Pelvic Floor Muscle Training Effect in Sexual Function in Postmenopausal Women: A Randomized Controlled Trial

BackgroundThe prevalence of sexual dysfunction is high in postmenopausal women and pelvic floor muscle training (PFMT) could improve sexual function during this period.AimTo assess the effect of a PFMT protocol on sexual function in postmenopausal women and to investigate the effect of this protocol on pelvic floor muscle function.MethodsThis is an assessor blinded randomized controlled trial including 77 postmenopausal women. The study was registered in ReBEC Trial: RBR-3s3ff7. The intervention group (n = 40) received an intensive supervised PFMT protocol during 12 weeks and the control group (n = 37) received no intervention.OutcomesThe primary outcome of the study was assessed by the Female Sexual Function Index (FSFI) questionnaire and the secondary outcome was the evaluation of pelvic floor muscle function performed by digital palpation using the modified Oxford scale at baseline and after 12 weeks.ResultsNo difference between groups was found in the FSFI domains and total score at baseline and in the second evaluation after 12 weeks. However, after 12 weeks, a higher percentage of women without sexual dysfunction was found in the intervention group (95% CI = 27.97–72.03) when compared to the control group (95% CI = 7.13–92.87). No difference was found between groups in relation to the pelvic floor muscle function at the baseline (P = .2) and after 12 weeks (P = .06).Clinical ImplicationsPFMT is a conservative intervention that can lead women to have less sexual dysfunction.Strengths & LimitationsThe protocol provided a reduced number of women with sexual dysfunction, the strength of this research is the study design and the limitation is to have used only one tool to assess sexual function although it is a validated questionnaire.ConclusionPFMT decreases sexual dysfunction in postmenopausal women. MM Franco, CC Pena, LM de Freitas, et al. Pelvic Floor Muscle Training Effect in Sexual Function in Postmenopausal Women: A Randomized Controlled Trial. J Sex Med 2021;18:1236–1244.     

Symptom evaluation in palliative medicine: patient report vs systematic assessment

Purpose This study examined symptoms reported by patients after open-ended questioning vs those systematically assessed using a 48-question survey.Materials and methods Consecutive patients referred to the palliative medicine program at the Cleveland Clinic Foundation were screened. Open-ended questions were asked initially followed by a 48-item investigator-developed symptom checklist. Each symptom was rated for severity as mild, moderate, or severe. Symptom distress was also evaluated. Data were collected using standardized pre-printed forms.Results Two hundred and sixty-five patients were examined and 200 were eligible for assessment. Of those assessed, the median age was 65 years (range 17–90), and median ECOG performance status was 2 (range 1–4). A total of 2,397 symptoms were identified, 322 volunteered and 2,075 by systematic assessment. The median number of volunteered symptoms was one (range zero to six). Eighty-three percent of volunteered symptoms were moderate or severe and 17% mild. Ninety-one percent were distressing. Fatigue was the most common symptom identified by systematic assessment but pain was volunteered most often. The median number of symptoms found using systematic assessment was ten (0–25). Fifty-two percent were rated moderate or severe and 48% mild. Fifty-three percent were distressing. In total, 69% of 522 severe symptoms and 79% of 1,393 distressing symptoms were not volunteered. Certain symptoms were more likely to be volunteered; this was unaffected by age, gender, or race.Conclusion The median number of symptoms found using systematic assessment was tenfold higher (p<0.001) than those volunteered. Specific detailed symptom inquiry is essential for optimal palliation in advanced disease.The Harry R. Horvitz Center for Palliative Medicine is a World Health Organization demonstration project in palliative medicinePresented at the American Society of Clinical Oncology 37th Annual Meeting, San Francisco, May 12–15, 2001     

Splenic artery embolization for spontaneous splenic rupture due to Babesiosis: a case report

Babesiosis incidence in the United States has been increasing with an 11% rise between 2018 and 2019 based on the latest CDC annual summary, reaching its highest ever reported incidence. This primarily tick-borne disease is particularly prevalent in New England. Despite predominantly nonspecific and at times subtle symptoms, life-threatening complications do occur. One such complication is splenic rupture which has been suggested to be more common in younger and otherwise healthy individuals. This is a report on a successful splenic artery embolization in a 65-year-old male from upstate New York who, unlike most prior studies, showed splenic rupture after he was discharged with negative parasitemia and general improvement following several days of targeted antibiotic therapy. Increased incidence and various presentations of Babesiosis call for an attempt to promote clinical awareness for radiologists among other specialties.     

Diffuse abdominal and pelvic endosalpingiosis: A case report

Endosalpingiosis is defined as the ectopic location of benign ciliated tubal epithelium outside of the fallopian tubes. It is a rare entity that was previously regarded as an incidental finding on pathology, and is becoming more prevalent within the medical literature. Diagnosis is made based on histologic sampling. There are no specific radiological features but commonly reported findings include numerous cystic and solid masses scattered throughout the pelvis. Common ectopic locations seen on imaging include the serosa of the uterus, fallopian tubes, ovaries and the pelvic cul-de-sac. Less common locations include the bladder wall, omentum, bowel serosa, and skin. We present the clinical presentation of a patient with histologically proven endosalpingiosis. Atypical imaging findings and correlative histology are also reviewed.