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1.
Am J Obstet Gynecol ; 222(6): 594.e1-594.e11, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31870730

RESUMO

BACKGROUND: Antecedents of chronic pelvic pain are not well characterized, but pelvic organ visceral sensitivity is a hallmark of these disorders. Recent studies have identified that some dysmenorrhea sufferers are much more likely to exhibit comorbid bladder hypersensitivity. Presumably, these otherwise healthy women may be at higher risk of developing full-blown chronic bladder pain later in life. To encourage early identification of patients harboring potential future risk of chronic pain, we describe the clinical profile of women matching this putative pain-risk phenotype. OBJECTIVE(S): The objectives of the study were to characterize demographic, menstrual, pelvic examination, and psychosocial profiles of young women with comorbid dysmenorrhea and bladder hypersensitivity, defined using a standardized experimental visceral provocation test, contrasted with healthy controls, pure dysmenorrhea sufferers, and women with existing bladder pain syndrome. STUDY DESIGN: This prospective cohort study acquired data on participants with moderate to severe dysmenorrhea (n = 212), healthy controls (n = 44), and bladder pain syndrome (n = 27). A subgroup of dysmenorrhea patients was found on screening with noninvasive oral water challenge to report significantly higher bladder pain during experimentally monitored spontaneous bladder filling (>15 out of 100 on visual analogue scale, based on prior validation studies) and separately defined as a group with dysmenorrhea plus bladder pain. Medical/menstrual history and pain history were evaluated with questionnaires. Psychosocial profile and impact were measured with validated self-reported health status Patient Reported Outcomes Measurement Information System short forms and a Brief Symptom Inventory for somatic sensitivity. Pelvic anatomy and sensory sensitivity were examined via a standardized physical examination and a tampon provocation test. RESULTS: In our largely young, single, nulliparous cohort (24 ± 1 years old), approximately a quarter (46 out of 212) of dysmenorrhea sufferers tested positive for the dysmenorrhea plus bladder pain phenotype. Dysmenorrhea-only sufferers were more likely to be African American (24%) than healthy controls (5%, post hoc χ2, P = .007). Pelvic examination findings did not differ in the nonchronic pain groups, except for tampon test sensitivity, which was worse in dysmenorrhea plus bladder pain and dysmenorrhea sufferers vs healthy controls (2.6 ± 0.3 and 1.7 ± 0.2 vs 0.7 ± 0.2, P < .05). Consistent with heightened pelvic sensitivity, participants with dysmenorrhea plus bladder pain also had more nonmenstrual pain, dysuria, dyschezia, and dyspareunia (P's < .05). Participants with dysmenorrhea plus bladder pain had Patient Reported Outcomes Measurement Information System Global Physical T-scores of 47.7 ± 0.9, lower than in women with dysmenorrhea only (52.3 ± 0.5), and healthy controls 56.1 ± 0.7 (P < .001). Similarly, they had lower Patient Reported Outcomes Measurement Information System Global Mental T-score than healthy controls (47.8 ± 1.1 vs 52.8 ± 1.2, P = .017). Similar specific impairments were observed on Patient Reported Outcomes Measurement Information System scales for anxiety, depression, and sleep in participants with dysmenorrhea plus bladder pain vs healthy controls. CONCLUSION: Women with dysmenorrhea who are unaware they also have bladder sensitivity exhibit broad somatic sensitivity and elevated psychological distress, suggesting combined preclinical visceral sensitivity may be a precursor to chronic pelvic pain. Defining such precursor states is essential to conceptualize and test preventative interventions for chronic pelvic pain emergence. Dysmenorrhea plus bladder pain is also associated with higher self-reported pelvic pain unrelated to menses, suggesting central nervous system changes are present in this potential precursor state.


Assuntos
Constipação Intestinal/fisiopatologia , Cistite Intersticial/fisiopatologia , Dismenorreia/fisiopatologia , Dispareunia/fisiopatologia , Disuria/fisiopatologia , Dor Pélvica/fisiopatologia , Adulto , Afro-Americanos , Americanos Asiáticos , Dor Crônica , Comorbidade , Constipação Intestinal/epidemiologia , Estudos Transversais , Cistite Intersticial/epidemiologia , Dismenorreia/epidemiologia , Dispareunia/epidemiologia , Disuria/epidemiologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Medidas de Resultados Relatados pelo Paciente , Dor Pélvica/epidemiologia , Fenótipo , Estudos Prospectivos , Angústia Psicológica , Adulto Jovem
2.
Am J Obstet Gynecol ; 220(4): 354.e1-354.e12, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30625295

RESUMO

Endometriosis can have a profound impact on women's lives, including associated pain, infertility, decreased quality of life, and interference with daily life, relationships, and livelihood. The first step in alleviating these adverse sequelae is to diagnose the underlying condition. For many women, the journey to endometriosis diagnosis is long and fraught with barriers and misdiagnoses. Inherent challenges include a gold standard based on an invasive surgical procedure (laparoscopy) and diverse symptomatology, contributing to the well-established delay of 4-11 years from first symptom onset to surgical diagnosis. We believe that remedying the diagnostic delay requires increased patient education and timely referral to a women's healthcare provider and a shift in physician approach to the disorder. Endometriosis should be approached as a chronic, systemic, inflammatory, and heterogeneous disease that presents with symptoms of pelvic pain and/or infertility, rather than focusing primarily on surgical findings and pelvic lesions. Using this approach, symptoms, signs, and clinical findings of endometriosis are anticipated to become the main drivers of clinical diagnosis and earlier intervention. Combining these factors into a practical algorithm is expected to simplify endometriosis diagnosis and make the process accessible to more clinicians and patients, culminating in earlier effective management. The time has come to bridge disparities and to minimize delays in endometriosis diagnosis and treatment for the benefit of women worldwide.


Assuntos
Dor Crônica/fisiopatologia , Dismenorreia/fisiopatologia , Dispareunia/fisiopatologia , Endometriose/diagnóstico , Infertilidade Feminina/fisiopatologia , Dor Pélvica/fisiopatologia , Dor Crônica/etiologia , Diagnóstico Tardio , Dismenorreia/etiologia , Dispareunia/etiologia , Endometriose/complicações , Endometriose/fisiopatologia , Feminino , Humanos , Infertilidade Feminina/etiologia , Laparoscopia , Dor Pélvica/etiologia , Sensibilidade e Especificidade , Tempo para o Tratamento , Ultrassonografia
3.
Gynecol Obstet Invest ; 84(2): 190-195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30380545

RESUMO

AIMS: The economic burden of endometriosis and pelvic pain involves direct and indirect healthcare costs due to work loss and decreased productivity. However, the relation between endometriosis, pelvic pain, and employment remains underinvestigated. This study aimed at providing preliminary insights into this topic. METHODS: We compared the employment status (having vs. not having a job) in 298 consecutive endometriosis patients and in 332 women without a history of endometriosis (control group). We also examined the association between pelvic pain and employment status. RESULTS: Women with endometriosis were less likely to be employed compared to women without endometriosis (OR 0.508; 95% CI 0.284-0.908; p = 0.022). Women with symptomatic endometriosis were less likely to be employed relative to controls (OR 0.345; 95% CI 0.184-0.650; p = 0.001), as well as to asymptomatic endometriosis patients (OR 0.362; 95% CI 0.167-0.785; p = 0.01). No significant differences emerged between asymptomatic endometriosis and the control group (p > 0.05). Greater severity of dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia was found in unemployed endometriosis patients (vs. employed endometriosis participants). CONCLUSION: Endometriosis symptoms may significantly affect women's professional life, with important socioeconomic, legal, and political implications. Community-based participatory research is encouraged.


Assuntos
Emprego , Endometriose/fisiopatologia , Dor Pélvica/fisiopatologia , Adulto , Dor Crônica , Constipação Intestinal , Efeitos Psicossociais da Doença , Dismenorreia/fisiopatologia , Dispareunia/fisiopatologia , Endometriose/economia , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Índice de Gravidade de Doença
4.
Gynecol Endocrinol ; 35(2): 150-154, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30132350

RESUMO

The aim of this study is to evaluate the sexual functionality before and after treatment of Bartholin's gland diseases (BGD) with CO2 laser and to compare our results to patients who underwent surgical cold knife and to a healthy control group (HCG). Consecutive patients (n = 15) affected by BG cyst or abscess who underwent CO2 laser treatment were evaluated. Patients were asked to complete the Italian translation of the Female Sexual Functioning Index (FSFI) before and 4 weeks after treatment. Results after CO2 laser were compared with two control groups: patients affected by BG cyst (n = 15) or abscess treated with surgical cold knife treatment and a HCG (n = 18). A statistically significant advantage of CO2 laser versus cold knife treatment in terms of lubrication, pain and global score were recorded. Both the single scores of five domains and total score of FSFI were globally higher after any treatment compared to before (CO2 and cold knife) of BGD. According to our data, CO2 laser therapy is often well tolerated by patients and correlated with a favorable sexual health recovery.


Assuntos
Abscesso/cirurgia , Glândulas Vestibulares Maiores/cirurgia , Cistos/cirurgia , Disfunções Sexuais Fisiológicas/fisiopatologia , Saúde Sexual , Doenças da Vulva/cirurgia , Abscesso/fisiopatologia , Adulto , Glândulas Vestibulares Maiores/fisiopatologia , Estudos de Casos e Controles , Cistos/fisiopatologia , Dispareunia/fisiopatologia , Feminino , Humanos , Terapia a Laser , Lasers de Gás , Medidas de Resultados Relatados pelo Paciente , Projetos Piloto , Recuperação de Função Fisiológica , Resultado do Tratamento , Doenças da Vulva/fisiopatologia
5.
Obstet Gynecol Clin North Am ; 45(4): 709-722, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30401552

RESUMO

Sexual function is an important component of quality of life for women. Midlife poses several challenges to optimal sexual function and intimacy for women. In addition to anatomic factors related to estrogen deficiency, such as genitourinary syndrome of menopause, vulvovaginal atrophy, and pelvic organ prolaps, psychosocial factors, including prior sexual trauma, play an important role in sexual function in women. Several treatments have emerged for female sexual dysfunction; long-term studies and head-to-head comparisons are lacking.


Assuntos
Dispareunia/fisiopatologia , Hormônios Gonadais/metabolismo , Menopausa/fisiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Saúde da Mulher , Administração Intravaginal , Dispareunia/psicologia , Terapia de Reposição de Estrogênios , Feminino , Humanos , Lubrificantes , Menopausa/metabolismo , Pessoa de Meia-Idade , Pós-Menopausa/metabolismo , Pós-Menopausa/fisiologia , Qualidade de Vida , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/psicologia
6.
Postgrad Med ; 130(8): 694-702, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30334456

RESUMO

OBJECTIVES: Diagnostic delay is common in endometriosis. There is an unmet need for a symptom-based, patient-completed screening tool to facilitate discussions between patients and physicians about potential endometriosis symptoms. The objective of this study was to develop and assess the patient-completed Painful Periods Screening Tool (PPST) to assess the presence of potential endometriosis symptoms. METHODS: To develop and refine the PPST, a cross-sectional qualitative study was conducted with women with endometriosis and healthy controls. Following identification of potentially relevant concepts in the literature and input from clinical experts, a draft version of the PPST was tested during in-depth individual interviews with 16 women: 11 with endometriosis and 5 healthy controls. RESULTS: The six draft items of the PPST were refined iteratively in two rounds of interviews, and one item was deleted following the second set of interviews. All concepts included in the final five-item PPST were found to be relevant to women with endometriosis, and all 11 participants with endometriosis endorsed at least one of the items. No core symptoms of endometriosis were noted as missing from the PPST. CONCLUSION: The PPST assesses the most important endometriosis-related symptoms and may help facilitate discussions between patients and physicians, promoting earlier diagnosis and treatment of endometriosis.


Assuntos
Endometriose/diagnóstico , Inquéritos e Questionários/normas , Adulto , Estudos Transversais , Diagnóstico Tardio/prevenção & controle , Dispareunia/fisiopatologia , Feminino , Humanos , Entrevistas como Assunto , Menstruação/fisiologia , Pessoa de Meia-Idade , Dor Pélvica/fisiopatologia , Pesquisa Qualitativa , Reprodutibilidade dos Testes
7.
J Sex Med ; 15(8): 1158-1166, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30078464

RESUMO

INTRODUCTION: The etiology of endometriosis-associated deep dyspareunia may include direct endometriosis-specific factors (eg, stage or invasiveness of disease) and/or indirect contributors such as bladder/pelvic floor dysfunction (eg, related to myofascial mechanisms or nervous system sensitization). AIM: This study aimed to determine whether bladder/pelvic floor tenderness and painful bladder syndrome were associated with severity of deep dyspareunia in women with endometriosis, regardless of Stage (I/II vs III/IV) or other endometriosis-specific factors. METHODS: Observational study from a prospective patient registry (January 2014 to December 2016) at a tertiary centre for endometriosis. Included were women aged 18 to 49 years who had surgical removal and histopathologic confirmation of endometriosis at the centre. Cases with Stage I/II vs Stage III/IV endometriosis were analyzed separately. Bivariate associations with the primary outcome (severity of deep dyspareunia) were tested for bladder/pelvic floor tenderness, painful bladder syndrome, as well as endometriosis-specific factors identified at the time of laparoscopic surgery (eg, deep infiltrating endometriosis) and demographic factors (eg, age). Multivariable ordinal logistic regression was carried out to adjust for factors associated with the primary outcome. MAIN OUTCOME MEASURE: Primary outcome was severity of deep dyspareunia on an 11-point numeric rating scale, categorized as none/mild (0-3), moderate (4-6), and severe (7-10), from a preoperative self-reported questionnaire. RESULTS: Overall, 411 women had surgically confirmed endometriosis: 263 had Stage I/II and 148 had Stage III/IV endometriosis. Among women with Stage I/II endometriosis, severity of deep dyspareunia was associated with both bladder/pelvic floor tenderness and painful bladder syndrome (AOR = 1.94, 95% CI: 1.11-3.38, P = .019 and AOR = 1.99, 95% CI: 1.15-3.44, P = .013, respectively), independent of endometriosis-specific factors or other factors associated with deep dyspareunia severity. Similar associations were found in women with Stage III/IV endometriosis (bladder/pelvic floor tenderness AOR =2.51, 95% CI: 1.25-5.02, P = .01, painful bladder syndrome: AOR = 1.90, 95% CI: 1.01-3.57, P = .048). CLINICAL IMPLICATIONS: Myofascial or nervous system mechanisms may be important for deep dyspareunia in women with endometriosis, even in those with moderate-to-severe disease (Stage III/IV). STRENGTHS & LIMITATIONS: Strengths include the prospective registry, and histological confirmation of endometriosis and staging by experienced endometriosis surgeons. Limitations include assessment of only one pelvic floor muscle (levator ani). CONCLUSION: In women with Stage I/II or Stage III/IV endometriosis, severity of deep dyspareunia was strongly associated with bladder/pelvic floor tenderness and painful bladder syndrome, independent of endometriosis-specific factors, which suggests the role of myofascial or sensitization pain mechanisms in some women with deep dyspareunia. Orr NL, Noga H, Williams C, et al. Deep Dyspareunia in Endometriosis: Role of the Bladder and Pelvic Floor. J Sex Med 2018;15:1158-1166.


Assuntos
Cistite Intersticial/epidemiologia , Dispareunia/epidemiologia , Endometriose/epidemiologia , Adolescente , Adulto , Cistite Intersticial/fisiopatologia , Dispareunia/fisiopatologia , Endometriose/fisiopatologia , Feminino , Humanos , Laparoscopia , Pessoa de Meia-Idade , Medição da Dor , Diafragma da Pelve/fisiopatologia , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
8.
Clin Obstet Gynecol ; 61(3): 463-469, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29851863

RESUMO

The first approved tissue-selective estrogen complex is a pairing of conjugated estrogen combined with the selective estrogen-receptor modulator, bazedoxifene. Advantages include relief of menopausal symptoms without the increased chance of bleeding or breast tenderness unlike with traditional estrogen-progestin therapy, which is associated with both bleeding and breast tenderness. Tissue-selective estrogen complex effects on relief of vasomotor symptoms, prevention of bone loss, improvement in vaginal symptoms, lack of significant cardiovascular effects beyond the expected 2-fold increase in venous thrombosis, neutral effect on breast, and protective effects on the endometrium are discussed.


Assuntos
Estrogênios Conjugados (USP)/uso terapêutico , Estrogênios/uso terapêutico , Indóis/uso terapêutico , Menopausa/fisiologia , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Densidade da Mama/efeitos dos fármacos , Dispareunia/fisiopatologia , Dispareunia/prevenção & controle , Endométrio/efeitos dos fármacos , Feminino , Fogachos/tratamento farmacológico , Fogachos/fisiopatologia , Humanos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Tromboembolia/induzido quimicamente
9.
Clin Obstet Gynecol ; 61(3): 488-495, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29762148

RESUMO

Gynecologic cancers are common in the United States and represent a significant health burden. Treatment of these cancers often causes premature cessation of ovarian function, with resultant symptoms that are often more severe than those associated with natural menopause. Hormone therapy is the most effective treatment for menopausal symptoms, but the decision-making process about its use can be complex for survivors of gynecologic cancer. In this review, we provide evidence-based recommendations about the use of hormone therapy after gynecologic cancer.


Assuntos
Sobreviventes de Câncer , Neoplasias dos Genitais Femininos , Terapia de Reposição Hormonal , Menopausa/fisiologia , Contraindicações de Medicamentos , Dispareunia/tratamento farmacológico , Dispareunia/fisiopatologia , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Terapia de Reposição Hormonal/métodos , Fogachos/tratamento farmacológico , Fogachos/fisiopatologia , Humanos , Recidiva Local de Neoplasia , Seleção de Pacientes , Medição de Risco
10.
Clin Obstet Gynecol ; 61(3): 508-516, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29787390

RESUMO

Genitourinary syndrome of menopause (GSM) describes a collection of exam findings and bothersome symptoms associated with estrogen deficiency involving changes to the labia, introitus, clitoris, vagina, urethra, and bladder. Vulvovaginal atrophy is a component of GSM. GSM is a highly prevalent medical condition with adverse effects on the health and quality of life of midlife women. There are many effective treatment options, including nonhormonal lubricants and moisturizers, physical therapy, low-dose vaginal estrogen therapy, vaginal dehydroepiandrosterone, and oral ospemifene. Despite the availability of safe and effective therapies, GSM often remains unrecognized and untreated.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Menopausa , Administração Intravaginal , Administração Oral , Atrofia/terapia , Desidroepiandrosterona/administração & dosagem , Dispareunia/fisiopatologia , Estrogênios/administração & dosagem , Feminino , Humanos , Terapia a Laser , Sintomas do Trato Urinário Inferior/fisiopatologia , Lubrificantes/uso terapêutico , Modalidades de Fisioterapia , Moduladores Seletivos de Receptor Estrogênico/administração & dosagem , Tamoxifeno/administração & dosagem , Tamoxifeno/análogos & derivados , Vagina/patologia , Vulva/patologia
11.
Climacteric ; 21(4): 397-403, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29741110

RESUMO

OBJECTIVE: To investigate awareness in Latin America, knowledge of postmenopausal vaginal atrophy was evaluated in a sample of women from this region. METHODS: A total of 2509 postmenopausal women aged 55-65 years, resident in Argentina, Brazil, Chile, Colombia and Mexico, completed a structured online questionnaire. RESULTS: Over half the surveyed population (57%) reported experiencing symptoms of vaginal atrophy. Only 6% of the overall cohort attributed symptoms of vaginal atrophy directly to the condition, and 71% did not consider the condition to be chronic, resulting in many women not accessing effective therapy. Half the women (49%) affected by vaginal atrophy had used lubricating gels and creams; 36% had used some form of local hormone treatment. To understand symptoms and/or treatment options for vaginal discomfort, the majority of survey participants (92%) were willing to seek advice from health-care professionals; most (61%) felt/would feel comfortable talking to their doctor about this. CONCLUSION: Many women in Latin America lack knowledge of postmenopausal vaginal atrophy, not appreciating the chronic nature of the condition, and may benefit from dialog initiated by health-care professionals to facilitate greater understanding and increased awareness of the availability of effective treatment.


Assuntos
Dispareunia/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Pós-Menopausa , Vagina/patologia , Doenças Vaginais/epidemiologia , Idoso , Atrofia , Dispareunia/fisiopatologia , Terapia de Reposição de Estrogênios/métodos , Estrogênios/uso terapêutico , Feminino , Humanos , América Latina/epidemiologia , Pessoa de Meia-Idade , Inquéritos e Questionários , Doenças Vaginais/terapia , Saúde da Mulher
12.
Clin Obstet Gynecol ; 61(2): 260-268, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29419532

RESUMO

For women at elevated risk of thrombosis, clinicians are challenged to relieve menopausal symptoms without increasing the risk of thrombosis. Oral menopausal hormone therapy increases the risk of venous thromboembolism by 2-fold to 3-fold. Observational studies suggest less thrombotic risk with transdermal therapies and with progesterone over synthetic progestogens (progestins), but the data are limited. Beneficial nonpharmacologic therapies include cognitive behavioral therapy and clinical hypnosis, whereas beneficial nonhormonal pharmacologic therapies include selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. For treatment of the genitourinary syndrome of menopause, vaginal lubricants and moisturizers, low-dose vaginal estrogen, and intravaginal dehydroepiandrosterone are options.


Assuntos
Fogachos/prevenção & controle , Menopausa/fisiologia , Trombose/prevenção & controle , Doenças Vaginais/terapia , Doenças da Vulva/terapia , Administração Intravaginal , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Atrofia/fisiopatologia , Atrofia/terapia , Dispareunia/fisiopatologia , Dispareunia/terapia , Estrogênios/administração & dosagem , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Fogachos/fisiopatologia , Humanos , Terapia a Laser , Lubrificantes/uso terapêutico , Fitoterapia , Prurido/fisiopatologia , Prurido/terapia , Risco , Inibidores de Captação de Serotonina/uso terapêutico , Sudorese/fisiologia , Trombose/etiologia , Doenças Vaginais/fisiopatologia , Doenças da Vulva/fisiopatologia
14.
Gynecol Endocrinol ; 34(7): 631-635, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29334798

RESUMO

The study aimed to assess the effects of ospemifene on vulvar vestibule in postmenopausal women with vulvar pain and dyspareunia. Fifty-five postmenopausal women used oral ospemifene 60 mg/d for 60 d. Symptoms of dryness, burning, and dyspareunia were evaluated on a 10 cm visual analog scale. Visual examination of the vulvar vestibule was also conducted. Patients also underwent current perception threshold (CPT) testing obtained from the vulvar vestibule. Fifty-five patients (94.6%) completed the treatment. Hot flashes were the most frequent adverse effects, but this led to a discontinuation of therapy in three patients (5.4%). After therapy, there was a statistically significant decrease from the baseline in the mean scores for dryness, burning, and dyspareunia and reduction of vestibular trophic score (baseline value of 11.2-4.2 after the therapy, p ≤ 002) and cotton swab test scores (2.81 compared with 1.25, p = .001). There was a difference in CPT values for all nerve fibers and more consistent for C fibers (-38% of sensitivity). These results confirm the efficacy of ospemifene on postmenopausal vestibular symptoms and signs; moreover, the drug was effective in normalizing vestibular innervation sensitivity.


Assuntos
Dispareunia/tratamento farmacológico , Tamoxifeno/análogos & derivados , Vestibulite Vulvar/tratamento farmacológico , Vulvodinia/tratamento farmacológico , Administração Bucal , Dispareunia/complicações , Dispareunia/epidemiologia , Dispareunia/fisiopatologia , Estimulação Elétrica , Feminino , Fogachos/induzido quimicamente , Fogachos/epidemiologia , Humanos , Pessoa de Meia-Idade , Medição da Dor/métodos , Percepção da Dor/efeitos dos fármacos , Projetos Piloto , Pós-Menopausa/efeitos dos fármacos , Pós-Menopausa/fisiologia , Síndrome , Tamoxifeno/administração & dosagem , Tamoxifeno/efeitos adversos , Vulva/efeitos dos fármacos , Vulva/fisiopatologia , Vestibulite Vulvar/complicações , Vestibulite Vulvar/epidemiologia , Vestibulite Vulvar/fisiopatologia , Vulvodinia/complicações , Vulvodinia/epidemiologia , Vulvodinia/fisiopatologia
15.
Eur J Obstet Gynecol Reprod Biol ; 222: 57-63, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29367167

RESUMO

OBJECTIVES: To evaluate outcomes and quality of life in patients operated transvaginally with an original mesh shape for uterus-sparing prolapse surgery and to demonstrate the safety and efficacy of the technique. STUDY DESIGN: We prospectively evaluated 66 postmenopausal patients (POP-Q Stage III: 32, IV: 34) operated between May 2008 and December 2013. We used wide weave polypropylene monofilament mesh that functions as a hammock anchored posteriorly to sacrospinous ligaments, its anterior wings exit the pelvis through the obturatory membrane. Follow-up was scheduled at 3-, 12- months and in May 2016. Prolapse-Quality of Life Questionnaire (P-QoL) was administered preoperatively, at 12 months and in May 2016. The chi square and Wilcoxon test were used for statistical analysis. RESULTS: Mean follow-up was 5.6 (SD: 1.6, Range: 1.1-8.1) years. The overall success rate (POP-Q ≤ 2) was 92.5% at 12 months and 84.4% at May 2016, these data remained stable over time (p > 0.05). Early complications occurred in 2 (3%) patients, late in 5 (7.8%) of which mesh extrusion in 4 (6.3%). Data from P-QoL showed significant improvement between preoperative and postoperative data (P < 0.01 for all domains) and they remained stable with time (p > 0.05). De-novo dyspareunia was 17.6% at 12 months and 10.3% at May 2016. CONCLUSIONS: The low rate and grade of complications demonstrates the safety of the procedure, which offers stable anatomical correction with significant improvement in QoL.


Assuntos
Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Tratamentos com Preservação do Órgão/efeitos adversos , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Telas Cirúrgicas/efeitos adversos , Prolapso Uterino/cirurgia , Idoso , Idoso de 80 Anos ou mais , Dispareunia/epidemiologia , Dispareunia/etiologia , Dispareunia/fisiopatologia , Desenho de Equipamento , Falha de Equipamento , Feminino , Seguimentos , Hospitais Urbanos , Humanos , Itália/epidemiologia , Tempo de Internação , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Risco , Índice de Gravidade de Doença , Prolapso Uterino/fisiopatologia , Vagina
16.
Hematology ; 23(8): 531-536, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29376481

RESUMO

OBJECTIVES: Pain is common in women with sickle cell disease (SCD), but the prevalence of dyspareunia in this unique patient population is unknown. In this study, we sought to determine whether chronic pain is associated with an increased prevalence of dyspareunia in premenopausal women with SCD. METHODS: A cross-sectional study of premenopausal women with SCD was systematically assessed for symptoms of dyspareunia and chronic pain using a standard questionnaire. These results were correlated with each subject's clinical pain phenotype determined by a review of the patient's electronic medical record. RESULTS: Ninety-one premenopausal women with SCD were examined. Thirty-two percent of the women reported dyspareunia. Women with dyspareunia were more likely to have a history of chronic pain (90% versus 61%, p = .006), report more pain days per week (median (interquartile range): 6 (4-7) vs. 3 (0-7), p = .005)), and had a higher oral morphine equivalent dose (145 (45-226) mg vs. 60 (9-160) mg, p = .030). Using a multivariable classification tree analysis, number of days of pain experienced per week was an important predictor of dyspareunia (p = .001). CONCLUSION: Dyspareunia is common in women with SCD, and more common in women with SCD and chronic pain. Providers should assess women with SCD for dyspareunia, especially those with a chronic pain syndrome.


Assuntos
Anemia Falciforme/epidemiologia , Dor Crônica/epidemiologia , Dispareunia/epidemiologia , Pré-Menopausa , Inquéritos e Questionários , Adolescente , Adulto , Anemia Falciforme/fisiopatologia , Dor Crônica/fisiopatologia , Estudos Transversais , Dispareunia/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade
17.
Curr Drug Targets ; 19(8): 916-926, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28228081

RESUMO

Vaginismus is an involuntary muscle contraction of the outer third of vaginal barrel causing sexual penetration almost impossible. It is generally classified under sexual pain disorder (SPD). In Diagnostic and Statistical Manual, 5th edition (DSM-5), it is classified under the new rubric of Genito-Pelvic Pain/Sexual Penetration Disorder. This fear-avoidance condition poses an ongoing significant challenge to the medical and health professionals due to the very demanding needs in health care despite its unpredictable prognosis. The etiology of vaginismus is complex: through multiple biopsycho- social processes, involving bidirectional connections between pelvic-genital (local) and higher mental function (central regulation). It has robust neural and psychological-cognitive loop feedback involvement. The internal neural circuit involves an inter-play of at least two-pathway systems, i.e. both "quick threat assessment" of occipital-limbic-occipital-prefrontal-pelvic-genital; and the chronic pain pathways through the genito-spinothalamic-parietal-pre-frontal system, respectively. In this review, a neurobiology root of vaginismus is deliberated with the central role of an emotional-regulating amygdala, and other neural loop, i.e. hippocampus and neo-cortex in the core psychopathology of fear, disgust, and sexual avoidance. Many therapists view vaginismus as a neglected art-and-science which demands a better and deeper understanding on the clinico-pathological correlation to enhance an effective model for the bio-psycho-social treatment. As vaginismus has a strong presentation in psychopathology, i.e. fear of penetration, phobic avoidance, disgust, and anticipatory anxiety, we highlighted a practical psychiatric approach to the clinical management of vaginismus, based on the current core knowledge in the perspective of neuroscience.


Assuntos
Dispareunia/fisiopatologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Vaginismo/fisiopatologia , Animais , Dor Crônica/fisiopatologia , Dispareunia/psicologia , Feminino , Humanos , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Vaginismo/psicologia
18.
J Huazhong Univ Sci Technolog Med Sci ; 37(6): 928-932, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29270755

RESUMO

To investigate the clinical course and management of congenital vaginal atresia. This retro-spective analysis included patients with congenital vaginal atresia treated from March 2004 to August 2014 at the Obstetrics and Gynecology Hospital of Fudan University. Thirty-nine patients were included in this study. Their average age was 16.87±2.2 years when they came to our hospital. Totally, 51% of the patients had isolated congenital vaginal atresia with a normal cervix, whereas the others had either cervical atresia or imperforate hymen. The primary presenting signs and symptoms included primary amenorrhea (71.8%), periodic abdominalgia (41.0%), abdominal pain (36.0%), dyspareunia (10.3%), menstrual disorders (5.1%), and pelvic mass (5.1%). Ultrasound and magnetic resonance imaging (MRI) were effective inspection methods for the screening of urogenital tract-associated anomalies. Vagi-noplasty mainly included simple vagina reconstruction with insertion of a mold (n=22) and split-thickness skin grafting (n=4). In 64% of surgical patients, normal menstrual bleeding was achieved. Four of the patients subsequently became pregnant and delivered at term. Primary amenorrhea, periodic abdominalgia and abdominal pain are the main reasons for the post pubertal patients to visit doctors. Surgical methods can successfully provide these patients an opportunity for subsequent conservative management, can result in normal menstrual bleeding, resolve cyclic pelvic pain, and provide some po-tential for fertility.


Assuntos
Dor Abdominal/cirurgia , Amenorreia/cirurgia , Dispareunia/cirurgia , Hímen/anormalidades , Distúrbios Menstruais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vagina/cirurgia , Dor Abdominal/fisiopatologia , Dor Abdominal/reabilitação , Adolescente , Amenorreia/fisiopatologia , Amenorreia/reabilitação , Dispareunia/fisiopatologia , Dispareunia/reabilitação , Feminino , Fertilização/fisiologia , Humanos , Hímen/cirurgia , Menstruação/fisiologia , Distúrbios Menstruais/reabilitação , Recuperação de Função Fisiológica , Vagina/anormalidades , Adulto Jovem
19.
Sex Med Rev ; 5(4): 495-507, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28778699

RESUMO

INTRODUCTION: Endometriosis is a common chronic disease affecting 1 in 10 women of reproductive age, with half of women with endometriosis experiencing deep dyspareunia. A review of research studies on endometriosis indicates a need for a validated question or questionnaire for deep dyspareunia. Moreover, placebo-controlled randomized trials have yet to demonstrate a clear benefit for traditional treatments of endometriosis for the outcome of deep dyspareunia. The reason some patients might not respond to traditional treatments is the multifactorial nature of deep dyspareunia in endometriosis, which can include comorbid conditions (eg, interstitial cystitis and bladder pain syndrome) and central sensitization underlying genito-pelvic pain penetration disorder. In general, there is a lack of a framework that integrates these multifactorial causes to provide a standardized approach to deep dyspareunia in endometriosis. AIM: To propose a clinical framework for deep dyspareunia based on a synthesis of pain mechanisms with genito-pelvic pain penetration disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. METHODS: Narrative review after literature search with the terms (endometriosis AND dyspareunia) OR (dyspareunia AND deep) and after analysis of placebo-controlled randomized trials. MAIN OUTCOME MEASURES: Deep dyspareunia presence or absence or deep dyspareunia severity on a numeric rating scale or visual analog scale. RESULTS: Four types of deep dyspareunia are proposed in women with endometriosis: type I that is directly due to endometriosis; type II that is related to a comorbid condition; type III in which genito-pelvic pain penetration disorder is primary; and type IV that is secondary to a combination of types I to III. CONCLUSION: Four types of deep dyspareunia in endometriosis are proposed, which can be used as a framework in research studies and in clinical practice. Research trials could phenotype or stratify patients by each type. The framework also could give rise to more personalized care for patients by targeting appropriate treatments to each deep dyspareunia type. Yong PJ. Deep Dyspareunia in Endometriosis: A Proposed Framework Based on Pain Mechanisms and Genito-Pelvic Pain Penetration Disorder. Sex Med Rev 2017;5:495-507.


Assuntos
Dispareunia/etiologia , Endometriose/complicações , Dor Pélvica/etiologia , Dispareunia/classificação , Dispareunia/fisiopatologia , Feminino , Humanos , Dor Pélvica/complicações
20.
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
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