RESUMEN
BACKGROUND: Women with female genital mutilation/cutting are known to have psychological sequelae from the cutting and other traumatic experiences. However, very few studies report immediate psychological sequelae of genital reconstructive surgery in this population. The present case is the first to our knowledge to report post-traumatic stress disorder symptoms immediately following defibulation, a procedure common in women with female genital mutilation/cutting type III. CASE PRESENTATION: We present the case of a 31-year-old Sudanese nulliparous woman in the second trimester of pregnancy with female genital mutilation/cutting type IIIa who was referred for antepartum defibulation to facilitate a vaginal birth. Immediately after an uncomplicated surgery under local anesthesia and just before the first micturition, she developed post-traumatic stress disorder symptoms and suddenly recalled the traumatic experience of her first micturition after female genital mutilation/cutting when she was a child in Sudan. The woman was offered psychiatric follow-up with psychotherapy for 4 months and a short course of benzodiazepines. She had fully recovered by the time of delivery, 4 months after surgery. CONCLUSIONS: We discuss the possibility of recall of a past traumatic experience of female genital mutilation/cutting during defibulation or other genital surgeries. We review the benefits and risks of defibulation, the impact of this procedure, and the setting and timing in which it is performed, focusing on women's mental health and psychological support.
Asunto(s)
Circuncisión Femenina , Procedimientos de Cirugía Plástica , Trauma Psicológico , Trastornos por Estrés Postraumático , Adulto , Niño , Circuncisión Femenina/efectos adversos , Circuncisión Femenina/psicología , Disuria/etiología , Disuria/psicología , Femenino , Humanos , Recuerdo Mental , Embarazo , Trauma Psicológico/etiología , Trauma Psicológico/psicología , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/psicología , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/psicología , Sudán , Micción , Trastornos Urinarios/etiología , Trastornos Urinarios/psicología , Vagina/cirugíaRESUMEN
OBJECTIVE: To assess the non-inferiority of Low-power Holmium laser enucleation of the prostate (LP-HoLEP) to high-power (HP-HoLEP) for enucleation efficiency pertaining to the advantages of lower cost and minimal postoperative dysuria, storage symptoms, and negative sexual impact. PATIENTS AND METHODS: HoLEP was performed using 100W Versapulse, Luminis Inc., with 2J/25Hz for LP-HoLEP (61 patients) and 2J/50Hz for HP-HoLEP (60 patients). Two surgeons with different experience performed equal number of both procedures. Non-inferiority of enucleation efficiency (enucleated weight/min) was evaluated. All perioperative parameters were recorded and compared. Dysuria was assessed at 2 weeks by dysuria visual analog scale, urinary (Q.max and IPSS) and sexual (sexual health inventory for men score) outcome measures were evaluated at 1, 4, and 12 months. RESULTS: Baseline and perioperative parameters were comparable between the two groups. Mean enucleation efficiency was 1.42±0.6 vs 1.47±0.6 gm/min, Pâ¯=â¯.6 following LP-HoLEP and HP-HoLEP, respectively. Patients reported postoperative dysuria similarly in both groups as per dysuria visual analog scale. There was significant comparable improvement in IPSS (international prostate symptom score) and Q.max in both groups at different follow-up points. At one year, median IPSS and Q.max were comparable in both groups (Pâ¯=â¯.4 and .7 following LP-HoLEP and HP-HoLEP, respectively). Median postoperative reduction in prostate specific antigen was 89% (42:99) following LP-HoLEP vs 81% (62:94) after HP-HoLEP, Pâ¯=â¯.92. Both groups showed comparable perioperative and late postoperative complications. There were no statistically significant changes in the last follow-up sexual health inventory for men score in comparison to baseline score. CONCLUSION: LP-HoLEP is non-inferior to HP-HoLEP in terms of all efficiency parameters regardless level of surgeon experience.
Asunto(s)
Disuria , Terapia por Láser , Láseres de Estado Sólido/uso terapéutico , Complicaciones Posoperatorias , Hiperplasia Prostática , Calidad de Vida , Disfunciones Sexuales Fisiológicas , Resección Transuretral de la Próstata , Anciano , Disuria/diagnóstico , Disuria/etiología , Disuria/psicología , Humanos , Terapia por Láser/efectos adversos , Terapia por Láser/instrumentación , Terapia por Láser/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/psicología , Próstata/diagnóstico por imagen , Próstata/patología , Próstata/cirugía , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/psicología , Hiperplasia Prostática/cirugía , Disfunciones Sexuales Fisiológicas/diagnóstico , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/psicología , Resección Transuretral de la Próstata/efectos adversos , Resección Transuretral de la Próstata/instrumentación , Resección Transuretral de la Próstata/métodos , Resultado del Tratamiento , Escala Visual AnalógicaRESUMEN
Endometriosis is a chronic disease of women during their reproductive age. The most typical symptoms are dysmenorrhoea, dyspareunia, dysuria, cyclical and acyclical pelvic pain, bleeding disorders and infertility. These symptoms lead to significant impairment of the quality of life and economic burden. The prevalence is estimated to be 2-20 % of all women in this age and due to this fact, it is one of the most frequently benign gynecological diseases. Not all women suffer from severe symptoms, but more than 50 % require ongoing treatment. Beside the severe physical impairment due to the pain, the high recurrence rate of 50-80 % also after surgical and/or hormonal treatment is problematic. The interval between onset of symptoms and diagnosis is approximately 6-8 years. These problems are a consequence of lack of knowledge about the pathogenesis of the disease and the pain mechanisms as well as the lack of awareness of physicians in this field.
Asunto(s)
Endometriosis/diagnóstico , Endometriosis/terapia , Adulto , Costo de Enfermedad , Diagnóstico Tardío , Diagnóstico Diferencial , Dispareunia/etiología , Dispareunia/psicología , Dispareunia/terapia , Disuria/etiología , Disuria/psicología , Disuria/terapia , Endometriosis/psicología , Femenino , Humanos , Infertilidad Femenina/etiología , Infertilidad Femenina/psicología , Infertilidad Femenina/terapia , Ciclo Menstrual/fisiología , Dolor Pélvico/etiología , Dolor Pélvico/psicología , Dolor Pélvico/terapia , Calidad de Vida/psicología , RecurrenciaRESUMEN
AIM: The aim of this paper was to show that self-assessed anxiety in patients with pelvic visceral discomforts is reduced after the intravaginal administration of adelmidrol. MATERIAL AND METHODS: Twenty-four patients who described themselves as anxious (scoring 5 or more in a 1 to 10 scale in a self-assessment test) and who suffered from pelvic visceral discomfort (during defecation, urination, sexual intercourse and menstruation) were enrolled in the study. Pelvic visceral discomforts were assessed using a questionnaire in which patients were asked to assign a score between 1 and 10 according to intensity. The patients were offered intravaginal adelmidrol therapy (2%, 4.5 mL twice a day for 30 days). The patients were interviewed again and asked to self-assess anxiety and pelvic visceral discomfort at the end of therapy. RESULTS: 12 patients underwent adelmidrol therapy. With the exception of urinary discomfort, all the median scores of pelvic visceral discomforts had improved after 30 days, with significant values achieved for menstruation (P=0.013) and sexual intercourse (P=0.013). Anxiety had also decreased after 30 days (P=0.025), regardless of changes in discomfort levels. CONCLUSION: Adelmidrol could selectively modulate the visceral nociceptive pathways (interoception), relieving pelvic discomfort. This action should have an independent effect on anxiety responses.