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1.
Giovanna Motta Chiara Crespi Valentina Mineccia Paolo Riccardo Brustio Chiara Manieri Fabio Lanfranco 《The journal of sexual medicine》2018,15(1):94-101
Background
The acquisition of phenotypic male features in transmen with gender dysphoria requires testosterone treatment. The suppression of menses is 1 of the most desired effects. The relation between testosterone levels and human aggressive behavior has been described. However, the effects of testosterone on anger expression have been poorly investigated in trans-persons.Aim
To assess the effects of testosterone treatment on anger expression in transmen using a validated self-report questionnaire (Spielberger's State-Trait Anger Expression Inventory–2 [STAXI-2]).Methods
52 transmen diagnosed with gender dysphoria were evaluated before (T0) and at least 7 months after (T1) initiation of continuous gender-affirming testosterone treatment. Sociodemographic characteristics, anthropometric parameters, diagnosis of psychiatric disorders, current psychopharmacologic treatments, and life events were investigated at T0.Outcomes
STAXI-2 scores, serum testosterone, and estradiol levels at T0 and T1 were compared.Results
Most of the sample (61.5%, n = 32) had no Axis I or II comorbidity. All subjects at T1 achieved significantly higher serum testosterone levels (5.67 ± 3.88 ng/mL), whereas no significant difference in estradiol levels was observed from T0 to T1. At T1 only 46.2% (n = 24) of the sample achieved iatrogenic amenorrhea, whereas most of the sample had persistent regular bleedings. A significant increase in STAXI anger expression and anger control scores from T0 to T1 was recorded. Patients with persistent bleedings and Axis I disorders seemed to have higher odds of expressing anger. However, circulating testosterone levels at T1 did not influence anger expression.Clinical Implications
Interestingly, despite the increase of anger expression scores, during continuous testosterone treatment, there were no reports of aggressive behavior, self-harm, or psychiatric hospitalization.Strengths and Limitations
A limitation to this study is that although the STAXI-2 is a well-validated instrument measuring anger expression, it is a self-report psychometric measure.Conclusion
This study demonstrates that during 7 months of continuous gender-affirming hormonal treatment, anger expression and anger arousal control increased in transmen. Persistence of menstrual bleedings and Axis I disorders, but not circulating testosterone levels, were predictive of the increase in anger expression score. Continuous psychological support to transmen during gender-affirming hormonal treatment was useful to prevent angry behaviors and decrease the level of dysphoria.Motta G, Crespi C, Mineccia V, et al. Does Testosterone Treatment Increase Anger Expression in a Population of Transgender Men? J Sex Med 2018;15:94–101. 相似文献2.
Amelia M. Stanton J. Gregory Hixon Lindsey M. Nichols Cindy M. Meston 《The journal of sexual medicine》2018,15(1):64-76
Background
Below average heart rate variability (HRV) has been associated with sexual arousal dysfunction and overall sexual dysfunction in women. Autogenic training, a psychophysiologic relaxation technique, has been shown to increase HRV. In a recent study, sexually healthy women experienced acute increases in physiologic (ie, genital) and subjective sexual arousal after 1 brief session of autogenic training.Aim
To build on these findings by testing the effects of a single session of autogenic training on sexual arousal in a sample of women who reported decreased or absent sexual arousal for at least 6 months.Methods
Genital sexual arousal, subjective sexual arousal, and perceived genital sensations were assessed in 25 women 20 to 44 years old before and after listening to a 22-minute autogenic training recording. HRV was assessed with electrocardiography.Outcomes
Change in genital sexual arousal, subjective sexual arousal, and perceived genital sensations from the pre-manipulation erotic film to the post-manipulation erotic film.Results
Marginally significant increases in discrete subjective sexual arousal (P = .051) and significant increases in perceived genital sensations (P = .018) were observed. In addition, degree of change in HRV significantly moderated increases in subjective arousal measured continuously over time (P < .0001). There were no significant increases in genital arousal after the manipulation.Clinical Implications
The results of this study suggest that autogenic training, and other interventions that aim to increase HRV, could be a useful addition to treatment protocols for women who are reporting a lack of subjective arousal or decreased genital sensations.Strengths and Limitations
There are few treatment options for women with arousal problems. We report on a new psychosocial intervention that could improve arousal. Limitations include a relatively small sample and the lack of a control group.Conclusion
Our findings indicate that autogenic training significantly improves acute subjective arousal and increases perceived genital sensations in premenopausal women with self-reported arousal concerns.Stanton AM, Hixon JG, Nichols LM, Meston CM. One Session of Autogenic Training Increases Acute Subjective Sexual Arousal in Premenopausal Women Reporting Sexual Arousal Problems. J Sex Med 2018;15:64–76. 相似文献3.
Chantal M. Wiepjes Nienke M. Nota Christel J.M. de Blok Maartje Klaver Annelou L.C. de Vries S. Annelijn Wensing-Kruger Renate T. de Jongh Mark-Bram Bouman Thomas D. Steensma Peggy Cohen-Kettenis Louis J.G. Gooren Baudewijntje P.C. Kreukels Martin den Heijer 《The journal of sexual medicine》2018,15(4):582-590
Background
Over the past decade, the number of people referred to gender identity clinics has rapidly increased. This raises several questions, especially concerning the frequency of performing gender-affirming treatments with irreversible effects and regret from such interventions.Aim
To study the current prevalence of gender dysphoria, how frequently gender-affirming treatments are performed, and the number of people experiencing regret of this treatment.Methods
The medical files of all people who attended our gender identity clinic from 1972 to 2015 were reviewed retrospectively.Outcomes
The number of (and change in) people who applied for transgender health care, the percentage of people starting with gender-affirming hormonal treatment (HT), the estimated prevalence of transgender people receiving gender-affirming treatment, the percentage of people who underwent gonadectomy, and the percentage of people who regretted gonadectomy, specified separately for each year.Results
6,793 people (4,432 birth-assigned male, 2,361 birth-assigned female) visited our gender identity clinic from 1972 through 2015. The number of people assessed per year increased 20-fold from 34 in 1980 to 686 in 2015. The estimated prevalence in the Netherlands in 2015 was 1:3,800 for men (transwomen) and 1:5,200 for women (transmen). The percentage of people who started HT within 5 years after the 1st visit decreased over time, with almost 90% in 1980 to 65% in 2010. The percentage of people who underwent gonadectomy within 5 years after starting HT remained stable over time (74.7% of transwomen and 83.8% of transmen). Only 0.6% of transwomen and 0.3% of transmen who underwent gonadectomy were identified as experiencing regret.Clinical Implications
Because the transgender population is growing, a larger availability of transgender health care is needed. Other health care providers should familiarize themselves with transgender health care, because HT can influence diseases and interact with medication. Because not all people apply for the classic treatment approach, special attention should be given to those who choose less common forms of treatment.Strengths and Limitations
This study was performed in the largest Dutch gender identity clinic, which treats more than 95% of the transgender population in the Netherlands. Because of the retrospective design, some data could be missing.Conclusion
The number of people with gender identity issues seeking professional help increased dramatically in recent decades. The percentage of people who regretted gonadectomy remained small and did not show a tendency to increase.Wiepjes CM, Nota NM, de Blok CJM, et al. The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in Prevalence, Treatment, and Regrets. J Sex Med 2018;15:582–590. 相似文献4.
James Furr Kristi Hebert Eric Wisenbaugh Joel Gelman 《The journal of sexual medicine》2018,15(12):1811-1817
Introduction
The objective of genital enlargement surgery is to increase length and/or girth for cosmetic reasons; however, newer techniques have been recently reported to be associated with only minor complications in a small percentage of patients.Aim
We aim to report the severe complications of penile augmentation surgery seen at a referral center and describe their subsequent management.Methods
Institutional review board approval was obtained. We reviewed our prospectively collected database for all patients who presented with complications of genital enlargement surgery from 2002–2016.Main Outcome Measure
Interventions following complications of genital enlargement surgery.Results
11 Patients were identified. Mean age was 47 (21–77) years. Prior procedures included subcutaneous injection of silicone outside a medical setting, girth enhancement procedures involving the subcutaneous placement or injection of substances including fat, other substances, or subcutaneous silicone implants. All patients who underwent subcutaneous penile implant underwent removal prior to presentation. Adverse changes included sexually disabling penile deformity and severe shortening, curvature, edema, subcutaneous masses, infection, non-healing wounds, and sexual dysfunction. 10 patients underwent corrective surgery, with 2 requiring multiple procedures and 3 requiring split-thickness skin grafting. All 10 patients had an improved cosmetic appearance and those who had disabling shortening had significantly improved functional length.Clinical Implications
Report of such adverse events should assist in appropriate perioperative counseling prior to genital enhancement surgery.Strength & Limitations
Few reports of debilitating complications of penile enlargement exist in literature. However, without knowing the overall number of procedures performed, the true complication incidence is not known.Conclusion
Penile and scrotal enhancement surgery can be associated with major disabling complications, leading to deformity and functional compromise in men with prior normal anatomy and function. Patients should be aware of these risks.Furr J, Hebert K, Wisenbaugh E, et al. Complications of Genital Enlargement Surgery. J Sex Med 2018;15:1811–1817. 相似文献5.
Karina Kapczuk Zbigniew Friebe Kinga Iwaniec Witold Kędzia 《Journal of pediatric and adolescent gynecology》2018,31(3):252-257
Study Objective
To assess the clinical course of obstructive Müllerian anomalies found in girls after menarche.Design
A retrospective case series of adolescents who, between 2009 and 2016, were treated for vaginal or uterine obstructive malformations diagnosed after menarche.Setting
Division of Gynecology, Poznań University of Medical Sciences, Poznań, Poland.Participants and Interventions
Twenty-two patients who, at the age range between 11.4 and 18.2 (median, 13.1) years, between 2 and 74 (median 7.5) months after menarche, underwent surgical repair of obstructive genital anomaly.Main Outcome Measures
Müllerian defect type, presentation, radiologic findings, pre- and postoperative course.Results
Eighteen patients (18 of 22; 81.8%) were diagnosed with obstructed hemivagina ipsilateral renal anomaly syndrome. One patient (1 of 22; 4.5%) was diagnosed with uterus didelphys and unilateral cervical atresia. Three patients (3 of 22; 13.6%) had unicornuate uterus with a cavitated, noncommunicating rudimentary horn. The right side was affected in 13 patients (13 of 22; 59.1%), and the left side in 9 patients (9 of 22; 40.9%; P > .05). All but 1 patient had renal agenesis on the side of obstruction. Before repair of the obstructive genital anomaly, 4 patients underwent unnecessary surgeries for misdiagnosed ovarian cysts. Serious complications (pelvic inflammatory disease, vesicovaginal fistula) occurred in 2 patients with microperforated pyocolpos. Pelvic endometriosis was found in 4 of our patients.Conclusion
Our case series suggests that obstructed hemivagina ipsilateral renal anomaly syndrome is the most common obstructive Müllerian anomaly diagnosed in adolescents after menarche. The differential diagnosis for unilateral kidney agenesis accompanied by dysmenorrhea in adolescent girls should include obstructive genital tract anomaly. Accurate diagnosis of an obstructive genital anomaly early after menarche might help prevent unnecessary surgeries and infection-related complications. Meanwhile, prompt surgical correction of an obstructive genital tract anomaly results in relief of symptoms and might reduce the risk of endometriosis. 相似文献6.
David Jiang Jonathan Witten Jens Berli Daniel Dugi 《The journal of sexual medicine》2018,15(6):902-906
Background
Gender-affirming vaginoplasty aims to create the external female genitalia (vulva) as well as the internal vaginal canal; however, not all patients desire nor can safely undergo vaginal canal creation.Aim
Our objective is to describe the factors influencing patient choice or surgeon recommendation of vulvoplasty and to assess the patient’s satisfaction with this choice.Methods
Gender-affirming genital surgery consults were reviewed from March 2015 until December 2017, and patients scheduled for or who had completed vulvoplasty were interviewed by telephone.Outcomes
We report demographic data and the reasons for choosing vulvoplasty as gender-affirming surgery for patients who either completed or were scheduled for surgery, in addition to patient reports of satisfaction with choice of surgery, satisfaction with the surgery itself, and sexual activity after surgery.Results
In total, 486 patients were seen in consultation for trans-feminine gender-affirming genital surgery: 396 requested vaginoplasty and 39 patients requested vulvoplasty. 30 Patients either completed or are scheduled for vulvoplasty. Vulvoplasty patients were older and had higher body mass index than those seeking vaginoplasty. The majority (63%) of the patients seeking vulvoplasty chose this surgery despite no contra-indications to vaginoplasty. The remaining patients had risk factors leading the surgeon to recommend vulvoplasty. Of those who completed surgery, 93% were satisfied with the surgery and their decision for vulvoplasty.Clinical Translation
Vulvoplasty creates the external appearance of female genitalia without creation of a neovaginal canal; it is associated with high satisfaction and low decision regret.Conclusions
This is the first study of factors impacting a patient’s choice of or a surgeon’s recommendation for vulvoplasty over vaginoplasty as gender-affirming genital surgery; it also is the first reported series of patients undergoing vulvoplasty only. Limitations of this study include its retrospective nature, non-validated questions, short-term follow-up, and selection bias in how we offer vulvoplasty. Vulvoplasty is a form of gender-affirming feminizing surgery that does not involve creation of a neovagina, and it is associated with high satisfaction and low decision regret.Jiang D, Witten J, Berli J, et al. Does Depth Matter? Factors Affecting Choice of Vulvoplasty Over Vaginoplasty as Gender-Affirming Genital Surgery for Transgender Women. J Sex Med 2018;15:902–906. 相似文献7.
Ariel B. Handy Amelia M. Stanton Carey S. Pulverman Cindy M. Meston 《The journal of sexual medicine》2018,15(1):52-63
Background
Many sexual psychophysiologic studies have failed to find differences in physiologic genital arousal between women with and those without sexual dysfunction. However, differences in self-reported (ie, perceived) measures of genital responses between these 2 groups of women have been noted.Aims
To determine whether women with and without sexual dysfunction differ on measures of physiologic and perceived genital arousal based on type of analytic technique used, to explore differences in perceived genital arousal, and to assess the relation between physiologic and perceived genital arousal.Methods
Data from 5 studies (N = 214) were used in this analysis. Women were categorized into 3 groups: women with arousal-specific sexual dysfunction (n = 40), women with decreased sexual function (n = 72), and women who were sexually functional (n = 102). Women viewed an erotic film while their physiologic genital arousal was measured using a vaginal photoplethysmograph. After watching the film, women completed a self-report measure of perceived genital arousal.Outcomes
There were differences in vaginal pulse amplitude (VPA) levels and association of VPA with perceived genital sensations based on level of sexual function.Results
Commonly used methods of analysis failed to identify significant differences in VPA among these groups of women. When VPA data were analyzed with hierarchical linear modeling, significant differences emerged. Notably, women with arousal-specific dysfunction exhibited lower VPA than sexually functional women at the beginning of the assessment. As the erotic film progressed, women with arousal-specific dysfunction became aroused at a faster rate than sexually functional women, and these 2 groups ultimately reached a similar level of VPA. Sexually functional women reported the highest levels of perceived genital responses among the 3 groups of women. No significant relation between VPA and perceived genital arousal emerged.Clinical Translation
Women's perception of their genital responses could play a role in women's experience of sexual dysfunction and might be more clinically relevant for women with sexual dysfunction than genital blood flow.Strengths and Limitations
This study's large sample is unique in sexual psychophysiology, and it strengthens the credibility of the findings. However, this study is limited in that arousal-specific dysfunction was determined with self-report measures, not by a clinician-administered assessment.Conclusion
These findings suggest distinct response trajectories in women with and without sexual dysfunction, and although perceived genital responses are important for women who are experiencing problems with arousal, they do not seem to be related to objective measures of physiologic arousal.Handy AB, Stanton AM, Pulverman CS, Meston CM. Differences in Perceived and Physiologic Genital Arousal Between Women With and Without Sexual Dysfunction. J Sex Med 2018;15:52–63. 相似文献8.
Maartje Klaver Renée de Mutsert Chantal M. Wiepjes Jos W.R. Twisk Martin den Heijer Joost Rotteveel Daniël T. Klink 《The journal of sexual medicine》2018,15(2):251-260
Background
Transgender adolescents aspiring to have the body characteristics of the affirmed sex can receive hormonal treatment. However, it is unknown how body shape and composition develop during treatment and whether transgender persons obtain the desired body phenotype.Aim
To examine the change in body shape and composition from the start of treatment with gonadotropin-releasing hormone agonists (GnRHa) until 22 years of age and to compare these measurements at 22 years with those of age-matched peers.Methods
71 transwomen (birth-assigned boys) and 121 transmen (birth-assigned girls) who started treatment from 1998 through 2014 were included in this retrospective study. GnRHa treatment was started and cross-sex hormonal treatment was added at 16 years of age. Anthropometric and whole-body dual-energy x-ray absorptiometry data were retrieved from medical records. Linear mixed model regression was performed to examine changes over time. SD scores (SDS) were calculated to compare body shape and composition with those of age-matched peers.Outcomes
Change in waist-hip ratio (WHR), total body fat (TBF), and total lean body mass (LBM) during hormonal treatment. SDS of measures of body shape and composition compared with age-matched peers at 22 years of age.Results
In transwomen, TBF increased (+10%, 95% CI = 7–11) while total LBM (?10%, 95% CI = ?11 to ?7) and WHR (?0.04, 95% CI = ?0.05 to ?0.02) decreased. Compared with ciswomen, SDS at 22 years of age were +0.3 (95% CI = 0.0–0.5) for WHR, and 0.0 (95% CI = ?0.2 to 0.3) for TBF. Compared with cismen, SDS were ?1.0 (95% CI = ?1.3 to ?0.7) for WHR, and +2.2 (95% CI = 2.2–2.4) for TBF. In transmen, TBF decreased (?3%, 95% CI = ?4 to ?1), while LBM (+3%, 95% CI = 1–4) and WHR (+0.03, 95% CI = 0.01–0.04) increased. Compared with ciswomen, SDS at 22 years of age were +0.6 (95% CI = 0.4–0.8) for WHR, and ?1.1 (95% CI = ?1.4 to ?0.9) for TBF. Compared with cismen, SDS were ?0.5 (95% CI = ?0.8 to ?0.3) for WHR, and +1.8 (95% CI = 1.6–1.9) for TBF.Clinical Implications
Knowing body shape and composition outcomes at 22 years of age will help care providers in counseling transgender youth on expectations of attaining the desired body phenotype.Strengths and Limitations
This study presents the largest group of transgender adults to date who started treatment in their teens. Despite missing data, selection bias was not found.Conclusions
During treatment, WHR and body composition changed toward the affirmed sex. At 22 years of age, transwomen compared better to age-matched ciswomen than to cismen, whereas transmen were between reference values for ciswomen and cismen.Klaver M, de Mutsert R, Wiepjes CM, et al. Early Hormonal Treatment Affects Body Composition and Body Shape in Young Transgender Adolescents. J Sex Med 2018;15:251–260. 相似文献9.
Robyn A. Jackowich Leah Pink Allan Gordon Évéline Poirier Caroline F. Pukall 《The journal of sexual medicine》2018,15(4):558-567
Background
Persistent genital arousal disorder (PGAD) is an understudied condition characterized by unwanted physiologic genital arousal in the absence of subjective sexual arousal. Markos and Dinsmore (Int J STD AIDS 2013;24:852–858) theorized that PGAD shares a number of similarities with vulvodynia (unexplained chronic vulvar pain [CVP]), including symptom characteristics and comorbidities.Aim
To compare medical histories, symptom characteristics, pain characteristics, and daily functioning among women with persistent genital pain (PGA) (n = 42), painful PGA (n = 37), and CVP (n = 42) symptoms.Methods
An online cross-sectional survey was conducted from October 2015 through April 2016.Outcomes
Self-report measures of symptoms, diagnosed medical conditions, pain characteristics (McGill Pain Questionnaire), catastrophizing (Pain Catastrophizing Scale), and daily functioning (Functional Status Questionnaire) were collected.Results
All 3 groups reported similar medical diagnoses and high frequencies of other chronic pelvic pain conditions. Women in all 3 groups reported comparable ages at symptom onset and timing of symptom expression (ie, constant vs intermittent). Women in the 2 PGA groups reported significantly greater feelings of helplessness than women in the CVP group. Women in the painful PGA and CVP groups endorsed significantly more sensory terms to describe their symptoms compared with women in the PGA group, whereas women in the painful PGA group reported significantly more affective terms to describe their symptoms compared with women in the CVP group. Women in the 2 PGA groups reported that their symptoms interfered significantly with most areas of daily functioning.Clinical Implications
Given the similarities between PGA and CVP symptoms, women with PGA may benefit from similar assessment, treatment, and research approaches.Strengths and Limitations
Limitations of the present study include its sole use of self-report measures; the presence of PGA or CVP symptoms was not confirmed by clinical assessment. However, the anonymous design of the online survey could have resulted in a larger and more diverse sample.Conclusion
The results of this study provide some initial support for the conceptualization of persistent genital arousal as a subtype of genital paresthesias/discomfort. These results also further highlight the negative impact that PGA symptoms have on many domains of daily living and the need for further research on this distressing condition.Jackowich RA, Pink L, Gordon A, et al. An Online Cross-Sectional Comparison of Women With Symptoms of Persistent Genital Arousal, Painful Persistent Genital Arousal, and Chronic Vulvar Pain. J Sex Med 2018;15:558–567. 相似文献10.
Background
Sex research lacks experimental studies in which both partners participate in a laboratory procedure. This is relevant in the context of genital pain because painful vaginal sensations often occur in the presence of the partner.Aim
To examine the effects of partner presence, sexual stimulation, and vaginal pressure on the appraisal of vaginal sensations and sexual arousal, ultimately aiming to increase the ecologic validity of laboratory designs.Methods
A community sample of 42 women and their male partners watched sexual and neutral films while separated or together. We induced gradually increasing vaginal pressure in the women using an intravaginal inflatable rubber balloon.Outcomes
Women reported on pleasant and painful vaginal pressure and perceived genital arousal. Men and women reported on subjective sexual arousal. We also examined whether these appraisals were moderated by relationship satisfaction.Results
The appraisal of vaginal pressure varied as a function of relationship satisfaction. Less satisfied women reported more painful pressure than women who were highly satisfied and highly satisfied women appraised the pressure as more pleasant in the context of a sex film and in the presence (vs absence) of their partner. In men and women, although partner presence had a negative effect on subjective sexual arousal, the presence of the partner did increase women's perception of genital arousal when vaginal pressure was induced during a sex film, particularly when women felt highly satisfied with their relationship. Also, the effects on subjective sexual arousal were moderated by relationship satisfaction. For couples in which the woman was less satisfied, the induction of vaginal pressure resulted in higher subjective sexual arousal when the partner was absent compared with when he was present, whereas when the man felt less satisfied, partner presence had a positive effect on sexual arousal.Clinical Implications
Interventions need to focus on the importance of sexual arousal during vaginal pressure stimulation and the way this is shaped by partner and relationship variables. Our results indicate that enhancing the relationship climate is an important target of intervention.Strengths and Limitations
We did not include physical indices of genital arousal and did not use a clinical sample of women with genital pain.Conclusions
The appraisal of vaginal sensations and sexual arousal are context-dependent responses that vary as a function of partner presence and sexual stimulation. Including both partners in the laboratory setting is important to create more valid models on sexual responding.Dewitte M, Schepers J, Melles R. The Effects of Partner Presence and Sexual Stimulation on the Appraisal of Vaginal Pressure and Sexual Arousal. J Sex Med 2018;15:539–549. 相似文献11.
Julie S. Downs Amie M. Ashcraft Pamela J. Murray Elise D. Berlan Wändi Bruine de Bruin Joan Eichner Baruch Fischhoff Janie M. Leary Robert B. McCall Elizabeth Miller Jennifer Salaway Janell Smith-Jones Gina S. Sucato 《Journal of pediatric and adolescent gynecology》2018,31(3):291-298.e2
Study Objective
To assess the effects of the Seventeen Days interactive video on young women's perceived self-efficacy for using condoms 6 months after being offered the intervention, relative to a control.Design
Multisite randomized controlled trial.Setting
Twenty participating health clinics and county health departments in Ohio, Pennsylvania, and West Virginia.Participants
Sexually active female adolescents ages 14 to 19 years.Interventions
Seventeen Days (treatment intervention; sex education) vs Driving Skills for Life (control intervention; driving education).Main Outcome Measures
Perceived self-efficacy for condom use.Results
Participants in the Seventeen Days group reported higher perceived condom acquisition self-efficacy after 6 months than those in the driving group. This finding held after controlling for baseline self-efficacy scores and other covariates.Conclusion
The Seventeen Days program shows promise to improve perceived self-efficacy to acquire condoms among sexually active female adolescents—an important precursor to behavior change. 相似文献12.
Lauren M. Bergeron Katherine C. Bishop Holly R. Hoefgen Margaret S. Abraham Nhial T. Tutlam Diane F. Merritt Jeffrey F. Peipert 《Journal of pediatric and adolescent gynecology》2017,30(1):123-127
Study Objective
The purpose of this study was to compare ovarian conservation rates and surgical approach in benign adnexal surgeries performed by surgeons vs gynecologists at a tertiary care institution.Design
A retrospective cohort review.Setting
Children's and adult tertiary care university-based hospital.Participants
Patients 21 years of age and younger who underwent surgery for an adnexal mass from January 2003 through December 2013.Interventions
Patient age, demographic characteristics, menarchal status, clinical symptoms, radiologic imaging, timing of surgery, surgeon specialty, mode of surgery, rate of ovarian conservation, and pathology were recorded. Patients were excluded if they had a uterine anomaly or pathology-proven malignancy.Main Outcome Measures
The primary outcome was the rate of ovarian conservation relative to surgical specialty; secondary outcome was surgical approach relative to surgical specialty.Results
Of 310 potential cases, 194 met inclusion criteria. Gynecologists were more likely than surgeons to conserve the ovary (80% vs 63%; odds ratio, 2.28; 95% confidence interval, 1.16-4.48). After adjusting for age, body mass index, mass size, and urgency of surgery, the difference was attenuated (adjusted odds ratio, 1.84; 95% confidence interval, 0.88-3.84). Surgeons and gynecologists performed minimally invasive surgery at similar rates (62% vs 50%; P = .11). A patient was more likely to receive surgery by a gynecologist if she was older (P < .001) and postmenarchal (P = .005).Conclusion
Results of our study suggest that gynecologists are more likely to perform ovarian-conserving surgery. However, our sample size precluded precise estimates in our multivariable model. Educational efforts among all pediatric and gynecologic surgeons should emphasize ovarian conservation and fertility preservation whenever possible. 相似文献13.
Jennifer E. McCabe-Beane Sara M. Stasik-O&#x;Brien Lisa S. Segre 《Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG》2018,47(1):105-113
Objectives
To examine the incremental identification of emotional distress in mothers of hospitalized newborns by screening for anxiety in addition to depression and to provide practical information about anxiety screening scales to facilitate instrument selection and screening implementation by nurses in the NICU.Design
In this secondary data analysis, screening data from the recruitment phase of a feasibility trial to evaluate a nurse-delivered counseling intervention for emotionally distressed mothers of newborns in the NICU were used to examine the effect of anxiety screening.Setting
A Level IV NICU at a large academic medical center in the Midwestern United States.Participants
Women 18 years of age and older (N = 190) with newborns in the NICU.Methods
Participants completed multiple measures of depression and anxiety symptoms.Results
Of participants who had negative screening results on a depression-only screening instrument, 4.7% to 14.7% endorsed clinically significant anxiety symptoms depending on the screening instrument used.Conclusion
Screening for anxiety in mothers of newborns in the NICU resulted in identification of distressed mothers who would otherwise have been missed during routine depression-only screening. Multiple options for anxiety screening exist that add incremental information to depression-only screening and require little additional burden on providers and mothers of newborns in the NICU. 相似文献14.
Soo Yoon Lee Mi-La Kim Seok Ju Seong Jong Woon Bae Yeon Jean Cho 《Journal of pediatric and adolescent gynecology》2017,30(2):228-233
Study Objective
To evaluate the cumulative recurrence rate of endometriomas after a laparoscopic endometriotic cyst enucleation in adolescents and to find the factors associated with recurrence.Design
A multicenter retrospective cohort study.Setting
Three university hospitals.Participants
One hundred five patients surgically treated with laparoscopic enucleation of endometriotic cysts younger than 20 years of age were selected.Interventions
None.Main Outcome Measures
Endometrioma recurrence was considered when transvaginal or transrectal sonography indicated a cystic mass with a diameter of 20 mm or greater. Recurrence rate of endometrioma and median time to recurrence were evaluated.Results
In total, 105 patients were followed for 47.3 (±44.3) months (range, 3-161 months). Seventeen patients (16.2%) experienced recurrence after the first-line surgery and 8 patients (7%) underwent a second surgery. The median time to recurrence was 53.0 (±8.5) months (range, 8-111 months). Using Kaplan-Meier method, the cumulative recurrence rates of endometrioma per patient at 24, 36, 60, and 96 months after the first-line surgery were 6.4%, 10%, 19.9% and 30.9%, respectively. Surgical characteristics, such as the diameter of the cyst, revised American Society for Reproductive Medicine stage, unilateral or bilateral involvement, and coexistence of deep endometriosis were not associated with recurrence in this age group.Conclusion
Although the short-term recurrence rate in adolescents after first-line surgery is relatively low, the recurrence rate appears to be higher according to the follow-up duration. Long-term and continuous follow-up is needed for patients who have undergone surgical treatment for endometriosis in the adolescent period. 相似文献15.
Hamada Ashry Abd El Wahed Ali Ahmed Emadeldin Arafa Nesreen Abd El Fattah Abd Allah Shehata Ashraf Samir Fahim 《Journal of pediatric and adolescent gynecology》2018,31(6):571-574
Study Objective
Female circumcision (FC) is a deeply rooted practice in Egypt with deblitating physical and psychological consequences. During the past 2 decades there have been sincere efforts to reduce this practice. The objective of this study was to investigate the prevalence of circumcision.Design
Cross-sectional study.Setting
Beni-Suef City, Egypt.Participants
Young women (12-25 years of age).Interventions
A survey was given to 3353 young women residing in Beni-Suef City. Data were collected using a questionnaire that included information about the sociodemographic characteristics of participants, their gynecological data, exposure to FC, and complaints associated with menses during the previous year.Main Outcome Measures
Prevalence of FC in rural areas in Beni Suef.Results
Of the 3353 interviewed women, 1846 (55%) were circumcised. Women residing in rural areas, married women, and those who had illiterate parents were more likely to have experienced circumcision. Students were less likely to be circumcised (P < .05). The circumcised girls reported shorter menstrual cycles and dysuria with menses (P < .05). Dysmenorrhea, generalized aching, and nervousness were the most common complaints associated with menses in both groups, with no statistically significant differences (P > .05).Conclusion
FC is highly prevalent in rural areas in Beni-Suef, however, compared with previous reports it seems that the rates of circumcision have decreased markedly. Despite this decrease, the practice of female genital mutilation is still highly prevalent, suggesting that future research and intervention will be needed to eliminate this practice. 相似文献16.
Brittany L. Murphy Amy E. Glasgow Dan S. Ubl Elizabeth B. Habermann Valerie Lemaine 《Journal of pediatric and adolescent gynecology》2018,31(3):299-303
Study Objective
Adolescent breast disorders are rare and typically benign in nature; however, surgical treatments might require multiple surgeries. Because of the limited existing data, we sought to evaluate national trends and describe our institutional experience to help guide patient conversations.Design
Retrospective review.Setting
National database and academic institution.Participants
Patients 20 years old or younger who underwent a breast procedure in the Kids' Inpatient Database from January 2000 to December 2012 and at Mayo Clinic-Rochester from January 2000 to July 2016. Conditions were categorized into common and complex breast disorders.Interventions
None.Main Outcome Measures
To assess any trend of adolescent breast procedures across the United States as a whole, weighted Kids' Inpatient Database data were assessed using a Rao-Scott χ2 test. Within the institutional data, the average number of procedures needed to correct common vs complex breast disorders were compared using an unequal variance t test.Results
In recent years, the estimated number of hospitalizations for breast procedures decreased in the United States from 1661 in 2000 to 1078 in 2012 (P < .001). At our institution, 241 patients underwent a breast procedure (75.1% [181/241] female) over 16 years. Common breast disorders were corrected with fewer procedures than complex breast disorders (mean 1.09 vs 2.22 procedures; P = .0003).Conclusion
Inpatient treatment of adolescent breast disorders has been decreasing in recent years, likely reflecting a trend to outpatient procedures. Common adolescent breast disorders might be surgically corrected with 1 procedure, whereas complex disorders often require multiple surgeries to correct. It is important to discuss this with patients and their families to adequately set up expectations. 相似文献17.
Patrick Campbell Michael Krychman Thomas Gray Holly Vickers John Money-Taylor Weiguang Li Stephen Radley 《The journal of sexual medicine》2018,15(11):1515-1517
Introduction
Vaginal laxity is increasingly recognized as an important condition, although little is known regarding its prevalence and associated symptoms.Aim
To report the prevalence of self-reported vaginal laxity in women attending a urogynecology clinic and investigate its association with pelvic floor symptoms and female sexual dysfunction.Method
Data were analyzed from 2,621 women who completed the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF).Main Outcome Measure
Response data from ePAQ-PF questionairre.Results
Vaginal laxity was self-reported by 38% of women and significantly associated with parity, symptoms of prolapse, stress urinary incontinence, overactive bladder, reduced vaginal sensation during intercourse, and worse general sex life (P < .0005).Clinical Implications
Clinicians should be aware that vaginal laxity is prevalent and has an associated influence and impact on sexual function.Strength & Limitations
The main strength of this study is the analysis of prospectively collected data from a large cohort of women using a validated questionnaire. The main limitation is lack of objective data to measure pelvic organ prolapse.Conclusion
Vaginal laxity is a highly prevalent condition that impacts significantly on a woman’s sexual health and quality of life.Campbell P, Krychman M, Gray T, et al. Self-reported vaginal laxity—Prevalence, impact, and associated symptoms in women attending a urogynecology clinic. J Sex Med 2018;15:1515–1517. 相似文献18.
Mayte Parada Marina Gérard Kevin Larcher Alain Dagher Yitzchak M. Binik 《The journal of sexual medicine》2018,15(2):217-229
Background
The few studies that have examined the neural correlates of genital arousal have focused on men and are methodologically hard to compare.Aim
To investigate the neural correlates of peripheral physiologic sexual arousal using identical methodology for men and women.Methods
2 groups (20 men, 20 women) viewed movie clips (erotic, humor) while genital temperature was continuously measured using infrared thermal imaging. Participants also continuously evaluated changes in their subjective arousal and answered discrete questions about liking the movies and wanting sexual stimulation. Brain activity, indicated by blood oxygen level-dependent (BOLD) response, was measured using functional magnetic resonance imaging.Outcomes
BOLD responses, genital temperature, and subjective sexual arousal.Results
BOLD activity in a number of brain regions was correlated with changes in genital temperature in men and women; however, activation in women appeared to be more extensive than in men, including the anterior and posterior cingulate cortex, right cerebellum, insula, frontal operculum, and paracingulate gyrus. Examination of the strength of the correlation between BOLD response and genital temperature showed that women had a stronger brain-genital relation compared with men in a number of regions. There were no brain regions in men with stronger brain-genital correlations than in women.Clinical Translation
Our findings shed light on the neurophysiologic processes involved in genital arousal for men and women. Further research examining the specific brain regions that mediate our findings is necessary to pave the way for clinical application.Strengths and Limitations
A strength of the study is the use of thermography, which allows for a direct comparison of the neural correlates of genital arousal in men and women. This study has the common limitations of most laboratory-based sexual arousal research, including sampling bias, lack of ecologic validity, and equipment limitations, and those common to neuroimaging research, including BOLD signal interpretation and neuroimaging analysis issues.Conclusions
Our findings provide direct sex comparisons of the neural correlates of genital arousal in men and women and suggest that brain-genital correlations could be stronger in women.Parada M, Gérard M, Larcher K, et al. How Hot Are They? Neural Correlates of Genital Arousal: An Infrared Thermographic and Functional Magnetic Resonance Imaging Study of Sexual Arousal in Men and Women. J Sex Med 2018;15:217–229. 相似文献19.
Alexa Kaskowitz Elisabeth Quint Melissa Zochowski Amy Caldwell Kavita Vinekar Vanessa K. Dalton 《Journal of pediatric and adolescent gynecology》2017,30(2):184-187
Study Objective
To characterize pediatricians' knowledge, attitudes, and self-efficacy around contraception.Design
Cross-sectional survey.Setting
United States.Participants
National sample of pediatricians.Interventions
Assessment of behaviors of providing contraception.Main Outcome Measures
Reproductive health practice score.Results
Two hundred twenty-three usable surveys were received, from 163 contraceptive prescribers and 60 nonprescribers. The mean reproductive health practice score was 43.1 (SD, 8.2; total possible score, 84). Prescribers differed in their mean reproductive health score (46.0; SD, 7.0) from nonprescribers (34.0; SD, 4.5; P < .001). Prescribers vs nonprescribers differed in their attitude and efficacy in providing contraception. More prescribers believed it was their responsibility to ask about patients' need for birth control, were confident in their ability to prescribe contraception options, and provided contraception to minors despite parental disapproval. Neither group was confident in their ability to place intrauterine devices or believed that the literature supports intrauterine device placement in adolescents. Only efficacy was related to prescribing contraception in a multivariate regression analysis (odds ratio, 1.7; P < .001).Conclusion
In this study, we showed that most pediatricians are contraception prescribers but the overall reproductive health score was low for prescribers and nonprescribers. The odds of prescribing contraception increased with higher self-efficacy scores rather than knowledge alone. Many prescribers and nonprescribers would not prescribe birth control if parents disapproved and do not believe it is their responsibility to assess patients' need for birth control. In addition very few pediatricians have training in long-acting reversible contraception, despite being the recommended method for adolescents. 相似文献20.
Kanika Ramchandani Penelope Morrison Melanie A. Gold Aletha Y. Akers 《Journal of pediatric and adolescent gynecology》2018,31(2):107-115