Evaluation of women's sexual quality of life, depression, and sexual functions in the pregnancy and postpartum periods: A multi-centered study.

AIM: This multi-centered, longitudinal, and prospective study aims to identify women's sexual functions, sexual quality of life, and depression and their relationships with each other in the pregnancy and postpartum periods. METHODS: The participating pregnant women (n = 113) were interviewed six times: once in each trimester, and once in the eighth week third month, and sixth month postpartum. This study was conducted in three regions of Turkey including Marmara, Mediterranean, and Central Anatolia regions. Data were collected through the "Socio-demographic Form," "Female Sexual Function Index (FSFI)," Sexual Quality of Life-Female Questionnaire (SQLQ-F), and "Center for Epidemiologic Studies-Depression Scale (CES-D)." While the first interviews were administered face to face, successive ones were administered via phone. RESULTS: The sexual dysfunction rates of the participants were found to be high in the pregnancy and postpartum periods, and their sexual quality of life, which decreased as the pregnancy months progressed, was found to increase significantly with the progress in the postpartum period. The sexual dysfunction increased and sexual quality of life decreased significantly with the increase in depression symptoms in the pregnancy and postpartum periods. When the depressive symptoms decreased especially in the sixth month postpartum, sexual quality of life was also found to increase. CONCLUSIONS: As a result, in the pregnancy and postpartum periods, it is highly important to provide women with diagnosis through a holistic approach by creating available environments to assess their psychological health and sexual functions and refer them to the related physicians when necessary.

Intraoperative superior hypogastric plexus block for pain relief after a cesarean section: a case-control study.

AIM: To investigate the efficacy of intraoperative superior hypogastric plexus (SHP) block for postoperative pain relief in patients undergoing a cesarean section. METHODS: One hundred and fifteen pregnant women scheduled for an elective cesarean under general anesthesia were randomly divided into an SHP block (n=65) and a control group (n=50). SHP block was administered with bupivacaine injection. The controls received saline injection in the SHP area. Postoperative pain was assessed by the 10-cm visual analog scale (VAS). The presence of side effects and complications, including opioid or non-steroidal anti-inflammatory drugs (NSAID) requirement, gastrointestinal function, nausea, and vomiting were evaluated. RESULTS: The SHP block group had significantly lower VAS scores 2, 6, 24, and 48 hours postoperatively (P<0.001) and required a significantly lower rescue dose of NSAID or opioids (P=0.003, P<0.05, respectively). CONCLUSIONS: SHP block may be an effective and safe pain relief treatment after a cesarean section.

Relationship Between Genitourinary Syndrome of Menopause and 3D High-Frequency Endovaginal Ultrasound Measurement of Vaginal Wall Thickness.

BACKGROUND: To date, there is no certain method for diagnosis of genitourinary syndrome of menopause (GSM) and vaginal atrophy. AIM: We aim to evaluate vaginal wall thickness (VWT) using 3D high frequency endovaginal ultrasound (3D EVUS) in GSM and also to investigate whether there is any association between VWT and postmenopausal sexual dysfunction. METHODS: Postmenopausal women applied for routine gynecologic examination were assessed at the Outpatient Clinic of Gynecology, Maltepe University Hospital. After pelvic examination, GSM symptoms were questioned for all women and vaginal health scoring tool was applied. Twenty women with GSM and 20 women without GSM were included in the study. OUTCOMES: All patients filled in the Female Sexual Function Index (FSFI) and underwent 3D EVUS to evaluate VWT. RESULTS: The women with GSM had significantly lower anterior and posterior VWT (P=.007 and P=.049, respectively). The total FSFI score, lubrication and pain sub-scores in patients with GSM was significantly lower than the patients without GSM. Anterior VWT was positively correlated with BMI and pain sub-score of FSFI (r=0.279, P=.047; r=0.344, P=.013, respectively). A significant negative correlation was detected between anterior vaginal VWT and age, time since menopause and satisfaction sub-score of FSFI (r=-0.332, P=.017; r=-0.354, P=.011; r=-0.301, P=.032, respectively). Posterior VWT was positively correlated with FSFI total score, arousal, lubrication and pain sub-scores (r=0.451, P=.001; r=0.437, P=.001; r=0.415, P=.002; r=0.335, P=.016; respectively). CLINICAL IMPLICATIONS: Based on our results, measurement of VWT using 3D EVUS can be a useful non-invasive tool for the objective diagnosis of GSM. STRENGTHS AND LIMITATIONS: Considering that only total vaginal thickness can be measured with traditional transabdominal and transvaginal techniques, the main strength of the study is the use of 3D EVUS for separate measurement of anterior and posterior VWT. The study has sufficient statistical power. The small sample size of study is the main limitation. CONCLUSION: The 3D EVUS can be used for objective diagnosis of GSM and can also shed light on the causes of various sexual dysfunction symptoms in postmenopausal women, as it enables measuring the anterior and posterior walls of the vagina separately. Peker H, Gursoy A. Relationship Between Genitourinary Syndrome of Menopause and 3D High-Frequency Endovaginal Ultrasound Measurement of Vaginal Wall Thickness. J Sex Med 2021;18:1230-1235.

3D high frequency endovaginal ultrasound evaluation of urethral and pelvic morphology in stress urinary incontinence in first pregnancy.

OBJECTIVE: We aimed to compare the morphological characteristics of pelvis and urethra in nulliparous pregnant women with and without stress urinary incontinence (SUI) by 3D high-frequency endovaginal ultrasound (3D-EVUS). STUDY DESIGN: At 36-38 weeks of gestation, 40 nulliparous pregnant women with and without SUI underwent 3D-EVUS assessment. The anteroposterior and transverse diameters of levator hiatus (LH), pubovisceral muscle thicknesses at 3,9 and 12 o'clock, right and left paravaginal areas, symphysis angle, bladder-symphysis distance (BSD), uretral complex thickness (Ut), urethral complex width (Uw), urethral complex volume (UV), urethral length (UL), intramural urethra, rhabdosphincter thickness (Rt), rhabdosphincter width (Rw), rhabdosphincter length (RL), and rhabdosphincter volume (RV) were measured by 3D-EVUS. RESULTS: Longer LH transverse diameter (34.8 ± 3.8 mm vs 31.1 ± 2.1 mm), shorter LH anteroposterior diameter (47.8 ± 6.2 mm vs 52.4 ± 2.6 mm), and wider symphysis angle (116.3 ± 5.6 vs 111.5 ± 5.3 degrees) were detected in nulliparous pregnant women with SUI compared those without SUI (p = 0.001, p = 0.001 and p = 0.013; respectively). RV of less than 1.26 cm3 was found to have a sensitivity of 100 % and a specificity of 100 % for the presence of SUI in nulliparous pregnant women. CONCLUSIONS: Constitutionally different pelvic shape and decreased urethral rhabdosphincter measurements can be used to predict SUI in nulliparous pregnant women.

Thyroid cancer incidence and clinicopathological differences in patients with end-stage renal failure.

AIM: In the present study we aimed to determine the prevalence of thyroid cancer and the clinicopathological properties of papillary thyroid cancer (PTC) in a patient population undergoing dialysis for end-stage renal failure (ESRF). MATERIAL AND METHODS: We retrospectively reviewed all thyroid ultrasonography (USG) examinations performed between January 2007 and December 2015 to determine the incidence of nodular thyroid disease in ESRF and normal patient populations. For both patient groups, differences between patient and tumor characteristics were evaluated in patients diagnosed to have PTC. RESULTS: Among 29.381 patients who underwent thyroid USG examination, 3.491 were included in the ESRF group (Group 1) and 25.890 in the control group (Group 2). Tyroid cancer was detected in 77 (2.2%) of 3.491 patients in Group 1 and 338 (1.3%) of 25.890 patients in Group 2. Thyroid cancer was significantly more prevalent in patients with ESRF (p<0.001). DISCUSSION: When only patients with papillary thyroid cancer were considered, no significant difference existed between the two groups with respect to the prevalence of PTC, although PTC cases in the ESRF group had a significantly higher rate of aggressive characteristics such as capsule invasion, multifocality, and lymph node metastasis. Whereas thyroid cancer is more common in patients with ESRF compared to normal controls, papillary thyroid cancer was not significantly more prevalent in the ESRF group. CONCLUSIONS: PTC in the ESRF group having more aggressive properties than those in the control group suggests that PTC should be diagnosed earlier in their course, treated more aggressively, and followed more closely in ESRF. KEY WORDS: End-Stage Renal Failure, Fine Needle Aspiration Biopsy, Papillary thyroid cancer.

Does YouTube Provide Reliable and High-Quality Information? Assessment of Pap Smear Test Videos.

AIM: YouTube is one of the most popular video-sharing platforms and is used by many people as a source of information regarding health conditions. Although there are many studies examining YouTube health-related videos in terms of quality, content and accuracy, there is not any study observing the content of YouTube videos about the "Pap smear test." Therefore, we intended to evaluate YouTube videos related to the Pap smear test. METHODS: We made a search by typing "Pap smear test" and observed the first 100 videos. According to our selection criteria, only 42 videos were reviewed. We used 3 different questionnaires to rate the videos. The videos were independently rated by 2 gynecologists in terms of technical aspects, follow-up protocol, and video quality. RESULTS: Our study showed that clarity of the technical aspects of Pap smear testing (Q1) was 40% and that of the follow-up protocol (Q2) was only 11%. In terms of video quality (Q3), the adequacy rate was 34%. There was a statistically significant negative correlation between search rank and the video power index (which increased as the ranking decreased to rank 1, r: -0.481). CONCLUSION: We did not find quality and reliable information on YouTube videos about the Pap smear test, which is important for early detection of cervical cancers. While preparing health-related videos for YouTube and similar websites, the support of professional healthcare workers will help provide more accurate content.

Laparoscopic Sacrohysteropexy in a Woman at 12 Weeks' Gestation.

STUDY OBJECTIVE: To demonstrate laparoscopic sacrohysteropexy for a case of uterine prolapse in a 12 weeks, 3 days pregnant woman. To our knowledge this is the first case of laparoscopic sacrohysteropexy performed at 12 weeks of gestation to be reported in literature. DESIGN: A step-by-step explanation of the surgical procedure (Canadian Task Force classification III). SETTING: Maltepe University Hospital. PATIENT: A 37-year-old pregnant woman. INTERVENTION: Laparoscopic sacrohysteropexy. Institutional Review Board ruled that approval was not required for this study. MEASUREMENTS AND MAIN RESULTS: Uterine prolapse is very rare condition, manifesting in an estimated 10 000 to 15 000 pregnancies [1]. The management plan must be individualized, and the obstetrician should aware of possible complications, such as preterm labor, high incidence of abortion, cervical ulceration, and cervical dystocia. In general, bedrest, good genital hygiene, and pessary use is recommended. Alternatively, in cases where conservative solutions have failed, laparoscopic surgery in the pregnant patient may be considered. To date, only 1 case of laparoscopic promontohysteropexy at 10th weeks of gestation was reported by Pirtea et al [2]. A 37-year-old woman, at 12 weeks and 3 days of gestation, with stage III pelvic organ prolapse was referred to our clinic. Conservative management with pessary failed. The patient underwent laparoscopic sacrohysteropexy after written informed consent form was obtained. In exploration, uterine manipulation was difficult because of softness and large size of the uterus. First, the sigmoid colon was suspended at the abdominal wall to gain an adequate surgical field. The promontorium was dissected and the parietal peritoneum incised on the right pelvic side wall after ureter visualization. A polypropylene mesh was fixed to the cervix at the level of the uterosacral ligaments. The other edge of the mesh was fixed at the level of the promontory using the Uplift device (Neomedic International, Barcelona, Spain). Then, the peritoneum was sutured to cover the mesh. The patient was discharged 2 days after surgery. At the examination the pelvic floor was detected to be normal. The patient delivered a healthy baby weighing 3030 g by cesarean section at 38 weeks of gestation. The position of the mesh was controlled during surgery. There was no peritoneal fold detected on the cervical part of mesh; however, no adhesion was observed. CONCLUSION: Laparoscopic sacrohysteropexy may be an alternative and safe approach, if conservative treatment fails, for pelvic organ prolapse during pregnancy.

Fluid intake and voiding parameters in asymptomatic Turkish women.

INTRODUCTION AND HYPOTHESIS: For an accurate evaluation of bladder diaries, we aim to investigate normal urinary habits and determining factors on functional bladder capacity, frequency, and 24-h volume in the bladder diaries of asymptomatic women. METHODS: One-hundred and fifteen asymptomatic women who recorded a 24-h bladder diary were included in the study. Linear regression analyses were used to explore associations between diary values and patient characteristics. RESULTS: Total number of voids was related to age, body mass index, total voided volume, total fluid intake, total diuresis rate, and maximum fluid intake in one go. Maximum, average, and minimum volumes per void were found to be related to body mass index, total voided volume, total fluid intake, total diuresis rate, and maximum fluid intake. When we used multiple regression analysis, only maximum fluid intake was found to be related to the total number of voids, maximum, average, and minimum volumes per void. CONCLUSIONS: Maximum fluid intake rather than total voided volume seems to be an important determinant factor for total number of voids and functional bladder capacity.

Relationship between bone mineral density, bone turnover markers and homocysteine, folate and vitamin B12 levels in postmenopausal women.

PURPOSE: We aimed to investigate whether levels of homocysteine (Hcy), folate, and vitamin B12 are related to bone turnover markers and bone mineral density (BMD) in postmenopausal women. METHODS: One hundred and twenty postmenopausal women were divided into three groups: osteoporotic, osteopenic and normal, according to the BMD measurements. The age, weight, body mass index (BMI), years since menopause (YSM), gravidity, parity, bone turnover markers [type I collagen C-telopeptides (CTx) and bone-specific alkaline phosphatase (BAP)], serum Hcy, parathyroid hormone (PTH), vitamin B12, folate, calcium and magnesium levels were compared with each other. RESULTS: Twenty-five women had osteoporotic, 42 women had osteopenic, and 53 had normal BMD values. After adjusting for confounding factors, serum Hcy levels were significantly higher in osteoporotic women [adj OR = 38.95 (1.474-1029.88) p = 0.02]. The age, YSM, PTH, CTx and BAP levels were related to serum Hcy in all women (beta = 0.523, p = 0.0001; beta = 0.446, p = 0.001; beta = 0.295, p = 0.005; beta = 0.239, p = 0.026; beta = 0.451, p = 0.001, respectively). CONCLUSIONS: Our data showed that vitamin B12, folate and Hcy levels were not related with BMD in postmenopausal women. We think that one of the underlying mechanisms of increased Hcy levels and osteoporosis may be a mechanistic link which cannot detected by BMD or biochemical markers.

The role of urethral hypermobility and intrinsic sphincteric deficiency on the outcome of transobturator tape procedure: a prospective study with 2-year follow-up.

INTRODUCTION AND HYPOTHESIS: The aim of this study is to investigate the effect of intrinsic sphincter deficiency (ISD) and urethral hypermobility on the outcome of the transobturator tape (TOT). METHODS: Sixty-five women were divided into three groups: group I, ISD with hypermobile urethra (n = 18); group II, ISD with fixed urethra (n = 16); and group III, hypermobile urethra without ISD (n = 31). Cure of stress urinary incontinence was defined if the patient had negative cough stress test. Cure and improvement rates were compared at 6, 12, and 24 months. RESULTS: The cure and improvement rates of groups I and III were similar at 6, 12, and 24 months (96.1% vs 96.6%, 96.1% vs 96.6%, and 87.5 vs %96.4%, respectively). Group II had the lowest cure and improvement rates (68.7%, 66.7%, and 66.7%, respectively). CONCLUSION: A lack of urethral hypermobility may be a risk factor for TOT failure.

Serotonin dilemma in postmenopausal women: is it low or high?

OBJECTIVE: In this study, we have studied with premenopausal (PM), naturally menopausal (NM) and surgically induced menopausal (SM) women in order to investigate the differences in serum cortisol, dehydroepiandrosterone sulfate (DHEA-S), follicle stimulating hormone (FSH) and estradiol (E2) levels on serum serotonin levels. METHODS: Forty premenopausal (36.7+/-3.5 years), 40 naturally menopausal (54.2+/-8.4 years) and 38 surgically induced menopausal (55.4+/-11.2 years) women were included in the study. None of the subjects were using antidepressants or hormone replacement therapy. In NM and SM, years since menopause (YSM) were 3.16+/-1.58 and 3.36+/-1.89, respectively. Cortisol, DHEA-S, FSH and E2 levels were determined by immunochemiluminisence while serotonin levels were determined by HPLC. RESULTS: Serum serotonin levels in NM women were higher than the other two groups [144.23+/-45.29 microg/L vs 61.35+/-37.72 microg/L in SM women and 98.74+/-50.29 microg/L in PM women]. E2 and DHEA-S were positively correlated, while FSH and cortisol were negatively correlated with serotonin in NM and SM. There was no significant correlation between serotonin and age or YSM. In the PM group, there was no significant correlation between serotonin and the hormones. CONCLUSION: In conclusion, increased serotonin levels in naturally menopausal women may be a compensatory mechanism to decreased E2 levels as it is postulated that there is strong interaction between E2 and the serotoninergic system.