Annual Gynecologic Examination Research Articles

The importance of the regularity of preventive examinations in the early diagnosis of ovarian cancer

Objective. To show the importance of regularity of preventive examinations in early diagnostics of ovarian cancer. Malignant ovarian tumors occupy the third place in the frequency of occurrence among the gynecological tumors after cancer of the uterine body and cervix but they leave them behind with regard to the mortality rate. Detection of the disease at late stages leads to only 17 % five-year survival rate in Europe and Russia.
 Materials and methods. A prospective study was conducted on the basis of the Gynecological Unit of Perm Regional Oncological Dispensary. It enclosed 50 patients aged 45 to 77 years, operated for ovarian cancer with various stages of the disease. The following methods were used: collection of complaints and anamnesis, study of outpatient cards and medical histories, assessment of morphological conclusions.
 Results. According to the anamnesis, all patients represented a risk group for ovarian cancer. The annual gynecological preventive examination was carried out in 40 % of patients, ultrasound examination of the pelvic organs was performed in 28 % of cases. The smallest group,10 % of patients, was a group of patients with stage I of the disease and asymptomatic course of pathology, who underwent preventive examinations and ultrasound in 100 % of cases. The largest number of patients had stage III 40 %, annual preventive examinations were carried out in 20 % of women of this group without ultrasound examination of the pelvic organs. In 64 % of cases, a late examination by a doctor was detected a year or more after the symptoms of the disease occurred. Patients with stages III and IV of the disease were postmenopausal, were unemployed and lived in rural areas.
 Conclusions. The absence of symptoms at an early stage of ovarian cancer and late onset of treatment with the complaints available actualizes the need for annual preventive gynecological examinations with mandatory ultrasound verification of the diagnosis to identify the disease in time.

The gynecological controls in the elderly female dogs

In canine geriatric medicine has many different research areas such as cardiology, endocrinology, dentistry. However, diagnosing many related diseases and complications can be late related to thoughts that spayed dog's genital exams are thought of as unneeded approaches. Reproductive infections, mammary/gynecologic tumoural diseases, and their complications decrease their life quality and have a considerable mortality rate in aged intact and spayed bitches. Therefore, an effective gynecologic health check program supported with different imaging techniques is highly needed in small animal clinics. In this review, it is planned an annual gynecologic examination for older/geriatrics dogs and presented the main steps to early diagnose and prevent genital diseases with high mortality and lower their life quality and longevity.

Expression of fascin in association with p16 and Ki-67 in cervical lesions: immunohistochemical study Expression of fascin in association with p16 and Ki-67 in cervical lesions: immunohistochemical study

Annual gynecological examination with cervical cancer screening and HPV vaccination ensures the appropriate prevention of the onset and progression of cervical cancer. Currently, efforts are being made to find new diagnostic and prognostic biomarkers. Fascin, an actin-bundling protein, promotes cellular migration. Its overexpression has been observed in many types of squamous carcinomas and was usually correlated with aworse prognosis and metastasis. However, the data on fascin expression in cervical lesions are limited. This study focuses on the quantitative evaluation of fascin expression, the immunoreaction intensity and subcellular localization of fascin expression in low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL) and squamous cell carcinomas (SCC). Fascin expression was also correlated with the routinely used diagnostic markers p16 and Ki-67. Biopsy specimens (n = 67) of LSIL, HSIL and SCC were taken from adult women in the age range 20-86 years. Fascin expression was detected by immunohistochemical analysis and quantified using morphometric software. Analysis of variance confirmed statistically significant differences in the percentage of fascin-positive cells between the LSIL, HSIL and SCC groups. Finally, the results showed asignificant positive correlation between fascin expression and p16 and Ki-67 expression.

Hereditary Nonpolyposis Colorectal Cancer (HNPCC)/Lynch Syndrome: Surveillance and Diagnostic strategies

Introduction: Hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) is an autosomal dominant genetic disease. The disease is caused by a mutation in one of four genes of the DNA mismatch repair system and increases the risk for various cancers, especially the uterine and colon cancers. The prevalence of this disease in the general population is about 1 in 500 and it causes about 2-3% of colorectal cancers. Lynch syndrome is diagnosed in two stages: 1) the person is suspected of having the disease (because a patient is unusually diagnosed with cancer at a young age), and 2) evidence of incomplete repair defect is seen in the tumor tissue (microsatellite instability). The detection of a pathogenic mutation confirms the diagnosis in these patients and enables predictive testing for other family members. Diagnostic evaluation of Lynch syndrome should be performed with appropriate genetic counseling. Systemic colonoscopy surveillance could identify colon cancers at an earlier stage before patients present clinical symptoms. Conclusion: Although many studies have been done, but the benefits of an individualized, risk-adapted surveillance strategy are still unclear. Until this is identified, Lynch syndrome patients and healthy carriers with causative mutations should be monitored by annual colonoscopy and annual gynecological examination (for women).

Results of a prospective phase II national study: Prophylactic radical fimbriectomy (NCT01608074), in women with a documented high risk of breast/ovarian cancer—Final pathological results and outcomes.

1594 Background: Risk-reducing salpingo-oophorectomy (RRSO) is the gold standard in surgical prophylaxis of pelvic high-grade serous carcinoma (HGSC) for women at risk of breast/ovarian cancer. Due to significant adverse effects of early oophorectomy, 20-30% of women delay or deny performing this operation. Recent data highlight the fallopian origin of most pelvic HGSC, especially its fimbrial part. Thus, we suggested a new two-step risk-reducing procedure: the radical fimbriectomy (RF) with delayed oophorectomy (DO) (Leblanc et al Gyn Oncol 2011), leading to the current RF/DO Phase 2 study. We present the definitive results on primary and secondary objectives of this trial. Methods: BRCA1/2 carriers or any women with a documented familial risk of breast/ovarian cancer were first counseled to perform a classical laparoscopic RRSO. If they denied, they were offered to enter the RF/DO study. All specimens were submitted to the SEE-FIM pathological protocol. Pathological data along with all intra- and 30-day and beyond post-operative adverse events were prospectively recorded. Follow-up consisted in an annual clinical breast and gynecological examination, with tumor markers and hormonal status assessment. Primary endpoint was the rate of pelvic serous carcinoma. Secondary endpoints were procedure morbidity, rates of tubal abnormalities, breast cancer, secondary oophorectomy. Results: From January 2012 to October 2014, 121 RF were performed: 120 by laparoscopy, 1 laparotomy (concurrent myomectomy). An occult neoplasia was found in 3 cases with 1 invasive HGSC. Intraoperative complications were two grade1 bleedings without transfusion with no grade ≥3 early post-operative or delayed complication. With a median follow-up of 5.3 years (0.2 -7.6), no patient developed any pelvic HGSC, 21 patients developed a breast cancer (3 de novo, 18 recurrences/contralateral.). 1 cancer-free BRCA1-mutated lady delivered safe twins, after an uneventful post-RF pregnancy obtained with assisted reproductive technology (ART). Overall, 29 women underwent DO (by choice: 12 or menopause: 17) resulting in grade 3b complication in 1 case, but no pathological abnormality. Conclusions: RF/DO appears as a safe, well tolerated and effective procedure in terms of occult neoplasia detection. A successful pregnancy with ART was possible after radical fimbriectomy. Longer follow-up and larger cohort are necessary to confirm its efficacy in terms of ovarian cancer prophylaxis. Clinical trial information: NCT01608074.

Tamoxifen in the Management of Breast Cancer: A Case Presented in Multidisciplinary Session With Clinical Discussion and Decision-Making

Background: Selective estrogen receptor modulators (SERMs) have been shown to reduce the risk of developing estrogen-positive breast cancer. Tamoxifen, a potent SERM, has been successfully administered as adjuvant therapy for breast cancer. However, uterine pathologic changes may develop due to the effect of tamoxifen as both an agonist and antagonist of estrogen on the uterus. Here, we discuss a case of breast cancer treated with tamoxifen to clarify one of the most important complications, namely, endometrial hyperplasia.
 Case Presentation: A 51-year-old woman presented with left breast mass and axillary lymphadenopathy. Mammography showed a 26-mm spiculated mass consistent with invasive ductal carcinoma in core needle biopsy. Immunohistochemical analysis revealed that the tumor was ER- and PR-positive, HER2-negative, and P53-negative. Adjuvant chemotherapy was completed, and the patient was referred to undergo adjuvant radiotherapy (RT). After the completion of RT, treatment with tamoxifen was initiated at the recommended dose of 20 mg/day.
 Questions: The questions are when to use tamoxifen as adjuvant therapy for breast cancer, How to follow the patient treated with tamoxifen, and when to discontinue tamoxifen therapy.
 Conclusion: Use of tamoxifen for at least 5 years after diagnosis is a reasonable option for the prevention of breast cancer or its recurrence in high-risk patients. Premenopausal women on tamoxifen presenting with abnormal uterine bleeding must undergo transvaginal ultrasonography. For premenopausal women taking tamoxifen, irregular vaginal bleeding should be evaluated by hysteroscopy or uterine ultrasonography, and, if the etiology remains unclear, a biopsy should be done. There are no evidence-based recommendations for uterine malignancy screening in patients who take tamoxifen. Current recommendations are annual gynecologic examination and evaluation of any abnormal vaginal bleeding.

Sequence of Pelvic Examination Affects Patient-Reported Pain

The purpose of this trial is to compare patient-reported pain based on the sequence of the pelvic examination and to assess the relationship between pain during the examination and quality of life, self-esteem, and sexual function. A randomized controlled trial of women presenting for annual gynecologic examinations. Women were assigned to either group A: a Q-tip touch test, speculum examination, then bimanual examination or group B: Q-tip touch test, bimanual examination, then speculum examination. The primary outcome was visual analog scales to assess pain at baseline and after each portion of the examination. Secondary outcomes were responses to questionnaires for self-esteem, quality of life, and sexual function. Of 200 women who enrolled, 192 (96%) completed all visual analog scale data points. Each portion of the examination caused minimal pain over baseline in each group. Pain during the speculum examination was higher than pain during the bimanual examination in both groups (P = 0.007 and P < 0.001). Group B, however, had significantly higher pain scores after the speculum examination than group A (P = 0.044). The groups did not differ on bimanual pain scores (P = 0.76). Pain scores were not statistically different when analyzed by age, parity, sexual activity, sexual orientation, education, or previous hysterectomy. Within both groups, patients who documented having any pain after the speculum examination or the bimanual examination were also more likely to have lower quality of life scores (P < 0.001 and P < 0.001). Pain associated with the speculum examination was lower in those undergoing speculum before bimanual examination. Speculum pain was greater than bimanual pain in both groups. Most patients reported minimal or no pain during the different portions of the examination.

Screening for ovarian cancer: Evidences

Cancer of the ovary is a leading cause of death among women. Early stage disease are not evident for the incumbent nature of disease in the abdominal cavity. When ovarian cancer is detected and treated while it is still confined to the ovary (stage I), the 5-year survival rate is approximately 90%, but 33% when the disease is diagnosed at stage III or IV. So screening had role in down staging the disease and improve survival. Evidence still does not support screening in average risk women but annual gynecologic examination with pelvic examination is recommended for preventive healthcare. Screening in women with increased risk and inherited risk result in a decrease in the number of deaths in women. For women with mutations in BRCA2, ovarian cancer screening should be initiated between ages 35 and 40.

A Perspective on Ovarian Cancer Biomarkers: Past, Present and Yet-To-Come.

The history of biomarkers and ultrasonography dates back over more than 50 years. The present status of biomarkers used in the context of ovarian cancer is addressed. Attention is given to new interpretations of the etiology of ovarian cancer. Cancer antigen 125 (CA125) and multivariate index assays (Ova1, Risk of Ovarian Malignancy Algorithm, Overa) are biomarker-driven considerations that are presented. Integration of biomarkers into ovarian cancer diagnostics and screening are presented in conjunction with ultrasound. Consideration is given to the serial application of both biomarkers and ultrasound, as well as morphology-based indices. Attempts are made to foresee how individualized molecular signatures may be able to both provide an alert of the potential for ovarian cancer and to provide molecular treatments tailored to a personalized genetic signature. In the future, an annual pelvic ultrasound and a comprehensive serum biomarker screening/diagnostic panel may replace the much maligned bimanual examination as part of the annual gynecologic examination. Taken together, it is likely that a new medical specialty for screening and early diagnostics will emerge for physicians and epidemiologists, a field of study that is independent of patient gender, organ, or the subspecialties of today.

The Knowledge, Attitudes and Practices (KAP) Regarding Human Papilloma Virus (HPV) Among Women in Karachi, Pakistan

<i>Background</i>: The burden of STIs in Pakistan is much larger than reported. Various research studies indicate that the knowledge of sexually transmitted infections (STIs) and Human Papilloma Virus (HPV) in the women is low. The objective of this study is to assess the knowledge, attitudes and practice regarding STIs, HPV and sexual behaviors of contraceptive practice among women in Karachi, Pakistan. <i>Methods</i>: The current study was conducted in a tertiary care hospital in Karachi from Aug 2014- Aug 2015, including 600 women (aged 19-50 years) by convenience sampling technique from waiting areas of out-patient clinics. <i>Results</i>: The mean age of participants was 39.5 ± 10.7 years. Eighty eight percent women (n = 529) were married, 8% (n = 50) female were unmarried and around 3% (n = 19) female were divorced, separated or widowed. Participants with no knowledge about STIs and viruses causing some cancers were 57% (n = 341) and 70% (n = 418) respectively. There was no knowledge about Pap smear in 80% (n = 479) of study population and the proportion of women not attending the annual gynecological examination were 88% (n = 525). Vaccine acceptability was found to be as low as 38% (n = 225). A similar trend 12% (n = 71) was seen in the response about willing to pay by themselves for the vaccination cost. <i>Conclusion</i>: The current study highlights inadequate knowledge about STDS, HPV, cervical cancer and its screening among women. Public health awareness programs should be raised at community level in order to increase the health seeking behavior of women.

The Annual Gynecologic Examination Updated for the 21st Century

The concept of an annual gynecologic screening visit to identify disease at an early stage has long been an established component of women’s health care. Women and their health care providers have historically accepted the schedule of an annual gynecologic examination with cervical cancer screening and a pelvic examination. Recently, researchers questioned the value of the annual breast and pelvic examinations in asymptomatic women and re-established the intervals for Pap test screening with the addition of human papillomavirus co-testing to establish cervical cancer risk. The updated well woman examination is now an opportunity to engage women in health education, screening for chronic disease risks, and health care concerns such as depression and violence.

Human papillomavirus infection and cervical dysplasia in female sex workers in Northeast China: an observational study.

BackgroundWomen having multiple sex partners are reportedly at an increased risk of HPV infection. However, the prevalence and risk factors of HPV infection in female sex workers (FSWs) vary considerably across racial/ethnic, socioeconomic, and geographic groups. This study aimed to determine the prevalence and risk factors of HPV infection in FSWs in Northeast China.MethodsA total of 309 FSWs identified and approached through a local police office and 1000 healthy subjects from a single factor undergoing annual gynecological examinations in Shenyang were recruited. A liquid-based ThinPrep Pap test and the Hybrid Capture II-based high-risk HPV DNA test, with or without a colposcopic examination, were performed on both FSWs and control subjects. Data on HPV infection and histological and cytological lesions of the cervix were obtained and analyzed. A questionnaire survey was administered to all 309 FSWs with their socio-demographic and behavioral information collected. The association of various socio-demographic and behavioral variables with HPV infection was assessed.ResultsHPV was significantly more prevalent in FSWs (61.90 %) than in healthy control subjects (21.00 %) (P < 0.01), so were cervical lesions (P < 0.01). HPV prevalence in our sample of FSWs fell in the upper range of reported values in FSWs across different countries, and was similar to that for FSWs in the southeast Chinese city of Huzhou but higher than that for FSWs in southwest China, Guangxi, as compared with data from other studies within China. HPV infection in FSWs was significantly associated with the age at first sexual intercourse (OR 0.699, 95 % CI 0.492–0.992) and post-menopause (OR 2.928, 95 % CI 1.099–7.800) (P < 0.05).ConclusionsFSWs are at a substantially high risk of HPV infection and cervical dysplasia development as compared with healthy control subjects in Shenyang, China. Age of first sexual intercourse and post-menopause are two independent risk factors for HPV infection in this special group of population. Intensified and coordinated efforts from government, public health sector, communities and families are needed to reduce the risk of HPV infection in this specific group of population.

History of Abuse in Women With Vulvar Pruritus, Vulvodynia, and Asymptomatic Controls.

Chronic vulvar pruritus and vulvodynia are common vulvar diseases. The aim of this study was to compare gynecologic and sexual and physical abuse histories from patients with these diagnoses and from healthy controls. Questionnaires were self-completed by patients diagnosed with vulvar itch-scratch (n = 93), patients diagnosed with vulvodynia (n = 232), and patients presenting for annual gynecologic examinations (n = 104) at the University of Michigan Hospitals, Ann Arbor, MI. Patients who came for annual examinations were less likely to report past gynecologic infections (p < .05) and indicated higher interest in and more frequent sexual activity than the other 2 groups (p = .003). Vulvodynia patients had the highest scores on the McGill Pain Questionnaire (p < .001). Subjects with either vulvar disorder were more likely to self-report a history of gynecologic infections than annual examination controls. Rates of sexual (p = .78) and physical abuse (p = .12) were similar for all 3 groups. Patients with vulvar pruritus and vulvodynia report similar rates of sexual and physical abuse.

The Updated, Annual, Gynecologic Examination

<h2>Poster Presentation</h2><h3>Background</h3> The practice of annual gynecologic screening to identify problems at an early stage for intervention has traditionally been a component of women's health care. Patients and providers have accepted the schedule of these examinations, which includes cervical cancer screening and a pelvic examination. However, there is little evidence to support the benefits of such annual screening in low risk women. The Institute of Medicine (IOM), the Centers for Disease Control and Prevention, and the Office of Population Affairs (OPA) have developed recommendations for providing essential preventive services for women. Other professional organizations provide evidence‐based guidelines for cervical cancer screening. The American College of Physicians currently recommends against performing screening pelvic examination in asymptomatic, nonpregnant, adult women. The American College of Obstetricians and Gynecologists (ACOG) further states that no evidence supports or refutes the annual pelvic examination and its performance should be based on shared decision making. <h3>Case</h3> Lucia, a 31‐year‐old healthy woman presented for her annual gynecologic examination. Her past history included negative annual Pap smears since age 18. As the office nurse or advance practice nurse using the most current evidence, what is the appropriate cervical cancer screening interval, and is a pelvic examination indicated? This poster presentation reviews current evidenced‐based recommendations for women's preventative health care, changes in cervical cancer screening protocols, and the evidence for the screening pelvic examination. The components of an evidence‐based, women's wellness visit is presented. <h3>Conclusion</h3> The wellness examination should be based on evidence‐based recommendations. In addition to breast and cervical cancer screening, this includes risk assessment for sexually transmitted infections, assessment of sexual wellness, screening for intimate partner violence, immunization review, and assessment of overall health and wellness. Preventive services should include pregnancy prevention with a focus on preconception care or options counseling if indicated. The prevention of chronic diseases through modifiable risks factors is stressed. The nursing profession has a long history of incorporating evidence‐based science into daily practice and of challenging long‐accepted patterns of providing care. A critical appraisal and redesign of the structure of the annual gynecologic examination can strengthen efforts to promote the overall health of women. Nurses can take leadership roles within the health care team to change protocols based on the best available evidence. After a careful review of Lucia's health history, she is eligible for Pap and human papilloma virus (HPV) cotesting every 5 years without a pelvic examination at today's visit.

U.S. clinicians' perspectives on less frequent routine gynecologic examinations

ObjectiveWith newer recommendations for less frequent cervical cancer screening, longer intervals between routine gynecologic examinations might also be considered. MethodsA nationally representative mailed survey of U.S. obstetrician–gynecologists (n=521, response rate 62%) was conducted in 2010–11. Clinicians were asked their views on annual gynecologic examinations and on the consequences of extending the interval from annually to every 3years for asymptomatic patients. ResultsOver two-thirds considered annual gynecologic examination very important for women in their reproductive years (69%); fewer consider it very important for women in menopause (55%). Most anticipated that shifting examinations to every 3years would result in lower patient satisfaction (78%), contraceptive provision (74%), and patient health and well-being (74%). Decreases in clinic volume (93%) and financial reimbursement (78%) were also expected. Anticipated effects of longer intervals varied by provider characteristics, geography, and practice setting. ConclusionObstetrician–gynecologists in the U.S. believed that longer intervals between routine examinations would have negative repercussions for patients and medical practice, but there were differences by region, practice, and personal characteristics. Redefining annual gynecologic visits as contraceptive counseling and health maintenance visits could address financial and patient volume concerns, and perspectives from patients and other providers might reveal possible benefits of less frequent gynecologic examinations.

Orientation of the Uterine Fundus in Reference to the Longitudinal Axis of the Body

The aim of this pilot study was to measure the angle of rotation of the uterus at the fundus from horizontal using 3-dimensional sonography in women presenting for annual gynecologic examinations. A total of 51 patients participated in the study. All patients underwent transvaginal sonography, and 3-dimensional volumes were acquired. The cervicouterine angle and the angle of rotation at the fundus were measured. The uteri were noted to be anteverted in 64.7%, retroverted in 25.5%, and euverted in 9.8%. They were noted to be pointing toward the right side of the pelvis in 49.0%, to the left side in 39.2%, and at the midline in 11.8%. The median cervicouterine angle was 122° (interquartile range [IQR], 105°-137°). The median angle of rotation at the fundus away from horizontal in either a clockwise or counterclockwise direction on the transverse B-plane was 10.4° (IQR, 7.1°-19.0°), with a maximal angle of 43°, and on the coronal C-plane, it was 10.0° (IQR, 3.0°-20.0°), with a maximal angle of 43°. Noneuverted uteri were more likely to be rotated at the fundus. Our study reveals that, contrary to traditional thinking, the uterus can be rotated at the fundus in relation to the body (z-axis) along the longitudinal axis of the cervical canal.

Hereditary Nonpolyposis Colorectal Cancer (HNPCC)/Lynch Syndrome

Hereditary nonpolyposis colorectal cancer HNPCC, Lynch syndrome) is a genetic disease of autosomal dominant inheritance. It is caused by a mutation in one of four genes of the DNA mismatch repair system and confers a markedly increased risk for various types of cancer, particularly of the colon and the endometrium. Its prevalence in the general population is about 1 in 500, and it causes about 2% to 3% of all colorectal cancers. Lynch syndrome is diagnosed in two steps: If it is suspected (because a patient develops cancer at an unusually young age or because of familial clustering), the tumor tissue is analyzed for evidence of deficient mismatch repair (microsatellite instability, loss of mismatch repair protein expression). If such evidence is found, a genetic mutation is sought. The identification of a pathogenic mutation confirms the diagnosis in the patient and enables predictive testing of other family members. Diagnostic evaluations for Lynch syndrome should be carried out with appropriate genetic counseling. Selective literature review. Prospective cohort studies from Germany, Finland and the Netherlands have shown that colorectal cancers detected by systematic colonoscopic surveillance tend to be at an earlier stage than those that are discovered after the patients present with symptoms. The Finnish study also showed an overall reduction in cancer risk from colonoscopic polypectomy at regular intervals. The studies conducted so far have not yet clearly documented the putative benefit of an individualized, risk-adapted surveillance strategy. Until this is done, patients with Lynch syndrome and healthy carriers of causative mutations should be monitored with annual colonoscopy and (for women) annual gynecological examination.

Mature Ovarian Teratoma with Carcinoid Tumor in a 28-Year-Old Patient

Introduction. Coexistence of carcinoid tumor inside a mature cystic teratoma is an extremely rare phenomenon, especially in young women. We present the case of a 28-year-old woman diagnosed with a right ovarian carcinoid and treated uneventfully with conservative surgical approach. Case Report. A 28-year-old woman, gravid 0, parity 0, presented to our department for her annual gynecological examination and Pap smear test. During her examination, a mobile cystic mass was detected in the right lower abdomen. Ultrasound indicated a right ovarian mass 10.5 × 6.3 cm, confirmed by CT scan. Further investigation revealed AFP levels (1539 ng/mL). The ovarian mass was excised by laparoscopy, leaving intact the remaining right ovary. Frozen sections showed a mature cystic teratoma. However, paraffin sections revealed the presence of a small carcinoid within the teratoma's gastric-type mucosa. The patient was set to a close followup. Nine months postoperatively, ultrasound pelvis imaging and CT scan of the abdomen as well as serum tumor markers have shown no evidence of recurrence disease. Conclusion. Despite the weak evidence, fertility spare surgical approach for women wanting to preserve their genital tract might be a reasonable option.

Granulosa cell tumor of the ovary after long‐term use of tamoxifen and toremifene

The relation between the use of tamoxifen and gynecologic tumors has been documented. In this case, a 58-year-old postmenopausal woman had been treated with tamoxifen for 5 years followed by toremifene for 1.5 years due to the presence of stage II estrogen receptor-positive breast cancer. The patient was found to have a stage Ic granulosa cell tumor of the ovary despite undergoing annual gynecologic examinations. This report presents a case of granulosa cell tumor of the ovary after the long-term use of tamoxifen and toremifene.

Screening of the pelvic organ prolapse without a physical examination; (a community based study)

BackgroundPelvic organ prolapse (POP) is a silent disorder with a huge impact on women's quality of life. There is limited data from community-based studies conducted to determine the prevalence of POP as its assessment needs a pelvic examination. We aimed to develop a simple screening inventory for identification of pelvic organ prolapse and then evaluate its sensitivity and specificity.MethodsThis study had two phases. In the first phase in order to develop a simple inventory for assessment of POP, the Pelvic Floor Disorder Inventory (PFDI) was completed for a convenience sample of 200 women, aged 18-45 years, referred for annual gynecologic examination, and their pelvic organ prolapse was assessed using the standard protocol. The most sensitive and specific questions were selected as pelvic organ prolapse simple screening inventory (POPSSI). In the second phase, using a stratified multistage probability cluster sampling method, the sensitivity and specificity of the POPSSI was investigated in a non selected sample of 954 women recruited from among reproductive aged women living in four randomly selected provinces of Iran.ResultsThe sensitivity and specificity of POPSSI for identification of pelvic organ prolapse in the general population were 45.5 and 87.4% respectively; these values were 96.7 and 20% among those women who were aware of their pelvic dysfunction.ConclusionCommunity based screening studies on pelvic organ prolapse could be facilitated by using the POPSSI, the sensitivity of which would be enhanced through conducting of public awareness programs.