The role of vaginal apex excision in the management of persistent posthysterectomy dyspareunia (original) (raw)
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Archives of Gynecology and Obstetrics
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Dyspareunia in gynaecological practice
Obstetrics, Gynaecology & Reproductive Medicine, 2009
Dyspareunia is defined as genital pain experienced just before, during or after sexual intercourse. it can significantly affect quality of life. it is a symptom of a variety of disease states with components of both physical and psychological dysfunction. it is important to obtain a comprehensive sexual history and perform a systematic examination of the lower genital tract to exclude any underlying pathology. Further investigations such as ultrasound rarely offer additional information. Diagnostic laparoscopy is an invasive procedure that is of limited use in the management of dyspareunia but may help detect pelvic adhesions or endometriosis in those where this condition is suspected. Before embarking on a laparoscopy it is important for the patient to be aware of a management plan if the laparoscopy does not show any obvious cause. Studies suggest that medical treatment for endometriosis is effective when commenced on clinical diagnosis alone without laparoscopic confirmation. Psychosexual causes are important to consider during the assessment of the patient experiencing dyspareunia. Keywords chronic pelvic pain; dyspareunia; endometriosis; sexual dysfunction; vaginismus Associated symptoms Dyspareunia is commonly associated with chronic pelvic pain (CPP) and other sensory pelvic symptoms that include dysmenorrhoea, tampon discomfort, urinary urgency, faecal urgency and irritable bowel symptoms.
Evaluation and Treatment of Dyspareunia
Obstetrics & Gynecology, 2009
Dyspareunia affects 8 -22% of women at some point during their lives, making it one of the most common pain problems in gynecologic practice. A mixture of anatomic, endocrine, pathologic, and emotional factors combine to challenge the diagnostic, therapeutic, and empathetic skills of the physician. New understandings of pain in general require new interpretations concerning the origins of pain during intercourse, but also provide new avenues of treatment. The outcomes of medical and surgical treatments for common gynecologic problems should routinely go beyond measures of coital possibility, to include assessment of coital comfort, pleasure, and facilitation of intimacy. This review will discuss aspects of dyspareunia, including anatomy and neurophysiology, sexual physiology, functional changes, pain in response to disease states, and pain after gynecologic surgical procedures.
American family physician, 2014
Dyspareunia is recurrent or persistent pain with sexual activity that causes marked distress or interpersonal conflict. It affects approximately 10% to 20% of U.S. women. Dyspareunia can have a significant impact on a woman's mental and physical health, body image, relationships with partners, and efforts to conceive. The patient history should be taken in a nonjudgmental way and progress from a general medical history to a focused sexual history. An educational pelvic examination allows the patient to participate by holding a mirror while the physician explains normal and abnormal findings. This examination can increase the patient's perception of control, improve self-image, and clarify findings and how they relate to discomfort. The history and physical examination are usually sufficient to make a specific diagnosis. Common diagnoses include provoked vulvodynia, inadequate lubrication, postpartum dyspareunia, and vaginal atrophy. Vaginismus may be identified as a contribu...
Sultan Qaboos University Medical Journal, 2014
(NHS), as a share of national income, has more than doubled, rising by an average of 4% a year in real terms. This period of rapid growth has now ended, but funding pressures on the NHS continue to rise igniting a debate on the most cost-effective way of offering treatment. In this context, we audited subtotal abdominal hysterectomy (STAH) and laparoscopic-assisted supra-cervical hysterectomy (LASH) for benign gynaecological indications in a large district general hospital. A retrospective audit was undertaken of records of patients who had STAH or LASH for benign conditions at Wishaw General Hospital between August and July 2012. Twenty-five patients for each procedure were identified from the theatre information system. As three sets of notes could not be traced, there were 22 patients in the STAH group and 25 in LASH group. The mean operating time for STAH was 61 min (34-85 min) and 145 min (75-237 min) for the LASH group. There was one major complication in the STAH group (1,000 ml blood loss) compared to five in the LASH group (a pelvic infection, two wound infections and two patients with neuropathic pain at port sites). The mean hospital stay in the STAH group was 2.5 nights (2-4 nights) and 2 nights for patients undergoing LASH (1-4 nights). Costs were £2,213.40 (= OMR 1420) for STAH and £2,613.80 (= OMR 1677) for LASH. In this study, complication rates and apparent costs seemed comparable. Shorter hospital stays and possibly quicker recovery are areas where the laparoscopic approach scores over open surgery. In days of austerity for the NHS, surgery options need careful consideration. Open surgery's shorter operating times will help tackle long waiting lists but, if the impact on post-operative recovery and time off work are considered, the laparoscopic approach might be better.
Gynecological associated disorders and management
International Journal of Urology
Background: Chronic pelvic pain syndrome is complex and involves multiple organ systems. The gynecological aspects of chronic pelvic pain syndrome can be divided into four different areas: intra-abdominal, vaginal, pelvic floor muscles and sexual pain. This article provides an overview of gynecological evaluation in patients with chronic pelvic pain and reviews the most common gynecological diagnoses and their management. Methods: An extensive review of the literature including guidelines from the International Continence Society, the European Association of Urology, and the International Association for the Study of Pain was performed. Results: Gynecological evaluation of patients with chronic pelvic pain begins with a thorough history and physical examination. Laboratory tests, imaging studies and diagnostic procedures can be used as adjuncts to make a diagnosis. Treatment modalities include physical therapy, medications, trigger points injections, and surgery. Conclusion: Common gynecological diagnoses of chronic pelvic pain include endometriosis, adenomyosis, vulvodynia, high tone pelvic floor dysfunction, and genitopelvic pain/penetration disorder. Gynecology is one of the many systems that can be associated with chronic pelvic pain. Managing patients with chronic pelvic pain requires a multimodal and multidisciplinary approach.