Revisión narrativa de la evidencia actual acerca de las alternativas hormonales y no hormonales en el manejo de los síntomas vasomotores y urogenitales de la menopausia / Narrative Review of Current Evidence Regarding Hormonal and Non-Hormonal Therapeutic Options for Vasomotor and Genitourinary Menopause Symptoms

La menopausia es el periodo de transición en que la mujer culmina su edad reproductiva y trae consigo cambios anatómicos y fisiológicos, manifestados principalmente por síntomas vasomotores y urogenitales, con gran afectación de la calidad de vida de las pacientes. Es de gran importancia conocer las alternativas terapéuticas que existen, la evidencia que las respalda, y así ofrecer la mejor alternativa según indicaciones, eficacia, perfil de efectos adversos y contraindicaciones de cada una. Métodos: Se realizó una búsqueda y selección de la literatura en las bases de datos Cochrane, Pubmed, SciELO, JAMA, en idiomas español e inglés, sin restricción de fecha. Conclusiones: Las terapias actuales no son satisfactorias, bien sea por la baja eficacia en el control de los síntomas o por su asociación con efectos adversos de importancia. Es necesario evaluar acuciosamente el riesgo-beneficio de cada intervención.

Menopause is the transitioning phase of a woman at the end of her reproductive age and which is associated with both anatomical and physiological changes, with great compromise of quality' of Iife. It is of upmost importance to be aware of the currently available therapeutic options, the evidence that supports them, and thus, be able to provide the best alternative according to medical indications, efficacy, adverse effects and counter-indications. Methods: We conducted a search on the databases Cochrane, Pubmed, SciELO, JAMA, both in English and Spanish, without date restrictions. Conclusión: Current therapies are not satisfactory, either because of their low efficacy in symptom control or because of the associated risks. It is necessary to make a thorough evaluation of the benefit/risk relation for every individualized case.

Anamnese em sexologia e os critérios diagnósticos das disfunções sexuais / Anamnesis in sexology and diagnostic criteria for sexual dysfunctions

Este protocolo visa apresentar os critérios e o algoritmo para o diagnóstico e o tratamento das disfunções sexuais femininas (DSFs), de acordo com os critérios da Classificação Internacional das Doenças (CID-10) utilizados pelo Sistema Único de Saúde (SUS) no Brasil. A classificação e os conceitos do DSM-V são utilizados para complementar a CID-10.(AU)

Female genito-pelvic pain/penetration disorder: review of the related factors and overall approach / Perturbação de dor Gênito-pélvica e da penetração: revisão dos fatores associados e abordagem geral

Abstract Genito-pelvic pain/penetration disorder (GPPPD) can be an extremely bothersome condition for patients, and a tough challenge for professionals regarding its assessment and treatment. The goal of the present paper is to review the etiology, assessment, and treatment of GPPPD, especially focusing on the cognitive aspects of the disease and cognitive-behavioral treatment options, through a non-systematic review of articles indexed to the Medline, Scopus and Web of Science databases, using the following MeSH queries: pelvic pain; dyspareunia; vaginismus; vulvodynia; and cognitive therapy. Altogether, 36 articles discussing the etiology, diagnosis and management of GPPPD were selected. We provide an overview of GPPPD based on biological, psychological and relational factors, emphasizing the last two. We also summarize the available medical treatments and provide strategies to approach the psychological trigger and persisting factors for the patient and the partner. Professionals should be familiarized with the factors underlining the problem, and should be able to provide helpful suggestions to guide the couple out of the GPPPD fear-avoidance circle.

Resumo A perturbação de dor gênito-pélvica e da penetração (PDGPP) é uma patologia com elevado impacto no bem-estar das pacientes, e traduz-se num desafio diagnóstico e de tratamento para os profissionais que as acompanham. O objetivo deste artigo é rever a etiologia e o tratamento da PDGPP, tendo em conta, principalmente, os aspetos cognitivos e as abordagens de inspiração psicoterapêutica cognitivo-comportamental. Para tal, foi efetuada uma revisão não sistemática dos artigos indexados às bases de dados Medline, Scopus e Web of Science, usando os termos: dor pélvica; dispareunia; vaginismo; vulvodinia; e terapia cognitiva. No total, foram incluídos 36 artigos discutindo a etiologia, diagnóstico e tratamento da PDGPP. Neste artigo, proporcionamos uma revisão do tratamento da PDGPP baseado em fatores biológicos, psicológicos e relacionais, enfatizando os últimos dois. Também resumimos as opções de tratamento

Sexual dysfunction among female patients of reproductive age in a hospital setting in Nigeria.

Although sexual dysfunction is an important public-health problem in Nigeria, little research has been conducted on this topic in Nigeria. This cross-sectional study was conducted to determine the prevalence of sexual dysfunction and their correlates among female patients of reproductive age using a questionnaire. Respondents were recruited from the out-patients clinics of a teaching hospital setting in Ile-Ife/ Ijesa administrative health zone, Osun State, Nigeria. Of 384 female patients interviewed, 242 (63%) were sexually dysfunctional. Types of sexual dysfunction included disorder of desire (n=20; 8.3%), disorder of arousal (n=l 3; 5.4%), disorder of orgasm (n=154; 63.6%), and painful coitus (dyspareunia) (n=55; 22.7%). The peak age of sexual dysfunction was observed among the age-group of 26-30 years. Women with higher educational status were mostly affected. The reasons for unsatisfactory sexual life mainly included psychosexual factors and medical illnesses, among which included uncaring partners, present illness, excessive domestic duties, lack of adequate foreplay, present medication, competition among wives in a polygamous family setting, previous sexual abuse, and guilt-feeling of previous pregnancy termination among infertile women. The culture of male dominance in the local environment which makes women afraid of rejection and threats of divorce if they ever complain about sexually-related matters might perpetrate sexual dysfunction among the affected individuals. Sexual dysfunction is a real social and psychological problem in the local environment demanding urgent attention. It is imperative to carry out further research in society at large so that the health and lifestyles of affected women and their partners could be improved.

Painful ejaculation; an underestimated sexual possible underlying serious etiology

Painful ejaculation, a previously an underestimated ejaculatory and sexual dysfunction, has gained increased attention being one of the significant sexual dysfunctions associating LUTS of BPH. Other underlying etiopathologic factors are not well studied, To study the underlying etiologic factors responsible for painful ejaculation in a group of patients having this symptom as the main complaint and the efficacy of different treatment modalities. Furthermore we want to test our hypothesis that in suspected cases of genital TB, it is better to search for it in semen rather than in urine. 60 male patients with painful ejaculation were enrolled in this study. Their mean age was 39,4 +/- 8.7 years while the mean duration of their complaint was 15.4 +/- 4.8 months. Patients were subjected to thorough history taking and physical examination including DRE. Patients were extensively investigated by urinalysis, urine culture, Ziehi Neelsen [Z,N.] staining and PCR for acid fast bacilli in both urine and semen ,semen culture, semen culture for TB, TRUS [ +/- biopsy] and/or cystoscopy when indicated in addition to PSA determination in all men above 50 years old. Associated symptoms were premature ejaculation, chronic prostatitis manifestations, ED, cystitis manifestations, infertility, partner dyspareunia or hemospermia in that order of frequency. Significant physical findings included BPH [15], epididymal mass[1], recurrent epididymoorchitis [1] scrotal sinus [1] and prostatic carcinoma [1], UTI was proved by urine culture in 20case with E-coli strains predominantly isolated. Urine PCR for TB was positive in 5 patients [13% sensitivity and 100% specificity] while same test in semen yielded astonishingly high incidence of TB in 40 patients [100% sensitivity and 91% specificity].Semen culture for TB confirmed its presence in 38 out of 40 PCR positive specimens. TRUS findings included calcular prostatitis [7], BPH [15], Prostatic adenocarcinoma [1], pathologic seminal vesicles [15],ejaculatory duct obstruction [3] and prostatic cysts [2]. Treatment of the underlying etiologies produced significant improvement of pain. Alpha blockers improved pain in 93% and 70% of BPH and chronic prostatitis patients respectively. Painful ejaculation may be an important indicator of a serious underlying disease such as prostatic carcinoma. In our locality genitourinary TB is prevalent among this group of patients. We introduce the application of PCR in semen as a highly sensitive and specific test which should be done whenever genitourinary TB is suspected as it showed better sensitivity than same test in urine. Alpha blockers proved effective in relieving painful ejaculation in BPH patients and to less extent in chronic prostatitis patients

Síndrome de útero doble: hemivagina obstruida y agenesia renal homolateral / Syndrome of uterus didelphys: imperforated hemivagina and ipsilateral renal agenesis

Estudiar las características, clínicas, diagnóstico y resultados terapeúticos, en pacientes con el síndrome de útero didelfo, hemivagina obstruida y agenesia renal homolateral. Estudio retrospectivo de siete casos, atendidos entre 1977 y 1997, con diagnóstico comprobado por la clínica, imágenes (ecografía, radiología, tomografía axial computada o resonancia magnética nuclear) y/o laparoscopia. Hospitales Chiquinquirá y "Manuel Noriega Trigo" y consulta ginecológica privada. La presentación clínica es proteiforme, con diferentes motivos de consulta. Las imágenes y la laparoscopia son decisivas en el diagnóstico. Un procedimiento quirúrgico simple de drenaje hemático seguido de plastia de un orificio para garantizar permeabilidad ulterior, con resultados positivos, tanto para la fertilidad como para otros motivos de consulta. Las malformaciones de útero y vagina deben ser detalladamente conocidas por el ginecólogo, para garantizar un diagnóstico a edades tempranas, evitándose así complicaciones como endometriosis pélvica y el deterioro funcional del riñon único. La canalización cérvico-vaginal del lado patológico, es el enfoque terapeútico recomendado

El uso del signo de Benjamín en el diagnóstico precoz de la endometriosis / Use of Benjamin's sign in the early diagnosis of endometriosis

Se analizan las razones que existen para usar el signo de Benjamín (persistencia de la temperatura basal del cuerpo elevada durante el período menstrual de la mujer) en el diagnóstico precoz de la endometriosis, especialmente en los grupos de menores de 25 años. En el grupo de 60 mujeres estudiado hay 40 por ciento menores de 25 años (13,4 por ciento menores de 20) y sexualmente inactivas 14, el 23,3 por ciento; 90 por ciento con dismenorrea importante y con signo de Benjamín + el 91,7 por ciento. Hubo 5 falsos negativos y 5 falsos positivos. La comprobación de la endometriosis se hizo mediante laparoscopía diagnóstico/quirúrgica pertinaz y progresiva, rebelde a tratamientos habituales con el objeto de hacer screening de candidatas a laparoscopía