Surgical Technique and Outcomes of Inverted-Y Plasty Procedure in Clitoral Hoodoplasty Operations.

STUDY OBJECTIVE: Labia minora reduction is the most common operation requested by women concerned with the appearance of their vulvar area. In most cases, a concomitant clitoral hoodoplasty (CP) should be performed to achieve better esthetic outcomes. There are different surgical methods for removing excess tissue in the clitoral hood area. This study aims to describe the surgical technique of inverted-Y plasty as with central longitudinal excision in CP and to elaborate on different hoodoplasty techniques in the literature. DESIGN: Case series. SETTING: Private practice. PATIENTS: A total of 63 patients who underwent labiaplasty with curvilinear labial excision and concomitant CP with the inverted-Y plasty technique. INTERVENTIONS: The operations were performed by a single senior surgeon between May 2017 and December 2019. The inverted-Y plasty technique is described in detail regarding its advantages and important issues. MEASUREMENTS AND MAIN RESULTS: The patients' median age was 33.2 (19-47) years. Of the patients, 57 (90.5%) requested the operation because of dissatisfaction with the esthetic appearance. Furthermore, 60 (95.2%) patients requested minimum remaining labia. The median operation time was 45 (35-62) minutes in labiaplasty and 34 (25-42) minutes in CP. No major complications occurred. At the postoperative second month, 96.9% of the patients were satisfied with the esthetic results. CONCLUSION: CP with the inverted-Y plasty technique is extremely safe and highly satisfactory in most patients, allowing maximum trimming of the excess tissue and providing lifting of the clitoral hood area.

Importance of gynecological assessment for the treatment of vaginismus as a predictive value.

AIM: In this study, we aimed to analyze the impact of a detailed anamnesis and gynecological examination findings of women with vaginismus on its treatment success in a tertiary therapy center with 18 years of experience. METHODS: The socio-demographical factors, gynecological examination notes and the treatment results of 281 vaginismus patients were analyzed between July 2018 and July 2019. The relationship with these parameters and the number of sessions for treatment were evaluated. RESULTS: The women with higher vaginismus grade had a longer duration of marriage (P < 0.001) and they needed more CBT sessions (P = 0.004). On the other hand, the age of the patient, duration of the relationship, education level, and surgical intervention (hymenotomy, hymenectomy) or presence of anatomically pathological hymen did not affect the outcomes regarding the number of sessions, duration of the treatment and the rate of successful penetration. CONCLUSION: Gynecological evaluation and detailed anamnesis that is taken upon the first admission has an important impact on the management of therapy and the treatment success.

Translation, cultural adaptation, and validation and reliability of assessment of pelvic floor disorders and their risk factors during pregnancy and postpartum questionnaire in Turkish population.

OBJECTIVES: This study was conducted in order to produce translation, cultural adaptation, and validation of Assessment of Pelvic Floor Disorders and Their Risk Factors During Pregnancy and Postpartum Questionnaire (APFDQ) to Turkish in pregnant and postpartum population. MATERIAL AND METHODS: The study included 80 pregnant women. Internal consistency was tested using Cronbach's alpha. Questionnaires were applied three different times in order to assess for sensitivity. Patients were asked to complete the questionnaire first in the third trimester, secondly in postpartum 6th week and finally in postpartum 6th month after birth. For translation process content, face/content validity, reliability, construct validity and reactivity studies were done. All women had undergone pelvic examination and prolapse was assessed by using Pelvic organ Prolapse Quantification System (POP-Q). Urinary symptoms were also evaluated with Urinary Distress Inventory (UDI-6) questionnaire. RESULTS: The mean age of patients was 27.7 ± 5.5 years. Forty-one (51.25%) of the patients had vaginal delivery and 39 (48.75%) had a cesarean section. Above 96% of the patients had completed the questionnaires. POP-Q assessments and UDI-6 results were used to evaluate construct validity. Cronbach's alpha results were found to be 0.7 for all the subscales of the questionnaire: bladder: 0.702, bowel: 0.744, prolapse: 0.701, sexual function: 0.706 respectively, indicating adequate reliability. The test/retest reliability was studied and Pabak values showed moderate reliability in the bowel, prolapse and sexuality, and good reliability for bladder subscale. The results of the patients were compared between pregnancy and postpartum to assess reactivity and shown to be reactive to changes. Also risk factors of the patients were assessed including, family predisposition, maternal age over 35 years, BMI > 25, nicotine use, subjective inability to contract pelvic floor and sense of postpartum wound pain. CONCLUSIONS: The Turkish version of APFDQ is a reliable and valid tool. It can be used for assessing the risk factors, incidence, assessing degree of PFDs and evaluating the impact on quality of life in pregnant and postpartum women.

The effects of menopausal uterine fibroids on the prognosis of endometrium cancer.

OBJECTIVE: This study aimed to evaluate any potential associations between uterine leiomyomas and endometrial cancer. MATERIALS AND METHODS: This is a retrospective study of 153 female patients who have been operated because of endometrial carcinoma in our hospital between 2012 and 2017. Data were collected from hospital records. Study participants were divided into two groups according to the presence and absence of leiomyomas. These two groups were compared in terms of histopathological adenocarcinoma type, nuclear and histological grades, disease stage, para-aortic lymph node involvement, and myometrial invasion. For data analysis, Statistical Package for Social Sciences 15.0 software package was used. Comparison between the two groups was made using the chi-square test, and each variable was tested with the Student's t-test for statistical significance. RESULTS: No statistically significant differences were found between the groups with respect to age, tumor type, myometrial invasion, nuclear grade, or histological grade (p>0.05 for all). A significant difference was found between leiomyomas presence and lymph node metastases. The lymph node metastases were more common in patients without uterine leiomyomas (20.55%) than in those with them (5%; p=0.004). Analysis using the Federation of Obstetrics and Gynecology stages for the presence of leiomyomas indicated that the mean stages were 1A and 1B in patients with and without uterine leiomyomas, respectively (p=0.002). CONCLUSION: Uterine leiomyomas did not adversely affect the prognosis of patients with endometrial carcinoma. Moreover, lymph node involvement was less common, and stages were lower in patients with leiomyomas.

Comparison of female sexual function and sexual function of their partners between groups of pregnant and non-pregnant women.

OBJECTIVES: To compare the female sexual function index and sexual function of their partners between groups of pregnant and non-pregnant Turkish women. MATERIAL AND METHODS: This was a cross-sectional study of 321 women, including 252 healthy pregnant and 69 healthy nonpregnant women. Assessment of female sexual function index (FSFI), ARIZONA scores of their partners were compared in relation to some of the sociodemographic characteristics and pregnancy trimesters. RESULTS: Comparison of the groups revealed a significantly higher FSFI score in the non-pregnant group whereas the ARIZONA score was significantly higher in the pregnant group (p < 0.001). Age, gravidity, parity and smoking rate adjusted mean differences of scores remained statistically significant (p < 0.001). Higher ARIZONA (> 11) score rate was significantly higher in pregnant groups (55.6% vs 23.2%, p < 0.001). Pregnancy was a risk factor for high ARIZONA score [OR: 4.1 (95% CI 2.2-7.6, p < 0.001)]. Lower FSFI score rate was significantly higher in the pregnant group (26.4% vs 69.4%, p < 0.001). Pregnancy was a risk factor for low FSFI score [OR: 6.4 (95% CI 3.5-11.7, p < 0.001)]. CONCLUSIONS: Both female sexual function index and ARIZONA scores of their partners were found to be significantly different between groups of pregnant and nonpregnant Turkish women which indicated altered sexual function of couples during pregnancy.

Effects of predisposing factors on the success and treatment period in vaginismus.

OBJECTIVE: There are many predisposing factors associated with vaginismus, but there is lack of data in the literature regarding which and how of these factors influence the success rate of treatment. Our aim is to investigate the effects of factors that are considered as predisposing factors for vaginismus on treatment prognosis and success rate, with cognitive-behavioral therapy and desensitization exercises after sexual therapy. METHODS: Patients with vaginismus were divided into three groups. Group 1: patients who successfully completed vaginal penetration exercises after sexual therapy and experienced vaginal sexual intercourse; Group 2: patients who started penetration exercises but could not reach success; Group 3: patients who discontinued treatment before starting exercises. Demographic and sexual parameters were compared between the groups. RESULTS: There were statistically significant differences between the groups in terms of history of vaginismus in relatives (4.3%, 23% and 35.7%, p=0.047, respectively), the unsuccessful therapy history (69%, 61% and 21.4%, p=0.014, respectively), and anal and/or oral sex ratios (47.8%, 7.7% and 57.1%, p=0.019, respectively). Mean number of sessions were significantly higher in patients saying, "It is my fault" than among those perceiving it as a common problem (10.6±2.9 ve 7.5±5.7, p=0.042, respectively), and in patients with sexual disorder in their male partners than those not having any problem (13.3±3.7 ve 8.2±3.7, p=0.013, respectively). CONCLUSION: Patients are more resistant to treatment if they have a history of vaginismus among relatives or when one of the couple say, it is his or her fault.

Effects of predisposing factors on the success and treatment period in vaginismus.

OBJECTIVE: There are many predisposing factors associated with vaginismus, but there is lack of data in the literature regarding which and how of these factors influence the success rate of treatment. Our aim is to investigate the effects of factors that are considered as predisposing factors for vaginismus on treatment prognosis and success rate, with cognitive-behavioral therapy and desensitization exercises after sexual therapy. METHODS: Patients with vaginismus were divided into three groups. Group 1: patients who successfully completed vaginal penetration exercises after sexual therapy and experienced vaginal sexual intercourse; Group 2: patients who started penetration exercises but could not reach success; Group 3: patients who discontinued treatment before starting exercises. Demographic and sexual parameters were compared between the groups. RESULTS: There were statistically significant differences between the groups in terms of history of vaginismus in relatives (4.3%, 23% and 35.7%, p=0.047, respectively), the unsuccessful therapy history (69%, 61% and 21.4%, p=0.014, respectively), and anal and/or oral sex ratios (47.8%, 7.7% and 57.1%, p=0.019, respectively). Mean number of sessions were significantly higher in patients saying, "It is my fault" than among those perceiving it as a common problem (10.6±2.9 ve 7.5±5.7, p=0.042, respectively), and in patients with sexual disorder in their male partners than those not having any problem (13.3±3.7 ve 8.2±3.7, p=0.013, respectively). CONCLUSION: Patients are more resistant to treatment if they have a history of vaginismus among relatives or when one of the couple say, it is his or her fault.

Investigation of the preventive effects of dehydroepiandrosterone (DHEA) and Caffeic acid phenethyl ester (CAPE) on cisplatin-induced ovarian damage in rats.

To investigate whether Dehydroepiandrosterone (DHEA) and Caffeic acid phenethyl ester (CAPE) had any preventive effect against the ovarian damage caused by cisplatin (CP) (cis-diamminedichloroplatinum) in rats. On the first day ovaries were removed, Anti-Müllerian hormone (AMH) was measured (Group1, n:6), in the other groups 7.5 mg/kg cisplatin was administered intraperitoneally. In Group 2 (n = 6), 0.1 ml saline, in Group 3 (n = 5), 20 umol/kg CAPE, in Group 4 (n = 7), DHEA 6 mg/kg were administered every day. On the 10th day, ovaries were removed, AMH was measured. Ovary reserve (primordial/primary/secondary/tertiary/atretic follicles, AMH), ovarian damage scores (follicular degeneration, congestion, hemorrhage, edema, inflammation) were compared. The number of tertiary follicles were statistically high in the CAPE group (p = .015), the inflammation score in the DHEA group (p = .012), AMH level (p = .009) in the control group. The lowest number of atretic follicles (AF) was in the control group, while the highest number of AF was in the DHEA group (p = .002). Significant decreases in AF were the case in the cisplatin and DHEA groups compared to the control group (p < .008). The AMH values had the highest positive correlation with the number of primordial follicles and the highest negative correlation with the number of AF. The cut off point for AMH was 1.57 ng/ml as an indicator of low ovarian reserve. Cisplatin causes total damage and increased numbers of AF on the ovary. Depending on this, AMH levels fall. These negative effects of cisplatin are not obstructed by CAPE or DHEA, and may even be increased by DHEA.

Comparison of the protective effects of sildenafil, vardenafil and tadalafil treatments in ischemia-reperfusion injury in rat ovary.

OBJECTIVES: The aim of this study was to compare the effects of sildenafil, vardenafil and tadalafil in treatment for ischemia/reperfusion injury which is created experimentally in rat ovaries. MATERIAL AND METHODS: For this study, 30 female Wistar albino rats were used, and the rats were separated randomly intofive groups consisting of six rats each: normal, torsion-detorsion, torsion-detorsion + sildenafil 1.4 mg/kg, torsion-detorsion+ vardenafil 1.7 mg/kg and torsion-detorsion + tadalafil 5.0 mg/kg. The agents were given intraperitoneally 30 minutesbefore detorsion. An ovarian torsion procedure was implemented in all other groups for 3 hours with the exception of thenormal group. Then, a detorsion procedure was implemented to the groups for 3 hours. RESULTS: The sildenafil and vardenafil treatments showed protective effect by preventing significant increase in inflammationparameters. (p = 0.058, 0.138). The tadalafil treatment was only protective for cellular degeneration (p = 0.140). Thevardenafil treatment was protective for edema (p = 0.238), vascular congestion (p = 0.111), inflammation (p = 0.138) andcellular degeneration (p = 0.532). Sildenafil, vardenafil and tadalafil inhibited the increase of atretic follicle. AMH levels werestatistically different between torsion and detorsion and vardenafil group (p = 0.004, 0.004), whereas tadalafil and sildenafilgroups were similar to normal group (p = 0.108, 0.108). CONCLUSIONS: PDE inhibitors were found to be effective in reducing ovarian ischemia/reperfusion injury. Sildenafil andtadalafil seem to be more effective than the vardenafil in protecting the ovarian reserve.

Cervix human papilloma virus positivity: Does it cause sexual dysfunction?

OBJECTIVE: To investigate whether testing positive for human papilloma virus (HPV) in cervical screening has an impact on female sexual functioning. MATERIALS AND METHODS: This study was designed as a single-center, prospective, descriptive-cross-sectional study and 300 women who received HPV testing in our hospital [HPV-positive (n=187) or HPV-negative (n=113)]. The Arizona Sexual Experiences (ASEX) scale and Female Sexual Functioning index (FSFI) were administered to study participants during face-to-face interviews. RESULTS: No significant differences were found between women who were HPV-positive and HPV-negative in sexual functions as assessed using the ASEX and FSFI scales (p=0.343 and p=0.604, respectively). In addition, the analyses addressing whether sexual functioning was affected by a positive test result, at diagnosis or during the follow-up (before 2 weeks, 2 weeks-1 month, 1-3 months, 3-6 months, 6 months-1 year and over 1 year) revealed no significant differences between HPV-positive and HPV-negative women in sexual functioning (p>0.05). Sexual dysfunction was less common in married women than in the ASEX scale (p=0.03), and this difference was not detected when the FSFI scale was applied. The incidence of dysfunction was more frequent in working women than in retirees (p=0.006, p=0.01). CONCLUSION: Educational attainment, socioeconomic status, age, employment status, and marital status were found to have statistically significant effects on sexual functioning. Sexual functioning was affected by neither HPV test results (positive/negative) nor time from diagnosis.