Genito-sensory analysis in women with arousal and orgasmic dysfunction.

INTRODUCTION: Diagnosis and treatment of female sexual dysfunction (FSD) are currently based on subjective female reports and physical examination. The GenitoSensory Analyzer (GSA) is a quantitative sensory testing tool designed to quantify vibratory and thermal sensation in the vagina and clitoris in a reproducible manner, and may therefore contribute to the diagnosis and management of FSD. AIM: To address the question of whether women with arousal and/or orgasmic sexual disorders have genital sensory abnormalities as measured by the GSA. MAIN OUTCOME MEASURES: Thresholds for warm, cold, and vibratory sensation at predetermined points in the vaginal wall and clitoris. METHODS: Female subjects complaining of arousal and/or orgasmic sexual disorders for more than 6 months were evaluated using a questionnaire based on the female sexual function index (FSFI). Women with a desire disorder, pain disorder, vulvar vestibulitis syndrome, or acute vaginal or/and introital infection were excluded. The GSA device measured thresholds for warm, cold, and vibratory sensation at predetermined points in the vaginal wall and clitoris. Eight measurements were obtained, and deviations from previously published normative values were identified. RESULTS: Twenty-eight women (age 40.4 +/- 13 years) complaining of arousal and/or orgasmic FSD comprised the study cohort. Twenty-five of them (89%) had at least one pathologic genitor-sensory threshold on GSA testing and 19 (68%) had >3 pathologic thresholds. Pathologic GSA results were associated with lower arousal scores on the FSFI questionnaire, older age, and menopausal status. CONCLUSIONS: Most of the study women had at least one genitor-sensory pathology on GSA testing, indicating a possible organic component in their disorder. Our findings support the incorporation of the GSA as a quantitative tool in the assessment and diagnosis of patients with FSD.

Cervical length in the early second trimester for detection of triplet pregnancies at risk for preterm birth.

OBJECTIVE: Preterm triplet delivery is common and has a tremendous impact on neonatal mortality and morbidity. We aimed at assessing early second-trimester cervical length as a means of detecting triplet pregnancies at risk for preterm birth. METHODS: Cervical length was measured in triplet pregnancies during weeks 14 to 20. Cervical length of less than 25 mm was used as a cutoff to divide individuals into 2 groups. Perinatal outcome parameters were compared between the 2 groups and included gestational age at delivery, birth weights, and neonatal intensive care unit admission rates. Sensitivity, specificity, and positive and negative predictive values were calculated for cervical length as a screening method for preterm birth. RESULTS: We evaluated 36 triplets during weeks 14 to 20. Cervical length of less than 25 mm was measured in 14 (group I), 12 of which were delivered before 32 weeks (mean +/- SD, 28.4 +/- 3.1 weeks). Four of 22 women with cervical length of greater than 25 mm (group II) had delivery before 32 weeks (mean, 30.1 +/- 1.8 weeks). The mean gestational age at delivery for all parturients from group II was 33.1 +/- 2.1 weeks (P < .05). Group I neonates had lower birth weights (972 versus 1889 g; P < .001) and higher rates of low 5-minute Apgar scores and neonatal intensive care unit admissions compared with group II neonates. The sensitivity of a shorter cervix as a predictor of preterm labor was 75%, with specificity of 90%, a positive predictive value of 83%, and a negative predictive value of 81%. CONCLUSIONS: Cervical length of less than 25 mm at 14 to 20 weeks' gestation is associated with preterm delivery and adverse perinatal outcome in triplet pregnancies.

Feasibility of nuchal translucency in triplet pregnancies.

OBJECTIVE: To assess the feasibility of nuchal translucency in triplets compared with singletons. METHODS: Nuchal translucency thickness as part of routine first-trimester screening in the general population was compared between 3128 singleton pregnancies and 51 triplets (153 fetuses). Crown-rump length was also noted. The 5th, 50th, and 95th percentiles were determined and compared between the 2 groups, and regression curves of nuchal translucency measurements plotted against crown-rump length were drawn. RESULTS: The mean nuchal translucency thickness was 1.23 mm for singletons and triplets. The 5th and 95th percentiles were also the same between the 2 studied groups. The regression curves of 5th, 50th, and 95th percentiles of nuchal translucency plotted against crown-rump length of triplets and singletons overlapped. CONCLUSIONS: Nuchal translucency values and distribution are the same in triplets and singletons, validating the utility of the cutoff values.