Women's sexual health improvement: sexual quality of life and pelvic floor muscle assessment in asymptomatic women.

Introduction: Problems related to the quality of sexual life in gynecological practice are usually neglected. This study aimed to highlight the significance of this area of concern and evaluate the usefulness of tools, such as patient-reported outcomes (PROs) and pelvic floor examination, to improve women's sexual wellbeing and to identify predictors of poor quality of sexual life during the well-woman annual visit. Methods: A cross-sectional study was designed to examine 300 healthy women to determine whether the sexual quality of life (SQOL) questionnaire (on electronic devices) and pelvic floor muscle assessment (the vulva, anus, muscles, and periurethral (VAMP) protocol) of asymptomatic women during the annual bimanual examination (BME) help differentiate patients who would benefit from discussing sexual problems with a gynecologist. Dyspareunia was an exclusion criterion. Results: The majority of subjects experienced high sexual wellbeing (82.0% with SQOL score of ≥84), with a mean of 85.7 points. SQOL scores were lower for psychiatric disorders or symptoms (37.0% of subjects), although they did not correlate with age, BMI, parity, contraception use, history of vulvovaginal symptoms, neurosurgical/orthopedic problems, and rectal, bowel, or bladder symptoms. Patients with dyspareunia (16.0% of participants, although they denied it during the face-to-face consultation) had a 3.6 times higher prevalence of low or moderate quality of sexual life. The VAMP protocol score was low in asymptomatic women, 33.0% met positive criteria (VAMP+, NRS ≥3) for pelvic floor dysfunction (overactivity), although at borderline levels. VAMP+ was positively correlated with chronic pain and genitourinary symptoms, but neither with dyspareunia nor incontinence, and was unrelated to the SQOL score (p = 0.151). Conclusion: Women's sexual health is a global health priority. Finding a way to start a discussion with an asymptomatic patient is crucial to increasing patients' interest in disclosing a sexual health problem to be resolved. PROs or simple questions about sexual wellbeing direct the discussion mainly toward the at-risk group for sexual deterioration: those with mental health problems and women with dyspareunia. Dyspareunia is considered a predictor of decreased quality of sexual life, a major sexual disorder that should not be overlooked. Gynecological consultation should resolve concerns, identify the problem, and refer for professional sexual care if still needed.

Vulvodynia in prepubertal girls: diagnosis.

OBJECTIVES: To identify specific features of vulvodynia in prepubertal girls, highlight potential triggers and concomitant diseases, outline diagnostic criteria is neglected problem in adolescent gynecology. MATERIAL AND METHODS: A retrospective study, based on medical records of an outpatient clinic, a cohort of 54 vulvodynia cases was evaluated, aged 3-10 years, seen between January 2016 and July 2018. RESULTS: The study cohort presented with pain (61%), sometimes aggravated at night, pruritus (44%) and a range of other varied and unusual vulvar complaints (26%). Concomitant diseases and/or psychological problems were present in 61% of cases. Overactive pelvic muscles accompanying symptoms like urological or gastrological problems were noted in half of children. Several potential triggers were identified in a third of the cases that were emotionally stressful to the children. From the commencement of symptoms, 93% of the girls have consulted more than one doctor with 43% seeing more than three doctors, without receiving a diagnosis of vulvodynia. CONCLUSIONS: A diagnosis of vulvodynia needs to be considered in the absence of vulva pathology with wide range of vulvar pain, pruritus and discomfort. All persistent or recurrent vulvar discomfort must be taken into consideration as a vulvodynia symptom, also various non-specific, worrisome complaints. Comorbid urological and gastrological symptoms associated with overactive pelvic muscles should not be overlooked. Chronic pain can be triggered by the psychological distress in some prepubertal girls. Proper diagnosis may prevent long-term negative sequelae, what emphasizes the need for professional education of healthcare providers in adolescent vulvar pain and discomfort.

Pilot study of testing a clinical tool for pelvic physical examination in patients with vulvodynia.

OBJECTIVES: Vulvodynia diagnosis is based on medical history and physical examination. The study is aimed to evaluate the clinical usefulness of a pelvic floor physical examination (VAMP protocol) for vulvodynia diagnosis, applied during gynecological examination, proposed as educational and diagnostic tool. MATERIAL AND METHODS: Pelvic physical examinations were performed for 650 non-pregnant female patients. A study group of 449 cases met the vulvodynia diagnostic criteria (120 with provoked, 104 with spontaneous, and 121 with mixed subtype) and were compared with those of 201 healthy individuals. Four anatomical regions were examined: the vulva (V) and anus (A) with a cotton swab, the internal pelvic muscles (M) with a digital examination of the levator ani, and the paraurethral (P) area with digital pressure. Only the maximum pain score for a given area was recorded, using a Numerical Rating Scale. The four anatomical regions were recorded under the VAMP acronym. RESULTS: Differences in mean scores VAMP protocol were statistically between vulvodynia and comparison group for V = 6.48 vs 0.98; M = 6.29 vs 1.05; and P = 6.89 vs 1.33, with exception of A = 0.03 vs 0.08. Patient age, weight, way of delivery, other concomitant diseases (e.g., dysuria, anal and bowel symptoms), vulvodynia subtype, and pain duration did not influence VAMP scores in patients with vulvodynia and comparison group. CONCLUSIONS: Pelvic examination according to VAPM protocol can be applied in vulvar pain patients for diagnostic purposes. Besides of vulvodynia symptoms any other analyzed variables did not influence on scores of VAMP protocols. We found that cut-off score ≥ 3 even in one of V, M or P component of VAMP protocol can be considered as diagnostic criterium for vulvodynia. Component A (anus area) was not useful for vulvodynia diagnosis.

Universal screening as a recommendation for thyroid tests in pregnant women.

According to recent recommendations, thyroid tests in pregnancy should be performed only in women in risk groups. However, detailed studies indicate that such an approach results in missing hypothyroidism in 30% and hyperthyroidism in 69% of pregnant women. The aim of this study was to compare the effectiveness of diagnosing hypothyroidism in pregnant women by applying universal screening tests, and assessing risk factors. The study was carried out on 270 non-selected women in single pregnancy who underwent screening for hypothyroidism (diagnostic criteria: TSH >2.5 mIU/L) during their fi rst prenatal visit between the 6th - 10th week of gestation. After excluding the patients with pre-gestational hypothyroidism, risk factors for this disorder were assessed in the remaining subjects. A group of 28 patients (10.4% of all subjects) with hypothyroidism was selected for further thyroid tests, while the remaining 242 pregnant women (TSH <2.5 mIU/L) aged 26.3+/-3.59 formed the control group. Twenty subjects (71.4%) were thyroid antibodies-positive, while 8 patients were thyroid antibodies-negative. When analyzing hypothyroidism risk factors, one was found in 10 subjects (35.7%), 2 in 5 subjects (17.8%), whereas, in 13 subjects (46.4%) none were present. Symptoms suggesting thyroid dysfunction were discovered in 8 patients (53.3%), goitre in 5 patients (33.3%), another 5 patients (33.3%) had a positive gynaecological history, and only 2 patients had a positive family history of autoimmune thyroid diseases. During the analysis, it was found that TSH positively correlated with the age of the subjects. In the whole study group, a significant correlation was found between log TSH and hypothyroidism risk factors. Hypothyroidism (TSH >2.5 mlU/L) was diagnosed in 10.4% of the patients. The primary cause of this pathology was thyroiditis which was diagnosed in 71.4% of the subjects. Hypothyroidism risk factors were present in 53.6% of the patients, while in 46.4% there were none, which indicates the necessity of carrying out screening tests in all pregnant women as a method of choice, regardless of the presence of thyroid disease risk factors. A positive correlation between the frequency of thyroid diseases risk factors, TSH, and the age of the patients in the presented study serves as an additional argument for the necessity of universal screening.

A case of unusual course of adolescent menorrhagia: decidual cast as a side effect of treatment.

OBJECTIVE: To present an unusual side effect of therapy for adolescent menorrhagia, with commentary on management options. DESIGN: Case report. SETTING: Tertiary gynecologic center. PATIENT(S): A 13-year-old girl presenting with profuse uterine bleeding. INTERVENTION(S): Dysfunctional uterine bleeding was diagnosed, and pharmacologic therapy with a monophasic oral contraceptive (OC) pill was introduced. MAIN OUTCOME MEASURE(S): A large decidual cast occurred during treatment. RESULT(S): After finishing therapy with OC followed by three cycles of cyclic progestogen, the patient experienced regular menses. CONCLUSION(S): A large decidual cast may occur during treatment of adolescent menorrhagia with OCs; patients should be informed about this possibility, to reduce stress connected with the appearance of this side effect.