Sexual Intercourse Pain Research Articles

(129) WOMEN WHO REPORT PAIN WITH SEX HAVE VARYING MICROBIOME PROFILES BASED ON AGE

Abstract Introduction Even though the vaginal microbiome (VM) is a known contributor to vaginal epithelial health, the VM of women who report pain with sex has not been characterized. It is known that the VM shifts during menopause, therefore we segmented out analysis based on menopausal status. Objective An observational analysis comparing the vaginal microbiome composition and symptom profiles in individuals of both menopausal and reproductive age who experience moderate to severe pain with sex and those that do not report pain with sex. Methods This study involved the collection of self-reported health profiles and shotgun metagenomic analysis of vaginal samples from two distinct demographic groups: menopausal women and women of reproductive age (defined as non-pregnant, non-menopausal, and aged under 40 years). The focus was on identifying the microbial composition in individuals experiencing moderate to severe sexual intercourse pain and those without any reported pain, excluding samples from individuals with mild pain. An additional criterion for inclusion was a reported history of sexual activity within the preceding 30 days. The menopausal group comprised 157 individuals reporting pain and 367 individuals without pain. In the reproductive age cohort, there were 968 participants with pain and 968 age-matched controls without pain. Statistical analysis between the pain and control groups in both cohorts revealed no significant differences in body mass index (BMI, menopause p = 0.74, reproductive p = 0.19), reported hormone use (menopause p = 0.2, reproductive p = 0.24), or history of previous infections (menopause p = 0.29, reproductive p = 0.09). Results In both the menopausal and reproductive-aged cohorts, individuals experiencing pain during sexual intercourse exhibited a higher prevalence of symptomatic conditions, as illustrated in Figure 1 A & B. Reported symptoms included increased severity of burning, itchiness, vaginal and vulvar pain, erythema, dysuria, and vaginal dryness. A significant correlation was observed between these enhanced symptomatology and variations in vaginal microbiome compositions among the menopausal group, as depicted in Figure 2 A & B. Specifically, pain during sexual intercourse in menopausal women was linked to elevated vaginal microbiota (VM) diversity (p=0.047) and a reduction in lactobacilli levels (p=0.06). Conversely, in the reproductive-aged cohort, a higher VM diversity was noted in the control group (p=0.014), with no significant differences in Lactobacillus or Gardnerella concentrations between those experiencing pain and the control group. Conclusions Preliminary examination of the vaginal microbiome in women who self-report moderate to severe pain with sex reveals significant differences, particularly in menopausal women experiencing pain. These individuals exhibited a more diverse vaginal microbiome and lower levels of Lactobacillus. This study underscores the need for further research to explore the potential of targeted microbiome modifications as a therapeutic approach to alleviate pain symptoms in this demographic. Disclosure Yes, this is sponsored by industry/sponsor: Evvy. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Evvy.

The benefits of Oukup to improve women sexual function after birth

Oukup is a traditional spa that has been existing and developing for thousands of years on Batak Land including in Karo. The Karo tribe in North Sumatra practice oukup for tradional treatment for women health after child birth. Good body care will restore women health and its beauty as before the pregnancy and overcome sexual dysfunction. The purpose of this study was to determine the benefits of Oukup for women after giving birth. This research employed descriptive exploratory ethnomedicine research design with mixed methods. The subjects of this research were women who have given birth. In collecting the data this research used google form to see the characteristics of informants’ understanding of oukup and the benefits obtained of oukup, FSFI scores, interviews, and focus groups discussion to explore how to use adequate and perceived benefits while the analysis was processed through content analysis. The results of the study reveals that all respondents are of reproductive age. Some of the respondents had a score of 20-26.5 (50%) and those >26.5 were 26.5%, respondents experienced sexual dysfunction are 83.3%. The domains that had the highest scores were lubrication and satisfaction are 3.61 and pain in sexual intercourse. The use of oukup is felt for relaxation, treatment of insomnia, anemia and indirectly increases sexual arousal as after bathing, the body feels fresh, smells good and all impurities come out.hot aromatherapy steam can loosen blocked breathing. Thus, oukup is important tradional culture for improving women health, disease prevention.

Comparison of ureteral stent-related symptoms in high-inserted stents with conventional ones

Objective: To assess whether high-inserted urinary stents (HIUS) provide substantial enhancements in patient comfort and overall quality of life, we compared the stent-related symptoms of HIUS and conventional ureteric stents (CUS). Methodology: We randomly assigned 54 patients who received simple ureteroscopic lithotripsy to a high-inserted or standard stent group. Baseline Ureteral Stent Symptom Questionnaire (USSQ) and visual analogue scale pain levels were assessed 2 weeks postoperatively and 4 weeks following stent removal. Also contrasted was subdomain analysis of all Stent-Related Symptoms (SRS) and stent problems. Results: Significant intergroup differences were seen in urinary symptoms, pain index on VAS, and overall health domain scores (p<0.001). No significant difference was seen in the work performance index (p=0.077) or sexual matter score (p=0.064). The HIUS group had significantly higher scores on USSQ subdomains, including frequency, urgency, incomplete emptying, burning at voiding, hematuria grade, difficulties with heavy physical activity, feeling comfortable, resting in bed due to symptoms, decreasing routine activities, and sexual intercourse pain (p<0.001). Patients in both groups who quit sex life owing to stents were similar (p=0.745). Complication rates were similar in both groups. Conclusion: HIUS dramatically reduced stent-related urine discomfort and pain. Thus, HIUS can be employed in clinical practice, especially for short-term stent implantation after simple ureteroscopic lithotripsy.

The Efficacy and Safety of Single-Incision Mini-Slings for Stress Urinary Incontinence: A Network Meta-Analysis.

To evaluate the efficacy and safety of single-incision mini-sling for stress urinary incontinence based on network Meta-analysis. We searched PubMed, Embase, and Cochrane libraries from August 2008 to August 2019. Randomized controlled trials comparing two or more indicators of Miniarc (Single Incision Mini-slings), Ajust (Adjustable Single-Incision Sling), C-NDL (Contasure-Needleless), TFS (Tissue Fixation System), Ophria (Transobturator Vaginal Tap), TVT-O (Transobturator Vaginal Tape), and TOT (Trans-obturatortape) in treating female stress urinary incontinence were collected. Totally, 3,428 patients from 21 studies were included. Ajust had the highest subjective cure rate (Rank=0.52), while Ophira had the worst (Rank=0.67). TFS had the highest objective cure rate, and the worst was found in Ophira. TFS required the shortest operating time (Rank=0.40), while TVT-O required the longest operating time (Rank=0.47). Miniarc had the least bleeding (Rank=0.47), while TVT-O had the most bleeding (Rank=0.37). C-NDL had the shortest postoperative hospital stay (Rank=0.77), while Ajust had the longest postoperative hospital stay (Rank=0.36). For postoperative complications, TFS performed best in groin pain (Rank=0.84), urinary retention (Rank=0.78), and repeat surgery (Rank=0.45). TVT-O performed worst in groin pain (Rank=0.36), and urinary retention (Rank=0.58). Miniarc had the highest repeat surgery rate (Rank=0.35). Ajust had the lowest probability of tap erosion (Rank=0.30), while Ophira had the highest tap erosion level (Rank=0.45). Miniarc showed the greatest advantage in urinary tract infections (Rank=0.84) and de novo urgency (Rank=0.60), while C-NDL had the highest incidence of urethral infections (Rank=0.51). Ophira performed worst in de novo urgency (Rank=0.60). C-NDL performed the best in sexual intercourse pain (Rank=0.79) while Ajust was the worst (Rank=0.49). In view of comprehensive efficacy and safety, we recommend that TFS or Ajust should be selected first for single-incision sling and the application of Ophria should be minimized.

Investigation and Multivariate Analysis of Gynecological Examination Fear

Objective: to analyze the subjective and objective factors of gynecological examination fear, and to provide a theoretical basis for eliminating gynecological examination fear. Methods: 350 valid and complete questionnaires were obtained from the subjects who underwent gynecological physical examination in the health management center of The First Affiliated Hospital of Ningbo University from October 2021 to December 2021. The subjective and objective factors of fear of gynecological examination were analyzed. Results: among the 350 respondents, 152 (43.43%) had fear of gynecological examination. The main subjective factor was that the previous gynecological examination was very painful; Objective factor analysis: there was a positive correlation between pre examination score and post examination score, and the degree of fear decreased after examination (t = 13.204, P = 0.000). Multivariate analysis showed that the fear of gynecological examination in recent asexual life was 0.369 times higher than that in others (P = 0.012), sexual intercourse pain was 8.304 times higher than that in painless people (P = 0.012), and regular physical examination was 2.979 times higher than that in non regular physical examination (P = 0.006); Cesarean section, childbirth and sexual intercourse pain are the influencing factors of poor cooperation score. Conclusion: gynecological examination fear is very common. The higher the degree of fear, the worse the degree of examination cooperation; Those with sexual intercourse pain, abortion history and regular physical examination have a relatively high degree of fear in gynecological examination. The history of cesarean section and sexual intercourse pain are the influencing factors of poor cooperation in examination. It is suggested that doctors should act gently during operation, use anesthesia during abortion operation, and guide pregnant women to adjust their emotions in time to avoid long-term fear.

Uterine Myoma Position-Based Radiofrequency Ablation (UMP-b RFA): 36 Months Follow-up Clinical Outcomes

(Abstracted from Eur J Obstet Gynecol 2023;281:23–28 The most frequently diagnosed benign pathology in the female population, uterine fibromatosis, is also a ubiquitous issue of health. Causing anemia, infertility, sexual intercourse pain, recurrent abortions, uterine bleeding, and pelvic pain, this pathology extends significant repercussions on not only women, but also their work activities and families. Treatments proven over time to be effective, such as gonadotropin hormone-releasing hormone antagonists, ulipristal acetate, or gonadotropin hormone-releasing hormone analogues, also give adverse effects in the process of failing to eliminate the pathology. In addition, these treatments cannot be used by patients attempting pregnancy.

Association between pelvic floor muscle strength and sexual function based on PISQ-12-an analysis of data from a multicenter cross-sectional study on 735 nulliparae during pregnancy.

Pelvic floor muscle strength is well-known to be associated with female sexual function. However, there were a few studies that reported on the relationship between pelvic floor muscle strength and female sexual function in pregnant women, and the presented results were inconsistent. Nulliparae represent a specific cohort with simplicity to exclude confounding factors that are caused by parity. The present study aimed to explore the association of pelvic floor muscle strength and sexual function based on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) of nulliparae during pregnancy. This is the second analysis of the baseline data from a randomized controlled trial (RCT), which aimed to study the protective efficacy of pelvic floor muscle training on stress urinary incontinence at 6th week postpartum (registration number: ChiCTR2000029618). Nulliparae aged 20-40 years with singleton pregnancy before 16 weeks of gestation were enrolled in this study, and data, including participants' demographic information, the Modified Oxford Scale (MOS), and PISQ-12, were collected. Eligible nulliparae were divided into two groups: Group MOS > 3 and Group MOS ≤ 3. Demographic information of the two groups was compared. Sexual function based on the PISQ-12 scores of the two groups was compared. A comparison of the PISQ-12 scores between the two groups was calculated by the Mann-Whitney U-test using SPSS version 23.0. A total of 735 eligible nulliparae were enrolled in this study. Along with MOS grading up, PISQ-12 scores tended to get lower. Of the 735 nulliparae, there were 378 and 357 participants included in Group MOS > 3 and Group MOS ≤ 3, respectively. The PISQ-12 scores of Group MOS > 3 were significantly lower than those of Group MOS ≤ 3 (11 vs. 12, p < 0.001). The scores of the frequency of feeling sexual desire, orgasm achievement, sexual excitement, sexual activity satisfaction, sexual intercourse pain, fear of urinary incontinence, and negative emotion reactions with the sexual intercourse of Group MOS > 3 were lower than those of Group MOS ≤ 3 (p < 0.05). Pelvic floor muscle strength was positively associated with sexual function based on the questionnaire of young nulliparae during their first trimester. Up to half of the nulliparae during the first trimester were suffering from weak pelvic floor muscle strength and nearly a quarter of the nulliparae were facing this weakness combined with sexual dysfunction. This study has been registered at http://www.chictr.org.cn (registration number: ChiCTR2000029618).

Effect of Mirena intrauterine device combined with GNRH-A on endometriosis, sex hormone level and carbohydrate antigen 125

To investigate the clinical value of Mirena (levonorgestrel intrauterine sustained release system) combined with gonadotropin-releasing hormone agonist (GnRH-a) in patients with endometriosis, 80 patients with endometriosis (March 2019 ~ March 2020) were selected as the research object. According to the "random number table method", they were divided into the control group (treated with GnRH-a) and the observation group (treated with Mirena IUD combined with GnRH-a), with 40 cases included in each group. The total clinical efficacy, sex hormone level, carbohydrate antigen 125 (CA125) level, degree of pain and recurrence rate indexes were compared between the two groups. Results showed that the total effective rate of 92.50% in the observation group was higher than 75.00% in the control group (P < 0.05). Intercourse pain of dysmenorrhea and sexual intercourse pain (VAS) in the two groups were compared before treatment. After treatment, the VAS scores in the two groups decreased, and the VAS scores in the observation group were lower than those in the control group (P<0.05). The levels of E2, FSH, LH and CA125 in the observation group were lower than in the control group (P<0.05). The recurrence rate of 5.00% in the observation group was lower than 20.00% in the control group (P<0.05). In conclusion, Mirena IUD combined with GnRH-a can improve the clinical efficacy of endometriosis, improve ovarian function, effectively regulate serum factors, further alleviate the symptoms of sexual intercourse pain and dysmenorrhea, control the risk of postoperative recurrence and achieve an ideal therapeutic effect.

Electroacupuncture for postpartum sexual dysfunction with urinary incontinence: A prospective case series study电针治疗产后性功能障碍伴尿失禁：前瞻性病例系列研究

ObjectiveTo observe the clinical therapeutic effect of electroacupuncture on postpartum sexual dysfunction associated with urinary incontinence. MethodsThe prospective case-series study was adopted. A total of 36 patients with postpartum sexual dysfunction associated with urinary incontinence were included consecutively. Electroacupuncture was applied to Shènshū (肾俞BL23), Huìyáng (会阳BL35), Pángguāngshū (膀胱俞BL28), Shíqīzhuī (十七椎EX-B8), Cìliáo (次髎BL32), Zhōngliáo (中髎BL33), Qìhăi (气海CV6), Guānyuán (关元CV4), Zhōngjí (中极CV3), Qūgŭ (曲骨CV2), Shuĭdào (水道ST28), Zĭgōng (子宫EX-CA1), Zúsānlĭ (足三里ST36) and Sānyīnjiāo (三阴交SP6), once daily, 6 times a week. The treatment for 2 weeks was as one phase and it should be completed in one menstrual cycle. For the cases without menstrual cycle recovery, the treatment should be given for any two weeks in one menstrual cycle and for those with menstrual cycle recovery, the treatment should avoid the menstrual period. Totally, the treatment lasted for 3 menstrual cycles. Before and after treatment, the scores of postpartum female sexual dysfunction diagnostic scale (PFSDDS), sexual intercourse pain assessment scale (SIPAS) and pelvic floor muscle strength test (PFMST), as well as the results of urodynamic examination (UE) were observed before and after treatment in the patients. ResultsAfter treatment, the scores of PFSDDS, SIPAS and PFMST were all increased as compared with those before treatment separately, presenting the statistical significance (all P < 0.05). Regarding UE, after treatment, the maximum bladder capacity, detrusor pressure at maximum flow, maximum flow rate and maximal urethral closure pressure were increased and postvoiding residual urine volume was reduced obviously as compared with the values before treatment, respectively, indicating the statistical differences (all P < 0.05). ConclusionElectroacupuncture has the significant effect on postpartum sexual dysfunction associated with urinary incontinence.

The Tampon Test as a Primary Outcome Measure in Provoked Vestibulodynia: A Mixed Methods Study

Provoked vestibulodynia (PVD) is characterized by severe pain, often induced by penetrative sex. This may lead to women abstaining from sexual intercourse, hence the recording of pain intensity levels in PVD research is often challenging. The standardized tampon test was designed as an alternative outcome measure to sexual intercourse pain and has frequently been used in clinical studies. The aim of this mixed methods study is to evaluate the tampon test as a primary outcome measure for an upcoming randomized clinical trial for women with PVD. An explanatory sequential design was applied, integrating quantitative and qualitative methods. In phase one, pain intensity levels were evaluated with the tampon test amongst 10 women, aged 18-33, with PVD. The test was repeated on day 1, 7 and 14. Pain intensity was rated on the Numerical Rating Scale (NRS), (0-10), 10 being worst possible pain. In phase two, the participants' experiences with the test were explored with semi-structured interviews using a descriptive and inductive qualitative design. All participants were recruited from the Vulva Clinic, Oslo University Hospital, Norway. The tampon test data and interviews were brought together to see how the interviews could refine and help to explain the quantitative findings. The tampon test data demonstrated large intra- and inter-individual variability. Median tampon pain intensity was 4.5 (min=1.7; max=10; Q1=2.5; Q3=6). Many experienced the test as an inadequate representation of pain during intercourse as it was less painful, different in nature and conducted in an entirely different context. Four participants had a mean score of four or lower on the NRS, whilst concurrently reporting high levels of pain during sexual intercourse. The findings indicate that the tampon test may underestimate severity of pain among some women with PVD. Participants with low pain scores would be excluded from studies where the tampon test is part of the trial eligibility criteria, even though severe pain was experienced during sexual intercourse. Large intra-individual variability in pain scores also reduces the test's ability to register clinical meaningful changes and hence necessitates repeated measurements per assessment time point. Although the tampon test has many advantages, this study indicates several potential problems with the application of the test as a primary outcome measure in PVD. In our opinion the test is most useful as a secondary outcome, preferably undertaken repeatedly in order to increase precision of the pain estimation.

Clinical value of traditional laparotomy, extensive vaginal hysterectomy, and laparoscope-assisted vaginal hysterectomy in the treatment of patients with cervical intraepithelial neoplasia III.

BackgroundCervical cancer is a common malignant tumor in women. This study aims to explore the clinical effects of traditional laparotomy, extensive vaginal hysterectomy and laparoscope-assisted vaginal hysterectomy in the treatment of patients with cervical intraepithelial neoplasia III (CIN III).MethodsA total of 79 cases with CIN III in situ who were treated in our hospital from July 2015 to February 2017 were selected as the study participants. According to the different surgical methods employed, patients were divided into a laparotomy group (n=21), a vaginal group (n=26), and a laparoscope-assisted vaginal group (n=32). The operative indicators in the three groups were compared, as well as the operative complications, quality of life, and female sexual function.ResultsThe operation time, intraoperative blood loss, and hospitalization time in the laparotomy group were all significantly greater than those in the vaginal and laparoscope-assisted vaginal groups (P<0.05), and the operative time was the shortest in the vaginal group. There was no significant difference in postoperative recovery time, drainage tube removal time, and time to out-of-bed activation between the vaginal group and the laparoscope-assisted vaginal group (P>0.05). After surgery, the main complications were poor wound healing, infection, vaginal discharge, and neoplasms of the vagina, and the total incidence of complications in the laparotomy group was 19.04%, which was significantly higher than that in the vaginal group (3.84%) and the laparoscope-assisted vaginal group (3.12%) (P<0.05). Three months after surgery, the physical and emotional function scores of patients in the laparoscope-assisted vaginal group were significantly higher than those in the laparotomy and vaginal groups (P<0.05). Six months after surgery, there were no significant differences among the three groups in scores of libido, sexual intercourse pain, orgasm, or difficulty in sexual intercourse (P>0.05).ConclusionsLaparoscope-assisted vaginal hysterectomy has a short recovery time and a low incidence of complications in patients with early cervical cancer in situ. Compared with laparotomy and vaginal hysterectomy, laparoscope-assisted vaginal hysterectomy is more conducive to improving the postoperative quality of life of patients.

Functional recovery following resection of large Tarlov cyst malformation: a multicentre longitudinal cohort study.

The authors report their experience with 44 consecutive patients who underwent cyst fenestration and wall repair or cerebrospinal fluid communication closure for the management of sacral Tarlov cysts. The procedure was performed on 32 women and 12 men with a mean age of 42 years. Clinical complaints in all patients included lumbar-sacral aching, sphincter dysfunction perineal pain, and sexual intercourse pain. The patients' symptoms had developed within a mean time period of 45 months. Five patients had a previous cyst puncture. In all patients, the cyst was exposed through a sacral laminectomy. In 30 patients, the cyst was partially resected its wall repaired, and in the remaining patients, the cyst was fenestrated, and the cerebrospinal fluid communication was located and tamponaded. Thirty-seven patients had intraoperative EMG monitoring. While the perineal pain, urinary, or sexual dysfunction improved in all patients, eleven patients reported lasting pain control following surgery. The cyst was reduced in all resected cases and seven of 14 patients with CSF tamponade. The mean length of the follow-up period was 57 months. Either cyst repair or CSF tamponade can be sufficient for alleviating symptoms in patients with Tarlov cyst. Advice should be given to patients regarding expectations for pain improvement after surgery.

Management and outcome of pelvic fracture associated with vaginal injuries: a retrospective study of 25 cases

BackgroundPelvic ring fractures associated with vaginal injuries were rarely reported due to low incidence. The displaced segments of pelvic ring may increase the risk of vaginal injury. The aim of this retrospective study was to evaluate the correlation between pelvic fracture and vaginal injury.MethodsWe conducted a retrospective review of 25 patients with pelvic fractures associated with vaginal injury treated at our institution. The medical records of these patients were collected and 24 patients were followed-up for 10–36 months.ResultsAll patients suffered anterior pelvic ring fracture. Young-Burgess fracture classification and compromised pubic symphysis were related to severity of vaginal injury. Gauze packing was done in 6 patients and 18 patients received surgical repair. Infection occurred in 6 patients, among them 4 were due to delayed diagnosis. Factors associated with pelvic outcome were age, urethral injury, and infection. Four patients suffered pain in sexual intercourse but no influence factor found correlated to sexual function.ConclusionVS type pelvic fracture and compromised pubic symphysis were related to higher severity of vaginal injury. Disruption of anterior ring and an unstable pelvic ring caused by forces on coronary and axial plane may increase the risk of vaginal injury.Trial registrationChiCTR1900020540. Registered 28 January 2019. Retrospectively registered. Trial registry: Chinese Clinical Trial Registry.

Clinical evaluation of pelvic floor rehabilitation training for patients with pelvic floor dysfunction after delivery via vagina

Objective To observe the clinical effect of pelvic floor rehabilitation training on patients with pelvic floor dysfunction after delivery through vagina. Methods From January 2017 to December 2017, 96 patients with pelvic floor dysfunction treated in the Maternal and Child Health Hospital of Lishui were randomly selected for clinical study.The patients were divided into observation group and control group by random number method, with 48 cases in each group.The control group was given pelvic floor dysfunction knowledge education, psychological counseling and general treatment methods such as guiding patients to perform functional exercises.The observation group received pelvic floor rehabilitation training on the basis of the treatment plan of the control group.The symptoms related to pelvic floor dysfunction, pelvic floor contraction ability before and after treatment, pelvic floor function and sexual quality of life were compared between the two groups. Results The incidence rates of clinical symptoms such as organ prolapse, urinary incontinence, asexuality and sexual intercourse pain in the observation group were 8.33%, 6.25%, 8.33% and 10.42%, respectively, which were significantly lower than those in the control group (25.00%, 27.08%, 22.92% and 27.08%) (χ2=4.800, P=0.028; χ2=7.500, P=0.006; χ2=3.872, P=0.049; χ2=4.376, P=0.036). There was no statistically significant difference between the two groups in grade I-V before treatment(P>0.05). After treatment, there were 2 cases, 4 cases, 8 cases, 18 cases and 17 cases in the observation group with grade I-V, which were significantly better than those in the control group (8 cases, 7 cases, 10 cases, 16 cases and 7 cases), and there was statistically significant difference (χ2=8.102, P=0.044). After treatment, the pelvic floor muscle tension of the observation group was higher than that of the control group[(4.16±0.33)grades vs.(3.84±0.27)grades], the difference was statistically significant(t=5.200, P=0.000). The sexual life quality score of the observation group was (87.33±10.24)points, which was significantly higher than (78.62±8.29)points in the control group(t=4.580, P=0.000). The total effective rate of the observation group was 95.83%, which was significantly higher than that of the control group (83.33%, χ2=4.019, P=0.048). Conclusion Pelvic floor rehabilitation training has good clinical effect on pelvic floor dysfunction after vaginal delivery.It can significantly improve pelvic floor function and sexual life ability, improve pelvic floor muscle tension and reduce visceral prolapse.It has important clinical application value. Key words: Pelvic floor; Hospitals, convalescent; Natural childbirth; Postpartum period

Malignant transformation of vaginal adenosis to clear cell carcinoma without prenatal diethylstilbestrol exposure: a case report and literature review

BackgroundWe report an extremely rare case of vaginal clear cell carcinoma, which originated from the malignant transformation of vaginal adenosis without prenatal diethylstilbestrol (DES) exposure.Case presentationIn this case, the patient was a Chinese woman with a history of two decades of intermittent vaginal pain, sexual intercourse pain and vaginal contact bleeding. On September 1, 2011, when the patient was 39 years old, a vaginal biopsy revealed vaginal adenosis. After intermittent drug and laser treatment, her symptoms did not improve. Four years later, on March 4, 2015, another vaginal biopsy for abnormal vaginal cytology revealed atypical vaginal adenosis. After treatment with sirolimus, her symptoms and abnormal vaginal cytology results persisted, and she underwent laparoscopic hysterectomy with bilateral salpingo-oophorectomy and excision of the vaginal lesions. One year after the hysterectomy, on August 15, 2017, the vaginal cytology results suggested atypical glandular cells, and a biopsy revealed vaginal clear cell carcinoma originating from the atypical vaginal adenosis. A wide local resection of the vaginal lesions was performed, followed by concurrent chemoradiotherapy. Regular follow-up over 16 months showed no evidence of the recurrence of vaginal adenosis or cancer.ConclusionsBased on the evolution of a series of pathological evidence, we report the fourth case in the world of vaginal clear cell carcinoma originating from vaginal adenosis without prenatal DES exposure. Wide local excision with radiotherapy provided at least 16 months of disease-free survival.

TRANSTORNOS DE DOR GÊNITO-PÉLVICA/PENETRAÇÃO: UMA EXPERIÊNIA DE ABORDAGEM INTERDISCIPLINAR EM SERVIÇO PÚBLICO

Este estudo relata a implantação de uma abordagem interdisciplinar oferecida nas Disfunções Sexuais Femininas, para as pacientes com queixas de dor génito-pélvica/penetração. Trata-se de um ambulatório especializado para atendimento em saúde sexual, em um hospital público, localizado na região sul do Brasil. As pacientes são atendidas através de consultas-conjuntas, as quais reúnem no mesmo cenário ginecologista especialista em saúde sexual e fisioterapeuta pélvica, junto a paciente com o intuito de aperfeiçoar a assistência. O objetivo é compartilhar a experiência das autoras na condução dessa abordagem dos Transtornos de Dor Gênito-pélvica/penetração, buscando demonstrar que é possível atender as pacientes com queixa de dor na relação sexual em um ambulatório público pelo Sistema Único de Saúde, alinhando estratégias de tratamento, de forma interdisciplinar.

Gabapentin for the Treatment of Vulvodynia: A Randomized Controlled Trial.

To evaluate whether extended-release gabapentin is more effective than placebo among women with vulvodynia. In a multicenter double-blind, placebo-controlled randomized crossover trial, gabapentin (1,200-3,000 mg/d) was compared with a placebo. The primary outcome was mean pain intensity (0, no pain at all to 10, worst pain ever) on the tampon test (a standardized tampon insertion and removal test used as a surrogate marker for dyspareunia) during the last 7 days of the maintenance phase. Secondary outcomes included sexual intercourse pain and daily pain. A sample size of 53 provided 90% power to detect a 1-point reduction on the tampon test (.05 level, two-sided) between the two treatment phases. From August 2012 to January 2016, 230 women were screened at three academic institutions and 89 (mean age 37 years; 65% black) were randomized: 45 to gabapentin first and then placebo and 44 to placebo first and then gabapentin. Tampon test pain with gabapentin was not different compared with the placebo (adjusted mean 4.0, 95% CI 3.0-4.9 vs 4.3, 95% CI 3.4-5.2, difference -0.3, 95% CI -0.7 to 0.0; P=.07). Gabapentin also did not improve pain over placebo for sexual intercourse pain (adjusted mean 3.9, 95% CI 2.4-5.3 vs 4.0, 95% CI 2.5-5.4, difference -0.1, 95% CI -0.9 to 0.6; P=.76) and daily pain (adjusted mean 2.7, 95% CI 1.8-3.6 vs 2.9, 95% CI 2.0-3.8, difference -0.2, 95% CI -0.5 to -0.2; P=.36). Subset analyses found that longer pain duration and oral contraceptive nonuse were associated with minimal improvement in tampon test pain with gabapentin. In this cohort, extended-release gabapentin, as compared with a placebo, did not reduce tampon test pain. These data do not support the recommendation of gabapentin alone as treatment for vulvodynia. ClinicalTrials.gov, NCT01301001.

Symptoms Improvement after Uterine Artery Embolization for Myomas Management

Background: Management of uterine myomas aims at improving symptoms that can be a problem and interfere in the patient’s quality of life. Less invasive approaches, such as uterine artery embolization (UAE), for selected patients is supposed to be a safer choice. Methods: Thirty-one women (mean age 38.5 ± 5.9) with symptomatic uterine myomas underwent UAE. All them scored 0 (mildest) to 10 (worst) for discomforting symptoms (abdominal pain (cramping) during and out of menstrual periods; bleeding during and out of menstrual periods; discomforting abdominal swelling; pain during sexual intercourse; general discomfort in diary activities and in social activities) before and 90 days after UAE. Results: Mean scores before and 90 days after UAE were significantly different for all symptoms, except for pain in sexual intercourse. Scores for bleeding out of menstrual periods increased after UAE, and decreased for all the other symptoms. Total scores before management (43.8 ± 25.4) decreased significantly (p<0.001) three months after UAE (16.1 ± 22.6). Conclusion: Clinical outcomes from UAE were very positive for this group of women, especially those presenting higher mean scores for abdominal pain and bleeding during menstrual periods.

Pain Rating in Women with Provoked Vestibulodynia: Evaluating Influence of Race.

Chronic pain may be perceived differently according to gender and race, which may affect physical health and psychological wellbeing. We evaluated daily pain ratings in black women as compared to white women with provoked vestibulodynia (PVD). Seventy-one women (44 black, 27 white) rated pain severity with tampon insertion and sexual intercourse and recorded daily vulvar pain level on a visual analogue scale (0 = no pain to 10 = worst pain imaginable). In addition, they completed the Brief Pain Inventory (BPI) Interference Scale and Hamilton Anxiety Depression Scale (HADS). Multivariate analysis was performed to determine the effect of race on pain intensity after adjusting for functional impairment, affective distress and demographic characteristics. Pain ratings from tampon insertion (6.37 ± 1.89 vs. 5.61 ± 1.98, p = .12) and sexual intercourse (6.28 ± 2.11 vs. 5.29 ± 2.50, p = 0.24) were similar, but daily vulvar pain (4.57 ± 2.27 vs 2.74 ± 2.43, p = <.01) was significantly higher in black women. BPI-interference scores were associated with small, but significant increases in tampon insertion pain (p = <.01, beta = .06 units) and daily pain (p < .01, beta = .10 units) and to a lesser degree with sexual intercourse pain when corrected for multiple comparisons (p = .05, beta = .06 units). Race had no effect on pain after adjusting for other variables. While race was associated with functional impairment, after accounting for this, race was not associated with level of vulvar pain with PVD.

Effect evaluation on Kegel exercise combined with full sexual health education in improving postpartum sexual problems

Objective To study the effect of Kegel exercise combined with full sexual health education in improving postpartum sexual problems of natural labor maternal.Methods 326 uniparas in our hospital were randomly divided into a control group and an experimental group (163 cases per group).Normal sexual health education was used in the control group,Kegel exercise combined with full sexual health education was used in the experimental group.The guidance of sexual health education and Kegel exercise was introduced to uniparas by charge nurses.Furthermore,telephone interviews were involved in this experiment.By using the Women Postpartum Sexual Problem Questionnaire,postpartum sexual condition and pelvic floor muscle function of the patients were checked six months later.Results The incidence of sexual intercourse pain,low sexual desire,vaginal relaxation,sexual dysfunction and sexual aversion of the uniparas in the experimental group were obviously lower than those in the control group (P ＜ 0.01).Their functions of pelvic floor muscle was better than those in the control group after 6 months (Hc=44.1194,P ＜ 0.01).The rate of their basic or complete recovery of pelvic floor muscle was both higher than that of the control group (61.4％ vs 31.3％,18.4％ vs 10.4％,P ＜ 0.01or 0.05).Conclusion Kegel exercise combined with full sexual health education are conducive to improve postpartum puerperas' functions of pelvic floor muscle and reduce the occurrence of postpartum sexual problems.It has an important sense to improve the postpartum puerperas' quality of sexual lives. Key words: Kegel exercise; Sexual health education; Sexual problems; Puerperas