Microablative fractional radiofrequency for the genitourinary syndrome of menopause: protocol of randomised controlled trial.

INTRODUCTION: Menopause is a physiological and progressive phenomenon secondary to decreased ovarian follicular reserve. These changes have consequences: vaginal dryness, dyspareunia, discomfort, burning and irritation, vulvovaginal pruritus, dysuria and increased frequency of genitourinary infections. The therapy more suitable for vaginal symptoms in postmenopause yet is the use of a topical hormone. However, the prescription of topical oestrogens should also be avoided in women with a history of breast cancer, oestrogen-sensitive tumours and thromboembolism, emphasising the necessity of alternative treatments. Recently, physical methods, such as laser and radiofrequency (RF), in their non-ablative, ablative and microablative forms have been used in the vaginal mucosa to promote neocolagenesis and neoelastogenesis. This randomised study aims to compare the efficiency of microablative fractional RF (MAFRF) treatment with vaginal oestrogens and no treatment. METHODS AND ANALYSES: This randomised, controlled clinical intervention trial with an open label design comparing the treatment of MAFRF with vaginal oestrogens and no treatment. Four important moments were considered to evaluate treatment results (T0, T1, T2 and T3). The primary outcome includes vulvovaginal atrophy (vaginal pain, burning, itching, dryness, dyspareunia and dysuria), and the secondary outcomes will be sexual function, vaginal health (epithelial integrity, vaginal elasticity, moisture, fluid volume and vaginal pH) and quality of life. ETHICS AND DISSEMINATION: Due to the nature of the study, we obtained approval from the ethics committee. All participants must sign an informed consent form before randomisation. The results of this study will be published in peer-reviewed journals. The data collected will also be available in a public repository of data. TRIAL REGISTRATION NUMBER: RBR-94DX93.

Case Report: Treatment for Rectovaginal Fistula in Crohn's Disease Using Fractionate CO2 Vaginal Laser with Anti-TNF Therapy.

Background: Rectovaginal fistulas (RVFs) are defined as any connection between the anorectum and the vagina. They can have several causes, being Crohn's disease, the second leading cause of RVFs, responsible for ∼10% of the RVFs. Despite the advances in surgical and clinical treatment, there is no consensus regarding the best line of treatment. Objective: To report another therapeutic option, we describe the case of a patient with Crohn's disease and RVF refractory to anti-tumor necrosis factor (TNF) therapy, submitted to intravaginal CO2 fractional laser treatment. Materials and methods: Three laser sessions with monthly interval and analysis by clinical examination, sexual evaluation questionnaire, and magnetic resonance of the pelvis were performed. Results: We obtained an important improvement of the symptoms and of the dimension of the fistulous path. Conclusions: We believe this method to be a complementary, promising, and safe therapeutic alternative for the management of vaginal fistula. Future studies using this therapeutic strategy are needed to confirm the efficacy of this method in this clinical setting.

Estimulação nervosa elétrica transcutânea (TENS) no tratamento da vulvodínia localizada provocada: revisão sistemática / Transcutaneous nervous electric stimulation (TENS) in the treatment of localized provoked vulvodynia: systematic review

Objetivo: Verificar a eficácia da TENS no tratamento de mulheres com vulvodínia localizada provocada. Métodos: Buscou-se, nas bases de dados SciELO, PEDro e PubMed, por estudos que utilizaram a TENS como tratamento da vulvodínia localizada provocada. Resultados: Dos 50 artigos recuperados, três foram analisados: dois ECRs e um estudo de coorte longitudinal não controlado. Conclusão: A TENS pode ser eficaz como uma opção de tratamento na melhora da dor vulvar, sendo uma opção de baixo custo, não invasivo e de fácil manejo; assim como outras terapias combinadas, parece ter um efeito positivo e benéfico no tratamento da vulvodínia localizada provocada. (AU)

Objective: To verify the efficacy of TENS in the treatment of women with localized provoked vulvodynia. Methods: Searched the databases SciELO, PEDro, PubMed, for studies that used TENS as a treatment of localized vulvodynia. Results: Of the 50 articles retrieved, 3 articles were analyzed: 2 RCTs, 1 uncontrolled longitudinal cohort study. Conclusion: The TENS can be effective as a treatment option in improving vulvar pain and is a low-cost, non-invasive and easy to use option, as well as other combined therapies, which appears to have a positive and beneficial effect in the treatment of localized provoked vulvodynia.(AU)

Physical Therapy Intervention for Women With Dyspareunia: A Randomized Clinical Trial.

Dyspareunia negatively affects women´s quality of life, and is a frequent complaint during the peri- and postmenopausal period. A randomized trial evaluated sexual function, quality of life, pain, and pelvic floor muscle function of climacteric women aged between 40 and 60 years old who were sexually active and had complaints of dyspareunia for at least six months. They were assessed before and after their randomization in one of the following interventions: the first group (n = 21) received five one-hour sessions of thermotherapy for relaxation of pelvic floor muscles, myofascial release, and pelvic training (pelvic floor muscle training-PFMT group). The second group (n = 21) received five one-hour sessions during which heat was applied to the lower back with myofascial release of abdominal diaphragm, piriformis, and iliopsoas muscles, with no involvement of pelvic training (lower back-LB group). Forty-two climacteric women with dyspareunia (mean ± SD, PFMT group: 51.9 ± 5.3 years, LB group: 50.6 ± 4.7 years, Student's t-test, p = 0.397) were studied. Pain scores (mean ± SEM) in the PFMT group decreased from 7.77 ± 0.38 to 2.25 ± 0.30; and in the LB group from 7.62 ± 0.29 to 5.58 ± 0.49 (generalized estimating equation-GEE model, p ≤ 0.001 for group, time, and interaction pairwise comparisons). Conclusion: The proposed pelvic floor muscle training protocol was effective to improve pain, quality of life, sexual function, and pelvic floor muscle function in climacteric women with dyspareunia.

Female genito-pelvic pain/penetration disorder: review of the related factors and overall approach / Perturbação de dor Gênito-pélvica e da penetração: revisão dos fatores associados e abordagem geral

Abstract 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.

Resumo A perturbação de dor gênito-pélvica e da penetração (PDGPP) é uma patologia com elevado impacto no bem-estar das pacientes, e traduz-se num desafio diagnóstico e de tratamento para os profissionais que as acompanham. O objetivo deste artigo é rever a etiologia e o tratamento da PDGPP, tendo em conta, principalmente, os aspetos cognitivos e as abordagens de inspiração psicoterapêutica cognitivo-comportamental. Para tal, foi efetuada uma revisão não sistemática dos artigos indexados às bases de dados Medline, Scopus e Web of Science, usando os termos: dor pélvica; dispareunia; vaginismo; vulvodinia; e terapia cognitiva. No total, foram incluídos 36 artigos discutindo a etiologia, diagnóstico e tratamento da PDGPP. Neste artigo, proporcionamos uma revisão do tratamento da PDGPP baseado em fatores biológicos, psicológicos e relacionais, enfatizando os últimos dois. Também resumimos as opções de tratamento

Female Genito-Pelvic Pain/Penetration Disorder: Review of the Related Factors and Overall Approach.

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.

A perturbação de dor gênito-pélvica e da penetração (PDGPP) é uma patologia com elevado impacto no bem-estar das pacientes, e traduz-se num desafio diagnóstico e de tratamento para os profissionais que as acompanham. O objetivo deste artigo é rever a etiologia e o tratamento da PDGPP, tendo em conta, principalmente, os aspetos cognitivos e as abordagens de inspiração psicoterapêutica cognitivo-comportamental. Para tal, foi efetuada uma revisão não sistemática dos artigos indexados às bases de dados Medline, Scopus e Web of Science, usando os termos: dor pélvica; dispareunia; vaginismo; vulvodinia; e terapia cognitiva. No total, foram incluídos 36 artigos discutindo a etiologia, diagnóstico e tratamento da PDGPP. Neste artigo, proporcionamos uma revisão do tratamento da PDGPP baseado em fatores biológicos, psicológicos e relacionais, enfatizando os últimos dois. Também resumimos as opções de tratamento médico disponíveis, e disponibilizamos estratégias para abordar os fatores desencadeantes e de manutenção tanto nas doentes quanto nos seus parceiros. Os profissionais devem estar familiarizados com os fatores subjacentes a este problema, e devem ser capazes de oferecer sugestões úteis para ajudar o casal a quebrar o círculo vicioso de medo e evitamento associado à PDGPP.

Atuação da fisioterapia nas disfunções sexuais / Performance of physiotherapy in sexual dysfunctions

As disfunções sexuais femininas (DSFs) são consideradas um problema de saúde pública pela Organização Mundial da Saúde (OMS). A disfunção sexual na mulher pode influenciar sua saúde física e mental. Dentre os transtornos sexuais femininos, os mais evidentes são vaginismo edispareunia. O vaginismo é a dificuldade de relaxamento da musculatura vaginal no momento da relação, e a dispareunia é definida como dor recorrente ou persistente associada à relação sexual. Assim, o objetivo desta revisão foi identificar as principais disfunções sexuais e verificar as intervenções da fisioterapia nas mesmas por meio de uma revisão da literatura. Foram encontrados artigos científicos nos idiomas inglês, português e espanhol, nas bases de dados Scielo e Pubmed. Os artigos analisados relatam o impacto negativo na vida das mulheres e mostram que a fisioterapia possui inúmeras técnicas para o tratamento dessas disfunções. Na busca inicial para a realização desta revisão integrativa, foram encontradas 28 publicações nas bases de dados Scielo e Pubmed. A maioria dos estudos analisados nesta revisão mostrou que a fisioterapia tem contribuído significantemente para a melhora da função sexual nas mulheres Os recursos utilizados pela Fisioterapia são: Cinesioterapia, Eletroestimulação, Ginástica Hipopressiva, Biofeedback, Cones Vaginais e Terapia Manual. A não padronização dos tratamentos dificulta concluir a melhor terapia, porém todos os estudos apresentaram melhora ou cura dos sintomas associados às disfunções sexuais, demonstrando os benefícios da fisioterapia.(AU)

Female sexual dysfunction (FSD) is considered a public health issue by the World Health Organization (WHO). Sexual dysfunction in women can influence their physical and mental health. Among the female sexual disorders, vaginismus and dyspareunia are the most evident. Vaginismus is the difficulty in relaxing the vaginal muscles during sexual relations and dyspareunia is defined as a persistent or recurrent pain associated with sexual intercourse. The purpose of this review was to verify the effectiveness of physical therapy treatments in female sexual dysfunction, through an literature review. The databases searched were PubMed and SciELO. 28 studies were found in English, Portuguese and Spanish. The analyzed articles report the negative impact of sexual dysfunction in women's lives and show that physical therapy has numerous techniques for treating such disorders. Most of the analyzed studies show a significant contribution of physical therapy to improve sexual function in women through resources such as kinesiotherapy, electrostimulation, hypopressive exercises, biofeedback, vaginal cones and manual therapy. The lack of standardization of treatments makes it difficult to conclude what the best therapy in the treatment of female sexual dysfunction is. However, all studies showed improvement or cure of the symptoms associated with sexual dysfunction, demonstrating the benefits of physical therapy in this condition.(AU)

Vaginismus in Assisted Reproductive Technology Centers: an invisible population in need of care.

OBJECTIVE: Genital and sexual pain is still neglected. Consequences may be dramatic, since infertility and sexual dysfunction may be reciprocally linked. This is the first study to focus on the identification of cases of vaginismus in the ART scenario and on the introduction of intra-cycle interventions as part of a comprehensive, integrated and patient-centered perspective. METHODS: This observational prospective study looked into 425 IVF/ICSI cycles and 226 frozen embryo transfers carried out from January 1, 2015 to December 31, 2016, and found seven cases of vaginismus. Within a six-month period, a questionnaire placed on SurveyMonkey was sent twice to 228 ART centers in Latin America. The purpose was to learn how often cases of vaginismus were found in ART centers and the perceptions around the presence of this condition. RESULTS: The few centers that took the time to answer the questionnaire (24/10.5%) stated that the number of cases in which they had trouble performing control ultrasound examination or needed to perform transfers with patients under sedation was not significant. Although 81% agreed that the incidence of these conditions is low, no references were made to cases of vaginismus, dyspareunia or sexual dysfunction. Our multidisciplinary team found seven cases of vaginismus, involving women with higher education degrees with a mean age of 37.8 years and married for a mean of four years. Although two reported they were able to tolerate intercourse, all reported undergoing treatments such as using vaginal dilators (3), psychotherapy (4) and psychiatric care (1). The care provided by the staff was designed to mitigate patient suffering. CONCLUSION: Gentle care and sensitive listening should be integral components in the work of multidisciplinary teams to identify women with vaginismus and offer couples better quality treatment.

New therapeutic option in genitourinary syndrome of menopause: pilot study using microablative fractional radiofrequency / Nova opção terapêutica na síndrome geniturinária da menopausa: estudo piloto utilizando radiofrequência fracionada microablativa

ABSTRACT Objective: To evaluate the clinical response of patients with symptoms of genitourinary syndrome of menopause after application of microablative fractional radiofrequency in the vagina and vaginal introitus. Methods: Fourteen patients with symptoms of genitourinary syndrome of menopause underwent three applications of microablative fractional radiofrequency with a 30-day interval, using the Wavetronic 6000HF-FRAXX device and a fractional vaginal electrode. The questionnaires World Health Organization Quality of Life (for quality of life evaluation), Female Sexual Function Index and Quality of Life Adapted Questionnaire in the Domain of Sexual Satisfaction (for sexual function and satisfaction evaluation) were administered before and after the applications (30 to 60 days after the last procedure), in addition to the satisfaction questionnaire after procedure. Results: There was an increase in almost all dimensions on average in quality of life, with statistical significance only in the health domain. There was a significant improvement in the sexual domains in almost all dimensions. All patients stopped using lubricant during intercourse after treatment. In the satisfaction questionnaire after treatment, we observed that the vast majority felt cured or much better (29% and 64%, respectively, total of 92.6%) and were very satisfied or satisfied (43 and 57%, respectively, total of 100%). The only patient who reported little improvement had an 18-year postmenopausal history and was treatment naïve. Conclusion: Microablative fractional radiofrequency was effective in treating symptoms of vaginal dryness and dyspareunia, and eliminated the use of vaginal lubricant during the period observed. Since this is a pilot study with a small number of patients, further studies are required to corroborate our findings and evaluate the long-term effects of microablative fractional radiofrequency on the vaginal tissue.

RESUMO Objetivo: Avaliar resposta clínica de pacientes com sintomas da síndrome geniturinária da menopausa após aplicação de radiofrequência fracionada microablativa na vagina e no introito vaginal. Métodos: Quatorze pacientes com sintomas de síndrome geniturinária da menopausa foram submetidas a três aplicações de radiofrequência fracionada microablativa com intervalo de 30 dias, utilizando aparelho Wavetronic 6000HF-FRAXX e eletrodo vaginal fracionado. Foram aplicados os questionários World Health Organization Quality of Life (para avaliar qualidade de vida), Female Sexual Function Index e Quality of Life Adapted Questionnaire in the Domain of Sexual Satisfaction (para verificar função sexual e satisfação) antes e depois das aplicações (30 a 60 dias após último procedimento), além do questionário de satisfação após procedimento. Resultados: Na qualidade de vida, houve aumento na média em geral, com significância estatística apenas no quesito saúde. No domínio sexual, houve melhora significativa em quase todas as dimensões. Todas as pacientes cessaram o uso de lubrificante na relação sexual após o tratamento. No questionário de satisfação após tratamento, a maioria se sentiu curada ou muito melhor (29 e 64%, respectivamente; total de 92,6%) e estava muito satisfeita ou satisfeita (43 e 57%, respectivamente; total de 100%). A única paciente que relatou pouca melhora tinha história de 18 anos de pós-menopausa e era virgem de tratamento. Conclusão: Radiofrequência fracionada microablativa foi efetiva em tratar sintomas de ressecamento vaginal e dispareunia, e eliminou o uso de lubrificante vaginal durante o período observado. Por se tratar de estudo piloto com pequena quantidade de pacientes, mais estudos são necessários para corroborar estes achados e avaliar os efeitos a longo prazo da radiofrequência fracionada microablativa no tecido vaginal.

A fisioterapia pélvica melhora a dor genitopélvica/desordens da penetração? / Does the pelvic physical therapy improves genitopelvic pain/penetration disorder?

Muitas vezes, as Disfunções Sexuais Femininas (DSF) são subdiagnosticadas, têm causas multifatoriais e não recebem devida atenção para o tratamento. Estas disfunções podem se manifestar em qualquer idade, sobretudo em mulheres adultas e idosas, e de diferentes formas. Para ajudar essa mulher na resolução do seu problema, o ideal é que profissionais especializados em saúde sexual a aborde, cada um em sua área de atuação. Além de apoio médico e psicológico, a fisioterapia tem papel fundamental na reabilitação sexual da dor genitopélvica/desordens da penetração (vulvodínea, vestibulodínea, dispareunia e vaginismo). O fisioterapeuta utiliza recursos como terapia manual, cinesioterapia, eletroestimulação, biofeedback, eletromiografia, cones vaginais e dilatadores na conduta terapêutica para essas disfunções. A literatura ainda apresenta-se restrita neste tema, mas é possível afirmar que a fisioterapia pélvica, se bem conduzida, é resolutiva, proporcionando satisfação e melhora da qualidade de vida da mulher.(AU)

Often, Female Sexual Dysfunction (FSD) is underdiagnosed, have multifactorial causes and do not receive adequate attention for treatment. These dysfunctions may appear at any age, especially in adult and elderly women, and in different ways. To help this woman in the resolution of her problem, the ideal is that professionals specialized in sexual health address her, each one in its area of operation. In addition to medical and psychological support, physiotherapy plays a key role in sexual rehabilitation genito-p-elvic pain/penetration disorders (vulvodynea, vestibulodynea, dyspareunia and vaginismus). The physical therapist works with manual therapy, therapeutic exercise, electrical stimulation, biofeedback, electromyography, vaginal cones and dilators in the therapeutic approach. The literature also presents restricted in this area, but we can say that the pelvic physical therapy, if well conducted, is resolute, providing satisfaction and improving quality of life of women.(AU)

Perineal Massage Improves the Dyspareunia Caused by Tenderness of the Pelvic Floor Muscles / Massagem perineal melhora a dispareunia causada por tensão dos músculos do assoalho pélvico

ABSTRACT Aim: To evaluate the long-term effectiveness of perineal Thiele massage in the treatment of women with dyspareunia caused by tenderness of the pelvic floor muscles. Methods: A total of 18 women with diagnoses of dyspareunia caused by tenderness of the pelvic floor muscles were included in the study. The women were divided in two groups: the dyspareunia (D) group - 8 women with dyspareunia caused by tenderness of the pelvic floor muscles; and the chronic pelvic pain group (CPP) group - 10 women with dyspareunia caused by tenderness of the pelvic floor muscles associated with CPP. Each patient filled out the Visual Analogue Scale (VAS), the McGill Pain Index, the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). After an evaluation, the women underwent transvaginal massage using the Thiele technique over a period of 5 minutes, once a week for 4 weeks. Results: All women had significant improvements in their dyspareunia according the VAS and the McGill Pain Index (p < 0,001), but the HADS scores did not show significant differences. Regarding sexual function, the D group showed improvements on all aspects of sexual function, while the CPP group showed differences only in the pain domain. Conclusion: Thiele massage is effective in the treatment of dyspareunia caused by tenderness of the pelvic floor muscles with a long-term pain relief.

RESUMO Objetivo: Avaliar a eficácia em longo prazo da massagem perineal de Thiele no tratamento de mulheres com dispareunia provocada pela tensão dos músculos do assoalho pélvico. Métodos: Foram incluídos no estudo dezoito mulheres com diagnóstico de dispareunia provocada pela tensão dos músculos do assoalho pélvico. As mulheres foram divididas em dois grupos: o grupo dispareunia (D) - 8 mulheres com dispareunia causada pela tensão dos músculos do assoalho pélvico; e o grupo de dor pélvica crônica (DPC): 10 mulheres com dispareunia causada pela tensão dos músculos do assoalho pélvico associados à DPC. Cada paciente preencheu Escala Visual Analógica (EVA), Índice de Dor de McGill, Índice de Função Sexual Feminino (IFSF) e Escala Hospitalar de Ansiedade e Depressão (EHAD). Após a avaliação, as mulheres foram submetidas a massagem transvaginal utilizando a técnica de Thiele ao longo de um período de 5 minutos, 1 vez por semana durante 4 semanas. Resultados: Todas as mulheres tiveram melhora significativa da dispareunia de acordo com a EVA e o Índice de Dor de McGill (p < 0,001), mas na pontuação do EHAD não mostraram diferenças significativas. Em relação à função sexual, o grupo D apresentou melhora de todos os aspectos da função sexual, enquanto o grupo DPC mostrou diferenças apenas no domínio dor. Conclusão: A massagem perineal de Thiele é eficaz no tratamento da dispareunia causada pela tensão dos músculos do assoalho pélvico, com alívio da dor a longo prazo.

Perineal Massage Improves the Dyspareunia Caused by Tenderness of the Pelvic Floor Muscles.

Aim To evaluate the long-term effectiveness of perineal Thiele massage in the treatment of women with dyspareunia caused by tenderness of the pelvic floor muscles. Methods A total of 18 women with diagnoses of dyspareunia caused by tenderness of the pelvic floor muscles were included in the study. The women were divided in two groups: the dyspareunia (D) group - 8 women with dyspareunia caused by tenderness of the pelvic floor muscles; and the chronic pelvic pain group (CPP) group - 10 women with dyspareunia caused by tenderness of the pelvic floor muscles associated with CPP. Each patient filled out the Visual Analogue Scale (VAS), the McGill Pain Index, the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). After an evaluation, the women underwent transvaginal massage using the Thiele technique over a period of 5 minutes, once a week for 4 weeks. Results All women had significant improvements in their dyspareunia according the VAS and the McGill Pain Index (p < 0,001), but the HADS scores did not show significant differences. Regarding sexual function, the D group showed improvements on all aspects of sexual function, while the CPP group showed differences only in the pain domain. Conclusion Thiele massage is effective in the treatment of dyspareunia caused by tenderness of the pelvic floor muscles with a long-term pain relief.

New therapeutic option in genitourinary syndrome of menopause: pilot study using microablative fractional radiofrequency.

OBJECTIVE: To evaluate the clinical response of patients with symptoms of genitourinary syndrome of menopause after application of microablative fractional radiofrequency in the vagina and vaginal introitus. METHODS: Fourteen patients with symptoms of genitourinary syndrome of menopause underwent three applications of microablative fractional radiofrequency with a 30-day interval, using the Wavetronic 6000HF-FRAXX device and a fractional vaginal electrode. The questionnaires World Health Organization Quality of Life (for quality of life evaluation), Female Sexual Function Index and Quality of Life Adapted Questionnaire in the Domain of Sexual Satisfaction (for sexual function and satisfaction evaluation) were administered before and after the applications (30 to 60 days after the last procedure), in addition to the satisfaction questionnaire after procedure. RESULTS: There was an increase in almost all dimensions on average in quality of life, with statistical significance only in the health domain. There was a significant improvement in the sexual domains in almost all dimensions. All patients stopped using lubricant during intercourse after treatment. In the satisfaction questionnaire after treatment, we observed that the vast majority felt cured or much better (29% and 64%, respectively, total of 92.6%) and were very satisfied or satisfied (43 and 57%, respectively, total of 100%). The only patient who reported little improvement had an 18-year postmenopausal history and was treatment naïve. CONCLUSION: Microablative fractional radiofrequency was effective in treating symptoms of vaginal dryness and dyspareunia, and eliminated the use of vaginal lubricant during the period observed. Since this is a pilot study with a small number of patients, further studies are required to corroborate our findings and evaluate the long-term effects of microablative fractional radiofrequency on the vaginal tissue.

Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial.

OBJECTIVE: Evaluate TENS effectiveness as a complementary treatment of chronic pelvic pain and deep dyspareunia in women with deep endometriosis. STUDY DESIGN: This randomized controlled trial was performed in a tertiary health care center, including twenty-two women with deep endometriosis undergoing hormone therapy with persistent pelvic pain and/or deep dyspareunia. This study was registered in the Brazilian Record of Clinical Trials (ReBEC), under n RBR-3rndh6. TENS application for 8 weeks followed a randomized allocation into two groups: Group 1 - acupuncture-like TENS (Frequency: 8Hz, pulse duration: 250µs) - VIF (n=11) and Group 2 - self-applied TENS (Frequency: 85Hz, pulse duration: 75µs) (n=11). The intensity applied was "strong, but comfortable". We evaluated patients before and after treatment by the use of the Visual Analogue Scale, Deep Dyspareunia Scale and Endometriosis Quality of Life Questionnaire. We used the Wilcoxon and Mann-Whitney tests to compare before and after treatment conditions. RESULTS: Despite the use of hormone therapy for 1.65±2.08 years, the 22 women with deep endometriosis sustained pelvic pain complaints (VAS=5.95±2.13 and 2.45±2.42, p<.001) and/or deep dyspareunia (DDS=2.29±0.46 and 1.20±1.01, p=.001). We observed significant improvement for chronic pelvic pain, deep dyspareunia and quality of life by the use of TENS. Both application types of TENS were effective for improving the evaluated types of pain. CONCLUSIONS: Both resources (acupuncture-like TENS and self-applied TENS) demonstrated effectiveness as a complementary treatment of pelvic pain and deep dyspareunia, improving quality of life in women with deep endometriosis regardless of the device used for treatment.

Láser erbium vaginal como tratamiento del síndrome genitourinario de la menopausia: resultados preliminares / Erbium vaginal laser as a treatment for genitourinary syndrome of menopause: preliminary results

ANTECEDENTES: El síndrome genitourinario de la menopausia (SGM) afecta hasta el 50% de las mujeres posmenopáusicas. Sus síntomas presentan un curso crónico y progresivo, pudiendo alterar significativamente la sexualidad y la calidad de vida. OBJETIVO: Evaluar efectividad a corto plazo y aceptabilidad del láser vaginal de Erbium en cristal de itrio-aluminio-granate (Er:YAG) como una terapia fototérmica no invasiva, no ablativa para el manejo del SGM. MÉTODO: Estudio longitudinal prospectivo, realizado en 28 mujeres posmenopáusicas con SGM. Se aplica láser vaginal Er:YAG en 3 sesiones cada 30 días. En todos los controles, se evalúa sequedad vaginal, dispareunia mediante escala visual analógica, y se registra el "vaginal health index score" (VHIS). Al final del tratamiento se evalúa la aceptabilidad del método. RESULTADOS: Se observa mejoría significativa de los síntomas (sequedad vaginal y dispareunia; p<0,01) durante todo el periodo de estudio y del VHIS (8,2 ± 1,3 previo al tratamiento vs. 19,2 ± 0,4 posterior al tratamiento; p<0,01). El 93,4% de las pacientes calificó el procedimiento como excelente o bueno. CONCLUSIÓN: Nuestro estudio piloto muestra que el tratamiento con láser Er:YAG en mujeres posmenopáusicas con síntomas de SGM es eficaz, factible y seguro en el corto plazo. Se requieren datos a más largo plazo y de mayor tamaño muestral para confirmar nuestros resultados.

BACKGROUND: The genitourinary syndrome of menopause (GSM) affects up to 50% of postmenopausal women. Symptoms are chronic and likely worsen over time. This complains may interfere with sexual function and quality of life. OBJECTIVE: To evaluate the short-term effectiveness and acceptability of Erbium in yttrium aluminum-garnet crystal Laser (Er:YAG) as a non-invasive, non-ablative photothermal therapy for the treatment of GSM. METHODS: Prospective longitudinal study performed in 28 postmenopausal women suffering from GSM. All participants were treated intravaginally with Er:YAG laser in 3 applications performed every 30 days. Symptoms (vaginal dryness and dyspareunia) were evaluated by a visual-analogic scale (VAS) and the vaginal health index score (VHIS). After therapy, the women were asked to evaluate the acceptability of the intervention. RESULTS: Er:YAG laser treatment was effective to improve symptoms (vaginal dryness and dyspareunia; p<0.01) at all the study period, as well the VHIS (8.2 ± 1.3 at baseline vs. 19.2 ± 0.4 after treatment; p<0.01). Satisfaction with the procedure was reported as excellent or good by 93.4% of women. CONCLUSION: Our pilot study shows that the Er:YAG treatment in postmenopausal women with GSM is effective, feasible, and safe. Further larger, long-term and controlled studies are required to confirm this data.

Actualizaciones en terapia sexual / Update in sex therapy

Dada la relevancia que ha presentado históricamente la terapia sexual, a partir de Masters y Johnson y el desarrollo de sus abordajes en disfunciones sexuales, se realiza una revisión del estado actual de las teorías, tratamientos y técnicas de los últimos 24 años en materia. Los hallazgos indican que las investigaciones son relativamente escasas y que los modelos explicativos no han sido suficientemente desarrollados por los psicólogos investigadores. Aún así todos los datos apuntan a señalar que una amplia variedad de técnicas y tratamientos específicos para disfunciones sexuales resultan eficaces. Por último, habría que destacar la necesidad de que la psicología mantenga su presencia en el área y continué investigando en conjunto con otras ciencias, de modo de mantenerse vigente y sumar esfuerzos en un terreno especialmente importante para los individuos.

Dispareunia: aspectos ginecológicos e psicossociais / Dispareunia: gynecologic and psychosocial aspects

A dispareunia é estudada de forma abrangente, sob uma nova metodologia de pesquisa sexológica. O homem é um elemento acrescentado ao tratamento, ajudando a mulher a identificar suas respostas e ajudando-a a organizar seu modo de amar. O tratamento geral é a terapia individual ou conjugal, cobrindo educaçäo sexual, treino em habilidades de comunicaçäo e terapia sexual. As técnicas de relaxaçäo, dessensibilizaçäo e reeducaçäo devem ser aprendidas. Deve ser dada especial atençäo ao papel dos músculos pélvicos na cópula e também ao reconhecimento das sensaçöes pélvicas, genitais e musculares. Na prevençäo da dispareunia, a Educaçäo Sexual pode impedir que as idéias errôneas sobre sexualidade possam ser perpetuadas por traiçäo oral familiar, o que tornará fácil o aparecimento de dispareunia de longa duraçäo quando as motivaçöes, somáticas e psíquicas, forem mínimas e transitórias