Novas disputas e intervenções no corpo feminino: fronteiras entre ginecologia e cirurgia plástica / New disputes and interventions in the female body: divisions between gynecology and plastic surgery

Resumo Este artigo analisa tensões e disputas entre o campo da ginecologia e da cirurgia plástica estética, especialidades autorizadas a realizar a cirurgia estética genital feminina no Brasil. Utiliza material documental, incluindo artigos científicos desde a década de 1990, e sites institucionais. Enquanto ginecologistas têm se mantido mais cautelosos com a prática, defendendo sua realização apenas quando há indicações funcionais, cirurgiões/ãs plásticos/as têm sido mais influentes na disseminação do procedimento, privilegiando a dimensão estética. Argumenta-se que, para além de disputas entre campos profissionais, esse fenômeno precisa ser entendido à luz da crescente ênfase no aprimoramento de si, via recursos biomédicos, e dos imperativos de gênero.

Abstract This article analyzes the tensions and disputes between the fields of gynecology and esthetic plastic surgery, the specialties which are authorized to perform aesthetic female genital surgeries in Brazil. Documentary materials are used, including scientific articles from the 1990s onward and institutional websites. While gynecologists have remained more cautious, recommending the surgery only for functional reasons, plastic surgeons have been more influential in publicizing these procedures and emphasizing the aesthetic dimension. Beyond professional disputes, we debate whether this phenomenon needs to be understood in light of the growing emphasis on self-improvement via biomedical resources and gender imperatives.

O dispositivo "antes e depois" nas cirurgias estéticas íntimas: novas formas de materialização das normas de gênero / The "before and after" dispositive in intimate aesthetic surgeries: new ways of materializing gender norms / El dispositivo "antes y después" en las cirugías estéticas íntimas: nuevas formas de materializar las normas de género

Resumo Este artigo tem como ponto de partida uma reflexão sobre a produção de imagens e narrativas circunscritas em torno do dispositivo antes e depois. Argumenta que a divulgação de padrões estéticos, especialmente nas redes sociais, opera de modo a prescrever uma necessária transformação e aprimoramento de si. Analisa relatos de experiências de mulheres que realizaram a chamada cirurgia íntima (ninfoplastia ou redução dos pequenos lábios vaginais) com a intenção de melhoria estética. Os depoimentos provêm de um grupo de discussão em torno desses procedimentos na internet. Nos casos em que as intervenções cirúrgicas são avaliadas negativamente, o antes e depois não se realizam da forma prevista. Nesse cenário, as mulheres tendem a ressignificar a necessidade da cirurgia e a reconhecer a imposição, por parte da sociedade, de padrões corporais idealizados. Este processo é discutido por meio do debate acerca do pós-feminismo e constrangimentos de gênero.

Abstract This article analyzes the production of images and narratives circumscribed around the dispositive before and after. It argues that the dissemination of aesthetic standards, especially on social networks, operates in order to prescribe a necessary transformation and improvement of the self. It analyzes reports of experiences of women who underwent the so-called intimate surgery (nymphoplasty or reduction of the labia minora) with the intention of aesthetic improvement. The testimonies come from a discussion group around these procedures on the internet. In cases where surgical interventions are negatively evaluated, the before and after are not performed as expected. In this scenario, women tend to resignify the need for surgery and recognize the imposition, by society, of idealized body standards. This process is discussed through the debate about post-feminism and gender constraints.

Resumen Este artículo tiene como punto de partida una reflexión sobre la producción de imágenes y narrativas circunscritas en torno al dispositivo antes y después. Argumenta que la difusión de normas estéticas, especialmente en las redes sociales, opera para prescribir una necesaria transformación y mejora del yo. Analiza relatos de experiencias de mujeres que se sometieron a la llamada cirugía íntima (ninfoplastía o reducción de labios menores) con la intención de mejorar estéticamente. Los testimonios provienen de un grupo de discusión sobre estos procedimientos en Internet. En los casos en que las intervenciones quirúrgicas son evaluadas negativamente, el antes y el después no se realizan como se esperaba. En ese escenario, las mujeres tienden a resignificar la necesidad de la cirugía y reconocen la imposición, por parte de la sociedad, de patrones corporales idealizados. Este proceso se discute a través del debate sobre el posfeminismo y las restricciones de género.

Vulvar ulcerative cutaneous tuberculosis secondary to genital tract tuberculosis

Abstract Tuberculosis is a chronic infectious disease that gradually poses a certain threat to public health and economic growth. Tuberculosis typically affects the lungs, pleura, and lymph nodes and rarely the skin. Cutaneous tuberculosis manifesting as ulcerated lesions is also rare and often misdiagnosed and missed by clinicians. Here, the authors report a 29-year-old female patient presenting a vulvar ulcer for 10 months, accompanied by irregular menstruation and increased vaginal secretions. After a skin biopsy and endometrial PCR testing, it was finally diagnosed as vulvar ulcerative cutaneous tuberculosis secondary to genital tuberculosis. Antituberculosis treatment was effective. Cutaneous tuberculosis is called a great imitator. In order to facilitate the diagnosis and treatment of tuberculosis by clinicians, the authors systematically reviewed this disease as well.

Vulvar ulcerative cutaneous tuberculosis secondary to genital tract tuberculosis.

Tuberculosis is a chronic infectious disease that gradually poses a certain threat to public health and economic growth. Tuberculosis typically affects the lungs, pleura, and lymph nodes and rarely the skin. Cutaneous tuberculosis manifesting as ulcerated lesions is also rare and often misdiagnosed and missed by clinicians. Here, the authors report a 29-year-old female patient presenting a vulvar ulcer for 10 months, accompanied by irregular menstruation and increased vaginal secretions. After a skin biopsy and endometrial PCR testing, it was finally diagnosed as vulvar ulcerative cutaneous tuberculosis secondary to genital tuberculosis. Anti-tuberculosis treatment was effective. Cutaneous tuberculosis is called a great imitator. In order to facilitate the diagnosis and treatment of tuberculosis by clinicians, the authors systematically reviewed this disease as well.

Abordaje biopsicosocial de la mutilación genital femenina en la Gambia / Biopsicosocial boarding of the feminine genital mutilation in the Gambia

RESUMEN En el presente trabajo de revisión se expone cómo, según los últimos datos de UNICEF, alrededor de tres millones de niñas y mujeres cada año son sometidas a algún tipo de mutilación genital femenina en África, lugar en el que el arraigo social y cultural sobre el que se sustenta y retroalimenta esta práctica se debe a la experiencia de sus mayores, a la de sus propias madres y abuelas, con mensajes religiosos confusos y leyes poco rigurosas. El proceso de socialización que moldea las actitudes de las niñas y las mujeres las prepara para aceptar el dolor y el sufrimiento como parte inevitable de la vida de una mujer y como una obligación a cumplir para ser aceptadas en la sociedad. Sin embargo, las mujeres que lo practican no necesitan una justificación y cuando se les pregunta, remiten a la tradición, a la religión y a cuestiones estéticas, sanitarias o de protección. Es necesario contar con una mirada antropológica del fenómeno para obtener una comprensión de su significación que permita abordar el tema con conocimiento y respeto y así trabajar para conseguir un cambio en la sociedad que conduzca a la eliminación de las causas de vulneración del derecho a la salud y para que se luche por terminar con esta práctica. Por ello, el objetivo del presente estudio es exponer elementos inherentes a la mutilación genital femenina en la República de la Gambia, desde la perspectiva biopsicosocial, de manera que los resultados del estudio se conviertan en una herramienta útil para los profesionales en contacto con la población en riesgo. El estudio se desarrolla en el contexto de la Universidad durante el período noviembre 2020-febrero 2021.

ABSTRACT This review work shows how, according to the latest UNICEF data, around 3 million girls and women each year are subjected to some type of Female Genital Mutilation (FGM) in Africa where the social and cultural roots on which FGM is supported and fed back, it is due to the experience of their elders, their own mothers and grandmothers, with confusing religious messages and lax laws. The socialization process that shapes the attitudes of girls and women prepares them to accept pain and suffering as an inevitable part of a woman's life, and as an obligation to fulfill in order to be accepted in their respective societies. However, the women who practice it do not need a justification and when asked, they refer to tradition, religion and aesthetic, health or protection issues. It is necessary to have an anthropological view of the phenomenon to obtain an understanding of its significance that allows to approach the subject with knowledge and respect and thus work to achieve a change in society that leads to the elimination of the causes of violation of the right to health and fight to end the practice of FGM. Therefore, the objective is to expose the practice of Female Genital Mutilation from a biopsychosocial perspective in the Republic of the Gambia, so that it is a useful tool for professionals in contact with the population at risk. The study is developed in the context the University during the period November 2020-February 2021.

Segmental Cervical Aplasia in a Colombian Creole Mare with Mosaic X-Chromosome Aneuploidy.

A 4-year-old Colombian Creole mare was presented for diagnosis because the external orifice of her cervix was not detectable when a uterine lavage as therapy for uterine fluid accumulation was attempted. Clinical and ultrasonographic evaluation of the genital tract revealed that ovaries were of normal size and showed structures suggestive of regular ovarian activity. However, granular free-floating fluid material distending the uterus was detected by ultrasound. Upon vaginal examination, the normal external cervical morphology was not evident. The vagina ended in a blind bag with a small papilla with no evident external cervical os. Cytology of uterine fluid obtained by transvaginal aspiration showed findings compatible with mucometra. Cytogenetic analysis revealed an abnormal karyotype (63,X and 64,XX both 45% and 65,XXX 10%). A diagnosis of congenital segmental cervical aplasia was proposed possibly related to the mosaicism detected. To our knowledge, this is the first case of this reproductive pathology in a mare with regular ovarian activity and confirmed aneuploidy in mosaic form of the X sex chromosome.

Women's Empowerment as It Relates to Attitudes Towards and Practice of Female Genital Mutilation/Cutting of Daughters: An Ecological Analysis of Demographic and Health Surveys From 12 African Countries.

Background: Women's empowerment may play a role in shaping attitudes towards female genital mutilation/cutting (FGM/C) practices. We aimed to investigate how empowerment may affect women's intention to perpetuate FGM/C and the practice of FGM/C on their daughters in African countries. Materials and methods: We used data from Demographic and Health Surveys carried out from 2010 to 2018. The countries included in our study were Benin, Burkina Faso, Chad, Côte d´Ivoire, Ethiopia, Guinea, Kenya, Mali, Nigeria, Senegal, Tanzania, and Togo. This study included 77,191 women aged 15-49 years with at least one daughter between zero and 14 years of age. The proportion of women who reported having at least one daughter who had undergone FGM/C as well as the mother's opinion towards FGM/C continuation were stratified by empowerment levels in three different domains (decision-making, attitude to violence, and social independence) for each country. We also performed double stratification to investigate how the interaction between both indicators would affect daughter's FGM/C. Results: The prevalence of women who had at least one daughter who had undergone FGM/C was consistently higher among low empowered women. Tanzania, Benin, and Togo were exceptions for which no differences in having at least one daughter subjected to FGM/C was found for any of the three domains of women's empowerment. In most countries, the double stratification pointed to a lower proportion of daughters' FGM/C among women who reported being opposed to the continuation of FGM/C and had a high empowerment level while a higher proportion was observed among women who reported being in favor of the continuation of FGM/C and had a low empowerment level. This pattern was particularly evident for the social independence domain of empowerment. In a few countries, however, a higher empowerment level coupled to a favorable opinion towards FGM/C was related to a higher proportion of daughters' FGM/C. Conclusion: Women's empowerment and opinion towards FGM/C seems to be important factors related to the practice of FGM/C in daughters. Strategies to improve women's empowerment combined with shifts in the wider norms that support FGM/C may be important for achieving significant reductions in the practice.

Mulheres com câncer ginecológico: significado da braquiterapia / Mujeres con cáncerginecológico: significado de la braquiterapia / Women with gynecological cancer: meaning of brachytherapy

RESUMO Objetivo: conhecer o significado da braquiterapia em mulheres com câncer ginecológico. Métodos: pesquisa qualitativa, descritiva e exploratória realizada com 32 mulheres, submetidas à braquiterapia em instituição oncológica de Santa Catarina, Brasil. Na coleta de dados, entre setembro de 2017 e julho de 2018, aplicou-se entrevista semiestruturada. As comunicações foram submetidas à análise de conteúdo, incluindo regras de enumeração para análise dos dados sociodemográficos, clínicos e para quantificação dos relatos agrupados. Publicações relacionadas com o tema e a Teoria do Conforto sustentaram teoricamente a inferência dos dados. Emergiram cinco categorias temáticas, neste artigo apresentam-se três. Resultados: a categoria "O medo e as crenças pessoais no enfrentamento do câncer ginecológico e da braquiterapia" destaca o medo da morte, o desejo pela cura e o apego à família e à religiosidade; "Medo do tratamento e desconfortos relacionados" retrata as alterações relacionadas aos contextos físico, psicológico e ambiental; "Dor como significado" revela a percepção dolorosa sentida pelas mulheres em decorrência da doença ou da braquiterapia. Conclusão: conhecer o significado da braquiterapia permite que os enfermeiros possam repensar a coleta de dados e o planejamento de enfermagem para melhor educação em saúde e redução dos desconfortos.

RESUMEN Objetivo: conocer el significado de la braquiterapia en mujeres con cáncer ginecológico. Métodos: investigación cualitativa, descriptiva y exploratoria realizada con 32 mujeres, sometidas a la braquiterapia en institución oncológica de Santa Catarina, Brasil. En la recolección de datos, entre septiembre de 2017 y julio de 2018, se aplicó entrevista semiestructurada. Los relatos fueron sometidos al análisis de contenido, incluyendo reglas de enumeración para análisis de los datos sociodemográfico, clínicos y para cuantificación de los relatos agrupados. Publicaciones relacionadas con el tema yla Teoría del Confort basaron teóricamente la inferencia de los datos. Surgieron cinco categorías temáticas, en este artículo se presentan tres. Resultados: la categoría "El miedo y las creencias personales en el enfrentamiento del cáncer ginecológico y de la braquiterapia" destaca el temor a la muerte, el deseo por la cura y el apego a la familia y a la religiosidad; "Miedo al tratamiento y las molestias relacionadas" retrata las alteraciones relacionadas a los contextos físico, psicológico y ambiental; "Dolor como significado" revela la percepción dolorosa sentida por las mujeres debido a la enfermedad o la braquiterapia. Conclusión: conocer el significado de la braquiterapia permite que los enfermeros puedan repensar la recolección de datos y la planificación de enfermería para una mejor educación en salud y reducción de las molestias.

ABSTRACT Objective: to know the meaning of brachytherapy in women with gynecological cancer. Methods: qualitative, descriptive and exploratory research conducted with 32 women who underwent brachytherapy at an oncology institution in Santa Catarina, Brazil. Data collection took place between September 2017 and July 2018 through semi-structured interviews. Communications were submitted to content analysis, including enumeration rules for the analysis of sociodemographic and clinical data and for the quantification of grouped reports. Publications related to the theme and the Comfort Theory theoretically supported the inference of the data. Five thematic categories emerged; in this article three are presented. Results: the category "Fear and personal beliefs in coping with gynecological cancer and brachytherapy" highlights the fear of death, the desire for healing and attachment to family and religiosity; "Fear of treatment and related discomforts" depicts changes related to physical, psychological and environmental contexts; "Pain as meaning" reveals the painful perception felt by women as a result of illness or brachytherapy. Conclusion: knowing the meaning of brachytherapy allows nurses to rethink data collection and nursing planning for better health education and reduction of discomfort.

Anatomia do sistema reprodutor feminino de Alouatta belzebul (Linnaeus, 1766) / [Anatomy of the female reproductive system of the Alouatta belzebul (Linnaeus, 1766)]

O conhecimento da anatomia de qualquer animal silvestre é de fundamental importância para sua preservação e proteção. Neste contexto, o presente estudo objetivou descrever a morfologia do sistema reprodutor feminino de Alouatta belzebul. Foram utilizados seis espécimes de A. belzebul, fêmeas, adultas, e livres de lesões. Observou-se macroscopicamente que os ovários têm características morfológicas em formato ovoides, com superfície lisa, e, na análise histológica na região de córtex, evidenciou-se folículos ovarianos em diferentes estágios de desenvolvimento. As tubas uterinas anatomicamente são finas e curvilíneas, apresentando uma camada mucosa, uma muscular e outra serosa. O útero possui formato simples, com fundo globoso, com um miométrio altamente vascularizado, sendo organizado em feixes de fibras musculares lisas. A estrutura anatômica da vagina apresentou-se como um tubo muscular longo de paredes finas, onde, na região vestibular, o óstio externo da uretra é marcado por uma papila uretral bilobada e, na região de vulva, em sua porção caudal, contatou-se um clitóris bem desenvolvido. No que concerne à análise histológica da vagina, verificou-se, em região de mucosa vaginal, um extrato basal composto por epitélio estratificado pavimentoso não queratinizado atrófico. As descrições morfológicas fornecem, de forma inédita, informações importantes relativas à anatomia macroscópica e microscópica do sistema reprodutor feminino dessa espécie.(AU)

Knowledge of the anatomy of any wild animal is of fundamental importance for its preservation and protection. In this context the present study aimed to describe the morphology of the female reproductive system of A. belzebul. We used 6 specimens of A. belzebul, female, adult and free of lesions. It was macroscopically observed that the ovaries are ovoid with smooth surface and the histological analysis in cortical region showed ovarian follicles in different stages of development. The fallopian tubes are anatomically thin and curvilinear, with one mucous layer, one muscular and one serous layer. The uterus was presented in a simple format with a globular fundus, with a highly vascularized myometrium, being organized in bundles of smooth muscle fibers. The anatomical structure of the vagina presented itself as a long thin-walled muscular tube where in the vestibular region the external orifice of the urethra is marked by a bilobed urethral papilla and in the caudal portion in its caudal portion a well-developed clitoris. Regarding the histological analysis of the vagina, a basal extract composed of atrophic non-keratinized stratified squamous epithelium was found in the vaginal mucosa region. The morphological descriptions provide important information regarding the macroscopic and microscopic anatomy of the female reproductive system of this species in an unprecedented way.(AU)

Desgarro perineal con mucosa vaginal íntegra tras primera relación sexual / Perineal tear with intact vaginal mucosa after first sexual intercourse

RESUMEN Las lesiones del tracto genital femenino tras relaciones sexuales son un problema frecuente en las urgencias de ginecología, pero poco estudiado salvo su aspecto médico-legal. Su incidencia es desconocida ya que muchas mujeres no llegan a consultar por miedo o pudor. El reconocimiento precoz de estas lesiones y su correcto tratamiento puede evitar la parición de secuelas que acompañarán a nuestra paciente durante el resto de su vida. Presentamos el caso de una paciente de 18 años con un desgarro perineal con mucosa vaginal íntegra tras su primera relación sexual.

ABSTRACT Injuries to the female genital tract after sexual intercourse are a frequent problem in gynecological emergencies, but little studied except for their medico-legal aspect. Its incidence is unknown since many women do not go to their specialist out of fear or embarrassment. Early recognition of these injuries and their correct treatment may prevent the appearance of sequelae that will accompany our patient for the rest of her life. We present the case of an 18-year-old patient with a perineal tear with intact vaginal mucosa after her first sexual intercourse.

Validação de um manual de orientações para pacientes submetidas à braquiterapia ginecológica / Validación de un manual de orientaciones para pacientes sometidas a braquiterapia ginecológica / Validation of a guidance manual for patients undergoing brachyterapy for gynecologic cancer

RESUMO Objetivo: validar o conteúdo de manual de orientações direcionado a mulheres com câncer ginecológico submetidas à braquiterapia. Método: pesquisa metodológica, realizada por 15 peritos na área temática do manual, entre enfermeiras, médicos, psicólogas e nutricionistas. Para que o manual fosse considerado válido, era necessário atingir Índice de Concordância mínimo de 80% entre os peritos. Resultados: dos 21 itens avaliados, três não alcançaram o índice mínimo estabelecido, e foram reformulados com base nas sugestões dos participantes e literatura atual. Todos os outros itens foram considerados adequados e/ou totalmente adequados nos três domínios avaliativos: objetivos - 81,3%, estrutura e apresentação - 86,6%, e relevância - 94,6%. Conclusão: o manual educativo foi validado quanto ao conteúdo, podendo ser utilizado como complemento às orientações verbais fornecidas durante a consulta de enfermagem para promoção do autocuidado, e facilitar a comunicação entre profissional de saúde e paciente, no que concerne ao seu tratamento.

RESUMEN: Objetivo: validar el contenido de manual de orientaciones para mujeres con cáncer ginecológico sometidas a braquiterapia. Método: investigación metodológica, hecha por 15 expertos por área temática, entre enfermeras, médicos, psicólogas y nutricionistas. Para que el manual fuera válido, se necesita alcanzar el Índice de Concordancia mínimo de 80% entre los expertos. Resultados: de los 21 ítems evaluados, tres no obtuvieron el índice mínimo establecido, siendo reformulados con base en las sugerencias de los participantes y de literatura actual. Todos los demás ítems se los consideraron adecuados y/o totalmente adecuados en los tres ámbitos evaluativos: objetivos - 81,3%, estructura y presentación - 86,6%, y relevancia - 94,6%. Conclusión: se validó el manual educativo en cuanto al contenido y éste se puede utilizar como complemento a las orientaciones verbales fornecidas durante la consulta de enfermería para promoción del autocuidado y facilitar la comunicación entre profesional de salud y paciente acerca del tratamiento.

ABSTRACT Objective: to validate the content of a guidance manual for women undergoing brachytherapy for gynecologic cancer. Method: methodological research conducted by 15 experts in the topic addressed in the manual, including nurses, doctors, psychologists and nutritionists. A minimum level of agreement of 80% between the experts was required for the validation of the manual. Results: Of the 21 items assessed, three did not reach the minimum level of consensus established and were reformulated based on the suggestions of the participants and on the current literature. All other items were considered appropriate and/or totally appropriate in the three assessment domains: objectives - 81.3%, structure and presentation - 86.6%, and relevance - 94.6%. Conclusion: the educational manual was validated for its content and can be used as a complement to the verbal guidelines provided during nursing consultations to promote self-care, and to facilitate communication between healthcare professionals and patients regarding the treatment.

Assessment of Female Genital Surgery Education in Plastic Surgery Training: Report of an Expert Opinion Survey.

BACKGROUND: Patient demand for aesthetic genital surgery has markedly increased. The International Society of Aesthetic Plastic Surgery reported 95,010 labiaplasties and 50,086 vaginal rejuvenation procedures in 2015. METHODS: We performed an online anonymous survey to evaluate the teaching of female genital procedures in plastic surgery training programs worldwide. RESULTS: A total of 1033 board certified plastic surgeons answered the survey. Most respondents were from the USA, Brazil, Mexico and Colombia. The majority of plastic surgeons performing these procedures were in private practice (77.62%) and (22.38%) in academic settings. Most plastic surgeons (75.63%) did not receive formal education in female genital rejuvenation procedures however 54.31% did receive education in reconstruction procedures. During their training, most were exposed to vaginal reconstruction (15.94%), labia minora reduction (11.9%), vulva reconstruction (11.53%), flaps for vaginal agenesis (11.39%) and monsplasty (7.98%). Additional training for female genital procedures was mostly at meetings and shadowing experts. Sixty-two percent reported that patients seldom requested those procedures, and 63.73% reported these procedures comprised less than 5% of their practice. The most commonly performed procedures were labia minora reduction, labia majora augmentation or reduction and monsplasty. The materials used were mostly fat grafting, hyaluronic acid injections and lasers. CONCLUSION: Additional formal training during residency for aesthetic genital surgery would be beneficial. Additionally, courses at meetings would be useful for plastic surgeons who have had insufficient training. More studies need to be conducted on the different female genital rejuvenation procedures offered in order to evaluate patients' long-term outcomes and satisfaction. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The high-risk human papillomavirus continuum along the female reproductive tract and its relationship to infertility and endometriosis.

RESEARCH QUESTION: Is there an association between the presence of sexually transmitted pathogens in the lower (LGT) and upper (UGT) female genital tract with endometriosis and infertility? DESIGN: Case-control study with 60 women submitted to gynaecological laparoscopic surgery. Samples from the UGT and LGT were collected and analysed by single polymerase chain reaction (PCR) for human papillomavirus (HPV) and by multiplex PCR for other sexually transmitted infections (STI). Patients were initially divided into two clinical groups: infertile patients (n = 25) with conjugal infertility and fertile control patients (n = 35). After the surgical findings patients were further divided for additional analysis: an endometriosis group (n = 29) and non-endometriosis control group (n = 31). RESULTS: Sixty per cent of patients were positive for DNA-HPV in some of the genital tract sites sampled. Infertile patients were associated with high-risk HPV (hrHPV) positivity in the UGT sites (P = 0.027). The endometriosis group was associated with hrHPV positivity in the LGT and UGT sites (P = 0.0002 and P = 0.03, respectively). Only hrHPV types were detected in the UGT in both groups. It may be that there is a hrHPV infection continuum, from LGT to UGT, in infertile and endometriosis patients. No association was observed among the other seven STI studied. CONCLUSIONS: This study shows both an association between hrHPV infections in the UGT with infertility and endometriosis, and a possible hrHPV infection continuum, from LGT to UGT. Larger studies are needed to fully investigate the role of hrHPV as a cause of endometriosis and infertility.

Mutilación genital femenina: un riesgo incrementado por la indiferencia social / Female genital mutilation: an increased risk by social indifference

Resumen La Mutilación Genital Femenina (MGF) constituye una grave violación a los derechos humanos, de la mujer y de la niñez. Si bien se considera una práctica ancestral en algunas culturas, y es justificada y reproducida bajo el relativismo cultural, es un problema que requiere una mayor atención de las instituciones en general y de la salud pública en particular. Colombia es uno de los pocos países en el continente que reporta casos de prácticas de mutilación; sin embargo, el problema es mundial, no solo por los altos flujos de migración de población en alto riesgo en Europa y Norteamérica, sino porque es un imperativo global erradicar de una de las peores formas de violencia contra la mujer.

Abstract Female genital mutilation constitutes a grave violation of human, women and children rights. It is considered an ancestral practice in some cultures, where it is justified and reproduced under the cultural relativism. It is a problem that requires greater attention of the institutions in general and public health in particular. Colombia is one of the few countries in America that reported cases of mutilation practices. However, the problem is global by large flows of high risk migrants to Europe and North America. Its eradication is a global imperative because it is one of the worst types of violence against women.

Perfil sociodemográfico e clínico de mulheres com câncer no trato genital submetidas à radioterapia / Perfil social demográfico y clínico de mujeres con cáncer en el trato genital sometidas a la radioterapia / Sociodemographic and clinical profile of women with cancer in the genital tract who underwent radiation therapy

RESUMO Objetivo caracterizar o perfil sociodemográfico e clínico de mulheres com câncer no trato genital submetidas à radioterapia no Centro de Pesquisas Oncológicas entre 2010 e 2014. Método estudo ecológico realizado em 880 arquivos do Registro Hospitalar de Câncer. A análise ocorreu por estatística descritiva, com cálculo de taxa de prevalência. Resultados a maior incidência, 204 casos (23,18%) ocorreu na faixa etária dos 40-49 anos; com maior taxa de prevalência dos 60 a 69 anos, 165 casos (82,28%) para cada 100.000 mulheres. Estádio III com 315 casos (35,8%), topografia colo do útero com 695 casos (78,97%) e respectivas taxas de prevalências 12,97%, 28,61%. Dos casos de câncer do colo do útero, 274 (39,77%) foram procedentes da Grande Florianópolis e 99 (14,37%) da macrorregião Sul. Conclusão reafirma-se a magnitude do câncer do colo do útero, a necessidade das políticas públicas para prevenção da doença e do diagnóstico precoce das lesões pré-neoplásicas e/ou neoplásicas.

RESUMEN Objetivo caracterizar el perfil social demográfico y clínico de mujeres con cáncer en el trato genital sometidas a la radioterapia en el Centro de Pesquisas oncológicas entre 2010 y 2014. Método estudio ecológico que se realizó por medio de 880 archivos del Registro Hospitalario de Cáncer. El análisis se hizo por estadística descriptiva, con cálculo de taja de prevalencia. Resultados la mayor incidencia, 204 casos (23,18%), ocurrió en la franja etaria de los 40-49 años; con mayor taja de prevalencia de los 60 a 69 años, 165 casos (82,28%) para cada 100.000 mujeres. Estadio III con 315 casos (35,8%), topografía de cuello del útero con 695 casos (78,97%) y respectivas tajas de prevalencias 12,97%, 28,61%. De los casos de cáncer del cuello de útero, 274 (39,77%) ocurrieron en la Grande Florianópolis (Santa Catarina, Brasil) y 99 (14,37%) en la macro región Sur. Conclusión se reafirman la magnitud del cáncer de cuello del útero, la necesidad de las políticas públicas para prevención de la enfermedad y el diagnóstico precoz de las lesiones pre neoplásicas y/o neoplásicas.

ABSTRACT Objective To characterize the sociodemographic and clinical profile of women with cancer in the genital tract who underwent radiation therapy at the Centro de Pesquisas Oncológicas between 2010 and 2014. Method Ecological study of 880 files of the Hospital-based Cancer Registry. Descriptive statistics, with calculation of the prevalence rate was used in the analysis. Results The higher incidence, 204 cases (23.18%) occurred in the age group of 40-49 years; with a higher prevalence rate from 60 to 69 years, 165 cases (82.28%) for every 100,000 women. Stage III with 315 cases (35.8%), cervical topography with 695 cases (78.97%) and respective prevalence rates 12.97%, 28.61%. Of the total cases of cervical cancer, 274 (39.77%) were from Grande Florianópolis (Santa Catarina, Brazil) and 99 (14.37%) from the southern macro-region. Conclusion The importance of cervical cancer, the need for public policies for disease prevention and early diagnosis of pre-neoplastic and/or cancer lesions are reaffirmed here.

Técnicas obliterativas en el tratamiento quirúrgico del prolapso genital femenino: experiencia en el Servicio de Salud Metropolitano Oriente, Santiago-Chile / Obliterative techniques in the surgical treatment of female genital prolapse: experience in the Metropolitan Health Service Oriente, Santiago-Chile

INTRODUCCIÓN Y OBJETIVOS: El prolapso genital afecta hasta al 50% de las mujeres a nivel mundial, su calidad de vida, percepción corporal y vida sexual. A las pacientes de edad avanzada frecuentemente les ofrecemos técnicas quirúrgicas obliterativas para su manejo. El objetivo fue evaluar los resultados de las técnicas obliterativas basados en nuestra experiencia local. MÉTODOS: análisis retrospectivo de pacientes tratadas con técnicas obliterativas en nuestro hospital entre los años 2008 y 2016. RESULTADOS: se incluyeron 78 pacientes, la edad promedio fue de 74.5 años, 11.5% de las pacientes presentaba comorbilidad de mayor riesgo quirúrgico, 24% eran pacientes histerectomizadas por prolapso y 30.8% presentaba incontinencia de orina al momento de la cirugía. El tiempo quirúrgico promedio fue 52 minutos, 73.1% de las cirugías fueron con técnica de LeFort y 5.1% presentó complicaciones postquirúrgicas precoces. Se contactaron telefónicamente 59 pacientes, 90% refirió mejor calidad de vida, 92% satisfacción con la cirugía, 3.4% recidiva del prolapso y 44% incontinencia urinaria, en su mayoría moderada o severa. La recidiva reportada estuvo acorde a lo reportado en la literatura, pero la incontinencia de orina reportada fue muy alta respecto a lo reportado y de predominio de urgencias. CONCLUSIÓN: las técnicas obliterativas son efectivas en el tratamiento quirúrgico del prolapso y el principal problema postquirúrgico a largo plazo asociado fue la incontinencia de orina de urgencias.

INTRODUCTION AND OBJECTIVES: Genital prolapse affects up to 50% of women worldwide, their quality of life, body perception and sex life. For older patients, we often offer obliterative surgical techniques to manage it. The objective was to evaluate the results of the obliterative techniques based on our local experience. METHODS: retrospective analysis of patients treated with obliterative techniques in our hospital between 2008 y 2016. RESULTS: 78 patients were included, with an average age of 74.5 years, 11.5% of the patients had comorbidities of high surgical risk, 24% were previously hysterectomized because of genital prolapse and 30.8% had urinary incontinence at the time of the surgery. Average surgical time was 52 minutes, 73.1% of the surgeries were performed with the LeFort technique and 5.1% presented early postoperative complications. 59 patients were contacted by telephone, 90% reported better quality of life, 92% were satisfied with the surgery, 3.4% had recurrence of the prolapse and 44% reported urinary incontinence, mostly moderate or severe. The reported relapse was in line with what was reported in the literature, but the reported urinary incontinence was very high compared to what was reported, and was predominantly urge incontinence. CONCLUSION: obliterative techniques are effective in the surgical treatment of genital prolapse and the main long term problem after surgery was urge incontinence.

Morfologia de órgãos genitais femininos de quelônio semi-aquático Mesoclemmys vanderhaegei / Morphology of the female genital organs of freshwater turtle Mesoclemmys vanderhaegei

O Mesoclemmys vanderhaegei (Testudines: Chelidae) é um quelônio de água doce cuja ocorrência é descrita nas bacias dos rios Amazonas, Tocantins, Paraguai, Paraná e Uruguai. Consta na lista vermelha de espécies ameaçadas da International Union for Conservation of Nature, como espécie de baixo risco, mas que poderá se tornar ameaçada, sendo necessário a atualização de seus dados ecológicos e biológicos. Considerando que planos de manejo e conservação de espécies dependem também de vasto conhecimento sobre a biologia reprodutiva, apresentamos a primeira descrição macroscópica dos órgãos genitais de fêmeas jovens e adultas de M. vanderhaegei correlacionando esses achados ao tamanho do espécime e ao período do ano. Exemplares de M. vanderhaegei foram coletados no município de Chapada dos Guimarães, área de ampla ocorrência natural da espécie. A descrição dos órgãos genitais foi realizada a partir de 17 fêmeas fixadas em formol a 10% e dissecadas para evidenciação de particularidades relacionadas à anatomia externa e interna. Os órgãos genitais M. vanderhaegei jovens e adultas são constituídos por pares de ovários e ovidutos que desembocam dorsolateralmente na cloaca, formando junto com o ureter a papila urogenital. Os ovários são órgãos alongados, com a extremidade cranial mais larga e caudal afunilada, já os ovidutos são longos e localizados lateralmente aos ovários, sendo em adultas, muito diferenciado na sua forma e tamanho em relação ao das jovens. Em ambas faixas etárias, os órgãos genitais são sustentados por pregas de membrana celomática que emergem do teto da cavidade, constituindo os mesovário e mesoviduto. De acordo com a forma e o padrão de mucosa do oviduto em fêmeas adultas, o segmento cranial corresponde as regiões do infundíbulo e magnum, o segmento médio, ao istmo e no caudal identificam-se as regiões útero e vagina. No assoalho do urodeum aloja-se o clitóris. O comprimento retilíneo de carapaça e massa corpórea entre fêmeas imaturas e adultas variam, respectivamente, entre 134-155,6mm e 134,43-365g. A maioria das fêmeas jovens foram capturadas no período chuvoso e as adultas sem e com ovos no período seco. As características macroscópicas dos órgãos genitais observadas em M. vanderhaegei são compartilhadas com outros Testudines, exceto pela papila urogenital e presença do clitóris.(AU)

Mesoclemmys vanderhaegei (Testudines: Chelidae) is a freshwater turtle with occurrence in Amazon, Tocantins, Paraguai, Paraná and Uruguai rivers basins. Although according to International Union for Conservation of Nature, it has low risk of extinction, there is an uptade necessity of ecological and biological data. Considering that the management and conservation plans are related to a wide knowledge of reproductive biology, a first macroscopic description about the young and adults females of M. vanderhaegei is important. These points were correlated to the specimens size and period of the year. The samples of M. vanderhaegei were collected in Chapada dos Guimarães county, Mato Grosso, Brazil, an area of large natural occurrence of the specimens. Genital organs of seventeen females were fixed in 10% formalin and then dissected to demonstrate the particularities related to external and internal anatomy. The young and adult M. vanderhaegei genitals organs are composed of ovaries and oviducts pairs that dorsolaterally discharge into the cloaca, forming with the ureter, the urogenital papilla. The ovaries are elongated organs with larger cranial and elongated caudal portions. The oviducts, which are in adults very differentiated in its shape and size compared to the young, are long and located laterally to the ovaries. In both age groups, the genital organs are supported by celomatic membrane folds that emerge from the ceiling of the cavity, constituting the mesovary and mesoviduct. In adult females, according to the shape and pattern of the oviduct mucosa, the cranial segment corresponds to the regions of the infundibulum and magnum; the middle segment, the isthmus and the caudal segment identify the uterus and vagina regions. The clitoris is sited on the floor of the urodeum. The carapace linear length and body mass between immature and adult females vary to 134-155.6mm e 134.43-365g respectively. The main part of young females was captured in rainy period and the adults, with and without eggs, at dry period. The macroscopic characteristics of the M. vanderhaegei genital organs are also observed in others Testudines, with the exception of urogenital papilla and by the clitoris presence.(AU)

Morfologia de órgãos genitais femininos de quelônio semi-aquático Mesoclemmys vanderhaegei / Morphology of the female genital organs of freshwater turtle Mesoclemmys vanderhaegei

O Mesoclemmys vanderhaegei (Testudines: Chelidae) é um quelônio de água doce cuja ocorrência é descrita nas bacias dos rios Amazonas, Tocantins, Paraguai, Paraná e Uruguai. Consta na lista vermelha de espécies ameaçadas da International Union for Conservation of Nature, como espécie de baixo risco, mas que poderá se tornar ameaçada, sendo necessário a atualização de seus dados ecológicos e biológicos. Considerando que planos de manejo e conservação de espécies dependem também de vasto conhecimento sobre a biologia reprodutiva, apresentamos a primeira descrição macroscópica dos órgãos genitais de fêmeas jovens e adultas de M. vanderhaegei correlacionando esses achados ao tamanho do espécime e ao período do ano. Exemplares de M. vanderhaegei foram coletados no município de Chapada dos Guimarães, área de ampla ocorrência natural da espécie. A descrição dos órgãos genitais foi realizada a partir de 17 fêmeas fixadas em formol a 10% e dissecadas para evidenciação de particularidades relacionadas à anatomia externa e interna. Os órgãos genitais M. vanderhaegei jovens e adultas são constituídos por pares de ovários e ovidutos que desembocam dorsolateralmente na cloaca, formando junto com o ureter a papila urogenital. Os ovários são órgãos alongados, com a extremidade cranial mais larga e caudal afunilada, já os ovidutos são longos e localizados lateralmente aos ovários, sendo em adultas, muito diferenciado na sua forma e tamanho em relação ao das jovens. Em ambas faixas etárias, os órgãos genitais são sustentados por pregas de membrana celomática que emergem do teto da cavidade, constituindo os mesovário e mesoviduto. De acordo com a forma e o padrão de mucosa do oviduto em fêmeas adultas, o segmento cranial corresponde as regiões do infundíbulo e magnum, o segmento médio, ao istmo e no caudal identificam-se as regiões útero e vagina. No assoalho do urodeum aloja-se o clitóris. O comprimento retilíneo de carapaça e massa corpórea entre fêmeas imaturas e adultas variam, respectivamente, entre 134-155,6mm e 134,43-365g. A maioria das fêmeas jovens foram capturadas no período chuvoso e as adultas sem e com ovos no período seco. As características macroscópicas dos órgãos genitais observadas em M. vanderhaegei são compartilhadas com outros Testudines, exceto pela papila urogenital e presença do clitóris.(AU)

Mesoclemmys vanderhaegei (Testudines: Chelidae) is a freshwater turtle with occurrence in Amazon, Tocantins, Paraguai, Paraná and Uruguai rivers basins. Although according to International Union for Conservation of Nature, it has low risk of extinction, there is an uptade necessity of ecological and biological data. Considering that the management and conservation plans are related to a wide knowledge of reproductive biology, a first macroscopic description about the young and adults females of M. vanderhaegei is important. These points were correlated to the specimens size and period of the year. The samples of M. vanderhaegei were collected in Chapada dos Guimarães county, Mato Grosso, Brazil, an area of large natural occurrence of the specimens. Genital organs of seventeen females were fixed in 10% formalin and then dissected to demonstrate the particularities related to external and internal anatomy. The young and adult M. vanderhaegei genitals organs are composed of ovaries and oviducts pairs that dorsolaterally discharge into the cloaca, forming with the ureter, the urogenital papilla. The ovaries are elongated organs with larger cranial and elongated caudal portions. The oviducts, which are in adults very differentiated in its shape and size compared to the young, are long and located laterally to the ovaries. In both age groups, the genital organs are supported by celomatic membrane folds that emerge from the ceiling of the cavity, constituting the mesovary and mesoviduct. In adult females, according to the shape and pattern of the oviduct mucosa, the cranial segment corresponds to the regions of the infundibulum and magnum; the middle segment, the isthmus and the caudal segment identify the uterus and vagina regions. The clitoris is sited on the floor of the urodeum. The carapace linear length and body mass between immature and adult females vary to 134-155.6mm e 134.43-365g respectively. The main part of young females was captured in rainy period and the adults, with and without eggs, at dry period. The macroscopic characteristics of the M. vanderhaegei genital organs are also observed in others Testudines, with the exception of urogenital papilla and by the clitoris presence.(AU)

Morfologia de órgãos genitais femininos de quelônio semi-aquático Mesoclemmys vanderhaegei

ABSTRACT: Mesoclemmys vanderhaegei (Testudines: Chelidae) is a freshwater turtle with occurrence in Amazon, Tocantins, Paraguai, Paraná and Uruguai rivers basins. Although according to International Union for Conservation of Nature, it has low risk of extinction, there is an uptade necessity of ecological and biological data. Considering that the management and conservation plans are related to a wide knowledge of reproductive biology, a first macroscopic description about the young and adults females of M. vanderhaegei is important. These points were correlated to the specimens size and period of the year. The samples of M. vanderhaegei were collected in Chapada dos Guimarães county, Mato Grosso, Brazil, an area of large natural occurrence of the specimens. Genital organs of seventeen females were fixed in 10% formalin and then dissected to demonstrate the particularities related to external and internal anatomy. The young and adult M. vanderhaegei genitals organs are composed of ovaries and oviducts pairs that dorsolaterally discharge into the cloaca, forming with the ureter, the urogenital papilla. The ovaries are elongated organs with larger cranial and elongated caudal portions. The oviducts, which are in adults very differentiated in its shape and size compared to the young, are long and located laterally to the ovaries. In both age groups, the genital organs are supported by celomatic membrane folds that emerge from the ceiling of the cavity, constituting the mesovary and mesoviduct. In adult females, according to the shape and pattern of the oviduct mucosa, the cranial segment corresponds to the regions of the infundibulum and magnum; the middle segment, the isthmus and the caudal segment identify the uterus and vagina regions. The clitoris is sited on the floor of the urodeum. The carapace linear length and body mass between immature and adult females vary to 134-155.6mm e 134.43-365g respectively. The main part of young females was captured in rainy period and the adults, with and without eggs, at dry period. The macroscopic characteristics of the M. vanderhaegei genital organs are also observed in others Testudines, with the exception of urogenital papilla and by the clitoris presence.

RESUMO: O Mesoclemmys vanderhaegei (Testudines: Chelidae) é um quelônio de água doce cuja ocorrência é descrita nas bacias dos rios Amazonas, Tocantins, Paraguai, Paraná e Uruguai. Consta na lista vermelha de espécies ameaçadas da International Union for Conservation of Nature, como espécie de baixo risco, mas que poderá se tornar ameaçada, sendo necessário a atualização de seus dados ecológicos e biológicos. Considerando que planos de manejo e conservação de espécies dependem também de vasto conhecimento sobre a biologia reprodutiva, apresentamos a primeira descrição macroscópica dos órgãos genitais de fêmeas jovens e adultas de M. vanderhaegei correlacionando esses achados ao tamanho do espécime e ao período do ano. Exemplares de M. vanderhaegei foram coletados no município de Chapada dos Guimarães, área de ampla ocorrência natural da espécie. A descrição dos órgãos genitais foi realizada a partir de 17 fêmeas fixadas em formol a 10% e dissecadas para evidenciação de particularidades relacionadas à anatomia externa e interna. Os órgãos genitais M. vanderhaegei jovens e adultas são constituídos por pares de ovários e ovidutos que desembocam dorsolateralmente na cloaca, formando junto com o ureter a papila urogenital. Os ovários são órgãos alongados, com a extremidade cranial mais larga e caudal afunilada, já os ovidutos são longos e localizados lateralmente aos ovários, sendo em adultas, muito diferenciado na sua forma e tamanho em relação ao das jovens. Em ambas faixas etárias, os órgãos genitais são sustentados por pregas de membrana celomática que emergem do teto da cavidade, constituindo os mesovário e mesoviduto. De acordo com a forma e o padrão de mucosa do oviduto em fêmeas adultas, o segmento cranial corresponde as regiões do infundíbulo e magnum, o segmento médio, ao istmo e no caudal identificam-se as regiões útero e vagina. No assoalho do urodeum aloja-se o clitóris. O comprimento retilíneo de carapaça e massa corpórea entre fêmeas imaturas e adultas variam, respectivamente, entre 134-155,6mm e 134,43-365g. A maioria das fêmeas jovens foram capturadas no período chuvoso e as adultas sem e com ovos no período seco. As características macroscópicas dos órgãos genitais observadas em M. vanderhaegei são compartilhadas com outros Testudines, exceto pela papila urogenital e presença do clitóris.