Operative Hysteroscopy Versus Levonorgestrel-Releasing Intrauterine System (LNG-IUS) Insertion: A Prospective Observational Study on the Effect of Surgical and Medical Treatments on Sexual Functions in Women With Abnormal Uterine Bleeding.

Background This study aims to evaluate the effect of operative hysteroscopy and levonorgestrel-releasing intrauterine system (LNG-IUS) insertion for abnormal uterine bleeding on sexual function and, if it improves sexual function, to examine differences in sexual function between women undergoing hysteroscopy and women using LNG-IUS. Methods Ninety women aged between 25 and 52 enrolled in the study. Participants were divided into two groups, including 45 operative hysteroscopy patients and 45 LNG-IUS patients. All patients completed the Female Sexual Function Index (FSFI) questionnaire pre-treatment and after three months post-treatment. Pre- and post-treatment FSFI scores were compared both within and between groups. Results The mean FSFI scores at three months following both treatments were significantly higher than baseline in both groups (p<0.05). When the two groups were compared, no significant difference was observed between baseline and three-month post-treatment differences in FSFI scores except for the pain domain. In the pain domain of the FSFI questionnaire, a more significant improvement was found in the LNG - IUS inserted group compared to the operative hysteroscopy group. Conclusion Patients had improvement in sexual functions after both operative hysteroscopy and LNG - IUS insertion treatment. No significant difference was observed in hysteroscopy and LNG-IUS patients after both treatments in terms of sexual function according to scores calculated by FSFI, except for the pain domain. Significant improvement was observed in the pain domain of the FSFI for the LNG - IUS inserted group compared to the operative hysteroscopy group, thus demonstrating a significant effect and improvement for dyspareunia and chronic pelvic pain complaint in the LNG-IUS inserted group.

Complete labial fusion causing urinary retention in a postmenopausal woman.

Labial fusion or labial adhesion can rarely be encountered postmenopausal and may be diagnosed in advanced stages especially in sexually inactive women. It may be a rare cause of voiding dysfunction or urinary retention. We present a case of a postmenopausal woman presenting with urinary retention due to complete labial fusion. The patient was treated both with topical estrogen and surgical separation of labial fusion. No recurrences developed after the procedure. Topical estrogen treatment may not resolve adhesions in postmenopausal women and invasive procedures may be necessary to resolve urinary retention.

Unique Diagnosis of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) at the Time of First-Trimester Ultrasound Imaging.

BACKGROUND: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is usually diagnose during adolescence due to pain-related symptoms; however, this syndrome can go unrecognized for several years, and unique presentations may occur later in life. CASE: We describe a 24-year-old-woman diagnosed with previously unknown OHVIRA syndrome and a 7-week intrauterine pregnancy in the obstructed side by the unique ultrasound image obtained during routine first-trimester ultrasonography. The patient was managed with single-stage vaginoplasty, and the rest of the pregnancy were uneventful. SUMMARY AND CONCLUSION: This report is unique in terms of showing that the pregnancy could develop in the uterine cavity on the side of the obstruction despite the blind hemivagina.

Management of Menstrual and Gynecologic Concerns in Girls with Special Needs

For girls with physical and developmental disabilities and their families/caregivers, puberty and menstruation can present significant problems such as vulnerability, abuse risk, unintended pregnancies, difficulties with managing menstrual hygiene, abnormal uterine bleeding, dysmenorrhea, behavioral difficulties/mood concerns or changes in seizure pattern. Healthcare providers may have an important and positive impact for both the adolescents and their families/caregivers during this stage of life. Whether menstrual manipulation is indicated should be decided after a detailed history is taken from both the patient and the caregivers to determine the impact of current problems on quality of life. It should be explained that complete amenorrhea is difficult to achieve and realistic expectations should be addressed. The goals for the management of menstrual concerns should be a reduction in the amount and total days of menstrual flow, reduction of menstrual pain and suppression of ovulatory or cyclic symptoms, depending on each individual patient's needs. Advantages and disadvantages of available treatment methods should also be discussed.

Efficacy of a New Crosslinked Hyaluronan Gel in the Prevention of Intrauterine Adhesions.

BACKGROUND AND OBJECTIVES: The authors sought to assess the effect of the use of a new crosslinked hyaluronan (NCH) gel on the prevention of intrauterine adhesions (IUAs) in women underwent curettage in the second trimester. METHODS: Between June 2016 and September 2017, 60 patients who underwent curettage for retained placental tissue after medically induced or spontaneous pregnancy loss in the second trimester were enrolled in the study. The patients were randomly assigned to 1 of 2 groups: Group 1 patients received curettage plus NCH gel (intervention group), and group 2 patients received curettage alone (control group). The main outcomes were the rate and severity of IUA formation, which were assessed by follow-up hysteroscopy performed in the ensuing 2-6 months. RESULTS: The hysteroscopic findings were available for 20 patients in group 1 and 28 patients in group 2. IUAs were observed in 6 patients in group 2, while no IUAs was observed in group 1 (P = .007). IUAs were staged as mild in 4 patients (14.28%) and moderate in 2 patients (7.14%) in group 2 according to the American Fertility Society classification of IUAs. CONCLUSIONS: Our study demonstrates that NCH gel appears to be able to reduce the formation of IUAs in women who undergo curettage in the second trimester, although larger controlled, randomized, multicenter studies are needed to confirm these results.

A Rare Dermatologic Disease in Pregnancy: Rosacea Fulminans- Case Report and Review of the Literature.

BACKGROUND: Rosacea is a common, chronic disorder that can present with a variety of cutaneous or ocular manifestations. Skin involvement primarily affects the central face, with findings such as persistent centrofacial redness, papules, pustules, flushing, telangiectasia, and phymatous skin changes. The pathways that lead to the development of rosacea are not well understood. The relationship of pyoderma faciale (also known as rosacea fulminans) to rosacea also is uncertain. We aimed to write this article with the aim of showing how a pregnant patient who has been aggravated by the degree of lesions on the face during the first trimester of pregnancy is treated and to show what is in the literature in this issue. CASE REPORT: A 22-year-old woman complained of painful erythema, papules and pustules on the face. She had fever and malaise during the sixth week of her first pregnancy and a history of the mild eruption and seborrhea before her pregnancy with flaring over the preceding 4 weeks. Dermatologic examination revealed red erythema of all involved facial areas; the lesions consisted of papules, pustules and nodules. The case was diagnosed as rosacea fulminans (pyoderma faciale) by these findings. In the literature, there are some effective therapeutic options such as retinoids, tetracyclines, antiandrogenic contraceptives, and dapsone and these were not used because they are contraindicated in pregnancy. Amoxicillin-clavulanic acid 1 gr/day, wet compresses, and a fusidic acid cream were started. After the activity of the disease had been suppressed for 10 days, antibiotic was stopped, and the other treatment options were applied topically for the next month. One month after cessation of treatment, the lesions had disappeared with only mild erythema remaining. There was minimally flushing on the face and no telangiectasia. CONCLUSION: In conclusion, there is no substantial evidence as to the mechanism by which pregnancy may trigger this conditioner whether the gender of the fetus influences the development of rosacea fulminans, but is generally accepted that hormonal changes in pregnancy play an important role. The pathogenesis of rosacea fulminans remains uncertain, but it is obvious that the further basic and clinical research is required to optimise the management of this rare facial dermatosis.