Urinary incontinence and other pelvic floor dysfunctions in female athletes in Brazil: A cross‐sectional study

The pelvic floor (PF) provides support to all pelvic organs, as well as appropriately closure/opening mechanism of the urethra, vagina, and anus. Therefore, it is likely that female athletes involved in high‐impact and in strong‐effort activities are at risk for the occurrence of urinary incontinence (UI). This study aimed to investigate the occurrence of UI and other PF dysfunctions (PFD) [anal incontinence (AI), symptoms of constipation, dyspareunia, vaginal laxity, and pelvic organ prolapse] in 67 amateur athletes (AT) compared with a group 96 of nonathletes (NAT). An ad hoc survey based on questions from reliable and valid instruments was developed to investigate the occurrence of PFD symptoms. The risk of UI was higher in AT group (odds ratio: 2.90; 95% CI: 1.50–5.61), mostly among artistic gymnastics and trampoline, followed by swimming and judo athletes. Whereas, AT group reported less straining to evacuate (OR: 0.46; 95% CI: 0.22–0.96), manual assistance to defecate (OR: 0.24; 95% CI: 0.05–1.12), and a higher stool frequency (OR: 0.29; 95% CI: 0.13–0.64) than NAT group. The occurrence of loss of gas and sexual symptoms was high for both groups when compared with literature, although with no statistical difference between them. Pelvic organ prolapse was only reported by nonathletes. Athletes are at higher risk to develop UI, loss of gas, and sexual dysfunctions, either practicing high‐impact or strong‐effort activities. Thus, pelvic floor must be considered as an entity and addressed as well. Also, women involved in long‐term high‐impact and strengthening sports should be advised of the impact of such activities on pelvic floor function and offered preventive PFD strategies as well.     

Varicose veins arising from the pelvis due to ovarian vein incompetence

Vulval varices and perivulval veins are common though often unrecognised, and pelvic pain is a common complaint, sometimes without an obvious cause, hence treatment is not always successful. An association between these two problems has long been established, and some cases of pelvic pain are clearly associated with venous pathology. Often, these patients present to the vein clinic with recurrent varicose veins, because the standard procedures have failed and the pelvic origin was not recognised. The understanding of the pathology has evolved and will be reviewed. To establish diagnosis, the communication from the atypical varicose veins in the legs to the ovarian veins must be shown and incompetence of one or both ovarian veins must be demonstrated. Treatment requires elimination of the retrograde flow in the ovarian veins. This can be by either surgical ligation and removal or obliteration with coils and sclerosant. Having removed the cause and relieved the pelvic symptoms, the leg veins can then be successfully treated.     

Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications

The relationship between chronic pelvic pain symptoms and endometriosis is unclear because painful symptoms are frequent in women without this pathology, and because asymptomatic forms of endometriosis exist. Our comprehensive review attempts to clarify the links between the characteristics of lesions and the semiology of chronic pelvic pain symptoms. Based on randomized trials against placebo, endometriosis appears to be responsible for chronic pelvic pain symptoms in more than half of confirmed cases. A causal association between severe dysmenorrhoea and endometriosis is very probable. This association is independent of the macroscopic type of the lesions or their anatomical locations and may be related to recurrent cyclic micro-bleeding in the implants. Endometriosis-related adhesions may also cause severe dysmenorrhoea. There are histological and physiopathological arguments for the responsibility of deeply infiltrating endometriosis (DIE) in severe chronic pelvic pain symptoms. DIE-related pain may be in relation with compression or infiltration of nerves in the sub-peritoneal pelvic space by the implants. The painful symptoms caused by DIE present particular characteristics, being specific to involvement of precise anatomical locations (severe deep dyspareunia, painful defecation) or organs (functional urinary tract signs, bowel signs). They can thus be described as location indicating pain. A precise semiological analysis of the chronic pelvic pain symptoms characteristics is useful for the diagnosis and therapeutic management of endometriosis in a context of pain.     

Dyspareunia and chronic pelvic pain in patients with interstitial cystitis/bladder pain syndrome

ObjectiveA previous study established that interstitial cystitis/bladder pain syndrome (IC/BPS) patients had significantly more dyspareunia and fear of pain than healthy controls. We evaluated the relationships between lower urinary tract symptoms and dyspareunia in IC/BPS patients.Materials and methodsA total of 156 IC/BPS female patients were included in this study. The diagnosis was made on the consensus of IC/PBS proposed by the Society for Urodynamics and Female Urology criteria in 2008. All women completed measures of pain severity (visual analog scale) and bladder symptom severity [IC Symptom Index, IC Problem Index, and the Pelvic Pain and Urinary/Frequency (PUF) scale]. Respondents were asked to recall if they experienced any sexual pain during or after sexual intercourse in the past 1 year. Cystoscopic hydrodistension during general anesthesia was performed for 5 minutes and maximal bladder capacity was also measured. Bivariate analyses were performed using chi-square and independent Student t tests.ResultsOf the women with a current sexual partner, 61% (96/156) reported dyspareunia during or after sexual intercourse. Of the 96 dyspareunia respondents, 46% (44/96) reported pain in the bladder only, 43% (41/96) in the vagina only, and 11% (11/96) in both the bladder and the vagina. Patients with dyspareunia complained of more severe urological pain (p = 0.02), a higher PUF scale score (p < 0.01), and larger anesthetic maximal bladder capacity (p = 0.04) than patients without dyspareunia. However, patients with dyspareunia at the bladder only had more severe urgency sensation (p < 0.01) but no differences in pain, PUF scale, severity of glomerulation, and maximal bladder capacity than those with dyspareunia at the vagina only.ConclusionIC/BPS women with dyspareunia have significantly more severe urological pain and a higher PUF scale score than women without dyspareunia. Physicians should consider sexual pain disorder in the management of patients with IC/BPS and use the PUF scale to evaluate not only IC-specific lower urinary tract symptoms, but also sexual pain disorder.     

Sexual and urinary dysfunction following rectal dissection compared with segmental colectomy

Introduction  The aim of this study was to assess the impact of nerve sparing surgery and major abdominal surgery on sexual and urinary function in men and women with colorectal cancer undergoing rectal dissection and segmental colectomy.
Method  Forty-eight patients (group A: 22 males, 26 females; median age 55 years) undergoing rectal dissection were compared with 24 having segmental colectomy (group B: 12 male, 12 female; median age 55 years). Preoperative data were also compared with age- and gender-matched controls (group C).
Results  More patients after rectal dissection vs segmental colectomy had urinary tract infections [15 (31%) vs 3 (17.5%), P  = 0.04]. At 37 months, urinary dysfunction after rectal excision was seen in 29 (60%; 20 men) vs nine (37.5%; eight men) after segmental colectomy. Postoperative urinary symptoms were significant in group A, but not in group B (pre: vs post; groups A and B: poor stream – 13% vs 38%, P  = 0.001 and 21% vs 21%, P  = NS; incontinence – 4.2% vs 17%, P  = 0.008 and 8% vs 8%, P  = NS; hesitancy – 13% vs 35%, P  = 0.034 and 17% vs 21%, P  = NS). Sexual health was worse after rectal excision compared with segmental colectomy (men – 62.5%, women – 25% vs 44% of men) respectively. Erectile dysfunction was the chief cause (rectal excision – 50% vs segmental colectomy – 33%). After rectal excision, 6% of women had dyspareunia and 19% reported reduced orgasm but none after segmental colectomy.
Conclusion  More men than women had urinary and sexual impairment after rectal excision than after segmental colectomy. Its aetiology is multifactorial.     

Urinary,climacteric and sexual symptoms 1 year after treatment of cervical cancer without brachytherapy

Objective.?Prospective studies elucidating the impact of the treatment of cervical cancer on urinary and climacteric symptoms and sexual life are relatively rare. The aim of this study was to seek information about the occurrence of urinary, climacteric and sexual symptoms in women with cervical cancer before and 1 year after treatment without brachytherapy.

Methods.?This prospective study evaluated 39 women treated for cervical cancer. Data were collected by two questionnaires (before and 1 year after treatment). In order to supplement the data from the questionnaires, some data were selected from the patient's medical records.

Results.?The number of voluntary micturitions, urgency, urinary incontinence and climacteric symptoms had not increased 1 year after treatment. Vaginal dryness and dyspareunia had increased and sexual desire was reduced 1-year post-treatment.

Conclusion.?This study has shown that urinary and climacteric symptoms are not frequent 1 year after treatment of cervical cancer without brachytherapy. However, there is an increased occurrence of vaginal dryness and sexual disorders 1-year post-treatment, mainly in the form of dyspareunia and reduced sexual desire. Taken together these symptoms affect the women's quality of life and it is, therefore, crucial that the medical providers become more aware of and skilled to deal with these conditions before and after treatment.     

Sexual problems in two inner city London sexual health centres: prevalence,attributions and need for psychosexual services

Sexual problems are common and psychosexual provision is recommended within sexual health services. This study aimed to explore and compare the prevalence and range of sexual problems in men and women attending two sexual health centres; explore patients' attributions for sexual problems; and establish the need for psychosexual clinics. Questionnaires were completed by 868 patients (452 men; 416 women) attending two sexual health centres in London, UK. Women reported more sexual problems than men overall (43 and 32%, respectively). Thirteen percent of men and 18% of women reported reduced interest in sex, 16% of men and 11% of women had arousal difficulties, 6% of men and 18% of women experienced painful sex and 19% of men and 24% of women reported ejaculation/orgasm problems. The majority of sexual problems interfered with patients' lives. Most sexual problems had started within the last year. However, ejaculation/orgasm problems had typically been experienced for longer. Men and women most commonly attributed their sexual problems to an emotional cause. Only a minority of patients with sexual problems were receiving help despite almost half of patients wanting it. Increased identification and treatment for sexual problems is essential in sexual health services.     

Rectocele repair by anterolateral rectopexy: long‐term functional outcome

Introduction Rectoceles are frequently associated with feelings of pelvic discomfort and symptoms of obstructed defaecation (OD). Repair by a transvaginal or transanal approach might result in de novo dyspareunia in up to approximately 40% of the cases. This study was designed to investigate whether anterolateral rectopexy provides an adequate rectocele repair without dyspareunia as a side effect. Method A consecutive series of 33 women (median age 55 years; range: 37–73) with a symptomatic rectocele (depth > 3 cm) underwent anterolateral rectopexy. Before the operation, all patients underwent evacuation proctography (EP), which was repeated 6 months after the repair in all but three patients. A standardized questionnaire concerning pelvic discomfort, OD and dyspareunia was used to assess the long‐term effect of rectocele repair. The response rate was 91%. Results Six months after the procedure, EP revealed a recurrent or persistent rectocele in six patients (20%). However, in four of these six patients, the depth of the rectocele was < 3 cm. The median duration of follow‐up was 74 months (range: 2–96). Among the patients with an adequate repair, signs of OD persisted in 55%. None of the patients encountered de novo dyspareunia after the procedure. Conclusion Anterolateral rectopexy provides an effective tool for anatomical correction of rectoceles and does not result in dyspareunia as a side effect. However, despite adequate repair, OD persist in the majority of patients.     

The psychological effects of stillbirth and neonatal death on fathers: Systematic review

The aim of the study was to investigate the prevalence of vulvar vestibulitis syndrome (VVS) in a sample of women suffering from lifelong vaginismus (N=91). Lifelong vaginismus is defined as "having a history of never having been able to experience penile entry of the vagina". The results with respect to VVS are compared with the results of women who are suffering from pain during intercourse (superficial dyspareunia) (N=84). Both patients groups were recruited from two treatment outcome studies. Using a standard physical examination, erythema was found in 77%, pain "on touch" in 69% and erythema and pain on the same location was seen in 56% of the patients with lifelong vaginismus. Furthermore, it was found that erythema (94%), pain (98%) and erythema and pain on the same location (92%) were more frequently found in patients with dyspareunia compared to women with lifelong vaginismus. It is concluded that pain is an integral part of the experiences in the majority of women with lifelong vaginismus.     

Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome

Vaginal sEMG biofeedback and pelvic floor physical therapists' manual techniques are being increasingly included in the treatment of vulvar vestibulitis syndrome (VVS). Successful treatment outcomes have generated hypotheses concerning the role of pelvic floor pathology in the etiology of VVS. However, no data on pelvic floor functioning in women with VVS compared to controls are available. Twenty-nine women with VVS were matched to 29 women with no pain with intercourse. Two independent, structured pelvic floor examinations were carried out by physical therapists blind to the diagnostic status of the participants. Results indicated that therapists reached almost perfect agreement in their diagnosis of pelvic floor pathology. A series of significant correlations demonstrated the reliability of assessment results across muscle palpation sites. Women with VVS demonstrated significantly more vaginal hypertonicity, lack of vaginal muscle strength, and restriction of the vaginal opening, compared to women with no pain with intercourse. Anal palpation could not confirm generalized hypertonicity of the pelvic floor. We suggest that pelvic floor pathology in women with VVS is reactive in nature and elicited with palpations that result in VVS-type pain. Treatment interventions need to recognize the critical importance of addressing the conditioned, protective muscle guarding response in women with VVS.