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Original Article
Sexual function in women with endometriosis and pelvic floor myofascial pain syndrome
- Rayanne Moreira da Cunha
, - Mariana Oliveira Veloso ,
- Samuel Soares Coutinho ,
- Luana Darc de Menezes Braga ,
- Adriana Silva de Barros , [ ... ],
- Leonardo Robson Pinheiro Sobreira Bezerra
06-03-2024
Summary
Original ArticleSexual function in women with endometriosis and pelvic floor myofascial pain syndrome
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo40
06-03-2024- Rayanne Moreira da Cunha ,
- Mariana Oliveira Veloso ,
- Samuel Soares Coutinho ,
- Luana Darc de Menezes Braga ,
- Adriana Silva de Barros ,
- Germana Mesquita Magalhães ,
- Pedro Olavo de Paula Lima ,
- Simony Lira do Nascimento ,
- Leonardo Robson Pinheiro Sobreira Bezerra
Views154Abstract
Objective:
To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS).
Methods:
Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests.
Results:
There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P<.001), difficulty in relaxation (P=.019), and lower Endurance on EMG (P=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (P=.02). TP in the right OIM presented increased muscle tone (P=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG.
Conclusion:
Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance.
Key-words EndometriosisMuscle tonusMyofascial pain syndromesPelvic floorPelvic painsexual satisfactionTrigger pointsSee moreViews154
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleSexual function in women with endometriosis and pelvic floor myofascial pain syndrome
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo40
06-03-2024- Rayanne Moreira da Cunha ,
- Mariana Oliveira Veloso ,
- Samuel Soares Coutinho ,
- Luana Darc de Menezes Braga ,
- Adriana Silva de Barros ,
- Germana Mesquita Magalhães ,
- Pedro Olavo de Paula Lima ,
- Simony Lira do Nascimento ,
- Leonardo Robson Pinheiro Sobreira Bezerra
Views154Abstract
Objective:
To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS).
Methods:
Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests.
Results:
There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P<.001), difficulty in relaxation (P=.019), and lower Endurance on EMG (P=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (P=.02). TP in the right OIM presented increased muscle tone (P=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG.
Conclusion:
Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance.
Key-words EndometriosisMuscle tonusMyofascial pain syndromesPelvic floorPelvic painsexual satisfactionTrigger pointsSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Rayanne Moreira da Cunha
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Original Article
Evaluation and Comparison of Respiratory Muscular Strength, Functionality, and Pelvic Floor in the Immediate Postpartum of Normal and Cesarean Birth
- Carolina Martins da Rosa ,
- Thariny Huesken Dockhorn ,
- Juliana Rezende Cardoso ,
- Soraia Genebra Ibrahim Forgiarini ,
- Luiz Alberto Forgiarini Junior , [ ... ],
- André Luiz Lisboa Cordeiro
07-10-2023
Summary
Original ArticleEvaluation and Comparison of Respiratory Muscular Strength, Functionality, and Pelvic Floor in the Immediate Postpartum of Normal and Cesarean Birth
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(3):121-126
07-10-2023- Carolina Martins da Rosa ,
- Thariny Huesken Dockhorn ,
- Juliana Rezende Cardoso ,
- Soraia Genebra Ibrahim Forgiarini ,
- Luiz Alberto Forgiarini Junior ,
- André Luiz Lisboa Cordeiro
Views155See moreAbstract
Objective:
To evaluate and compare peripheral, pelvic floor, respiratory muscle strength, and functionality in the immediate puerperium of normal delivery and cesarean section.
Methods:
This is a cross-sectional study that verified respiratory, pelvic floor, peripheral, and functional muscle strength through manovacuometry, pelvic floor functional assessment (PFF), dynamometry, and the Time Up and Go (TUG) test, respectively. The groups were divided according to the type of delivery, into a cesarean section group and a normal parturition group.
Results:
The sample was composed of 72 postpartum puerperae, 36 of normal parturition, and 36 of cesarean section, evaluated before hospital discharge, mean age ranged from 25.56 ± 6.28 and 28.57 ± 6.47 years in puerperae of normal parturition and cesarean section respectively. Cesarean showed higher pelvic floor strength (PFF) compared to normal parturition (p < 0.002), but puerperae from normal delivery showed better functionality (p < 0.001). As for peripheral muscle strength and respiratory muscle strength, there was no significance when comparing the types of parturirion.
Conclusion:
There is a reduction in pelvic muscle strength in puerperae of normal delivery and a decrease in functionality in puerperae of cesarean section.
Views155This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleEvaluation and Comparison of Respiratory Muscular Strength, Functionality, and Pelvic Floor in the Immediate Postpartum of Normal and Cesarean Birth
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(3):121-126
07-10-2023- Carolina Martins da Rosa ,
- Thariny Huesken Dockhorn ,
- Juliana Rezende Cardoso ,
- Soraia Genebra Ibrahim Forgiarini ,
- Luiz Alberto Forgiarini Junior ,
- André Luiz Lisboa Cordeiro
Views155See moreAbstract
Objective:
To evaluate and compare peripheral, pelvic floor, respiratory muscle strength, and functionality in the immediate puerperium of normal delivery and cesarean section.
Methods:
This is a cross-sectional study that verified respiratory, pelvic floor, peripheral, and functional muscle strength through manovacuometry, pelvic floor functional assessment (PFF), dynamometry, and the Time Up and Go (TUG) test, respectively. The groups were divided according to the type of delivery, into a cesarean section group and a normal parturition group.
Results:
The sample was composed of 72 postpartum puerperae, 36 of normal parturition, and 36 of cesarean section, evaluated before hospital discharge, mean age ranged from 25.56 ± 6.28 and 28.57 ± 6.47 years in puerperae of normal parturition and cesarean section respectively. Cesarean showed higher pelvic floor strength (PFF) compared to normal parturition (p < 0.002), but puerperae from normal delivery showed better functionality (p < 0.001). As for peripheral muscle strength and respiratory muscle strength, there was no significance when comparing the types of parturirion.
Conclusion:
There is a reduction in pelvic muscle strength in puerperae of normal delivery and a decrease in functionality in puerperae of cesarean section.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Carolina Martins da Rosa
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Review Article
Assessment of Pelvic Floor Disorders due to the Gestational Diabetes Mellitus Using Three-Dimensional Ultrasonography: A Narrative Review
- Carlos Izaias Sartorão Filho ,
- Angélica Mércia Pascon Barbosa ,
- Iracema de Mattos Paranhos Calderon ,
- Marilza Vieira Cunha Rudge
03-24-2022
Summary
Review ArticleAssessment of Pelvic Floor Disorders due to the Gestational Diabetes Mellitus Using Three-Dimensional Ultrasonography: A Narrative Review
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(12):1134-1140
03-24-2022- Carlos Izaias Sartorão Filho ,
- Angélica Mércia Pascon Barbosa ,
- Iracema de Mattos Paranhos Calderon ,
- Marilza Vieira Cunha Rudge
Views131See moreAbstract
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.
Views131This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticleAssessment of Pelvic Floor Disorders due to the Gestational Diabetes Mellitus Using Three-Dimensional Ultrasonography: A Narrative Review
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(12):1134-1140
03-24-2022- Carlos Izaias Sartorão Filho ,
- Angélica Mércia Pascon Barbosa ,
- Iracema de Mattos Paranhos Calderon ,
- Marilza Vieira Cunha Rudge
Views131See moreAbstract
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.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Carlos Izaias Sartorão Filho
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Review
Effect of Surgical Treatment for Deep Infiltrating Endometriosis on Pelvic Floor Disorders: A Systematic Review with Meta-analysis
- Mirian Vieira Fraga ,
- Cristina Laguna Benetti-Pinto ,
- Daniela Angerame Yela ,
- Ticiana Alves de Mira ,
- Luiz Gustavo Oliveira Brito
02-17-2022
Summary
ReviewEffect of Surgical Treatment for Deep Infiltrating Endometriosis on Pelvic Floor Disorders: A Systematic Review with Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(5):503-510
02-17-2022- Mirian Vieira Fraga ,
- Cristina Laguna Benetti-Pinto ,
- Daniela Angerame Yela ,
- Ticiana Alves de Mira ,
- Luiz Gustavo Oliveira Brito
Views161See moreAbstract
Objectives
To evaluate the impact of surgical treatment of deep infiltrative endometriosis (DIE) on pelvic floor dysfunction (urinary incontinence [UI], pelvic organ prolapse [POP], fecal incontinence [FI)] or constipation, and sexual function [dyspareunia]).
Data Source
The present systematic review was performed in the PubMed database. For the selection of studies, articles should be published by January 5, 2021, without language restriction.
Study Selection
Six randomized controlled studies that evaluated surgical treatment for DIE and the comparison of different surgical techniques were included.
Data Collection
The studies were selected independently by title and abstract by two authors. Disagreements were resolved by a third author. All included studies were also evaluated according to the Cochrane risk of bias tool and the quality of the evidence was analyzed using the GRADE criteria. Subgroup analysis by different treatments and follow-up periods was also performed.
Results
Six studies were included in the quantitative analysis. The risk of bias between studies showed an uncertain risk of bias for most studies, with concealment of allocation being the least reported category. The quality of the evidence was considered low. High heterogeneity was found between the studies. No study has evaluated UI or POP comparatively before and after surgery.
Conclusion
Dyspareunia and FI have improved after the surgical procedure, but it was not possible to demonstratewhich surgical technique was related to these outcomes as there was surgical heterogeneity. This diversity was found across data, with the recommendation of future prospective studies addressing pelvic floor disorders withDIE.
Views161This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
ReviewEffect of Surgical Treatment for Deep Infiltrating Endometriosis on Pelvic Floor Disorders: A Systematic Review with Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(5):503-510
02-17-2022- Mirian Vieira Fraga ,
- Cristina Laguna Benetti-Pinto ,
- Daniela Angerame Yela ,
- Ticiana Alves de Mira ,
- Luiz Gustavo Oliveira Brito
Views161See moreAbstract
Objectives
To evaluate the impact of surgical treatment of deep infiltrative endometriosis (DIE) on pelvic floor dysfunction (urinary incontinence [UI], pelvic organ prolapse [POP], fecal incontinence [FI)] or constipation, and sexual function [dyspareunia]).
Data Source
The present systematic review was performed in the PubMed database. For the selection of studies, articles should be published by January 5, 2021, without language restriction.
Study Selection
Six randomized controlled studies that evaluated surgical treatment for DIE and the comparison of different surgical techniques were included.
Data Collection
The studies were selected independently by title and abstract by two authors. Disagreements were resolved by a third author. All included studies were also evaluated according to the Cochrane risk of bias tool and the quality of the evidence was analyzed using the GRADE criteria. Subgroup analysis by different treatments and follow-up periods was also performed.
Results
Six studies were included in the quantitative analysis. The risk of bias between studies showed an uncertain risk of bias for most studies, with concealment of allocation being the least reported category. The quality of the evidence was considered low. High heterogeneity was found between the studies. No study has evaluated UI or POP comparatively before and after surgery.
Conclusion
Dyspareunia and FI have improved after the surgical procedure, but it was not possible to demonstratewhich surgical technique was related to these outcomes as there was surgical heterogeneity. This diversity was found across data, with the recommendation of future prospective studies addressing pelvic floor disorders withDIE.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Mirian Vieira Fraga
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Original Article
Risk Factors for Urinary Incontinence in Pregnancy: A Case Control Study
- Fernanda Borsatto Caruso ,
- Lucas Schreiner ,
- Alexandra Damasio Todescatto ,
- Isabel Crivelatti ,
- Julia Monteiro de Oliveira
01-11-2020
Summary
Original ArticleRisk Factors for Urinary Incontinence in Pregnancy: A Case Control Study
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(12):787-792
01-11-2020- Fernanda Borsatto Caruso ,
- Lucas Schreiner ,
- Alexandra Damasio Todescatto ,
- Isabel Crivelatti ,
- Julia Monteiro de Oliveira
Views83See moreAbstract
Objective
Urinay incontinence (UI) is amajor public health problemthat can harm women in any period of life, including during the gestational period. Urinary incontinence during pregnancy has been studied because this condition can reduce the quality of life and interfere in several aspects of the maternal-fetal binomial. The aim of this study was to determine the prevalence of UI in nullipara pregnant women and to identify risk factors associated with UI in this population.
Methods
This is a case-control study in which we invited nullipara women between 12 and 20 weeks of pregnancy to participate in the research. They were asked to answer a specific questionnaire, write a 3-day bladder diary, and undergo a urogynecological evaluation including pelvic organ prolapse quantification (POP-Q), empty stress supine test (ESST), and pelvic floor muscle assessment.
Results
A total of 70 out of 73 patients accepted to participate in the study, and the prevalence of UI in this population was 18.3%. Tobacco use was identified as an independent risk factor for UI in pregnant women (odds ratio 8.0). All other factors analyzed were not significantly associated to UI in pregnancy.
Conclusion
Urinary incontinence can be a major problem in pregnancy.We identified the use of tobacco as a risk factor for developing UI in pregnancy, which provides an extra reason to encourage patients to quit smoking.
Views83This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleRisk Factors for Urinary Incontinence in Pregnancy: A Case Control Study
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(12):787-792
01-11-2020- Fernanda Borsatto Caruso ,
- Lucas Schreiner ,
- Alexandra Damasio Todescatto ,
- Isabel Crivelatti ,
- Julia Monteiro de Oliveira
Views83See moreAbstract
Objective
Urinay incontinence (UI) is amajor public health problemthat can harm women in any period of life, including during the gestational period. Urinary incontinence during pregnancy has been studied because this condition can reduce the quality of life and interfere in several aspects of the maternal-fetal binomial. The aim of this study was to determine the prevalence of UI in nullipara pregnant women and to identify risk factors associated with UI in this population.
Methods
This is a case-control study in which we invited nullipara women between 12 and 20 weeks of pregnancy to participate in the research. They were asked to answer a specific questionnaire, write a 3-day bladder diary, and undergo a urogynecological evaluation including pelvic organ prolapse quantification (POP-Q), empty stress supine test (ESST), and pelvic floor muscle assessment.
Results
A total of 70 out of 73 patients accepted to participate in the study, and the prevalence of UI in this population was 18.3%. Tobacco use was identified as an independent risk factor for UI in pregnant women (odds ratio 8.0). All other factors analyzed were not significantly associated to UI in pregnancy.
Conclusion
Urinary incontinence can be a major problem in pregnancy.We identified the use of tobacco as a risk factor for developing UI in pregnancy, which provides an extra reason to encourage patients to quit smoking.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Fernanda Borsatto Caruso
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Review Article
Do Women have Adequate Knowledge about Pelvic Floor Dysfunctions? A Systematic Review
- Júlia Ferreira Fante,
- Thais Daniel Silva,
- Elaine Cristine Lemes Mateus-Vasconcelos,
- Cristine Homsi Jorge Ferreira,
- Luiz Gustavo Oliveira Brito
09-16-2019
Summary
Review ArticleDo Women have Adequate Knowledge about Pelvic Floor Dysfunctions? A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(8):508-519
09-16-2019- Júlia Ferreira Fante,
- Thais Daniel Silva,
- Elaine Cristine Lemes Mateus-Vasconcelos,
- Cristine Homsi Jorge Ferreira,
- Luiz Gustavo Oliveira Brito
Views198See moreAbstract
Objective
We sought to investigate whether women present adequate knowledge of the main pelvic floor disorders (PFDs) (urinary incontinence - UI, fecal incontinence - FI, and pelvic organ prolapse - POP).
Data
sources A systematic review was performed in the MEDLINE, PEDro, CENTRAL, and Cochrane databases for publications from inception to April 2018. Selection of studies A total of 3,125 studies were reviewed. Meta-analysis was not possible due to the heterogeneity of primary outcomes and the diversity of instruments for measuring knowledge. The quality of the articles included in the analysis was evaluated with the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies.
Data collection
Two authors performed data extraction into a standardized spreadsheet.
Data synthesis
Nineteen studies were included, comprising 11,512 women. About the methodological quality (NOS), most of the studies (n= 11) presented a total score of 6 out of 10. Validated questionnaires and designed pilot-tested forms were the most frequently used ways of assessing knowledge. Some studies were stratified by race, age, or group minorities. The most used questionnaire was the prolapse and incontinence knowledge questionnaire (PIKQ) (n= 5). Knowledge and/or awareness regarding PFD was low to moderate among the studies. Urinary incontinence was the most prevalent PFD investigated, and the most important risk factors associated with the lack of knowledge of the pelvic floor were: African-American ethnicity (n= 3), low educational level (n= 4), low access to information (n= 5) and socioeconomic status (n= 3).
Conclusion
Most women have a gap in the knowledge of pelvic floor muscle dysfunctions, do not understand their treatment options, and are not able to identify risk factors for these disorders.
Views198This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticleDo Women have Adequate Knowledge about Pelvic Floor Dysfunctions? A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(8):508-519
09-16-2019- Júlia Ferreira Fante,
- Thais Daniel Silva,
- Elaine Cristine Lemes Mateus-Vasconcelos,
- Cristine Homsi Jorge Ferreira,
- Luiz Gustavo Oliveira Brito
Views198See moreAbstract
Objective
We sought to investigate whether women present adequate knowledge of the main pelvic floor disorders (PFDs) (urinary incontinence - UI, fecal incontinence - FI, and pelvic organ prolapse - POP).
Data
sources A systematic review was performed in the MEDLINE, PEDro, CENTRAL, and Cochrane databases for publications from inception to April 2018. Selection of studies A total of 3,125 studies were reviewed. Meta-analysis was not possible due to the heterogeneity of primary outcomes and the diversity of instruments for measuring knowledge. The quality of the articles included in the analysis was evaluated with the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies.
Data collection
Two authors performed data extraction into a standardized spreadsheet.
Data synthesis
Nineteen studies were included, comprising 11,512 women. About the methodological quality (NOS), most of the studies (n= 11) presented a total score of 6 out of 10. Validated questionnaires and designed pilot-tested forms were the most frequently used ways of assessing knowledge. Some studies were stratified by race, age, or group minorities. The most used questionnaire was the prolapse and incontinence knowledge questionnaire (PIKQ) (n= 5). Knowledge and/or awareness regarding PFD was low to moderate among the studies. Urinary incontinence was the most prevalent PFD investigated, and the most important risk factors associated with the lack of knowledge of the pelvic floor were: African-American ethnicity (n= 3), low educational level (n= 4), low access to information (n= 5) and socioeconomic status (n= 3).
Conclusion
Most women have a gap in the knowledge of pelvic floor muscle dysfunctions, do not understand their treatment options, and are not able to identify risk factors for these disorders.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article
Pelvic Floor 3D Ultrasound of Women with a TVT, TVT-O, or TVT-S for Stress Urinary Incontinence at the Three-year Follow-up
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):471-479
09-01-2017
Summary
Original ArticlePelvic Floor 3D Ultrasound of Women with a TVT, TVT-O, or TVT-S for Stress Urinary Incontinence at the Three-year Follow-up
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):471-479
09-01-2017Views96See moreAbstract
Objective
Using three-dimensional ultrasound (3D-US), we aimed to compare the tape position and the angle formed by the sling arms in different techniques of midurethral sling insertion for the surgical treatment of stress urinary incontinence, three years after surgery. In addition, we examined the correlations between the US findings and the clinical late postoperative results.
Methods
A prospective cross-sectional cohort study of 170 patients who underwent a sling procedure between May 2009 and December 2011 was performed. The final sample, with US images of sufficient quality, included 26 retropubic slings (tension-free vaginal tape, TVT), 42 transobturator slings (tension-free vaginal tape-obturator, TVTO), and 37 single-incision slings (tension-free vaginal tape-Secur, TVT-S). The images (at rest, during the Valsalva maneuver, and during pelvic floor contraction) were analyzed offline by 2 different observers blinded against the surgical and urinary continence status. Group comparisons were performed using the Student t-test, the chi-squared and the Kruskal-Wallis tests, and analyses of variance with Tukey multiple comparisons.
Results
Differences among the groups were found in themean angle of the tape arms (TVT = 119.94°, TVT-O = 141.93°, TVT-S = 121.06°; p < 0.001) and in the distance between the bladder neck and the tape at rest (TVT = 1.65 cm, TVT-O = 1.93 cm, TVTS = 1.95 cm; p = 0.010). The global objective cure rate was of 87.8% (TVT = 88.5%, TVT-O = 90.5%, TVT-S = 83.8%; p = 0.701). The overall subjective cure rate was of 83.8% (TVT = 88.5%, TVT-O = 88.5% and TVT-S = 78.4%; p = 0.514). The slings were located in the mid-urethra in 85.7% of the patients (TVT = 100%, TVT-O = 73.8%, TVTS = 89.2%; p = 0.001), with a more distal location associated with obesity (distal: 66.7% obese; mid-urethra: 34% obese; p = 0.003). Urgency-related symptoms were observed in 23.8% of the patients (TVT = 30.8%, TVT-O = 21.4%, TVT-S = 21.6%; p = 0.630).
Conclusions
The angle formed by the arms of the sling tape was more obtuse for the transobturator slings compared with the angles for the retropubic or single-incision slings. Retropubic slings were more frequently located in the mid-urethra compared with the other slings, regardless of obesity. However, the analyzed sonographic measures did not correlate with the urinary symptoms three years after the surgery.
Views96This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticlePelvic Floor 3D Ultrasound of Women with a TVT, TVT-O, or TVT-S for Stress Urinary Incontinence at the Three-year Follow-up
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(9):471-479
09-01-2017Views96See moreAbstract
Objective
Using three-dimensional ultrasound (3D-US), we aimed to compare the tape position and the angle formed by the sling arms in different techniques of midurethral sling insertion for the surgical treatment of stress urinary incontinence, three years after surgery. In addition, we examined the correlations between the US findings and the clinical late postoperative results.
Methods
A prospective cross-sectional cohort study of 170 patients who underwent a sling procedure between May 2009 and December 2011 was performed. The final sample, with US images of sufficient quality, included 26 retropubic slings (tension-free vaginal tape, TVT), 42 transobturator slings (tension-free vaginal tape-obturator, TVTO), and 37 single-incision slings (tension-free vaginal tape-Secur, TVT-S). The images (at rest, during the Valsalva maneuver, and during pelvic floor contraction) were analyzed offline by 2 different observers blinded against the surgical and urinary continence status. Group comparisons were performed using the Student t-test, the chi-squared and the Kruskal-Wallis tests, and analyses of variance with Tukey multiple comparisons.
Results
Differences among the groups were found in themean angle of the tape arms (TVT = 119.94°, TVT-O = 141.93°, TVT-S = 121.06°; p < 0.001) and in the distance between the bladder neck and the tape at rest (TVT = 1.65 cm, TVT-O = 1.93 cm, TVTS = 1.95 cm; p = 0.010). The global objective cure rate was of 87.8% (TVT = 88.5%, TVT-O = 90.5%, TVT-S = 83.8%; p = 0.701). The overall subjective cure rate was of 83.8% (TVT = 88.5%, TVT-O = 88.5% and TVT-S = 78.4%; p = 0.514). The slings were located in the mid-urethra in 85.7% of the patients (TVT = 100%, TVT-O = 73.8%, TVTS = 89.2%; p = 0.001), with a more distal location associated with obesity (distal: 66.7% obese; mid-urethra: 34% obese; p = 0.003). Urgency-related symptoms were observed in 23.8% of the patients (TVT = 30.8%, TVT-O = 21.4%, TVT-S = 21.6%; p = 0.630).
Conclusions
The angle formed by the arms of the sling tape was more obtuse for the transobturator slings compared with the angles for the retropubic or single-incision slings. Retropubic slings were more frequently located in the mid-urethra compared with the other slings, regardless of obesity. However, the analyzed sonographic measures did not correlate with the urinary symptoms three years after the surgery.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
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Original Articles
Perineal Massage Improves the Dyspareunia Caused by Tenderness of the Pelvic Floor Muscles
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(1):26-30
01-01-2017
Summary
Original ArticlesPerineal Massage Improves the Dyspareunia Caused by Tenderness of the Pelvic Floor Muscles
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(1):26-30
01-01-2017Views221See moreABSTRACT
Aim:
To evaluate the long-term effectiveness of perineal Thiele massage in the treatment of women with dyspareunia caused by tenderness of the pelvic floor muscles.
Methods:
A total of 18 women with diagnoses of dyspareunia caused by tenderness of the pelvic floor muscles were included in the study. The women were divided in two groups: the dyspareunia (D) group - 8 women with dyspareunia caused by tenderness of the pelvic floor muscles; and the chronic pelvic pain group (CPP) group - 10 women with dyspareunia caused by tenderness of the pelvic floor muscles associated with CPP. Each patient filled out the Visual Analogue Scale (VAS), the McGill Pain Index, the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). After an evaluation, the women underwent transvaginal massage using the Thiele technique over a period of 5 minutes, once a week for 4 weeks.
Results:
All women had significant improvements in their dyspareunia according the VAS and the McGill Pain Index (p < 0,001), but the HADS scores did not show significant differences. Regarding sexual function, the D group showed improvements on all aspects of sexual function, while the CPP group showed differences only in the pain domain.
Conclusion:
Thiele massage is effective in the treatment of dyspareunia caused by tenderness of the pelvic floor muscles with a long-term pain relief.
Views221This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticlesPerineal Massage Improves the Dyspareunia Caused by Tenderness of the Pelvic Floor Muscles
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(1):26-30
01-01-2017Views221See moreABSTRACT
Aim:
To evaluate the long-term effectiveness of perineal Thiele massage in the treatment of women with dyspareunia caused by tenderness of the pelvic floor muscles.
Methods:
A total of 18 women with diagnoses of dyspareunia caused by tenderness of the pelvic floor muscles were included in the study. The women were divided in two groups: the dyspareunia (D) group - 8 women with dyspareunia caused by tenderness of the pelvic floor muscles; and the chronic pelvic pain group (CPP) group - 10 women with dyspareunia caused by tenderness of the pelvic floor muscles associated with CPP. Each patient filled out the Visual Analogue Scale (VAS), the McGill Pain Index, the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). After an evaluation, the women underwent transvaginal massage using the Thiele technique over a period of 5 minutes, once a week for 4 weeks.
Results:
All women had significant improvements in their dyspareunia according the VAS and the McGill Pain Index (p < 0,001), but the HADS scores did not show significant differences. Regarding sexual function, the D group showed improvements on all aspects of sexual function, while the CPP group showed differences only in the pain domain.
Conclusion:
Thiele massage is effective in the treatment of dyspareunia caused by tenderness of the pelvic floor muscles with a long-term pain relief.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
Pelvic floor Archives - Revista Brasileira de Ginecologia e Obstetrícia
