Evaluation of Sexual Function of Transgender Individuals.

PURPOSE: The current study sought to evaluate the sexual function of transgender men and women and to identify associated factors. METHODS: Trans individuals who were outpatients at our gender incongruence (GI) center for follow-up of gender-affirming hormone therapy with age ranging 27 to 50 years were invited to participate in this cross-sectional study. Clinical data were collected from the medical records. Two scales, the Female Sexual Function Index (FSFI) and the Male Sexual Function Index (MSFI), were administered to all females (n = 50) and all males (n = 58). Each participant also responded to a semi-structured questionnaire that assessed feelings regarding being transgender and satisfaction with sexual life. RESULTS: Relative to trans women, trans men had a higher total FSFI score, and higher scores in the FSFI domains of arousal, lubrication, orgasm, and satisfaction (all p < 0.01), and in the total MSFI score, and higher scores in the MFSI domains of arousal, erection, orgasm, and satisfaction (all p < 0.01). A separate semi-structured evaluation indicated that more than half of the trans men and almost half of the trans women were satisfied or very satisfied with their sexual life. CONCLUSIONS: The total scores from the FSFI and MSFI indicated a high risk of sexual dysfunction in trans men and especially, in trans women. However, the semi-structured evaluation showed that more than half of the trans men and almost half of the trans women were satisfied with their sexual life.

BCORL1, POF1B, and USP9X copy number variation in women with idiopathic diminished ovarian reserve.

PURPOSE: To analyze the copy number variation (CNV) in the X-linked genes BCORL1, POF1B, and USP9X in idiopathic diminished ovarian reserve (DOR). METHODS: This case-control study included 47 women, 26 with DOR and 21 in the control group. Age, weight, height, BMI, and FSH level were evaluated, as well as antral follicle count (AFC), oocyte retrieval after controlled ovarian stimulation, and metaphase II (MII) oocytes. The CNVs of BCORL1, USP9X, and POF1B genes were measured by quantitative real time PCR (qPCR) using two reference genes, the HPRT1 (X-linked) and MFN2 (autosomal). Protein-protein interaction network and functional enrichment analysis were performed using the STRING database. RESULTS: The mean age was 36.52 ± 4.75 in DOR women and 35.38 ± 4.14 in control. Anthropometric measures did not differ between the DOR and control groups. DOR women presented higher FSH (p = 0.0025) and lower AFC (p < .0001), oocyte retrieval after COS (p = 0.0004), and MII oocytes (p < .0001) when compared to the control group. BCORL1 and POF1B did not differ in copy number between DOR and control. However, DOR women had more copies of USP9X than the control group (p = 0.028). CONCLUSION: The increase in the number of copies of the USP9X gene may lead to overexpression in idiopathic DOR and contribute to altered folliculogenesis and oocyte retrieval.

Downregulation of DROSHA: Could It Affect miRNA Biogenesis in Endometriotic Menstrual Blood Mesenchymal Stem Cells?

Menstrual blood mesenchymal stem cells (MenSCs) have gained prominence in the endometriosis scientific community, given their multifunctional roles in regenerative medicine as a noninvasive source for future clinical applications. In addition, changes in post-transcriptional regulation via miRNAs have been explored in endometriotic MenSCs with a role in modulating proliferation, angiogenesis, differentiation, stemness, self-renewal, and the mesenchymal-epithelial transition process. In this sense, homeostasis of the miRNA biosynthesis pathway is essential for several cellular processes and is related to the self-renewal and differentiation of progenitor cells. However, no studies have investigated the miRNA biogenesis pathway in endometriotic MenSCs. In this study, we profiled the expression of eight central genes for the miRNA biosynthesis pathway under experimental conditions involving a two-dimensional culture of MenSCs obtained from healthy women (n = 10) and women with endometriosis (n = 10) using RT-qPCR and reported a two-fold decrease in DROSHA expression in the disease. In addition, miR-128-3p, miR-27a-3p, miR-27b-3p, miR-181a-5p, miR-181b-5p, miR-452-3p, miR-216a-5p, miR-216b-5p, and miR-93-5p, which have been associated with endometriosis, were identified through in silico analyses as negative regulators of DROSHA. Because DROSHA is essential for miRNA maturation, our findings may justify the identification of different profiles of miRNAs with DROSHA-dependent biogenesis in endometriosis.

MIR146A and ADIPOQ genetic variants are associated with birth weight in relation to gestational age: a cohort study.

PURPOSE: To evaluate the genetic variants related to polycystic ovary syndrome (PCOS) and its metabolic complications in girls born small for gestational age (SGA). DESIGN: Retrospective birth cohort study. MATERIALS AND METHODS: We evaluated 66 women of reproductive age born at term (37-42 weeks of gestational age) according to the birth weight in relation to gestational age: 26 SGA and 40 AGA (Adequate for gestational age). Anthropometric and biochemical characteristics were measured, as well as the PCOS prevalence. We analyzed 48 single nucleotide polymorphisms (SNPs) previously associated with PCOS and its comorbidities using TaqMan Low-Density Array (TLDA). miRNet and STRING databases were used to predict target and disease networks. RESULTS: Anthropometric and biochemical characteristics did not differ between the SGA and AGA groups, as well as insulin resistance and PCOS prevalence. Two SNPs were not in Hardy-Weinberg equilibrium, the rs2910164 (MIR146A C > G) and rs182052 (ADIPOQ G > A). The rs2910164 minor allele frequency (MAF) was increased in SGA (OR, 2.77; 95%; CI, 1.22-6.29), while the rs182052 was increased AGA (OR, 0.34; 95%; CI, 0.13 - 0.88). The alleles related to reduced miRNA-146a (C) and ADIPOQ (A) activity showed increased frequency in SGA. The mature miR-146a targets 319 genes, been the CXCR4, TMEM167A and IF144L common targets and contributes to PCOS. The ADIPOQ main protein interactions were ERP44, PPARGCIA and CDH13. CONCLUSIONS: The miR-146a (rs2910164) and ADIPOQ (rs182052) allelic variants are related to birth weight in SGA and may predict health-related outcomes, such as PCOS and obesity risk.

miR-532-3p: a possible altered miRNA in cumulus cells of infertile women with advanced endometriosis.

RESEARCH QUESTION: Is the profile of microRNA (miRNA) altered in cumulus cells of infertile women with early (EI/II) and advanced (EIII/IV) endometriosis? DESIGN: In this prospective case-control study, a miRNA profile including 754 targets was evaluated in samples of cumulus cells from infertile women with endometriosis (5 EI/II, 5 EIII/IV) and infertile controls (5, male and/or tubal factor) undergoing ovarian stimulation for intracytoplasmic sperm injection, using TaqMan® Array Human MicroRNA Cards A and B. The groups were compared with Kruskal-Wallis test, followed by Benjamini-Hochberg correction and Dunn's post hoc test. An in silico enrichment analysis was performed to list the possibly altered pathways in which the altered miRNA target genes are involved. RESULTS: Only the miRNA miR-532-3p showed significant differences among the analysed groups, being down-regulated in the EIII/IV group compared with the infertile control group, as well as compared with the EI/II group. The enrichment analysis showed that some genes regulated by this miRNA are involved in important pathways for the acquisition of oocyte competence, such as the oxytocin, calcium, Wnt, FoxO, ErbB and Ras signalling pathways, as well as the oocyte meiosis pathway. CONCLUSION: The present findings bring new perspectives to understanding the follicular microenvironment of infertile women with different stages of endometriosis. It is suggested that the dysregulation of miR-532-3p may be a potential mechanism involved in the aetiopathogenesis of endometriosis-related infertility. Further studies are needed to evaluate these pathways in cumulus cells of infertile women with the disease, as well as their impact on the acquisition of oocyte competence.

Effects of continuous and intermittent aerobic physical training on hormonal and metabolic profile, and body composition in women with polycystic ovary syndrome: A randomized controlled trial.

OBJECTIVE: To evaluate the effects of continuous (CA) and intermittent (IA) aerobic training on hormonal and metabolic parameters and body composition of women with polycystic ovary syndrome (PCOS). DESIGN: Prospective, interventional, randomized study. METHODS: Randomized controlled training (RCT) with sample allocation and stratification into three groups: CAT (n = 28) and IAT (n = 29) training and no training [control (CG), n = 30]. Before and after 16 weeks of intervention (CAT or IAT) or observation (CG), hormonal and metabolic parameters, body composition and anthropometric indices were evaluated. Aerobic physical training on a treadmill consisted of 30- to 50-minute sessions with intensities ranging from 60% to 90% of the maximum heart rate. RESULTS: In the CA group, there was reduction in waist circumference (WC) (P = .045), hip circumference (P = .032), cholesterol (P ≤ .001), low-density lipoprotein (P = .030) and testosterone (P ≤ .001). In the IAT group, there was a reduction in WC (P = .014), waist-to-hip ratio (P = .012), testosterone (P = .019) and the free androgen index (FAI) (P = .037). The CG showed increases in WC (P = .049), total body mass (P = .015), body fat percentage (P = .034), total mass of the arms (P ≤ .001), trunk fat percentage (P = .033), leg fat percentage (P = .021) and total gynoid mass (P = .011). CONCLUSION: CAT and IAT training reduced anthropometric indices and hyperandrogenism in PCOS, whereas only IAT training reduced the FAI. Furthermore, only CAT training improved the lipid profile.

Telomere length is not altered in girls with idiopathic central precocious puberty treated with a GnRH analog - leuprolide acetate.

BACKGROUND: Idiopathic central precocious puberty (iCPP) presents a disproportionate advancement of bone age and maturation, as well as metabolic and endocrinological changes that may be related to effects on telomere biology. OBJECTIVE: To investigate the telomere length in iCPP girls treated with GnRHa. STUDY DESIGN: Observational case-control study with 85 girls, including 45 iCPP treated with GnRHa and 40 controls. It was analyzed age, height, weight and body mass index (BMI), insulin, triglycerides, testosterone, insulin resistance by HOMA, and telomere length by real-time PCR. Statistical analyses were determined by Wilcoxon test and Spearman correlation was carried out. RESULTS: Weight, BMI, insulin level and HOMA index were higher in the iCPP than in the control group (p < .01); without difference between mean ages. The telomere length did not differ between iCPP and control group. However, a negative correlation was observed between the telomere length and age in iCPP (p = .0009) and control group (p = .014), and weight in the iCPP (p = .017). CONCLUSIONS: We did not observe any difference in the telomere length in the iCPP and control group. Even though, some characteristics of the disease, such as increased weight and body fat, negatively influence the telomere biology.

Peritoneal fluid of women with endometriosis reduces SOD1 in bovine oocytes in vitro maturation.

Studies have demonstrated oxidative stress in peritoneal fluid (PF) from women with endometriosis and the importance of enzymatic antioxidant machinery to avoid oocyte oxidative damage. Considering that PF constantly surrounds the ovaries and has direct contact with the oocyte at ovulation, we wonder if PF from women with endometriosis may affect antioxidant enzyme gene expression. Thus, the present study aims to evaluate the PF impact from infertile women with minimal and mild endometriosis and from fertile control women without endometriosis on SOD1, CAT, GSR gene's expression in experimental bovine oocytes matured in vitro. Samples of PF were obtained from women who underwent videolaparoscopy-7 infertile with EI/II and 7 fertile without endometriosis. Immature bovine oocytes underwent in vitro maturation in the absence of PF and in the presence of three concentrations (1, 5 and 10%) of PF from fertile and from infertile women with EI/II. After 22 to 24 h of IVM, oocytes were denuded and stored for analysis of SOD1, CAT and GSR by real-time polymerase chain reaction. Oocyte SOD1 expression was significantly lower in the 10% endometriosis group (0.67 ± 0.32) when compared with no-peritoneal fluid (1.05 ± 0.24, p < 0.008) and 10% control groups (1.06 ± 0.22, p < 0.006). These findings raise the possibility of a deleterious influence of PF from women with EI/II on the oocyte, not only after ovulation but also during the maturation process, which could contribute to worsening oocyte quality, being one of the mechanisms related to infertility in patients with endometriosis.

Comparison of the Effect of Intermittent and Continuous Aerobic Physical Training on Sexual Function of Women With Polycystic Ovary Syndrome: Randomized Controlled Trial.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common condition characterized by hyperandrogenism, anthropometric changes (increased weight and waist-to-hip ratio [WHR]), behavioral changes (sexual dysfunction, anxiety, and depression), and reduced quality of life. Physical exercise may reduce many of the adverse effects of PCOS. However, no studies have yet evaluated the effects of aerobic exercise on the sexual function of women with PCOS. AIM: To compare the effects of continuous and intermittent aerobic physical training on the sexual function and mood of women with PCOS. METHODS: This is a secondary analysis of a controlled clinical trial in which women with PCOS (18-39 years of age) were randomly allocated to 1 of 3 groups for 16 weeks: continuous aerobic training (CAT, n = 23), intermittent aerobic training (IAT, n = 22), or no training (control group, n = 24). The Female Sexual Function Index (FSFI) was used to assess sexual function, and the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. MAIN OUTCOME MEASURE: The main outcome measure used was the FSFI. OUTCOMES: The primary outcomes were changes from baseline in total FSFI score and HAD scores at week 16 to prove the superiority of intermittent aerobic exercise compared with continuous aerobic exercise. RESULTS: After 16 weeks, the CAT group had a significant increase in the total FSFI score, improvements in the FSFI domains of satisfaction and pain, and a reduction in the WHR. The CAT and IAT groups also had significantly lower levels of testosterone after 16 weeks. The IAT group had a significant increase in the total FSFI score and improvements in the desire, excitation, lubrication, orgasm, and satisfaction FSFI domains. The CAT and IAT groups both had significant reductions in anxiety and depression scores after 16 weeks. CLINICAL IMPLICATIONS: Aerobic physical training protocols could be indicated to promote mental and sexual health in women with PCOS. STRENGTH & LIMITATIONS: This is one of the first studies to examine the effects of different physical training protocols on the sexual function of women with PCOS. The limitations of this study are that we did not consider diet or the frequency of sexual relations of participants with their partners. These factors could have interfered with the outcomes. CONCLUSION: The CAT and IAT protocols improved the sexual function and reduced the anxiety and depression of women with PCOS. Both protocols were similar to improve FSFI domain scores. Lopes IP, Ribeiro VB, Reis RM, et al. Comparison of the Effect of Intermittent and Continuous Aerobic Physical Training on Sexual Function of Women With Polycystic Ovary Syndrome: Randomized Controlled Trial. J Sex Med 2018;15:1609-1619.

Assessment of Sexual Function in Infertile Women in a Gynecological Care Setting.

INTRODUCTION: Infertility has a high prevalence worldwide. There is also a high prevalence of sexual problems, mainly in gynecological care settings, but many women are unlikely to discuss sexual problems with their physicians. AIMS: To verify how second-year gynecology residents (SGRs) assess the sexual function of infertile women who are undergoing assisted reproductive techniques (ART) at a single infertility tertiary care center in Brazil. MAIN OUTCOME MEASURES: Medical records of patients. METHODS: This retrospective cohort study evaluated all medical records of women who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) between January 2011 and December 2012 at a fertility clinic of the Hospital das Clinicas of Ribeirão Preto Medical School, University of São Paulo. RESULTS: A total of 616 women underwent ART during the study period. The mean patient age was 34.5 ± 4.4 years, mean weight was 65.6 ± 12.4 kg, mean height was 163 ± 0.6 cm, and mean body mass index (BMI) was 24.8 ± 4.3 kg/m(2). We classified the methods that medical residents used to assess the sexual frequency of these women as a numerical method, by categorization, or none (no assessment). A total of 26.7% (n = 166) of the SGRs did not assess female sexual function and 26.2% (n = 163) made assessments using categorization. SGRs who used a numerical method rather than categorization to classify the sexual frequency of their female patients were more likely to record answers to other questions on sexual desire, arousal, and orgasm. CONCLUSION: SGRs typically do not assess female sexual function in infertile couples. There was considerable heterogeneity among SGRs in their assessment of coital frequency and female sexual function.

Factors Related to Coital Frequency of Women in Their Thirties.

This cross-sectional study aimed to identify factors related to coital frequency (CF) among 254 women in their 30s using a semistructured interview to collect sociodemographic, anthropometric, reproductive, clinical, and relationship data. CF was characterized as (a) never, (b) rarely (≤1 times/month), (c) occasionally (≤1 times /week), (d) regularly (2-3 times/week), or (e) frequently (>3 times/week). The mean age was 34.38 ± 0.43 years, mean body mass index (BMI) was 27.86 ± 6.52 kg, mean family income was US$1,044.18 ± 796.19, mean number of children was 1.71 ± 0.89, and mean relationship duration was 8.87 ± 5.11 years. Eighty-seven women (35.2%) were taking hormonal contraceptives, 143 (98.0%) were employed, 239 (96.48%) had a secondary or higher education, and 9 (3.62%) had primary schooling. CF was classified as >3 times/week in 22 (8.66%), 2-3 times/week for 98 (38.58%), ≤1 times/week in 40 (15.75%), ≤1 times/month in 14 (5.51%), and never in 5 (1.97%). Women who reported having coitus >3 times/week a week had significantly higher body mass index (BMI; 32.72 ± 7.42 kg/m(2)) than those who had coitus 2-3 times/week (28.45 ± 6.76 kg/m(2)) and ≤1 times /week (26.81 ± 5.39 kg/m(2)) (p < 0.01 for both comparisons). Thus, coital frequency varies in women in their 30s. Obese women had a higher CF than normal-weight and overweight women.

Surface electromyography and ultrasound evaluation of pelvic floor muscles in hyperandrogenic women.

INTRODUCTION: High levels of androgens increase muscle mass. Due to the characteristics of hyperandrogenism in polycystic ovary syndrome (PCOS), it is plausible that women with PCOS may have increased pelvic floor muscle (PFM) thickness and neuromuscular activity levels compared with controls. The aim of this study was to assess PFM thickness and neuromuscular activity among hyperandrogenic women with PCOS and controls. METHODS: This was an observational, cross-sectional, case-control study evaluating PFM by ultrasound (US) and surface electromyography (sEMG) in nonobese women with and without PCOS. Seventy-two women were divided into two groups: PCOS (n = 33) and controls (n = 39). PFM thickness during contraction was assessed by US (Vingmed CFM 800). Pelvic floor muscle activity was assessed by sEMG (MyoTrac Infinit) during contractions at different time lengths: quick, and 8 and 60 s. Descriptive analysis, analysis of variance (ANOVA), and Student's t test were used for statistical analyses. RESULTS: There were no significant differences in PFM sEMG activity between PCOS and controls in any of the contractions: quick contraction (73.23 mV/ 71.56 mV; p = 0.62), 8 s (55.77 mV/ 54.17 mV; p = 0.74), and 60 s (49.26 mV/ 47.32 mV; p = 0.68), respectively. There was no difference in PFM thickness during contractions evaluated by US between PCOS and controls (12.78 mm/ 13.43 mm; p = .48). CONCLUSIONS: This study did not find statistically significant differences in pelvic floor muscle thickness or in muscle activity between PCOS women and controls.

Bleeding patterns of HIV-infected women using an etonogestrel-releasing contraceptive implant and efavirenz-based or lopinavir/ritonavir-based antiretroviral therapy.

OBJECTIVES: The use of progestogen-only contraceptives may cause a change in bleeding pattern, which is a common cause of discontinuation of these methods. Co-administration with some antiretroviral therapies (ART) changes the bioavailability of the etonogestrel (ENG)-releasing contraceptive implant, possibly affecting the bleeding pattern. Bleeding patterns were evaluated in HIV-positive users of the ENG implant co-administered with two common ART regimens. METHODS: Forty-five HIV-positive women who wished to use an ENG implant were included in this study: 15 had received zidovudine/lamivudine (AZT/3TC) + lopinavir/ritonavir (LPV/r) for ≥3 months (LPV/r-based ART group), 15 had received AZT/3TC + efavirenz (EFV) for ≥3 months (EFV-based ART group), and 15 had not received ART (non-ART group). Bleeding patterns were evaluated at 3 and 6 months after implant placement using a standard bleeding calendar. RESULTS: Amenorrhoea and infrequent bleeding rates were higher in the LPV/r-based ART group (50% and 36%, respectively) than in the other groups (non-ART group, 36% and 29%, respectively; EFV-based ART group, 7% and 14.5%, respectively; p = 0.01). The EFV-based ART group more frequently had regular bleeding (71.5%) compared with the other groups (LPV/r-based ART group, 7%; non-ART group, 21%; p = 0.01). The proportions of women with frequent and prolonged bleeding were similar (p > 0.05) in the three groups. CONCLUSIONS: The co-administration of EFV-based or LPV/r-based ART with the ENG implant affected the expected bleeding patterns during use of the implant, although unfavourable bleeding (frequent and prolonged) was not associated with the medications under evaluation.

Exogenous activated NK cells enhance trafficking of endogenous NK cells to endometriotic lesions.

BACKGROUND: Endometriosis is defined as the presence of endometrial glands and stroma at ectopic locations. Although the prevalence of endometriosis is as high as 35%-50%, its pathogenesis remains controversial. An increasing number of studies suggest that changes in immune reactivity may be primarily involved in the development of endometriosis development. In this sense, it has been strongly suggested that a fundamental part of immunologic system, the natural killer cells (NK cells), are an important part of this process. NK cells, a component of the innate immune system, have been extensively studied for their ability to defend the organism against infections and malignancy. Recent studies have shown that IL-2-activated NK (A-NK) cells are able to attack and destroy tumors in lungs and livers of mice, demonstrating the therapeutic potential of these cells. Similarly to metastatic tumor cells, endometrial cells are able to adhere, infiltrate and proliferate at ectopic locations. Therefore, in this study, we evaluated the ability of adoptively transferred and endogenous NK cells to infiltrate endometriosis lesions. METHODS: As NK cells donors were used C57BL/6 B6. PL- Thy 1.1 female mice. As uterine horns donors were used C57/BL6+GFP female mice and as endometriosis recipients C57BL/6 Thy1.2 female mice. Endometriosis induction was made by injection of endometrial tissue fragments. After 4 weeks, necessary for endometriosis lesions establishment the animals were divided in 3 experimental groups with 10 animals each. Group 1 received i.v doses of 5x106 A-NK in 200µl RPMI; Group 2 received i.p dose of 5x106 A-NK in 200µl RPMI and Group 3 received i.p dose of IL2 (0.5 mL RPMI containing 5.000U of IL2). RESULTS: Our data show that exogenous A-NK cells injected via ip combined with endogenous A-NK cells seems to be the most efficient way for activated NK cells track and infiltrate endometriosis. CONCLUSION: For the first time, it was shown that both endogenous as exogenous A-NK cells are able to track, migrate and infiltrate endometriosis lesion. This seems to be a promising result, and if confirmed the efficiency of A-NK cells in killing endometriosis lesions, maybe in the future we could use this approach as an alternative treatment for women with endometriosis.

Pathogenesis of polycystic ovary syndrome: multifactorial assessment from the foetal stage to menopause.

Polycystic ovary syndrome (PCOS) is a multifactorial disorder that arises from interactions between genetic, environmental and intra-uterine factors. Small-for-gestational-age (SGA) babies and the daughters of mothers with PCOS represent possible postnatal clinical targets for developmental programming by steroid excess. The presence of excess glucocorticoids and/or androgens during foetal organogenesis and growth might promote changes in gene expression, and these changes might be related to an increase in the risk of PCOS-like reproductive and metabolic disorders in postnatal life, such as rapid growth and weight gain during the first 2 years of life (only in SGA babies), hyperinsulinaemia, adipocyte dysfunction and childhood visceral obesity, premature pubarche and adrenarche (only in SGA babies) and PCOS. In the fourth decade of life, women who have PCOS may be at higher risk for type 2 diabetes mellitus, dyslipidaemia and systemic arterial hypertension, which suggests that these women are also at higher risk for cardiovascular disease during menopause. However, PCOS can also occur in women who were born at appropriate weight for GA or in newborns of women without PCOS, which suggests that genetic variation and environmental factors play important roles in the development and maintenance of PCOS in a population. Genome-wide association studies based on adequate population samples have shown a higher frequency of genetic polymorphisms of the LHCGR, THADA and DENND1A genes in women with PCOS. Genetic studies of PCOS have also included analyses of structural changes in the chromosome based on an assessment of telomere length in single, cross-sectional evaluations, and these studies have produced controversial results. The present narrative review assesses the multifactorial origins of PCOS (including environmental, genetic and intra-uterine factors) and the development of conditions associated with this disorder. It is concluded that although PCOS might originate in the intra-uterine environment through developmental programming by steroid excess, the interaction between genetic and environmental factors is crucial for its appearance. Follow-up studies should be conducted to assess the same populations over their entire lifespans while taking into account different aspects of the pathogenesis of PCOS.

Down-regulation of the CYP19A1 gene in cumulus cells of infertile women with endometriosis.

Aromatase plays a fundamental role in the establishment of oocyte quality, which might be compromised in infertile women with endometriosis. The expression of the CYP19A1 gene (that encodes aromatase) was compared in cumulus cells and oestradiol concentrations in the follicular fluid of infertile women with and without endometriosis submitted to ovarian stimulation for intracytoplasmic sperm injection. Cumulus cells were isolated and the expression of the CYP19A1 was quantitated through real-time polymerase chain reaction. Oestradiol concentrations in follicular fluid were measured by chemiluminescence immunoassay. A lower expression of the CYP19A1 in the cumulus cells of infertile women with endometriosis was observed compared with controls (0.17 ± 0.13 and 0.56 ± 0.12, respectively), and no significant difference in the follicular fluid oestradiol concentrations was observed between groups. Our results show reduced expression of the CYP19A1 in cumulus cells of infertile women with endometriosis, which may play a role in the pathogenesis of endometriosis-related infertility.

Impact of Physical Resistance Training on the Sexual Function of Women with Polycystic Ovary Syndrome.

INTRODUCTION: There is a need for specific measures to address overall care in women with polycystic ovary syndrome (PCOS). Physical resistance training (PRT) has been shown to improve certain body parameters. However, the effect of PRT on the sexual function of PCOS women has not been evaluated. AIM: The study aimed to assess sexual function and emotional status of PCOS women after 16 weeks of PRT. METHODS: This case-control study involved 43 women with PCOS and 51 control ovulatory women, aged 18-37 years. All women were subjected to a supervised PRT protocol for 16 weeks and evaluated at the end of the program. Sexual function was assessed at baseline and after PRT protocol. MAIN OUTCOME MEASURES: The main outcome measure used was the Female Sexual Function Index (FSFI). RESULTS: Of the 43 women with PCOS, 30 (69.70%) had a basal total FSFI score ≤ 26.55 and 24 of them (58.54%) had a score ≤ 26.55 after PRT (P = 0.08). Of the 51 control women, 32 (62.7%) and 27 (52.9%) had FSFI scores < 26.55 at baseline and after PRT, respectively (P = 0.06). Control women experienced a significant improvement in pain domain score after PRT (P < 0.03). PCOS women experienced significant increases in total score and in the desire, excitement and lubrication domains after PRT (P < 0.01 each). After PRT, there was a significant difference between the PCOS and control groups in the sexual desire domain (4.09 ± 1.29 vs. 3.75 ± 1.42, P = 0.04). Significantly fewer women in the PCOS group were at risk of depression (P < 0.01) and anxiety (P < 0.02) after than before PRT, whereas the differences in the control group were not significant. Mean depression and anxiety scores were reduced significantly in both the PCOS (P < 0.01 each) and control (P < 0.01) groups. CONCLUSIONS: PRT significantly enhanced total score and the desire, excitement, and lubrication domains of the FSFI in PCOS women. PRT reduced pain, and total depression and anxiety scores in both groups.

Body composition characteristics predict sexual functioning in obese women with or without PCOS.

Polycystic ovary syndrome is frequently related to obesity and hyperandrogenism that potentially may impair sexual function. This case-control study aimed to determine the effect of the polycystic ovary syndrome on the sexual functioning of obese women and to determine which body measures can predict sexual functioning among 87 sexually active women obese women with and without polycystic ovary syndrome, 18-40 years old, divided in two groups; obese women (n = 44) or obese women with polycystic ovary syndrome (n = 43). The groups were compared using the Sexual Quotient-Female version and Hospital Anxiety and Depression scales, and by serum tests. No significant difference between groups was observed in weight, waist-hip ratio, body mass index, serum glucose, cholesterol, triglycerides, total testosterone, sex hormone binding globulin, total Sexual Quotient-Female version score, and the total score of ≤ 60 for subjects (risk for sexual dysfunction) and Hospital Anxiety and Depression. Significant difference was observed in age, parity, and Free Androgen Index. Each unit increase in waist-hip ratio conferred a greater chance of score of ≤ 60. A height of less than 161 cm and the presence of depression were found to be risk factors with a score of ≤ 60. Women with a score of ≤ 60 had significantly smaller hip measurements and waist-hip ratio. The presence of polycystic ovary syndrome was not a risk factor for decreased sexual functioning.

Sexual function of women practicing sex in nonconventional settings.

The quality of sexual intercourse in the context of conjugal visits by women to their jailed partners is unknown. This study aimed to assess the quality of the sex lives and psychological conditions of women attending conjugal visits with their jailed inmate partners. This controlled study involved 124 women between the ages of 18 to 40 years who engaged in sexual relations with their inmate partners (conjugal visit group) or with their partners at home (control group). Sexual function was assessed using a semi-structured questionnaire and the Female Sexual Function Index, and psychological parameters were evaluated using the Hospital Anxiety and Depression scale. The total Female Sexual Function Index scores was similar in the 2 groups. The percentage of women reporting good quality of the relationship was significantly higher in the conjugal visit group. Also, the Hospital Anxiety and Depression scale scores were higher in the conjugal visit group. Depression was a risk factor for sexual dysfunction and had a negative effect on scores in the desire, excitement, lubrication, and sexual satisfaction domains, whereas anxiety was associated with lower sexual desire scores. A regular + poor quality of the relationship and being religious were factors associated with sexual dysfunction. Sexual practices in jail were not a risk for sexual dysfunction in this sample.

Presentation and treatment of uterine leiomyoma in adolescence: a systematic review.

BACKGROUND: Uterine leiomyoma is the most common gynecological tumor in the reproductive years. However, it is extremely rare in adolescence (<1%), with few reports found in the literature. The biological behavior of such tumors in this age group is unknown, as well as the best possible treatment for this population. We aimed to analyze all available reports of uterine leiomyoma in adolescence. METHODS: A systematic review was performed at PubMed/MEDLINE and EMBASE. Between 1965 and 2014, 19 reports were found on uterine leiomyoma in patients under 18 years. The following parameters were discussed: age, tumor diameter, symptoms, clinical treatments, surgical treatments, hemodynamic changes. RESULTS: Mean age was 15.35 (14-17) years. Mean tumor diameter was 12.28 cm (3-30) and median diameter was 10 cm. Most patients presented with symptoms (87.5%), including abnormal uterine bleeding (10/18) and pelvic/abdominal pain (6/18). A pelvic mass was the most common finding. Two patients required transfusion due to anemia. One patient underwent abdominal hysterectomy, and the others underwent myomectomy. Mean follow-up was 1 year and 8 months, and only case recurred, after 6 months. CONCLUSION: Leiomyomas' biologic behavior in adolescents may be different from that of older women, but their molecular characteristics still haven't been analyzed. Optimal treatment is still not defined, but myomectomy has several advantages in this population. Leiomyomas must be remembered as an important differential diagnosis of pelvic mass in adolescents.