Efeito do tônus do corpo perineal nas disfunçõessexuais em mulheres jovens nulíparas / Effect of perineal body tone on sexual dysfunctionsin young nulliparous women

Objetivo: avaliar o tônus do corpo perineal em mulheres jovens nulíparas e correlacionar com as funções sexuais e a presença de disfunção sexual. Método: foi realizado um estudo descritivo, observacional, transversal utilizando uma amostra de conveniência incluindo mulheres adultas jovens nulíparas. A avaliação das participantes consistiu na aplicação dos questionários socioclínico, Pelvic Organ Prolaps / Urinary Incontinence Sexual Questionnaire (PISQ-12), Female Sexual Function Index (FSFI) e exame físico do tônus do corpo perineal. Os dados foram analisados pelo programa Statistical Package for the Social Sciences (SPSS®), versão 23, adotando um nível de significância de 5%. Resultados: participaram 77 mulheres jovens nulíparas (21,68 ± 2,94 anos), destas 77, 92% apresentavam vida sexual ativa e 66,03% tônus normal do corpo perineal. Dentre as alterações tônicas, o aumento do tônus predominou (33,76%). Houve alta prevalência de disfunção sexual (87,01%) pelo FSFI (23,38 ± 7,21) com maior queixa de dispareunia. Mulheres com tônus aumentado apresentaram maior disfunção sexual em relação a desejo e estímulo subjetivo (p=0,04), à excitação (p=0,01), satisfação (p=0,04) e dor ou a desconforto (p=0,03). Houve correlação inversa entre a presença de aumento do tônus e os domínios FSFI desejo e estímulo subjetivo (R= - 0,56) e excitação (R= - 0,34) e correlação direta para dor ou desconforto (R= 0,30). Conclusão: o aumento do tônus do corpo perineal piora a função sexual de mulheres jovens nulíparas.

Sexual Function Index (FSFI) and physical examination of the tone of the perineal body. The data were analyzed using the Statistical Package for the Social Sciences (SPSS®), version 23, adopting a significance level of 5%. Results: 77 young nulliparous women (21.68 ± 2.94 years) participated, of which 77, 92% had an active sexual life and 66.03% had normal tone of the perineal body. Among the tonic changes, increased tone predominated (33.76%). There was a high prevalence of sexual dysfunction (87.01%) according to the FSFI (23.38 ± 7.21) with greater complaints of dyspareunia. Women with increased tone had greater sexual dysfunction in relation to desire and subjective stimulation (p=0.04), excitement (p=0.01), satisfaction (p=0.04) and pain or discomfort (p=0.03). There was an inverse correlation between the presence of increased tone and the FSFI domains desire and subjective stimulus (R= - 0.56) and excitement (R= - 0.34) and a direct correlation for pain or discomfort (R= 0.30). Conclusion: increased perineal body tone worsens sexual function in young nulliparous women.

Associated factors of vaginal laxity and female sexual function: a cross-sectional study.

BACKGROUND: Female sexual dysfunction (FSD), including vaginal laxity (VL), can lead to a decrease in quality of life and affect partner relationships. AIM: We aimed to investigate the associated factors of VL and FSD and their relationship with other pelvic floor disorders in a female population. METHODS: This cross-sectional study was conducted at Chelsea and Westminster Hospital from July to December 2022. All women referred to clinical care at the urogynecology clinic were included. Participants were assessed according to sociodemographic and clinical aspects, the Pelvic Organ Prolapse Quantification system, sexual function, VL, sexual attitudes, sexual distress, sexual quality of life, vaginal symptoms, and pelvic floor disorders. Unadjusted and adjusted associated factors of VL and FSD were analyzed. OUTCOMES: The primary outcome was the identification of the associated factors of VL and FSD in a female population, and secondary outcomes included the association between VL and pelvic organ prolapse (POP) with the questionnaire scores. RESULTS: Among participants (N = 300), vaginal delivery, multiparity, perineal laceration, menopause, and gel hormone were significantly more frequent in those reporting VL (all P < .05). When compared with nulliparity, primiparity and multiparity increased the odds of VL by approximately 4 and 12 times, respectively (unadjusted odds ratio [OR], 4.26 [95% CI, 2.05-8.85]; OR, 12.77 [95% CI, 6.53-24.96]). Menopause and perineal laceration increased the odds of VL by 4 and 6 times (unadjusted OR, 4.65 [95% CI, 2.73-7.93]; OR, 6.13 [95% CI, 3.58-10.49]). In multivariate analysis, menopause, primiparity, multiparity, and POP remained associated with VL. CLINICAL IMPLICATIONS: Parity, as an obstetric factor, and menopause and staging of POP, as clinical factors, were associated with VL. STRENGTHS AND LIMITATIONS: The investigation of associated factors for VL will contribute to the understanding of its pathophysiology. The study design makes it impossible to carry out causal inference. CONCLUSION: Menopause, primiparity, multiparity, and POP were highly associated with VL complaints in multivariate analysis.

Pelvic Floor Dysfunction in Transgender Men on Gender-affirming Hormone Therapy: A Descriptive Cross-sectional Study.

INTRODUCTION AND HYPOTHESIS: The objective of this research is to explore the effects of hormone therapy using testosterone on pelvic floor dysfunction (PFD) in transgender men. We hypothesize that PFD might be prevalent among transgender men undergoing hormone therapy. Therefore, this study was aimed at verifying the frequency of these dysfunctions. METHODS: A cross-sectional study was conducted between September 2022 and March 2023 using an online questionnaire, which included transgender men over 18 years old who underwent gender-affirming hormone therapy. Volunteers with neurological disease, previous urogynecology surgery, active urinary tract infection, and individuals without access to the internet were excluded. The questionnaire employed validated tools to assess urinary symptoms, such as urinary incontinence (UI), as well as sexual dysfunction, anorectal symptoms, and constipation. The data were analyzed descriptively and presented as frequencies and prevalence ratios with their respective confidence intervals (95% CI), mean, and standard deviation. RESULTS: A total of 68 transgender men were included. Most participants had storage symptoms (69.1%), sexual dysfunction (52.9%), anorectal symptoms (45.6%), and flatal incontinence (39.7%). Participants with UI symptoms reported moderate severity of the condition. CONCLUSIONS: Transgender men on hormone therapy have a high incidence of PFD (94.1%) and experience a greater occurrence of urinary symptoms (86.7%).

Pelvic floor therapy program for the treatment of female urinary incontinence in Belize: a pilot study.

Introduction: Urinary incontinence (UI) is highly prevalent in low- and middle-income countries (LMIC). Concurrently, the availability of surgical or conservative UI treatments in LMIC is limited. Methods: We conducted a prospective feasibility study of Belize women with UI treated with pelvic floor physical therapy (PFPT) and education (PFE). Patients received individual PFPT/PFE over 2 days, consisting of biofeedback-enhanced PFMT in addition to behavioral, dietary, and general pelvic education. Patient completed a daily 6-month home regimen including 7 PFMT exercises (total 70 repetitions) comprising both endurance and quick flick exercises. Patients also performed comprehensive dietary and behavioral modification activities. Outcomes were assessed at baseline and 6-months, including validated symptom (ICIQ-FLUTS) and QOL (IIQ-7) questionnaires, and strength testing (PERFECT score, perineometry). Results: Twenty-eight patients underwent baseline assessment. Four patients were lost to in-person 6-month follow-up, with two of these patients completing subjective assessment only by telephone. The mean (±SD) patient age, BMI, and parity were 50.0 (±10.0) years, 33.2 (±5.8), and 2.8 (±1.5). Provider assessment demonstrated patient comprehension of basic, endurance, and quick flick pelvic floor contractions in 28 (100%), 24 (86%), and 24 (86%) patients, respectively. At 6-month follow-up, significant improvements were seen across multiple validated questionnaire and strength measurement assessments. Median patient-reported improvement level was 7.0 on a 10-point Likert scale. Discussion: Study patients demonstrated good understanding of PFMT/PFE and program completion was associated with significant improvements across a variety of subjective incontinence and quality of life outcomes, as well as objective strength testing.

Effects of health education on women with urinary incontinence: systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: The objective was to investigate the effects of health education (HE) on urinary symptoms and quality of life in women with urinary incontinence (UI). METHODS: A systematic review and meta-analysis of trials evaluating HE for women with UI. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. RESULTS: The search identified 5,118 articles. Eighteen papers were considered eligible. The interventions investigated included health education (HE), combined intervention, self-management (SM), and structured training (ST). Outcomes included quality of life (QoL), UI frequency, UI severity, impression of improvement, incontinence symptoms, urine leakage, fear of leakage, urgency, and incontinence impact. Compared with the control group there was a significant improvement in the frequency, severity, and impact on the QoL for women with UI (assessed by the total score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ SF); RR = -1.47, 95% CI [-2.07, -0.88]; two trials; low certainty of the evidence). CONCLUSIONS: This review shows that HE seems to be beneficial in the treatment of women with UI when compared with control women (no treatment or general health care), improving the frequency, severity, and impact on QoL assessed by the ICIQ SF total score. However, the certainty of this evidence is low.

Botulinum-toxin-A injection following conservative management in patients with dyssynergic defaecation only improves symptoms in the short term: a retrospective study

Objective: Dyssynergic defaecation (DD) is an important cause of chronic constipation. In patients where conservative treatments fail, injections of botulinum toxin A (BTX-A) into the puborectalis and anal sphincter muscles can be effective. Complications of this procedure are reported to be rare and generally mild. This study aimed to identify the complication rates and short- to medium-term success rates of BTX-A injections as a treatment for DD. Methods: A retrospective review was conducted on patients diagnosed with DD who had undergone BTX-A injections at a functional colorectal unit. Patient demographics, manometric assessment, conservative management, and injection technique were collected through a chart review. Subjective patient reports and comparison of pre- and postprocedure symptom scores were used to determine efficacy. Results: The 21 patients included (24 procedures, with 3 patients receiving BTX-A on two separate occasions) all received stool modification and dietary advice, and 20 patients underwent pelvic floor physiotherapy, averaging 8 sessions. The injections were universally applied under general anesthetic, primarily targeting the anal sphincter and/or puborectalis muscles. There were 6 reports of faecal urge/incontinence, with all but one being resolved within weeks. The BTX-A injection was subjectively reported as beneficial in 19 cases, averaging 4.7 months (range 1-32) of improvement. Only 2 were sustained beyond 12 months. Despite overall improvements in symptom scores from pre- to postprocedure, none were statistically significant. Conclusion: Following a course of conservative management, the BTX-A injection appears to be a safe treatment for DD, but only has short term efficacy. (AU)

Prevalence and factors associated with the perception of perineal laceration: a cross-sectional study with data from the Nascer no Brasil Survey, 2011 and 2012 / Prevalencia y factores asociados a la percepción de laceración perineal: estudio transversal con datos de la Encuesta Nascer no Brasil, 2011 y 2012 / Prevalência e fatores associados à percepção da laceração perineal: estudo transversal com dados do Inquérito Nascer no Brasil, 2011 e 2012

Abstract Objective: To describe the prevalence of perineal laceration, based on the self-reported perception of postpartum women, and to analyze factors associated with its occurrence in Brazil. Methods: This was a cross-sectional study conducted with 23,894 postpartum women, excluding twin pregnancies, cesarean sections, and births with episiotomies, between 2011 and 2012. Prevalence ratios (PR) and 95% confidence intervals (95%CI) of association between the event and maternal, fetus/newborn, obstetric and clinical management characteristics were estimated in hierarchical Poisson regression models. Results: Out of 4,606 postpartum women, 49.5% (95%CI 46.1;42.9) self-reported perineal laceration. Being an adolescent (PR = 1.12; 95%CI 1.02;1.25), primipara (PR = 1.47; 95%CI 1.33;1.63), having had excessive gestational weight gain (PR = 1.17; 95%CI 1.07;1.29) and having undergone the Kristeller maneuver (PR = 1.18; 95%CI 1.08;1.29) increased the proportion of the outcome. Conclusion: The results found call for prenatal care and adjustments to childbirth care so as to be in accordance with current recommendations.

Resumen Objetivo: Describir la prevalencia de laceración perineal, a partir de la percepción autoinformada de puérperas, y analizar los factores asociados a su aparición en Brasil. Métodos: Estudio transversal entre 2011 y 2012, con 23.894 puérperas, excluyendo embarazos gemelares, cesáreas y partos con episiotomías. Se estimaron razones de prevalencia (RP) e intervalos de confianza del 95% (IC95%) de la asociación entre el evento y las características maternas, feto/recién nacido, obstétricas y de manejo clínico en modelos de regresión jerárquica de Poisson. Resultados: Entre 4.606 mujeres en posparto, el 49,5%(IC95%:46,1;42,9) informó laceración perineal. Ser adolescente (RP = 1,12; IC95% 1,02;1,25), primipara (RP = 1,47; IC95% 1,33;1,63), haber tenido aumento excesivo de peso gestacional (RP = 1,17; IC95% 1,07;1,29) y haber sido sometido a la maniobra de Kristeller (RP = 1,18; IC95% 1,08;1,29) aumentó la proporción de resultados. Conclusión: Los resultados encontrados requieren atención prenatal y ajustes en la atención del parto de acuerdo con las recomendaciones actuales.

Resumo Objetivo: Descrever a prevalência da laceração perineal segundo a percepção autorrelatada da puérpera, e analisar os fatores associados à sua ocorrência no Brasil. Métodos: Estudo transversal conduzido em 23.894 puérperas, excluindo-se gestações gemelares, cesarianas e partos com episiotomias entre 2011 e 2012. Razões de prevalência (RP) e intervalos de confiança de 95% (IC95%) da associação entre o evento e as características maternas, feto/recém-nato, obstétricas e manejo clínico foram estimadas em modelos de regressão de Poisson hierarquizados. Resultados: Entre 4.606 puérperas, 49,5% (IC95% 46,1;42,9) autorrelataram laceração perineal. Ser adolescente (RP = 1,12; IC95% 1,02;1,25), primípara (RP = 1,47; IC95% 1,33;1,63), ter tido ganho de peso gestacional excessivo (RP = 1,17; IC95% 1,07;1,29) e ter sido submetida à manobra de Kristeller (RP = 1,18; IC95% 1,08;1,29) elevaram a proporção do desfecho. Conclusão: Os resultados encontrados demandam atenção pré-natal e adequações na assistência ao parto conforme recomendações vigentes.

Prevalence of pelvic floor disorders and the associated quality of life among institutionalized and noninstitutionalized elderly women: A cross-sectional study.

Background: An increase in life expectancy has led to an increased elderly population. In turn, this aging population is more likely to develop health conditions, such as pelvic floor disorders (PFDs). This study aimed to assess the prevalence of these disorders and the associated quality of life in institutionalized and noninstitutionalized elderly women. Materials and methods: A cross-sectional study was conducted with 80 female participants older than 60 years, divided into 2 groups: institutionalized and noninstitutionalized participants. The Pelvic Floor Distress Inventory Short-Form and a sociodemographic questionnaire were used. A chi-squared test was used to assess the differences in prevalence between groups. Results: There was no statistically significant difference between the groups in the prevalence of PFDs or quality of life. In this study, the prevalence of PFDs was higher than that reported previously. In institutionalized women, a higher prevalence of PFDs and impaired quality of life were expected, although not observed. Conclusions: There was a higher prevalence of pelvic disorders and impaired quality of life due to these disorders in elderly women.

Functional outcomes and satisfaction rates of sacral nerve stimulation in the treatment of one and multiples pelvic floor dysfunctions

Objective: Few studies have addressed the use of sacral nerve stimulation (SNS) in the treatment of patients with multiple pelvic floor dysfunctions (PFD). So, we evaluated the functional outcomes and level of satisfaction with SNS in selected patients with one or multiples PFD. Methods: A prospective database was used to collect information on eligible patients treated for PFD with SNS, and severity of symptoms was assessed with scores and satisfaction rates by visual analogue scale (VAS) at baseline and by the end of follow-up. Results: We recruited 70 patients, 98.6% of whom responded positively during the evaluation period (Global Response Assessment ≥ 50% for at least one type of PFD), resulting in the implantation of a permanent SNS device. Additionally, 49 of the patients (71%) had a single PFD (fecal incontinence [FI] = 38; constipation/obstructed defecation syndrome [C/ODS] = 11), while 20 (29%) had more than one PFD (double incontinence/n = 12; double incontinence + C/ODS/n = 8). All scores improved significantly between baseline (pre-SNS) and the end of follow-up (post-SNS), as did VAS in all groups (single and multiple PFD). The pre-SNS scores were higher in patients with a single PFD, including FI (Cleveland clinic Florida incontinence score [CCF-FI]) and C/ODS (Cleveland clinic constipation score [C-CCF] and the Renzi ODS score). The pre-SNS impact of VAS scores was similar in all groups (single and multiple PFD), but the VAS (post-SNS) was significantly lower (better response) for FI alone compared with multiple PFD. Conclusion: The SNS technique is an effective and safe option for patients with one or more PFD refractory to conservative measures. Response was positive for at least two PFD, based on reduced correspondent scores and satisfaction rate. (AU)

Adherencias del capuchón del clítoris al glande: una condición poco estudiada y poco examinada / Clitoral hood adhesions to the glans penis: an understudied and under-examined condition

INTRODUCCIÓN: El clítoris es una de las estructuras vulvares menos examinadas, pese a su relevancia en la vida sexual y sus importantes relaciones anatómicas. Las adherencias del capuchón del clítoris han sido descritas y clasificadas según la exposición del glande, siendo relacionadas con trastornos del deseo sexual. La inervación del clítoris depende de raíces de S3-S4, siendo posible que síntomas frecuentes del piso pélvico tengan relación con esta condición. Realizamos un análisis retrospectivo de pacientes de policlínico de piso pélvico entre noviembre de 2021 y abril de 2022. Se incluyeron 100 pacientes con adherencias al ingreso. RESULTADOS: Promedio de edad 45,8 ± 15,5 años. Las adherencias fueron el 19% leves, el 62% moderadas y el 18% graves. Los principales síntomas eran mal vaciado vesical (38%), dolor (28%), disfunción sexual (39%) y síntomas irritativos vesicales (43%); solo una paciente fue asintomática. El área visible promedio del clítoris era de 20,7 ± 13,7 mm2. CONCLUSIONES: Las adherencias del capuchón del clítoris son un hallazgo común, muchas veces no diagnosticadas, por lo que su evaluación debe ser parte de la exploración física. Pueden asociarse a sintomatología de piso pélvico.

INTRODUCTION: The clitoris is one of the least examined vulvar structures despite its relevance in sexual life and important anatomical relationships. Clitoral hood adhesions have been described in the literature, classified based on glans exposure, and related to sexual desire disorders. The innervation of the clitoris depends on the roots of S3-S4, and frequent pelvic floor symptoms may be associated with this condition. We retrospectively analyzed the clinical record of patients admitted to a pelvic floor clinic between November 2021 and April 2022. One hundred patients with adhesions at the time of admission were registered. RESULTS: Average 45.8 ± 15.5 years. Clitoral hood adhesions were mild (19%), moderated (62%), or severe (18%). The main symptoms were voiding dysfunction symptoms (38%), pain (28%), sexual dysfunction (39%), and irritative bladder symptoms (43%); only one patient was asymptomatic. The visible area of the clitoris was 20.7 ± 13.7 mm2. CONCLUSIONS: Adhesions of the clitoral hood are often undiagnosed, and its analysis should be part of the physical exam. Clitoral hood adhesions could be associated with pelvic floor symptoms.

Multivisceral transplantation of pelvic organs in rats.

Background: Multivisceral transplantation of pelvic organs would be a potential treatment for severe pelvic floor dysfunction with fecal and urinary incontinence, extensive perineal trauma, or congenital disorders. Here, we describe the microsurgical technique of multivisceral transplantation of pelvic organs, including the pelvic floor, in rats. Donor operation: We performed a perineal (including the genitalia, anus, muscles, and ligaments) and abdominal incision. The dissection progressed near the pelvic ring, dividing ligaments, muscles, external iliac vessels, and pudendal nerves, allowing pelvic floor mobilization. The aorta and vena cava were isolated distally, preserving the internal iliac and gonadal vessels. The graft containing the skin, muscles, ligaments, bladder, ureter, rectum, anus and vagina, uterus and ovarian (female), or penile, testis and its ducts (male) was removed en bloc, flushed, and cold-stored. Recipient operation: The infrarenal aorta and vena cava were isolated and donor/recipient aorta-aorta and cava-cava end-to-side microanastomoses were performed. After pelvic floor and viscera removal, we performed microanastomoses between the donor and the recipient ureter, and the rectum and pudenda nerves. The pelvic floor was repositioned in its original position (orthotopic model) or the abdominal wall (heterotopic model). We sacrificed the animals 2 h after surgery. Results: We performed seven orthotopic and four heterotopic transplantations. One animal from the orthotopic model and one from the heterotopic model died because of technical failure. Six orthotopic and three heterotopic recipients survived up to 2 h after transplantation. Conclusion: The microsurgical technique for pelvic floor transplantation in rats is feasible, achieving an early survival rate of 81.82%.

Impact of a Community-Based Pelvic Floor Kinesic Rehabilitation Program on the Quality of Life of Chilean Adult Women with Urinary Incontinence.

The pelvic floor forms the primary bottom tissue of the pelvic cavity. It comprises muscles that play a fundamental role in bowel and bladder emptying. Alterations of pelvic floor muscles will result in dysfunctions such as urinary incontinence (UI). Given the high prevalence of UI and its impact on the quality of life (QoL) in patients with pelvic floor muscle dysfunctions, it is necessary to implement public, community, and generalized programs focused on treating these dysfunctions. OBJECTIVE: To determine the effect of a community rehabilitation program on QoL, UI severity, and pelvic floor muscle strength in patients with UI. PATIENTS AND METHOD: A descriptive prospective cohort study. Twenty subjects between 44 and 75 years old with a diagnosis of UI, participants of a community kinesic rehabilitation program on the pelvic floor in Maipú, Santiago, Chile, were evaluated. These volunteers were intervened for six months, and QoL was measured with the 36-Item Short-Form Health Survey (SF-36) and International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) scales, UI severity with the Sandvick test, and pelvic floor muscle strength with the Oxford scale. Patients were followed up three months post-intervention. RESULTS: Significant improvements were observed in all scales after applying for the community kinesic rehabilitation program, and the changes were maintained at a 3-month follow-up. CONCLUSIONS: Since the improvement in QoL, UI severity, and pelvic floor muscle strength after the intervention, it is relevant to consider the implementation of community programs aimed at education, screening, and early rehabilitation of these patients.

Sensory and muscular functions of the pelvic floor in women with endometriosis - cross-sectional study.

PURPOSE: The aim of this study was to analyze the sensory and muscle functions of the pelvic floor in women with endometriosis, trying to improve overall knowledge/findings regarding pelvic floor muscle functions in patients with endometriosis. METHODS: Sample size calculated as 92 patients with endometriosis, aged between 18 and 45 years, not virgin, without other causes of pain and could not be pregnant. Patients underwent the Pelvic Floor Sensorial and Muscle Function Exam (EFSMAP). Descriptive data were recorded with mean and standard deviation, median (range), and absolute and relative frequency. The Kolmogorov-Smirnov test was used to observe the normality of quantitative variables. The significance level adopted for this study was 5%. RESULTS: Of 92 women assessed, 93.3% had pain and 75% had increased tone in the levator ani muscle; 50.4% had impaired pelvic floor relaxation with median strength of 3 by the Oxford scale and endurance of 2 s. CONCLUSIONS: The patients had a high prevalence of pain and dysfunction of the pelvic floor muscles, such as low muscle endurance and difficulty to relax. It shows that these patients should be referred to a pelvic floor physiotherapist, as soon as they have the diagnosis of endometriosis, to be assessed to prevent and/or treat pelvic floor impairments.

Pelvic floor dysfunctions in women with fibromyalgia: A cross-sectional study.

BACKGROUND: Fibromyalgia (FM) is a rheumatic syndrome that causes musculoskeletal disorders and is associated with several problems that affect quality of life. As the musculoskeletal system is affected, it can have an impact on the pelvic floor muscles, leading to pelvic floor dysfunction (PFD). OBJECTIVE: Investigate the occurrence of PFD, such as urinary incontinence (UI) and anal incontinence (AI), sexual problems, and pelvic organ prolapse (POP), in women with FM compared to a control group composed of women without FM; and investigate the association between FM and PFD. STUDY DESIGN: This was an online cross-sectional survey. Demographic and anthropometric data, the description of PFD (UI, nocturia, AI, genital-pelvic pain/penetration disorder, and POP), and previous obstetric history were collected through a web-based questionnaire. The groups were compared using the independent t-test for quantitative variables and the chi-square test for categorical variables. The association between FM and PFD was tested using logistic regression analysis. RESULTS: A total of 175 women answered the questionnaire (97 with FM and 78 healthy controls). The women with FM reported significantly more UI, mixed urinary incontinence, AI, POP, and vaginismus than the healthy controls (p ≤ 0.05). FM was associated with mixed urinary incontinence (OR: 2.6; 95 % CI: 1.1-6.4; p = 0.04), anal incontinence (OR: 2.9; 95 % CI: 1.3-6.1; p = 0.01), and flatus incontinence (OR: 2.6; 95 % CI: 1.2-5.4; p = 0.01). CONCLUSION: The prevalence of PFD was significantly higher in women with FM compared to healthy women. Indeed, the women with FM were 2.6-fold to 2.9-fold more likely to report mixed urinary incontinence, anal and flatus incontinence than those in the control group. The present findings show possible impairment of the pelvic floor musculature in women with FM.

Pelvic floor dysfunctions in women with systemic lupus erythematosus: A cross-sectional study.

INTRODUCTION AND HYPOTHESIS: As a result of the impairment of the musculoskeletal system, the pelvic floor muscles are likely compromised in women with systemic lupus erythematosus (SLE). We hypothesized that women with SLE would report more symptoms of pelvic floor dysfunction (PFD) and there will be an association between SLE and PFD. METHODS: An online cross-sectional survey was conducted. Data were collected on demographic and anthropometric characteristics, PFD (urinary incontinence, nocturia, anal incontinence, genital-pelvic pain/penetration disorder and pelvic organ prolapse) and obstetric history using a web-based questionnaire. The groups were compared using the Mann-Whitney test for quantitative variables and the chi-squared test for categorical variables. The association between SLE and PFD was tested using logistic regression analysis. RESULTS: A total of 196 women answered the questionnaire (102 with SLE and 94 healthy controls). Women with SLE reported significantly more urinary incontinence, nocturia, anal incontinence, pelvic organ prolapse and genital-pelvic pain/penetration disorder than the healthy controls (p ≤ 0.05). Women with SLE were 2.8- to 3.0-fold more likely to report genital-pelvic pain/penetration disorder than healthy women. CONCLUSIONS: The prevalence of PFD was significantly higher in women with SLE compared to healthy women. Thus, PFD seems to be an important problem in women with this disease. An in-depth investigation of these disorders could contribute to the understanding of how SLE impacts pelvic floor function.

Implementing telemedicine in urogynecology: A feasibility study.

INTRODUCTION AND HYPOTHESIS: Telemedicine has been recommended for the management of urogynecological conditions during the coronavirus (COVID 19) pandemic. This study aimed to evaluate the feasibility of telemedicine for urogynecology at a Brazilian public hospital. METHODS: A descriptive observational study was performed at a urogynecology outpatient clinic. The primary outcome was the desire to continue with telemedicine. Secondary outcomes were appointment resolvability, technical aspects of the appointment, and patient satisfaction. The participants had in-person appointments that were canceled because of the COVID-19 pandemic. We collected data on sociodemographic characteristics and clinical and technical aspects of the appointments. The participants responded to satisfaction questionnaires 7-15 days post-procedure. The categorical variables were evaluated based on absolute and relative frequency. The continuous variables were described as the mean and standard deviation. A chi-square test was performed to determine the association between variables. RESULTS: In total, 225 patients had appointments canceled due to the COVID-19 pandemic, of which 171 were eligible for the study. Telemedicine appointments were agreed upon by 48% of the participants and 85.5% responded to the satisfaction survey. We found that 57.7% of the participants desired to continue with telemedicine. The appointment resolvability rate was 76.1%, 63.4% of the appointments met the technical criteria, and the satisfaction rate was 93%. The only variable associated with the desire to continue telemedicine was overall patient satisfaction (p=0.02). CONCLUSIONS: Telemedicine in urogynecology is feasible and can be implemented in the studied population. However, actions are essential to adequately support patient preference and improve the acceptance of telemedicine.

Efficacy of Sacrospinous Fixation or Uterosacral Ligament Suspension for Pelvic Organ Prolapse in Stages III and IV: Randomized Clinical Trial / Eficácia da fixação sacroespinhal ou da suspensão do ligamento útero-sacro no prolapso de órgãos pélvicos nos estágios III e IV: Ensaio clínico randomizado

Abstract Objective To evaluate the efficacy and outcomes of the surgical treatment for pelvic organ prolapse (POP) in stages III and IV by sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (USLS) by comparing anatomical and subjective cure rates and quality-of-life parameters (through the version validated for the Portuguese language of the Prolapse Quality of Life [P-QoL] questionnaire) under two definitions: genital prolapse Ba, Bp, and C< −1 (stage I) and Ba, Bp, and C ≤ 0 (stage II). Materials and Methods After we obtained approval from the Ethics Committee (under CAAE 0833/06) and registered the study in ClinicalTrials.gov (NCT 01347021), 51 patients were randomized into two groups: the USLS group (N = 26) and the SSLF group (N = 25), with follow-up 6 and 12 months after the procedures. Results There was a significant improvement in the P-QoL score and anatomical measurements of all compartments in both groups after 12 months (p< 0.001). The anatomical cure rates in the USLS and SSLF groups, considering stage 1, were of 34.6% and 40% (anterior) respectively; of 100% both for groups (apical); and of 73.1% and 92% (posterior) respectively. The rates of adverse outcomes were of 42% (N = 11) and 36% (N = 11) for the USLS and SSLF groups respectively (p= 0.654), and those outcomes were excessive bleeding, bladder perforation (intraoperative) or gluteal pain, and urinary infection (postoperative), among others, without differences between the groups. Conclusion High cure rates in all compartments were observed according to the anatomical criterion (stage I), without differences in P-QoL scores and complications either with USLS or SSLF for the surgical treatment of accentuated POP.

Resumo Objetivo Avaliar a eficácia e os resultados do tratamento cirúrgico para prolapso de órgãos pélvicos (POP) nos estágios III e IV, por meio da técnica de fixação do ligamento sacroespinal (FLSE) ou suspensão do ligamento útero-sacro (SLUS), ao comparar os índices de cura anatômicos, subjetivos, e os parâmetros de qualidade de vida (por meio do questionário Prolapse Quality of Life [P-QoL] validado para a língua portuguesa) sob duas definições: prolapso genital Ba, Bp e C< −1 (estágio I) e Ba, Bp e C ≤ 0 (estágio II). Materiais e Métodos Após aprovação do Comitê de Ética (CAAE 0833/06) e registro no ClinicalTrials.gov (NCT 01347021), 51 pacientes foram randomizadas em dois grupos: grupo SLUS (N = 26) e (2) grupo FLSE (N = 25), com seguimento de 6 e 12 meses. Resultados Houve melhora significativa nas pontuações no P-QoL e nas medidas anatômicas de todos os compartimentos em ambos os grupos após 12 meses (p< 0,001). As taxas de cura anatômica nos grupos SLUS e FLSE , considerando o estágio 1, foram de 34,6% e 40% (anterior), respectivamente; de 100% em ambos os grupos (apical); e de 73,1% e 92% (posterior), respectivamente. As taxas de resultados adversos foram de 42% (N = 11) e 36% (N = 11), respectivamente, nos grupos SLUS e FLSE (p= 0,654), e elas foram sangramento excessivo, perfuração da bexiga (intraoperatória) ou dor glútea, e infecção urinária (pós-operatória), entre outras, sem diferenças entre os grupos. Conclusão Altas taxas de cura em todos os compartimentos foram observadas segundo critério anatômico (estágio I), sem diferença quanto às pontuações no P-QoL e às complicações tanto com SLUS quanto com FLSE para o tratamento cirúrgico de POP acentuado.

EFETIVIDADE DO APLICATIVO IPELVIS® NA REABILITAÇÃO DE PACIENTES COM INCONTINÊNCIA URINÁRIA: UM ENSAIO-CLÍNICO ALEATORIZADO / EFFECTIVENESS OF THE IPELVIS® APPLICATION IN THE REHABILITATION OF PATIENTS WITH URINARY INCONTINENCE: A RANDOMIZED CLINICAL TRIAL

Objetivo: Verificar a efetividade do aplicativo Ipelvis® na reabilitação de pacientes com incontinência urinária comparada com a fisioterapia pélvica convencional e domiciliar. Metodologia: Trata-se de um ensaio-clínico aleatorizado realizado 20 mulheres que apresentavam sintomas de incontinência urinária. Foram utilizados os instrumentos para avaliar antes e após a intervenção: The 3 Incontinence Questions, International Consultation on Incontinence Questionnaire ­ Short Form e Qualidade de vida medida pelo King's Health Questionnaire. As participantes foram divididas aleatoriamente em grupos e receberam orientações de tratamento domiciliar por três meses, com o Grupo 1 utilizando o aplicativo como tratamento domiciliar e o Grupo 2, utilizou uma folha convencional com exercícios terapêuticos. Os dados foram analisados por meio da estatística descritiva. Resultados: Após intervenção, 85% das pacientes não apresentaram nenhum sintoma de incontinência, 10% apresentaram Incontinência urinária de esforço, 5% de Incontinência urinária de urgência e nenhuma paciente apresentou Incontinência urinária de mista, evidenciando a melhora do quadro das pacientes com incontinência urinária posteriormente à realização dos exercícios terapêuticos de assoalho pélvico em ambos os grupos. Conclusão: Os exercícios terapêuticos de assoalho pélvico foram eficazes para pacientes com incontinência urinária em ambos os grupos, mas os resultados foram mais eficazes no método de tratamento digital, por meio do aplicativo Ipelvis® quando comparado com o método tradicional por meio da folha.

Objective: To verify the effectiveness of the Ipelvis® application in the rehabilitation of patients with urinary incontinence compared to conventional and home pelvic physiotherapy. Methodology: This is a randomized clinical trial carried out with 20 women who had symptoms of urinary incontinence. The following instruments were used to assess before and after the intervention: The 3 Incontinence Questions, International Consultation on Incontinence Questionnaire ­ Short Form and Quality of life measured by the King's Health Questionnaire. Participants were randomly divided into groups and received home treatment guidelines for three months, with Group 1 using the app as home treatment and Group 2 using a conventional sheet with therapeutic exercises. Data were analyzed using descriptive statistics. Results: After the intervention, 85% of the patients had no symptoms of incontinence, 10% had stress urinary incontinence, 5% had urge urinary incontinence and no patient had mixed urinary incontinence, showing the improvement in the condition of patients with urinary incontinence. after performing therapeutic pelvic floor exercises in both groups. Conclusion: Therapeutic pelvic floor exercises were effective for patients with urinary incontinence in both groups, but the results were more effective in the digital treatment method, through the Ipelvis® application, when compared to the traditional method through the sheet.

Assessment of Pelvic Floor Disorders due to the Gestational Diabetes Mellitus Using Three-Dimensional Ultrasonography: A Narrative Review / Avaliação das desordens do assoalho pélvico decorrentes do diabetes gestacional usando a ultrassonografia tridimensional: Uma revisão narrativa

Abstract Gestational diabetes mellitus (GDM)is an entity with evolving conceptual nuances that deserve full consideration. Gestational diabetes leads to complications and adverse effects on the mother's and infants' health during and after pregnancy. Women also have a higher prevalence of urinary incontinence (UI) related to the hyperglycemic status during pregnancy. However, the exact pathophysiological mechanism is still uncertain. We conducted a narrative review discussing the impact of GDM on the women's pelvic floor and performed image assessment using three-dimensional ultrasonography to evaluate and predict future UI.

Resumo O diabetes gestacional (DG)é uma entidade com nuances conceituais em evolução que merecem total consideração. O DG leva a complicações e efeitos adversos na saúde da mãe e do bebê durante e após a gravidez. As mulheres também apresentam maior prevalência de incontinência urinária (IU) relacionada ao estado hiperglicêmico durante a gravidez. No entanto, o mecanismo fisiopatológico exato ainda é incerto. Realizamos uma revisão narrativa discutindo o impacto do DG no assoalho pélvico das mulheres e utilizamos o exame de ultrassonografia tridimensional para avaliar e predizer a ocorrência de IU.

Efectividad de la Terapia Física en la Disfunción Eréctil Posterior a Prostatectomía Radical: Scoping Review / Effectiveness of Physical Therapy in Erectile Dysfunction Following Radical Prostatectomy: Scoping Review

Introducción. El cáncer de próstata es una patología con alta prevalencia, la prostatectomía radical es la técnica quirúrgica utilizada y la disfunción eréctil es una de las secuelas más frecuentes de ésta. En la actualidad existen diferentes intervenciones en el manejo de la disfunción eréctil. La literatura refiere como tratamiento de primera línea el uso de inhibidores de la fosfodiesterasa-5, también se describe que el uso de terapia física podría potenciar la mejora de la disfunción eréctil en conjunto con el tratamiento farmacológico. Objetivo. Identificar y describir la evidencia científica disponible referente a la efectividad de la terapia física en pacientes con disfunción eréctil posterior a una prostatectomía. Métodos. Se realizó una búsqueda en Pubmed, LILACS, Cochrane Library, de artículos publicados entre el 2012 y 2022. Se seleccionaron los relacionados con los efectos de la terapia física en la disfunción eréctil posterior a prostatectomía Resultados: En esta revisión se incluyeron 9 estudios. La mayoría demostró mejoras en la disfunción eréctil con la aplicación de la terapia de ondas de choque extracorpóreas de baja intensidad y entrenamiento muscular de piso pélvico, combinada con el tratamiento farmacológico. Conclusión. Debido a la alta prevalencia de la disfunción eréctil posterior a prostatectomía radical y a la escasa evidencia existente, se sugieren más investigaciones en el área, con diseños metodológicamente rigurosos, que incluyan un mayor tamaño de muestra y profundicen en la creación protocolos de rehabilitación y su posterior seguimiento.

Background. Prostate cancer is a pathology with high prevalence, radical prostatectomy is the surgical technique used and erectile dysfunction is one of the most frequent sequelae of this. Currently there are different interventions in the management of erectile dysfunction. The literature refers as first line treatment the use of phosphodiesterase-5 inhibitors, it is also described that the use of physical therapy could enhance the improvement of erectile dysfunction in conjunction with pharmacological treatment. Objective. To identify and describe the available scientific evidence regarding the effectiveness of physical therapy in patients with erectile dysfunction following prostatectomy. Methods. A search was performed in Pubmed, LILACS, Cochrane Library, of articles published between 2012 and 2022. Those related to the effects of physical therapy on post-prostatectomy erectile dysfunction were selected Results. 9 studies were included in this review. Most demonstrated improvements in erectile dysfunction with the application of low-intensity extracorporeal shock wave therapy and pelvic floor muscle training combined with pharmacological treatment. Conclusion. Due to the high prevalence of erectile dysfunction after radical prostatectomy and the scarce existing evidence, more research is suggested in this area, with methodologically rigorous designs, including a larger sample size and deepening in the creation of rehabilitation protocols and their subsequent follow-up.