Consultant Gynaecologist Research Articles

Clinico-epidemiological factors of pelvic inflammatory disease

Introduction: Pelvic inflammatory disease (PID) is the most frequent serious infection in women between 16 and 25 years old. Early ages are the period of highest risk of occurrence due to the higher incidence of risk factors related to unsafe sexual behaviors. Methodological Design: An observational, descriptive, cross-sectional research was carried out with the objective of reducing the incidence of PID risk factors in young patients diagnosed in Gynecology consultations of Primary Health Care, belonging to the Pedro Borras Astorga Polyclinic, in the period from January 2022 to March 2024. The universe consisted of 3655 women between 16 and 25 years of age from the aforementioned health area and a sample of 63 patients who met the inclusion criteria was used. Statistical method: Excel, Windows version 11 for automated processing and analysis, summary measures for qualitative variables: absolute frequencies and percentages.Results: It was found that most of the adolescents had unprotected sexual relations, began sexual relations before the age of 14, reported a history of induced abortions, 100 % requested attention for pelvic pain and in all of them the clinical response to the indicated medical treatment was evaluated, based on the decrease in the intensity of the pelvic pain and the changes in the initial ultrasound findings. The most effective combination was triple antibiotic therapy.

The Impact of Pelvic Floor Muscle Strengthening on the Functional State of Women Who Have Experienced OASIS After Childbirth.

Background and Objectives: The primary objective of this study was to assess the impact of pelvic floor muscle (PFM) strengthening on the pelvic floor function in women who have experienced OASIS two years after delivery, and the secondary objective was to educate women about PFM strengthening and instruct them on the correct way to exercise. Methods and Materials: A prospective case-control study was conducted. The participants were divided into two groups: the case group (women who experienced OASIS) and the control group (women who did not experience perineal tears but had similar obstetric-related data to the case). Women were invited for a gynecological exam, PFM assessment, and consultation on PFM training. Women in the case group had three consultations, and women in the control group had two. Women were presented with four sets of questions about pre-pregnancy condition and questions related to UI and FI after delivery. Results were considered significant when p < 0.05. Results: OASIS were detected in 13 (0.4%) women in 2021. Risk factors for OASIS were found to be fetal macrosomia (p = 0.012), fetal occiput posterior position (p = 0.001), and epidural analgesia (p = 0.003). After one year of performing PFM strengthening exercises, some women in the study group exhibited stronger PFM contractions (p = 0.076), while others held the contracted PFM for a longer time (p = 0.133). UI affected women in the control group more often (p = 0.019). Two years after delivery, gas incontinence was mentioned significantly more frequently in the case group (p = 0.019). One year after initial consultation, gas incontinence was also more significantly common in the case group (p = 0.037). Conclusions: This study found that PFM strengthening exercises significantly improved pelvic floor function in women who experienced OASIS two years after delivery. Participants exhibited stronger PFM contractions and an increased ability to maintain these contractions. Women reported a better understanding of PFM exercises and proper techniques.

Should gynecologists approach obesity? A survey analysis

ABSTRACT This study evaluated the prevalence of women attending gynecological consultations who wish to discuss weight issues, barriers preventing physicians from addressing obesity, and differences in perceptions between patients and physicians. A cross-sectional study was conducted from July 2021 to June 2022 at the Centro de Atenção Integral à Saúde da Mulher in São Bernardo do Campo, including 404 female patients (median age: 47.5 years) and 140 gynecologists. Most patients were obese, with class I obesity being the most common (58 percent). Among obese participants, 46.4 percent reported chronic hypertension, and 12.7 percent had type 2 diabetes. Nearly 90 percent of women supported discussing weight during consultations, and 80 percent recognized the benefits of modest weight loss. Physicians (average consultation time: 30 minutes) addressed weight regularly (75 percent) but cited insufficient time (55.7 percent) and inadequate training (40 percent) as barriers. While 67 percent of patients felt motivated to lose weight, 77.8 percent of physicians believed their patients lacked motivation. Both groups largely rejected pharmacological and surgical treatments. Most women viewed weight loss as their personal responsibility, while fewer than half of physicians agreed. These findings highlight gaps in communication and differing perceptions, emphasizing the need for educational interventions to enhance physician-patient interactions and integrate weight management into routine gynecological care.

Navigating Sensitive Conversations: Patient-Centered Communication and Politeness Markers in Chinese Online Medical Consultations.

Background/Objectives: In China, discussing sexual and reproductive health remains taboo, often preventing patients from seeking care or advice on sensitive topics. Online medical consultations (OMCs) offer a unique platform for patients to discuss these concerns more openly. This study investigates how patient-centered communication (PCC) practices, including conversational themes and the use of politeness markers, influence patient satisfaction in Chinese OMCs, with a focus on sensitive gynecology and andrology topics. Methods: This study used a mixed-methods approach, including theme-oriented discourse analysis (TODA) and content analysis on 328 OMCs (179 in andrology, 149 in gynecology) collected from Dr. Chunyu, a popular Chinese online healthcare platform that provides medical consultations, from 19 to 22 March 2022. Logistic regressions were conducted to assess the influence of politeness markers on patient satisfaction, while TODA examined PCC practices in sensitive conversations. Results: TODA identified two key themes in PCC that enhanced patient satisfaction: normalizing sensitive health concerns and fostering collaborative decision-making. Politeness markers, specifically the use of polite words and expressions of best wishes, were positively associated with patient satisfaction. However, downtoners, emojis, and sentence-final particles showed no significant effect. There were no significant differences in the impact of politeness markers between gynecology and andrology consultations. Conclusions: This study highlights the importance of PCC and politeness markers in improving patient satisfaction in OMCs, especially when addressing sensitive sexual health topics.

Study on the clinical characteristics, persistent infection capability and viral load of human papillomavirus type 26 single infection

BackgroundHuman papillomavirus (HPV) infection is the main cause of cervical cancer. Different types of HPV have varying carcinogenic capabilities, and viral load is one of the key indicators of pathogenicity. Currently, there is a lack of clinical data on HPV26. This study analyzed the clinical characteristics of patients with HPV26 single infection.MethodsExfoliated cervical cells were collected for HPV genotyping from women who attended gynecological outpatient clinics or physical examinations. The clinical characteristics of HPV26 single infections in both cross-sectional and follow-up studies were examined, and the association of viral load with HPV26 persistent infection and pathogenicity was investigated.ResultsThe HPV26 positive rate among women visiting hospitals for gynecological medical consultation or physical examination was approximately 0.09% (379/435,072). Among the HPV types tested, the detection rate of HPV26 was 0.37% (379/103,608). In the cross-sectional histopathological study of 101 patients with HPV26 single infection, 62.37% (63/101) presented lesion-free. The numbers of patients with cervical intraepithelial neoplasia (CIN) 1, CIN2, and CIN3 were 25, eight, and five, respectively. Cervical cancer was not detected in any patient. 71 patients attended follow-up examinations as well as HPV26 retesting up to two years, during which, 28.57% (6/21) of CIN1 patients have developed into high-grade lesions, and 9.61% (5/52) of lesion-free patients have progressed to CIN stage. The viral load in the CIN group was significantly higher than that in the lesion-free group (p = 0.012). Similarly, the viral load in the persistent infection group was significantly higher than that in the viral-clearance group (p < 0.001).ConclusionsThe pathogenicity of single HPV26 infections is moderate among high-risk types, warranting the inclusion of HPV26 in expanded screening for HPV. High viral load is an important factor in the persistent infection and pathogenicity of HPV26. Viral load is expected to serve as a screening risk factor for persistent infection and disease progression associated with HPV26.

Gynecological health care services utilization and violence among female sex workers in Togo in 2021

BackgroundFemale Sex Workers (FSW) in Sub Saharan Africa face multiple challenges increasing their vulnerability to poor health, particularly poor sexual and reproductive (SRH) health outcomes and violence. The aim of this study was to assess the use of gynecology health care services and factors associated with its use as well as experiences of violence among FSW in Togo.MethodA cross-sectional study was carried out in 2021 among FSW in two cities of Togo. A snowball sampling method was used and initial seeds were identified in each site in collaboration with FSW non-governmental organizations. A logistic regression was performed to identify factors associated with the use of a SRH service and violence.ResultsA total of 447 FSW with a median age of 30 [IQR: (24–38)] participated in this study and 43.4% of them had reached at least secondary school. Among them, 29.1% reported having been to a gynecological consultation over the previous year. Factors associated with a gynecological consultation included: living in the Lomé capital city (aOR = 0.35, 95%CI 0.22–0.54), and an experience of condom breakage or slippage (aOR = 2.00; 95%CI 1.19–2.64). The majority reported at least one lifetime pregnancy (87.9%), 39.8% reported ever having an unintended pregnancy and 67.6% of them ever had an abortion. Finally, 61.1% indicated being victims of physical, sexual, or emotional violence in the previous six months. Sex workers living in Lomé (aOR = 1.78; 95%CI 1.16–2.73); a history of abortion (aOR = 1.53; 95%CI 1.03–2.31) and having more than 15 clients per week (aOR = 4.87; 95% CI 1.99–11.94), were more likely to experience violence.ConclusionThere is an under-utilization of health care services among FSW in Togo in addition to overall poor sexual and reproductive health outcomes with a high prevalence of gender-based violence. Those results highlight the importance of continued advocacy for the integration of SRH care with HIV prevention services geared toward FSW as well as a holistic approach to SRH care with innovative ways to prevent violence.

Morphology in action: Diminutives in Brazilian obstetric and gynecological consultations

Morphology in action: Diminutives in Brazilian obstetric and gynecological consultations

Factors associated with cervical cancer screening among women attending gynecological consultations at the Maroua Regional Hospital, Cameroon

This study aimed to assess the factors associated with cervical cancer screening at the Maroua Regional Hospital. A cross-sectional study was conducted among 376 women aged &amp;ge;25 years attending gynecological consultations at the Maroua Regional Hospital between February and May 2023. Data were collected through a structured questionnaire survey. These factors were evaluated through multiple logistic regression analyses, and associations were established by calculating the odds ratios, confidence intervals, and p-values. A total of 376 women were interviewed. Their mean age was 39.21 &amp;plusmn; 10.45 years. Of the 376 women, 9.3% had already been screened for cervical cancer. Results of multivariate analyses indicated that age &amp;ge;45 years, belief that every woman should be screened at age 25 years, perceived need for frequent screening, use of screening as a preventive measure, and having had first intercourse before age 15 years or between ages 15 and 20 years significantly increased the likelihood of having been screened. Strategies need to be developed to improve access to cervical cancer screening services in Cameroon by strengthening existing screening programs and effectively implementing campaigns to improve access to screening services.

Contribution of Pelvic Ultrasonography in Perimenopausal Abnormal Uterine Bleeding

Background: About 70% of gynecological consultations for women in perimenopause are due to metrorrhagia. In most cases, they are only the witness of hormonal disturbances resulting from a luteal deficiency. Transvaginal ultrasound is the first innocuous and available additional examination that is requested as part of an etiological assessment. Objective: Our study aims to evaluate the contribution of ultrasonography in perimenopausal metrorrhagia and investigate possible clinical-ultrasound correlation. Methods: This analytical descriptive study was carried out on 50 treated for perimenopausal metrorrhagia in the emergency department of the Tunis Maternity and Neonatology Center for four months (November 1, 2017, to February 28, 2018). We included in our study patients who were not yet postmenopausal who were ≥ 45 years of age, and who sought care for breakthrough bleeding. All patients in our study initially underwent endovaginal ultrasonography, sometimes coupled with suprapubic ultrasonography. Results: The mean age of our patients was 46.3 years. Pelvic ultrasonography revealed an enlarged uterus in 16 patients (32%), with 14 of them having fibromatous uteri measuring between 3 to 10 centimeters. The findings indicate no significant correlation between ultrasound results and bleeding abundance (P = 0.321), pelvic pain (P = 0.108), and general condition (P = 0.437). Conclusion: Endovaginal pelvic ultrasonography is a quick, painless test and is the first test to be done first in an emergency department with perimenopausal vaginal bleeding. The correlation between clinical and ultrasound findings is highly random, making it impossible to assume a well-- coded diagnostic and therapeutic presumption.

Uptake of gynecological consultation following domestic or sexual violence: A case-control study in the context of induced abortion

ObjectiveThe aim of this study was to determine the prevalence of domestic and sexual violence and to characterize the association between exposure to domestic and sexual violence and low uptake of gynecological care, in the context of induced abortion.Study design.We conducted a case-control study among women seeking abortion care, in mother and child centers and sexual health centers in the Paris, France area (April 2022-March 2023). ResultsA total of 103 women were included in the study during induced abortion care. Physical, psychological or sexual domestic violence was reported by 48.5 % and sexual violence, whoever the perpetrator, was reported by 23.3 %. In the bivariate analysis, a history of physical, psychological or sexual domestic violence was not associated with the absence of a gynecological consultation in the past two years, compared with no history of intimate partner violence (p = 0.09). After adjustment for regular pelvic pain, dysmenorrhea, vulvodynia and dyspareunia, there was no association between a history of sexual violence and the absence of a gynecological consultation in the past two years (OR 1.05; CI95% 0.27–4.13, p = 0.93). ConclusionViolence was a common finding among women seeking abortion care. We did not find any association between a history of sexual violence and the absence of a gynecological consultation in the past two years. We suggest investigating multiple or frequent use of gynecological care following violence. The combination of ethical, moral, and psychological constraints associated with violence screening and abortion care is a challenge to patient recruitment in future studies.

Macro-FSH is a rare cause of inappropriately high FSH concentrations.

Assessment of hormone concentrations can be subjected to laboratory pitfalls. Macro-hormones are hormone-autoantibody complexes which are cleared slowly from circulation and cause a false elevation in hormones' concentrations. Macro-prolactin and macro-thyroid-stimulating hormone (TSH) are most frequently encountered while macro-follicle-stimulating hormone (FSH) has been rarely reported. We describe the case of a 30-year-old woman who had a gynaecological consultation due to failure in achieving pregnancy after 8 months of unprotected intercourse. She had regular menses, did not complain of climacteric symptoms and her medical history was unremarkable. Antral follicle count and anti-mullerian hormone concentrations were normal, and regular ovulation was documented. Unexpectedly, high early follicular phase FSH concentrations were confirmed on two occasions (57 and 51 IU/L), raising the suspicion of primary ovarian insufficiency. After excluding Turner's syndrome and autoimmune oophoritis, a laboratory artifact was hypothesized. Following polyethylene glycol precipitation, FSH levels dropped from 41.1 IU/L to 6.54 IU/L (recovery 16%) and the presence of macro-FSH was concluded. Laboratory interference can lead to misdiagnosis and unnecessary treatments. A laboratory artifact should be suspected when inconsistency exists between clinical presentation and laboratory results. Only five other cases of macro-FSH have been reported to date. Although macro-hormones generally have low biological activity and do not require treatment, the role of anti-FSH antibodies has been hypothesized in primary ovarian insufficiency and in vitro fertilization failure. Hormone quantification is a cornerstone in the diagnostic workup of endocrine disorders, but it can be subjected to laboratory interferences which can lead to unnecessary investigations and inappropriate treatments. A laboratory artifact should be suspected when a discrepancy is observed between clinical presentation and laboratory results, when extremely unusual analyte concentrations are observed and when inconsistent results are obtained by different analytical methods. Macro-hormones are hormone-autoantibody complexes which are cleared slowly from circulation and cause a false elevation in hormone concentrations. Macro-prolactin and macro-TSH are most frequently encountered, while macro-FSH has been rarely reported. Macro-hormones can be detected by polyethylene glycol precipitation, gel filtration chromatography, or by using protein G or protein A columns. Although macro-hormones generally have low biological activity and do not require treatment, the role of anti-FSH antibodies has been hypothesized in primary ovarian insufficiency and in vitro fertilization failure.

Membranous Dysmenorrhea: An Underdiagnosed Condition

Dysmenorrhea is the most prevalent gynecological symptom in menopausal women. Currently defined as menstrual cramps, it is on the list of the main complaints in gynecological consultations. A sub-classification forgotten in medical dictionaries is membranous dysmenorrhea (MD), which corresponds to the elimination of membranes through the vaginal canal. The definitive diagnosis requires anatomopathological study, and abortion is the main differential diagnosis. As there are few cases in the literature, this study aims to present a series of eight cases, highlighting the pathophysiology and comparing the data with other studies to encourage discussion on the subject. This is an observational, longitudinal, retrospective study including women with clinical membranous dysmenorrhea (spontaneous elimination of fibroelastic material via the vagina). The results show that of the eight patients, seven had used or were using exogenous female hormones; 62.5% of the total had MD in the 2nd - 3rd decade of life, two had had previous abortions, and one was nulliparous. All these facts have been associated in the literature as etiological or contributing factors to MD. However, while diverging from the literature, our article showed that the infection factor is not mandatory for the occurrence of MD. In conclusion, proposing a single pathophysiological and etiological mechanism based on a series of cases and in comparison with other data in the literature is a challenge. However, consistently with what has been published, most of the cases presented were the result of an increased vascular response of the endometrium when exposed to an exogenous source of estrogen and progesterone, and this could be a hypothesis which, of course, requires further studies to establish the exact casuistry, but which contributes greatly as a source of data for future research.

Multi-Institutional Study of Referral Patterns for Gynecologic Oncology Consultation.

Evaluation by a gynecologic oncologist (GO) is associated with improved clinical outcomes for patients with gynecologic cancers, yet little is known about health care factors that influence patients' referrals to GO. Medical records of 50 consecutive new patients seen in GO clinics at each of six referral centers across the United States were reviewed. Patient and disease characteristics were collected along with referral indication, evaluation and referral dates, diagnostic procedures, provider specialties, and zone improvement plan (ZIP) code of up to three referring providers per patient. The primary outcome was interval between first evaluation and referral. Univariate associations were evaluated with Chi-square and Wilcoxon rank-sum tests and multivariable associations with negative binomial regression models. Secondary outcome was prolonged time to GO referral, defined as greater than the 75th percentile. Logistic regression was used for multivariable modeling. Three hundred patient records were analyzed. The median time from first health care encounter to referral was 15 days (IQR, 5-43). The mean distance from residence to GO was 39.8 miles (standard deviation, 53.8). Seventy-one percent of GO referrals were initiated by obstetrician-gynecologists, 9% by family physicians, and 6% internists. Presentation-to-referral interval was 76% shorter for patients evaluated by an emergency medicine clinician (exp(Beta), 0.24; 95% CI, 0.11 to 0.53; P < .001). Public insurance was associated with 1.47 times longer time to referral compared with private insurance (exp(Beta), 1.47; 95% CI, 1.05 to 2.04; P = .001). Residents of nonmetropolitan ZIP codes were less likely to have prolonged time to referral (odds ratio [OR], 0.288; P = .017). Distance from residence to GO (per 10 miles) increased the likelihood of prolonged time to referral (OR, 1.10; P = .010). Interventions are needed to improve recognition and referral of patients for gynecologic oncology evaluation. Community outreach and engagement with obstetrician-gynecologists should be prioritized to improve times to referral.

Association between type of menopause and mild cognitive impairment: The REDLINC XII study

ObjectiveTo evaluate the association between type of menopause (spontaneous or surgical) and mild cognitive impairment (MCI). Study designThis study was a cross-sectional, observational, and sub-analytical investigation conducted within gynecological consultations across nine Latin American countries. MethodWe assessed sociodemographic, clinical, and anthropometric data, family history of dementia, and the presence of MCI using the Montreal Cognitive Assessment (MoCA) tool. ResultsThe study involved 1185 postmenopausal women with a mean age of 55.3 years and a body mass index of 26.4 kg/m2. They had an average of 13.3 years of education, and 37 % were homemakers. Three hundred ninety-nine experienced menopause before 40, including 136 with surgical menopause (bilateral oophorectomy). Out of the 786 women who experienced menopause at 40 or more years, 110 did so due to bilateral oophorectomy. There were no differences in MoCA scores among women who experienced menopause before or after the age of 40. However, lower MoCA scores were observed in women with surgical menopause than in those with spontaneous menopause (23.8 ± 4.9 vs. 25.0 ± 4.3 points, respectively, p < 0.001). Our logistic regression model with clustering of patients within countries found a significant association between MCI and surgical menopause (OR 1.47, 95 % CI: 1.01–2.16), use (ever) of menopausal hormone therapy (OR 0.33, 95 % CI: 0.21–0.50), and having >12 years of education (OR 0.21, 95 % CI: 0.14–0.30). ConclusionWhen comparing women who experience spontaneous menopause over the age of 40 with those who undergo it before this age, there was no observed increased risk of developing MCI, while those with surgical menopause, independent of age, are more prone to cognitive decline. Women who have ever used menopausal hormone therapy have a lower MCI risk. Further research is warranted to delve deeper into this topic.

Migration of an intrauterine contraceptive device into the bladder complicated by stone formation an exceptional complication: case report and literature review

BackgroundWe report a rare and unusual case of intravesical migration of an intrauterine device with stone formation. The intrauterine device (IUD) is the most common method of reversible contraception in women. However, its insertion is not without risk, it can cause early or late complications. IUD can perforate the uterus wall and migrate into adjacent structures.Case presentationA 35 year-old female 5 gravid, 4 para has been benefited from intrauterine contraceptive device (IUCD) 5 years ago, she was presented to gynecological consultation for chronic pelvic pain with urinary symptoms. There was history of a good IUD insertion 5 years ago, considered expelled after one month of its pose. Physical examination was normal, but a pelvic ultrasound and a plain abdominal radiography allowed the detection of an IUD outside the uterine cavity, but inside bladder. A diagnostic and therapeutic cystoscopy was performed, and the IUD with calculus was successfully removed. There were no postoperative complications.ConclusionThis case is reported to highlight and to reiterate the need to think about one of the rare complication of IUD insertion, which every practitioner must know, it’s the transuterovesical migration, before concluding wrongly to its expulsion. It’s a consequence of, non-compliance with the rules for inserting an IUD and poor monitoring. The evolution towards calcification is a certain consequence; its screening involves rigorous clinical monitoring.

Characterization of the vaginal microbiota in Italian women with endometriosis: preliminary study

PurposeThis cross-sectional study aims to assess the interplay between the vaginal microbiota and endometriosis.Methods123 consecutive Italian fertile women, aged between 20 and 40 years old, were enrolled during a routine gynecological consultation; 24 were diagnosed with endometriosis and 99 did not complain of any gynecological disease. All women underwent a vaginal swab for the evaluation of the composition and diversity of vaginal microbiota by means of 16 s rDNA metagenomic sequencing.ResultsCompared to women with no gynecological disease, the vaginal microbiota in women with endometriosis showed a similar abundance of Lactobacillus spp.; however, a statistically significant lower abundance in the genera Pseudomonas (p < 0.01), Bifidobacterium (p < 0.05), Novispirillum (p < 0.0000001) and Sphingomonas (p < 0.0000001), and a statistically significant increase in the abundance of the genera Escherichia (p < 0.00001), Megasphaera (p < 0.00001), and Sneathia (p < 0.0001) were observed.ConclusionsThere is a complex interplay between vaginal microbiota composition and endometriosis, showing a distinct microbial signature in the bacterial genera usually found in dysbiosis.

Severe menopausal symptoms linked to cognitive impairment: an exploratory study.

To evaluate the association between menopausal symptoms and cognitive decline in postmenopausal women. This was a subanalysis of a cross-sectional, observational study conducted among women attending gynecological consultations across nine Latin American countries. The survey involved late postmenopausal women who were asked to complete a general questionnaire and the Menopause Rating Scale (MRS) to assess menopausal symptoms, with the Montreal Cognitive Assessment used to evaluate cognitive function as an outcome. A Montreal Cognitive Assessment score of less than 21 was used to define women with mild cognitive impairment (MCI). The study included 1,287 postmenopausal women with a mean age of 55.5 years and a mean body mass index of 26.3 kg/m 2 . On average, participants had 13.8 years of education and 2.3 ± 1.8 children, with 72.8% reporting having a partner. Additionally, 36.7% ever used menopausal hormone therapy. Regarding lifestyle factors, 50.3% engaged in a sedentary lifestyle, whereas 70.5% had never smoked. 15.3% of women had MCI exhibited significantly more intense menopausal symptoms compared with those without MCI (MRS total score 15.24 ± 12.58 vs 10.53 ± 8.84, respectively, P < 0.001). Logistic regression analysis revealed a significant association between severe menopausal symptoms (MRS total score ≥14 points) and MCI (odds ratio [OR], 1.74; 95% CI, 1.25-2.42). Conversely, a lower body mass index (OR, 0.96; 95% CI, 0.95-0.98), sexual activity (OR, 0.70; 95% CI, 0.51-0.96), physical exercise (OR, 0.55; 95% CI, 0.39-0.76), menopausal hormone therapy use (OR, 0.36; 95% CI, 0.24-0.55), and higher educational level (OR, 0.31; 95% CI, 0.21-0.46) were associated with lower odds for MCI. Severe menopausal symptoms in postmenopausal women were associated with cognitive impairment. This study highlights the intricate interplay between hormonal, lifestyle, and sociodemographic factors and cognitive health.

Consequences of wartime stress on women’s reproductive health

Background. Experts observe that Russia’s war against Ukraine led to a significant decline in the demographic situation and caused a severe impact on the reproductive health of women. Objective of the review: to assess and predict the consequences of war-related stress on the reproductive health of women residing in various zones - war zones, adjacent areas, remote territories, and even abroad; managing menopausal disorders in women with premature menopause and perimenopause remotely becomes crucial due to the existing limitations of in-person gynecological consultations. Analysis of literary data. The findings indicate a detrimental influence of wartime stress on the reproductive health of women across different categories - those experiencing active combat in adjacent regions, in remote areas, and even overseas. There is an increase in the frequency of diseases of the female reproductive system, namely: menstrual cycle disorders, abnormal uterine bleeding, premature menopause, hyperandrogenism, severe climacteric disorders. Due to severe negative stressor consequences caused by the war in Ukraine, the number of younger women with premature ovarian failure syndrome has increased, as well as the number of perimenopausal women with severe manifestations of menopause.Taking into account the difficult social and domestic conditions of some Ukrainian women and the impossibility of seeing a doctor, it is important to prescribe initial therapy for stress-induced consequences of reproductive disorders. The drugs of choice in treatment are modern estrogen-progestagen preparations, the effectiveness and safety of which has been proven by numerous scientific studies. Patients who complain of manifestations of concomitant pathology should be referred to the relevant specialists.Conclusion: The impact of war-related stress on the female reproductive health system poses a considerable challenge for gynecologists and healthcare professionals in preventing and managing these issues.

Extensive rectovaginal space hematoma causing urine retention as a complication of vaginoplasty: A case report

Background: Rectovaginal space hematoma following vaginoplasty is a rare complication that canlead to serious morbidity and disability. In the literature, reported cases remain few, especially inlow-income countries where cosmetic gynecology consultations are increasing.Case presentation: We present a case of extensive rectovaginal space hematoma presenting withurine retention following vaginoplasty. The patient had anemia, hypotension, tachycardia, vulvalswelling, and a suprapubic mass from the overdistend bladder. She was surgically managed and didwell postoperatively.Conclusion: Rectovaginal space hematomas are rare and associated with significant morbidity ifinappropriately managed. Cosmetic gynecological surgeons should be aware of this complication.

Sexual Assault of the Female Gender Admitted to the "One Stop Centre" Unit in Commune I of the District of Bamako: Epidemiological, Clinical and Legal Management Aspects

Sexual violence is an all-encompassing expression that designates "any sexual act, attempt to obtain a sexual act, comment or advance of a sexual nature directed against a person's sexuality using coercion. The general objective was to study sexual assaults based on the female gender in the "One Stop Center" unit of the reference health center in commune I of the district of Bamako, Republic of Mali. Methodology: This was a descriptive cross-sectional study of sexual assaults on women admitted to the commune I One Stop Center. All survivors of sexual assault admitted to the One Stop Center during the study period were included; confidentiality and anonymity were respected. Results: We recorded 224 cases of victims of gender-based violence out of 10,924 gynaecological consultations received at the department, a frequency of 2.05%. Of the 224 victims of gender-based violence admitted to the One Stop Centre, 109 (48.66%) were victims of sexual assault. The average age of the patients was 14.12 ± 5.06 years, with extremes of 2 and 36 years. The victims were all female. The majority of survivors (94%) were single. More than half of the victims (55%) were pupils. More than half of the assaults (57.8%) took place between 7pm and midnight. 60.6% of the assaults took place at the survivors' homes. In 8% of cases, weapons were threatened. We found that hymenal lesions were predominant in 76.2% of cases. HIV serology was positive in 1% of victims. Antibiotic prophylaxis was the predominant medical treatment in 69.7% of cases. Suture of the vulvo-perineal tear was the surgical treatment in 2.8% of cases. Out-of-court settlements were the solution in the majority of cases (20.18% of cases), followed by withdrawal of the complaint to the court (6.4% of victims). Conclusion: This study has shown that sexual violence against women is increasing in scale and severity despite the regulatory and legislative framework