Current status of laparoscopy teaching in gynecology and obstetrics medical residency in Brazil.

OBJECTIVE: To characterize laparoscopy teaching in Medical Residency Programs in Gynecology and Obstetrics in Brazil, and to evaluate preceptors' characteristics in laparoscopy programs and map laparoscopic training practice scenarios. METHODS: This descriptive cross-sectional study evaluated questionnaire responses from coordinators of the Medical Residency Programs in Gynecology and Obstetrics from 2019 to 2021. RESULTS: The questionnaire was sent to 175 programs, and 90 responses were received (51.4%). From the 85 valid responses, it was noted that 67 programs had laparoscopic training. Of the 64 responses received regarding location, 32 replies (50%) indicated the Southeast of Brazil, particularly some country's capitals. In 37.3% (n=25) of the cases, the program coordinator performed laparoscopy. The chief of the laparoscopy sector has advanced experience in most 52.5% (n=10) medical residency services; the preceptors also had advanced experience in 89.4% (n=59) of the services. Residents received laboratory training in 39.4% (n=26) of the services. In most cases, training was performed using a physical simulator. Of the 26 medical residency services with laparoscopy training outside the operating room, 80.8% (n=21) performed them as part of the curriculum, 61.5% (n=16) had a schedule for the same, and only 3.9% (n=1) were objectively evaluated. CONCLUSION: Laparoscopy teaching in Brazil is heterogeneous, with only a few programs offering any training in laparoscopy. The preceptors had advanced experience and participated in laboratory and operating room training. Only a few programs have their own laboratories or training centers, and most teaching programs do not plan to set up training centers.

Epidemiologia, clínica y evolución en pacientes con endometriosis / Epidemiology, clinic and evolution in patients with endometriosis

Objetivo: Estudiar la relación que existe entre algunos factores predisponente a desarrollar endometriosis y síntomas más frecuentes que manifiestan las pacientes. Métodos: Estudio observacional longitudinal, retrospectivo y descriptivo, mediante la revisión de 455 historias tomadas 560 pacientes que acudieron a la consulta de endometriosis y realizando diagnóstico definitivo en el Hospital Universitario "Dr. Ángel Larralde" y consulta privada, en Venezuela, estado Carabobo, en el periodo de enero 2006 a mayo 2023. Resultados: El diagnóstico se realizó en un 47,1 % de las pacientes con edades entre 26 a 35 años. La menarquia se presentó entre los 8 y los 12 años (el 69 %). El 63 % no tenía embarazos. La dismenorrea primaria fue más frecuente en el 63,07 %. El dolor pélvico y dispareunia en el 48 %, los síntomas digestivos en el 21 %. La localización más frecuente fue en ovario (78,7 %). Conclusión: La endometriosis, enfermedad inflamatoria benigna, estrógeno dependiente, se caracteriza por presencia de glándulas y estroma endometrial ectópico, usualmente acompañados de fibrosis. Se manifiesta en el periodo reproductivo, su principal síntoma es el dolor. Se localiza con mayor frecuencia en la pelvis y de esta en los ovarios, en intestino, vejiga, hígado, pulmones, cerebro, pared abdominal y periné. No hay tratamiento para su cura, pero si para los síntomas y retardar su progreso. Su diagnóstico por su desarrollo multifactorial y manifestaciones clínicas en muchas oportunidades se realiza en forma tardía(AU)

Objective: To study the relationship that exists between some predisposing factors to develop endometriosis and the most frequent symptoms manifested by patients. Methods: Longitudinal, retrospective and descriptive observational study, through the review of 455 records taken from 560 patients who attended the endometriosis consultation and made a definitive diagnosis at the "Dr. Ángel Larralde" and private consultation, in Venezuela, Carabobo state, in the period from January 2006 to May 2023. Results: The diagnosis was made in 47.1% of the patients aged between 26 and 35 years. Menarche occurred between 8 and 12 years of age (69%). 63% did not have pregnancies. Primary dysmenorrhea was more frequent in 63.07%. Pelvic pain and dyspareunia in 48%, digestive symptoms in 21%. The most frequent location was in the ovary (78.7%). Conclusion: Endometriosis, a benign, estrogen-dependent inflammatory disease, is characterized by the presence of ectopic endometrial glands and stroma, usually accompanied by fibrosis. It manifests itself in the reproductive period, its main symptom is pain. It is located most frequently in the pelvis and from this in the ovaries, intestine, bladder, liver, lungs, brain, abdominal wall and perineum. There is no treatment to cure it, but there is treatment for the symptoms and slowing its progress. Its diagnosis due to its multifactorial development and clinical manifestations is often made late(AU)

Premature ovarian insufficiency: knowledge, attitudes, and quality of care offered by gynecologists.

OBJECTIVE: Premature ovarian insufficiency (POI) affects up to 3% of the global female population, influencing metabolic, cardiovascular, and reproductive health. Medical expertise in diagnosis, effects, and treatment strategies, particularly for gynecologists, is crucial for ensuring improved healthcare for women. The objective of this study is to assess the state of medical knowledge regarding the diagnosis, treatment, and follow-up of POI among Brazilian gynecologists. METHODS: A cross-sectional study was conducted using online questionnaires administered to 16,000 members of the Brazilian Federation of Gynecology and Obstetrics. RESULTS: In total, 460 questionnaires were received from gynecologists who had an average age of 44.49 ± 12.57 years and 19.37 ± 12.95 years of professional experience. Fifty-three percent of gynecologists diagnosed POI correctly, and 49% requested karyotype analysis, while fewer than 10% identified all POI etiologies. Over 90% of gynecologists understood the long-term consequences of POI for bone and cardiovascular health. Despite being a consequence of hypoestrogenism, hormone therapy was recommended only by 20% of doctors, with no more than 50% of them prescribing appropriate doses for young women. Regarding self-perception, 60% of gynecologists declared deficient knowledge regarding how to offer care and guidance to women, with hormone therapy being reported as the most important reason (47%). CONCLUSIONS: Current concepts and guidelines for POI are not adequately understood or applied in Brazilian clinical practice, leading to suboptimal care.

Estrés laboral y desempeño profesional en Personal de Salud del área de Ginecología y Obstetricia de un Hospital Peruano en el año 2023 / Work stress and professional performance in health personnel in the Gynecology and Obstetrics area of a Peruvian Hospital in 2023

Objetivo: Describir la relación entre el estrés laboral y el desempeño profesional en el servicio de Ginecología y Obstetricia en el Hospital Sergio Bernales durante el año 2023. Métodos: Estudio de tipo cuantitativo, observacional, prospectivo y transversal. Los participantes del estudio formaban parte del personal de salud que labora en el servicio de Ginecología y Obstetricia del Hospital Nacional Sergio E. Bernales. Resultados: El personal de salud presenta un nivel medio de estrés laboral 45,4 %, seguido por un 29,3 % con alto nivel y un 25,3 % con bajo nivel de estrés laboral. Los médicos residentes (18; 100 %) y los obstetras (26; 46,2 %) mostraron, predominantemente, un nivel medio de estrés laboral. Los niveles medio y alto de estrés se asociaron a un nivel de rendimiento bueno (26 personas; 45,6 %) y 15 entrevistados (26,3 %), respectivamente, y muy bueno: 18 personas (56,3 %) y 13 (40,6 %). Conclusión: Se destaca que el 57,6 % del personal tiene un buen desempeño profesional, siendo las obstetras mayoritarias en este grupo. Se observó que predominaron los niveles medio y alto de estrés laboral en el personal de salud, sin embargo, se encontró un nivel medio de desempeño profesional. Los hallazgos revelan que la mayoría de encuestados logró mantener un buen desempeño profesional a pesar de experimentar niveles medios o altos de estrés laboral, lo que sugiere la complejidad de la relación entre el estrés y el rendimiento laboral en este ámbito de la salud(AU)

Objective: To describe the relationship between work stress and professional performance in the Gynecology and Obstetrics service at the Sergio Bernales Hospital during the year 2023. Methods: Quantitative, observational, prospective and cross-sectional study. The study participants were health personnel working in the Gynecology and Obstetrics service of the Sergio E. Bernales National Hospital. Results: Health personnel have a medium level of work-related stress (45.4%), followed by 29.3% with a high level and 25.3% with a low level of work-related stress. Resident physicians (18; 100%) and obstetricians (26; 46.2%) predominantly showed a medium level of work-related stress. Medium and high levels of stress were associated with a good level of performance (26 people; 45.6%) and 15 interviewees (26.3%), respectively, and very good performance: 18 people (56.3%) and 13 (40.6%). Conclusions: It should be noted that 57,6% of the personnel have a good professional performance, with obstetricians being the majority in this group. It was observed that medium and high levels of work stress predominated among health personnel; however, a medium level of professional performance was found. The findings reveal that the majority of respondents managed to maintain good professional performance despite experiencing medium or high levels of job stress, suggesting the complexity of the relationship between stress and job performance in this health care setting(AU)

Findings and Challenges in Replacing Traditional Uterine Cervical Cancer Diagnosis with Molecular Tools in Private Gynecological Practice in Mexico.

We have been encouraging practicing gynecologists to adopt molecular diagnostics tests, PCR, and cancer biomarkers, as alternatives enabled by these platforms, to traditional Papanicolaou and colposcopy tests, respectively. An aliquot of liquid-based cytology was used for the molecular test [high-risk HPV types, (HR HPV)], another for the PAP test, and one more for p16/Ki67 dual-stain cytology. A total of 4499 laboratory samples were evaluated, and we found that 25.1% of low-grade samples and 47.9% of high-grade samples after PAP testing had a negative HR HPV-PCR result. In those cases, reported as Pap-negative, 22.1% had a positive HR HPV-PCR result. Dual staining with p16/Ki67 biomarkers in samples was positive for HR HPV, and 31.7% were also positive for these markers. Out of the PCR results that were positive for any of these HR HPV subtypes, n 68.3%, we did not find evidence for the presence of cancerous cells, highlighting the importance of performing dual staining with p16/Ki67 after PCR to avoid unnecessary colposcopies. The encountered challenges are a deep-rooted social reluctance in Mexico to abandon traditional Pap smears and the opinion of many specialists. Therefore, we still believe that colposcopy continues to be a preferred procedure over the dual-staining protocol.

Prevalence and factors associated with anxiety, depression and burnout in gynecology and obstetrics residents during the COVID-19 pandemic.

Objective: To determine the prevalence of anxiety, depression and burnout in residents of Gynecology and Obstetrics during COVID-19 pandemic in Brazil and its associated factors. Methods: Cross-sectional study involving all regions of Brazil, through the application of a sociodemographic questionnaire, the Hospital Anxiety and Depression Scale (HAD) and the Maslach Burnout Inventory (MBI-HSS) instrument. Multivariate analysis was performed after adjusting the Poisson model. Results: Among the 719 participating medical residents, screening was positive for anxiety in 75.7% and for depression in 49.8% of cases. Burnout syndrome was evidenced in 41.3% of the physicians studied. Those with depression are more likely to have anxiety (OR 0.797; 95%CI 0.687 - 0.925) and burnout syndrome (OR 0.847 95%CI 0.74 - 0.97). Residents with anxiety (OR 0.805; 95%CI 0.699 - 0.928) and burnout (OR 0.841; 95%CI 0.734 - 0.963) are more likely to have depression. Conclusion: High prevalence of anxiety, depression and burnout were found in residents of Gynecology and Obstetrics in Brazil, in addition to important correlations between anxiety-depression and depression-burnout.

Prevalence of colorectal symptoms and anal incontinence in patients with pelvic organ prolapse attended at an outpatient urogynecology service.

Objective: To analyze data of patients with symptomatic pelvic organ prolapse evaluated with PFDI20 and its subscales to report the prevalence of lower gastrointestinal symptoms and anal incontinence in the population of a public hospital and analyze its impact on quality of life. Methods: Cross-sectional study of patients with symptomatic POP. Patients were evaluated with demographic data, POP-Q, pelvic floor ultrasonography, urological parameters, and pelvic floor symptoms (PFDI-20), and quality of life (P-QoL) surveys. Patients were classified as CRADI-8 "positive" for colorectal symptoms, with responses "moderate" in at least 3 and/or "severe" in at least 2 of the items in the CRADI-8 questionnaires. Results: One hundred thirteen patients were included. 42.5% (48) were considered positive for colorectal symptoms on CRADI-8. 53.4% presented anal incontinence. No significant differences were found in sociodemographic variables, POP-Q stage, ultrasound parameters, or urological parameters. Positive patients had a significantly worse result in PFDI-20, POPDI (48 vs 28; p<0.001), UDI6 (51 vs 24; p<0.001), and in the areas of social limitation (44.4 vs 22.2; p = 0.045), sleep- energy (61.5 vs 44.4; p = 0.08), and severity (56.8 vs 43.7, p=0.015) according to P-QoL. Conclusion: Moderate or severe colorectal symptoms are seen in 40% of patients with symptomatic POP in our unit. Full evaluation of pelvic floor dysfunction symptoms should be performed routinely in urogynecology units.(FONIS SA12I2I53 - NCT02113969).

The personal experience of female obstetricians and gynaecologists with contraceptive use influences the guidance and prescription of contraceptive methods: a web-survey.

OBJECTIVE: To evaluate the influence of the personal experience of female obstetricians and gynaecologists (Obst/Gyns) who utilise contraceptive methods on the provision of these methods. METHODS: An anonymous online web-based survey was carried out with female Obst/Gyns. The instrument contained questions about their current and previous contraceptive methods use, factors that influenced the choice and satisfaction with the ongoing method, as well as the occurrence of adverse events. They were also asked whether the experience of any adverse events influenced their decision in prescribing any particular contraceptive method. RESULTS: 476/9000 (5.3%) female Obst/Gyns answered the survey. The most common contraceptive in use was the 52-mg levonorgestrel-intrauterine device (52-mg LNG-IUD) (34%), followed by non-Long-Acting Reversible Contraception hormonal methods (21.2%). More than half of the respondents (57.6%) reported having some adverse effects and 18.7% reported that the personal experience of an adverse effect with the use of a contraceptive method influenced the prescription of that method. CONCLUSION: Half of female Obst/Gyns encountered adverse events linked to contraceptive usage. Additionally, almost one-fifth believe that their own encounter with adverse effects from a contraceptive method impacts their decision to prescribe the same method.

Almost one-fifth of the female obstetrics and gynaecologists that answered the online survey reported that the personal experience of an adverse effect with the use of a contraceptive method influenced the prescription of that method.

Professional activity and experience after a residency training program in ObGyn: A 10-year analysis.

OBJECTIVE: To describe the profile and professional trajectory of the obstetrics and gynecology (ObGyn) graduates over the past decade, at a referral university hospital. METHODS: A cross-sectional study was conducted, utilizing a survey that targeted graduates of the ObGyn residency program from the last decade, asking about demographics, medical undergraduate, residency details, post-residency trajectory, satisfaction levels, and social media usage. A descriptive analysis was performed. Comparative analyses, including gender-based differences, were assessed using chi-squared or Fisher exact tests (P < 0.05). RESULTS: Among 126 graduates, 84 agreed to participate (66.67%), predominantly comprising females with an average age of 33 years. Most identified themselves as white. The majority had pursued their undergraduate studies at the same institution (78.6%) and subsequently acquired specialized titles in ObGyn from the national society. Most of them were employed in both public and private sectors (71.08%). Male graduates held the majority of medical shifts in obstetrics. A significant gender-based salary discrepancy was noted, favoring males. More than half of the professionals utilized social media for work-related purposes. Many expressed the necessity for supplementary education beyond public health, particularly career management. CONCLUSION: The findings highlight a predominance of female and white individuals among the graduates. Overall, graduates expressed contentment with their education and professional engagements. A gender-based income disparity was identified, favoring male graduates. Studies like this can provide insights for improving medical residency education.

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

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

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

Management of hypoactive sexual desire dysfunction at a specialized service in women's sexual health.

Hypoactive sexual desire dysfunction (HSDD) is prevalent among women. This retrospective cohort study aimed to verify the results of the strategies used by Gynecologists and Obstetricians (Ob-gyn) residents in the management of female HSDD. For this, we conducted a data collection of patient medical records of women with HSDD from the Human Sexuality Studies outpatient clinic of the Human Reproduction Center, Department of Gynecology and Obstetrics of FMRP-USP, from 2005 to 2019. Among the 437 women included, 361 (82.6%) answered the question concerning the effect of the protocol to which they were submitted, whereas 234 (64.8%) reported improvements in sexual desire. The univariate model showed that patients without chronic pelvic pain were 19.0% less likely to report improvements in HSDD than those with chronic pelvic pain (p = 0.03). Patients without depression and without orgasmic dysfunction were, respectively 32% and 23% more likely to show improvements in their HSDD than those who had depression or orgasmic dysfunction (respectively p = 0.001, p = 0.008). However, the multivariate model did not identify any associations. The assistance regarding HSDD by the Ob-gyn resident in training to deal with female sexual complaints may be effective in improving sexual complaints.

Producción científica sobre obstetricia y ginecología en revistas científicas estudiantiles cubanas (2014-2022) / The Scientific Production about Gynecology and Obstetrics in Cuban Student Journals (2014-2022)

Introducción: El desarrollo de la investigación científica en las ciencias de la salud constituye un componente medular en el sistema de asistencia médico-sanitaria que influye en los niveles de salud y la calidad de vida de la población. Objetivo: Caracterizar la producción científica sobre obstetricia y ginecología en revistas científicas estudiantiles cubanas en el período 2014-2022. Métodos: Se realizó un estudio bibliométrico de la producción científica anteriormente descrita, cuyo universo quedó conformado por 104 artículos publicados. No se aplicaron técnicas de muestreo y fueron evaluadas las variables: año de publicación, idioma, revistas científicas estudiantiles, cantidad de autores, institución de procedencia, temáticas abordadas, tipo de artículo y cantidad de referencias. Se aplicó la estadística descriptiva. Resultados: El año 2021 resultó el más productivo con 31 artículos (29,81 por ciento); la revista científica 16 de Abril publicó el 28,85 por ciento de estos. Existió un predominio de investigaciones con autoría múltiple, aquellos firmados por cuatro autores fueron los más destacados con el 29,81 por ciento y el 16,34 por ciento de los autores provenían de la Universidad de Ciencias Médicas de Pinar del Río. Las investigaciones vinculadas al área de la obstetricia como temática central tuvieron la mayor prevalencia. Sobresalieron los artículos originales con 74 investigaciones para un 71,15 por ciento. Conclusiones: La actividad científica estudiantil en la especialidad de ginecología y obstetricia se ha visto favorecida por un crecimiento ascendente. Respaldada por la colaboración entre múltiples autores, así como por varios órganos de difusión, permiten lograr un mayor alcance e impacto, en especial mediante la publicación de investigaciones originales(AU)

Introduction: The development of scientific research in health sciences is a fundamental component within medical-healthcare systems that influences the health levels and the quality of life of the population. Objective: To characterize the scientific production on obstetrics and gynecology in Cuban student scientific journals in the period 2014-2022. Methods: A bibliometric study was carried out of the scientific production described above, the universe of which consisted of 104 published articles. No sampling techniques were applied, and the variables year of publication, language, student scientific journals, number of authors, institution of origin, addressed topics, type of article, and number of references were evaluated. Descriptive statistics were applied. Results: The year 2021 was the most productive, with 31 articles (29.81 percent); the scientific journal 16 de Abril published 28.85 percent of them. There was a predominance of research with multiple authorship; those signed by four authors were the most widely represented, accounting for 29.81 percent. 16.34 percent of the authors came from Universidad de Ciencias Médicas de Pinar del Río. Pieces of research related to the area of obstetrics as the central topic had the highest prevalence. Original articles stood out, with 74 pieces of research, accounting for 71.15 percent. Conclusions: The student scientific activity in the specialty of gynecology and obstetrics has been favored by an upward growth. Supported by the collaboration among multiple authors, as well as by several dissemination bodies, they allow achieving greater reach and impact, especially through the publication of original pieces of research(AU)