Routine Gynaecological Practice Research Articles

THE INFLUENCE OF THE GENITAL MICROBIOME AND SEXUALLY TRANSMITTED INFECTIONS ON THE DEVELOPMENT OF ENDOMETRIAL HYPERPLASIA WITHOUT ATYPIA

Proliferative processes in the uterus, in particular endometrial hyperplasia (EH), are an important problem in gynecology, as they can lead to impaired reproductive health in women. The aim of the study was to investigate the prevalence of opportunistic pathogens and sexually transmitted infections in the vagina and uterine cavity among women with GE without atypia. Materials and methods. The study included 55 patients with abnormal uterine bleeding (AUB) in whom, after surgical removal of the functional layer of the endometrium by curettage, EH was diagnosed. The control group consisted of 35 women with secretory changes in the endometrium. Microbiological and bacteriological examination of the biopsy from the uterus and vaginal contents was carried out by standard methods. Determination of pathogens of sexually transmitted infections was carried out by ELISA and PCR methods. The significance of the intergroup relationships by quantitative distribution was determined using the nonparametric coefficient χ2, due to small samples. The difference between subgroups was considered significant at p < 0.05. Results. Gardnerella vaginalis was significantly more frequently detected in women with EH (12.7% versus 2.9% in the control group), with an odds ratio (OR) of 4.96. Mycoplasma hominis also significantly increases the risk of EH (34.5% in women with EH, OR = 5.04). The frequency of detection of Candida albicans in women with EH was 38.2%, which exceeds the indicators in the control group. Contamination of the uterine cavity with vaginal microflora (for example, Escherichia coli and Proteus vulgaris) is also associated with pathological changes in the endometrium. Chronic endometritis is more common in women with EH (6.1% vs. 3.7% in the control group), which emphasizes the role of chronic inflammation in the development of proliferative processes. Conclusions. The study confirmed the relationship between infectious-inflammatory processes and the development of EH. The data obtained indicate the need for timely diagnosis and treatment of sexually transmitted infections to prevent the development of EH. Careful control of the vaginal microflora is an important component of prevention. The importance of integrating microbiological examination into routine gynecological practice is emphasized to increase the effectiveness of EH treatment and prevent recurrences.

"Modernizing Cervical Cytology Screening with Liquid-Based Methods at Community-Level Hospitals: A Much-Needed Breakthrough for India".

Cervical cancer still ranks highest causing cancer-related morbidity and mortality in women in India. It is prudent to emphasise and implement cervical cancer screening strategies in the population efficiently and with regular intervals. Conventionally, PAP smear cytology is obtained by wooden spatula-Ayre's spatula. To improve sensitivity and specificity of the procedure and detection rate, better techniques of cells retrieval are available mainly liquid-based cytology (LBC), with help of cyto-brush. Literature has consistently proven efficiency of the technique and also reduced the proportion of inadequate sampling. We conduct this study to compare both the techniques and efficiency in a community hospital from data over 6years,to asses its role and benefits among Indian women. To compare conventional PAP smear and liquid-based cytology techniques analysing detection rates of positive lesions (CIN and also includes ASCUS and malignant), incidence of inadequate sampling, efficiency and cost-effectiveness. This is retrospective study at tertiary care obstetric hospital affiliated to government-run medical college in a metropolitan city of Mumbai. Data are retrieved from the Pathology Department, Medical Records Department, laboratory books and OPD registers. Pap's smear sampling was done mainly from OPD with all indications including routine tests as a part of gynaecological evaluation and screening, as well as for suspicious lesions on inspection. Group A consists women who had conventional PAP smear test for 3years (Dec 2015-Nov 2018) and Group B had women who benefited by LBC method for 3years (Dec 2018-Nov 2021). COVID-19 pandemic majorly affected the routine gynaecological OPD practice during 2021 as hospital was COVID facility hospital. Demographic parameters and presentations were comparable and similar. LBC methods have higher detection rate for positive reports, including ASCUS. But results were comparable in both groups and not statistically different. Importantly, incidences of inadequate sampling are reduced significantly with the LBC method. Unsatisfactory smears war high in Group A (7.752%) compared to Group B (3.712%) p-value 0.005, stating the increased rate of requirement of sending repeat smears, which involves higher engagement of time, resources and active participation from healthcare personnel. Good detection rates and significantly low rates of unsatisfactory smears make LBC rational and cost-effective. These are the times to switch to liquid-based cytology techniques, especially at the community level hospitals; in order to detect more women with cervical premalignant as well as malignant neoplastic lesions and to save lives. This can be made possible by emphasising the policy makers to incorporate these services through quality resources.

AYURVEDIC MANAGEMENT OF COMPLEX OVARIAN CYST- A CASE REPORT

Cysts in the ovaries can be simple or complex. Ovarian cysts classified as complexes include either blood or a solid material. In routine gynaecological practice, ovarian cystic masses are a prevalent concern. The prevalence of ovarian cysts varies greatly, according to data. According to reports, ovarian cysts affect 8–18% of women who are postmenopausal and premenopausal. The majority of the cysts are asymptomatic and are only found via standard ultrasonography. Some of them are very symptomatic, making it difficult for women to go about their daily lives. The size of the cysts has a significant impact on the symptoms. In modern times, therapy options include combined oral contraceptive pills and surgery to address cysts that don't go away after three months. Due to the numerous adverse effects of oral contraceptives, there is a growing need for other forms of management, particularly among patients who prefer not to undergo surgery. Ayurveda treats ovarian cysts under the general category of Granthi, where they are associated explicitly with Kaphaja Granthi. Treatment for an 18-year-old female patient who had a complicated left ovarian cyst with cystitis, dyspareunia, burning micturition, and significant lower abdominal pain was based on Ayurvedic principles. The patient was administered Srotosanghar Churn, Granthihar Kwath, Capsule Liv Fit, Search Cordial capsule, and Search Cordial syrup for one month. A follow-up USG revealed that the cyst had disappeared entirely, and the symptoms had decreased significantly. The current study highlights how Ayurveda can help control ovarian cysts beneficially.

A Comparison of Newer and Traditional Approaches to Diagnosing Vaginal Infections.

Molecular diagnostic testing (eg, polymerase chain reaction [PCR]-based vaginitis testing) is widely used in clinical practice, although vaginitis experts have reservations about its use for vaginitis diagnosis. As with any new technology, cost to the health system is a large concern. Although clinical evaluation of signs and symptoms along with wet mount microscopy is traditionally used for vaginitis diagnosis, it is less accurate compared with molecular diagnostic testing. Here we review the benefits of adopting newer molecular diagnostics into routine gynecologic practice with some guidance from vaginitis experts that favor both traditional and more modern approaches. We argue that instead of trying to resist the oncoming tide of molecular diagnostics, we can embrace them and put them to appropriate use to effect rapid, accurate, and more flexible diagnosis of vaginitis conditions for our patients.

Subspecialty care for peripartum pelvic floor disorders

Obstetrical perineal and anal sphincter lacerations can be associated with considerable sequelae. The diagnosis of short-term bowel, bladder, and healing problems can be delayed if patients are not seen until the traditional postpartum visit at 4 to 6 weeks. Specialized peripartum clinics create a unique opportunity to collaborate with obstetrical specialists to provide early, individualized care for patients experiencing a variety of pelvic floor issues during pregnancy and in the postpartum period. Although implementation of these clinics requires thoughtful planning and partnering with care providers at all levels in the obstetrics care system, many of the necessary resources are available in routine gynecologic practice. Using a multidisciplinary approach with pelvic floor physical therapists, nurses, advanced practice providers, and other specialists is important for the success of this service line and enhances the level of care provided. Overall, these clinics provide a structured means by which pregnant and postpartum women with pelvic floor symptoms can receive specialized counseling and treatment.

Patient reported outcomes measures in gynecologic oncology: A primer for clinical use, part I

•Patient reported outcomes measurements (PROMs) are an essential component of comprehensive, patient centered care. •Practical considerations and challenges to collecting PROMs in routine gynecologic oncology practice are discussed. •Pragmatic, disease-specific recommendations for the use of PROMs are provided for women with gynecologic malignancies.

Patient reported outcomes measures in gynecologic oncology: A primer for clinical use, Part II

•Patient reported outcomes measurements (PROMs) are an essential component of comprehensive, patient centered care. •Practical considerations and challenges to collecting PROMs in routine gynecologic oncology practice are discussed. •Pragmatic, disease-specific recommendations for the use of PROMs are provided for women with gynecologic malignancies.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (VNOTES) For Endometrial Carcinoma: A Feasibility and Safety Study

Study Objective To investigate the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for endometrial carcinoma (EC). Design Retrospective study. Setting The First Affiliated Hospital of Third Military Medical University, Chongqing, China Patients or Participants Women with federation international of gynecology and obstetrics (FIGO) stage IA endometrial cancer. Interventions vNOTES surgery consist of hysterectomy, bilateral salpingo- oophorectomy and bilateral pelvic and para-aortic lymph node dissection were performed by by a gynecologic oncologist. Clinicopathologic, surgical, and perioperative outcomes were analyzed. Measurements and Main Results All the 12 patients were successfully operated. Vaginal hysterectomy was performed in five patients, and vNOTES hysterectomy was performed in seven patients. All the 12 cases underwent bilateral salpingo-oophorectomy under vNOTES. Pelvic lymph node dissection was performed in six patients, sentinel lymph node biopsy was performed in four patients, and pelvic lymph node dissection plus para-aortic lymphadenectomy was performed in two patients. The median operative time was 172 minutes (94-235 minutes), the median blood loss was 117 (50-200) ml, and the median postoperative hospital stay was 5 (4-9) days. The median time for postoperative recovery of gastrointestinal function was 21 hours (12-40 hours), the median pain score at postoperative 12 hours was 2 (1-4) and 1 (1-2) at postoperative 24 hours. The median follow-up time was 5 months. The vaginal stump incision healed well in all the patients. Conclusion vNOTES is a safe and effective method for comprehensive surgical staging of EC. Larger studies are needed to confirm whether the increased technical difficulty of this procedure justifies its use in routine gynecologic oncology practice. To investigate the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for endometrial carcinoma (EC). Retrospective study. The First Affiliated Hospital of Third Military Medical University, Chongqing, China Women with federation international of gynecology and obstetrics (FIGO) stage IA endometrial cancer. vNOTES surgery consist of hysterectomy, bilateral salpingo- oophorectomy and bilateral pelvic and para-aortic lymph node dissection were performed by by a gynecologic oncologist. Clinicopathologic, surgical, and perioperative outcomes were analyzed. All the 12 patients were successfully operated. Vaginal hysterectomy was performed in five patients, and vNOTES hysterectomy was performed in seven patients. All the 12 cases underwent bilateral salpingo-oophorectomy under vNOTES. Pelvic lymph node dissection was performed in six patients, sentinel lymph node biopsy was performed in four patients, and pelvic lymph node dissection plus para-aortic lymphadenectomy was performed in two patients. The median operative time was 172 minutes (94-235 minutes), the median blood loss was 117 (50-200) ml, and the median postoperative hospital stay was 5 (4-9) days. The median time for postoperative recovery of gastrointestinal function was 21 hours (12-40 hours), the median pain score at postoperative 12 hours was 2 (1-4) and 1 (1-2) at postoperative 24 hours. The median follow-up time was 5 months. The vaginal stump incision healed well in all the patients. vNOTES is a safe and effective method for comprehensive surgical staging of EC. Larger studies are needed to confirm whether the increased technical difficulty of this procedure justifies its use in routine gynecologic oncology practice.

Diagnosis of endometrial hyperplasia in routine gynecological practice

Мета роботи. Визначити діагностичну точність, чутливість, специфічність, позитивне та негативне прогностичні значення ультразвукової діагностики гіперплазії ендометрія за допомогою порівняння результатів трансвагінального ультразвукового дослідження з патогістологічним висновком. Матеріали та методи. Здійснили ретроспективний аналіз 156 історій хвороби пацієнток, котрим виконано гістерорезектоскопію або лікувально-діагностичне вишкрібання порожнини матки, з наступним порівнянням передопераційного діагнозу за результатами трансвагінального ультразвукового дослідження (ТвУЗД) і патогістологічного висновку. Відповідно до результатів ТвУЗД перед процедурою пацієнток поділили на 2 групи. Перша група – 71 жінка з передопераційним діагнозом гіперплазія ендометрія. У другій групі було 85 жінок, яким входження в порожнину матки виконали за іншими показаннями. За допомогою статистичних і математичних методів визначена діагностична цінність методу ТвУЗД для виявлення гіперплазії ендометрія та для патології, котра надалі потребує інвазивного втручання в порожнину матки. Результати. У першій групі збіг передопераційного діагнозу (за даними ТвУЗД) із патогістологічним висновком гіперплазія ендометрія визначили тільки у 35 жінок, тобто позитивне прогностичне значення становило тільки 49,3 %. Аналіз другої групи жінок показав, що правильний діагноз (відсутність гіперплазії ендометрія) спостерігали у 52 випадках, тобто негативне прогностичне значення дорівнювало 61,18 %. Чутливість ТвУЗД під час діагностики гіперплазії ендометрія становила тільки 51,47 % (95 % CI 39,03–63,78). Специфічність ТвУЗД під час діагностики гіперплазії ендометрія становила 59,09 % (95 % CI 48,09–69,46). Але щодо лікувальної тактики, то відсутність показань до інвазивного внутрішньоматкового втручання спостерігали в 4,22 % жінок першої групи та у 2,35 % другої групи. Висновки. ТвУЗД має низьку діагностичну цінність для встановлення точного діагнозу гіперплазія ендометрія. ТвУЗД має високу діагностичну цінність для визначення лікувальної тактики (необхідності виконання гістерорезектоскопії чи лікувально-діагностичного вишкрібання порожнини матки) при внутрішньоматковій патології. Встановили низьку діагностичну цінність ТвУЗД під час діагностики гіперплазії ендометрія, що диктує необхідність додаткового аналізу, враховуючи кваліфікацію фахівців з УЗ-діагностики, з’ясування адекватності виконання наказу МОЗ № 676, який вимагає наведення таких параметрів, як структура ендометрія, включення, звукопровідність, зовнішній контур М-ЕХО та рельєф порожнини матки, а в пацієнток у пери- і постменопаузі – визначення ендометріально-маткового співвідношення.

Impact of vulvovaginal atrophy of menopause: prevalence and symptoms in Italian women according to the EVES study

This cross-sectional study included postmenopausal women, aged 45–75 years, with the aim to assess the presence of vulvovaginal atrophy (VVA) confirmed by a clinical assessment in the Italian population attending menopausal/gynecological centers. Apart from baseline variables, women scored vaginal, vulvar and urinary VVA symptoms. Impact of VVA on sexual function and quality of life (QoL) was assessed thorough EuroQoL questionnaire (EQ5D3L), Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-revised (FSDS-R). A physical examination was carried out in accordance with routine gynecological practice. VVA was confirmed in 90% of the 1226 evaluable patients (aged 59.0 ± 7.3 years). The prevalence of postmenopausal women with VVA confirmed by gynecological clinical assessment was 75.3%. The patients with VVA confirmed (n = 926) had more severe symptoms (p < .0005), lower QoL (EQ-visual analog scale, p = .008 and DIVA, p < .0005) and worsened sexual function (FSFI and FSDS-R, p < .0005 for both) when compared with the patients having nonconfirmed VVA (n = 140). VVA is highly prevalent among postmenopausal Italian women. The objective of VVA confirmation is associated with severe symptoms and impaired QoL and sexual function. A proactive approach of Italian clinicians to promote regular and early gynecological evaluation should be performed in order to delay the advancing of the disorder.

PCP49 - EXPLORING THE SENSITIVITY TO CHANGE OF THE SAMANTA QUESTIONNAIRE IN HEAVY MENSTRUAL BLEEDING: THE SAMIRA STUDY

Despite the important impact of Heavy Menstrual Bleeding (HMB) in many women’s lives, its management is complex due to the inconvenience of the techniques to assess the real blood loss and the poor correlation between blood loss and women’s perception. A 6 item-questionnaire in Spanish language has been elaborated to address the need to develop an easy-to-handle validated tool to identify HMB cases: the SAMANTA questionnaire. It has shown good sensitivity and specificity to discriminate between women with and without HMB. The main objective of SAMIRA study is to explore, under routine gynaecological practice, if the SAMANTA questionnaire, designed to diagnose HMB, can also be sensitive to change in women with HMB who have been treated for 12 months with a chronic hormonal treatment under therapeutic indication in Spain. This is an observational, prospective and cohort study with a 12 month follow-up that will be carried out in Spain. The sensitivity to change of SAMANTA scale will be explored by estimating the change from baseline to final score in relation to the change in different clinical measurements such as duration of period, blood loss and presence of amenorrhea, and in comparison with patient’s and clinician’s global impressions of severity and change of menstrual bleeding. The SAMIRA study aims to go one step further in order to evaluate whether the SAMANTA questionnaire is also able to detect changes in menstrual blood loss in women with HMB. If the SAMANTA questionnaire shows a consistent behaviour with the rest of clinical measurements, it can be hypothesized that it might be useful for clinicians not only to screen for HMB but also to evaluate the change in HMB severity in patients under a hormonal treatment.

English

Management of problems after menopause is an important aspect of routine gynecological practice. Age related changes include thinning of trigonal and urethral epithelium, decrease in blood flow through urethral plexus resulting in reduced cooptation, and overall connective tissue (elasticity, striated muscles and total collagen) diminution. The effects on other organ systems and comorbidities add to urological problems in the aged.Though it is very difficult to attribute all these changes to aging, estrogen deprivation after menopause seems to contribute significantly to the urological problems. The problems are more cumbersome in the elderly worsened by thecomorbidities. Incontinence of any kind is abnormal regardless of any age. Treatment of the factors beyond the bladder for the voiding related worries including incontinence is required. A multipronged, creative, persistent and optimistic approach is needed to treat these cases.

Is bedside ultrasound now a routine part of specialist obstetrics and gynaecology outpatient consultation?

Introduction: Portable ultrasound is extensively used in the delivery suite, and there is anecdotal evidence that ultrasound is increasingly common in routine outpatient gynaecological practice. We could find no published data regarding the prevalence of ‘rooms’ ultrasound use in outpatient gynaecology. Methods: A survey instrument was developed containing demographic questions about ‘rooms’ ultrasound use, and three clinical vignettes regarding dysmenorrhoea in a young woman, bleeding in early pregnancy, and postmenopausal bleeding. For each vignette, respondents were asked whether they would refer for ‘formal’ ultrasound or rely on their own findings. The anonymous questions were sent to every obstetrician/gynaecologist in private practice in Australia. Results: 438 surveys were posted and 242 returned (response rate 55%). 226 respondents (93.8%) reported using ultrasound in their consulting rooms, with 201 (88.9%) using transvaginal ultrasound. For the dysmenorrhoea vignette, 59% of respondents would rely on their own ultrasound findings and not refer for additional imaging. For the bleeding in early pregnancy vignette, 91% would rely on their own ultrasound findings and not refer for additional imaging. For post‐menopausal bleeding, 54% would rely on their own clinical and ultrasound findings and would not refer for additional imaging. Conclusion: The majority of practitioners would not refer for tertiary ultrasound if their own imaging revealed apparent normal findings.

Laparoendoscopic Single-site Radical Hysterectomy With Pelvic Lymphadenectomy: Initial Multi-institutional Experience for Treatment of Invasive Cervical Cancer

Study ObjectiveTo describe the feasibility, safety, and outcomes of women with stage I cervical cancer treated with laparoendoscopic single-site surgery radical hysterectomy (LESS-RH). DesignA retrospective descriptive study (Canadian Task Force classification III). SettingMultiple academic teaching hospitals. PatientsWomen with Fédération Internationale de Gynécologie et d'Obstétrique FIGO stage IA1 to IB1 cervical cancer. InterventionsLESS-RH as the primary therapy for cervical cancer performed by a gynecologic oncologist with expertise in LESS. A multichannel, single-port access device; a flexible-tipped 5-mm laparoscope; and a multifunctional instrument were used in all cases. Clinicopathologic, surgical, and perioperative outcomes were analyzed. Measurements and Main ResultsTwenty-two women were identified in whom a LESS-RH was attempted; 20 (91%) successfully underwent the procedure, including 19 in whom pelvic lymphadenectomy (PLND) was completed. Of the 2 converted procedures, 1 patient underwent 2-port laparoscopy secondary to truncal obesity, and 1 patient underwent conversion to laparotomy secondary to external iliac vein laceration during PLND. The median age and body mass index were 46 years and 23.3 kg/m2, respectively. The median number of pelvic lymph nodes removed was 22. One patient experienced an intraoperative complication, and no patient required reoperation. The margins of excision were negative. One patient with 2 positive pelvic nodes and 1 patient with microscopic parametrial disease received adjuvant chemosensitized radiation; 3 additional patients received adjuvant radiation therapy secondary to an intermediate risk for recurrence. After a median follow up of 11 months, no recurrences were detected. ConclusionLESS-RH/PLND is feasible and safe for select patients with stage I cervical cancer. Larger studies are needed to confirm whether the increased technical difficulty of this procedure justifies its use in routine gynecologic oncology practice.

Committee Opinion No. 488: Pharmacogenetics

Pharmacogenetics is the study of genetic variations in drug response that are determined by specific genes. It is hoped that the use of pharmacogenetics in clinical practice may improve drug safety and decrease the rate of adverse drug reactions. Given the potential applications of pharmacogenetics to women's health care, obstetricians and gynecologists should be aware of this rapidly developing field. Currently, however, there are limited clinical indications for the use of pharmacogenetics in routine obstetric and gynecologic practice.

Extended Cycles with the Combined Oral Contraceptive Chlormadinone Acetate 2 mg/Ethinylestradiol 0.03 mg

The prescribing of extended regimens of oral contraceptives (OCs) is increasing in routine gynaecological practice as a means of reducing the number of annual menstrual bleeds. Typically, this involves taking one pill per day for, say, 84 days continuously (4×21 days), followed by a 7-day pill-free interval. Low-dose OCs are suitable for extended use, and many gynaecologists in Germany prescribe the combination of chlormadinone acetate 2 mg/ethinylestradiol 0.03 mg (CMA 2 mg/EE 0.03 mg). The aim of the current study was to assess the risks and benefits of CMA 2 mg/EE 0.03 mg in extended regimens, using pooled data from observational studies. This pooled analysis of three large-scale, non-interventional, observational studies assessed the results in women receiving Belara® (CMA 2 mg/EE 0.03 mg) according to an extended regimen compared with conventional regimens documented in the summary of product characteristics. A total of 625 women were identified as extended-regimen users (mean±SD age 24.9±9.0 years). Extended-cycle use was associated with decreases in skin problems, dysmenorrhoea symptoms (as shown by reductions in analgesic use; absence from school, university, or work; and restrictions in leisure and sporting activities), cycle-dependent symptoms (e.g. headache/migraine, breast tenderness), withdrawal bleeding, bleeding duration and reduced libido. Mean bodyweight remained almost constant over 6 months. Only nine adverse drug reactions, none severe, were reported in eight women (1.3%). This pooled analysis confirms that extended regimens of CMA 2 mg/EE 0.03 mg reduce cycle-related complaints and are very well tolerated.

Routine evaluation and treatment of unexplained menorrhagia: do we consider haemostatic disorders?

Objective Unexplained menorrhagia can be caused by underlying bleeding disorders. The aim of this study was to investigate the current work-up of menorrhagia in routine gynaecological practice, with a special interest in haemostatic evaluation. Secondly, we investigated the outcome of individualized treatment in our centre. Study design Retrospective medical chart review of 112 consecutive patients referred with menorrhagia to a general gynaecology clinic of a university teaching hospital in the Netherlands between January 2006 and January 2007. In April 2008 we performed a structured telephone interview evaluating the effectiveness of their therapy. Results We included 112 patients, whose median age was 42 years. Twenty-nine percent were anaemic (hemoglobin <12.0 g/dL). Seventy-one (63%) had unexplained menorrhagia. Only two patients had haemostatic evaluation and neither had von Willebrand's disease. Forty percent (29/71) needed two or more different therapies, 17% (12/71) needed three different therapies and two patients needed a total of seven different therapies. Eight patients underwent hysterectomy, six of them after endometrial ablation. Most patients (80%) were successfully treated medically or surgically and were satisfied with their therapy during follow-up. Eleven patients declined therapy and accepted their heavy periods. Conclusion Haemostatic evaluation in women with unexplained menorrhagia is uncommon in gynaecological practice in our centre. Although most of the patients were satisfied with their treatment, a significant number required hysterectomy and another important proportion had to accept their menorrhagia. We hypothesize that the identification of haemostatic disorders might improve care for these women.

Use of the Italian translation of the Female Sexual Function Index (FSFI) in routine gynecological practice

Aims. To investigate domains of sexual function in healthy women attending a gynecological office for routine annual check-up using the Italian translation of the Female Sexual Function Index (FSFI) according to age, reproductive status and hormonal treatments; and to confirm the usefulness of the FSFI in detecting relevant clinical entities.Methods. Of 720 women (age range 18–65 years), 564 (78%) filled in a short anamnestic questionnaire and the FSFI assessing desire, arousal, lubrication, orgasm, satisfaction and pain. A semi-structured DSM-IV-TR clinical interview was administered to a convenience sample of women selected according to the quartile distribution of the median full scale FSFI score. Analysis of data was performed by frequency tables and non-parametric statistics.Results. The median full scale score of FSFI in our study population was 27.6 (lower quartile: 18.7, upper quartile: 30.9) and the percentage of women under the lower quartile of the distribution was 24.4%. Sexual function decreased progressively with age, being significantly lower after 30 years and after 60 years (χ2 = 52.6; p = 0.0001). Menopausal women had significantly lower median FSFI full scale score compared with fertile women and women who used oral contraception (OC) (p < 0.0001 for both), while users of hormone replacement therapy (HRT) displayed better overall sexual function than untreated postmenopausal women (p < 0.005). A positive diagnosis of female sexual dysfunction (FSD) was evident only in young women scoring under the lower quartile of the distribution (cut-off score: 23.4 for women not taking OC and 20.8 for OC users), while older women were dysfunctional also above the lower quartile of the distribution (cut-off score: 14.1 for menopause, 18.5 for HRT) of the FSFI full scale score.Conclusions. The FSFI is a powerful screening tool for FSD, especially in young fertile women, and may be used effectively in routine gynecological practice.

367: A Review of the Prehysterectomy Diagnostic Accuracy of Adenomyosis

Preoperatively adenomyosis remains largely a clinical diagnosis since sensitivity and specificity of transvaginal ultrasound scans (TVS) are low. Although this can be somewhat improved by MRI scan, the latter is not widely available for routine gynaecological practice. We wanted to evaluate how good are clinicians in suspecting adenomyosis prior to a hysterectomy?

Cystoscopy for gynaecologists

Cystoscopy is a commonly employed procedure in both urological and gynaecological practice. Unfortunately, the practicalities of when and how to perform cystoscopy are often poorly taught during general gynaecological training. A basic understanding of the equipment as well as a systematic approach to performing cystoscopy is the key to gaining the full benefit of this procedure and ensuring no pathology is missed. The technique and indications for cystoscopy in routine gynaecological practice are discussed.