Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 245
Filtrar
1.
Eur J Cancer ; 128: 7-16, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32109852

RESUMO

BACKGROUND: Concurrent chemoradiotherapy is the standard treatment for anal cancer. Following national UK implementation of intensity-modulated radiotherapy (IMRT), this prospective, national cohort evaluates the one-year oncological outcomes and patient-reported toxicity outcomes (PRO) after treatment. MATERIALS AND METHODS: A national cohort of UK cancer centers implementing IMRT was carried out between February to July 2015. Cancer centers provided data on oncological outcomes, including survival, and disease and colostomy status at one-year. EORTC-QLQ core (C30) and colorectal (CR29) questionnaires were completed at baseline and one-year followup. The PRO scores at baseline and one year were compared. RESULTS: 40 UK Cancer Centers returned data with a total of 187 patients included in the analysis. 92% received mitomycin with 5-fluorouracil or capecitabine. One-year overall survival was 94%; 84% were disease-free and 86% colostomy-free at one-year followup. At one year, PRO results found significant improvements in buttock pain, blood and mucus in stools, pain, constipation, appetite loss, and health anxiety compared to baseline. No significant deteriorations were reported in diarrhea, bowel frequency, and flatulence. Urinary symptom scores were low at one year. Moderate impotence symptoms at baseline remained at one year, and a moderate deterioration in dyspareunia reported. CONCLUSIONS: With national anal cancer IMRT implementation, at this early pre-defined time point, one-year oncological outcomes were reassuring and resulted in good disease-related symptom control. one-year symptomatic complications following CRT for anal cancer using IMRT techniques appear to be relatively mild. These PRO results provide a basis to benchmark future studies.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias do Ânus/terapia , Medidas de Resultados Relatados pelo Paciente , Lesões por Radiação/epidemiologia , Radioterapia de Intensidade Modulada/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Ânus/mortalidade , Diarreia/diagnóstico , Diarreia/epidemiologia , Diarreia/etiologia , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Relação Dose-Resposta à Radiação , Dispareunia/diagnóstico , Dispareunia/epidemiologia , Dispareunia/etiologia , Disfunção Erétil/diagnóstico , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Feminino , Flatulência/diagnóstico , Flatulência/epidemiologia , Flatulência/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Estudos Prospectivos , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Índice de Gravidade de Doença , Reino Unido/epidemiologia
2.
Ther Umsch ; 73(9): 565-571, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31113317

RESUMO

Vulvar Pain Abstract. During their lifetime, many women experience vulvar and / or vaginal pain. The reasons of those pains or discomforts can be multiple and sometimes hard to identify and therefore difficult to treat. Besides organic causes such as infections, inflammations, changes after operations and others we can find complex conditions such as vulvodynia and dyspareunia. Vulvodynia is a vulvar pain of at least 3 months duration without clear identifiable cause, which may have potential associated factors. It is important for a successful therapy to identify these factors. It will need an individual access to every woman and there is no single therapy that fits all women. Dyspareunia is also a less common but also complex problem that needs accurate approach and therapy. With this article, we would like to give you insights in these disorders in a practical way in order to make them find their place in our daily practice.


Assuntos
Dispareunia , Doenças da Vulva/diagnóstico , Vulvodinia , Dispareunia/diagnóstico , Feminino , Humanos , Dor/diagnóstico , Dor/etiologia , Disfunções Sexuais Psicogênicas/diagnóstico , Doenças da Vulva/complicações , Vulvodinia/diagnóstico
3.
Univ. med ; 60(1)2019. ilus, tab
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-995084

RESUMO

La menopausia es el periodo de transición en que la mujer culmina su edad reproductiva y trae consigo cambios anatómicos y fisiológicos, manifestados principalmente por síntomas vasomotores y urogenitales, con gran afectación de la calidad de vida de las pacientes. Es de gran importancia conocer las alternativas terapéuticas que existen, la evidencia que las respalda, y así ofrecer la mejor alternativa según indicaciones, eficacia, perfil de efectos adversos y contraindicaciones de cada una. Métodos: Se realizó una búsqueda y selección de la literatura en las bases de datos Cochrane, Pubmed, SciELO, JAMA, en idiomas español e inglés, sin restricción de fecha. Conclusiones: Las terapias actuales no son satisfactorias, bien sea por la baja eficacia en el control de los síntomas o por su asociación con efectos adversos de importancia. Es necesario evaluar acuciosamente el riesgo-beneficio de cada intervención.


Menopause is the transitioning phase of a woman at the end of her reproductive age and which is associated with both anatomical and physiological changes, with great compromise of quality' of Iife. It is of upmost importance to be aware of the currently available therapeutic options, the evidence that supports them, and thus, be able to provide the best alternative according to medical indications, efficacy, adverse effects and counter-indications. Methods: We conducted a search on the databases Cochrane, Pubmed, SciELO, JAMA, both in English and Spanish, without date restrictions. Conclusión: Current therapies are not satisfactory, either because of their low efficacy in symptom control or because of the associated risks. It is necessary to make a thorough evaluation of the benefit/risk relation for every individualized case.


Assuntos
Menopausa , Dispareunia/diagnóstico , Estrogênios/análise
4.
Semin Reprod Med ; 36(2): 152-158, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30566981

RESUMO

A variety of conditions can give rise to the perception of painful sexual intercourse in women with pelvic pain. Female sexual dysfunction may stem from psychological, medical such as endocrinological disturbances, and gynecological pathologies. This article provides a discussion of various conditions, offering diagnostic and therapeutic measures to consider in women with pelvic pain experiencing sexual dysfunction. Treatment and management options are also reviewed.


Assuntos
Dispareunia , Dor Pélvica/complicações , Disfunções Sexuais Fisiológicas , Dispareunia/complicações , Dispareunia/diagnóstico , Dispareunia/psicologia , Dispareunia/terapia , Feminino , Humanos , Relações Profissional-Paciente , Disfunções Sexuais Fisiológicas/complicações , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Fisiológicas/terapia
5.
Rev Bras Ginecol Obstet ; 40(12): 787-793, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30428492

RESUMO

Genito-pelvic pain/penetration disorder (GPPPD) can be an extremely bothersome condition for patients, and a tough challenge for professionals regarding its assessment and treatment. The goal of the present paper is to review the etiology, assessment, and treatment of GPPPD, especially focusing on the cognitive aspects of the disease and cognitive-behavioral treatment options, through a non-systematic review of articles indexed to the Medline, Scopus and Web of Science databases, using the following MeSH queries: pelvic pain; dyspareunia; vaginismus; vulvodynia; and cognitive therapy. Altogether, 36 articles discussing the etiology, diagnosis and management of GPPPD were selected. We provide an overview of GPPPD based on biological, psychological and relational factors, emphasizing the last two. We also summarize the available medical treatments and provide strategies to approach the psychological trigger and persisting factors for the patient and the partner. Professionals should be familiarized with the factors underlining the problem, and should be able to provide helpful suggestions to guide the couple out of the GPPPD fear-avoidance circle.


Assuntos
Dispareunia , Dor Pélvica , Vaginismo , Vulvodinia , Dispareunia/diagnóstico , Dispareunia/etiologia , Dispareunia/terapia , Feminino , Humanos , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Dor Pélvica/terapia , Vaginismo/diagnóstico , Vaginismo/etiologia , Vaginismo/terapia , Vulvodinia/diagnóstico , Vulvodinia/etiologia , Vulvodinia/terapia
6.
J Clin Endocrinol Metab ; 103(11): 4146-4154, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30239842

RESUMO

Context: Intravaginal testosterone (IVT) is a potential treatment of vulvovaginal atrophy (VVA) associated with aromatase inhibitor (AI) use. Objective: To investigate the effects of IVT on sexual satisfaction, vaginal symptoms, and urinary incontinence (UI) associated with AI use. Design: Double-blind, randomized, placebo-controlled trial. Setting: Academic clinical research center. Participants: Postmenopausal women taking an AI with VVA symptoms. Intervention: IVT cream (300 µg per dose) or identical placebo, self-administered daily for 2 weeks and then thrice weekly for 24 weeks. Main Outcomes and Measures: The primary outcome was the change in the sexual satisfaction score on the Female Sexual Function Index (FSFI). Secondary outcomes included vaginal symptoms and responses to the Profile of Female Sexual Function, the Female Sexual Distress Scale-Revised (FSDS-R), and the Questionnaire for UI Diagnosis. Serum sex steroids were measured. Results: A total of 44 women were randomly assigned and 37 provided evaluable data, (mean age 56.4 years, SD 8.8 years). At 26 weeks, the mean between-group difference in the baseline-adjusted change in FSFI satisfaction scores was significantly greater for the IVT group than the placebo group (mean difference 0.73 units; 95% CI, 0.02 to 1.43; P = 0.043). IVT cream resulted in significant improvements, compared with placebo, in FSDS-R scores (P = 0.02), sexual concerns (P < 0.001), sexual responsiveness (P < 0.001), vaginal dryness (P = 0.009), and dyspareunia (P = 0.014). Serum sex steroid levels did not change. Few women had UI symptoms, with no treatment effect. Conclusion: IVT significantly improved sexual satisfaction and reduced dyspareunia in postmenopausal women on AI therapy. The low reporting of UI among women on AI therapy merits further investigation.


Assuntos
Inibidores da Aromatase/efeitos adversos , Dispareunia/tratamento farmacológico , Testosterona/administração & dosagem , Incontinência Urinária/tratamento farmacológico , Doenças Vaginais/tratamento farmacológico , Administração Intravaginal , Atrofia/induzido quimicamente , Atrofia/tratamento farmacológico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Método Duplo-Cego , Dispareunia/diagnóstico , Dispareunia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Índice de Gravidade de Doença , Inquéritos e Questionários/estatística & dados numéricos , Resultado do Tratamento , Incontinência Urinária/diagnóstico , Incontinência Urinária/etiologia , Vagina/efeitos dos fármacos , Vagina/patologia , Cremes, Espumas e Géis Vaginais/administração & dosagem , Doenças Vaginais/induzido quimicamente , Doenças Vaginais/complicações , Doenças Vaginais/patologia , Vulva/efeitos dos fármacos , Vulva/patologia
7.
J Womens Health (Larchmt) ; 27(9): 1114-1123, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30070938

RESUMO

BACKGROUND: Endometriosis has been associated with higher rates of various chronic conditions, but its epidemiological data are fragmented and dated. We sought to compare the incidence of developing commonly occurring comorbidities among patients with and without endometriosis in a large, contemporary patient cohort that reflects real-world clinical practice. MATERIALS AND METHODS: A cohort of women aged 18-49 with incident endometriosis was extracted from the 2006-2015 de-identified Clinformatics® DataMart commercial insurance claims database (OptumInsight, Eden Prairie, MN). Endometriosis was identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 617.x on ≥1 inpatient or emergency department claim or ≥2 outpatient claims. Nonendometriosis control patients were exactly matched 4:1 to cases based on state, insurance plan type, and age (±1 year). Based on a literature review and expert consultation, 22 comorbidities were identified for analysis. The risk of developing a comorbidity post-index date was analyzed with stratified Cox proportional hazards models. RESULTS: There were 26,961 cases and 107,844 controls. Mean age was 36 years. The adjusted risk of developing a comorbid condition among endometriosis cases was statistically significantly higher than the matched controls for all 22 comorbidities (p ≤ 0.001) and was at least twice as large for nine comorbidities (infertility/subfertility, ovarian cyst, uterine fibroids, pelvic inflammatory disorder, interstitial cystitis, irritable bowel syndrome, constipation/dyschezia, ovarian cancer, and endometrial cancer). CONCLUSION: The incidence of developing many comorbidities was significantly higher among endometriosis patients compared with matched women without endometriosis. Additional research is needed to establish the implications for healthcare resource use.


Assuntos
Endometriose/diagnóstico , Laparoscopia , Dor Pélvica/etiologia , Adulto , Estudos de Casos e Controles , Comorbidade , Constipação Intestinal/diagnóstico , Constipação Intestinal/epidemiologia , Dismenorreia/diagnóstico , Dismenorreia/epidemiologia , Dispareunia/diagnóstico , Dispareunia/epidemiologia , Endometriose/epidemiologia , Feminino , Humanos , Incidência , Leiomioma/diagnóstico , Leiomioma/epidemiologia , Pessoa de Meia-Idade , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/epidemiologia , Dor Pélvica/diagnóstico , Dor Pélvica/epidemiologia , Estudos Retrospectivos
8.
Clin Anat ; 31(7): 1013-1017, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30113086

RESUMO

Dyspareunia can be described as continuous unremitting or intermittent pain associated with intercourse. It can be classified based on the location of the pain - entry or deep dyspareunia, or based on when the pain was first experienced - primary or secondary dyspareunia. There are different causes of dyspareunia and some of the most important causes include the following: vulvodynia, postpartum dyspareunia, endometriosis, inadequate vaginal lubrication or arousal, and other anogenital causes such as hemorrhoids and anal fissures. In this review, our objective is to apply the anatomical knowledge of dyspareunia to patient care, increase awareness among clinicians about the diverse etiology of dyspareunia and ensure that the whole patient, not just the pain of dyspareunia is being treated as the causes of dyspareunia can be due to various pathologies. Clin. Anat., 31:1013-1017, 2018. © 2018 Wiley Periodicals, Inc.


Assuntos
Dispareunia/etiologia , Dispareunia/diagnóstico , Dispareunia/patologia , Dispareunia/terapia , Feminino , Genitália Feminina/anatomia & histologia , Humanos , Diafragma da Pelve/anatomia & histologia
10.
Fertil Steril ; 110(1): 137-152.e1, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29937152

RESUMO

OBJECTIVE: To review the available clinical evidence on the use of combined hormonal contraceptive (CHC) agents (estrogen [E]-progestin combinations) for the treatment of endometriosis-related pain. DESIGN: A systematic review of the MEDLINE, Embase, and Derwent Drug File databases for prospective clinical studies. SETTING: Not applicable. PATIENT(S): Women with endometriosis diagnosed by validated means. INTERVENTION(S): Combined hormonal contraceptive agents, active comparators, placebo, or no treatment. MAIN OUTCOME MEASURE(S): Endometriosis-related pain (dysmenorrhea, pelvic pain, and dyspareunia). RESULT(S): Nine randomized controlled trials and nine observational studies met the inclusion criteria. The quality of data was low: only two of the nine randomized trials were placebo controlled, and most trials were not blinded. The CHC agents were reported to significantly reduce dysmenorrhea, pelvic pain, and dyspareunia from baseline in most studies; continuous administration seemed to be more useful than cyclic administration. The effectiveness of CHC agents for pain reduction was similar to or less than that of oral progestins and GnRH agonists. CONCLUSION(S): The available literature suggests that CHC treatment is effective for relief of endometriosis-related dysmenorrhea, pelvic pain, and dyspareunia; however, the supportive data are of low quality. Furthermore, insufficient data exist to reach conclusions about the overall superiority of any given CHC therapy, and the relative benefit in comparison to other approaches. Additional high-quality studies are needed to clarify the role of CHC agents and other treatments in women with endometriosis-related pain.


Assuntos
Analgésicos/uso terapêutico , Anticoncepcionais Orais Combinados/uso terapêutico , Anticoncepcionais Orais Hormonais/uso terapêutico , Dismenorreia/tratamento farmacológico , Dispareunia/tratamento farmacológico , Endometriose/tratamento farmacológico , Dor Pélvica/tratamento farmacológico , Analgésicos/efeitos adversos , Anticoncepcionais Orais Combinados/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Dismenorreia/diagnóstico , Dismenorreia/etiologia , Dispareunia/diagnóstico , Dispareunia/etiologia , Endometriose/complicações , Endometriose/diagnóstico , Medicina Baseada em Evidências , Feminino , Humanos , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Resultado do Tratamento
11.
Post Reprod Health ; 24(2): 67-71, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29409388

RESUMO

Objective To estimate the prevalence of vaginal symptoms in postmenopausal women with breast cancer exposed to aromatase inhibitors, and to investigate if the risk of vaginal symptoms is associated with previous episodes of bacterial vaginosis. Methods Patients from Rigshospitalet and Herlev University Hospital, Denmark, were identified through the register of Danish Breast Cancer Cooperation Group and 78 patients participated in the study. Semiquantitave questionnaires and telephone interview were used to assess the prevalence of vaginal symptoms and previous episode(s) of bacterial vaginosis. Multivariable logistic regression models were used to assess the association between vaginal symptoms and previous episodes of bacterial vaginosis. Results Moderate to severe symptoms due to vaginal itching/irritation were experienced by 6.4% (95% CI: 2.8-14.1%), vaginal dryness by 28.4% (95% CI: 19.4-39.5%), and dyspareunia by 23.1% (95% CI: 11.0-42.1%). Patients with earlier episodes of bacterial vaginosis had an increased risk of vaginal dryness when exposed to a treatment with an aromatase inhibitor, adjusted OR 5.5 (95% CI 1.3-21.6). Conclusion A considerable number of patients exposed to aromatase inhibitor have vaginal symptoms and the risk is highest among patients with earlier episodes of bacterial vaginosis.


Assuntos
Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Dispareunia , Vagina/patologia , Doenças Vaginais , Vaginose Bacteriana , Inibidores da Aromatase/administração & dosagem , Atrofia , Causalidade , Dinamarca/epidemiologia , Dispareunia/diagnóstico , Dispareunia/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa/fisiologia , Doenças Vaginais/induzido quimicamente , Doenças Vaginais/diagnóstico , Doenças Vaginais/epidemiologia , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/epidemiologia
12.
J Urol ; 199(6): 1577-1583, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29307687

RESUMO

PURPOSE: We sought to determine the types and frequency of presenting symptoms in women undergoing suburethral mid urethral sling removal to improve outcome reporting after removal. MATERIALS AND METHODS: Following institutional review board approval women who underwent suburethral mid urethral sling removal of 1 mid urethral sling were evaluated for their presenting symptoms and correlation with the UDI-6 (Urogenital Distress Inventory-Short Form) questionnaire. Demographic data were recorded. Patient reported presenting symptoms were categorized into 5 domains, including storage symptoms, voiding symptoms, pain, recurrent urinary tract infections or urinary incontinence. The UDI-6 was reviewed preoperatively and 6 to 12 months postoperatively. We also calculated an ideal outcome, defined as resolution of incontinence, pain, resumption of sexual activity and no need for further anti-incontinence procedures. RESULTS: A total of 230 women from 2006 to 2017 met study inclusion criteria, including 116 who completed the UDI-6 postoperatively. Of the women 80% had 3 or more presenting symptoms with pain as the most common symptom. The most common combination of symptoms was all 5 domains, which was noted in 46 of the 230 women (20%). An increasing number of symptoms correlated with the total preoperative UDI-6 score. Symptom domains were associated with the corresponding UDI-6 subdomain questions. Domains not covered by the UDI-6, ie recurrent urinary tract infections and dyspareunia, accounted for 27% of reported symptoms. Due to limited data on sexual activity an ideal outcome was reached in 10% of patients but this rate was 40% after sexual activity information was excluded. CONCLUSIONS: In this series the presenting symptoms were manifold in women undergoing suburethral mid urethral sling removal. The UDI-6 questionnaire correlated with many of these complaints. It may be used in outcome analysis in conjunction with self-reported symptoms.


Assuntos
Remoção de Dispositivo , Dispareunia/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/diagnóstico , Slings Suburetrais/efeitos adversos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Idoso , Dispareunia/etiologia , Dispareunia/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Recidiva , Autorrelato/estatística & dados numéricos , Resultado do Tratamento , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação
13.
J Gynecol Obstet Hum Reprod ; 47(2): 69-79, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29133195

RESUMO

PURPOSE: To develop a questionnaire based on patients' verbal descriptors, to measure the painful symptoms of endometriosis. METHODS: We performed a two-round modified DELPHI procedure mixing endometriosis patients and physicians to select a set of statements to describe the painful symptoms of endometriosis. Each panelist rated each statement based on diagnosis validity and clarity. The clinicians were experts in endometriosis management selected from various geographic regions in France. Patients were women with surgically confirmed endometriosis who volunteered from a patient association and from the recruitment of the participating physicians. The first round questions were derived from words and phrases in narratives of pain by endometriosis patients. RESULTS: Overall, 76 experts were invited, and of these 56 (74%), comprising 33 patients and 23 gynecologists, responded to the first round questionnaire, and 40 (71.4%) to the second round. Among the 48 statements assessed in the first-round questionnaire, 11 were selected after completion of the two round DELPHI procedure. After discussion and rewording of some items, a total of 21 questions were selected during a final face-to-face meeting. The content of the final questionnaire is organized according to four dimensions: (i) spontaneous pelvic pain and dysmenorrhea, (ii) dyspareunia, (iii) painful bowel symptoms, (iv) and other symptoms. We also provide an English (UK) version produced using several steps of translation and back-translation. CONCLUSIONS: The questionnaire has content validity to measure the subjective experiences of patients with painful endometriosis and can provide a solid basis on which to develop an efficient patient-centered outcome to measure the painful symptoms in therapeutic or in diagnostic studies of endometriosis.


Assuntos
Dispareunia/diagnóstico , Endometriose/complicações , Medição da Dor/métodos , Dor Pélvica/diagnóstico , Psicometria/métodos , Inquéritos e Questionários , Adulto , Técnica Delfos , Dismenorreia/diagnóstico , Dismenorreia/etiologia , Dispareunia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor/instrumentação , Dor Pélvica/etiologia , Narrativas Pessoais como Assunto , Médicos , Psicometria/instrumentação
14.
Midwifery ; 58: 27-36, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29277039

RESUMO

OBJECTIVE: The aim is to develop a new tool to evaluate postpartum sexual function and dyspareunia which will facilitate better evaluation of perineal pain in woman after vaginal delivery. DESIGN: The development and validation of the Carol Postpartum Sexual Function and Dyspareunia Assessment Scale. SETTING: The Obstetrics and Gynecology Service of a University Hospital in central Spain. PARTICIPANTS: 102 women after being attended for vaginal birth, and 5 midwife assessors. FINDINGS: 81women reinitiated sexual activity (with vaginal intercourse) during the first three months postpartum. The Carol Postpartum Sexual Function and Dyspareunia Assessment Scale (Carol Scale) was internally reliable with a Cronbach-α value of 0.79 (95%CI0.72-0.85). Cronbach-α coefficients for Carol Scale domains were: preparation for the sexual activity 0.69 (95%CI0.55-0.79), pain or discomfort on caressing the vulval area 0.86 (95%CI0.79-0.91), pain or discomfort related to vaginal intercourse 0.93 (95%CI0.90-0.95) and pain or discomfort after vaginal intercourse 0.86 (95%CI0.78-0.91). CONCLUSIONS: The Carol Postpartum Sexual Function and Dyspareunia Assessment Scale is valid and reliable for measuring sexual function and postpartum dyspareunia in women after being attended for vaginal birth. IMPLICATIONS FOR PRACTICE: The Carol Scale could be used both clinically and in research to improve the quality of care for the mother after childbirth. The scale could help to identify problems in the reinitiation of postpartum sexual activity and, therefore, could contribute to widening the clinical information about these women and help in decision making.


Assuntos
Dispareunia/diagnóstico , Psicometria/normas , Comportamento Sexual/psicologia , Adulto , Dispareunia/psicologia , Feminino , Humanos , Gravidez , Psicometria/instrumentação , Psicometria/métodos , Reprodutibilidade dos Testes , Medição de Risco/métodos , Espanha
15.
Hum Reprod ; 32(9): 1812-1818, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28854723

RESUMO

STUDY QUESTION: Is it possible to develop a validated score that can identify women with Bowel Endometriosis Syndrome (BENS) and be used to monitor the effect of medical and surgical treatment? SUMMARY ANSWER: The BENS score can be used to identify women with BENS and to monitor the effect of medical and surgical treatment of women suffering from bowel endometriosis. WHAT IS KNOWN ALREADY: Endometriosis is a heterogeneous disease with extensive variation in anatomical and clinical presentation, and symptoms do not always correspond to the disease burden. Current endometriosis scoring systems are mainly based on anatomical and surgical findings. STUDY DESIGN, SIZE, DURATION: The score was developed and validated from a cohort of 525 women with medically or surgically treated bowel endometriosis from Aarhus and Copenhagen University Hospitals, Denmark. PARTICIPANTS/MATERIALS, SETTING AND METHODS: Patients filled in questionnaires on pelvic pain, quality of life (QoL) and urinary, sexual and bowel function. Items were selected for the final score using clinical and statistical criteria. The chosen variables were included in a multivariate analysis. Individual score values were designated items to form the BENS score, which was divided into 'no BENS', 'minor BENS' and 'major BENS.' Internal and external validations were performed. MAIN RESULTS AND THE ROLE OF CHANCE: The six most important items were 'pelvic pain', 'use of analgesics', 'dyschezia', 'straining to urinate', 'fecal urgency' and 'satisfaction with sexual life'. The range of the BENS score (0-28) was divided into 0-8 (no BENS), 9-16 (minor BENS) and 17-28 (major BENS). External validation showed a significant association between BENS score and QoL (P = 0.0001). LIMITATIONS, REASONS FOR CAUTION: The BENS scoring system is limited by the fact that it was developed from a single endometriosis unit in Denmark, making it susceptible to social, cultural and demographic bias. WIDER IMPLICATIONS OF THE FINDINGS: It is the first endometriosis classification system to be based directly on the symptomatology of the patient. Validation in other languages will promote comparison of treatments and results across borders. STUDY FUNDING/COMPETING INTEREST(S): No external funding was either sought or obtained for this study. A.F. is an investigator for Bayer, outside this work.


Assuntos
Dispareunia/diagnóstico , Endometriose/diagnóstico , Enteropatias/diagnóstico , Dor Pélvica/diagnóstico , Qualidade de Vida/psicologia , Disfunções Sexuais Fisiológicas/diagnóstico , Adulto , Dispareunia/etiologia , Dispareunia/psicologia , Endometriose/complicações , Endometriose/psicologia , Feminino , Humanos , Enteropatias/complicações , Enteropatias/psicologia , Pessoa de Meia-Idade , Dor Pélvica/etiologia , Dor Pélvica/psicologia , Índice de Gravidade de Doença , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/psicologia , Inquéritos e Questionários , Adulto Jovem
17.
Minerva Ginecol ; 69(4): 381-389, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28381078

RESUMO

Common gynecological and dermatological conditions resulting in sexual pain are often observed in gynecological practice and are easily diagnosed with visual observation and laboratory tests. The lower genital tract diseases we are referring to are vaginitis, vaginoses, dermatoses, hypoestrogenism and endometriosis. All of them affect the vaginal mucosa with diverse mechanisms, their effects lasting for only few days or many months. Furthermore, they change the women's sense of wellbeing sometimes significantly and for a long period. The conditions we mentioned above are recognized promptly with basic gynecological interventions but when burning or sharp pain occurs with light pressure (as in case of penetration attempts) without physical signs we must suspect the genitopelvic pain penetration disorder. This condition was defined for the first time in the Diagnostic and Statistical Manual of Mental Disorders-5 and its dimensions include difficulty or pain at penetration associated with fear, anxiety, and pelvic floor hypertonus. Pain is most often localized at the vulvar vestibule and described as burning, pressure, and itching. These dimensions are iconic of sexual pain associated with vulvodyina and vaginismus but are common also in fibromyalgia, a syndrome of widespread chronic pain of unknown origin; sexual pain in fibromyalgia is mostly attributed both to the joint pathology and to the lower sensitive threshold that are the pathognomonic signs of this condition. In our study we analyzed the characteristics of pain as reported for each disease to evaluate its influence on sexuality and marital relations.


Assuntos
Dispareunia/fisiopatologia , Doenças dos Genitais Femininos/complicações , Qualidade de Vida , Dispareunia/diagnóstico , Dispareunia/etiologia , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/fisiopatologia , Humanos , Comportamento Sexual
18.
J Cutan Med Surg ; 21(5): 418-424, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28453946

RESUMO

BACKGROUND: Genitourinary syndrome of menopause (GSM) is a debilitating condition caused by hypoestrogenism that presents with vaginal dryness and dyspareunia as well as other genital, sexual, and urinary symptoms. Previously known as atrophic vaginitis, the term GSM is now used. OBJECTIVE: To help familiarise dermatologists with diagnosing and managing GSM. METHODS: In total, 218 articles were identified and reviewed by 2 independent authors using PubMed. Articles included were from December 2005 to December 2015. Sixty-seven articles met our inclusion criteria. RESULTS: GSM is a clinical diagnosis, requiring the presence of symptoms that should be bothersome and not accounted for by another condition. A pH test may help with diagnosis as vaginal pH will be increased from acidic to neutral. The Papanicolaou test is not recommended because of poor clinical correlation. First-line treatment is low-dose local vaginal estrogen therapy, which has proven efficacy and safety. Serum estrogen levels are not significantly affected with the exception of creams containing high-dose conjugated equine estrogens. Other options have yet to be approved for use in Canada but show promise. CONCLUSION: GSM is a debilitating and common condition that suffers from barriers to diagnosis and treatment. Current treatments are well tolerated, rewarding, and effective with rapid onset.


Assuntos
Vaginite Atrófica/tratamento farmacológico , Dermatologia , Dispareunia/tratamento farmacológico , Estrogênios/uso terapêutico , Menopausa , Papel do Médico , Vaginite Atrófica/diagnóstico , Dispareunia/diagnóstico , Estrogênios/administração & dosagem , Feminino , Humanos , Concentração de Íons de Hidrogênio , Síndrome , Vagina/química , Cremes, Espumas e Géis Vaginais
19.
J Obstet Gynaecol Can ; 39(3): 145-151, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28343555

RESUMO

OBJECTIVE: To explore factors associated with the diagnosis of provoked vestibulodynia (PVD) through (1) self-reported pain characteristics and (2) Friedrich's criteria (vestibular pain during sexual activity/gynaecological examination). We also identified cases in which incorrect diagnoses were assigned and explored group differences in gynaecological examination presentation and associations with self-reported pain. METHODS: Data were extracted from nine studies conducted in our research laboratory. Information obtained during a telephone interview and a standardized gynaecological examination was compiled for 106 participants with vulvar pain and 106 pain-free control participants, matched for age, hormonal contraceptive use, and parity. RESULTS: Cohen's kappa (0.78) indicated substantial agreement (87.3%) between the telephone interview group categorization and diagnosis after the gynaecological examination. A discriminant function analysis yielded one significant function: Friedrich's first two criteria correctly classified 84.2% of cases, accounting for 76.0% of group membership variance. Of note, those in the other genital pain group were most likely to have received an incorrect diagnosis following the telephone interview (P < 0.001). Paired-samples t tests showed that those with pain reported lower pain intensity during the gynaecological examination than during intercourse (P < 0.001) and that intercourse pain was not necessarily related to pain during the examination. However, many participants (72.8%) indicated that the pain elicited during the cotton swab test was similar to the pain they felt with intercourse. CONCLUSION: These results support the use of a targeted clinical interview and the evaluation of vestibular pain during sexual activity and the gynaecological examination for diagnosing PVD. Caution should be exercised when a patient presents with genital pain symptoms other than those typically observed in PVD. Furthermore, the cotton swab test may underestimate the degree of pain regularly experienced.


Assuntos
Dispareunia/diagnóstico , Exame Ginecológico , Autorrelato , Vulvodinia/diagnóstico , Adolescente , Adulto , Estudos de Casos e Controles , Coito , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Comportamento Sexual , Adulto Jovem
20.
Clin Exp Obstet Gynecol ; 44(2): 268-271, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29746036

RESUMO

This work aimed to analyze the effect of deep infiltrating endometriosis (DIE) in young women. Twenty-seven cases of patients (below 38-years-old) diagnosed with DIE and admitted to the present hospital from January 2008 to July 2014 were reviewed, and their pre- and postoperative states of illness were summarized. The main preoperative symptoms included dysmenorrhea, chronic pelvic pain, dyspareunia, nodule in rectouterine fossa, and reduced level of fertility. All patients underwent surgery (17 laparoscopies and ten laparotomies). Postoperative pathological explanation confirmed DIE in lesions. DIE significantly affects the health of young women.


Assuntos
Endometriose , Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/métodos , Laparotomia/métodos , Adulto , China/epidemiologia , Dismenorreia/diagnóstico , Dismenorreia/etiologia , Dispareunia/diagnóstico , Dispareunia/etiologia , Endometriose/diagnóstico , Endometriose/patologia , Endometriose/fisiopatologia , Endometriose/cirurgia , Feminino , Humanos , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Avaliação de Sintomas/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA