RESUMO
Abstract Objective To assess themedical doctors andmedical students' opinion regarding the evidence and ethical background of the performance of vulvovaginal aesthetic procedures (VVAPs). Methods Cross-sectional online survey among 664 Portuguese medical doctors and students. Results Most participants considered that there is never or there rarely is amedical reason to perform: vulvar whitening (85.9% [502/584]); hymenoplasty (72.0% [437/607]); mons pubis liposuction (71.6% [426/595]); "G-spot" augmentation (71.0% [409/576]); labia majora augmentation (66.3% [390/588]); labia minora augmentation (58.3% [326/559]); or laser vaginal tightening (52.3%[313/599]).Gynecologists and specialistsweremore likely to consider that there are no medical reasons to performVVAPs; the opposite was true for plastic surgeons and students/residents. Hymenoplasty raised ethical doubts in 51.1% (283/554) of the participants. Plastic surgeons and students/residents were less likely to raise ethical objections, while the opposite was true for gynecologists and specialists. Most considered that VVAPs could contribute to an improvement in self-esteem(92.3% [613/664]); sexual function (78.5% [521/664]); vaginal atrophy (69.9% [464/664]); quality of life (66.3% [440/664]); and sexual pain (61.4% [408/664]). Conclusions While medical doctors and students acknowledge the lack of evidence and scientific support for the performance of VVAPs, most do not raise ethical objections about them, especially if they are students or plastic surgeons, or if they have had or have considered having plastic surgery.
Resumo Objetivos Avaliar a opinião de médicos e estudantes de medicina relativamente à evidência e contexto ético para a realização de procedimentos estéticos vulvovaginais (PEVVs). Métodos Estudo transversal, consistindo de inquérito online a 664 médicos e estudantes de medicina portugueses. Resultados A maioria dos participantes considerou que nunca ou raramente há uma razão médica para a realização de: branqueamento vulvar (85,9% [502/584]); himenoplastia (72,0% [437/607]); lipoaspiração do mons pubis (71,6% [426/595]); aumento do "ponto G" (71,0% [409/576]); aumento dos grandes lábios (66,3% [390/588]); aumento dos pequenos lábios (58,3% [326/559]) ou aperto vaginal com laser (52,3% [313/599]). Ser ginecologista e especialista associou-se a maior probabilidade de considerar não haver razões médicas para a realização de PEVV; o oposto foi verdade para os cirurgiões plásticos e estudantes/internos. A himenoplastia levantou dúvidas em termos éticos em 51,1% (283/554) dos participantes. Cirurgiões plásticos e estudantes/internos relatarammenos dúvidas emtermos éticos; o oposto foi verdade para os ginecologistas ou especialistas. Amaioria considerou que os PEVVs podemcontribuir para uma melhoria na autoestima (92,3% [613/664]); função sexual (78,5% [521/664]); atrofia vaginal (69,9% [464/664]); qualidade de vida (66,3% [440/664]); e dor sexual (61,4% [408/664]). Conclusões Ainda que os médicos e estudantes de medicina reconheçam a falta de evidência e bases científicas para a realização de PEVVs, a maioria não levanta objecções em termos éticos, especialmente se forem estudantes, cirurgiões plásticos, ou se eles próprios tiverem sido submetidos a cirurgia plástica ou considerem vir a sê-lo.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Idoso , Adulto Jovem , Médicos , Estudantes de Medicina , Vagina/cirurgia , Vulva/cirurgia , Atitude do Pessoal de Saúde , Procedimentos de Cirurgia Plástica/métodos , Portugal , Estudos Transversais , Autorrelato , Pessoa de Meia-IdadeRESUMO
Objective To assess the medical doctors and medical students' opinion regarding the evidence and ethical background of the performance of vulvovaginal aesthetic procedures (VVAPs). Methods Cross-sectional online survey among 664 Portuguese medical doctors and students. Results Most participants considered that there is never or there rarely is a medical reason to perform: vulvar whitening (85.9% [502/584]); hymenoplasty (72.0% [437/607]); mons pubis liposuction (71.6% [426/595]); "G-spot" augmentation (71.0% [409/576]); labia majora augmentation (66.3% [390/588]); labia minora augmentation (58.3% [326/559]); or laser vaginal tightening (52.3% [313/599]). Gynecologists and specialists were more likely to consider that there are no medical reasons to perform VVAPs; the opposite was true for plastic surgeons and students/residents.Hymenoplasty raised ethical doubts in 51.1% (283/554) of the participants. Plastic surgeons and students/residents were less likely to raise ethical objections, while the opposite was true for gynecologists and specialists.Most considered that VVAPs could contribute to an improvement in self-esteem (92.3% [613/664]); sexual function (78.5% [521/664]); vaginal atrophy (69.9% [464/664]); quality of life (66.3% [440/664]); and sexual pain (61.4% [408/664]). Conclusions While medical doctors and students acknowledge the lack of evidence and scientific support for the performance of VVAPs, most do not raise ethical objections about them, especially if they are students or plastic surgeons, or if they have had or have considered having plastic surgery.
Objetivos Avaliar a opinião de médicos e estudantes de medicina relativamente à evidência e contexto ético para a realização de procedimentos estéticos vulvovaginais (PEVVs). Métodos Estudo transversal, consistindo de inquérito online a 664 médicos e estudantes de medicina portugueses. Resultados A maioria dos participantes considerou que nunca ou raramente há uma razão médica para a realização de: branqueamento vulvar (85,9% [502/584]); himenoplastia (72,0% [437/607]); lipoaspiração do mons pubis (71,6% [426/595]); aumento do "ponto G" (71,0% [409/576]); aumento dos grandes lábios (66,3% [390/588]); aumento dos pequenos lábios (58,3% [326/559]) ou aperto vaginal com laser (52,3% [313/599]). Ser ginecologista e especialista associou-se a maior probabilidade de considerar não haver razões médicas para a realização de PEVV; o oposto foi verdade para os cirurgiões plásticos e estudantes/internos.A himenoplastia levantou dúvidas em termos éticos em 51,1% (283/554) dos participantes. Cirurgiões plásticos e estudantes/internos relataram menos dúvidas em termos éticos; o oposto foi verdade para os ginecologistas ou especialistas.A maioria considerou que os PEVVs podem contribuir para uma melhoria na autoestima (92,3% [613/664]); função sexual (78,5% [521/664]); atrofia vaginal (69,9% [464/664]); qualidade de vida (66,3% [440/664]); e dor sexual (61,4% [408/664]). Conclusões Ainda que os médicos e estudantes de medicina reconheçam a falta de evidência e bases científicas para a realização de PEVVs, a maioria não levanta objecções em termos éticos, especialmente se forem estudantes, cirurgiões plásticos, ou se eles próprios tiverem sido submetidos a cirurgia plástica ou considerem vir a sê-lo.
Assuntos
Atitude do Pessoal de Saúde , Médicos , Procedimentos de Cirurgia Plástica/métodos , Estudantes de Medicina , Vagina/cirurgia , Vulva/cirurgia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Portugal , Autorrelato , Adulto JovemRESUMO
Durante o climatério podem ocorrer sinais clínicos de hiperandroginismo. Contudo quadros de virilização exigem investigação para exclusão de uma fonte produtora de androgênios. Doente de 66 anos, com menopausa espontânea aos 50, referenciada à consulta de ginecologia por hirsutismo após a menopausa, com agravamento no último ano e episódios demetrorragia que não valorizava. Ao exame objetivo tinha masculinização da voz, alopécia androgênica, aumento da pilosidade na face, tronco e membros e hipertrofia do clitóris.Feita ecografia endovaginal que revelou espessamento endometrial e ovários aumentados de volume para a idade; estudo analítico que demonstrou um valor de testosterona total elevado (225ng/dL); tomografia computadorizada da suprarrenal e ressonância magnética crânio-encefálica que não revelaram alterações; e histeroscopia com remoção de pólipo endometrial, associado a hiperplasia endometrial simples sem atipia. Submetida a histerectomia total com anexectomia bilateral. O estudo histológico concluiu tratar-se de hipertecose ovárica. Seis meses após a cirurgia apresentava normalização da testosterona sérica, acentuada redução do hirsutismo e melhoria da alopécia.O diagnóstico de hiperandrogenismo em mulheres na pós-menopausa constitui um desafio. Os meios complementares de diagnóstico nem sempre permitem detectar a origem da hiperandrogenemia. O tratamento da hipertecose ovárica melhora o hirsutismo e pode reduzir o risco de patologia maligna hormonodependente.
tMild clinical signs of hyperandrogenism such as hirsutism may arise during the menopausal transition as part of the aging process. However, development of virilization may be interpreted as the presence a specific source of androgen excess. 66 year-old menopausal woman, with a record of progressive hirsutism since menopausal age (50 years-old) exacerbated over the past year. Episodes of metrorrhagia were not valued by the patient. Physical examination showed deepening of voice, frontotemporal alopecia, hirsutism in face, trunk and limbs and hypertrophy of the clitoris. A transvaginal ultrasound revealed a thickened endometrium and enlarged ovaries considering her age and analytical study showed an increase of total testosterone (225ng/dL). No changes were detected at computerized tomography of adrenals and cerebral magnetic resonance. Performed an hysteroscopy with removal of endometrial polyp, associated to simple endometrial hyperplasia without atypia. The histological diagnosis after hysterectomy and bilateral salpingo-oophorectomy, revealed a ovarian hyperthecosis. Six months after surgery it was observed a testosterone within the normal range, marked hirsutism reduction and alopecia improvement.Diagnosis of hyperandrogenism in postmenopausal is a challenging task. Imaging techniques do not always reveal the source of excess androgens. The ovarian hyperthecosis treatment effectively improves hirsutism and reduces the risk of hormone-dependent tumors.
Assuntos
Humanos , Feminino , Idoso , Hirsutismo/diagnóstico , Pós-Menopausa , Hiperandrogenismo/diagnósticoRESUMO
OBJETIVO: avaliar o efeito da terapêutica hormonal (TH) no peso de mulheres na peri-menopausa, assim como o efeito de diferentes regimes terapêuticos no referido parâmetro. MÉTODOS: estudo retrospectivo de 139 mulheres, com menopausa há menos de 2 anos, acompanhadas na consulta de climatério do nosso departamento. Obtiveram-se dois grupos: mulheres a quem se iniciou TH (n=89) e outro, grupo controle, sem terapia hormonal (n=50). Em cada grupo, foi avaliada a modificação ponderal no intervalo de 1 ano após a primeira consulta. Nas submetidas a TH, avaliou-se esse mesmo parâmetro em função de diferentes regimes terapêuticos preconizados: estrogênio isolado vs estroprogestagênio e dose standard vs baixa dosagem. A análise estatística foi realizada com recurso ao programa SPSS®, adotando-se como nível de significância valores p<0,05. RESULTADOS: os dois grupos foram semelhantes no que diz respeito a características basais e demográficas. No nosso estudo, constatou-se um aumento ponderal médio superior no grupo controle relativamente ao grupo de mulheres sob TH (434 vs 76 g), embora a diferença verificada não seja estatisticamente significativa (p=0,406); Nas usuárias de TH, aquelas sob estrogênio isolado tiveram um aumento ponderal acrescido face a mulheres sob terapêutica com estroprogestativo (775 vs 24 g), embora com diferenças não significativas, o mesmo sucedendo quando analisada a dosagem de TH inicialmente prescrita (92 vs 49 g). CONCLUSÕES: apesar da crença comum do aumento ponderal associado à TH, os resultados do estudo descrito parecem contrariar esse aspecto, não havendo um ganho ponderal adicional ao normalmente associado a este período da vida da mulher.
PURPOSE: to evaluate the effect of hormone replacement therapy (HT) on the weight on perimenopausal women as well as the effect of different treatment regimens on this parameter. METHODS: a retrospective study of 139 women with menopause for less than 2 years, who were monitored with periodical visits in our department. We compared two groups: women who started HT (n=89) with women who had no hormonal treatment (n=50) and in the two groups, we evaluated the changes in body weight over a 1-year period. In the first group, we assessed the same parameter as a function of different treatment regimens: estrogen alone versus estrogen combined with progestin and standard dose versus low dose. The SPSS® program was used for statistical analysis, with the level of significance set at p<0.05. RESULTS: the groups were similar with respect to demographic and baseline characteristics; weight gain was higher in the untreated group (434 vs 76 g), but the difference observed was not significant (p = 0.406); among HT users, those taking estrogen alone had an increased weight gain compared to women taking estrogen with progestin (775 vs 24 g), although no statistically significant difference was observed and the same applied when comparing the dose initially prescribed (92 vs 49 g). CONCLUSIONS: despite the common belief about weight gain associated with HT, the results of the present study seem to contradict this point, with no additional weight gain beyond that normally associated with this period in a woman´s life.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Peso Corporal/efeitos dos fármacos , Terapia de Reposição de Estrogênios , Aumento de Peso/efeitos dos fármacos , Menopausa , Estudos RetrospectivosRESUMO
PURPOSE: to evaluate the effect of hormone replacement therapy (HT) on the weight on perimenopausal women as well as the effect of different treatment regimens on this parameter. METHODS: a retrospective study of 139 women with menopause for less than 2 years, who were monitored with periodical visits in our department. We compared two groups: women who started HT (n=89) with women who had no hormonal treatment (n=50) and in the two groups, we evaluated the changes in body weight over a 1-year period. In the first group, we assessed the same parameter as a function of different treatment regimens: estrogen alone versus estrogen combined with progestin and standard dose versus low dose. The SPSS® program was used for statistical analysis, with the level of significance set at p<0.05. RESULTS: the groups were similar with respect to demographic and baseline characteristics; weight gain was higher in the untreated group (434 vs 76 g), but the difference observed was not significant (p = 0.406); among HT users, those taking estrogen alone had an increased weight gain compared to women taking estrogen with progestin (775 vs 24 g), although no statistically significant difference was observed and the same applied when comparing the dose initially prescribed (92 vs 49 g). CONCLUSIONS: despite the common belief about weight gain associated with HT, the results of the present study seem to contradict this point, with no additional weight gain beyond that normally associated with this period in a woman's life.
Assuntos
Peso Corporal/efeitos dos fármacos , Terapia de Reposição de Estrogênios , Aumento de Peso/efeitos dos fármacos , Feminino , Humanos , Menopausa , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: In a previous report, we described the results of a randomized, controlled trial that evaluated the potential of raloxifene to induce or exacerbate hot flushes. Here, we provide additional analyses that were undertaken to identify potential predictors of hot flushes and to assess the clinical usefulness of various therapeutic strategies for the reduction of hot flushes in postmenopausal women who receive raloxifene therapy. STUDY DESIGN: In this randomized, double-blind, placebo-controlled study, 487 unselected postmenopausal women were assigned randomly to receive treatment for 8 months with raloxifene, which was administered either at a dose of 60 mg/d every other day for 2 months followed by 60 mg/d (slow-dose escalation) or 60 mg/d throughout (raloxifene), or placebo. Data on the number, duration, intensity, and severity of hot flushes and awakenings because of night sweats were collected. Logistic regression models were used to examine the predictive value of various demographic and menopausal factors on the development or worsening of hot flushes. RESULTS: At baseline, 40.4% of all randomly assigned patients had hot flushes. The mean number of hot flushes (3-5 per week) was low. Fewer years postmenopause, surgical menopause, and previous estrogen or estrogen/progestin therapy were significant predictors of hot flushes at baseline but were not predictive of incident hot flushes during treatment with raloxifene. Of the women who received raloxifene therapy who had pre-existing hot flushes at baseline, 36% women had none at the end point. Early postmenopause and surgical menopause were significant predictors of a biologically relevant increase in hot flushes (>/=14 flushes/week). Early postmenopause, previous estrogen/progestin therapy, high body mass index, and greater duration of hot flushes at baseline were significant predictors of the need for symptomatic treatment. After 2 months of treatment, women in early postmenopause had significantly more hot flushes with raloxifene therapy than with slow-dose escalation ( P = .042), whereas there was no significant difference between raloxifene therapy and slow-dose escalation among women in later postmenopause. In the 50 patients who requested symptomatic treatment during the study, phytohormones or veralipride did not reduce the number of hot flushes markedly. CONCLUSION: A shorter time since menopause and surgical menopause are important predictors of hot flushes both before and during treatment with raloxifene. Previous estrogen/progestin therapy also increases the risk of hot flushes at baseline. For women in early postmenopause, slow-dose escalation of raloxifene therapy may be a suitable therapeutic strategy for the reduction of the risk of hot flushes.