Genital Stage Research Articles

Subtotal vaginal hysterectomy with cervical ring preservation and cervical stump suspension to the sacrospinous ligament in women with pelvic organ prolapse: An exposed cohort study

To evaluate the short-term safety and efficacy of vaginal hysterectomy with cervical preservation in patients with genital prolapse stages II to IV. This is a descriptive case series study. It included women with genital prolapse stages II to IV, indicated for vaginal hysterectomy, with negative cervicovaginal cytology for malignancy, who underwent subtotal vaginal hysterectomy with suspension of the cervical stump to the sacrospinous ligament between June 1 and December 31, 2023, at a high-complexity general clinic. Sociodemographic variables and complications six months postoperatively were analyzed. The surgical technique is presented, and descriptive analysis, along with a detailed surgical technique exposition of cervical stump suspension to the sacrospinous ligament, was conducted. During the described period, 10 patients consulted, of whom eight met the inclusion criteria. The mean duration of the surgical procedure was 133 minutes. Average blood loss was 200 cc. One patient required analgesic use of pregabalin for peripheral neuropathic pain, achieving adequate postoperative pain control. No other intraoperative or postoperative complications were reported. No prolapse recurrence was observed six months postevaluation. Subtotal vaginal hysterectomy with cervical stump suspension to the sacrospinous ligament is a surgical repair technique that could be considered for the management of uterine prolapse. Randomized studies comparing this technique with other management alternatives are needed to evaluate its long-term efficacy and safety.

Frequency of Delayed Puberty in Boys with Contemporary Management of Duchenne Muscular Dystrophy.

Delayed puberty is thought to be common in boys with Duchenne muscular dystrophy (DMD) treated with long term oral glucocorticoid. This study aims to report the frequency of delayed puberty in DMD from examination by a paediatric endocrinologist alongside detailed endocrine investigations. All boys with DMD aged at least 14 years in January 2022 known to the paediatric neuromuscular service (2016-2022) were included in this study. Delayed puberty was defined based on testicular volume and genital staging in comparison to published puberty nomogram. Twenty-four out of 37 boys (65%) had evidence of delayed puberty, 23/24 (96%) of those with delayed puberty were on glucocorticoid therapy all of whom were on daily glucocorticoid. On the other hand, 7/13 (54%) of those with normal timing of puberty were on glucocorticoid; 2/7 (29%) were on the intermittent regimen. Of those who were on daily glucocorticoid therapy at the time of assessment of puberty, 23/28 (82%) had evidence of delayed puberty. In boys with delayed puberty, endocrine investigations showed low luteinizing hormone (LH) with undetectable testosterone levels, a pre-pubertal response with lutenizing hormone releasing hormone test and sub-optimal testosterone levels with prolonged human chorionic gonadotropin stimulation. The frequency of delayed puberty in boys with DMD was 65%. Eighty-two percent of adolescent boys with DMD on daily glucocorticoid had evidence of delayed puberty. Biochemical investigations point to functional central hypogonadism in these adolescents. Our data supports the routine monitoring of puberty in boys with DMD.

Characteristics Associated With Surgical Failure After Native Tissue Apical Prolapse Repair.

To identify clinical and demographic characteristics associated with prolapse recurrence by 12 months after native tissue transvaginal repair. This was a planned secondary analysis of a randomized trial including postmenopausal participants with stage 2 or greater apical or anterior vaginal prolapse scheduled for surgical repair at three U.S. sites. Participants underwent vaginal hysterectomy (if uterus was present) and standardized uterosacral or sacrospinous ligament suspension at the surgeon's discretion. The intervention was perioperative (5 weeks or more preoperatively and 12 months postoperatively) vaginal estrogen compared with placebo cream. The primary outcome was time to failure by 12 months after surgery, defined by objective prolapse of the anterior or posterior walls beyond the hymen or the apex descending more than one-third of the vaginal length, symptomatic vaginal bulge, or retreatment. For this analysis, participants were grouped according to failure compared with success, and multiple factors were compared, including age, time since menopause, race and ethnicity, parity, body mass index (BMI), baseline genital hiatus measurement, prolapse stage and point of maximal prolapse, surgery type (uterosacral or sacrospinous ligament suspension), and concomitant procedures. Factors were assessed for association with the hazard of surgical failure using Cox proportional hazards models, adjusted for site and treatment group. Factors with P <.50 from this analysis were considered for inclusion in the final multivariable model; site and treatment group were kept in this model. One hundred eighty-six participants underwent surgery; 183 provided complete data. There were 30 failures (16.4%) and 153 successes (83.4%) at 12 months. On bivariate analysis, failure was associated with decreasing age, shorter duration since menopause, Latina ethnicity, and greater baseline genital hiatus. In the final multivariable model, which included age, BMI, and point of maximal prolapse, only age remained significantly associated with surgical failure (adjusted hazard ratio [per year] 0.92, 95% CI, 0.86-0.98, P =.016). Among postmenopausal women, younger age was associated with increased frequency of prolapse recurrence by 12 months after native tissue repair. ClinicalTrials.gov , NCT02431897.

Mini review shows that a testicular volume of 3 mL was the most reliable clinical sign of pubertal onset in males.

We aimed to evaluate aspects of pubertal development to identify the most reliable clinical sign of pubertal onset in males. We performed a mini review of the literature. In 1951 Reynolds and Wines categorised pubic hair growth and genital development in five stages by visual inspection. Today the Tanner scale is used to assess the five stages of pubertal development, The second genital stage, characterised by enlargement of the scrotum defines pubertal onset in males. Testicular volume may be evaluated by using a calliper or by ultrasound scan. The Prader orchidometer, described in 1966, offers a method for evaluating testicular growth by palpation. Pubertal onset is commonly defined as testicular volume >3 or ≥4 mL. The development of sensitive laboratory methods has enabled studies analysing hormonal activity in the hypothalamus-pituitary-gonadal axis. We review the relationships between physical and hormonal signs of puberty. We also discuss the results of studies assessing different aspects of pubertal development with a focus on identifying the most reliable clinical sign of pubertal onset in males. A substantial amount of evidence supports testicular volume of 3 mL as the most reliable clinical sign of male pubertal onset.

Mixed exposure to phthalates and organic UV filters affects Children's pubertal development in a gender-specific manner

BackgroundPrevious studies showed phthalates and UV filters are endocrine-disruptive and associated with puberty. However, few studies have examined effects of mixed exposure. MethodsSix phthalate metabolites and 12 organic UV filters were detected among 223 school-age children. Puberty development was evaluated at baseline and after 18 months of follow-up. Ordered logistic regression models, least absolute shrinkage and selection operator (LASSO) regression and quantile-based g-computation (qgcomp) were used to evaluate relationships between phthalate metabolites or UV filters exposure and pubertal development. ResultsSix phthalate metabolites and 5 UV filters were detectable in urine samples. In boys, BP-3 and 4′-MAP were negatively associated with genital (ORBP-3 = 0.52, (0.27, 0.93), OR4′-MAP = 0.45, (0.25, 0.74)) and pubic hair development (ORBP-3:0.24, (0.05, 0.76), OR4′-MAP:0.24, (0.05, 0.77)). In girls, MEP levels were associated with advanced breast development (OR: 1.29, (1.04, 1.64)). LASSO regression identified BP-3, 4′-MAP, and OD-PABA for inverse associations with pubertal development in boys. MEP was related to an increase in girls' breast development (OR: 1.64, (1.08, 2.63)). Overall mixture was related to a 70% reduction in boys' genital development stage, with a larger effect size than a single chemical in qgcomp. Mixed exposure was associated with girls' earlier puberty onset (OR: 2.61, (1.06, 6.42)). ConclusionsOur results suggested higher levels of phthalate metabolites and UV filters were associated with delayed pubertal development in boys but with earlier puberty in girls. Higher effect size of joint exposure than single chemicals suggested phthalates and UV filters might have synergistic effects on puberty and distort adolescent endocrine function together.

Prenatal and postnatal exposures to endocrine disrupting chemicals and timing of pubertal onset in girls and boys: a systematic review and meta-analysis.

Globally, the ages at pubertal onset for girls and boys have been decreasing during recent decades, partly attributed to excess body fat accumulation. However, a growing body of literature has recognized that endocrine disrupting chemicals (EDCs) may play an important role in this global trend, but the association has not yet been fully established. EDCs can interfere with normal hormone function and metabolism and play a role in pubertal onset. We aimed to systematically identify and evaluate the current evidence on the timing of pubertal onset in girls and boys following prenatal or postnatal exposures to xenobiotic EDCs. Following PRISMA guidelines, we performed a systematic literature search of original peer-reviewed publications in the PubMed database through a block search approach using a combination of index MeSH and free text search terms. Publications were considered if they covered biomarkers of prenatal or postnatal exposures to xenobiotic EDCs (European Commission's list of category 1 EDCs) measured in maternal or child biospecimen and pubertal onset defined by the progression of the following milestones (and assessed in terms of the following measures): menarche (age), thelarche (Tanner staging) and pubarche (Tanner staging), in girls, and genital stage (Tanner staging), testicular volume (ml) and pubarche (Tanner staging), in boys. The literature search resulted in 703 references, of which we identified 52 publications fulfilling the eligibility criteria for the qualitative trend synthesis and 23 publications for the meta-analysis. The qualitative trend synthesis provided data on 103 combinations of associations between prenatal or postnatal exposure to EDC compounds groups and puberty outcomes and the meta-analysis enabled 18 summary risk estimates of meta-associations. Statistically significant associations in the qualitative trend synthesis suggested that postnatal exposure to phthalates may be associated with earlier thelarche and later pubarche. However, we did not find consistent evidence in the meta-analysis for associations between timing of pubertal onset in girls and boys and exposures to any of the studied xenobiotic EDCs. We were not able to identify specific pre- or postnatal windows of exposure as particularly critical and susceptible for effects of EDCs. Current evidence is subject to several methodological challenges and inconsistencies and evidence on specific exposure-outcome associations remains too scarce to firmly confirm EDC exposure as a risk factor for changes in age of pubertal onset in the general child population. To create a more uniform foundation for future comparison of evidence and to strengthen pooled studies, we recommend the use of more standardized approaches in the choice of statistical analyses, with exposure transformations, and in the definitions and assessments of puberty outcomes. The impact of mixtures of EDC exposures on the association also remains unestablished and would be valuable to elucidate for prenatal and postnatal windows of exposure. Future large, longitudinal epidemiological studies are needed to clarify the overall association.

Adolescent's Generational Practices, Parent-Child Relationship and Parenting Style of Mothers to their Adolescent Children

Adolescence is a critical period for brain maturation and is described as a stage of vulnerability. Today's adolescents belong to the generation called "Generation Z," also called "Gen Zers," which are people aged 22 and below. These people are identified as unique, unlimited, and ethical. This study assessed the adolescent's generational practices of parent-child relationships and mothers' parenting styles toward their adolescents. The study utilized the descriptive- correlational design conducted in Iligan City, with one hundred twenty mothers selected through purposive and snowball sampling. It used three researcher- made questionnaires, all validated and underwent pilot testing and reliability testing. The researcher gathered data, strictly followed the ethical considerations, and analyzed the data following statistical methods and techniques with the aid of statistical software Minitab: mean, standard deviation, and Pearson’s r. The results then revealed that common generational practice in their generation is that adolescents are commonly interested in their phones and depend on them. In addition, the mother's parent-child relationships and parenting styles are found satisfactory. However, results show no significant relationship between the parenting style and the generational practices of adolescents in lifestyle practices and behavior/attitude and between the parent-child relationship and their parenting style. Keywords : behavior, gadget dependency, generation Z, genital stage, lifestyle

PD31-11 VAGINAL STENOSIS FOLLOWING VAGINOPLASTY IN THE CAH COHORT

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD31)1 Sep 2021PD31-11 VAGINAL STENOSIS FOLLOWING VAGINOPLASTY IN THE CAH COHORT Kiersten Craig, Wael Abosena, Lauren Balsamo, Ardavan Akhavan, and Dix Poppas Kiersten CraigKiersten Craig More articles by this author , Wael AbosenaWael Abosena More articles by this author , Lauren BalsamoLauren Balsamo More articles by this author , Ardavan AkhavanArdavan Akhavan More articles by this author , and Dix PoppasDix Poppas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002032.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the last 20 years, techniques in vaginal restorative surgery have evolved. Studies evaluating post-operative outcomes following contemporary surgical approaches in congenital adrenal hyperplasia (CAH) patients with variation in genital anatomy (VGA) remain scarce. Vaginal stenosis (VS) is a complication of vaginal restorative surgery and requires specialized care and management. We reviewed our surgical experience with CAH patients to understand patterns of occurrence, classification, and management of VS at our institution. METHODS: We retrospectively reviewed CAH patients with VGA who underwent primary vaginoplasty from 1996 to 2016. Patient demographics, procedure characteristics, occurrence of VS, and subsequent management were recorded. Prader score was further stratified to a 7-point genital stage. Annual physical exam was performed from post-op to toilet training then after menarche unless clinically indicated. VS was defined as narrowing at the vaginal introitus or inability to use tampons/have penetrative intercourse. VS was further categorized as Suspected (minor narrowing observed on exam without clinical impact, S-VS) or Clinically Significant (severe narrowing requiring intervention once menarche is achieved, CS-VS). Patients without a vaginoplasty or one performed at another institution, identified as male, lost to follow up, or without follow up records were excluded. RESULTS: 130 patients were included for evaluation. Mean age was 3.5 years (0.32-34.5 years). Classic CAH occurred in 94.4%. A genital score of 3 (Prader III) predominated (39,7%). Mean anesthesia and surgery time was 4.3 (2-9.5) and 3.1 (1.1-8.0) hrs, respectively. Mean admission and follow up length was 3.2 days and 4.5 (0.01-17.6) years. S-VS and CS-VS occurred in 13 and 14 patients, respectively. Management of CS-VS included redo vaginoplasty (5, 1 planned but lost to follow-up), expectant management (8). The development of S-VS correlated with procedure type (flap alone p=0.012 and PT + flap p=0.043) and genital score 7 (p=0.022). CS-VS was only associated with PT (p=0.035). Logistic regression to predict VS was not statistically significant. CONCLUSIONS: VS remains a concern following vaginal restorative surgery in CAH patients. This descriptive study at a CAH center of excellence is an initial step toward characterization of VS. Higher genital score and procedure type was associated with the development of VS. In the future, standardization of the definition of VS will help assess clinical outcomes, defining risk factors, and tailoring management. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e543-e543 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kiersten Craig More articles by this author Wael Abosena More articles by this author Lauren Balsamo More articles by this author Ardavan Akhavan More articles by this author Dix Poppas More articles by this author Expand All Advertisement Loading ...

Urinary and salivary endocrine measurements to complement Tanner staging in studies of pubertal development.

BackgroundMany studies investigating pubertal development use Tanner staging to assess maturation. Endocrine markers in urine and saliva may provide an objective, sensitive, and non-invasive method for assessing development.ObjectiveOur objective was to examine whether changes in endocrine levels can indicate the onset of pubertal development prior to changes in self-rated Tanner stage.MethodsThirty-five girls and 42 boys aged 7 to 15 years were enrolled in the Growth and Puberty (GAP) study, a longitudinal pilot study conducted from 2007–2009 involving children of women enrolled in the Agricultural Health Study (AHS) in Iowa. We collected saliva and urine samples and assessed pubertal development by self-rated Tanner staging (pubic hair, breast development (girls), genital development (boys)) at three visits over six months. We measured dehydroepiandrosterone (DHEA) in saliva and creatinine-adjusted luteinizing hormone (LH), testosterone, follicle stimulating hormone (FSH), estrone 3-glucuronide (E13G) and pregnanediol 3-glucuronide (Pd3G) concentrations in first morning urine. We evaluated the relationships over time between Tanner stage and each biomarker using repeated measures analysis.ResultsAmong girls still reporting Tanner breast stage 1 at the final visit, FSH levels increased over the 6-month follow-up period and were no longer lower than higher stage girls at the end of follow-up. We observed a similar pattern for testosterone in boys. By visit 3, boys still reporting Tanner genital stage 1 or pubic hair stage 1 had attained DHEA levels that were comparable to those among boys reporting Tanner stages 2 or 3.ConclusionsIncreasing concentrations of FSH in girls and DHEA and testosterone in boys over a 6-month period revealed the start of the pubertal process prior to changes in self-rated Tanner stage. Repeated, non-invasive endocrine measures may complement the more subjective assessment of physical markers in studies determining pubertal onset.

The Prevalence of Vaginal Flatus in Women With Pelvic Floor Disorders and Its Impact on Sexual Function

BackgroundVaginal flatus is involuntarily passing gas from the vagina. Women seldom voluntarily report it, and related data are limited. AimTo investigate the prevalence of vaginal flatus in women with pelvic floor disorders and its impact on sexual function. MethodsThis was an observational study involving women who visited a urogynecologic clinic in a tertiary medical center. Patients were asked about their experience of vaginal flatus. Other evaluations included urodynamics, genital prolapse stage, and quality-of-life questionnaires, including the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, Urogenital Distress Inventory, and Incontinence Impact Questionnaire. OutcomesClinical characteristics, vaginal anatomic landmarks, stage of prolapse, urodynamic parameters, and quality-of-life scores were compared between women with and without vaginal flatus. ResultsAmong 341 women, 118 (35%) reported vaginal flatus, which was more common in those who were younger (a mean age of 49.3 ± 9.2 years; range 25–74 years vs 49.3 ± 9.2 years; range 25–74 years, P < .001) and sexually active (98% vs 55%, P < .001). Women with vaginal flatus had significantly worse sexual function (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, 16.3 ± 15.9 vs 30.9 ± 8.0, P < .001) and incontinence-related quality of life (Urogenital Distress Inventory, 23.4 ± 10.5 vs 17.8 ± 8.9, P = .039; Incontinence Impact Questionnaire, 25.5 ± 14.5 vs 17.2 ± 12.5, P = .012). For frequency and bother, 48 of 116 (46%) women reported often or always having symptoms during sexual activity, 5 of 34 (15%) when performing daily activities, and 4 of 31 (12%) when exercising, and 70 of 116 (60%) felt least moderate bothersome during sexual activity compared with 2 of 34 (5%) when performing daily activities and 6 of 31 (18%) when exercising. Clinical ImplicationsVaginal flatus is prevalent in women with pelvic floor disorders, particularly in those who are younger and sexually active. Strengths & LimitationsThe strength of this study is to evaluate the sexual function with validated questionnaires. The lack of data after pelvic floor management is the major limitation. ConclusionsAmong women with pelvic floor disorders, those with vaginal flatus reported poorer sexual function. Routine counseling should be considered for these patients.J-H Lau, T-H Su, Y-Y Chen, et al. The Prevalence of Vaginal Flatus in Women With Pelvic Floor Disorders and Its Impact on Sexual Function. J Sex Med 2020;XX:XXX–XXX.

Pubertal Timing During Early Adolescence: Advanced Pubertal Onset in Females with Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is characterized by impaired social communication and poor adaptation to change; thus, the onset of puberty may be a pivotal transition. This cross-sectional study measured pubertal timing to examine hypothesized differences for sex (female vs. male) and group (ASD vs. typical development [TD]). Participants included 239 children (137 ASD, 102 TD) between 10 and 13 years. The ASD group included 35 females and 102 males; the TDs included 44 females and 58 males. Pubertal onset measured by genital or pubic stage was investigated with linear regression using main effects of sex and age-by-sex interactions in TD and ASD groups and main effects of diagnosis and diagnosis-by-age interactions in males and females, controlling for body mass index, socioeconomic status, and race. In TD, examination of main effects for genital (penis/breast) stage showed no difference for male and female children (t = 1.33, P = 0.187, rdf = 92); however, there were significant differences in ASD (t = 2.70, P = 0.008, rdf = 121). For diagnosis modeled separately by sex, there was significantly earlier pubertal development in females with ASD (t = 1.97, P = 0.053, rdf = 70, but not males (t = 1.329, P = 0.186, rdf = 143). In addition, analysis of menses revealed females with ASD had significantly earlier onset than TD (t = -2.56, P = 0.018, rdf = 21). Examination of pubic stage revealed expected sex differences for TD (t = 2,674, P = 0.009, rdf = 91) and ASD (t = 3.482, P = 0.001, rdf = 121). Females with ASD evidence advanced pubertal onset relative to ASD males and TD females. Findings underscore the need for enhanced understanding of pubertal development in ASD, as differences may have significant psychological, social, physiological, and developmental consequences. LAY SUMMARY: Children with autism spectrum disorder (ASD) have difficulty with social communication and respond poorly to change, which may include the onset and course of puberty. The study measured the timing of puberty in 239 children (137 ASD and 102 typical development [TD]) between 10 and 13 years based on pubertal stage of genital (breast/penis) and pubic hair development. Females with ASD evidence advanced pubertal onset relative to ASD males and TD females. Findings underscore the need for an enhanced understanding of pubertal development in ASD.

Pelvic Organ Prolapse Severity and Genital Hiatus Size With Long-Term Pessary Use.

To evaluate the association between pessary use more than 1 year and change in prolapse severity. This is a secondary analysis of a previously published randomized controlled trial of women undergoing office management of pessaries for management of symptomatic pelvic organ prolapse and incontinence. Primary outcome was change in pelvic organ prolapse quantification measurement genital hiatus (GH). Secondary outcomes included change in prolapse stage, type of pessary, size of pessary, number of pessary changes, and duration of use. Baseline data were collected from the earliest documented examination within the hospital record before pessary placement and compared with their final study visit. Demographics were analyzed using descriptive statistics. Student t test and Mann-Whitney tests were used for categorical comparisons. Pearson and Spearman correlation coefficients were used to evaluate change over time. The cohort was 132 predominantly non-Hispanic White (75%) women with symptomatic prolapse >stage 2 (70.5%). All were postmenopausal. Median duration of pessary use was 39.5 months (interquartile range, 17-64.5 months). Genital hiatus (P = 0.014) and prolapse stage (P = 0.001) decreased as duration of pessary use increased. Those with baseline stages ≥3 had a significant decrease in GH as duration of pessary use increased compared with stages <3 (-0.5 cm vs 0 cm, P < 0.001). There was no difference in change in GH when comparing women with baseline GH less than 3 to 3 cm or greater. Pessary use by women with pelvic organ prolapse causes a change in vaginal anatomy over time as seen by decreasing stage and point GH.

SUN-594 Pubertal Timing and Hormonal Correlates in Male Obesity

An early, normal or delayed pubertal onset have been described in overweight/ obese males(1). A greater prepubertal adiposity has been associated with a greater risk for delayed puberty in males, but an underlying mechanism was not explored(2). We investigated whether an increased testosterone aromatization or an higher degree of low-grade inflammation might be more prevalent in obese males with a delay in genital development. Pubertal status assessment by Tanner staging and measurement of morning serum testosterone, estradiol, leptin, and hSCRP by standard laboratory methods were performed in 191 male adolescents, aged between 10 and 18.6 yr (median 12.8 yr) with overweight (BMI z-score > 1.3), starting an ambulatory (n = 138) or a residential weight loss program (n = 55). Their median (range) BMI z-score was 2.32 (1.34 – 3.38). Delayed / slow and early / rapid genital development was defined by a Tanner genital stage respectively above the 90th or below 10th percentile age distribution (national Flemish standards of 2004). In 3 males pubertal development was advanced, while in 34 it was delayed. In the remaining 154 adolescents genital stage was normally timed. Males with a delayed timing or progression of genital development were older (median(range) age:14.8 (11.6-18.6) yr vs 12.3 (10-18.6) yr; p< 0.005) and shorter (height sds: -0.55 (-1.90- 1.48) vs 0.49 (-3 – 3.19); p < 0.005), and had a higher birthweight (birthweight z-score: 0.15(-3.51-2.75) vs -0.34(-4.7-3.30); p = 0.058), but a similar BMI and waist z-score in comparison with males with a normally timed puberty. Median serum estradiol, leptin, and hSCRP concentrations did not differ significantly between those with a normal or a delayed pubertal onset or progression. In conclusion, pubertal delay is more frequently observed than early puberty in males referred to obesity clinics. Neither low grade inflammation nor increased estradiol production appear to be associated with a later onset of slower progression of genital development in male obesity. References (1) Li W et al. Int J Environ Res Public Health. 2017 Oct 24;14(10) (2) Lee JM et al. Arch Pediatr Adolesc Med. 2010 Feb;164(2):139-44.

Obesity Is Associated with Earlier Pubertal Onset in Boys.

Pubertal timing in boys is associated with body mass index (BMI). Studies consistently report an inverse correlation of BMI and pubertal timing within the normal BMI range. However, observations in obese boys are conflicting with different studies reporting either early or delayed pubertal onset in obese boys. We aimed to assess the association of male pubertal timing with age-specific BMI (zBMI) in obese boys. A total of 218 obese boys (zBMI > +2SD, with a median age at baseline of 10.8 years (range 4.2-17.0), were recruited as part of a prospective outpatient childhood obesity intervention program at Nordsjællands Hospital, Hillerød, Denmark, between 2009 and 2017. Serving as controls, we included 660 healthy boys participating in the population-based COPENHAGEN Puberty Study (-2SD < zBMI ≤ +2SD, 2006-2014). Subanalyses were performed on overweight controls (+1SD < zBMI ≤ +2SD). The clinical assessment of pubertal development by Tanner staging, including testis volume using a Prader's orchidometer, was performed by trained physicians. The timing of pubertal milestones was estimated by probit analyses. Timing of testicular volume ≥ 4 mL, genital stage ≥ 2, and pubarche. The mean (95% confidence interval [CI]) age of onset of pubertal event in obese boys was as follows: testicular volume ≥ 4 mL, 11.3 years (11.0-11.6); genital stage ≥ 2, 11.6 yrs (11.3-11.9); and pubarche, 11.9 years (11.5-12.3). Testicular volume ≥ 4 mL occurred significantly earlier in obese boys compared to controls (-2SD < zBMI ≤ +2SD) (P = 0.01). We did not observe significant differences for either the timing of pubarche nor the genital stage ≥ 2 (P = 0.06 and P = 0.94, respectively). We demonstrate that testicular enlargement in obese boys occurs significantly earlier compared to a population-based normal-weight reference cohort.

Comparative prospective study of biofeedback therapy and neuromuscular electrical stimulation in rehabilitation of patients with pelvic floor dysfunctions

Aim. To evaluate the effectiveness of the combined effects of biological feedback (BFB therapy) and electroimpulse stimulation (EIS) in rehabilitation of patients with pelvic floor dysfunctions. Materials and methods. A comparative prospective study included 235 women with clinical and ultrasound signs of genital prolapse stages I-IV according to POP-Q. The observation program was completed by 209 patients who were divided into group 1 with stage I-II prolapse and group 2 with stage III-IV prolapse. Vaginal extraperitoneal vaginopexy with installation of mesh implant was performed in group 2 patients before inclusion in the study. Lifestyle modification was recommended for all patients. In each group, patients were divided into subgroups of control and treatment (BOS-therapy and EIS). Group 1: subgroup A - control (n=47), subgroup B - treatment (n=56); group 2: subgroup C - control (n=49), subgroup D - treatment (n=57). Index of influence on the quality of life (IQOLI) and parameters of ultrasound were evaluated.Results. After a year of observation, in subgroup A, the IQOLI decreased by 5%, in subgroup B by 64% ( p< 0.05); in subgroup C, IQOLI decreased by 32%, in subgroup D - by 63% of the initial value ( p <0.05). In subgroup B, there was a statistically significant decrease in the size of the anterior urethro - vesical angle during the Valsalva test and in rotation of the alpha angle under load, leveling or reducing signs of genital prolapse in all patients. In subgroup A, the ultrasound parameters did not change, the dynamics of the prolapse stages were not noted. After a year of the program, the size of the anterior urethro - vesical angle at rest statistically significantly decreased in subgroups C and D. In subgroup D, the rotation of the alpha angle during loading, the size of the anterior urethro - vesical angle during the Valsalva test, and the smoothness of the beta angle at rest also decreased. In subgroup C, 4 (8%) cases of recurrence of genital prolapse were recorded; in subgroup D, no relapses were observed ( p =0.023).Conclusion. In patients with genital prolapse, both I-II stages and III-IV stages after surgical treatment, the use of biofe - edback therapy and EIS are more effective than the standard recommendations for lifestyle modification with regard to reducing IQOLI and changing ultrasound parameters. Adherence to rehabilitation program was 89%.

Voice break in boys-temporal relations with other pubertal milestones and likely causal effects of BMI.

STUDY QUESTIONHow is timing of voice break related to other male pubertal milestones as well as to BMI?SUMMARY ANSWERWe provide a comprehensive temporal analysis of male pubertal milestones, including reproductive hormone dynamics, confirm voice break as a late milestone of male puberty and report a likely causal relationship between higher BMI and earlier age at voice break in men.WHAT IS KNOWN ALREADYVoice break represents a late pubertal milestone and recalled age at voice break is frequently used in epidemiological studies as a measure of puberty. In contrast, clinical studies use mainly testicular enlargement and/or genital tanner stage as the marker of pubertal onset. However, neither correlation of pubertal milestones nor reproductive hormone dynamics have been assessed in detail previously. Further, although BMI and puberty timing are known to be closely linked, cause and effect between these traits are not known.STUDY DESIGN, SIZE, DURATIONThe study included a population-based mixed cross-sectional and longitudinal cohort (2006–2014, COPENHAGEN Puberty Study) of 730 healthy Danish boys. Data for 55 871 male research participants from the 23andMe study were obtained, including genome-wide single nucleotide polymorphism data and age at voice break.PARTICIPANTS/MATERIALS, SETTING, METHODSWe performed a detailed evaluation of pubertal milestones and reproductive hormone levels (study population 1). A Mendelian randomization (MR) approach was used to determine the likely causal link between BMI and timing of voice break (study population 2).MAIN RESULTS AND THE ROLE OF CHANCEVoice break occurred at mean age 13.6 (95% CI: 13.5–13.8) years. At voice break, mean (95% CI) testosterone levels, LH levels and bi-testicular volume were 10.9 (10.0–11.7) nmol/L, 2.4 (2.2–2.5) IU/L and 24 (23–25) mL, respectively. Voice break correlated moderately strongly with timing of male pubertal milestones, including testicular enlargement, gonadarche, pubarche, sweat odor, axillary hair growth and testosterone above limit of detection (r2 range: 0.43–0.61). Timing of all milestones was negatively associated with age-specific BMI (all P ≤ 0.001). MR analyses inferred likely causal effects of higher BMI on earlier voice break in males (−0.35 years/approximate SD, P < 0.001).LIMITATIONS, REASONS FOR CAUTIONParticipation rate of the population-based cohort was 25%. Further, boys that were followed longitudinally were examined approximately every 6 months limiting the time resolution of pubertal milestones. Using adult BMI as exposure instead of prepubertal BMI in the MR analysis and the known inaccuracies of the testosterone immunoassay at low testosterone levels may be further limitations.WIDER IMPLICATIONS OF THE FINDINGSWe provide valuable normative data on the temporal relation of male pubertal milestones. Further, the likely causal relationship between BMI and puberty timing highlights the importance of preventing obesity in childhood.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by Danish Agency for Science, Technology and Innovation (09-067 180); Danish Ministry of the Environment, CeHoS (MST-621-00 065); Capital Region of Denmark (R129-A3966); Ministry of Higher Education and Science (DFF-1331-00 113); Innovation Fund Denmark (InnovationsFonden, 14-2013-4); The International Center for Research and Research Training in Endocrine Disrupting Effects of Male Reproduction and Child Health. B.H., F.R.D., J.R.B.P. and K.K.O. are supported by the Medical Research Council (MC_UU_12015/2). The 23andMe study is supported by the National Human Genome Research Institute of the National Institutes of Health (R44HG006981). Members of the 23andMe Research Team are employees of 23andMe, Inc. and hold stock or stock options in 23andMe.TRIAL REGISTRATION NUMBERNCT01411527

Stretched Penile Length and Testicular Size from Birth to 18 Years in Boys from Western Maharashtra.

Background:Genital stage and testicular volume examination and assessment are essential for assessment of growth puberty in boys. There is paucity of Indian data for penile and testicular parameters particularly in pubertal years.Aim:The aim of this study is to present normative data for penile length, testicular volume, and testicular length from birth to 18 years in boys from western Maharashtra and to correlate these parameters with sexual maturity staging (SMR) (Tanner staging).Materials and Methods:A cross-sectional observational study was undertaken in apparently healthy boys from 0 to 18 years of age from western Maharashtra from October 2016 to October 2017. Age, anthropometric parameters, stretched penile length (SPL), testicular volume, and testicular length were measured. Pubertal stage was categorized using Tanner staging. Data were entered in Microsoft excel 2013 and using SPSS version 16. LMS method was used to construct age-specific Z-scores for SPL, testicular volume, and testicular length.Results:A total of 843 boys were enrolled in the study. Mean SPL was 4.1 ± 0.4, 5.4 ± 0.8, and 10.2 ± 1.7 cm at 1, 10, and 18 years of age, respectively, and showed a gradual rise from birth to 18 years. Mean testicular volume was 1.8 ± 0.5, 3.3 ± 1.2, and 24.1 ± 3.5 ml, whereas testicular length was 1.3 ± 0.4, 2.1 ± 0.5, and 4.4 ± 0.7 cm respectively, at 1, 10, and 18 years, respectively. The magnitude of increase for SPL and testicular volume was greater around 9–10 years. The increase in SPL and testicular size was hand in hand with SMR for genital development as well as for axillary and pubic hair stages.Conclusion:Normative data on SPL, testicular volume, and testicular length from western Maharashtra are presented. These data may be useful in disorders of puberty and genitalia in boys.

Timing of puberty in boys and girls: A population-based study.

BackgroundA secular trend towards earlier puberty has been observed in girls, while a similar trend has been more uncertain in boys. We estimated current ages at pubertal development in both boys and girls.MethodsIn this population‐based cohort study, 14 759 of 22 439 invited boys and girls born from 2000 to 2003 in the Danish National Birth Cohort gave half‐yearly self‐reported information on puberty from the age of 11.5 years and throughout puberty. This late start of follow‐up limits the estimation of age at onset of puberty but not later pubertal milestones. We estimated mean age at attaining the following pubertal milestones in years with 95% confidence intervals (CI): age at menarche, voice break, first ejaculation of semen and Tanner stages for pubic hair development and breast development or genital development. Further, the difference in mean age at menarche between mothers and daughters was estimated.ResultsIn boys, voice break occurred at 13.1 (95% CI 13.0, 13.1) years, first ejaculation of semen occurred at 13.4 (95% CI 13.3, 13.4) years, and Tanner Genital Stage 5 occurred at 15.6 (95% CI 15.5, 15.6) years. In girls, age at menarche occurred at 13.0 (95% CI 13.0, 13.1) years and Tanner Breast Stage 5 occurred at 15.8 (95% CI 15.7, 15.9) years. Daughters had menarche 3.6 (95% CI 3.1, 4.2) months earlier than their mothers had.ConclusionThese data indicate that age at menarche has declined and to some extent support a decline in age at attaining other markers of pubertal development among boys.

Self-assessment of pubertal development in a puberty cohort.

Background We evaluated the inter-rater agreement between self-assessed Tanner staging and clinical examination and the intra-individual agreement of self-assessed information on various puberty markers in late adolescents from the longitudinal nationwide Puberty Cohort, a sub-cohort of the Danish National Birth Cohort (DNBC). Methods We invited 715 children from the ongoing Puberty Cohort between June 2016 and January 2017. In total, 366 children (51%) returned an add-on questionnaire identical to the questionnaire used to collect information on puberty markers, including Tanner staging, in the Puberty Cohort. Of these, 197 (54%) also participated in a clinical examination with Tanner staging. We used percentage agreement and weighted kappa statistics to evaluate the inter-rater and intra-individual agreement. Results Due to late entry, more than 75% of children were Tanner stage 4 or above at clinical examination. In girls, the inter-rater agreement for pubic hair and breast staging was 54% and 52%, respectively, yielding weighted kappas of fair strength. In boys, pubic hair and genital staging agreed in 55% and 33%, respectively, corresponding to weighted kappas of fair to moderate strength. Boys tended to underestimate genitalia staging consistently. The intra-individual agreement on Tanner staging was 75-77% in girls and 69% in boys, whereas the intra-individual agreement on axillary hair and acne was above 92%. Conclusions Self-assessment of late stages of pubertal development may be misclassified, leading to random errors in studies of puberty timing. However, self-assessment continues to serve as an important time- and cost-saving tool in large prospective puberty cohorts.

Girls with a History of Premature Adrenarche Have Advanced Growth and Pubertal Development at the Age of 12 Years.

Premature adrenarche (PA) has been linked to early thelarche and menarche, but longitudinal data on growth and pubertal development after PA are insufficient. Growth and pubertal development of mostly full-term and appropriate for gestational age-born 43 PA (36 girls) and 63 control children (52 girls) were analyzed prospectively. Children examined first at the mean age of 7.6 years were reexamined at the mean age of 12.0 years. The PA girls but not the boys were taller and had higher body mass index (BMI) than the controls. A higher proportion of the PA than control girls had reached menarche, while the same percentage of the PA and control boys were at Tanner genital stage ≥2. The PA girls with premature pubarche (PP) were taller but not heavier and had more often reached menarche by the age of 12 years than the PA girls without PP. The PA girls with menarche had lower birth length (BL) and higher prepubertal insulin-like growth factor 1 (IGF-1) concentrations compared with non-menarcheal PA girls. In logistic regression analyses for all girls, lower BL standard deviation score, earlier maternal menarche, and higher prepubertal IGF-1 were independently associated with menarche. At 12 years of age, the PA girls had higher BMI, advanced linear growth, and accelerated pubertal development with earlier menarche than the control girls. The PA girls with PP were taller and had earlier menarche than the PA girls without PP. Lower BL and higher prepubertal IGF-1 concentration were predictive factors for menarche by the age of 12 years.