Características clínicas, diagnóstico e tratamento de mulher com síndrome de Meigs: relato de caso e revisão narrativa / Clinical characteristics, diagnosis and treatment of a woman with Meigs syndrome: case report and narrative review

O objetivo deste estudo é descrever o caso de mulher com síndrome de Meigs e apresentar a revisão narrativa sobre o tema. Paciente do sexo feminino, 30 anos, nulípara, encaminhada ao hospital por massa anexial e história prévia de drenagem de derrame pleural. Evoluiu com instabilidade hemodinâmica por derrame pleural hipertensivo à direita, sendo submetida a drenagem torácica, com citologia do líquido negativa. Após, foi submetida a laparotomia: realizada salpingo-ooforectomia esquerda. A congelação e a análise histopatológica diagnosticaram fibroma ovariano. A citologia ascítica foi negativa. CA-125 elevado, presença de derrames cavitários e exame de imagem suspeito podem mimetizar um cenário de neoplasia maligna de ovário em estágio avançado. Entretanto, na síndrome de Meigs clássica, o tratamento é cirúrgico, sendo o diagnóstico obtido por meio da análise histopatológica do tumor ovariano. O manejo da síndrome de Meigs clássica é cirúrgico e, após a remoção do tumor, o derrame pleural e a ascite desaparecem.

To describe a case of Meigs syndrome and present a narrative review of the condition. Female patient, 30 years old, nulliparous, referred to the hospital due to an adnexal mass and a previous drainage of pleural effusion. She developed hemodynamic instability due to a hypertensive right pleural effusion being submitted to chest drainage, with negative cytology of the fluid. She underwent laparotomy: Left salpingo-oophorectomy was performed and frozen section and histopathological analysis diagnosed an ovarian fibroma. Ascites cytology was negative. Elevated CA-125, presence of cavitary effusions, suspicious imaging exam can mimic a scenario of ovarian cancer at an advanced stage. However, in classical Meigs syndrome, treatment is surgical, and the diagnosis is obtained through histopathological analysis of the ovarian tumor. Classical Meigs syndrome' management is surgical. After tumor removal, pleural effusion and ascites resolve.

Manejo del Síndrome de Hiperestimulación Ovárica / Management of Ovarian Hyperstimulation Syndrome

INTRODUCCIÓN: El síndrome de hiperestimulación ovárica es una respuesta exagerada del ovario a los tratamientos hormonales para estimular la formación de óvulos. OBJETIVO: Describir el caso clínico de una mujer con síndrome de hiperestimulación ovárica; revisar el abordaje, manejo, tratamiento y cómo prevenirlo. CASO CLÍNICO: Paciente femenina de 37 años, multigesta, en tratamiento con metformina por Síndrome de ovario poliquístico , que presenta infertilidad secundaria a factor tubárico, que desarrolló un cuadro moderado de síndrome de hiperestimulación ovárica como consecuencia de la aplicación de las técnicas de fertilización in vitro (Folitropina alfa humana recombinante (GONAL-F®) y Cetrolerelix (CETROTIDE®); al cuarto día del procedimiento de aspiración folicular presenta dolor pélvico intenso, disuria, deposiciones diarreicas, ecografía abdominal y vaginal evidencia líquido libre en cavidad alrededor de 1000cc, además de ovarios tanto derecho e izquierdo con volumen de 102 mL y 189 mL respectivamente. Paciente es ingresada para realizar tratamiento hidratación parenteral, Enoxaparina 40mg subcutánea, Cabergolina 0.5mg vía oral, alta a las 72 horas. DISCUSIÓN: Las claves para la prevención del síndrome de hiperestimulación ovárica son la experiencia con la terapia de inducción de la ovulación y el reconocimiento de los factores de riesgo para el síndrome de hiperestimulación ovárica. Los regímenes de inducción de la ovulación deberían ser altamente individualizados, monitorizados cuidadosamente y usando dosis y duración mínimas del tratamiento con gonadotropinas para conseguir la meta terapéutica. CONCLUSIONES: El síndrome de hiperestimulación ovárica constituye la complicación más temida durante el uso de inductores de la ovulación; el conocimiento de factores de riesgo, puede prevenir o evitar que llegue a ser de un caso severo, lo cual puede causar mayor morbilidad o hasta mortalidad. La vitrificación se convierte en la técnica que permite prevenir el síndrome de hiperestimulación ovárica, junto con esta técnica hay 2 alternativas: la inducción con análogo de la hormona liberadora de gonadotropina o el uso de agonistas dopaminérgicos.

INTRODUCTION: Ovarian hyperstimulation syndrome is an exaggerated response of the ovary to hormonal treatments to stimulate egg formation. OBJECTIVE: To describe the clinical case of a woman with ovarian hyperstimulation syndrome; to review the approach, management, treatment and how to prevent it. CLINICAL CASE: 37-year-old female patient, multigestation, under treatment with metformin for polycystic ovary syndrome, presenting infertility secondary to tubal factor, who developed a moderate picture of ovarian hyperstimulation syndrome as a consequence of the application of in vitro fertilization techniques (recombinant human follitropin alfa (GONAL-F®) and Cetrolerelix (CETROTIDE®); On the fourth day of the follicular aspiration procedure she presents intense pelvic pain, dysuria, diarrheic stools, abdominal and vaginal ultrasound shows free fluid in the cavity of about 1000cc, in addition to right and left ovaries with a volume of 102 mL and 189 mL respectively. Patient was admitted for parenteral hydration treatment, Enoxaparin 40mg subcutaneous, Cabergoline 0.5mg orally, discharged after 72 hours. DISCUSSION: The keys to prevention of ovarian hyperstimulation syndrome are experience with ovulation induction therapy and recognition of risk factors for ovarian hyperstimulation syndrome. Ovulation induction regimens should be highly individualized, carefully monitored, and using minimal doses and duration of gonadotropin therapy to achieve the therapeutic goal. CONCLUSIONS: Ovarian hyperstimulation syndrome constitutes the most feared complication during the use of ovulation inducers; knowledge of risk factors, may prevent or avoid it from becoming a severe case, which may cause increased morbidity or even mortality. Vitrification becomes the technique that allows preventing ovarian hyperstimulation syndrome, along with this technique there are 2 alternatives: induction with gonadotropin-releasing hormone analog or the use of dopaminergic agonists.

Evaluación clínica y manejo de la endometriosis: resumen de la orientación técnica MINSAL para el manejo de personas con endometriosis / Clinical evaluation and management of endometriosis: summary of the national ministry of health guidance for the management of people with endometriosis

La endometriosis es una de las enfermedades más comunes en las edades reproductivas y afecta la calidad de vida y la fertilidad de las pacientes. A la fecha, no existen guías clínicas nacionales disponibles para la evaluación y el manejo de esta patología. El presente corresponde a una síntesis del trabajo liderado por la Sociedad Chilena de Obstetricia y Ginecología y el Ministerio de Salud para la conformación de una Orientación Técnica que sirva a los profesionales de salud para el mejor manejo de las personas con esta dolencia. Esta revisión presenta pautas para el diagnóstico y el manejo de la endometriosis en el ciclo de vida de la persona, incluyendo la adolescencia y la menopausia, y en personas infértiles. De igual manera, da directrices para el manejo médico, terapias complementarias y tratamiento quirúrgico, junto con el seguimiento en el tiempo y la estructuración en red del manejo de las personas con endometriosis.

Endometriosis is one of the most common diseases in reproductive ages and affects the quality of life and fertility of patients. To date, there are no national clinical guidelines available for the evaluation and management of this pathology. This paper corresponds to a synthesis of af effort led by the Chilean Society of Obstetrics and Gynecology and the Ministry of Health to create a national Guideline that serves health professionals for the better management of people with this condition This review presents recommendations for the diagnosis and management of endometriosis in the life cycle of the person with endometriosis including adolescence, menopause and in infertile persons. Moreover, provides guidelines for medical management, complementary therapies and surgical management, along with monitoring over time and network structuring of the management of people with this disease.

Estrógeno potenciado en el tratamiento homeopático del dolor pélvico asociado a endometriosis: un estudio aleatorizado, doble ciego, controlado con placebo, de 24 semanas / Potentiated estrogen in the homeopathic treatment of pelvic pain associated with endometriosis: a 24-week randomized, double-blind, placebo-controlled study

Evaluar la eficacia y seguridad del estrógeno potenciado en comparación con el placebo en el tratamiento homeopático del dolor pélvico asociado a endometriosis (EAPP, por sus siglas en inglés). Diseño del estudio: El presente fue un estudio clínico aleatorizado, doble ciego, controlado con placebo, de 24 semanas, el cual incluyó a 50 mujeres de entre 18 y 45 años de edad con diagnóstico de endometriosis infiltrante profunda con base en ultrasonido transvaginal o imágenes de resonancia magnética después de preparación intestinal, así como puntaje ≥ 5 en una escala visual analógica (VAS: rango de 0 a 10 puntos) para el dolor pélvico asociado con la endometriosis. Se administró estrógeno potenciado (12cH, 18cH y 24cH) o placebo dos veces al día por vía oral. La medida principal de resultado fue el cambio en la severidad de los puntajes parcial y global de EAPP (VAS) de la línea basal a la semana 24, determinada como la diferencia en el puntaje medio de cinco modalidades de dolor pélvico crónico (dismenorrea, dispareunia profunda, dolor pélvico no cíclico, dolor intestinal cíclico y/o dolor urinario cíclico). Las medidas secundarias de resultado fueron la diferencia media de puntaje para la calidad de vida evaluada con el Cuestionario de Salud SF-36, los síntomas de depresión en el Inventario de la Depresión de Beck (BDI) y los síntomas de ansiedad en el Inventario de Ansiedad de Beck (BAI). Resultados: El puntaje global de EAPP (VAS: rango de 0 a 50 puntos) se redujo en 12.82 (p < 0.001) en el grupo tratado con estrógeno potenciado de la línea basal a la semana 24. El grupo que utilizó estrógeno potenciado también presentó una reducción en el puntaje parcial (VAS: rango de 0 a 10 puntos) en tres modalidades de EAPP: dismenorrea (3.28; p < 0.001), dolor pélvico no cíclico (2.71; p = 0.009) y dolor intestinal cíclico (3.40; p < 0.001). El grupo de placebo no mostró cambio significativo alguno en los puntajes global o parcial de EAPP. Además, el grupo de estrógeno potenciado mostró un mejoramiento significativo en tres de ocho ámbitos de SF-36 (dolor de cuerpo, vitalidad y salud mental) y síntomas de depresión (BDI). El grupo de placebo no mostró un mejoramiento significativo a este respecto. Estos resultados demuestran la superioridad del estrógeno potenciado sobre el placebo. Se asociaron pocos eventos adversos con el estrógeno potenciado. Conclusiones: El estrógeno potenciado (12cH, 18cH y 24cH) en dosis de 3 gotas dos veces al día durante 24 semanas fue significativamente más efectivo que el placebo para reducir el dolor pélvico asociado con la endometriosis. Registro del estudio clínico: ClinicalTrials.gov Identificador: https://clinicaltrials.gov/show/NCT02427386.

To evaluate the efficacy and safety of potentized estrogen compared to placebo in homeopathic treatment of endometriosis-associated pelvic pain (EAPP). Study design: The present was a 24-week, randomized, doubleblind, placebocontrolled trial that included 50 women aged 18-45 years old with diagnosis of deeply infiltrating endometriosis based on magnetic resonance imaging or transvaginal ultrasound after bowel preparation, and score ≥ 5 on a visual analogue scale (VAS: range 0 to 10 points) for endometriosis-associated pelvic pain. Potentized estrogen (12cH, 18cH and 24cH) or placebo was administered twice daily per oral route. The primary outcome measure was change in the severity of EAPP global and partial scores (VAS) from baseline to week 24, determined as the difference in the mean score of five modalities of chronic pelvic pain (dysmenorrhea, deep dyspareunia, non-cyclic pelvic pain, cyclic bowel pain and/or cyclic urinary pain). The secondary outcome measures were mean score difference for quality of life assessed with SF-36 Health Survey Questionnaire, depression symptoms on Beck Depression Inventory (BDI), and anxiety symptoms on Beck Anxiety Inventory (BAI). Results: The EAPP global score (VAS: range 0 to 50 points) decreased by 12.82 (p < 0.001) in the group treated with potentized estrogen from baseline to week 24. Group that used potentized estrogen also exhibited partial score (VAS: range 0 to 10 points) reduction in three EAPP modalities: dysmenorrhea (3.28; p < 0.001), non-cyclic pelvic pain (2.71; p = 0.009), and cyclic bowel pain (3.40; p < 0.001). Placebo group did not show any significant changes in EAPP global or partial scores. In addition, the potentized estrogen group showed significant improvement in three of eight SF-36 domains (bodily pain, vitality and mental health) and depression symptoms (BDI). Placebo group showed no significant improvement in this regard. These results demonstrate superiority of potentized estrogen over placebo. Few adverse events were associated with potentized estrogen. Conclusions: Potentized estrogen (12cH, 18cH and 24cH) at a dose of 3 drops twice daily for 24 weeks was significantly more effective than placebo for reducing endometriosis-associated pelvic pain.

Adaptation and Validation of the International Pelvic Pain Society's Quality of Life Questionnaire in Portuguese / Adaptação e validação do questionário de qualidade de vida da International Pelvic Pain Society em português

Abstract Objective In the present study, our aim was to translate, adapt, and validate the Pelvic Health History Form (a quality of life [QoL] questionnaire) of the International Pelvic Pain Society (IPPS) from English to Portuguese. Methods The study was approved by the Ethics and Research Committee (CEP, in the Portuguese acronym) and the IPPS. The "Transcultural Adaptation" method comprised 5 stages: translation, synthesis, backtranslation, expert review, and pretest. Cultural adaptation and validation included cognitive interviews and statistical analysis of unanswered items (> 15%) in 14 clinic patients from CPP and endometriosis clinic at Santa Casa de São Paulo. Results Strong equivalences were established between the USA and Brazil questionnaires in terms of semantics, idioms, experiences, and concepts. Eighteen culturally inappropriate items were identified and adjusted using the revised response rate index. The subjective form underwent rigorous assessments, confirming its accurate measurement of intended targets. Conclusion The methodology showed efficiency and equivalence, confirming its validity. The user-friendly format and inclusion of translated, adapted, and validated instruments in Portuguese make the form valuable for evaluating pelvic health, with potential for future research.

Resumo Objetivo Realizar a tradução, adaptação e validação do questionário de qualidade de vida Pelvic Health History Form da International Pelvic Pain Society (IPPS, na sigla em inglês) para a língua portuguesa. Métodos Aprovação do Comitê de Ética e Pesquisa (CEP) e consentimento do IPPS. A metodologia "Adaptação Transcultural" foi utilizada em cinco etapas: (I) tradução; (II) síntese; (III) retradução; (IV) revisão pelo comitê de especialistas; (V) pré-teste, seguido de adaptação cultural e validação por meio de entrevista cognitiva e análise estatística da taxa de ausência de respostas> 15% após aplicação do instrumento em 14 pacientes do ambulatório de DPC e endometriose da Santa Casa de São Paulo. Resultados Equivalências semântica, idiomática, experiencial e conceitual entre o questionário de país fonte (EUA) e alvo (Brasil) foram bem estabelecidas. Dezoito itens culturalmente impróprios, de acordo com o índice de ausência de respostas revisados, adaptados e realizada validade de face e de constructo, avaliando forma subjetiva, confiável que o instrumento mede o que pretende medir. Conclusão A metodologia utilizada foi eficiente, com boa equivalência com o material de origem concluindo a sua validade. Formulário de formato simples, fácil aplicação e compreensão, composto por diversos instrumentos já traduzidos, adaptados e validados em nossa língua. O formulário auxilia avaliação multidimensional da saúde pélvica destas pacientes e poderá ser utilizado em estudos futuros.

Dispareunia profunda 1 ano após cirurgia minimamente invasiva de endometriose / Deep dyspareunia 1 year after minimally invasive endometriosis surgery

A endometriose é uma doença crônica associada à dor pélvica e infertilidade, que afeta a vida das mulheres em diversos aspectos como as relações sociais, sexualidade e saúde mental. O tratamento cirúrgico pode auxiliar no tratamento de diferentes tipos de dores relacionadas à endometriose, mas as consequências do procedimento em mulheres que não apresentavam dor antes da cirurgia normalmente não são reportadas. Este estudo observacional multidisciplinar do tipo série de casos avaliou 195 casos consecutivos de mulheres sexualmente ativas que foram submetidas a cirurgia de endometriose para infertilidade ou dor persistente em uma instituição privada especializada em cirurgia minimamente invasiva. O objetivo do estudo foi avaliar as alterações na dispareunia profunda um ano após cirurgia minimamente invasiva para endometriose. De um total de 259 mulheres elegidas para o estudo, 195 atenderam aos critérios de inclusão/exclusão e completaram o acompanhamento clínico de 12 meses após a cirurgia. Usando uma escala verbal numérica (EVN) de 11 pontos (0-10), as mulheres foram agrupadas de acordo com a intensidade da dispareunia profunda relatada antes da cirurgia: AUSENTE (EVN = 0), LEVE (1 ≤ EVN ≤ 3), MODERADA (4 ≤ EVN ≤ 6), e INTENSA (EVN ≥ 7). Em uma análise inicial, houve melhora significativa após 1 ano e quase metade das mulheres com dispareunia profunda (NRS>0) tornou se livre deste sintoma (NRS=0). No grupo AUSENTE (N=87), 11 mulheres reportaram dispareunia profunda 6 meses após a cirurgia, mas apenas 1 persistiu com esse sintoma no seguimento de 1 ano, condição denominada Dispareunia Profunda De Novo. Nos grupos MODERADA (N=41) e INTENSA, a melhora da dispareunia profunda 12 meses após a cirurgia foi significativa (P<0,001). Com base nos resultados, o risco de uma mulher com dispareunia profunda intensa (EVN>7) ser beneficiada pela cirurgia com diminuição do escore ≥ 3 pontos é de 82,2% (IC95%: 72,4-92,0), enquanto o risco de uma mulher sem dispareunia profunda (EVN=0) permanecer sem este sintoma após a cirurgia é de 70,1% (IC95%: 60,3-79,2). Uma análise detalhada dos casos com desfechos desfavoráveis permitiu identificar que o desenvolvimento da dispareunia profunda nos primeiros 6 meses após a cirurgia pode estar relacionado à manipulação cirúrgica do septo retovaginal e vagina, o que não foi comum nos casos que desenvolveram dispareunia profunda 12 meses após a cirurgia.

Endometriosis is a chronic disease associated with pelvic pain and infertility that affects women's lives in various aspects such as social relationships, sexuality and mental health. Surgical treatment can help in treating different types of endometriosis-related pain, but the consequences of the procedure in women who did not experience pain before surgery are usually not. This multidisciplinary case series observational study assessed 195 consecutive cases of sexually active women who had undergone endometriosis surgery for infertility or persistent pain in a private medical facility specialized in minimally invasive surgery. The aim of the study was to evaluate changes in deep dyspareunia one year after minimally invasive endometriosis surgery. Of a total of 259 women selected for the study, 195 met the inclusion/exclusion criteria and completed clinical follow-up 12 months after surgery. Using a numeric rating scale (NRS) of 11 points (0-10), women were grouped according to the intensity of deep dyspareunia prior to surgery: ABSENT (NRS = 0), MILD (1 ≤ NRS ≤ 3), MODERATE (4 ≤ NRS ≤ 6), and SEVERE (NRS ≥ 7). In an initial analysis, there was a significant improvement after 1 year and almost half of women with deep dyspareunia (NRS >0) became free of this symptom (NRS = 0). In the ABSENT group (N=87), 11 women developed deep dyspareunia 6 months after surgery, but only 1 persisted with this symptom in the following 1 year, a condition called De Novo Deep Dyspareunia. In the MODERATE (N=41) and SEVERE groups, the improvement in deep dyspareunia 12 months after surgery was significant (P<0,001). A thorough analysis of the cases with a focus on individual variations allowed the detection of different response patterns over the first year after surgery. According to the findings, the risk of a woman with severe deep dyspareunia (EVN>7) benefiting from surgery with ≥ 3 point decrease in score is 82.2% (IC95%: 72.4-92,0), while the risk of a woman without deep dyspareunia (EVN=0) remaining without this symptom after surgery is 70.1% (IC 95%: 60,3- 79,2). A detailed examination of the cases with negative outcomes revealed that the development of deep dyspareunia in the first 6 months after surgery may be related to surgical manipulation of the rectovaginal septum and vagina, which was not seen in cases with deep dyspareunia 12 months after surgery.

A cross-sectional descriptive study on the quality of life, anxiety and depression among Filipino patients with pelvic endometriosis

Objective@#To determine the impact of endometriosis on the quality of life, risk of anxiety and depression among Filipino women in a tertiary hospital. @*Methods@#A cross-sectional study was conducted among 210 patients aged 18-50 diagnosed clinically and sonographically with pelvic endometriosis. Verbal and written consent were secured. Descriptive statistical analysis was used to describe the baseline characteristics of the population. Short Form McGill Pain Questionnaire (SF-MPQ) was used to assess the degree of pain symptoms of the patients. WHO Quality of Life Tool (WHOQOL-BREF), Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D) in Filipino version were used to evaluate the quality of life, anxiety and depression of the respondents. Series of paired t-tests were performed to determine the differences in the average outcomes (i.e. level of depression, anxiety, quality of life and subscales, pain scores and types of pain). McNemar’s chi-square test was utilized to determine the differences in the frequency of mild to severe anxiety and depression before and after treatment. Spearman’s rho rank correlation was performed to determine the relationship of the level of pain to the outcome measures. One-way analysis of variance was performed to determine differences in the current mean levels of depression, anxiety, quality of life and its subscales across disease conditions (i.e. endometriosis alone, myoma uteri, adenomyosis, other gynecologic conditions, infertility). The level of significance was set at a p-value < 0.05 using two-tailed comparison. @*Results@#The most common symptoms reported were the presence of dysmenorrhea (90.95%) and pelvic pain (88.57%), which were both rated at pain scale 8/10. Majority (73.8%) of patients have some form of depression (mild-28.57%, moderate-27.13%, severe-13.33%, very severe-4.76%) with an average level of depression at 12.39 ± 6.5. Majority (54.76%) of patients likewise have some form of anxiety (mild-15.24%, moderate-20.95%, severe-18.57%) with an average level of anxiety at 15.44 ± 10.38. Depression and anxiety scores significantly decreased after medical treatment. In terms of overall quality of life and perceived level of health, respondents demonstrated an average score of 3.25 ± 0.91 and 2.86 ± 0.96, respectively. These post-treatment scores showed significant improvement from baseline. The sub-domains (i.e. physical, psychological, social and environmental) also have relatively high scores ranging from 13.44 ± 2.39 to 15.60 ± 2.63. These are indicative of very satisfactory quality of life.Other gynecologic conditions, such as infertility, myoma uteri, and adenomyosis, do not contribute significantly to the outcomes measured.@*Conclusion@#Pelvic endometriosis is a chronic, life-long, inflammatory disease that presents mainly as pelvic pain. This debilitating pain can significantly affect patients’ psychological well-being and mental health, which is manifested by the very high incidence of anxiety and depression among Filipino women with endometriosis. Management of endometriosis is complex, hence a multi-disciplinary approach that includes psychiatric counseling may be necessary.

Implicações físicas e psicológicas da episiotomia no puerpério / Physical and psychological implications of episiotomy in the puerperium

A episiotomia é um procedimento cuja aplicação rotineira ou seletiva vem sendo discutida desde a publicação do Manual de Boas Práticas de Atenção ao Parto e Nascimento pela Organização Mundial da Saúd e (OMS) em 1996. Esta revisão de bibliografia procurou, então, investigar as informações disponíveis até o momento sobre as implicações físicas e emocionais da episiotomia no puerpério, levando em consideração o nível de conhecimento das puérperas sobre o procedimento, a dor, as limitações físicas percebidas e as repercussões na sexualidade da mulher nesse período. A análise dos dados apontou para a exclusão da mulher na tomada de decisões de seu trabalho de parto e para o impacto negativo na autoestima e na sexualidade, trazendo, também, limitações físicas ausentes nos casos de laceração. A comparação do nível de dor entre mulheres com episiotomias e lacerações foi inconclusivo, sugerindo a necessidade de maiores estudos.(AU)

Episiotomy is a procedure which's routine or selective application has been discussed since the publication of the Good Practices for Attention to Childbirth and Birth Manual by World Health Organization (WHO) in 1996. This bibliography review aims to investigate the available information regarding the physical and emotional aspects of episiotomy`s healing in the puerperium. Women's level of knowledge about the subject, pain, perceived physical limitations and the impact on sexuality during this period were the main points taken into consideration. Results pointed to the exclusion of women in the decision-making process of their labors and to a negative impact on self-esteem and sexuality, also inflicting physical limitations that were absent in cases of laceration. The comparison of pain level between women with episiotomies and lacerations was inconclusive, suggesting the need for further studies.(AU)

The Effect of Neuromodulatory Drugs on the Intensity of Chronic Pelvic Pain in Women: A Systematic Review / Efeito de neuromoduladores na intensidade da dor pélvica crônica em mulheres: Revisão sistemática

Abstract Objective: To evaluate the effect of neuromodulatory drugs on the intensity of chronic pelvic pain (CPP) in women. Data sources: Searches were carried out in the PubMed, Cochrane Central, Embase, Lilacs, OpenGrey, and Clinical Trials databases. Selection of studies: The searches were carried out by two of the authors, not delimiting publication date or original language. The following descriptors were used: chronic pelvic pain in women OR endometriosis, associated with MESH/ENTREE/DeCS: gabapentinoids, gabapentin, amitriptyline, antidepressant, pregabalin, anticonvulsant, sertraline, duloxetine, nortriptyline, citalopram, imipramine, venlafaxine, neuromodulation drugs, acyclic pelvic pain, serotonin, noradrenaline reuptake inhibitors, and tricyclic antidepressants, with the Boolean operator OR. Case reports and systematic reviews were excluded. Data collection: The following data were extracted: author, year of publication, setting, type of study, sample size, intervention details, follow-up time, and results. Data synthesis: A total of 218 articles were found, with 79 being excluded because they were repeated, leaving 139 articles for analysis: 90 were excluded in the analysis of the titles, 37 after reading the abstract, and 4 after reading the articles in full, and 1 could not be found, therefore, leaving 7 articles that were included in the review. Conclusion: Most of the studies analyzed have shown pain improvement with the help of neuromodulators for chronic pain. However, no improvement was found in the study with the highest statistical power. There is still not enough evidence that neuromodulatory drugs reduce the intensity of pain in women with CPP.

Resumo Objetivo: Avaliar o efeito de drogas neuromoduladoras na intensidade da dor pélvica crônica em mulheres. Fontes de dados: As buscas foram realizadas nas bases de dados PubMed, Cochrane Central, Embase, Lilacs, OpenGrey e Clinical Trials. Seleção dos estudos: As buscas foram realizadas por dois dos autores, não delimitando data de publicação ou idioma de publicação. Foram usados os seguintes descritores: chronic pelvic pain in women OR endometriosis, associated with MESH/ENTREE/DeCS: gabapentinoids, gabapentin, amitriptyline, antidepressant, pregabalin, anticonvulsant, sertraline, duloxetine, nortriptyline, citalopram, imipramine, venlafaxine, neuromodulation drugs, acyclic pelvic pain, serotonin, noradrenaline reuptake inhibitors e tricyclic antidepressants, com o operador booleano OR. Relatos de caso e revisões sistemáticas foram excluídos. Coleta de dados: Foram extraídos os seguintes dados: autor, ano de publicação, local de origem, tipo de estudo, tamanho da amostra, detalhes da intervenção, tempo de seguimento e resultados. Síntese dos dados: Foram encontrados 218 artigos, sendo 79 deles excluídos por serem repetidos, restando 139 artigos para análise, dos quais 90 foram excluídos na análise dos títulos, 37 após a leitura do resumo e 4 após a leitura dos artigos na íntegra, e 1 não foi encontrado, restando, então, 7 artigos que foram incluídos na revisão. Conclusão: A maioria dos estudos analisados mostrou melhora da dor crônica com auxílio de neuromoduladores. No entanto, nenhuma melhora foi encontrada no artigo com maior poder estatístico. Ainda não há evidências suficientes de que drogas neuromoduladoras reduzam a intensidade da dor pélvica crônica em mulheres.

Hernia obturatriz: Aspectos clínicos, imagenológicos y tratamiento / Obturator hernia: Clinical, imaging and treatment aspects

Introducción. Debido a la rareza de la hernia obturatriz y la imposibilidad para desarrollar estudios controlados de alto grado de evidencia, la mayoría de la literatura al respecto proviene de reportes de casos. Lo anterior, aunado al poco conocimiento del área anatómica de presentación y el cuadro clínico, la convierte en la hernia con mayor mortalidad. Métodos. Se realizó una búsqueda de la literatura en las principales bases de datos, ilustrado con pacientes manejados en el Servicio de Cirugía general de la Clínica Santa María de Sincelejo, Colombia. Discusión. La hernia obturatriz se puede descubrir en mujeres ancianas con antecedentes de cirugía abdominal o multiparidad. El signo de Howship­Romberg, que se presenta en la mitad de los pacientes, puede acompañarse de dolor abdominal en hipogastrio, vómitos y distensión progresiva. La radiografía de abdomen simple muestra tardíamente niveles hidroaéreos con ausencia de gas en ampolla rectal, pero como es poco específica para demostrar el sitio de obstrucción, es preferible la Tomografía computarizada. Conclusión. La hernia obturatriz requiere alto índice de sospecha, que ayude a la detección temprana e intervención quirúrgica inmediata, para evitar las complicaciones.

Introduction. Due to the rarity of the obturator hernia and the impossibility to develop controlled studies with a high degree of evidence, most of the reference in the literature comes from case reports. This, coupled with little knowledge of the anatomical area of presentation and clinical picture, makes it the hernia with the highest mortality. Methods. A literature search was carried out in the main databases, illustrated with patients managed in the General Surgery Service of the Clínica Santa María de Sincelejo. Discussion. Obturator hernia can be discovered in elderly women with a history of abdominal surgery or multiparity. The Howship ­ Romberg sign occurs in half of the patients, it can be associated with lower abdominal pain, vomiting, and progressive distension. Plain abdominal X-ray shows delayed air-fluid levels with absence of gas in the rectal ampulla, but since it is not very specific to demonstrate the site of obstruction, computed axial tomography is preferable. Conclusion. Obturator hernia requires a high index of suspicion, which helps early detection and immediate surgical intervention, to avoid complications.

Aspectos epidemiológicos de las infecciones de transmisión sexual en mujeres de la provincia de Santiago de Cuba / Epidemiologic aspects of sexually transmitted infections in women from the province of Santiago de Cuba

Introducción: Las infecciones de transmisión sexual constituyen un relevante problema de salud a nivel mundial; particularmente afectan la salud sexual de las mujeres ocasionando dolencias y efectos muy negativos, como la infertilidad, los embarazos ectópicos y el cáncer cervicouterino. Objetivo: Describir las características epidemiológicas de las infecciones de transmisión sexual relevantes en mujeres de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y retrospectivo en la provincia de Santiago de Cuba de la población femenina que presentó infecciones de transmisión sexual durante el período 2007-2017, detallando cada afección según año, municipio, edad, entre otras variables de interés. Asimismo, se analizaron la frecuencia, las tasas de incidencia, las tendencias y las variaciones temporales. Resultados: Las entidades clínicas predominantes fueron el síndrome de dolor pélvico y la secreción vaginal, en tanto, las menos frecuentes resultaron ser el herpes genital y la blenorragia. En el análisis por cada tipo de infección se observó una mayor afectación en féminas de edades jóvenes. Conclusiones: Las infecciones de transmisión sexual constituyen un serio problema de salud en mujeres de la provincia de Santiago de Cuba, que deviene causa importante de embarazos ectópicos y esterilidad. Sin embargo, se debe mejorar la vigilancia epidemiológica de estas enfermedades, pues existe un marcado subregistro de algunas y, por ende, una inadecuada atención, sobre todo en el sexo femenino.

Introduction: Sexually transmitted infections constitute an outstanding health problem worldwide; they particularly affect the sexual health of women causing ailments and very negative effects as infertility, ectopic pregnancies and cervical uterine cancer. Objective: To describe the epidemiologic characteristics of the outstanding sexually transmitted infections in women from Santiago de Cuba. Methods: A descriptive and retrospective study was carried out in the province of Santiago de Cuba in the female population that presented sexually transmitted infections during 2007-2017, with details of each affection according to year, municipality, age, among other variables of interest. Also, frequency, rates of incidence, tendencies and temporary variations were analyzed. Results: The predominant clinical entities were the pelvic pain syndrome and vaginal secretion, as long as, the less frequent were genital herpes and blennorrhagia. In the analysis for each type of infection a higher affectation was observed in young females. Conclusions: Sexually transmitted infections constitute a serious health problem in women from the province of Santiago de Cuba that becomes important cause of ectopic pregnancies and sterility. However, the epidemiologic surveillance of these diseases should be improved, because there is a marked subrecord of some of them and, therefore, an inadequate care, mainly in the female sex.

Extirpación laparoscópica de quiste paraovárico gigante en pediatría / Laparoscopic removal of giant paraovarian cyst in pediatrics

El quiste paraovárico se desarrolla en el ligamento ancho, entre la trompa de Falopio y el ovario. Son estructuras redondeadas de pared lisa, llenas de líquido seroso, que se ubican en el mesosálpinx, el ligamento ancho o sobre la propia trompa uterina. Tienen una incidencia aproximada de 1 en 1 500 0002 son frecuentes en la tercera y cuarta década de la vida; raramente se presentan en la edad pediátrica. Generalmente, son benignos y tiene un crecimiento lento y progresivo, suelen ser asintomáticos por lo que el diagnóstico suele ser incidental. En casos de quistes de gran volumen, los síntomas son dolor pélvico o la tumoración ab-dominal. Usualmente son diagnosticados clínicamente y se confirman por imágenes ultrasonográficas. La importancia de este caso es la poca frecuencia de estos tumores en la edad pediátrica y su identificación oportuna por parte de los profesionales de la salud

The paraovarian cyst develops in the broad ligament, between the fallopian tube and the ovary. They are rounded structures with a smooth wall, filled with serous fluid, which are located in the mesosalpinx, the broad ligament or on the uterine tube itself. They have an approximate incidence of 1 in 1,500,0002 and are common in the third and fourth decades of life; they rarely occur in childhood. Generally, they are benign and have a slow and progressive growth, they are usually asymptomatic, so the diagnosis is usually incidental. In cases of large volume cysts, the symptoms are pelvic pain or abdominal mass. They are usually diagnosed clinically and confirmed by ultrasonographic images. The importance of this case is the infrequency of these tumors in the pediatric age and their timely identification by health professionals

A importância da intervenção fisioterapêutica no vaginismo: uma revisão sistemática / The importance of physiotherapeutic intervention in vaginism: a systematic review

Objetivo: Descrever a importância da intervenção fisioterapêutica para mulheres com vaginismo. Fonte de dados: Foram utilizadas as bases de dados SciELO, PubMed, Biblioteca Virtual de Saúde (BVS) e Literatura Cinza, incluindo artigos nacionais e internacionais, sem delimitação temporal. Foram propostas para as buscas as seguintes palavras-chave e operadores boleanos: [("vaginismus") AND ("physiotherapy" OR "intervention" OR "efficiency")], sendo esses posteriormente adequados para as demais bases que foram utilizadas nesta revisão sistemática. Seleção dos estudos: A seleção dos estudos foi realizada por três examinadores independentes. Coleta de dados: Inicialmente foram excluídos estudos com base no título, em seguida os resumos foram analisados e, dos 353 artigos encontrados inicialmente, quatro foram elegíveis para esta revisão. Síntese dos dados: Os artigos incluídos descreveram que o tratamento fisioterapêutico é de extrema importância para as mulheres com vaginismo, pois aumenta a força e o controle sobre a musculatura do assoalho pélvico, diminuindo os sintomas do vaginismo e promovendo o incremento da satisfação sexual. Conclusão: A intervenção fisioterapêutica é imprescindível para mulheres que apresentam vaginismo, tendo em vista que suas técnicas têm efetividade na prevenção e tratamento do vaginismo, além de promover melhora importante na qualidade de vida e na satisfação sexual das mulheres.(AU)

Objective: To describe the importance of physical therapy intervention for women with vaginismus. Data source: The SciELO, PubMed, Virtual Health Library (BVS) and Gray Literature databases were used, including national and international articles, without temporal delimitation. The following keywords and Boolean operators were proposed for the searches: [("vaginismus") AND ("physiotherapy" OR "intervention" OR "efficiency")], which were later suitable for the other bases that were used in this systematic review. Study selection: Study selection was performed by three independent examiners. Data collection: Initially, studies were excluded based on the title, then the abstracts were analyzed and of the 353 articles found initially, 4 were eligible for this review. Data synthesis: The articles included described that physical therapy treatment is extremely important for women with vaginismus, as it increases strength and control over the pelvic floor muscles, decreasing the symptoms of vaginismus and promoting increased sexual satisfaction. Conclusion: Physical therapy intervention is essential for women who have vaginismus, considering that its techniques are effective in preventing and treating vaginismus, in addition to promoting an important improvement in women's quality of life and sexual satisfaction.(AU)

Bloqueio do Nervo Hipogástrico Superior (BNHS) para o manejo da dor após Embolização de Artérias Uterinas (EAU): revisão de literatura / Superior Hypogastric Nerve Block (SHNB) for pain management in Uterine Artery Embolization (UAE): a literature review

Introdução: a embolização de artérias uterinas (EAU) é uma opção terapêutica no tratamento de miomas uterinos sintomáticos; todavia, a dor pós-procedimento representa um grande desafio para essa técnica. Nesse contexto, o Bloqueio do Nervo Hipogástrico Superior (BNHS), já utilizado no tratamento de dor pélvica crônica associada à malignidade, apresenta-se como opção de intervenção intraprocedimento para melhorar a recuperação das pacientes e fomentar o uso da EAU na prática clínica. Objetivo: realizar uma revisão integrativa da literatura disponível sobre o BNHS no manejo de dor pós EAU. Métodos: bases de dados PubMed, The Cochrane Library, Lilacs e Medline foram avaliadas a partir da combinação dos termos "uterine artery embolization", "pain" e "superior hypogastric block". Foram incluídos estudos clínicos, disponíveis em texto completo, com pacientes adultas, submetidas à EAU, cujo objetivo era avaliar o uso do BNHS e seu impacto na dor pós-procedimento. Foram excluídos artigos de revisão, carta ao editor, e publicação em anais de congresso. Resultados: 8 artigos, em maior parte retrospectivos, indicaram consistência do BNHS em termos de sucesso terapêutico a curto prazo e redução da dor. Apenas uma complicação foi relatada, e evoluiu de forma satisfatória. Conclusões: BNHS tem potencial de aprimorar o manejo da dor após EAU, podendo impactar positivamente no tempo e na qualidade da recuperação, com redução da dor e consumo de opiodes no período pós-operatório. Esses benefícios valorizam o procedimento de embolização como uma alternativa a ser considerada no tratamento de leiomiomas sintomáticos para mulheres candidatas à preservação uterina.

Introduction: Uterine Artery Embolization (UAE) is a therapeutic option in the treatment of symptomatic uterine fibroids; however, post-procedure pain imposes as a great challenge in this technique. In this context, the Superior Hypogastric Nerve Block (SHNB), already used in the treatment of chronic pelvic pain associated with malignancy, presents itself as an option for intraprocedural intervention, to improve patients' recovery and to promote UAE in the clinical setting. Objective: to perform an integrative literature review about the effectiveness of SHNB in pain management after UAE. Methods: databases PubMed, The Cochrane Library, Lilacs and Medline were assessed using the combination of the terms "uterine artery embolization", "pain" and "superior hypogastric block". Clinical studies were included once available in full text, with adult patients submitted to UAE, whose objective was to evaluate the use of SHNB and its impact in post-procedure pain. Review articles, letters to the editor, and publication in conference proceedings were excluded. Results: 8 articles were found, most of them retrospective, indicated SHNB's consistency in terms of short-term therapeutic success and pain reduction. The single reported complication evolved satisfactorily. Conclusions: SHNB has the potential to improve pain management after UAE, which can positively impact recovery time and quality, with reduced pain and consumption of opioids in the postoperative period. Benefits like these can enhance the embolization procedure as an alternative to be considered for the treatment of symptomatic fibroids for women candidates for uterine preservation.

Effects of plication procedures in special cases of Peyronie's disease: a single-center retrospective study of 72 patients / 亚洲男科学杂志(英文版)

General recommendations regarding surgical techniques are not always appropriate for all Peyronie's disease (PD) patients. Therefore, the purpose of this study was to investigate the effects of plication procedures in PD patients with severe penile curvature and the effects of early surgical correction in patients who no longer have progressive deformities. The clinical data from 72 patients who underwent plication procedures were analyzed in this study. Patients were divided into Groups A and B according to the curvature severity (≤60° or >60°) and Groups 1 and 2 according to the duration of disease stabilization (≥3 months or <3 months). At the 1-year follow-up, 90.0% (36/40) and 90.6% (29/32) patients reported complete penile straightening, and 60.0% (24/40) and 100.0% (32/32) patients reported penile shortening in Groups A and B, respectively. No curvature recurrence occurred in any patient, and no significant differences were observed in postoperative International Index of Erectile Function-Erectile Function domain (IIEF-EF), erectile pain, sensitivity, or suture knots on the penis whether such outcomes were grouped according to the curvature severity or the duration of stabilization. However, the duration from symptom onset to surgical management in Group 1 was significantly longer than that in Group 2 (mean ± standard deviation [s.d.]: 20.9 ± 2.0 months and 14.3 ± 1.2 months, respectively, P < 0.001). The present study showed that the plication procedures seemed to be an effective choice for the surgical treatment of PD patients with severe penile curvature. In addition, the early surgical treatment seemed to benefit those patients who already had no erectile pain and no longer exhibited progressive deformity.

Effect of thermophilic bacterium HB27 manganese superoxide dismutase in a rat model of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) / 亚洲男科学杂志(英文版)

We investigated the therapeutic effects of superoxide dismutase (SOD) from thermophilic bacterium HB27 on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and its underlying mechanisms. A Sprague-Dawley rat model of CP/CPPS was prepared and then administered saline or Thermus thermophilic (Tt)-SOD intragastrically for 4 weeks. Prostate inflammation and fibrosis were analyzed by hematoxylin and eosin staining, and Masson staining. Alanine transaminase (ALT), aspartate transaminase (AST), serum creatinine (CR), and blood urea nitrogen (BUN) levels were assayed for all animals. Enzyme-linked immunosorbent assays (ELISA) were performed to analyze serum cytokine concentrations and tissue levels of malondialdehyde, nitric oxide, SOD, catalase, and glutathione peroxidase. Reactive oxygen species levels were detected using dichlorofluorescein diacetate. The messenger ribonucleic acid (mRNA) expression of tissue cytokines was analyzed by reverse transcription polymerase chain reaction (RT-PCR), and infiltrating inflammatory cells were examined using immunohistochemistry. Nuclear factor-κB (NF-κB) P65, P38, and inhibitor of nuclear factor-κBα (I-κBα) protein levels were determined using western blot. Tt-SOD significantly improved histopathological changes in CP/CPPS, reduced inflammatory cell infiltration and fibrosis, increased pain threshold, and reduced the prostate index. Tt-SOD treatment showed no significant effect on ALT, AST, CR, or BUN levels. Furthermore, Tt-SOD reduced inflammatory cytokine expression in prostate tissue and increased antioxidant capacity. This anti-inflammatory activity correlated with decreases in the abundance of cluster of differentiation 3 (CD3), cluster of differentiation 45 (CD45), and macrophage inflammatory protein 1α (MIP1α) cells. Tt-SOD alleviated inflammation and oxidative stress by reducing NF-κB P65 and P38 protein levels and increasing I-κBα protein levels. These findings support Tt-SOD as a potential drug for CP/CPPS.

CO2 laser moxibustion for endometriosis related pelvic pain of cold coagulation and blood stasis: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical therapeutic effect of CO2 laser moxibustion on endometriosis related pelvic pain of cold coagulation and blood stasis.@*METHODS@#A total of 76 patients with endometriosis related pelvic pain of cold coagulation and blood stasis were randomized into a laser moxibustion group and a sham laser moxibustion group, 38 cases in each group. In the laser moxibustion group, moxibustion was applied at bilateral Zigong (EX-CA 1) using CO2 laser moxibustion instrument. In the sham laser moxibustion group, the manipulation of moxibustion was same as the laser moxibustion group, without laser output. The treatment was given once every other day, 30 min each time, 3 times a week for 4 weeks in both groups. Before and after treatment and follow-up of 3 months after treatment, the scores of Gracely box scale (GBS) and visual analogue scale (VAS) were observed, the usage of non-steroidal anti-inflammatory drug for the duration of the treatment and the average days of taking drugs were recorded in both groups.@*RESULTS@#Compared before treatment, the GBS and VAS scores were decreased after treatment and during follow-up in the laser moxibustion group (P<0.05), while those in the sham moxibustion group had no significant differences (P>0.05). Compared with the sham moxibustion group, the GBS and VAS scores were decreased after treatment and during follow-up (P<0.05), the cases and average days of taking drugs were less in the laser moxibustion group (P<0.05).@*CONCLUSION@#CO2 laser moxibustion can improve the pain symptom in patients with endometriosis related pelvic pain of cold coagulation and blood stasis, and reduce the use of analgesic drugs.

Schwannoma retrorrectal / Retrorectal Schwannoma

RESUMEN Los tumores de la región retrorrectal son lesiones poco frecuentes, con potencial de malignidad e infección. Generalmente cursan asintomáticos. Presentamos el caso de una paciente de 62 años, con dolor pélvico crónico, cuyos estudios imagenológicos informan lesión ocupante de espacio de 3 cm en región presacra. Se procedió a su resección quirúrgica con diagnostico histopatológico de schwannoma.

ABSTRACT Retrorectal tumors are rare but have potential malignant transformation and risk of infection. Thet are usually asymptomatic. We report the case of a 62-year-old female patient with chronic pelvic pain and imaging tests showing a 3-cm space-occupying lesion in the presacral region. The lesion resected and the histopathologic diagnosis was schwannoma.

Overview of the Effect of Complementary Medicine on Treating or Mitigating the Risk of Endometriosis / Visão geral do efeito da medicina complementar no tratamento ou mitigação do risco de endometriose

Abstract Objective Endometriosis is a hormone-dependent chronic inflammatory disease with symptoms such as pelvic pain, which affect the physical, emotional, and social health of women in reproductive age. The current overview article aims to explore the effect of complementary medicine on the treatment or in mitigating the risk of endometriosis. Methods This is an overview article done in Iran. Two separate researchers systematically searched 3 databases (Medline, Scopus, and Cochrane Central Register Trials) until September 2020. The methodological quality of each study was assessed using the assessment of multiple systematic reviews (AMSTAR) tool. Results The results of two reviews suggested that physical activity, tobacco smoking, diet, coffee and caffeine intake had no effect on mitigating the risk of endometriosis or improving its treatment, but acupuncture successfully reduced pain and related marker (serum CA-125) levels. Conclusion As endometriosis is an annoying disease with many complications and is hard to diagnose and treat, related studies in complementary medicine can help patients with endometriosis. Based on the relevant literature review, among the complementary medicine available for the treatment or to mitigate the risk of endometriosis, only acupuncture seems to alleviate the pain of endometriosis.

Resumo Objetivo A endometriose é uma doença inflamatória crônica hormono-dependente com sintomas como dores pélvicas, que afetam a saúde física, emocional e social de mulheres em idade reprodutiva. O presente artigo de visão geral tem como objetivo explorar o efeito da medicina complementar no tratamento ou na mitigação do risco de endometriose. Métodos Trata-se de um artigo de visão geral feito no Irã. Dois pesquisadores separados pesquisaram sistematicamente 3 bancos de dados (Medline, Scopus e Cochrane Central Register Trials) até setembro de 2020. A qualidade metodológica de cada estudo foi avaliada usando a ferramenta avaliação da qualidade dos relatos de revisão sistemática (AMSTAR, na sigla em inglês). Resultados Os resultados de duas revisões sugeriram que atividade física, tabagismo, dieta, consumo de café e cafeína não tiveram efeito na redução do risco de endometriose ou na melhoria do tratamento, mas a acupuntura reduziu com sucesso a dor e os níveis de marcadores relacionados (CA-125 sérico). Conclusão Como a endometriose é uma doença incômoda, com muitas complicações e de difícil diagnóstico e tratamento, estudos relacionados em medicina complementar podem ajudar pacientes com endometriose. Com base na revisão da literatura relevante, entre os medicamentos complementares disponíveis para o tratamento ou risco de endometriose, apenas a acupuntura parece aliviar a dor da endometriose.

Ozonoterapia en pacientes con dolor pélvico crónico / Ozone therapy in patients with chronic pelvic pain

Introducción: La factibilidad y seguridad del empleo de la ozonoterapia se evidencia en los resultados expuestos por varios autores, en enfermedades cuyo síntoma fundamental es el dolor crónico. Objetivo: Determinar la evolución clínica de las pacientes con dolor pélvico crónico, tratadas con ozono asociado al tratamiento médico convencional. Métodos: Estudio descriptivo, observacional, retrospectivo, en el que se determinó la evolución clínica de las pacientes con dolor pélvico crónico tratadas con ozono, asociada al tratamiento médico convencional. La muestra fue de 54 mujeres. Las variables utilizadas fueron: edad, causa del dolor pélvico, tiempo de evolución, puntuación de la escala de dolor antes y después de la aplicación de la ozonoterapia y evaluación del tratamiento. Resultados: Prevalecieron las pacientes con edad de 26-35 años. El 57,4 por ciento tenían entre 2 y 2 años de evolución del dolor. La enfermedad inflamatoria pélvica crónica fue la causa de mayor frecuencia con 42,5 por ciento. Antes de la aplicación de la ozonoterapia la media de puntuación en la escala de dolor fue de 6,31, y disminuyó a 3 después del tratamiento, con una evaluación de bien en el 81,1 por ciento de los casos. Conclusiones: Después de la aplicación de la ozonoterapia asociada al tratamiento médico convencional, se produce mejoría clínica, por lo que puede ser una alternativa de tratamiento(AU)

Introduction: The feasibility and safety of the use of ozone therapy is evidenced in the results presented by several authors, in diseases whose main symptom is chronic pain. Objective: To determine the clinical evolution of patients with chronic pelvic pain treated with ozone associated with conventional medical treatment. Methods: Descriptive, observational, retrospective study, in which the clinical evolution of patients with chronic pelvic pain treated from January 2018 to January 2020, with ozone therapy, associated with conventional medical treatment. The sample was 54 women. The variables used were: age, cause of pelvic pain, time of evolution, score on the pain scale before and after the application of ozone therapy, and evaluation of the treatment. Results: Patients aged 26-35 years prevailed. 57,4 percent had between two and four years of pain evolution. Chronic pelvic inflammatory disease was the most frequent cause with 42,5 percent. Before the application of ozone therapy, the mean score on the pain scale was 6.31, and it decreased to 3 after treatment, with an evaluation of good in 81,1percent of the cases. Conclusions: After the application of ozone therapy associated with conventional medical treatment, there is evident clinical improvement, which is why it constitutes an alternative of treatment(AU)