PCOS and Urethrovaginal Space: 3-D Volumetric and Vascular Analysis

IntroductionThe vaginal orgasm seems to be evocated by the stimulation of the G-spot: a highly sensitive area on the anterior wall of the human vagina. However, the existence of such a spot is controversial.AimTo evaluate, by the use of three-dimensional (3-D) ultrasonography, the anatomic structures of the urethrovaginal space both in polycystic ovarian syndrome (PCOS) patients and eumenorrheic non-hirsute controls.MethodsTwenty-three (Group I) PCOS patients and 25 eumenorrheic young women (Group II) were submitted to two-dimensional (2-D) and 3-D ultrasonography and color Doppler analysis of the urethrovaginal space and of the clitoris.Main Outcome Measures2-D ultrasonographic evaluation of the ovaries and of the urethrovaginal space; color Doppler evaluation of the ovarian stromal arteries, urethrovaginal main feeding artery, and dorsal clitoral arteries; 3-D volume calculation of the urethrovaginal space, and 3-D power Doppler analysis of the vascularization index; flow index; and vascularization flow index; hormonal evaluation.ResultsThe vaginal orgasm was present in 13/23 (56%) patients in PCOS Group and in 13/25 (52%) in the controls. The 3-D reconstruction of the urethrovaginal space demonstrated a gland-like aspect with small feeding vessels: “female prostate.” The 3-D mean volume of the “female prostate” was significantly higher in Group I (0.48 ± 0.21 mL) than in Group II (0.39 ± 0.19 mL; P = 0.044). The Virtual Organ Computer-aided AnaLys (VOCAL) built mean volume of the “female prostate” was positively correlated with the time since intercourse (r = 0.486; P = 0.032), with the total length of the urethrovaginal space (r = 0.616; P = 0.025) and with the testosterone (r = 0.424; P = 0.048) circulating values.ConclusionsThe presence of the G-spot and its role in vaginal orgasm remains controversial. In Italians, and normal weight PCOS patients the hyperandrogenism seems to result in ovarian stromal and “female prostate” hyperplasia. Battaglia C, Nappi RE, Mancini F, Alvisi S, Del Forno S, Battaglia B, Venturoli S. PCOS and urethrovaginal space: 3-D volumetric and vascular analysis.     

Recurrent Postcoital Hematuria. A Case of Fibroepithelial Urethral Polyp in an Adult Female

IntroductionIn males, an isolated gross postcoital hematuria is a very rare clinical phenomenon. No cases of postcoital macroscopic hematuria have been previously reported in females.AimTo report a case of female urethral fibroepithelial polyp (FEP) associated with recurrent postcoital hematuria.MethodsA young (31 years old), eumenorrheic woman complained of three episodes of postcoital macrohematuria. The patient was assessed with a detailed history, with a bimanual pelvic examination and with bidimensional and tridimensional ultrasonographic and color Doppler analyses of the internal genitalia and of the urethrovaginal space.Main Outcomes MeasuresTransvaginal two‐dimensional (2‐D) ultrasonographic evaluation of internal genitalia, bladder and urethra and three‐dimensional (3‐D) analysis of the urethra and paraurethral structures.ResultsThe 2‐D transvaginal evaluation and the 3‐D reconstruction showed a polypoid hypervascularized structure arising from the anterior urethral wall. A cystourethroscopy confirmed the presence of a FEP arising from the anterior wall of the urethra and allowed its removal.ConclusionsA gross postcoital hematuria may be associated with a urethral polyp. The ultrasonographic evaluation of the urethrovaginal space can facilitate the diagnosis. Battaglia C, Battaglia B, Ramacieri A, Paradisi R, and Venturoli S. Recurrent postcoital hematuria. A case of fibroepithelial urethral polyp in an adult female.     

Flujo diastólico umbilical intermitente en gestación gemelar monocorial: descripción de un nuevo signo en la exploración Doppler y asociación con mal pronóstico perinatal

ObjectiveTo evaluate the incidence and clinical relevance of intermittent diastolic flow on umbilical artery Doppler in monochorionic twin pregnancies.MethodsWe performed a prospective study that included 3 groups of monochorionic pregnancies: group I: a cohort of monochorionic pregnancies with ultrasonographic follow-up every 15 days from the first trimester (n = 80); group II: monochorionic twins with selective intrauterine growth retardation (n = 40), and group III: severe twin-twin transfusion syndrome (n = 50). The presence and persistence over time of intermittent absent and/or reverse diastolic flow on umbilical artery Doppler was recorded. Placentas were examined and placental sharing and the presence of large arterio-arterial anastomoses (> 2 mm) were assessed. Perinatal outcome was recorded in all cases.ResultsIntermittent diastolic flow was present in 5% (4/80) of pregnancies in group I, 45% (18/40) in group II and 2% (1/50) in group III (p < 0.0001, group II versus groups I and III). Large arterioarterial anastomoses were identified in all examined pregnancies with intermittent flow (18/18) and in 3.6% (4/112) of those without. The in utero mortality rate was 0% in group I and in group II fetuses without intermittent flow. However, intrauterine mortality was 19.4% in fetuses in group II with intermittent diastolic flow.ConclusionsIntermittent diastolic flow should be considered a characteristic sign of monochorionic pregnancy. This sign seems to result from the presence of large arterio-arterial anastomoses. The incidence of intermittent diastolic flow is significantly increased in the context of selective intrauterine growth retardation, indicating a poor perinatal outcome in these cases.     

Nuevo sistema de puntuación ecográfico para el diagnóstico diferencial de las tumoraciones anexiales

ObjectiveTo design and evaluate a new ultrasonographic score to predict malignancy in annexal tumorsMethodsIn this study ultrasonographic and Doppler data from 705 annexal tumors (141 malignant and 564 benign) evaluated between January 1995 and July 2001 were used to design an ultrasonographic score. The following data were analyzed: age, tumoral volume, wall thickness, the presence of thick septa, papillae and solid areas, echogenicity, the presence, localization and quantity of flow, and velocimetry. These data were introduced into a multivariate logistic regression analysisResultsIn the regression analysis, only the following variables were retained: the presence of thick papillae (OR = 1.9), solid areas (OR = 8.6), central flow (OR = 15.5) and high velocity-low resistance velocimetry (OR = 5.3). The ROC curve revealed that the best cut-off point was > 6 (sensitivity: 90%, false positives: 7.6%)ConclusionsThe new score proposed is simple, is based on logistic regression analysis and provides a high diagnostic yield     

Bulbocavernosus Reflex to Stimulation of Prostatic Urethra in Patients with Lifelong Premature Ejaculation

IntroductionLifelong premature ejaculation (LPE) is a prevalent sexual dysfunction among men, while its precise pathologic mechanisms have remained poorly understood.AimIn our study, the correlation between excitability of bulbocavernosus reflex (BCR) to stimulation of the prostatic urethra and LPE was studied.MethodsTwenty normal potent male volunteers and 42 patients with LPE were studied by inserting a specially designed Foley catheter with two electrodes mounted on its distal surface (intraurethral catheter electrode) into bladder to evoke the BCR to stimulation of prostatic urethra. Also, sensitivity of glans penis to electrical stimulation was detected by two surface electrodes.Main Outcome MeasuresSensory thresholds of BCR to stimulation of prostatic urethra, thresholds to evoke stable BCR, latencies of BCR, and sensory thresholds of glans penis to electrical stimulation.ResultsThe mean sensory thresholds of BCR to stimulation of prostatic urethra, thresholds to evoke stable BCR, latencies of BCR, and sensory thresholds of glans penis were 12.38 ± 3.71 mA (0.2 ms in duration,1 Hz), 23.81 ± 5.55 mA (0.2 ms, 1 Hz), 70.48 ± 6.33 ms, and 11.89 ± 2.26 mA (0.04 ms in duration,3 Hz) in the patients with LPE, respectively, and were 18.20 ± 2.68 mA (0.2 ms, 1 Hz), 34.76 ± 4.15 mA (0.2 ms, 1 Hz), 71.20 ± 5.77 ms, and 14.16 ± 1.94 mA (0.04 ms, 3 Hz) in the normal potent men, respectively (mean ± SD). Statistically significant differences were seen regarding the sensory thresholds of BCR to stimulation of prostatic urethra, the thresholds to evoke stable BCR and the sensory thresholds of glans penis between the two groups (P < 0.001). No statistically significant differences were seen regarding the latencies of BCR between the two groups (P > 0.05).ConclusionsPatients with LPE might have hyperexcitable BCR to stimulation of prostatic urethra, which is probably one of the important factors for its etiology. Zhou C, Jiang X, Xu Z, Guo L, Chen J, Wang H, Zhang D, and Shi B. Bulbocavernosus reflex to stimulation of prostatic urethra in patients with lifelong premature ejaculation.     

The Effect of Renal Transplantation for End-Stage Renal Disease on Female Sexual Function and Depression

IntroductionStudies have suggested that women with end-stage renal disease (ESRD) had higher risk of sexual dysfunction than healthy women.AimsTo prospectively determine the effect of renal transplantation for ESRD on female sexual function and depression.MethodsDuring a 5-year period, the study included 21 sexually active women who underwent renal transplantation for ESRD at a single university hospital. After obtaining demographic characteristics, female sexual function was evaluated with a detailed 19-item questionnaire (The Female Sexual Function Index, FSFI), and depression was assessed using Beck Depression Inventory (BDI) scale.Main Outcome MeasuresIn all women, FSFI and BDI scores were compared before and after the renal transplantation surgery.ResultsThe mean age of the women was 35.04 ± 9.6 years, and mean follow-up duration after renal transplantation was 27.5 ± 20.4 months. Mean total sexual function score increased from 17.57 ± 7.07 to 25.3 ± 3.28, revealing significant difference (P = 0.001). Compared with preoperative period, sexual function domains including sexual desire (P = 0.001), arousal (P = 0.001), lubrication (P = 0.003), orgasm (P = 0.001), satisfaction (P = 0.001), and pain (P = 0.02) significantly improved after renal transplantation. Mean BDI score significantly decreased from 17.91 ± 8.56 to 3 ± 4.17 after renal transplantation (P = 0.001).ConclusionsSuccessful renal transplantation may improve female sexual functions and depression. Therefore, life quality increases as sexual functions and depression improve after the renal transplantation surgery. Ketta? E, Çayan F, Efesoy O, Akbay E, and Çayan S. The effect of renal transplantation for end-stage renal disease on female sexual function and depression.     

Yoga in Female Sexual Functions

IntroductionYoga is a popular form of complementary and alternative therapy. It is practiced both in developing and developed countries. Female sexual dysfunctions are common and do not always get adequate clinical attention. Pharmacotherapies for treating female sexual dysfunctions are available but suffer from drawbacks such as poor compliance, low efficacy, and side effects. Many patients and yoga protagonists claim that it is useful in improving sexual functions and treating sexual disorders.AimTo establish the effect yoga can have on female sexual functions.MethodsWe recruited 40 females (age range 22–55 years, average age 34.7 ± 8.49 years) who were enrolled in a yoga camp and were given a standardized questionnaire named Female Sexual Function Index (FSFI) before and after the 12 weeks session of yoga.Main Outcome MeasuresFSFI scores.ResultsIt was found that after the completion of yoga sessions; the sexual functions scores were significantly improved (P < 0.0001). The improvement occurred in all six domains of FSFI (i.e., desire, arousal, lubrication, orgasm, satisfaction, and pain). The improvement was more in older women (age > 45 years) compared with younger women (age < 45 years).ConclusionsYoga appears to be an effective method of improving all domains of sexual functions in women as studied by FSFI. Dhikav V, Karmarkar G, Gupta R, Verma M, Gupta R, Gupta S, and Anand KS. Yoga in female sexual functions.     

The prevalence of sexual dysfunction and potential risk factors that may impair sexual function in Malaysian women

IntroductionFemale sexual dysfunction (FSD) is a prevalent sexual health problem that does not spare the women in Malaysia, a nation with a conservative multiethnic society.AimTo investigate the prevalence of FSD and the potential risk factors that may impair sexual function among women at a primary care setting in Malaysia.Main Outcome MeasureThe prevalence, the risk factors, and the main predictors for FSD were measured among these women.MethodsA validated Malay version of the Female Sexual Function Index was used to assess FSD. A total of 230 married women aged 18–70 years participated in this study. The sociodemographic and marital profiles of women who had FSD and those who did not were compared; the risk factors for FSD were determined.ResultsThe majority of the respondents were younger than 50 years old, predominantly Malays, and had a higher academic achievement. The prevalence of FSD in the primary care population was 29.6%. The prevalence of women with lack of orgasms, low sexual arousal, lack of lubrication, sexual dissatisfaction, and sexual pain were 59.1%, 60.9%, 50.4%, 52.2%, and 67.8%, respectively.ConclusionThe risk factors for FSD are older age, Malays, married longer (more than 14 years), having less sexual intercourse (less than 1–2 times a week), having more children, married to an older husband (aged >42 years), and having a higher academic status. Lack of lubrication is found to be the main predictor for FSD in this study. Is lack of lubrication a cause or a complication of FSD? Prospective research is needed in the near future. Sidi H, Puteh SEW, Abdullah N, and Midin M. The prevalence of sexual dysfunction and potential risk factors that may impair sexual function in Malaysian women.     

Impact of Dry Ejaculation Caused by Highly Selective α1A-blocker: Randomized,Double-blind,Placebo-controlled Crossover Pilot Study in Healthy Volunteer Men

IntroductionDry ejaculation with loss of seminal emission is reported in patients who have been administered silodosin, an alpha1A-adrenoceptor antagonist.AimWe investigated the impact of dry ejaculation caused by orally administered silodosin on orgasmic function.MethodsIn a double-blind crossover study, 50 healthy volunteer men were randomly assigned to receive either a single dose of 4-mg silodosin or placebo with 3 days of washout before crossover. Subjects masturbated 4 hours after administering agents.Main Outcome MeasuresNumerical rating scale (NRS) score from 0 (highest) to 10 (lowest) for subjective quality of orgasm, the subjective number of contractions of the bulbocavernosus/pelvic floor muscles, and the amount of semen were examined.ResultsAfter the administration of silodosin, the NRS score worsened by 1.3 points (P = 0.003), the number of contractions of the bulbocavernosus/pelvic floor muscles decreased by about 1 (P = 0.003), and there was a decrease of 1.8 mL in the amount of semen produced (P < 0.0001). Eleven men overall (22%) on silodosin administration had less than a 50% decrease from baseline in the amount of semen.ConclusionsSilodosin may adversely affect the subjective orgasmic function by causing an abnormal ejaculation with decreased (or no) semen discharge and a decrease in the number of bulbocavernosus/pelvic floor muscle contractions. Semen passing through the urethra and sufficient rhythmic contraction of the muscle of the pelvic floor may contribute to the subjective pleasure of orgasm. Shimizu F, Taguri M, Harada Y, Matsuyama Y, Sase K, and Fujime M. Impact of dry ejaculation caused by highly selective α1A-blocker: Randomized, double-blind, placebo-controlled crossover pilot study in healthy volunteer men.     

Sexual Functioning among Women with and without Diabetes in the Boston Area Community Health Study

AimTo examine sexual dysfunction among women with and without diabetes in a community-based sample of women aged 30–79 years.MethodsWe conducted a cross-sectional analysis of survey responses of female participants in the Boston Area Community Health Study, a community-based random sample, who answered questions regarding sexual functioning and diabetes status and also reported sexual activity (n = 1,291). Associations between diabetes and overall sexual function as well as domain of sexual function were examined in multivariable linear regression models.ResultsWomen with type 2 diabetes (n = 75) were older, less often white, and more likely to have decreased physical activity levels, elevated body mass index, and cardiovascular disease than women without diabetes (n = 1,190). Women with type 1 diabetes (n = 26) were similar to women without diabetes except for higher depression scores and lower levels of activity. Age, marital status, and depressive symptoms were correlated with overall sexual function. After adjustment for age and race, women with and without diabetes had similar arousal, lubrication, orgasm, dyspareunia, satisfaction, and desire. After further adjustment for other factors, including age, depression, and marital status, women with type 1 diabetes had increased dyspareunia compared with women without diabetes, and women with type 2 diabetes had similar functioning to women without diabetes.ConclusionWomen with type 2 diabetes may have similar sexual functioning to women without diabetes, although women with type 1 diabetes may more often have dyspareunia. Factors such as depression, which are common in women with diabetes, are more strongly related to sexual dysfunction than diabetes status. Wallner LP, Sarma AV, and Kim C. Sexual functioning among women with and without diabetes in the Boston Area Community Health Study.     

Transvaginal laparoscopic surgery for ovarian cysts

ObjectiveTo evaluate the effectiveness and feasibility of transvaginal laparoscopic surgery (TLS) using endoscopic instruments for management of ovarian cysts.MethodsIn a retrospective study, data from 140 patients with benign ovarian cysts who underwent TLS at Konkuk University Hospital between June 2007 and December 2008 were evaluated. The preoperative characteristics of patients, operative time, blood loss, complications, and postoperative outcomes were evaluated.ResultsThe mean age of patients was 38 years (range, 16–82 years). TLS was accomplished in 136 women (97.1%). The more common pathology findings included 35 dermoid cysts, 28 endometriotic cysts, 23 mucinous cysts, 21 serous cysts, and 13 functional ovarian cysts. The median operative time was 35 minutes (range 15–110 minutes). The maximum diameter of the ovarian cysts ranged from 3 to 20 cm (mean 6 cm). The median estimated blood loss was 38 mL (range 10–80 mL). No patients received a blood transfusion. All of the patients were discharged within 24 hours of surgery. No major complications occurred.ConclusionTransvaginal laparoscopic surgery was found to be a feasible and cosmetically beneficial surgical technique for managing selected patients with benign ovarian cysts.     

Sexual Function and Quality of Life in Women with Urinary Incontinence Treated by a Complete Pelvic Floor Rehabilitation Program (Biofeedback,Functional Electrical Stimulation,Pelvic Floor Muscles Exercises,and Vaginal Cones)

IntroductionUrinary incontinence (UI) is a debilitating condition that can cause discomfort, embarrassment, loss of confidence; it can lead to withdrawal from social life, and adversely affects physical and mental health, sexual function and quality of life (QoL) in women.AimThe aim is to determine the impact of combined pelvic floor rehabilitation (PFR) on UI, female sexual dysfunction, and QoL.Main Outcome MeasuresFemale Sexual Function Index questionnaire (FSFI) and King's Health Questionnaire (KHQ).MethodsSixteen patients with UI were selected and underwent a complete PFR program (biofeedback, functional electrical stimulation, pelvic floor muscles exercises, and vaginal cones). Patient filled out the FSFI questionnaire and the KHQ at the baseline and at follow-up.ResultsAfter PFR none of the patients reported urine leakage during sexual activity. Resolution of incontinence was achieved in 13 (81.25%) women. Only three (18.75%) patients had positive 1-hour pad test after the treatment. There was significant difference between pad test leakage before and after the PFR (P < 0.001).The mean Stamey incontinence score was 1.37 ± 0.5 at the baseline vs. 0.25 ± 0.57 at the follow up (P < 0.001). Before PFR, FSFI total score ranged from 25.8 to 2 (mean 14.65 ± 6.88), after treatment the FSFI total score ranged from 36 to 2 (mean 22.65 ± 9.5) (P < 0.001). The improvement of the scores in the six FSFI domains, 5 months after the conclusion of PFR, was statistically significant (desire, arousal, lubrication, orgasm, satisfaction, and pain). All the nine domains in the KHQ presented a low average score after treatment and the improvements were statistically significant.ConclusionsPFR led to a significant difference in the daily use of pads, 1-hour pad test, and Stamey incontinence scores. The treatment caused an improvement in patient's QoL index and sexual function. Rivalta M, Sighinolfi MC, Micali S, De Stefani S, and Bianchi G. Sexual function and quality of life in women with urinary incontinence treated by a complete pelvic floor rehabilitation program (biofeedback, functional electrical stimulation, pelvic floor muscles exercises, and vaginal cones).     

Estimation clinique du poids fœtal et hauteur utérine dans le dépistage de l’hypotrophie fœtale à terme

ObjectivesTo evaluate the estimation of fetal weight by external abdominal measurements, alone or associated with fundal height measurement and/or ultrasonographic exams near 32 weeks, to detect intra-uterine growth retardation (IUGR) near term.Patients and methodsA retrospective cohort study included all women who delivered a small-for-gestational-age infant less than 37 weeks gestation during 2008–2009. We analyzed the sensitivity of estimation of fetal weight by external abdominal measurements and the others different routine exams during third trimester, and compared them to detect IUGR near term.ResultsThe estimation of fetal weight by external abdominal measurements was used in 263 pregnant patients. External abdominal measurements and fundal height measurement were not statistically different and were better tests than ultrasonographic exams at 32 weeks to detect IUGR near term (sensitivity: 41.4%, 42.2% and 22.8%, respectively; P < 0.05). External abdominal measurements associated with regular ultrasonographic examination at 32 weeks of gestation significantly increased the sensitivity to detect IUGR near term (42.9% vs 22.8%; P < 0.05). But, the association of external abdominal measurements and fundal height measurement did not increase the rate of detection (47.9% vs 42.2%; P = 0.22).Discussion and conclusionThe present findings confirm that the use of the estimation of fetal weight by external abdominal measurements to detect intra-uterine growth retardation is effective. Measures to improve the learning of this technique and its reproducibility are recommended.     

Biochemical and ultrasonographic predictors of outcome in threatened abortion

ObjectivesTo evaluate different biochemical and ultrasonographic markers as predictors of outcome in cases with threatened abortion.Study designA prospective observational study involving 250 women in their 1st trimester was divided into three groups: group I (65 women) in whom threatened abortion ended in abortion, group II (85 women) with threatened abortion who completed their pregnancy and group III (100 women) with normal pregnancy. Biochemical markers studied included CA 125, beta human chorionic gonadotropin (β HCG), progesterone, Estradiol (E2), Lactate dehydrogenase (LDH), and Total leucocytic count (TLC) and ultrasonographic markers included Embryonic/Fetal heart rate (E/FHR), Gestational sac diameter (GSD), Crownrump length (CRL) and Yolk sac diameter (YSD). Comparison between markers was done using sensitivity, specificity, PPV and NPV.ResultsThere was a statistically significant difference between GI and the other two groups regarding CA 125 β HCG, progesterone, FHR and CRL.There was no significant difference between the three study groups regarding E₂ level, LDH, TLC, GSD or yolk sac diameter.The sensitivity, specificity, PPV and NPV of CA 125 at 80 IU/ml were 80.2, 78.3, 69.6 and 82.4, respectively, for β HCG at 19887 mIU/ml were 88.6, 81.1, 45,6 and 96.8, respectively, for Progesterone at 25 ng/ml were 90.1, 87.2, 51,2 and 97, respectively, for FHR at 110 bpm were 98.1, 99.1, 89,2 and 91.4, respectively and for CRL at 21 mm were 46.4, 40.1, 35,5 and 33.7, respectively.ConclusionCA125, β HCG and progesterone are good biochemical markers and FHR and CRL are good ultrasonographic markers for the prediction of outcome in women with threatened abortion. FHR at 110 bpm gives the best predictivity followed by serum P at 25 ng/ml, β HCG at 19887 mIU/ml, CA 125 at 80 IU/ml and CRL at 21 mm with the least predictive accuracy among studied markers. Adding serum progesterone to FHR gave a sensitivity and specificity of 100%.     

Evaluation of isosorbide mononitrate for cervical ripening prior to induction of labor for postdated pregnancy in an outpatient setting

ObjectiveTo determine the safety and effectiveness of self-administered treatment with isosorbide mononitrate (IMN) for cervical ripening in Indian women with postdated pregnancies.MethodsA randomized, placebo-controlled study was conducted with 200 women with postdated pregnancies and unfavorable cervices who self-administered vaginally either 2 40-mg tablets of IMN or 2 40-mg tablets of pyridoxine as placebo prior to admission for induction of labor. The main outcome variables were change in Bishop score, time from admission to delivery, and presence or absence of fetal and maternal morbidity.ResultsThe Bishop score was significantly improved 24 hours after initiation of the outpatient IMN treatment (P < 0.001) and the needs for further cervical ripening and oxytocin infusion were less in the study than in the control group (P < 0.001 and P = 0.008). The time from admission to delivery was also less (P < 0.001). Moreover, the IMN treatment had no major adverse maternal or fetal effects. The vast majority of women in both groups were either satisfied or very satisfied with the outpatient treatment.ConclusionThe self-administration, at home, of isosorbide mononitrate leads to a safe and effective cervical ripening prior to labor induction in women with postdated pregnancies.CTRI Registration No.: CTRI/2011/091/000121     

Hysteroscopic Surgery of Ectopic Pregnancy in the Cesarean Section Scar

Study ObjectiveTo evaluate the effect of hysteroscopy in the treatment of caesarean section scar pregnancy.DesignRetrospective review.ParticipantsThirty-nine patients with cesarean scar pregnancy.InterventionsBetween January 2006 and June 2008, 39 patients with caesarean section scar pregnancy underwent hysteroscopic removal of conceptive tissues in our department. Their medical records were reviewed retrospectively.Measurements and Main ResultsThe diagnosis was confirmed by serum human chorionic gonadotropic concentration and at ultrasonographic or magnetic resonance imaging. All patients underwent hysteroscopic removal of conceptive tissues under ultrasonographic guidance. Before surgery, 36 patients received 25 mg of oral mifepristone, 25 mg, twice a day for 3 days, and 3 patients received an injection of methotrexate salt, 50 mg, and underwent preoperative bilateral uterine artery embolization. Results were reported as good in 37 patients; only 2 patients required additional surgery.ConclusionHysteroscopic removal of conceptive tissues implanted in a cesarean section scar seems to be a feasible and safe procedure that might be considered as a treatment option.     

Yoga in Male Sexual Functioning: A Noncompararive Pilot Study

IntroductionYoga is practiced both in developing and developed countries. Many patients and yoga protagonists claim that it is useful in improving sexual functions and treating sexual disorders.AimWe wanted to study the effect of yoga on male sexual functioning.MethodsWe studied 65 males (age range = 24–60 years, average age = 40 ± 8.26 years) who were enrolled in a yoga camp and administered a known questionnaire, i.e., Male Sexual Quotient (MSQ) before and after 12 weeks session of yoga.Main Outcome MeasuresMSQ scores before and after yoga sessions.ResultsIt was found that after the completion of yoga sessions, the sexual functions scores were significantly improved (P < 0.0001). The improvement occurred in scores of all the domains of sexual functions as studied by MSQ (desire, intercourse satisfaction, performance, confidence, partner synchronization, erection, ejaculatory control, orgasm).ConclusionsYoga appears to be an effective method of improving all domains of sexual functions in men as studied by MSQ. Dhikav V, Karmarkar G, Verma M, Gupta R, Gupta S, Mittal D, and Anand K. Yoga in male sexual functioning: A noncompararive pilot study.     

The Impact of Multimorbidity on Sexual Function in Middle-Aged and Older Women: Beyond the Single Disease Perspective

IntroductionLittle is known about sexual activity and function in women with multiple chronic health conditions.AimTo examine the impact of multimorbidity on sexual activity and function in middle-aged and older women.MethodsMultiethnic cross-sectional cohort of 1,997 community-dwelling women (mean age of 60.2 [±9.5] years) in California. Structured questionnaires assessed prior diagnoses of common cardiometabolic, colorectal, neuropsychiatric, respiratory, musculoskeletal, and genitourinary conditions.Main Outcome MeasuresSexual desire, frequency of sexual activity, overall sexual satisfaction, and specific sexual problems (i.e., difficulty with arousal, lubrication, orgasm, and pain) were assessed by structured questionnaires.ResultsSeventy-one percent of women had two or more diagnosed chronic conditions. Fifty-nine percent reported low sexual desire, 53% reported less than monthly sexual activity, and 47% reported low overall sexual satisfaction. Multimorbidity was associated with increased odds of reporting low sexual desire (OR = 1.11, 95% CI = 1.06–1.17, per each additional chronic condition), less than monthly sexual activity (OR = 1.11, 95% CI = 1.05–1.17 per each additional condition), and low sexual satisfaction (OR = 1.10, 95% CI = 1.04–1.16 per each additional condition), adjusting for age, race/ethnicity, and partner status. Depression and urinary incontinence were each independently associated with low desire (OR = 1.53, 95% CI = 1.19–1.97, and OR = 1.23, 95% CI = 1.00–1.52, respectively), less than monthly sexual activity (OR = 1.39, 95% CI = 1.06–1.83, and OR = 1.29, 95% CI = 1.02–1.62, respectively), and low sexual satisfaction (OR = 1.49, 95% CI = 1.14–1.93, and OR = 1.38, 95% CI = 1.11–1.73, respectively), adjusting for other types of conditions. After adjustment for total number of chronic conditions, age remained a significant predictor of low desire and less than monthly sexual activity, but not sexual satisfaction.ConclusionsWomen with multiple chronic health conditions are at increased risk for decreased sexual function. Depression and incontinence may have particularly strong effects on sexual desire, frequency of activity, and satisfaction in women, independent of other comorbid conditions. Women's overall sexual satisfaction may be more strongly influenced by multimorbidity than age. Appa AA, Creasman J, Brown JS, Van Den Eeden SK, Thom DH, Subak LL, and Huang AJ. The impact of multimorbidity on sexual function in middle-aged and older women: Beyond the single disease perspective. J Sex Med 2014;11:2744–2755.     

Penile Enhancement Using Autologous Tissue Engineering with Biodegradable Scaffold: A Clinical and Histomorphometric Study

IntroductionAutologous tissue engineering with biodegradable scaffolds is a new treatment option for real penile girth enhancement.AimThe aim of this article is to evaluate tissue remodeling after penile girth enhancement using this technique.MethodsBetween June 2005 and May 2007, a group of 12 patients underwent repeated penile widening using biodegradable scaffolds enriched with expanded autologous scrotal dartos cells. Clinical monitoring was parallel to histological investigation of tissue remodeling. During second surgical procedure, biopsies were obtained 10–14 months after first surgery (mean 12 months, N = 6) and compared with those obtained after 22–24 months (mean 23 months, N = 6), and control biopsies from patients who underwent circumcision (N = 5). Blind evaluation of histomorphometrical and immunohistochemical finding was performed in paraffin sections.Main Outcome MeasurementsPenile girth gain in a flaccid state ranged between 1.5 and 3.8 cm (mean 2.1 ± 0.28 cm) and in full erection between 1.2 and 4 cm (mean 1.9 ± 0.28 cm). Patients' satisfaction, defined by a questionnaire, was good (25%) and very good (75%).ResultsIn biopsies obtained 10–14 months after first surgery, highly vascularized loose tissue with collagen deposition associated with small foci of mild chronic and granulomatous inflammation surrounding residual amorphous material was observed. Fibroblast-like hyperplasia and small vessel neoangiogenesis occurred intimately associated with the progressive growth of vascular-like structures from accumulation of CD34 and alpha-smooth muscle actin-positive cells surrounding residual scaffold-like amorphous material. Capillary neoangiogenesis occurred inside residual amorphous material. In biopsies obtained after 22–24 months, inflammation almost disappeared and tissue closely resembled that of the dartos fascia of control group.ConclusionsAutologous tissue engineering using expanded scrotal dartos cells with biodegradable scaffolds is a new and promising method for penile widening that generates progressive accumulation of stable collagen-rich, highly vascularized tissue matrix that closely resemble deep dartos fascia. Perovic SV, Sansalone S, Djinovic R, Ferlosio A, Vespasiani G, and Orlandi A. Penile enhancement using autologous tissue engineering with biodegradable scaffold: A clinical and histomorphometric study.     

A multicenter,double-blind,randomized, placebo-controlled study of rifaximin for the treatment of bacterial vaginosis

ObjectiveTo compare efficacy and tolerability between different regimens of rifaximin vaginal tablets and a placebo for treatment of bacterial vaginosis.MethodsIn a prospective study carried out at 13 sites in 3 European countries between August 2009 and October 2010, White, non-pregnant, premenopausal women with bacterial vaginosis were randomly assigned to receive rifaximin at 100 mg for 5 days (100 mg/5 days), 25 mg/5 days, or 100 mg/2 days, or placebo. Women were assessed at 7–10 and 28–35 days. Diagnosis and cure were based on Amsel criteria and Nugent score. Fisher exact test was used to compare cure rates.ResultsAmong 114 women recruited, 103 were evaluable for drug efficacy. Therapeutic cure rate at first follow-up was higher in the rifaximin 25 mg/5 days (48%, P = 0.04), 100 mg/2 days (36.0%), and 100 mg/5 days (25.9%) groups than in the placebo group (19.0%). At second follow-up, therapeutic cure rate was 28.0%, 14.8%, and 4.0% in the respective groups versus 7.7% in the placebo group. No difference in adverse events was observed.ConclusionRifaximin at 25 mg/5 days showed better therapeutic cure rates and maintenance of therapeutic cure after 1 month versus placebo. All treatment regimens were well tolerated.EudraCT number: 2009-011826-32.