Exame físico em ginecologia / Physical examination in gynecology

O exame físico na prática ginecológica diuturna é o sustentáculo de uma perspectiva diagnóstica com vistas a uma abordagem individualizada, oportuna e humanizada da paciente. Lança mão de técnica semiótica clássica, inicialmente, após avaliação de sinais vitais, minuciosa inspeção ectoscópica, seguida de exame físico especial. E deverá ser realizado em ambiente adequadíssimo, sem nenhuma improvisação e ou adaptações não compatíveis, com a importância e a segurança garantidas por um exame físico de boa qualidade. O exame físico de mamas tem como objetivo primordial a identificação de nódulos mamários e, eventualmente, de tumores localmente avançados; e relativa tranquilidade é assegurada às pacientes quando ele é considerado normal. O exame físico vulvar permite a identificação de prolapso de órgãos pélvicos, neoplasia intraepitelial e/ou invasiva vulvar e distúrbios de desenvolvimento sexual, além de oferecer subsídios para a propedêutica da vulvodínea, sendo, principalmente, uma oportunidade para o diagnóstico em dermatologia vulvar, mesmo a vulva correspondendo a apenas 1% da pele feminina. O exame especular, um clássico da ginecologia, é indispensável para a triagem do câncer de colo uterino. Por fim, o toque genital, a despeito de sua subjetividade, permite a avaliação dos órgãos genitais internos.

Physical examination in daytime gynecological practice is the mainstay of a diagnostic perspective with a view to an individualized, timely and humanized approach to the patient; resorting to the classical semiotic technique, initially, after assessing vital signs, a thorough ectoscopic inspection, followed by a special physical examination; which should be carried out in a very suitable environment, without any improvisation or adaptations that are not compatible with the importance and safety guaranteed by a good quality physical examination. The primary objective of the physical examination of the breasts is to identify breast nodules and possibly locally advanced tumors; in addition to relative tranquility, assured to patients, when the respective exam is considered normal. Vulvar physical examination allows the identification of pelvic organ prolapse; vulvar intraepithelial and/or invasive neoplasia; sexual development disorders; in addition to offering subsidies for the propaedeutics of vulvodynia; and, above all, it is an opportunity for diagnosis in vulvar dermatology, even though the vulva accounts for only 1% of female skin. Specular examination, a classic in gynecology, is essential for screening for cervical cancer. Finally, the genital touch which, despite its subjectivity, allows the evaluation of the internal genital organs.

Caracterización clínica de las disfunciones de piso pélvico en mujeres chilenas sintomáticas que consultan en un hospital universitario / Clinical characterization of pelvic floor dysfunctions in symptomatic Chilean women who visit an academic hospital

INTRODUCCIÓN: La prevalencia de las disfunciones de piso pélvico (DPP) puede llegar hasta un 25%, y esta incrementando con los años. El objetivo de este estudio es mostrar las características clínicas de pacientes sintomáticas sometidas a cistometría simple en el Hospital La Florida, entre diciembre del 2015 y marzo 2020. MÉTODOS: Es un estudio retrospectivo transversal. Se evaluaron los datos de todos los resultados de cistometrías simples de pacientes derivadas por sintomatología de piso pélvico entre los años 2015 y 2020. RESULTADOS: Se evaluaron 1.211 cistometrías simples. El motivo de derivación más frecuente fue prolapso de órganos pélvicos + incontinencia de orina (IO) (39.6%). 13.5% tuvieron resultado normal. 58% presentó test de esfuerzo positivo. 22.5% tenían prueba de estrés con vejiga vacía positiva. 17.6% presentó IO oculta. 21.9% de IO mixta. De las pacientes derivadas por vejiga hiperactiva o IO mixta, en el 14.2% se constató la presencia de contracciones no inhibidas y en el 34.8% la presencia de urgencia. CONCLUSIONES: Nuestro estudio aporta información sobre las DPP en la mujer chilena en un hospital universitario.

INTRODUCTION: Prevalence of pelvic floor dysfunctions (PFD) can be as high as 25%, and it is increasing over the years. The objective if this study is to show the clinical characteristics of symptomatic patients undergoing simple cystometry at La Florida Hospital, between December 2015 and March 2020. METHODS: This is a cross-sectional study. The data of all simple cystometries of patients derived for pelvic floor symptoms between 2015 and 2020 were evaluated. RESULTS: 1211 simple cystometries were evaluated. The most frequent reason for referral was pelvic organ prolapse + urinary incontinence (UI) (39.6%). 13.% had a normal result. 58% presented positive stress test. 22.% had a positive empty stress test. 17.6% had occult UI. 21.9% mixed UI. Of the patients referred by overactive bladder or mixed UI, 12.2% had detrusor contractions and 34.8% had urgency. CONCLUSIONS: Our study provides information on PFD in Chilean women in a university hospital. .

Conocimiento y cuidados de la mujer para la prevención de prolapso de órganos pelvicos / Knowledge and care of women for the prevention of pelvic organ prolapse

Las disfunciones del piso pélvico tienen unaelevada incidencia en la población femenina,dentrodeestassedestacanlospro-lapsos uterinos, de la cúpula vaginal, entero-cele, cistóceles, retóceles, la incontinencia uri-nariaylafecal.Seestimaquedel3%al6%de la población femenina desarrollará alguna de estas disfunciones en algún momento de sus vidas. Objetivo: Determinar los conocimientos y cuidados que tienen las mujeres en etapa reproductiva y no reproductiva para prevenir prolapsos de órganos pélvicos en el Centro de Salud Miguel Paz Barahona (CSMPB) de San Pedro Sula en el primer semestre del año 2018. Pacientes y métodos: Estudio cuantita-tivo, transversal, descriptivo, instrumento tipo cuestionario aplicado a mujeres en etapa re-productivaynoreproductivaenelCSMPB,du-rante el primer semestre del año 2018. Pobla-ción 1766, muestra probabilística 316mujeres. Resultados: El 55% de la población tenían en-tre20-35añosdeedad,58%norealizabaejer-cicio físico, más de 90% desconocían sobre el prolapso de órganos pélvicos y sus cuidados, 19.2%presentósignosysíntomasdeprolapso de órganos pélvicos. Conclusión: Los resul-tados señalan que la mayoría mujeres tienen poco conocimiento sobre el prolapso de órga-nospélvicosyunporcentajepresentósintoma-tología, por lo tanto, no realizan cuidados para prevenir algún tipo de prolapso en el trascurso de suvida...(AU)

Biochemical evaluation of the supporting structure of pelvic organs in selected numbers of premenopausal and postmenopausal Malaysian women.

Context: Pelvic organ prolapse (POP) is associated with menopause and changes in the proteins of the pelvic supporting system, but there is scant data on the precise alterations in Malaysian women. Aim: The aim of this study is to determine the differences in the extracellular matrices (ECM) of uterosacral ligaments in premenopausal and postmenopausal Malaysian women with or without POP. Settings and Design: The observational study was conducted for 9 months in three general hospitals involving 30 women who underwent hysterectomies for various indications except for carcinoma of pelvic organs. Materials and Methods: Three groups were identified: Premenopausal women (Group 1), postmenopausal women without POP (Group 2), and postmenopausal women with POP (Group 3). Age, duration of menopause, body mass index (BMI), parity, and vaginal deliveries were documented. Only 21 samples of the uterosacral ligaments were stained immunohistochemically for collagen I and III, matrix metalloproteinases (MMPs) 1 and 2, elastin, and tenascin. Statistical Analysis Used: Image J software analysis was utilized for quantification, while non-parametric statistics (Kruskal-Wallis with post-hoc Dunns Multiple Comparison test) was used for result analysis. Results: The profile parameters were not significantly different except for mean age and duration of menopause in Group 3. Samples from Group 2 showed lower expression of almost all proteins except MMP1 and tenascin (higher) as compared to Group 1. The changes appeared to be exaggerated in Group 3, though statistically insignificant. Conclusion: A significant difference in the expression of ECM was apparent in postmenopausal subjects as compared to premenopausal ( P = 0.05), compromising the uterosacral ligament tensile strength. The findings are proven similar as those changes in women from other studies.

Prolapso genital / Genital prolapse

O prolapso genital é condição comum. Ocorre por fraqueza ou defeitos nos órgãos pélvicos de suspensão, que são constituídos de ligamentos, e/ou aqueles de sustentação, constituídos por fáscias e músculos. Sua avaliação constitui uma etapa importante do exame ginecológico, devendo, sempre que possível, ser classificado o grau de prolapso por meio de métodos padronizados. Atualmente, a quantificação é realizada por meio do POP-Q, preconizada pela Sociedade Internacional de Continência (ICS). Embora não seja uma afecção fatal, pode determinar sequelas importantes para a saúde da mulher, comprometendo sua qualidade de vida. Seu diagnóstico precoce previne o estágio final da doença. O tratamento pode ser conservador ou cirúrgico, dependendo do grau do prolapso, idade e estado clínico da paciente.

The pelvic prolapse is a common condition. It's occurs because of weakness or defects in the suspension pelvic organs - consisting of ligaments, and/or those of support, which consist of fascias and muscles. It's assessment is an important phase of the gynecological exam and, whenever possible, the degree of prolapse should be identified by means of standard methods. Currently the measurement is performed using POP-Q, as recommended by the International Continence Society (ICS). Although the disease is not considered fatal, it can determine serious sequela for women's health, affecting their quality of life. It's early diagnosis prevents the final stage of the disease. Treatment can be conservative or surgical depending on the degree of prolapse, and the patient age and medical condition.