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Clitoral blood flow using color Doppler ultrasonography in women with and without provoked vestibulodynia. Int Urogynecol J 2022; 33:1489-1494. [PMID: 35298682 DOI: 10.1007/s00192-022-05147-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To compare blood flow of the dorsal clitoral artery in women diagnosed with provoked vestibulodynia (PVD) and in healthy controls using color Doppler ultrasonography. We hypothesized that women with PVD would have a restricted blood flow compared to controls. METHODS This cross-sectional study evaluated the function of the dorsal clitoral artery through the spectral wave analysis of color Doppler ultrasonography (US) in 20 women diagnosed with PVD according to Friedrich's criteria and 21 healthy controls. Participants were evaluated during their follicular phase and were asked to abstain from sexual activities 24 ho prior the examination. Assessment was performed by an assessor blinded to participant diagnosis, in the morning after a 10-min rest period in a supine lying position in a room with temperature set at 22 °C. Measurements of the peak systolic velocity (PSV), time-averaged maximum velocity (TAMX), end-diastolic velocity (EDV), pulsatility (PI) and resistance index (RI) were performed at rest considering the mean value of three consecutive waveforms. RESULTS Women with PVD and healthy controls did not present any statistically different baseline characteristics. Participants with PVD presented higher values of Doppler-US PSV, TAMX, EDV and RI compared to controls (p ≤ 0.05), which are suggestive of a decrease in blood flow. However, non-significant difference was found regarding PI values between the two groups (p > 0.05). CONCLUSION Our findings revealed decreased peripheral tissue perfusion in women with PVD compared to healthy controls using color Doppler US, based on the alteration of four of the five assessed data of US parameters.
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Molina-Payá FJ, Ríos-Díaz J, Carrasco-Martínez F, Martínez-Payá JJ. Reliability of a New Semi-automatic Image Analysis Method for Evaluating the Doppler Signal and Intratendinous Vascular Resistance in Patellar Tendinopathy. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3491-3500. [PMID: 34538534 DOI: 10.1016/j.ultrasmedbio.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/09/2021] [Accepted: 08/14/2021] [Indexed: 06/13/2023]
Abstract
The aim of this study was to determine the intra- and inter-rater reliability of a new semi-automatic image analysis method for quantification of the shape of the Doppler signal and the intratendinous vascular resistance in patellar tendinopathy. Thirty athletes (27.4 y, standard deviation = 8.57 y) with patellar intratendinous vascularity were included in a cross-sectional study (42 tendons analyzed). The intratendinous blood flow was assessed with power Doppler and ImageJ (Version 1.50b, National Institutes of Health, Bethesda, MD, USA) quantification software over a manually selected region of interest. Two blinded observers performed the analysis of the Doppler signal (vascular resistance) and shape descriptors (number of signals, pixel intensity, area, perimeter, major diameter, minor diameter, circularity and solidity). The intraclass correlation coefficient (ICC) was calculated, and the Bland-Altman mean of differences (MoD) and 95% limits of agreement (LoA) were determined. Also, small real differences (SRDs) and the standard error of measurement (SEM) were calculated. Intra-rater reliability was at a maximum for area (ICC = 0.999, 95% confidence interval [CI] = 0.998-0.999) and at a minimum for solidity (ICC = 0.782, 95% CI: 0.682-0.853). The MoD and 95% LoA were very low, and the relative SRD and SEM were below 5.3% and 2%, respectively. The inter-rater reliability was the maximum for area (ICC = 0.993, 95% CI = 0.989-0.996) and the minimum for circularity (ICC = 0.73; 95% CI=0.611-0.817). The MoD and 95% LoA were low, with the SRD and SEM below 6% and 2.2%. The proposed quantitative method for studying the intratendinous Doppler signal in the patellar tendon is reliable and reproducible.
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Affiliation(s)
| | - José Ríos-Díaz
- Fundación San Juan de Dios. Centro de Ciencias de la Salud San Rafael, Universidad Nebrija, Madrid, Spain.
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Mercier J, Morin M, Tang A, Reichetzer B, Lemieux MC, Samir K, Zaki D, Gougeon F, Dumoulin C. Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause. Climacteric 2020; 23:468-473. [PMID: 32105155 DOI: 10.1080/13697137.2020.1724942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: This study aims to investigate the mechanism of action of pelvic floor muscle training (PFMT) for the improvement of the signs and symptoms of genitourinary syndrome of menopause (GSM) in postmenopausal women with GSM and urinary incontinence (UI).Methods: Twenty-nine women were included in the secondary analysis of a single-arm feasibility study. Using color Doppler ultrasound, the peak systolic velocity, time-averaged maximum velocity, and pulsatility index of the internal pudendal and dorsal clitoral arteries were measured at rest and after a pelvic floor muscle (PFM) contraction task. PFM function was assessed by dynamometry, and vulvovaginal tissue elasticity was measured using the Vaginal Atrophy Index.Results: PFMT significantly improved blood flow parameters in both arteries (p < 0.05) and significantly increased the speed of PFM relaxation after a contraction (p = 0.003). After the intervention, a marginally significant decrease in PFM tone was observed, as well as an increase in PFM strength (p = 0.060 and p = 0.051, respectively). Finally, improvements in skin elasticity and introitus width were observed as measured by the Vaginal Atrophy Index (p < 0.007).Conclusion: Our findings suggest that PFMT improves blood flow in vulvovaginal tissues, PFM relaxation capacity, and vulvovaginal tissue elasticity in postmenopausal women with GSM and UI.
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Affiliation(s)
- J Mercier
- Centre de recherche, Institut universitaire de gériatrie de Montréal, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - M Morin
- Centre de recherche, Centre hospitalier universitaire de Sherbrooke, School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | - A Tang
- Department of Radiology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - B Reichetzer
- Department of Obstetrics and Gynecology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - M-C Lemieux
- Department of Obstetrics and Gynecology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - K Samir
- Department of Obstetrics and Gynecology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - D Zaki
- Department of Obstetrics and Gynecology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - F Gougeon
- Department of Pathology and Cell Biology, Université de Montréal, Montreal, QC, Canada
| | - C Dumoulin
- Centre de recherche, Institut universitaire de gériatrie de Montréal, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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Scavello I, Maseroli E, Di Stasi V, Cipriani S, Verde N, Magini A, Maggi M, Vignozzi L. Nomegestrol acetate/17beta-estradiol does not negatively alter the vascular resistance of clitoral arteries: a prospective, exploratory study. Int J Impot Res 2019; 32:239-247. [PMID: 31263248 DOI: 10.1038/s41443-019-0162-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/18/2019] [Accepted: 05/14/2019] [Indexed: 01/08/2023]
Abstract
The effect of nomegestrol acetate/estradiol (NOMAC/E2) on clitoral and uterine vascularization has never been evaluated. We aimed to investigate, in women consulting for contraceptive needs, the possible changes in clitoral and uterine arteries hemodynamic parameters after 6 months treatment with NOMAC/E2 as compared with other hormonal contraceptives (HCs). In this observational, prospective pilot study, ten women were enrolled. Color Doppler ultrasound was performed on the clitoral and uterine arteries at baseline and after 6 months treatment with NOMAC/E2 (n = 5) or other HCs (n = 5). NOMAC/E2 did not exert any significant effect on clitoral vascular resistance expressed by the pulsatility index (PI); conversely, treatment with other HCs significantly increased this parameter (p = 0.04). The change in clitoral PI between the two groups retained a statistically significant difference even after adjusting for age. In the NOMAC/E2 group, at follow-up, uterine artery PI and acceleration were significantly reduced (p = 0.04), whereas no significant differences were observed in the HCs group; however, the change in uterine artery parameters did not differ significantly between the two groups. NOMAC/E2, differently from other COCs, does not negatively alter the vascular resistance of clitoral arteries and appears as a good contraceptive choice to protect both cardiovascular and sexual health.
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Affiliation(s)
- Irene Scavello
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Andrology, Women's Endocrinology and Gender Inconguence Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Elisa Maseroli
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Andrology, Women's Endocrinology and Gender Inconguence Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Vincenza Di Stasi
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Andrology, Women's Endocrinology and Gender Inconguence Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Sarah Cipriani
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Andrology, Women's Endocrinology and Gender Inconguence Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Nunzia Verde
- Medicine and Surgery, Section of Endocrinology, Federico II, University of Naples, Naples, Italy
| | - Angela Magini
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Andrology, Women's Endocrinology and Gender Inconguence Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Mario Maggi
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Endocrinology Unit, Medical-Geriatric Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.,Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
| | - Linda Vignozzi
- Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy. .,Andrology, Women's Endocrinology and Gender Inconguence Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. .,Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy.
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