Adherencias del capuchón del clítoris al glande: una condición poco estudiada y poco examinada / Clitoral hood adhesions to the glans penis: an understudied and under-examined condition

INTRODUCCIÓN: El clítoris es una de las estructuras vulvares menos examinadas, pese a su relevancia en la vida sexual y sus importantes relaciones anatómicas. Las adherencias del capuchón del clítoris han sido descritas y clasificadas según la exposición del glande, siendo relacionadas con trastornos del deseo sexual. La inervación del clítoris depende de raíces de S3-S4, siendo posible que síntomas frecuentes del piso pélvico tengan relación con esta condición. Realizamos un análisis retrospectivo de pacientes de policlínico de piso pélvico entre noviembre de 2021 y abril de 2022. Se incluyeron 100 pacientes con adherencias al ingreso. RESULTADOS: Promedio de edad 45,8 ± 15,5 años. Las adherencias fueron el 19% leves, el 62% moderadas y el 18% graves. Los principales síntomas eran mal vaciado vesical (38%), dolor (28%), disfunción sexual (39%) y síntomas irritativos vesicales (43%); solo una paciente fue asintomática. El área visible promedio del clítoris era de 20,7 ± 13,7 mm2. CONCLUSIONES: Las adherencias del capuchón del clítoris son un hallazgo común, muchas veces no diagnosticadas, por lo que su evaluación debe ser parte de la exploración física. Pueden asociarse a sintomatología de piso pélvico.

INTRODUCTION: The clitoris is one of the least examined vulvar structures despite its relevance in sexual life and important anatomical relationships. Clitoral hood adhesions have been described in the literature, classified based on glans exposure, and related to sexual desire disorders. The innervation of the clitoris depends on the roots of S3-S4, and frequent pelvic floor symptoms may be associated with this condition. We retrospectively analyzed the clinical record of patients admitted to a pelvic floor clinic between November 2021 and April 2022. One hundred patients with adhesions at the time of admission were registered. RESULTS: Average 45.8 ± 15.5 years. Clitoral hood adhesions were mild (19%), moderated (62%), or severe (18%). The main symptoms were voiding dysfunction symptoms (38%), pain (28%), sexual dysfunction (39%), and irritative bladder symptoms (43%); only one patient was asymptomatic. The visible area of the clitoris was 20.7 ± 13.7 mm2. CONCLUSIONS: Adhesions of the clitoral hood are often undiagnosed, and its analysis should be part of the physical exam. Clitoral hood adhesions could be associated with pelvic floor symptoms.

Barreras y facilitadores de los médicos de atención primaria para abordar las consultas vinculadas a la sexualidad de pacientes durante el climaterio / Barriers and facilitators of primary care physicians to address consultations related to the sexuality of patients during the climacteric

Introducción. Pese a la alta prevalencia de disfunciones sexuales femeninas durante el climaterio y a que existen intervenciones para mejorarlas, este problema no suele ser consultado por las pacientes ni explorado por los profesionales de la salud. Si bien suponemos que existen condicionamientos culturales que actuarían como barreras para su abordaje, no conocíamos las percepciones, incomodidades y experiencias de los profesionales que atienden en el ámbito de la atención primaria a pacientes que transitan su climaterio. Objetivos. Comprender desde la perspectiva de los médicos de atención primaria los factores que contribuyen a la invisibilidad de la problemática de las disfunciones sexuales femeninas durante el climaterio en mujeres de clase media atendidas en el Área Metropolitana de Buenos Aires. Diseño. Estudio exploratorio transversal con enfoque cualitativo realizado en el Hospital Italiano de Buenos Aires durante2020 y 2021. Resultados. A partir del análisis de diez entrevistas semiestructuradas a médicos de atención primaria (de familia, clínicos y ginecólogos) identificamos seis ejes temáticos: 1) un modelo institucional en el que el tiempo limitado para la consulta y forma de pago capitada incentivaría a que las las disfunciones sexuales femeninas permanezcan invisibilizadas; 2) la longitudinalidad de la relación médico-paciente contribuiría como un facilitador del abordaje de problemáticas vinculadas con la esfera sexual; 3) la discordancia de género entre los profesionales y las pacientes operaría como un obstáculo para abordar aspectos de la sexualidad durante el climaterio; 4) la biografía y la formación de los profesionales de la salud influiría sobre sus habilidades para abordar la problemática de la sexualidad de sus pacientes; 5) el examen ginecológico y/o la detección de síntomas de depresión contribuyen a abrir la puerta para indagar sobre la disfunción sexual femenina; y 6) el prejuicio de que el fin de la etapa reproductiva implicaría el fin de la actividad sexual. Conclusiones. Si bien no existen recomendaciones formales para la pesquisa sistemática de disfunciones sexuales femeninas, su elevada prevalencia, su fácil diagnóstico y la existencia de herramientas terapéuticas para aliviarlas, ameritan que estén más disponibles entre nuestras hipótesis diagnósticas. (AU)

Background. Despite the high prevalence of female sexual dysfunctions during the climacteric and the existence of interventions to improve them, this problem is not usually consulted by patients or explored by health professionals. Although weassume that there are cultural conditioning factors that would act as barriers to its approach, we were unaware of the perceptions, discomforts, and experiences of the professionals who care for patients who are going through their climactericin the field of primary care. Objectives. To understand, from the perspective of primary care physicians, the factors that contribute to the invisibility of the female sexual dysfunctions problem during the climacteric in middle-class women treated in the Buenos Aires Metropolitan Area. Design. Cross-sectional exploratory study with a qualitative approach carried out at Hospital Italiano de Buenos Aires during 2020 and 2021. Results. From the analysis of ten semi-structured interviews with primary care physicians (family, clinicians and gynecologists) we identified six thematic axes: 1) an institutional model in which the limited time for consultation and capitated form of payment would encourage female sexual dysfunctions to remain invisible; 2) the longitudinality of the doctor-patient relationship would contribute as a facilitator in addressing problems related to the sexual sphere; 3) the gender discrepancy between professionals and patients would operate as an obstacle to address aspects of sexuality during the climacteric; 4) the biography and training of health professionals would influence their abilities to address the problems of their patients'sexuality; 5) gynecological examination and/or the detection of symptoms of depression contribute to opening the door toinquire about FSD; 6) the prejudice that the end of the reproductive stage would imply the end of sexual activity. Conclusions. Although there are no formal recommendations for the systematic screening of female sexual dysfunctions, its high prevalence, its easy diagnosis and the existence of therapeutic tools to alleviate them, deserve that they be more available among our diagnostic hypotheses. (AU)

Sangrado genital por cuerpo extraño en niñas prepuberales: a propósito de un caso / Genital bleeding caused by foreign body in prepubertal girls: a case report

El sangrado genital en niñas prepúberes es un signo poco frecuente y siempre requiere determinar su causa. Se necesitan una detallada anamnesis y examen físico, con el conocimiento adecuado de la anatomía uroginecológica, y, en muchos casos, estudios de imágenes y exámenes complementarios, para arribar al diagnóstico. Se presenta el caso de una niña de 7 años con sangrado genital, cuyo examen físico y estudios complementarios fueron poco concluyentes, y que requirió un procedimiento invasivo para su resolución. (AU)

Genital bleeding in prepubertal girls is a rare sign and always requires determining its cause. A detailed history and physical examination are needed, with adequate knowledge of urogynecological anatomy, and in many cases, imaging studies and complementary tests, to arrive at the diagnosis. We present the case of a 7-year-old girl with genital bleeding, whose physical examination and complementary studies were inconclusive, requiring an invasive procedure for its resolution. (AU)

Chikungunya associated vulvitis: case report and literature review / Vulvite associada a Chikungunya: relato de caso e revisão de literatura

Introduction: Chikungunya virus is spreading worldwide due to migration and globalization and could be presented with systemic and with unusual symptoms. Objective: To report a case of virus-transmitted infection detected in a woman during the gynecological examination at a vulvar clinic. Case report: A 73-year-old Caucasian woman attended a vulvar clinic because of dyspareunia and vulvar burning. Ulcers were observed on labia minora and perineum. A Chikungunya was diagnosed by seroconversion in paired specimens. She was prescribed prednisolone 40 mg once a day for 10 days. After oral steroid treatment, the woman had no body rashes or lesions on her genitals. Conclusion: This study emphasized that rare signs of unusual vulvitis with ulcers could be associated with Chikungunya infection.

Introdução: O vírus Chikungunya está se espalhando pelo mundo por conta da migração e da globalização, podendo apresentar sintomas sistêmicos e incomuns. Objetivo: Relatar um caso de infecção pelo vírus detectado em uma mulher por ocasião do exame ginecológico em clínica de patologia vulvar. Relato do caso: Uma mulher caucasiana de 73 anos foi a uma clínica vulvar por causa de dispareunia e queimação vulvar. Úlceras foram observadas nos pequenos lábios e no períneo. O diagnóstico de Chikungunya foi realizado por soroconversão em espécimes pareados. Foi prescrita prednisolona 40 mg uma vez ao dia por dez dias. Após o tratamento com esteróides orais, a mulher não apresentou erupções ou lesões nos órgãos genitais. Conclusão: Este estudo enfatizou que quadros raros de vulvite com úlcera podem estar associados à infecção por Chikungunya.

Análisis del uso de las técnicas de tamizaje para la detección de cáncer cervicouterino en Chile / Analysis of the use of screening techniques for the detection of cervical cancer in Chile

El Cáncer Cervicouterino es una de las principales problemáticas en salud de las mujeres a nivel mundial. Las técnicas de tamizaje para la detección de Cáncer Cervicouterino han ido desarrollándose a través de la historia reciente tanto intencionada como casualmente, incorporando con cada nuevo descubrimiento a las nuevas tecnologías. Actualmente existen diversos procedimientos vigentes que van desde pruebas sencillas de inspección visual, pasando por las tradicionales muestras citológicas, hasta la utilización de tecnología molecular, y los usos que se les dan a estos métodos de cribado potencian la detección temprana del Cáncer Cervicouterino, razón por lo cual se realiza una revisión respecto de las técnicas de tamizajes disponibles y su aplicación en Chile.

Cervical Cancer is one of the main problems in women's health worldwide. Screening techniques for the detection of Cervical Cancer have been developed throughout recent history both intentionally and incidentally, incorporating new technologies with each new discovery. Currently there are various procedures in force that range from simple visual inspection tests, through traditional cytological samples, to the use of molecular technology, and the uses that are given to these screening methods enhance the early detection of Cervical Cancer, which is why which is carried out a review regarding the available screening techniques and their application in Chile.

Desigualdades regionais e sociais na realização de mamografia e exame citopatológico nas capitais brasileiras em 2019: estudo transversal / Desigualdades regionales y sociales en la realización de mamografías y exámenes citopatológicos en las capitales brasileñas en 2019: un estudio transversal / Regional and social inequalities in mammography and Papanicolaou tests in Brazilian state capitals in 2019: a cross-sectional study

Objetivo: Analisar desigualdades regionais e sociais na realização de mamografia e exame citopatológico. Métodos: Estudo transversal, com dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel), de 2019. As variáveis de desfecho foram realização de mamografia e exame citopatológico; e as variáveis de exposição, raça/cor da pele, escolaridade e macrorregião nacional de residência. Medidas de desigualdades absolutas foram apresentadas por meio do slope index of inequality (SII) e equiplots. Resultados: Foram incluídas 23.339 mulheres. A realização de mamografia foi 5,2 pontos percentuais maior naquelas com maior escolaridade, e de exame citopatológico, 5,3 pontos percentuais menor nas mulheres de raça/cor da pele preta. A realização de mamografia e exame citopatológico foram 3,9 e 11,2 pontos percentuais maiores na região Sul, respectivamente. Conclusão: Desigualdades sociais e regionais persistem no país e afetam, principalmente, mulheres de raça/cor da pele preta, de baixa escolaridade e residentes no Nordeste brasileiro.

Objetivo: Analizar las desigualdades regionales y sociales en la realización de mamografías y exámenes citopatológicos. Métodos: Estudio transversal con datos de la Vigilancia de Factores de Riesgo y Protección de Enfermedades crónicas por encuesta telefónica de 2019. Las variables de resultado fueron mamografía y examen citopatológico. Las variables de exposición fueron raza/color de piel, nivel de educación y macrorregión nacional de residencia. Las desigualdades absolutas se presentaron utilizando el slope index of inequality y el equiplots. Resultados: Se estudiaron 23.339 mujeres. La realización de mamografía fue 5,2 puntos porcentuales más alta en las mujeres con educación superior y la citopatología fue 5,3 puntos porcentuales más baja en mujeres de raza /piel negra. La mamografía y la citopatología fueron 3,9 y 11,2 puntos porcentuales más altos, respectivamente, en la Región Sur. Conclusión: Las desigualdades sociales y regionales persisten en Brasil y afectan principalmente a mujeres de piel negra, con baja escolaridad y residentes en la región Nordeste del país.

Objective: To assess regional and social inequalities in mammography and Papanicolaou tests. Methods: This was a cross-sectional study with data from the 2019 Chronic Disease Risk and Protective Factors Surveillance Telephone Survey (Vigitel). The outcome variables were mammography and cytopathology test. The exposure variables were race/skin color, schooling and region of residence in Brazil. Absolute inequality measurements were presented using the slope index of inequality (SII) and equiplots. Results: 23,339 women were included in this study. Having a mammography was 5.2 percentage points higher in women with higher levels of education, while having a cytopathology test was 5.3 percentage points lower in women of Black race/skin color. Having mammography and cytopathology tests was 3.9 and 11.2 percentage points higher, respectively, in the Southern region. Conclusion: Social and regional inequalities persist in Brazil and affect mainly women of Black race/skin color, with low education levels and living in the Northeast region of the country.

Simulation-based training for pelvic and breast physical examination: Effect on the anxiety and self-confidence of medical students / Treinamento baseado em simulação para exame físico pélvico e de mamas: Efeito na ansiedade e autoconfiança dos estudantes de medicina

Abstract Objective: To evaluate factors associated with anxiety and the effect of simulation-based training (SBT) on student anxiety, self-confidence and learning satisfaction in relation to pelvic and breast examination. Methods: A longitudinal study was conducted with 4th year medical students at the Universidade José do Rosário Vellano. A 12-item, self-report questionnaire on student anxiety at performing gynecological examinations was applied before and after SBT, with answers being given on a Likert-type scale. After training, the self-confidence levels and satisfaction of the students related to the learning process were also evaluated. Results: Eighty students with a mean age of 24.1 ± 4.2 years were included in the study. Of these, 62.5% were women. Pre-SBT evaluation showed that students were more anxious at performing a pelvic examination than a breast examination (2.4 ± 1.0 versus 1.7 ± 0.8, respectively; p < 0.001). The primary reason for anxiety regarding both pelvic and breast examination was fear of hurting the patient. SBT significantly reduced student anxiety (2.0 ± 0.8 versus 1.5 ± 0.5, respectively; p < 0.001). The satisfaction and self-confidence of the students were found to be high (6.8 ± 0.3 and 6.0 ± 0.9, respectively), with no difference between genders. Conclusion: The use of SBT in teaching students to perform pelvic and breast examinations resulted in reduced anxiety and increased self-confidence in a group of medical students of both genders, with high levels of satisfaction in relation to the training.

Resumo Objetivo: Avaliar os fatores relacionados à ansiedade e ao efeito do treinamento baseado em simulação (TBS) na ansiedade, autoconfiança e satisfação do estudante em relação ao aprendizado do exame pélvico e de mamas. Métodos: Estudo longitudinal com alunos do quarto ano de medicina da Universidade José do Rosário Vellano, utilizando questionário autorrespondido com 12 itens em escala tipo Likert sobre a ansiedade em relação ao exame ginecológico, pré e pós-TBS. Após o treinamento, avaliou-se também o grau de autoconfiança e satisfação com o processo de aprendizado. Resultados: Foram incluídos 80 alunos com média etária de 24,1 ± 4,2 anos, dos quais 62,5% eram mulheres. Na avaliação pré-treinamento, a ansiedade dos alunos em relação ao exame pélvico foi maior do que a ansiedade em relação ao exame das mamas (2,4 ± 1,0 versus 1,7 ± 0,8, respectivamente; p < 0,001). O principal motivo de ansiedade em relação tanto ao exame pélvico quanto ao de mamas foi o receio de machucar a paciente. O TBS reduziu significativamente a ansiedade dos alunos (2,0 ± 0,8 versus 1,5 ± 0,5, respectivamente; p < 0,001). A satisfação e autoconfiança dos estudantes foram elevadas (6,8 ± 0,3 e 6,0 ± 0,9, respectivamente), sem diferença entre gêneros. Conclusão: O uso de TBS no ensino de exame pélvico e mamário resultou em uma diminuição na ansiedade e elevada autoconfiança em um grupo de estudantes de medicina, de ambos os gêneros, e bons níveis de satisfação em relação ao treinamento.

Cervical cancer prevention in Pernambuco: improvements for whom? Inequity scenario in the state of the Northeast Region / Prevenção do câncer do colo do útero: avanços para quem? Um retrato da iniquidade em estado da Região Nordeste

Abstract Objectives: to analyze the access to cervical cancer preventive examination in Pernambuco between 2002 and 2015 by cytopathological exam coverage. Methods: public data from SUS Computer Department were used, then processed by Tabnet and Excel and calculated the slope of the over time coefficient trend by simple regression techniques. Afterwards, they were plotted in thematic maps covering cytopathological exams on Terraview app 4.2.2. Results: Pernambuco State presented an increase of exam coverage trend in all the health regions until 2010. Since that year it started to have stabilization and decreased the tendency. Comparing the coverage of the two first years, in 2002, 42.7% of the cities coverage was below 0.2 and in 2015 the scenario changed, 41.1% of the cities coverage was above 0.6. We emphasize that even in that same year 13.5% of the cities still had a low or too low coverage (less than 0.4). The over time trends in increase and decline were strongly meaningful. Conclusions: this study revealed that all health regions presented a coverage lower than recommended, in some period or in all of them, even with the State growth tendency it demonstrated an unequal and heterogeneous characteristic.

Resumo Objetivos: analisar o acesso ao exame preventivo para o câncer de colo do útero em Pernambuco, entre 2002 e 2015, por meio da cobertura do citopatológico. Métodos: foram utilizados dados de domínio público do Departamento de Informática do SUS, processados no Tabnet e Excel® e calculados os coeficientes de inclinação de tendência temporal, por meio de técnicas de regressão simples. Por fim, foram plotados em mapas temáticos de cobertura de exames citopatológicos no aplicativo Terraview 4.2.2. Resultados: Pernambuco apresentou aumento na tendência de cobertura ao exame para todas as regiões de saúde até 2010. A partir deste ano, apresentou uma tendência de estabilização e diminuição. Ao comparar a cobertura no primeiro e no último ano, em 2002 42,7% dos municípios estavam com cobertura abaixo de 0.2 e em 2015 o cenário muda para 41,1% de municípios com cobertura acima 0.6. Destaca-se que neste mesmo ano 13,5% dos municípios ainda apresentavam uma cobertura baixa e muito baixa (<0.4). Tendências temporais de crescimento e decréscimo tiveram forte significância. Conclusões: todas as regiões de saúde apresentaram cobertura inferior ao preconizado, em algum período ou em todos, mesmo com a tendência estadual de crescimento, demonstrando uma característica heterogênea e desigual.

Mitos y creencias del cuidado e higiene íntima en mujeres peruanas jóvenes / Myths and beliefs of intimate care and hygiene in young peruvian women

Introducción: Muchas veces se propagan mitos y creencias sobre la higiene íntima femenina, que podrían traer consecuencias en muchos aspectos. Objetivo: Determinar la asociación entre los mitos y creencias del cuidado e higiene íntima y los cuidados reales de higiene íntima en mujeres peruanas jóvenes. Método: Se realizó un estudio transversal analítico, que presentó una revisión del tema para realizar una encuesta de 21 interrogantes, en temas comunes en la higiene íntima, post piloto, se preguntó de su realización y la frecuencia semanal; esta última se asoció a variables socio-educativas. Resultados: De las 600 mujeres jóvenes encuestadas, hubo diferencia en cuanto la edad según la percepción del uso de ropa interior de algodón (p=0,013), la limpieza de la zona íntima de adelante hacia atrás (p<0,001), el uso de ropa interior no muy ajustada (p<0,001), el uso de ropa sintética (p=0,045), el uso de jabón exclusivo para la zona íntima (p<0,001), la edad de inicio de relaciones sexuales (p=0,031) y el uso de métodos anticonceptivos como causantes de flujo (p=0,008). En cuanto al ser o no estudiantes, hubo diferencia en la percepción de que el rasurado del pubis para la limpieza (p=0,018) y que los ejercicios de relajación disminuyen el flujo vaginal (p=0,030). Conclusiones: Se describió algunos mitos y creencias en cuanto a la limpieza íntima; a su vez, se encontró que algunas prácticas de higiene tienen asociación con la edad y el ser estudiante. Esto debe ser estudiado a profundidad, ya que, esto podría llevar a problemas mayores.

Introduction: Myths and beliefs about female intimate hygiene are often spread, which could have consequences in many aspects. Objective: To determine the association between the myths and beliefs of intimate care and hygiene and the actual care of intimate hygiene in young Peruvian women. Method: An analytical cross-sectional study was conducted, which exposed a review of the topic to conduct a survey of 21 questions on common issues in intimate hygiene, post pilot, asked about its performance and weekly frequency; The latter was associated with socio-educational variables. Results: Of the 600 young women surveyed, there was a difference regarding age according to the perception of the use of cotton underwear (p = 0.013), the cleaning of the intimate area from front to back (p <0.001), the use of underwear not very tight (p <0.001), the use of synthetic clothing (p = 0.045), the use of exclusive soap for the intimate area (p <0.001), the age of onset of sexual intercourse (p = 0.031) and the use of contraceptive methods as causing flow (p = 0.008). Regarding whether or not they were students, there was a difference in the perception that shaving the pubis for cleaning (p = 0.018) and that relaxation exercises decrease vaginal discharge (p = 0.030). Conclusions: Some myths and beliefs regarding intimate cleansing were described; In turn, some hygiene practices were found to be associated with age and being a student. This should be studied in depth, as this could lead to bigger problems.

Conhecimento e adesão ao Papanicolau de mulheres de uma rede de Atenção Primária à Saúde / Knowledge and adherence to the Papanicolau of women from a primary health care network

Objetivo Analisar o conhecimento e a adesão ao Papanicolau de mulheres que frequentam Unidades Básicas de Saúde. Métodos Um questionário composto de questões pré-codifi cadas e abertas foi aplicado às usuárias de duas Unidades Básicas de Saúde da cidade de São José do Rio Preto, São Paulo, localizadas em bairros com perfi l socioeconômico distinto. Os dados foram analisados estatisticamente pelo programa Statistical Package for the Social Sciences.Resultados Após a análise de 99 questionários respondidos, ficou evidente um nível de conhecimento melhor sobre o exame de Papanicolau das residentes do bairro com melhores condições socioeconômicas e das mulheres mais jovens. Ficou evidente que muitas fazem esse exame sem saber o devido objetivo desse procedimento. A vergonha e a falta de tempo foram relatadas como motivos relevantes para não realizar o exame. Conclusão A falta de informação sobre o exame de Papanicolau das mulheres com mais de 60 anos e menor nível socioeconômico ficou evidente neste estudo e pode ser considerada um dos aspectos mais relevantes à não adesão à prevenção do câncer do colo de útero. Dessa maneira, ações de saúde alternativas deveriam ser adotadas pelas Unidades Básicas de Saúde para melhor orientar a população e, assim, aumentar a adesão a esse exame.

Objective To analyze the knowledge and adhesion to the Papanicolaou smear test of women attending Basic Health Units. Methods A questionnaire composed of pre-coded and open questions was applied to users of two Basic Health Units of the city of São José do Rio Preto, São Paulo, located in districts with different socioeconomic profiles. The data were statistically analyzed by the Statistical Package for the Social Sciences program. Results After the analysis of 99 questionnaires answered, a better level of knowledge about the Pap smear was found among the residents of the better socioeconomic neighborhood and the younger women. It has become evident that many take this test without knowing the proper purpose of this procedure. Shame and lack of time were reported as relevant reasons for not doing the test. Conclusion The lack of information on the Papanicolaou smear of women over 60 years of age and lower socioeconomic level was evident in this study and may be considered one of the most relevant aspects to non-adherence to cervical cancer prevention. In this way, alternative health actions should be adopted by the Basic Health Units to better guide the population and thus increase adherence to this examination.

Conversas entre mulheres durante o exame citopatológico / Conversations between women during cytopathological exam

Resumo Este artigo aborda conversas entre enfermeiras e mulheres, durante consultas ginecológicas para realização de exame citopatológico. Trata-se de estudo qualitativo que analisou as conversas produzidas durante consultas realizadas em três serviços de atenção básica de saúde de um município do Sul do Brasil. A análise das conversas entre enfermeiras e mulheres usuárias dos serviços foi pautada na perspectiva teórico-metodológica da fala-em-interação, abordagem em que as categorias não são definidas a priori, mas emergem a partir das interações entre os falantes. Os fenômenos interacionais de interesse são analisados a partir de excertos de conversas entre três enfermeiras e sete das 26 mulheres que buscaram os serviços de atenção básica em saúde, transcritas segundo as convenções adotadas por analistas da conversa. Por meio de análise das categorias de pertença, observou-se que nas conversas as mulheres se identificam de acordo com os papéis tradicionais de mãe e esposa. Enfermeiras e usuárias compartilham a ideia de que a sexualidade dos homens, pautada no biológico, é irrefreável, e acreditam que devem cumprir as obrigações matrimoniais de esposas, atendendo à necessidade sexual dos maridos, mesmo quando sentem desconforto e dor. Os achados desta pesquisa podem auxiliar os profissionais da saúde a refletirem criticamente acerca das interações conversacionais com as usuárias de serviços de saúde.

Abstract This article is about conversations between nurses and women, during gynecological consultations for cytopathological examination. This is a qualitative study that analyzed the conversations made during consultations carried out in three primary health care services of a municipality in the southern Brazil. The analysis of the conversations between nurses and women users of services was based on the theoretical-methodological perspective of speech in interaction, an approach in which the categories are not defined a priori, but they emerge from the interactions among the speakers. The interactional phenomena of interest are analyzed in excerpts from conversations between three nurses and seven of the 26 women who sought primary health care services, transcribed according to the conventions adopted by conversation analysts. Through the membership categorization analysis, one observed in the conversations women identify themselves with the traditional roles of mothers and wives. Nurses and users share the idea that men's sexuality, based on the biological aspect, is unstoppable and believe they must fulfill spousal obligations, meeting the husbands' sexual needs, even when they feel discomfort and pain. The findings of this study may help health professionals to reflect critically on their conversational interactions with health service users.

Atendendo a adolescente no consultório de ginecologia / Assisting the teenager in the gynecology office

A presença de pacientes adolescentes tem sido uma situação cada vez mais frequente para os ginecologistas. Dentre os motivos de consulta, destacam-se a avaliação do desenvolvimento da puberdade, distúrbios do ciclo menstrual, corrimento e o desejo de contracepção. Obter a confiança da adolescente é um dos maiores desafios para o profissional que atende uma paciente adolescente, tanto pelos aspectos biopsicossociais como também pelas questões éticas e legais que estão envolvidas na consulta. Embora a consulta ginecológica da adolescente tenha diversos pontos em comum com a da mulher adulta, os aspectos relacionados à sexualidade devem ser indagados com cautela, pois, na maioria das vezes, a adolescente está acompanhada e nem sempre compartilha sua prática sexual com seus familiares. A empatia mútua poderá beneficiar a adolescente, garantindo um momento propício para a abordagem dos cuidados relacionados aos aspectos da sua saúde sexual e reprodutiva.(AU)

The first case of vaginal angiomatoid Spitz nevus causing vaginal bleeding

Angiomatoid Spitz nevus is a variant of melanocytic nevus with prominent vasculature. Due to its pathologic features, angiomatoid Spitz nevus in the vaginal wall is extremely rare. A 42-year-old woman presented to the hospital with abnormal vaginal bleeding. Vaginal examination revealed a 2×2-cm well-demarcated tumor on the posterior wall of the vagina. The mass was successfully removed by complete excision and was diagnosed as angiomatoid Spitz nevus on pathologic examination. We present the first reported case of vaginal angiomatoid Spitz nevus, which caused vaginal bleeding. Although angiomatoid Spitz nevus has many histopathological similarities with malignant melanoma, precise histopathological diagnosis is important for preventing overtreatment.

Clinical presentation and management outcome of emergency adolescent gynecological disorders at federal teaching hospital, abakaliki, Nigeria

Background: Gynecological emergencies which affect the adolescents may pose a serious challenge to both the patient and the gynecologist. Objectives: The objective of this study is to determine the clinical presentations and management outcomes of emergency adolescent gynecological disorders at Federal Teaching Hospital, Abakaliki. Materials and Methods: This is a retrospective review of all cases of adolescent gynecological emergencies managed at Federal Teaching Hospital Abakaliki between January 1, 2012, and December 31, 2014. Data obtained from their case notes were analyzed using the IBM statistics version 20 (IBM Corp., Armonk, NY, USA). Data were presented using percentages and pie chart. Results: The prevalence of adolescent gynecological emergency disorders was 5.1%. The majority (82%) of the patients belong to the age bracket 15­19 with a mean age of 16.7 (2.4) years. About 90% of the patients were nulliparous. Unmarried patients comprised 80% of the study group. Vaginal bleeding was the most common clinical presentation (86%). The two most common diagnoses were abortion (60%) and sexual assault (26%). Only 10% of sexually active adolescent were using any form of contraception. Care received includes manual vaccum aspiration, laparotomy, and antibiotics. Blood transfusion was given in 18% of the cases. No death was recorded in all the cases. Conclusion: Abortive conditions and sexual assault were the most common clinical diagnosis among adolescents in the study. The percentage of adolescent assaulted in our study is unacceptable and should be prevented and efforts should be made to reduce the high unmet need for contraception seen in the study