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1.
Am J Obstet Gynecol ; 222(2): 103-113, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31473229

RESUMO

Genitourinary syndrome of menopause is a condition describing the hypoestrogenic effects on the female genitals and lower urinary tract leading to symptoms such as vaginal dryness, vulvar and vaginal burning, dyspareunia and dysuria. Genitourinary syndrome of menopause is experienced by over half of postmenopausal women, and is even more pervasive in women with cancer. Due to treatments such as surgery, chemotherapy, radiation, and hormonal therapy, women may experience early menopause resulting in earlier and more severe symptoms. Understanding the scope of this issue in female breast and gynecologic cancer survivors and identifying treatment options for this complex patient population are paramount. Tailored patient treatments include nonhormonal therapies (vaginal moisturizers, lubricants, pelvic floor physical therapy, dilator therapy, counseling), systemic and local hormonal therapies. Consensus recommendations by medical societies and associated evidence are reviewed, with emphasis on safety and efficacy of local vaginal hormonal therapies, and management variations noted depending on cancer type and characteristics. With knowledge and understanding of the unmet need associated with under-recognition and under-treatment of genitourinary syndrome of menopause, providers caring for women with cancer are in a position to improve the quality of life of their patients by providing safe and effective treatments.


Assuntos
Neoplasias da Mama , Terapia de Reposição de Estrogênios/métodos , Doenças Urogenitais Femininas/terapia , Neoplasias dos Genitais Femininos , Menopausa , Administração Intravaginal , Anestésicos Locais/uso terapêutico , Sobreviventes de Câncer , Dispareunia/terapia , Disuria/terapia , Feminino , Humanos , Terapia a Laser , Lidocaína/uso terapêutico , Lipídeos/uso terapêutico , Lubrificantes/uso terapêutico , Seleção de Pacientes , Diafragma da Pelve , Modalidades de Fisioterapia
2.
Obstet Gynecol ; 135(1): 113-121, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31809431

RESUMO

OBJECTIVE: To describe patient outcomes after modified vestibulectomy for vulvodynia. METHODS: This is a mixed-methods study of patients who had undergone modified vestibulectomy for vulvodynia at a tertiary care hospital from 2009 through 2016. Demographics, preoperative and postoperative examinations, symptoms, and treatments were obtained through retrospective review. Prospective semistructured interviews were conducted from 2018 through 2019 to address patient-reported changes in pain and sexual function. Qualitative analysis was performed using a grounded theory approach. RESULTS: Twenty-two patients underwent modified vestibulectomy from 2009 through 2016. Age ranged from 22 to 65 years and mean body mass index was 24.3±5.4. The majority of patients were premenopausal (57%), sexually active (68%), and partnered (76%). Postoperatively, data on pain improvement were retrieved on 18 patients, of which 17 (94%) reported improvement. Patients used pelvic floor physical therapy, medications, and lubricants both preoperatively and postoperatively. For the qualitative analysis, thematic saturation was achieved with 14 interviews. Of 14 participants interviewed, 13 (93%) reported improvement with pain after surgery, 11 (79%) reported satisfaction with surgery, 8 (57%) reported satisfaction with sexual function, and 11 (79%) reported recommending the surgery to others. The following lead themes were identified: vulvodynia symptoms significantly affect quality of life; there is difficulty and delay in diagnosis owing to lack of information and awareness among patients and health care providers; and surgical success and satisfaction are influenced by patient perceptions with sexual dysfunction often persisting despite vulvar pain improvement. CONCLUSION: Vulvodynia patients report improvement in pain and high overall satisfaction after modified vestibulectomy, but more variable long-term effects on sexual function.


Assuntos
Dispareunia/terapia , Avaliação de Resultados da Assistência ao Paciente , Qualidade de Vida , Vulvodinia/cirurgia , Adulto , Idoso , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Medição da Dor , Dor Intratável , Modalidades de Fisioterapia , Estudos Prospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
3.
Minerva Med ; 111(1): 79-89, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31726815

RESUMO

Endometriosis is a chronic gynecological disease that generally affects young and sexually active women in different stages of their development and sexual life. Because endometriosis affects about 5-10% of women in reproductive age, it is possible to estimate that about 2-4% of those who are sexually active may suffer from sexual dysfunction caused by this disease. Surgical and pharmacological treatments of endometriosis can improve the patient's sexual function in the medium and long term, but not necessarily lead to a definitive resolution of the sexual issue. For this reason, the ideal treatment should be conducted by a multidisciplinary team, with the aim to improve overall sexual functioning and not only to reduce the painful symptoms during intercourse. In light of these considerations, the aim of this narrative review was to provide a general overview about the impact of endometriosis on sexuality of women affected and the effectiveness of surgical and pharmacological treatments in improving sexual function.


Assuntos
Endometriose/complicações , Disfunções Sexuais Fisiológicas/etiologia , Sexualidade , Adulto , Dispareunia/etiologia , Dispareunia/terapia , Endometriose/psicologia , Endometriose/terapia , Feminino , Humanos , Relações Interpessoais , Equipe de Assistência ao Paciente , Disfunções Sexuais Fisiológicas/terapia
5.
Eur J Contracept Reprod Health Care ; 24(5): 337-346, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31364893

RESUMO

Objective: To quantify the effects of available treatments of vestibulodynia. Methods: Systematic review of randomised controlled trials (RCTs) in six search engines until December 2018, comparing any intervention vs. placebo or sham in women with vestibulodynia. Primary outcome was dyspareunia assessed with visual analogue (VAS) or numeric rating (NRS) scales. Secondary outcomes were daily vestibular symptoms (DVS), McGill Pain Questionnaire (MPQ) and Index of Sexual Satisfaction (ISS). Effects were described as mean differences (MDs) with their 95% confidence intervals (CIs). Traditional and frequentist network meta-analyses (NMA) were performed using random effect models. Results: Four RCTs (n = 275) were included evaluating vaginal cream of conjugated oestrogens, oral desipramine with or without topical lidocaine, topical lidocaine, laser therapy and transcranial direct current. In traditional MA, interventions did not reduce dyspareunia (MD = 0.08; 95%CI = -0.49 to 0.64), DVS (MD = -0.04; 95%CI = -0.31 to 0.24; 4 interventions), or MPQ (MD = -0.17; 95%CI = -2.16 to 1.81; 4 interventions). ISS was significantly improved (MD = -5.14; 95%CI = -9.52 to -0.75). In NMA, oral desipramine with or without lidocaine significantly improved ISS vs. other treatments. Conclusions: Several existing interventions were not associated with improvements in vestibulodynia. There only was improvement of sexual function with oral desipramine with or without lidocaine.


Assuntos
Dispareunia/terapia , Vulvodinia/terapia , Administração Intravaginal , Administração Oral , Adulto , Anestésicos Locais/administração & dosagem , Desipramina/administração & dosagem , Dispareunia/etiologia , Estrogênios/administração & dosagem , Feminino , Humanos , Terapia a Laser/métodos , Lidocaína/administração & dosagem , Metanálise em Rede , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Comportamento Sexual , Estimulação Transcraniana por Corrente Contínua , Resultado do Tratamento , Cremes, Espumas e Géis Vaginais , Vulvodinia/complicações
6.
Photobiomodul Photomed Laser Surg ; 37(7): 451-454, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31210577

RESUMO

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.


Assuntos
Doença de Crohn/complicações , Dispareunia/etiologia , Dispareunia/terapia , Lasers de Gás/uso terapêutico , Fístula Retovaginal/etiologia , Fístula Retovaginal/terapia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Dióxido de Carbono , Terapia Combinada , Feminino , Humanos , Imagem por Ressonância Magnética , Fístula Retovaginal/diagnóstico por imagem
7.
J Sex Marital Ther ; 45(5): 378-394, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30640585

RESUMO

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.


Assuntos
Dispareunia/terapia , Terapia por Exercício/métodos , Distúrbios do Assoalho Pélvico/terapia , Disfunções Sexuais Fisiológicas/terapia , Adulto , Dispareunia/complicações , Dispareunia/psicologia , Feminino , Temperatura Alta/uso terapêutico , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/psicologia , Qualidade de Vida , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/psicologia , Resultado do Tratamento
9.
Eur Rev Med Pharmacol Sci ; 22(23): 8480-8486, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30556890

RESUMO

OBJECTIVE: This is a pilot study to evaluate the effectiveness of concomitant administration of hyaluronic acid and topical hyperbaric oxygen therapy (THOT) by a specifically designed medical device (vaginal natural oxygenation device, VNOD) in improving the symptomatology of postmenopausal patients with vulvo-vaginal atrophy (VVA). PATIENTS AND METHODS: Women with diagnosis of severe VVA from September 2017 to May 2018 were included. Five biweekly administration of THOT and concomitant of hyaluronic acid were performed with a specifically designed medical device. In each occasion, the intensity of patient's symptoms (well-being such as absence of dyspareunia, vaginal dryness, vulvar and/or vaginal itching; vaginal burning; presence of fluid) was determined with a graduated scale from 1 to 6 and the vaginal elasticity and the vaginal wall epithelium appearance were also determined with a graduated scale from 1 to 5. The change in all parameters from baseline to end of therapy was evaluated. RESULTS: Twenty-five patients were considered for the final analysis. A significant improvement in well-being (0.3 vs. 5.1, p < 0.001), vaginal burning (0.2 vs. 5.1, p < 0.001), presence of fluid (0.6 vs. 4.9, p < 0.001), vaginal epithelium appearance (1.8 vs. 4.7, p < 0.001), and vaginal elasticity (1.1 vs. 3.8, p < 0.001) was observed between the first and the last therapy session. All the patients reported a recovery of their sexuality at the end of the five treatment sessions. CONCLUSIONS: In this pilot study, the use of VNOD seems to be a valid treatment of VVA, resulting in a completely natural type of therapy well accepted by patients with immediate therapeutic effects and without side effects; these findings must be confirmed in a well-designed randomized controlled trial.


Assuntos
Ácido Hialurônico/administração & dosagem , Oxigenação Hiperbárica/métodos , Pós-Menopausa , Doenças Vaginais/terapia , Administração Intravaginal , Adulto , Idoso , Atrofia , Dispareunia/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Comportamento Sexual , Vagina/patologia , Vulva/patologia
10.
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
11.
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
12.
J Sex Med ; 15(12): 1752-1764, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30446469

RESUMO

INTRODUCTION: Although vaginismus is a condition with a great impact on psychosexual well-being, the evidence on the efficacy of interventions is lacking. AIM: To review all information on vaginismus treatment, including data from randomized clinical trials (RCTs) and observational studies. METHODS: A systematic search was conducted of MEDLINE, EMBASE, PsycINFO, and ClinicalTrials.gov. 2 Independent meta-analyses of RCTs and observational studies were performed. For RCTs, only those having no treatment as the comparator were considered eligible. MAIN OUTCOME MEASURE: The primary outcome was the success rate (number of successes/total sample) in the completion of sexual intercourse. RESULTS: 43 Observational studies (n = 1,660) and 3 RCTs (n = 264) were included in the final analyses, respectively. In the meta-analysis of RCTs, the use of psychological interventions showed a trend toward a significantly better result vs waiting list control (OR 10.27 [95% CI 0.79-133.5], P = .075). The combination of the results obtained from the observational studies showed that treating vaginismus is associated with the completion of sexual penetrative intercourse in 79% of cases, independently of the therapy used (success rate 0.79 [0.74-0.83]). When only moderate- or strong-quality studies were considered, the success rate was 0.82 (0.73-0.89). As for the different definitions of vaginismus, studies with unconsummated marriage as the inclusion criterion showed the worst success rate (0.68). The origin of vaginismus (primary, secondary, or both), its duration, the mean age of the participants, the involvement of the partner in the intervention, or the geographic setting did not exert a significant effect on the outcome. Studies enrolling women with unconsummated marriage showed a significantly worse success rate. CLINICAL IMPLICATIONS: No approach is superior to the others in allowing the achievement of penetrative intercourse in women with vaginismus. STRENGTH & LIMITATIONS: Only studies specifically enrolling patients with vaginismus were selected, and analyses were performed on an intention-to-treat approach. The main limitations are the small number of trials in the meta-analysis of RCTs and the lack of a comparison group in the meta-analysis of observational studies, which cannot rule out a placebo effect. Due to the limited evidence available, great caution is required in the interpretation of results. Further well-designed trials, with more appropriate outcomes than penetrative sex, are required. CONCLUSION: The meta-analysis of RCTs documented a trend toward higher efficacy of active treatment vs controls, whereas the meta-analysis of observational studies indicated that women with vaginismus benefit from a range of treatments in almost 80% of cases. Maseroli E, Scavello I, Rastrelli G, et al. Outcome of Medical and Psychosexual Interventions for Vaginismus: A Systematic Review and Meta-Analysis. J Sex Med 2018;15:1752-1764.


Assuntos
Coito/psicologia , Vaginismo/psicologia , Vaginismo/terapia , Adaptação Psicológica , Dispareunia/psicologia , Dispareunia/terapia , Feminino , Humanos , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Parceiros Sexuais
13.
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
15.
Surg Endosc ; 32(8): 3720-3731, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29796819

RESUMO

BACKGROUND: Pudendal nerve entrapment can produce a pudendal syndrome comprising perineodynia together with urinary, sexual, and anorectal symptoms. This syndrome can be treated surgically by the transperineal approach. By using an endoscope during the procedure ("operative pudendoscopy"), the surgeon has close-up visual control of each decompression steps, demonstrates the different levels of entrapment, and cuts the sacrospinous ligament under visual control. The aim of this study was to describe the technical details of this new technique and its outcome in the treatment of the pudendal syndrome. METHODS: A series of 113 patients with severe pudendal syndrome underwent operative pudendoscopy. A complete history, pain visual analog scale (VAS) for perineodynia, and four scores evaluating the main symptoms (ICIQ-SF, NHI-CPSI, St Mark's, and Wexner) were obtained before and at least 24 months after surgery. The three clinical signs of pudendal syndrome (abnormal pinprick sensitivity, painful skin rolling test, and painful pudendal nerve) and perineal descent were analyzed before and after surgery in 91 patients. RESULTS: The mean operating time per side was 50.3 ± 15.2 min and the average hospital stay was 2.1 ± 0.4 days. Perineodynia VAS dropped from 7.2 ± 1.4 to 4.5 ± 2.9 after surgery (p < 0.0001) and the symptoms scores significantly improved. Frequency of sexual arousal syndrome, dyspareunia, and cystalgia was also significantly reduced. Pathological perineal descent (≥ 1.5 cm measured with a Perineocaliper®) observed in 13 patients was reduced from 1.81 to 0.77 cm after surgery (p < 0.0001). The only significant complication was severe hemorrhage in one patient induced by an inferior gluteal vessel laceration and successfully treated by arterial embolization. CONCLUSIONS: A complete pudendal nerve decompression, from the distal branches to the sacral foramina, safely performed under visual control by using operative pudendoscopy markedly improves clinical signs and symptoms of the pudendal syndrome.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Nervo Pudendo/cirurgia , Neuralgia do Pudendo/cirurgia , Dispareunia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Disfunções Sexuais Psicogênicas/terapia , Escala Visual Analógica
16.
J Sex Med ; 15(5): 705-715, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29631955

RESUMO

BACKGROUND: Vulvodynia is a poorly characterized condition with multiple treatment options that have been described as largely ineffective in research settings. AIM: To describe treatment patterns in women enrolled in the National Vulvodynia Registry and determine if there is an association between selected treatments and patient-reported outcomes such as pain, sexual function, and psychological distress after 6 months of treatment. METHODS: Participants completed questionnaires on general medical history and patient-reported outcomes using the short-form McGill Pain Questionnaire, the Female Sexual Function Index, the Short Form-12 quality-of-life questionnaire, the Coping Strategies Questionnaire, and the State-Trait Anxiety Inventory. The evaluation also included pain sensitivity assessment of the vaginal mucosa using a cotton-tipped applicator and the vaginal muscles using a single-digit. In this prospective cohort study, all measurements were collected at baseline and again at 6 months after treatment. OUTCOMES: Type of treatment, number of treatments, self-reported pain intensity, dyspareunia, and pain-related psychological distress measures are reported at baseline and 6 months. RESULTS: Of 344 women enrolled, 282 received treatment; 78 different treatments were identified and categorized by type (eg, topical, oral, physical therapy) and number. The most commonly used treatments were topical (85%, n = 241), physical therapy (52%, n = 147), and oral medications (45%, n = 128). Notably, 73% of participants received ≥2 treatments. There was no association between type or number of treatments and patient characteristics. At 6 months, women reported improvements in general pain (P = .001), pain during intercourse (P = .001), catastrophizing (P = .000), and anxiety (P = .000). The Short Form-12 quality-of-life questionnaire showed improvements in physical limitations (P = .024), emotional limitations (P = .003), well-being (P = .025), and social function (P = .010). However, all domains of the Female Sexual Function Index indicated worsening in sexual function (P = .000) except for pain. CLINICAL TRANSLATION: Multi-modal treatments were most commonly used in clinical practice and improvements in patient-reported outcomes such as quality of life, distress, and pain were noted; however, participants who returned at 6 months continued to report poor sexual function. CONCLUSIONS: Strengths include a prospective and long-term study design that evaluated women in clinical settings. Limitations include a high rate of loss to follow-up for certain measures and inability to evaluate efficacy of individual treatments. In a setting where women were receiving highly specialized care, we found wide variation in the type and number of treatments used to treat vulvodynia. Despite this heterogeneity in treatment selection, women reported significant improvements in all study measures except sexual function. Lamvu G, Alappattu M, Witzeman K, et al. Patterns in Vulvodynia Treatments and 6-Month Outcomes for Women Enrolled in the National Vulvodynia Registry-An Exploratory Prospective Study. J Sex Med 2018;15:705-715.


Assuntos
Vulvodinia/terapia , Adaptação Psicológica , Adulto , Ansiedade/psicologia , Coito/psicologia , Dispareunia/psicologia , Dispareunia/terapia , Emoções , Feminino , Humanos , Pessoa de Meia-Idade , Manejo da Dor , Medição da Dor , Limiar da Dor , Modalidades de Fisioterapia , Estudos Prospectivos , Qualidade de Vida , Autorrelato , Comportamento Sexual/psicologia , Vulvodinia/tratamento farmacológico , Vulvodinia/psicologia
17.
Lasers Med Sci ; 33(5): 1047-1054, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29492713

RESUMO

The composition of vaginal microbiome in menopause and cancer survivor women changes dramatically leading to genitourinary syndrome of menopause (GSM) in up to 70% of patients. Recent reports suggest that laser therapy may be valuable as a not hormonal therapeutic modality. The aim of the present study was to evaluate the effects of fractional CO2 laser treatment on the vaginal secretory pathway of a large panel of immune mediators, usually implicated in tissue remodeling and inflammation, and on microbiome composition in postmenopausal breast cancer survivors. The Ion Torrent PGM platform and the Luminex Bio-Plex platform were used for microbiome and immune factor analysis. The significant reduction of clinical symptoms and the non-significant changes in vaginal microbiome support the efficacy and safety of laser treatment. Moreover, the high remodeling status in vaginal epithelium is demonstrated by the significant changes in inflammatory and modulatory cytokine patterns. Laser therapy can be used for the treatment of GSM symptoms and does not show any adverse effects. However, further studies will be needed to clarify its long-term efficacy and other effects.


Assuntos
Lasers de Gás/uso terapêutico , Vagina/microbiologia , Doenças Vaginais/radioterapia , Neoplasias da Mama/cirurgia , Sobreviventes de Câncer , Citocinas/metabolismo , Dispareunia/terapia , Feminino , Humanos , Menopausa , Microbiota , Pessoa de Meia-Idade , Estudos Prospectivos , Síndrome , Vagina/metabolismo , Vagina/efeitos da radiação , Doenças Vaginais/metabolismo
18.
Gynecol Obstet Fertil Senol ; 46(3): 248-255, 2018 Mar.
Artigo em Francês | MEDLINE | ID: mdl-29510963

RESUMO

A major symptom of endometriosis is pelvic pain with a wide range of intensity, rhythm, type, and expression, without clearly established relationship between pain and the disease. Endometriosis-associated pain has physical, psychological/behavioral and social consequences with a significant impact on patient quality-of-life in relation with the biopsychosocial model of chronic pain. Pain assessment in all of its dimensions, as well as assessing the consequences of pain is therefore a crucial part of therapeutic management. Conventional analgesics are commonly used although studies demonstrating their efficacy in the treatment of endometriosis-related pelvic pain are lacking. Non-steroid anti-inflammatory drugs (NSAIDs), known to be effective in dysmenorrhea unrelated to endometriosis, have not been recently re-assessed in patients with endometriosis. Following rigorous assessment, the characterization of neuropathic components of endometriosis-related pelvic pain may lead to treatment with antiepileptic of antidepressant drugs, although gabapentin and amitriptyline have yet to be specifically assessed in the setting of endometriosis-related pain. Other pharmacologically active compounds have been tested to treat endometriosis-related pain but did not demonstrate efficacy with sufficient level of evidence. Diets, dietary supplements and herbal medicine are often proposed and/or used as adjuncts without any conclusive evidence. Although the effects on endometriosis-related pain are methodologically difficult to assess, physical adjunctive therapies such as acupuncture, transcutaneous neurostimulation, osteopathy/chiropractics, physical therapy and physical activity, the long-term therapeutic relationship they establish may potentiate beneficial effects perceived by patients. However, it remains difficult to demonstrate significant effects of cognitive and/or behavioral interventions on endometriosis-related pain. CONCLUSION: The complexity of managing endometriosis-related pain requires a holistic approach with sustained attention to the patient. Treatments, either pharmacologic or non-pharmacologic, including adjuvant therapies, associate a technical expertise to which a human approach must be added in order to bring value to these treatments. Multidisciplinary and/or inter disciplinary approaches are therefore essential to the care of patients suffering from endometriosis.


Assuntos
Analgésicos/uso terapêutico , Terapias Complementares , Endometriose/terapia , Dispareunia/etiologia , Dispareunia/terapia , Endometriose/complicações , Feminino , Humanos , Dor Pélvica/etiologia , Dor Pélvica/terapia
19.
Gynecol Obstet Fertil Senol ; 46(3): 267-272, 2018 Mar.
Artigo em Francês | MEDLINE | ID: mdl-29510966

RESUMO

OBJECTIVE: To provide clinical practice guidelines for the management of painful endometriosis in women without infertility. METHODS: Systematic review of the literature literature since 2006, level of evidence rating, external proofreading and grading of the recommendation grade by an expert group according to HAS methodology. RESULTS: Combined hormonal contraceptives (COP) and the levonorgestrel-releasing intra-uterin system (LNG-IUS) are recommended as first-line hormonal therapies for the treatment of painful endometriosis (grade B). Second-line therapy relies on oral desogestrel microprogestative, etonogestrel-releasing implant, GnRH analogs (GnRHa) and dienogest (grade C). It is recommended to use add-back therapy containing estrogen in association with GnRHa (grade B). After endometriosis surgery, hormonal treatment relying on COP or LNG-IUS is recommended to prevent pain recurrence (grade B). COP is recommended to reduce the risk of endometrioma recurrence after surgery (grade B) but the prescription of GnRHa is not recommended (grade C). Continuous COP is recommended in case of dysmenorrhea (grade B). GnRHa is not recommended as first line endometriosis treatment for adolescent girl because of the risk of bone demineralization (grade B). The management of endometriosis-induced chronic pain requires an interdisciplinary evaluation. Physical therapies improving the quality of life such as yoga, relaxation or osteopathy can be proposed (expert agreement). Promising medical alternatives are currently under preclinical and clinical evaluation.


Assuntos
Endometriose/terapia , Analgésicos/uso terapêutico , Terapias Complementares , Anticoncepcionais Orais , Dispareunia/etiologia , Dispareunia/terapia , Endometriose/complicações , Feminino , Humanos , Dispositivos Intrauterinos Medicados , Dor Pélvica/etiologia , Dor Pélvica/terapia
20.
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
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