Tactile Electrosurgical Ablation: A Technique for the Treatment of Intractable Heavy and Prolonged Menstrual Bleeding.

Objective. To study the efficacy and safety of tactile electrosurgical ablation (TEA) in stopping a persistent attack of abnormal uterine bleeding not responding to medical and hormonal therapy. Methods. This is a case series of 19 cases with intractable abnormal uterine bleeding, who underwent TEA at the Women's Health Center of Assiut University. The outcomes measured were; patient's acceptability, operative time, complications, menstrual outcomes, and reintervention. Results. None of the 19 counseled cases refused the TEA procedure which took 6-10 minutes without intraoperative complications. The procedure was successful in the immediate cessation of bleeding in 18 out of 19 cases. During the 24-month follow-up period, 9 cases developed amenorrhea, 5 had scanty menstrual bleeding, 3 were regularly menstruating, 1 case underwent repeat TEA ablation, and one underwent a hysterectomy. Conclusions. TEA represents a safe, inexpensive, and successful method for management of uterine bleeding emergencies with additional long-term beneficial effects. However, more studies with more cases and longer follow-up periods are warranted.

Impact of the complete ban on female genital cutting on the attitude of educated women from Upper Egypt toward the practice.

OBJECTIVE: To compare the prevalence of female genital cutting (FGC) before and 5 years after the law completely banned the practice in Egypt, and evaluate the attitude of educated mothers of girls toward FGC in Upper Egypt. METHODS: All women attending 2 outpatient clinics in Upper Egypt were approached from January 1 through November 30, 2011. A trained nurse interviewed those who had daughters, and factors influencing their attitude toward FGC were evaluated. The participants in a previous study done in the same locality acted a historical comparison group. RESULTS: The percentage of women who had FGC performed on at least 1 daughter was significantly lower in 2011 than in 2006 (71.6% vs 77.8%, P=0.04). The main reason for performing FGC, given by 42.6% of the participants, was family pressure. The percentage of FGC procedures practiced by physicians was significantly lower in 2011 than it was in 2006 (34.6% vs 39.3%, P=0.04). CONCLUSION: The decrease in prevalence of FGC after its complete ban was small after 5 years, with little change in attitude among educated families in Upper Egypt. In addition to the current law, a change in attitude will be needed to wipe out this custom.

Primary infertility and health-related quality of life in Upper Egypt.

OBJECTIVE: To assess the effect of infertility on the health-related quality of life and sexual function of infertile women in Upper Egypt. METHOD: The Quality-of-Life Questionnaire (QLQ) C30, version 2, and a visual analog scale were used to assess the quality of life and sexual satisfaction of 116 women with primary infertility and 116 fertile women with similar sociodemographic characteristics. We also looked for associations between the results and infertility duration. RESULTS: Compared with the fertile women, the women with primary infertility had significantly lower scores for both health-related quality of life and sexual function, and their sexual function was the most disturbed during the fourth, fifth, and sixth years of their marriage. CONCLUSION: Women with primary infertility need to be treated medically and psychologically to improve their quality of life and sexual function.

Prevalence and characteristics of female sexual dysfunction in a sample of women from Upper Egypt.

OBJECTIVE: To study the prevalence and associated risk factors for female sexual dysfunction (FSD) in Upper Egypt. METHODS: Married women attending the outpatient clinic of Sohag University Hospital between February 2008 and March 2009 were recruited. Through direct interviews, each woman completed a questionnaire that included questions on sexual dysfunction. RESULTS: From 648 recruited patients, 47 declined to participate in the study. Of the 601 remaining participants, 462 women (76.9%) reported 1 or more sexual problems. Low sexual desire was the most common sexual problem (66.4%). Patients with FSD were significantly more likely to be older than 40 years, have sexual intercourse fewer than 3 times a week, have been married for 10 years or more, have 5 children or more, be circumcised, have a husband aged 40 years or more, and be postmenopausal. Age of the women maintained a statistically significant positive relationship with FSD in the regression model (odds ratio 1.39; 95% CI, 1.26-1.53). CONCLUSIONS: There was a high prevalence of FSD in this sample of women from Upper Egypt. The prevalence of sexual problems increased with increasing age of the women.

Effect of oral N-acetyl cysteine on recurrent preterm labor following treatment for bacterial vaginosis.

OBJECTIVE: To evaluate the effect of N-acetyl cysteine (NAC) on gestational age at delivery in women with previous preterm labor and bacterial vaginosis. METHODS: A randomized, double-blind, placebo-controlled trial with 280 women between 16 and 18 weeks of pregnancy who had 1 previous preterm birth and had just been successfully treated for bacterial vaginosis with metronidazole for 1 week. The women were randomized to receive 0.6 g of NAC per day plus 17-hydroxyprogesterone caproate (17-OHPC) or placebo plus 17-OHPC until 36 completed weeks of pregnancy or active labor. A vaginal swab was taken during labor. RESULTS: Reaching 36 weeks of pregnancy was more frequent (P<0.05) and gestational age at delivery was significantly higher in the NAC than in the placebo group (37.4 weeks+/-0.4 weeks vs 34.1 weeks+/-1.2 weeks, P<0.05). The discontinuation rate was 11.4% in the NAC group. CONCLUSIONS: Oral NAC was found to reduce the recurrence of preterm birth in patients with bacterial vaginosis.

Bilateral uterine artery ligation via minilaparotomy for heavy menstrual bleeding.

OBJECTIVE: To assess the safety and short-term efficacy of bilateral uterine artery ligation (UAL) via minilaparotomy for the management of heavy menstrual bleeding (HMB). METHODS: A prospective study of 30 women with HMB who underwent UAL. The primary outcome was cumulative treatment failure 12 months after the procedure. Treatment failure was defined as the need for hysterectomy during the follow-up period. RESULTS: At 12 months, 6 women had undergone hysterectomy for bleeding, for a cumulative failure rate of 20% (95% CI, 9%-38%). The number of bleeding days was significantly reduced by 11.9+/-1.5 days (P<0.001) and hemoglobin level significantly increased by 1.3+/-0.15 g/dL (P<0.001). Of the 30 women, 24 (80%) were satisfied with the results. No major complications were reported during the procedure or median follow-up period of 13.2 months. CONCLUSION: Bilateral UAL is a safe and effective minimally invasive procedure that can provide an alternative treatment for HMB.

Psychiatric morbidity following hysterectomy in Egypt.

OBJECTIVE: To evaluate psychiatric morbidity in Egyptian women before and after hysterectomy for benign indications. METHOD: A 2-year prospective observational study at Sohag University Hospital, Egypt, in which 96 women scheduled for hysterectomy were assessed for psychiatric comorbidity before and after the operation using the General Health Questionnaire (GHQ-28), Beck Depression Inventory, and Hamilton Anxiety Scale. RESULTS: Of these, 35 (36.5%) had scores of 4 or higher, signifying psychiatric comorbidity (group 1), and 61 (63.5%) had scores less than 4, suggesting no psychiatric comorbidity (group 2). Postoperatively, severe anxiety and depressive symptoms were common in group 1. In group 2, 48 (78.7%) of the 61 women had scores of 4 or higher. In that subgroup, depressive and anxiety symptoms were more common among nulliparas whereas women with a high parity experienced the least psychiatric comorbidity. CONCLUSIONS: As women undergoing hysterectomy risk psychiatric morbidity, gynecologists should consider less invasive interventions to treat benign conditions.