Prevalence and risk factors for female sexual dysfunction among Egyptian women

Purpose

To assess sexual function among married women and determine associated risk factors for sexual dysfunction.

Participants and method

Cross-sectional hospital-based study involving 509 non-pregnant married females 20–59 years old who were enrolled into the study after approval of the ethics committee. The study population was recruited among women attending gynecology outpatient clinic or their relatives visiting inpatients of obstetrics and gynecology department at Suez Canal University Hospital. Female and male partner-related data were collected using an interview questionnaire. Sexual dysfunction was assessed using female sexual function index (FSFI).

Results

Mean female age was 39.5 years. About half of the participants were premenopausal (48.7 %). Most of the females were circumcised (71.7 %). Desire and Orgasm domains were the most affected with 52.8 % of the participants having sexual dysfunction. Total FSFI score of ≤26.55 was the cutoff value for diagnosis of FSD and female age, postmenopausal status, duration of marriage, circumcision, partner’s age, and the presence of male sexual dysfunction were found to be significant associated factors with FSD.

Conclusion

FSD is highly prevalent in Egypt and orgasm and desire scores were the most affected domains. Several personal (female age, postmenopausal status, duration of marriage and circumcision) and male partner (age, and the presence of sexual dysfunction) factors were significantly associated.     

Intraperitoneal bupivacaine for pain relief after minilaparoscopy in patients with infertility

Aim

To evaluate the efficacy of intraperitoneal bupivacaine to reduce post operative pain after diagnostic minilaparoscopy in patients with infertility.

Design

A prospective randomized study was performed.

Materials and methods

The study group consisted of 104 women with infertility undergoing diagnostic minilaparoscopy. At the end of the procedure, the treatment group (Group A) was given 10 mL of intraperitoneal 0.25 % bupivacaine (100 mg) and the control group (Group B) given 10 mL of intraperitoneal saline. Post operative pain was recorded with the use of a visual analog scale with scores ranging from 1 to 10 at 2, 4, 6 and 8 h intervals after the surgery. Additional analgesics given to the patients in the post operative period and any other side effects were noted.

Results

The treatment group had significantly lower pain scores at 2, 4, 6 and 8 h after the procedure (P < 0.05). The need for post operative analgesics also was significantly lower in the treatment group (P = 0.007).

Conclusion

Post operative intraperitoneal bupivacaine administration is beneficial for patients undergoing diagnostic minilaparoscopy. It can significantly decrease post operative pain for up to 8 h and reduce the need for additional analgesics.     

Effect of counseling on quality of marital relationship of infertile couples: a randomized, controlled trial (RCT) study

Background

Infertility is a major cause of marital problems and sexual dissatisfaction. This study was conducted to determine the effects of counseling on infertile couple’s marital relationship and sexual satisfaction.

Materials and methods

This study was performed as a randomized controlled trial (RCT) in which 100 infertile couples (200 participants) who visited Reproductive Health Research Center Tehran, Iran were randomly assigned into two groups: intervention (n = 50 couples, 50 wives and 50 husbands) and control (n = 50 couples, 50 wives and 50 husbands). Intervention was defined as three counseling sessions per week, each lasting 60–90 min. Counseling in the intervention group was conducted separately for each couple. Demographic characteristics and marital and sexual satisfaction were investigated using three questionnaires through interviews. The outcomes, including changes in marital satisfaction and sexual satisfaction, were compared between the two groups 3 months later.

Results

Based on the data collected 3 months after the intervention period, the mean scores of marital and sexual satisfaction in intervention and control groups for wives were 49.62 ± 11.09 versus 54.97 ± 12.64 (P = 0.036) and 36.00 ± 8.37 versus 40.04 ± 7.69 (P = 0.019), respectively. Respective scores for husbands were 45.48 ± 9.55 versus 50.08 ± 11.43 (P = 0.042) and 33.37 ± 7.09 versus 36.63 ± 6.52 (P = 0.025), respectively. It should be noted that higher scores in questionnaires inspecting marital and sexual satisfaction indicate lower satisfaction.

Conclusions

Infertility counseling improves marital and sexual satisfaction in infertile couples.     

Apple consumption is related to better sexual quality of life in young women

Introduction

Even if some evidence exists of a positive correlation between regular intake of phytoestrogens, polyphenols, antioxidants and women’s sexual health, there is not a study addressing the potential correlation between daily apple consumption and women’s sexual function. We aim to assess whether there is a tie between daily apple intake and sexual function in a sample of healthy young sexually active Italian women, not complaining of any sexual disorders.

Materials and methods

Seven hundred and thirty-one women (mean age 31.9, range 18–43) were enrolled in this cross-sectional study (from September 2011 to April 2012). All participants completed anonymously the Female Sexual Function Index (FSFI) and were asked to report on their amount of daily apple consumption and their eating habits. On the basis of apple consumption all women were split into two groups: Group A––regular daily apple consumption, Group B––no regular apple consumption (<1 apple/day). The main outcome measure was the FSFI questionnaire result.

Results

Three hundred and forty-three women reported a regular daily apple intake and were classified in Group A, while 388 were included in Group B. Group A had a significantly higher total (p = 0.001; Cohen’s d = 3.39) and lubrication domain (p = 0.001; Cohen’s d = 3.02) FSFI scores than participants in Group B. Multivariate analysis demonstrated that daily apple intake must be considered as an independent parameter (p = 0.002) in predicting a better score at questionnaire examination.

Discussion

This study suggests a potential relationship between regular daily apple consumption and better sexuality in our young women population.     

Impact of transobturator tape procedure on female and their partner sexual function: it improves sexual function of couples

Aim

To assess the impact of transobturator tape (TOT) procedure on female sexual function as well as their male partners.

Materials and methods

Sexually active 28 women and their partners included for the study. Before TOT operation, the patients completed incontinence impact questionnaire (IIQ-7) and urogenital distress inventory (UDI-6) to assess the effect of surgery on incontinence. Also the women and their partners completed a self-administered questionnaire evaluating the female sexual function index (FSFI) and international index of erectile function (IIEF-5), respectively. Three months after TOT surgery, the women were asked to complete IIQ-7 and UDI-6 questionnaires to measure the success of TOT procedure. Also, FSFI and IIEF forms were completed by the women and their partners to assess TOT-related sexual life change.

Results

After TOT procedure, the mean value of IIQ-7 and UDI-6 questionnaires was lower than the mean scores that measured before treatment (p < 0.001). The mean values of FSFI scores before and 3 months after the operation were 23.15 ± 8.21 vs. 30.01 ± 9.13, respectively (p < 0.001). The mean values of IIEF before and 3 months after the operation were 50.14 ± 5.21 vs. 60.96 ± 10.03, respectively (p < 0.001).

Conclusion

According to our results, both women and their partners’ sexual life improved after TOT surgery for incontinence.     

Influence of prophylactic oophorectomy on mood and sexual function in women of menopausal transition or postmenopausal period

Aim

To evaluate the impact of prophylactic oophorectomy on mood and sexual function in women at menopausal transition or postmenopausal period.

Methods

Patients who underwent operations due to benign diseases of uterus and ovaries were included and were stratified into two groups, namely Group A with 256 patients undergoing hysterectomy and prophylactic oophorectomy and Group B with 337 patients undergoing simple hysterectomy. Follow-ups included demographic data, Self-Rating Zung Depression Scale (ZDS), Self-Rating Zung Anxiety Scale (ZAS), and Female Sexual Function of Index (FSFI).

Results

Five hundred and ninety-three patients were successfully followed. 69.27 % of patients at menopausal transition period chose ovary conservation whilst 79.22 % of postmenopausal women chose oophorectomy due to fear of potential cancer and economy issue. Ovarian cancer was not found in this cohort. Incidence of distress was higher in Group A (P = 0.001). No difference was obtained in ZAS scores between the two groups (P = 0.110). Incidence of anxiety was higher in Group A (P = 0.010). Percentage of patients scoring above 20 in FSFI was significantly higher in Group B (P = 0.003). Oophorectomy and marital status were independent factors for depression (P = 0.009 and <0.001, respectively).

Conclusion

Adverse influence on mental and sexual status was severer in women undergoing prophylactic oophorectomy at menopausal transition or postmenopausal period. Comprehensive evaluation may contribute to better ovary conservation strategy for women with benign morbidities.     

Sexual function and quality of life following retropubic TVT and single-incision sling in women with stress urinary incontinence: results of a prospective study

Purpose

The objective of this prospective cohort study was to compare effectiveness, morbidity, quality of life (QoL) and sexual function in women treated with tension-free vaginal tape (TVT) versus single-incision sling (SIS) in the treatment of female stress urinary incontinence (SUI).

Methods

Retropubic TVT sling or SIS was implanted in local anesthesia and patients were followed post-operatively for 6 months. Evaluation was performed to assess post-operative rate of continence, complications, changes in sexual function and patient reported quality of life. Female sexual function was evaluated before and after sling procedure using Female Sexual Function Index (FSFI) in sexually active patients.

Results

From January 2009 to December 2011, 150 patients were enrolled and underwent a procedure to implant the retropubic TVT (n = 75) or the MiniArc^® and Ajust^® SIS (n = 75). Overall, 93.3 % of the patients who successfully received SIS demonstrated total restoration (84 %) or improvement of continence (9.3 %) at the 6 month post-operative study visit. In TVT group we found 88 % total continence and 6.7 % improvement, respectively. Improvements were seen in the QoL scores related to global bladder feeling (89.3 %) in SIS group and 96 % for TVT. Post-operative FSFI score improves significantly and were comparable in both groups (SIS pre-operative 24.30 ± 4.56 to 27.22 ± 4.66 (P < 0.001) post-operative; TVT 24.63 ± 6.62 to 28.47 ± 4.41, respectively).

Conclusions

The SIS procedure appears to be as effective in improving incontinence-related quality of life and sexual function as the TVT through 6 months of post-operative follow-up. No differences in complications and sexual function were demonstrated between the groups.     

Analysis of sperm telomere length in men with idiopathic infertility

Purpose

Telomeres are multifunctional nucleoprotein domains with hexanucleotide tandem repeat (5′ TTAGGG 3′) sequences, which cap the chromosome ends. However, the role of telomere and its length in sperm with regard to fertility remains unknown.

Methods

In this pilot study, we analyzed 32 idiopathic infertile men and 25 controls for sperm telomere length by quantitative polymerase chain reaction (Q-PCR), and correlated it with sperm DNA fragmentation index (DFI) and reactive oxygen species (ROS) levels.

Results

The relative sperm mean telomere length (T/S) of infertile men was found to be significantly lower (p < 0.005) when compared to controls (0.674 ± 0.028 vs. 0.699 ± 0.030). None of the sperm parameters such as sperm count, forward motility, morphology, ROS, and DFI were found to correlate with the sperm telomere length.

Conclusion

Shorter telomeres in sperm may be one of the causative factors responsible for male infertility, but further detailed studies are needed to confirm these findings.     

Sexual function after childbirth by the mode of delivery: a prospective study

Purpose

The objective of the present study was to evaluate sexual behavior longitudinally in the postpartum period by mode of delivery.

Methods

In this prospective study, five groups were defined: women who delivered vaginally without an episiotomy (n = 16), women who delivered vaginally with an episiotomy (n = 14), women who delivered by instrumental delivery (n = 16), women who delivered by an emergent cesarean section (n = 19), and women who delivered by an elective cesarean section (n = 17). Sexual behavior was assessed by the female sexual function index (FSFI) questionnaire at 6, 12, and 24 weeks postpartum and by the timing of resumption of sexual intercourse.

Results

The mean ± SD self-reported timing of resumption of sexual activity was 4.5 ± 1.8, 7.9 ± 3.0, 7.3 ± 3.4, 6.1 ± 2.6, and 6.1 ± 2.4 weeks in the vaginal delivery without an episiotomy group, in the vaginal delivery with an episiotomy group, in the instrumental delivery group, in the elective cesarean delivery group, and in the emergent cesarean delivery group, respectively (p = 0.013). The FSFI total score in the entire study group (n = 82) was 14.1 ± 10.8, 24.6 ± 7.6, and 27.7 ± 5.1 at 6, 12, and 24 weeks postpartum, respectively (p < 0.05). The FSFI total score did not differ significantly across types of mode of delivery at 6, 12, or 24 weeks postpartum.

Conclusion

The significance by delivery mode difference in the postpartum resumption of sexual activity was not accompanied by difference in sexual function scores. Specifically, elective cesarean delivery was not associated with a protective effect on sexual function after childbirth.     

Sperm exposure during menses is a risk factor for developing antisperm antibody (ASA) in female

Purpose

Intercourse during menses is a sexual behavior practiced by 3–30 % of sexually active women. Defense responses of mucosal immunity in the female genital tract regulated by sex hormones would be impaired during menses. The present study seeks to clarify whether unprotected sexual activity during menses will increase the risk for antisperm antibody (ASA) production in female.

Methods

In this prospective study, 27 women who had a usual practice of vaginal intercourse during menses admitted in the First Affiliated Hospital of Jinan University with infertility were included, while 30 age-matched infertile women without this practice were set as controls. Indirect immunobead test (I-IBT) performed according to the World Health Organization (WHO) manual was used to measure the ASA levels.

Results

No case was revealed to develop significant ASA level. 6 of 27 women (22.2 %) in the case group and 1 of 30 women (3.3 %) in the control group were detected to be ASA subpositive, and a significant difference was found in the subpositive incidence between these two groups (P < 0.05). Among these 6 subpositive cases, 3 became pregnant in the subsequent 2-year follow-up after condom therapy for 6 months.

Conclusions

Sperm exposure during menses is a risk factor for ASA production in female. Although a precisely causal linkage between ASA and infertility in these women cannot be drawn from the present data, the potential disadvantages of sexual activity during menses should still be given importance.     

Mitochondrial DNA polymerase gamma gene polymorphism is not associated with male infertility

Purpose

CAG repeat length of human miotochondrial DNA Polymerase gamma (POLG) gene is polymorphic with a major allele at 10 repeats and considered as the common allele whereas the mutant alleles (not 10/not 10 CAG repeats) were found to be associated with oligospermia / oligoasthenospermia in male infertility. To explore whether CAG trinucleotide repeat expansion in exon 1 of POLG gene is associated with spermatogenic failure.

Methods

One hundred twenty four infertile men (sperm count <20 million/ml) and 60 normozoospermic (sperm count >20 million/ml) control Indian men of Tamil Nadu, were enrolled. DNA was extracted from 10 ml of peripheral blood and from semen using standard procedures. CAG repeat expansion was analyzed by polymerase chain reaction. Amplified products were quantified by 2 % agarose gel electrophoresis and subjected to genescan analysis to ascertain the size of POLG-CAG alleles.

Results

This analysis interestingly revealed that the common allele 10 (10-CAG repeats) was widespread in infertile and normozoospermic control men with a frequency of 79 % and 71.7 % respectively. No statistical significance was found in POLG genotypic frequency distribution between infertile men and normospermic men.

Conclusion

The present study confirmed no association between the POLG gene polymorphism and male infertility. Thus, if associated with infertility, the POLG gene polymorphism should be only considered as a minor possible contributing factor in infertile male patients with no impact on obtaining a pregnancy.     

Morgagni hydatids: a new factor in infertility?

Purpose

To evaluate the effect of Morgagni hydatid (MH) on infertility by comparing women known to be fertile and infertile with respect to MH frequency.

Methods

The study was conducted in Gaziantep University Faculty of Medicine with the precipitation of total 455 patients. The 240 of them were pregnant to whom planned cesarean section (C/S) and the other 215 were infertile one who have undergone diagnostic laparoscopy. Fertile Group (Group 1) consisted of women whom have become spontaneously pregnant without any kind of infertility management. These are planned to undergo C/S with different indications. Infertile group (Group 2) consisted of women diagnosed as unexplained infertility and planned to undergo diagnostic laparoscopy according to ASRM 2006 guidelines. The frequency, number, and the bilaterality of the MH were evaluated during the C/S in fertile group and diagnostic laparoscopy in infertile group. SPSS was used for statistical analyses.

Results

The MH frequency was higher in Group 2 than Group 1 (P < 0.05). The bilaterality of MHs were significantly higher in Group 2 than Group 1 (P < 0.05).The number of the MHs were significantly higher in Group 2 than Group 1 (P < 0.05).

Conclusions

These findings suggest a possible effect of MH on fertility. The theory of MH disturbing tubal motility with respect to the pick-up and transport of ovum appears logical in this aspect.     

Vitamin D improves endometrial thickness in PCOS women who need intrauterine insemination: a randomized double-blind placebo-controlled trial

Purpose

To determine whether administration of vitamin D affects the success rates of intra uterine insemination (IUI) in infertile polycystic ovarian syndrome (PCOS) women and their endometrial thickness.

Methods

This randomized, double-blind, placebo-controlled trial was conducted in an infertility clinic of Women’s Hospital, and 110 infertile PCOS patients undergoing IUI were randomly divided to receive vitamin D or placebo. Endometrial thickness, IUI results, number of dominant follicles, duration of IUI cycle, and dose of HMG used in IUI were determined.

Results

The endometrial thickness was significantly different in the group treated with vitamin D versus the placebo group (p = 0.003). There was no statistical difference in pregnancy out come between the two groups (RR = 1.167, CI 95 % 0.70–1.93). No statistical difference was found in number of dominant follicles (p = 0.96), duration of IUI cycles (p = 0.70) and dose of HMG used for IUI (p = 0.95).

Conclusions

It seems that administration of vitamin D induces endometrial proliferation in PCOS women during IUI cycle.     

Effects of gender roles, child wish motives, subjective well-being, and marital adjustment on infertility-related stress: a preliminary study with a Hungarian sample of involuntary childless men and women

Purpose

The aim of the study is to investigate the infertility-related stress in a Hungarian infertile population and examine the effects of gender roles, child wish motives, subjective well-being, and marital relationship on the experience of infertility according to our self-constructed conceptual framework.

Methods

Validated self-report questionnaires measuring the factors of the conceptual framework were taken in the study carried out in a sample of 53 people attending the fertility unit of a Hungarian clinic.

Results

Infertility-related global stress, infertility-related social concerns, and general health problems have more intensive effect on women than on men (all p < 0.05). Women from the infertile group scored higher their femininity (p < 0.001) and lower their general health (p < 0.05) than the reference population. Infertile men believe deeper in meaning of life than women (p < 0.05) or reference population (p < 0.01). Femininity (β = 0.460, p < 0.05), traditional gender role concepts (β = ?0.248, p < 0.05), general health (β = ?0.474, p < 0.05), and marital relationship (β = ?0.251, p < 0.05) play the strongest role to predict stress caused by infertility.

Conclusions

The current study emphasizes the importance of interrelations of gender role attitudes, gender role identification, general health, and satisfaction in couple relationship with infertility-related stress. In further investigations, both social and personal aspects and their effect on experiencing infertility need to be measured in infertile people, particularly in different cultural settings.     

Effect of high-intensity focused ultrasound on sexual function in the treatment of uterine fibroids: comparison to conventional myomectomy

Background

Uterine fibroids are the most common benign tumors in women. As a new minimally invasive clinical technology, high-intensity focused ultrasound (HIFU) has been widely applied to the treatment of uterine fibroids, but no study using objective criteria has evaluated the effect of HIFU on sexual function.

Methods

A total of 100 premenopausal patients were enrolled in this randomized clinical trial (RCT). The brief index of sexual functioning (BISF-W) was used to evaluate changes in sexual function. Differences in the outcome were calculated for each individual before treatment and at 3 and 6 months after treatment, and changes were compared between the HIFU group (HIFUG) and the myomectomy group (MYG).

Results

Preoperative BISF-W scores were similar in both groups (P < 0.05). No significant differences were found between the two groups at 3 and 6 month after treatment. Within the groups, patients reported less arousal and less problems at 3 month compared to baseline. There was a trend toward improved sexual satisfaction and overall quality of sexual life in both groups 6 months after treatment compared with the baseline, although it failed to reach statistical significance except for the dimensions of relational satisfaction and problems affecting sexuality.

Conclusions

Sexual function improved on average to some degree after both HIFU and conventional myomectomy.     

Postoperative sexual functioning in total versus subtotal laparoscopic hysterectomy: what do women expect?

Purpose

To evaluate sexual functioning and expected changes in sexual functioning in women with planned total versus subtotal laparoscopic hysterectomy.

Methods

A total of 120 women undergoing laparoscopic hysterectomy were preoperatively enrolled in this study with a cross-sectional design. Full data sets were available for 112 patients, so that 56 patients with planned total laparoscopic hysterectomy (TLH) and 56 women with planned laparoscopic supracervical hysterectomy (LASH) were preoperatively assessed. Sexual functioning was evaluated using the female sexual function index (FSFI). Additionally, participants filled in a standardised questionnaire concerning expected changes on sexual function after the procedure. Demographic parameters, expectations concerning postoperative sexuality and FSFI scores were analysed and compared in women undergoing TLH and LASH.

Results

There were no significant differences concerning demographic parameters and FSFI scores comparing collectives. Sexuality in general was considered more important in women undergoing LASH (2.88 ± 0.83 vs. 2.48 ± 0.89; p = 0.011). Also, in 29 patients (52%) opting for LASH and 8 (14%) patients undergoing TLH a potential change in postoperative sexuality had an impact on their choice for a subtotal/total hysterectomy, respectively (p < 0.001).

Conclusion

Patients’ expectations concerning preservation of the cervix and postoperative sexuality appear to have the potential to bias investigations comparing total with subtotal hysterectomy. Hence, future research focusing on this issue should be accomplished incorporating patients’ expectations stratified by mode of intervention.

     

Polycystic ovarian syndrome and congenital uterine anomalies: the hidden common player

Objective

To study the association between polycystic ovary syndrome (PCOS) and congenital uterine (Müllerian) anomalies in infertile patients. The ultimate aim was to check for a common factor linking both reproductive health problems.

Design

A prospective observational study.

Setting

Tertiary referral infertility center.

Subjects and methodology

3,900 infertile patients were included. The diagnoses of PCOS and uterine anomalies were made. Patients with or without PCOS were correlated to the presence or absence of uterine anomalies and statistically assessed.

Main outcome measures

Study of the prevalence of PCOS/uterine anomalies in the studied population and the ratio of coexistence.

Results

The prevalence of PCOS in the studied cohort was 10.48 %. 409 (10.48 %) patients were confirmed to have PCOS, while 204 (5.23 %) were with confirmed uterine anomalies. Of the patients with confirmed PCOS, almost one-third (n = 149, 31.4 %) had uterine anomalies, while in patients with confirmed uterine anomalies, almost three-fourths (n = 149, 73 %) had PCOS.

Conclusions

There is evident association between PCOS and uterine anomalies in infertile patients. We suggest a genetic rather than a developmental defect to be a possible common player for the development of both PCOS and uterine anomalies.     

Evaluation of subgroups of the human sperm hypoosmotic swelling test in normozoospermic male cases with recurrent fertilization failure: a prospective case-controlled study

Purpose

To compare subgroups of the human sperm hypoosmotic swelling test subgroups in both recurrent fertilization negative infertile cases with normal semen analysis and fertilization positive controls.

Methods

This was a prospective case-controlled study performed with normospermic 33 previously fertile male (secondary infertility) and 41 infertile men who had undergone two or three unsuccessful in vitro fertilization attempts. HOS test was investigated in 4 subgroups including HOS 1, HOS 2, HOS 3, and HOS 4 according to the degree of sperm tail swelling and compared between the two groups.

Results

Four subgroups were compared and statistical significance was demonstrated in HOS 1, HOS 3 and HOS 4 tests (p < 0.001) in fertile and infertile men. Highest HOS 1 and lowest HOS 4 grades were determined in Group A. However, no statistical significance was determined between two groups in HOS 2 test which was minimal swelling in sperm tails.

Conclusions

HOS 1, HOS 3 and HOS 4 subgroups of HOS test are reliable and useful methods providing important information regarding the sperm function. A high HOS test 1 grade plus a low HOS test 4 grade should suggest a fertility problem, despite a normal semen analysis. HOS test subgroups provide additional information in normospermic cases with unexplained infertility.     

Hysterectomy and women satisfaction: total versus subtotal technique

Introduction

The impact of different surgical procedures on women’s satisfaction after hysterectomy is a topical issue. The aim of this study was to investigate the impact of sub-total and total hysterectomy on women’s satisfaction, evaluated with questionnaire assessment of sexual activity, body image, and health status.

Materials and methods

A prospective, randomized, non-blind study was conducted. In the study period of 3 years, 105 women were enrolled and completed the questionnaires [EuroQol (EQ-5D), body image scale (BIS), sexual activity questionnaire] 2 weeks before and 1 year after surgery.

Results

Both total and sub-total hysterectomy resulted with improvements in the women’s sexual satisfaction (1 year after surgery), but no statistically significant differences were reached between the two groups. A highly significant difference (P < 0.001) in the perception of the body image between total and sub-total hysterectomy, at 1 year after surgery, was underlined. The health-related quality of life resulted significantly better in the “sub-total hysterectomy” group 1 year after surgery (P < 0.05).

Conclusion

Considering these results, why should a total hysterectomy be performed, if the women’s satisfaction seems to be higher using the sub-total technique? In our opinion, the woman undergoing hysterectomy for benign conditions must be counseled regarding the differences between the two techniques and, when possible, a choice must be offered to the woman.     

Effects of etonogestrel implant on quality of life,sexual function,and pelvic pain in women suffering from endometriosis: results from a multicenter,prospective, observational study

Purpose

Progestins are successfully employed as treatment for endometriosis. Our study evaluates the effects of the etonogestrel (ENG) implant on pelvic pain, quality of life, and sexual function in women requiring long-term reversible contraception and presenting ovarian cysts of probable endometriotic origin.

Methods

We enrolled 25 women asking for contraception with the ENG implant and presenting a cyst with the ultrasound features of an endometrioma and pain symptoms. Patients were interviewed on pain symptoms (dysmenorrhea, dyspareunia, dyschezia, and dysuria) using a VAS score (0–10), on quality of life (QoL) using the Short Form-36 questionnaire, and on sexual activity using the Female Sexual Function Index (FSFI) questionnaire before inserting the implant (T0) and after 6 (T1) and 12 months (T2).

Results

We found a significant decrease in dysmenorrhea and dyspareunia VAS scores comparing baseline scores to 6 and 12 months. After 12 months, the bodily pain, general health, vitality, social functioning, and mental health domains of the QoL score were significantly improved. The total FSFI score results increased in comparison with baseline both at 6 and 12 months. In particular, we highlighted a significant improvement in desire, satisfaction, and pain domains already at 6 months; the arousal domain improved only after 12 months. Finally, mean diameters of endometrioma-like cysts were not changed after 12 months of treatment.

Conclusions

Etonogestrel implants seem to be able to reduce pelvic pain, improve sexual function, and quality of life in patients with ovarian cysts suspected of endometriotic origin.