outcome of the SRS implant shows an excellent subjective and objective success with minimal risk of complications or need for reintervention.

Advanced Cystocele is a Risk Factor for Surgical Failure after Robotic-assisted Laparoscopic Sacrocolpopexy.

STUDY OBJECTIVE: To assess the outcome of robotic-assisted laparoscopic sacrocolpopexy (RALSCP) and to identify risk factors for surgical failure and long-term complications in patients at high risk for surgical failure. DESIGN: Retrospective cohort study. SETTING: A university hospital. PATIENTS: Sixty-seven women with pelvic organ prolapse (POP) at high risk for surgical failure. INTERVENTIONS: RALSCP from November 2012 to July 2020. MEASUREMENTS AND MAIN RESULTS: Information was collected from the electronic medical records. Preoperative and postoperative assessment included urogynecologic history, prolapse staging, cough stress test, and validated quality of life questionnaires. Anatomic success was defined as POP stage < 2 at the last follow-up. Mean follow-up was 24.6 ± 17.9 months. Sixteen women (23.9%) reported bulge symptoms at the latest follow-up; upon POP Quantification staging, surgical failure or recurrence was observed in 35 patients (52.2%). On multiple logistic regression analysis, a preoperative POP Quantification point Ba measurement ≥3 cm beyond the hymen was independently related to surgical failure. Late postoperative complications included 3 cases (4.5%) of postoperative ventral hernia and 5 cases (7.5%) of mesh erosion, all in patients operated using Ethibond sutures. CONCLUSIONS: Anatomic success of RALSCP in POP patients at high risk for surgical failure is worse than previously reported. Advanced preoperative anterior vaginal wall prolapse is a risk factor for surgical failure. Delayed absorbable sutures for vaginal mesh fixation seem to be safer than multifilament, permanent sutures, in terms of the risk of mesh erosion.

Increase rate of ruptured tubal ectopic pregnancy during the COVID-19 pandemic.

OBJECTIVE: During the 2020 COVID-19 pandemic there was a decrease in emergency room arrivals. There is limited evidence about the effect of this change in behavior on women's health. We aimed to evaluate the impact of the COVID-19 pandemic on the diagnosis, treatment and complications of women presenting with a tubal Ectopic Pregnancy (EP). STUDY DESIGN: This is a single centre retrospective cohort study. We compared the clinical presentation, treatment modalities and complications of all women presenting in our institution with a tubal EP during the COVID-19 pandemic between 15 March and 15 June 2020, with women who were treated in our institution with the same diagnosis in the corresponding period for the years 2018-2019. RESULTS: The study group included 19 cases of EP (N = 19) that were treated between the 15 March 2020 and 15 June 2020. The control group included 30 cases of EP (N = 30) that were admitted to in the corresponding period during 2018 and 2019. Maternal age, parity, gravity and mode of conception (natural vs. assisted) were similar between the two groups. There was no difference in the mean gestational age (GA) according to the last menstrual period. In the study group more women presented with sonographic evaluation of high fluid volume in the abdomen than in the control group (53 % vs 17 %, P value 0.01). This finding is correlated with a more advanced disease status. In the study group there was a highly statistically significant 3-fold increase in rupture among cases (P < 0.005) and a 4-fold larger volume of blood in the entrance to the abdomen (P < 0.002). We found that there were no cases of ruptured EP in the group of women who were pregnant after assisted reproduction. CONCLUSION: We found a higher rate of ruptured ectopic pregnancies in our institution during the COVID-19 pandemic. Health care providers should be alerted to this collateral damage in the non-infected population during the COVID-19 pandemic.

"The Overactive Pelvic Floor (OPF) and Sexual Dysfunction" Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response.

INTRODUCTION: Overactive pelvic floor (OPF) muscles are defined as muscles that do not relax, or may even contract, when relaxation is needed, for example, during micturition or defecation. Conditions associated with OPF are multifactorial and include multiple possible etiologies and symptom complexes. The complex interplay between biological and psychosocial elements can lead to the persistence of OPF symptoms along with psychological and emotional distress. OBJECTIVES: (1) To review and contextualize, from a pathophysiologic perspective, the evidence for OPF, (2) to provide an overview of common clinical presentations and comorbidities of OPF, and (3) to discuss the effect of OPF on sexual function in men and women. METHODS: Review of the updated literature on the pathophysiology of OPF was carried out. OPF-associated conditions were overviewed, with special emphasis on the impact on sexual function in men and women. RESULTS: Individuals with suspected OPF often present with a combination of gastrointestinal, gynecological, musculoskeletal, sexual, and urological comorbidities, mostly accompanied by psychoemotional distress. In both women and men, sexual function is significantly impaired by OPF and genitopelvic pain penetration disorders are often the primary manifestation of this condition. Women with OPF report less sexual desire, arousal, and satisfaction; more difficulty reaching orgasm; lower frequencies of intercourse; more negative attitudes toward sexuality; and more sexual distress than women without sexual pain. The most frequently reported sexual dysfunctions in men with OPF include erectile dysfunction, premature ejaculation, and ejaculatory pain. CONCLUSION: The complex pathophysiology of OPF involving multisystemic comorbidities and psychosocial factors emphasize the importance of a biopsychosocial assessment for guiding effective and personalized management. Padoa A, McLean L, Morin M, et al. "The Overactive Pelvic Floor (OPF) and Sexual Dysfunction" Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med 2021;9:64-75.

Vaginal postcoital injuries requiring surgical intervention: a case series and literature review.

This case series describes clinical features and management of women who required surgical repair of vaginal injuries following consensual intercourse in our institution during the last decade. As a secondary aim, we reviewed the literature on the topic. We searched our institution's database for procedures coded as "Suture of Vagina," excluding trauma not related to consensual sexual activity: between January 2008 and December 2017, 20 women underwent hemostatic suturing for vaginal injuries following intercourse. Mean age was 27.6 ± 12.5 (range, 16-63) years, 5 (25%) women were parous, 13 (65%) women used no contraception, and 1 (5%) used birth control pills. Three patients (15%) were postmenopausal. Eight injuries (40%) occurred following first-time intercourse, two (10%) occurred after intercourse with a new partner. Median time from bleeding onset to admission was 12 (range, 2-24) h. One patient (5%) was hemodynamically unstable and required treatment with packed cells. Median time from admission to surgery was 56 (range, 15-540) min. The laceration site was identified at the vaginal fornix in nine (45%) patients, at mid-vagina in four (20%), at the hymenal ring, or the posterior fourchette in six (30%). Tear of a longitudinal vaginal septum was identified in one patient (5%). To conclude, vaginal postcoital injuries are a rare occurrence, nevertheless they may involve significant blood loss and therefore require prompt evaluation and treatment. Once the patient is hemodynamically stable, psychosexual assessment and support should be offered to the patient and her partner.

The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients.

INTRODUCTION: The assessment of pelvic floor muscle (PFM) overactivity is part of a comprehensive evaluation including a detailed history (medical, gynecological history/antecedent), appraisal of the psychosocial contexts of the patient, as well as a musculoskeletal and a neurological examination. OBJECTIVES: The aims of this article are to review (i) the assessment modalities evaluating pelvic floor function in women and men with disorders associated with an overactive pelvic floor (OPF), and (ii) therapeutic approaches to address OPF, with particular emphases on sexual pain and function. METHODS: We outline assessment tools that evaluate psychological and cognitive states. We then review the assessment techniques to evaluate PFM involvement including digital palpation, electromyography, manometry, ultrasonography, and dynamometry, including an overview of the indications, efficacy, advantages, and limitations of each instrument. We consider each instrument's utility in research and in clinical settings. We next review the evidence for medical, physiotherapy, and psychological interventions for OPF-related conditions. RESULTS: Research using these assessment techniques consistently points to findings of high PFM tone among women and men reporting disorders associated with OPF. While higher levels of evidence are needed, options for medical treatment include diazepam suppositories, botulinum toxin A, and other muscle relaxants. Effective psychological therapies include cognitive behavioral therapy, couple therapy, mindfulness, and educational interventions. Effective physiotherapy approaches include PFM exercise with biofeedback, electrotherapy, manual therapy, and the use of dilators. Multimodal approaches have demonstrated efficacy in reducing pain, normalizing PFM tone, and improving sexual function. Multidisciplinary interventions and an integrative approach to the assessment and management of OPF using a biopsychosocial framework are discussed. CONCLUSION: Although the efficacy of various intervention approaches has been demonstrated, further studies are needed to personalize interventions according to a thorough assessment and determine the optimal combination of psychological, physical, and behavioral modalities. Padoa A, McLean, L, Morin M, et al. The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients. Sex Med 2021;9:76-92.

Sexual Health Implications of COVID-19 Pandemic.

INTRODUCTION: A novel coronavirus (COVID-19) reached pandemic levels by March 11th, 2020, with a destructive impact across socioeconomic domains and all facets of global health, but little is known of its impact on sexual health. OBJECTIVE: To review current knowledge on sexual health-related containment measures during pandemics, specifically COVID-19, and focus on 2 main areas: intimacy and relational dynamics and clinical effects on sexual health. METHODS: We carried out a literature search encompassing sexual health and pandemic issues using Entrez-PubMed and Google Scholar. We reviewed the implications of the COVID-19 pandemic on sexual health regarding transmission and safe sex practices, pregnancy, dating and intimacy amid the pandemic, benefits of sex, and impact on sexual dysfunctions. RESULTS: Coronavirus transmission occurs via inhalation and touching infected surfaces. Currently, there is no evidence it is sexually transmitted, but there are sexual behaviors that pose a higher risk of infectivity due to asymptomatic carriers. Nonmonogamy plays a key role in transmission hubs. New dating possibilities and intimacy issues are highlighted. Sexual activity has a positive impact on the immune response, psychological health, and cognitive function and could mitigate psychosocial stressors. COVID-19 pandemic affects indirectly the sexual function with implications on overall health. CONCLUSION: Increased awareness of health-care providers on sexual health implications related to the COVID-19 pandemic is needed. Telemedicine has an imperative role in allowing continued support at times of lockdown and preventing worsening of the sexual, mental, and physical health after the pandemic. This is a broad overview addressing sexual issues related to the COVID-19 pandemic. As this is an unprecedented global situation, little is known on sexuality related to pandemics. Original research is needed on the topic to increase the understanding of the impact the current pandemic may have on sexual health and function. Pennanen-Iire C, Prereira-Lourenço M, Padoa A, et al. Sexual Health Implications of COVID-19 Pandemic. Sex Med Rev 2021;9:3-14.

Anchorless implant for the treatment of advanced anterior and apical vaginal prolapse - Medium term follow up.

OBJECTIVE: to evaluate the mid-term safety and efficacy of a surgical technique using an anchorless implant. STUDY DESIGN: This is a prospective study. Women with symptomatic POP were recruited. The technique involved placement of an open trapezoid-shaped frame which retains a polypropylene mesh stretched within its parameter. No fixation techniques used. Demographic data and pre-operative quality of life (QoL) questionnaires were collected. Peri-operative data were documented. Patients were followed at 2, 6, 12, 24 and 36 months. Follow-up included repeated QoL questionnaires, Pelvic Organ Prolapse- Quantification (POP-Q) measurements and assessment for possible complications. RESULTS: Seventy women were recruited. Mean age was 63.1 years, mean parity was 4.6 deliveries. Mean pre-operative POP-Q were Ba = 3.1 (-1 to 6) cm and C = 0.4 (-8 to 6) cm. No intra-operative complications were observed. Surgical time averaged 24.7 min. Estimated blood loss averaged 155 cc. Mean follow up at last visit was 27.7 months. Two patients (2.8 %) underwent partial frame resection and two patients (2.8 %) underwent a TVT-O for de-novo stress urinary incontinence (SUI). At follow-up, the mean POP-Q were Ba= -2.8 (-3 to -1) cm and C = -6.8 (-10 to 1) cm. Two patients (2.8 %) had recurrent prolapse. One was symptomatic and received treatment. No mesh erosion or chronic pelvic pain were documented. Pelvic Function Distress Inventory (PFDI20) scores showed significant improvement. Thirty-eight (54 %) patients completed the Pelvic organ prolapse/Urinary Incontinence Sexual Questionnaire (PISQ12) showing no chronic dyspareunia. CONCLUSION: The Self Retaining Support (SRS) implant provides 97 % subjective and 94.3 % objective cure. Two patients (2.8 %) had the implant's frame removed surgically. The SRS is a safe and effective treatment for pelvic organ prolapse.

Self-retaining support implant: an anchorless system for the treatment of pelvic organ prolapse-2-year follow-up.

INTRODUCTION AND HYPOTHESIS: The search for an improved vaginal mesh prompted the development of a new anchorless implant. The objective was to report on outcome after 2 years of a technique using a self-retaining support (SRS) implant. METHODS: Patients with anterior vaginal wall prolapse, with/without apical prolapse, were recruited. Participants underwent surgical repair using the SRS device. Demographic data, pre-surgical Pelvic Organ Prolapse Quantification (POP-Q) scoring, quality of life (QoL) questionnaires (Pelvic Floor Distress Inventory Short Form 20 [PFDI-20], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire 12 [PISQ-12]), and surgical data were collected. Patients were followed at 2 weeks, 2, 6, 12, and 24 months after surgery. Objective anatomical success was defined using the NIH criteria. RESULTS: Twenty women were recruited for the study with an average age of 62.1 years and an average parity of 4.0 deliveries. Average BMI was 28. Pre-operative mean POP-Q measurements were Aa =1.40 (-1 to 3) cm, Ba = 2.3 (-1 to 6) cm and C = 0.4 (-7 to 6) cm. Surgical time averaged 31.2 min. Estimated blood loss averaged 165 ml. No intra-operative complications were observed. One case (5%) of frame erosion was documented 8 months after surgery. At 2 years' follow-up, mean POP-Q measurements were: Aa = -2.95 (-3 to -2) cm, Ba = -2.85 (-3 to -2) cm, and C point -6.90 (-10 to -3) cm. Seventeen (85%) patients had stage 0 and 3 patients (15%) had stage 1. No mesh erosions or chronic pelvic pain were documented at follow-up. The total PFDI score at follow-up was decreased by 92.8 points (p < 0.0001). CONCLUSIONS: At 2 years' follow-up, the SRS implant was found to be safe, showing no intra-operative or immediate post-operative complications. All women presented with POP-Q measurements of the anterior and apical compartment at normal value (Ba ≤ -2 cm) and statistically significant subjective improvement.

Pain during Female Urethral Catheterization: Intraurethral Lubricant Injection versus Catheter Tip Lubrication--A Prospective Randomized Trial.

PURPOSE: Urethral lubrication during catheterization can be performed by instilling the gel directly in the urethra or by pouring the gel on the catheter tip. In this study we compared the pain level associated with each technique during female urethral catheterization in the setup of a multichannel urodynamic study. MATERIALS AND METHODS: A total of 94 women with a mean ± SD age of 55 ± 14 years who were referred for a multichannel urodynamic study were prospectively randomized into 2 groups according to lubrication technique, including 1) instillation of 5 ml 2% lidocaine gel in the urethra 5 minutes before catheterization or 2) lubrication of the distal part of the catheter with 5 ml 2% lidocaine gel. A visual analog pain scale of 0 to 10 was completed at different time points, including prior to gel instillation (baseline), during gel instillation (group 1), during catheterization, and 5 and 30 minutes after the procedure ended. RESULTS: The study groups did not differ in demographic, clinical or urodynamic parameters. The mean visual analog scale score during catheterization was 2.3 ± 1.4 and 2.4 ± 1.6 in groups 1 and 2, respectively (p = 0.71). There was no difference in the reported visual analog scale score at the other checkpoints. The mean recorded visual analog scale score during instillation of the lubricant in the urethra in group 1 was 1.9 ± 0.9. CONCLUSIONS: The actual act of lubricant instillation in the urethra during catheterization in women causes additional and unnecessary pain. Therefore, it is not recommended. Other than that there is no difference in the urethral pain level between the 2 lubrication techniques.

[Urogynecology: from past to future].

Over the last decade, the field of urogynecologic surgery has been subject to deep changes. A thorough understanding of the injury mechanisms responsible for pelvic organ prolapse (POP) and urinary incontinence in women, greatly contributed to the development of innovative surgical techniques and changing therapeutic approaches. The variety of treatment options to correct POP and incontinence has greatly expanded, partly thanks to the development of several advanced surgical kits by biotechnology companies. This review describes the evolution of surgical techniques in the field of pelvic floor reconstruction during the last century and raises questions regarding the safety and efficacy of the various techniques available in this field. This paper summarizes the "state of the art" for POP and the incontinence surgery approach in Western countries. It also provides a number of general recommendations based on the authors personal experience [expert opinion]. Such recommendations with slight variations appear in position statements of professional societies worldwide.

Validation of Hebrew versions of the Pelvic Floor Distress Inventory, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and the Urgency, Severity and Impact Questionnaire.

OBJECTIVE: Validated objective tools in the native languages of investigated populations are important for evaluating effects of medical disorders and treatments. The aim of our study was to validate a Hebrew version of the validated questionnaires commonly used in the field of urogynecology. METHODS: This is a 2-step, prospective, multicenter study. Using a back-translation method, Hebrew-language versions of the following questionnaires were developed: Pelvic Floor Distress Inventory, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and the Urgency, Severity and Impact Questionnaire. The questionnaires were administered in both Hebrew and English to 56 bilingual patients with pelvic organ prolapse and/or urinary incontinence. To test reliability, the participants were asked to refill the questionnaires in Hebrew 2 weeks later. Scores from the Hebrew and English versions were compared, using the Wilcoxon signed rank test. Correlations between versions were assessed by the Spearman test. P < 0.05 or less was considered significant. RESULTS: Scores from the Hebrew and English versions were found to be highly correlated, ρ = 0.61-0.96; P < 0.001. No differences in total scores were detected between the 2 versions of the 3 questionnaires and their subcategories (P > 0.05). Cronbach alpha values were good (0.65-096) for all questionnaires. Scores were highly correlated when the patients refilled the questionnaires in Hebrew (ρ = 0.81-0.98; P < 0.001). CONCLUSIONS: This study provides validated Hebrew versions of 3 well-accepted pelvic floor questionnaires. These questionnaires will enable standardization when assessing women with pelvic floor dysfunction.

Managing pregnancy and delivery in women with sexual pain disorders.

INTRODUCTION: Vaginismus and dyspareunia most commonly affect women in their childbearing years, yet sexual function, and not childbirth, has been the focus of most research. AIM: The aim of this study is to discuss pregnancy and birth outcomes in women with sexual pain disorders (SPDs) and address practical concerns of patients and practitioners regarding management during pregnancy, pelvic examination, labor, and delivery. METHODS: Review of the relevant literature and recommendations based on clinical expertise of the authors. RESULTS: A review of SPD, conception, and birth outcomes is provided as well as clinical recommendations for prenatal, labor, and delivery management of women with SPD. CONCLUSIONS: Practitioners involved in obstetrical care should be knowledgeable about SPD and provide appropriate modifications and interventions.