Postoperative sexual concerns and functioning in patients who underwent lysis of vulvovaginal adhesions.

OBJECTIVE: This study aimed to determine satisfaction and functioning before and after surgery among women with lichen planus, who have undergone lysis of vulvovaginal adhesions, and to compare their sexual functioning with those of women without this disorder. MATERIALS AND METHODS: The study was approved by the University of Michigan Internal Review Board. A retrospective self-administered survey was completed by 22 women (50-76 years). Eleven women who had undergone surgery to release vulvovaginal adhesions from lichen planus answered a mailed, 75-item questionnaire about health, sexual functioning (using the Female Sexual Function Index), and satisfaction with surgical outcomes 6 months to 6 years after their lysis of vulvovaginal adhesions followed by long-term vaginal dilation. They were compared with 11 age-matched normal controls. We used descriptive statistics such as mean and SDs to describe the population and χ and t tests to determine significant differences between groups. RESULTS: Surgery in women with lichen planus scarring allowed intercourse in 55% and decreased urination difficulties in 75%. Of the patients, 91% stated they were happy with the surgery and would recommend it to others. However, sexual difficulties may persist even after surgery. Approximately 50% of the patients continue to fear pain. There continues to be differences between cases and controls in sexual discomfort and sexual satisfaction. CONCLUSIONS: After surgery for lichen planus, women tend to be more likely to have intercourse, to have less urinary symptoms or infections, and to have fewer genital symptoms. However, for some, sexual difficulties persisted. It may be wise to consider sexual counseling for this population. Nevertheless, most of the patients stated that they were happy with the surgery and would recommend it to others.

Anal intraepithelial lesions in women with human papillomavirus-related disease.

OBJECTIVE: This study aimed to determine the prevalence of anal intraepithelial lesions in women with histologic diagnosis of intraepithelial lesions of the lower genital tract. MATERIALS AND METHODS: This was a cross-sectional study conducted at the Lower Genital Tract and Colposcopy Unit of Hospital de Clínicas "José de San Martín," University of Buenos Aires, Argentina. A total of 481 women with histologically confirmed low-grade and high-grade cervical, vaginal, or vulvar intraepithelial lesions were evaluated between 2005 and 2011. They were referred for cytologic samples and examination with high-resolution anoscopy. We obtained biopsy specimens of any suspicious colposcopic images. RESULTS: Of a total of 481 patients, 404 (84%) were immunocompetent, 31 (6.4%) were HIV+, and 46 (9.6%) had other causes of immunosuppression. Moreover, of the 481 patients, 134 (27.86%) had anal intraepithelial neoplasia (AIN); 28 (5.82%) had high-grade AIN and 106 (22%) had low-grade AIN. Women with high-grade cervical intraepithelial neoplasia (CIN 2, 3) had 2 times the odds of developing AIN compared with women with low-grade CIN (CIN 1) (odds ratio = 1.91, 95% confidence interval = 1.1-3.6). Regarding localization, we found statistically significant difference between the frequency of vulvar and anal lesions. Women with vulvar condylomata and vulvar intraepithelial neoplasia (VIN) may be more likely to develop AIN. CONCLUSIONS: Immunocompetent women with CIN, vaginal intraepithelial neoplasia, or VIN may also present high-grade or low-grade anal intraepithelial lesions so we should consider AIN as part of multicentric disease of the lower genital tract. Cervical intraepithelial neoplasia, VIN, condyloma accuminatta, and vaginal intraepithelial neoplasia could be warning signs of anal intraepithelial lesions.

Adoção de crianças maiores: percepções de profissionais do Serviço de Auxílio à Infância / Adoption of older children: perceptions of professionals in the Department of Aid to Children

O presente estudo busca problematizar a realidade da adoção brasileira à medida que urge em diminuir a distância entre crianças/adolescentes e requerentes à adoção, justamente por o perfil idealizado destes ir à contramão da realidade existente nas instituições de acolhimento de nosso país. Para tanto, à luz do referencial teórico que fundamenta tal estudo e a partir da análise de aspectos relevantes de entrevistas com profissionais do Serviço de Auxílio à Infância de uma cidade do centro-sul do Paraná, é possívelfazer algumas considerações acerca da adoção de crianças maiores a fim de proporcionar reflexões sobre as percepções predominantes no imaginário social, bem como ressonâncias para um a possível nova realidade que contemple a felicidade de crianças maiores/adolescentes que sonham por um lar. (AU)

This study seeks to discuss the adoption of the Brazilian reality as it is urgent to reduce the widening gap between children / adolescents and theadoption applicants just for the idealized profile of these go against the grain of the existing reality in the host institutions of our country. To do so, in light of the theoretical framework that underlies this study and the analysis of relevant aspects of interviews with professionals from the Service Aid to Children of a city in central-southern Paraná, you can make some considerations about the adoption of older children to provide reflections on the prevailing perceptions in the social as well as resonances for a new reality that includes the happiness of older children / teenagers who dream of a home. (AU)

Tratamiento quirúrgico de las lesiones anales intra-epiteliales (AIN) de alto grado / Surgical treatment of high grade intraepitelial anal lesions (AIN)

Introducción: La incidencia del Cáncer de ano se encuentra en aumento tanto en pacientes HIV positivos o inmunosuprimidos como en los inmunocompetentes. Éste se asocia a la infección por HPV, con un comportamiento similar al del desarrollo del cáncer de cuello uterino, a través de la producción de lesiones intra-epiteliales escamosas (SIL). Para su diagnóstico se utiliza la anoscopía de alta resolución. Su tratamiento es aún controversial. Objetivo: Presentamos nuestra experiencia en el tratamiento quirúrgico de lesiones intra-epiteliales anales de alto grado (AIN III) guiadas con anoscopía de alta resolución. Lugar de aplicación o marco de referencia: Hospital Universitario. Diseño: Estudio retrospectivo. Material y métodos: Realizamos una revisión de los pacientes diagnosticados y operados (escisión/cauterización de las lesiones visualizadas con anoscopia de alta resolución) con diagnóstico de lesiones anales intra-epiteliales de alto grado (AIN III) en el marco del Programa de Prevención, Diagnóstico, Terapéutica y Vacunación en Patología del Tracto Genital Inferior del Hospital de Clínicas de Buenos Aires "José de San Martín". Resultados: A las pacientes con antecedentes de infección por HPV en el tracto genital inferior, se las evaluó con anoscopía magnificada. Entre enero de 2005 y agosto de 2010, se estudiaron 305 pacientes (32 inmunosuprimidas). De éstas, 18 (5.9%) presentaron lesiones intra-epiteliales de alto grado (AIN III) confirmadas por histología. Las mismas fueron remitidas para tratamiento quirúrgico. Tres eran inmunosuprimidas, dos por HIV. La edad media fue de 34 años (19-63 años). El seguimiento medio fue de 15 meses, 4 a 39 meses. Se produjo una recurrencia a los 4 meses. Ningún paciente desarrolló incontinencia, estenosis, infección postoperatoria, o hemorragia significativa después del tratamiento quirúrgico... (TRUNCADO)

Introduction: Over the last decades, anal cancer incidence rose to an epidemic range in general population and in some risk groups like inmuno-supressed or HIV patients. Anal cancer develops from squamous intraepithelial lesion (SIL) in the anal transitional zone produced by HPV infection. High resolution anoscopy is used to diagnose these dysplastic changes. There is no consensus about the best treatment option for high grade anal intraepithelial neoplasia (AIN III). Objective: To report our experience in the treatment of high grade anal intraepithelial neoplasia targeted by high resolution anoscopy. Design: Retrospective study. Material and method: Patients diagnose and treated for AIN III in the "Prevention, Diagnosis, Treatment and Vaccination of the Inferior Genital Tract" Program of the Hospital de Clínicas de Buenos Aires "José de San Martín". Results: Patients with history of HPV disease in the genital tract were studied with high resolution anoscopy. 305 patients (32 inmunosupressed) were studied between January of 2005 and August of 2010. 18 (5.9%) had AIN III and were surgically treated. Mean age was 34 years (19-63). Mean follow-up was 15 months (4 to 39). We observed one recurrenee at 4 month. No complications were present. Conclusions: High resolution anoscopy targeted surgery AIN III is feasible and seams to eradicate these lesions in the inmunocompetent patient.