Painful love-"hispareunia" after sling erosion of the female partner.

INTRODUCTION: Sling erosion/extrusion is a complication after suburethral sling insertion for female stress urinary incontinence that occurs in approximately 6% of patients. Symptoms may include vaginal discharge, infections, postcoital bleeding, and alterations of the sexual function. Little is known about the effect of sling erosion on the sexual function of the male partner. AIM: The aim of this study was to determine male sexual function in partners of women who had undergone sling insertion for stress urinary incontinence and who developed sling erosion postoperatively. MAIN OUTCOME MEASURES: Main outcome measures were the Brief Male Sexual Function Inventory (BMSFI) and visual analog scale (VAS) scores. METHODS: Male partners of patients who presented with sling erosion for various reasons were addressed and asked to fill in the BMSFI and assess sexual pain using the VAS before and 6 months after the sling erosion of their female partners was treated. Participants gave informed consent and those who had undergone prostate surgery during the past 12 months were excluded. For statistical analyses, SPSS version 10.0 (SPSS Inc., Chicago, IL, USA) was used. RESULTS: Thirty-two males were included in the study and produced a full set of data. VAS scores as a measurement for "hispareunia" improved from a median score of 8 before to a median score of 1 after intervention. Some domains of male sexual function (sexual interest, sexual drive, ejaculation, and erection) were significantly improved whereas the strength of erection, problems with ejaculation, and problems with lack of interest were not statistically significantly changed. CONCLUSIONS: Changes of male sexual function and particularly pain after sling insertion in their female partners may be due to sling exposure. Sexual interest and drive may be negatively influenced. Male dyspareunia is a complaint that can be treated effectively by correcting the sling exposure.

Evidence for benefits from treating cervical ectopy: literature review.

CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS: The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS: The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no evidence of an association between ectopy and cervical cancer, or of protection against cervical cancer associated with ectopy treatment. CONCLUSIONS: 1) No data were found in the medical literature to support routine treatment for ectopy; 2) Treatment could be recommended for symptom relief, but more symptoms are attributed to ectopy than could be demonstrated in a controlled study; 3) Further studies to test the hypothesis of protection against cervical cancer associated with treatment are necessary.

Evidence for benefits from treating cervical ectopy: literature review / Evidências de benefícios no tratamento de ectopia do colo do útero: revisão de literatura

CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS: The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS: The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no evidence of an association between ectopy and cervical cancer, or of protection against cervical cancer associated with ectopy treatment. CONCLUSIONS: 1) No data were found in the medical literature to support routine treatment for ectopy; 2) Treatment could be recommended for symptom relief, but more symptoms are attributed to ectopy than could be demonstrated in a controlled study; 3) Further studies to test the hypothesis of protection against cervical cancer associated with treatment are necessary.

CONTEXTO E OBJETIVO: A ectopia do colo do útero é hoje considerada um fenômeno fisiológico, mas parece ainda haver uma forte tendência no sentido da intervenção (tratamento). Este estudo se propõe a realizar revisão da literatura buscando evidências de benefícios conseqüentes ao tratamento da ectopia. MÉTODOS: Pesquisa nas bases Medical Literature Analysis and Retrieval Sysem Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americane e do Caribe em Ciências da Saúde (Lilacs), Biblioteca Cochrane e seis livros especializados. RESULTADOS: A revisão mostrou que: 1) existe provavelmente associação de ectopia com infecção cervical por Chlamydia trachomatis, pelo vírus HPV e maior risco de soroconversão para HIV; 2) existe provavelmente associação entre ectopia e neoplasia intra-epitelial cervical; 3) existe associação com mucorréia e nictúria; 4) não existem evidências sobre associação entre ectopia e câncer de colo do útero nem sobre proteção contra este câncer proporcionada pelo tratamento da ectopia. CONCLUSÕES: 1) Não foram encontrados na literatura dados que justifiquem o tratamento rotineiro da ectopia; 2) O tratamento pode ser utilizado para tratar sintomas associados à ectopia, porém mais sintomas são atribuídos à ectopia do que se pôde confirmar em um estudo controlado; 3) Seriam necessários novos estudos para testar a hipótese de proteção contra o câncer de colo proporcionada pelo tratamento.

The management of pre-invasive stage of cervical disease in a low-resource setting.

Cervical cancer is one of the commonest cancers in women. It is also the most preventable cancer. Numerous population based studies have shown that the development of a population based screening program can significantly reduce the incidence of and death rate from cervical cancer. However, it is expensive and requires a large and complex infrastructure to run such a program. As the disease goes through a prolonged pre-invasive phase (cervical intraepithelial neoplasia, CIN) there is ample time in which to treat this phase. Furthermore, this treatment only involves the destruction of the surface epithelium of the cervix. There is ample evidence that those women who have undergone cervical diathermy, for whatever reason, have a lower subsequent incidence of cervical cancer.

[Erosion of the uterine cervix in women with primary infertility treated with CO2 laser]. / Nadzerka szyjki macicy u kobiet z nieplodnoscia pierwotna leczona laserem CO2.

The authors described the results of treatment of erosions of the uterine cervix in 78 women with primary sterility with CO2-laser vaporisation in Department of Reproduction, Institute of Gynecology and Obstetrics, Academy of Medicine, Poznan. The results were estimated through clinical, cytological and colposcopical examinations in the term of 6 weeks and 3 months after therapy. The Insler's cervical mucus test was done in all women after 3 months. In all women the healing was achieved and five of them were needed for second laser therapy because of superficial endometriosis. The authors think that CO2-laser vaporisation (under colposcopical control) of erosions of the uterine cervix in women with primary sterility is the reliable method. The wound's healing after laser therapy is quick and without any complications. Laser therapy causes no trauma of the cervix structure and does not disturb in excretion of mucus by cervical glands.

[A comparable study of microwave tissue coagulation (MTC) and CO2 laser in treatment of cervical erosion].

In a randomized study, 300 patients with cervical erosion were allocated to either MTC(154) or CO2 Laser(146). The patients were treated on an outpatient basis without anesthesia. In the case of initial treatment failure the same method was to be used for retreatment. All the patients were followed-up for an average of 11 weeks (8-12). 142 of 154 microwave-coagulated patients (92.20%) and 116 of 146 Laser-evaporated patients (79.45%) were cured after one treatment, and there was significant difference between MTC and Laser group (P < 0.005). Bleeding during operation occurred in 5 of 154 MTC group (3.25%) and 32 of 146 Laser group (21.92) (P < 0.005). The result suggested that MTC had higher cure rate and less complications. It is easy to handle, safe and economic.

[Reproductive and menstrual functions in women after cryosurgical treatment of cervical diseases]. / Sostoianie detorodnoi i menstrual'noi funktsii u zhenshchin posle kriokhirurgicheskogo lecheniia zabolevanii sheiki matki.

Short- and long-term results of patients with a history of cryosurgery of cervical pseudoerosions suggested a lack of its adverse effects on reproductive and menstrual function. Cryotherapy of the uterine cervix resulted in normalization of local immunity, an advantage in the presence of a cervical factor of infertility.

Conization of the cervix uteri. Complications in connection with plain catgut or silk suturing.

During a retrospective study on postoperative complications in 213 patients who had undergone conization, a (non-significant) reduction in the bleeding rate from 27.9% to 18.6% was found when using silk sutures (102 patients) instead of plain catgut (111 patients) for adaption of the edges of the wound (0.1 less than p less than 0.2). The reduction was most pronounced and significant in cases where bleeding had occurred during the first 4 days after surgery, the usual period for hospital stay under normal conditions. After discharge the bleeding rates were more comparable, 12.6% in the catgut group and 16.6% in the silk group. On the other hand, more cases of stenosis of the cervical canal were observed, i.e., 25.5% in the silk group and 8.1% in the catgut group (p less than 0.001). The period of hospitalization was reduced on an average by 2 days when using silk (p less than 0.001).