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Er-Rabiai Y, Torres-Lacomba M, Casaña J, López-Bueno R, Núñez-Cortés R, Calatayud J. The Effectiveness of Adding Transvaginal Radiofrequency to Pelvic Floor Muscle Training for 6 Weeks in Women with Stress Urinary Incontinence. A Double-Blind Randomised Controlled Trial. Int Urogynecol J 2024:10.1007/s00192-024-05874-5. [PMID: 39060727 DOI: 10.1007/s00192-024-05874-5] [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: 03/21/2024] [Accepted: 06/30/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the clinically beneficial effect of adding transvaginal monopolar non-ablative radiofrequency (RF) to pelvic floor muscle training (PFMT) on leakage severity, quality of life and urinary incontinence-related symptoms in women with stress urinary incontinence (SUI). METHODS A double-blind randomised controlled trial was conducted, with a 6-week intervention and a 6-month follow-up. Participants were randomly assigned to the experimental group (PFMT plus RF; n = 18) or the control group (PFMT plus placebo; n = 20). The primary outcome was the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). Secondary outcomes included the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), self-efficacy, female sexual function, pelvic floor muscle dynamometry, 1-h pad test and number of SUI episodes per week. Inferential analyses of the data were performed using a two-factor analysis of variance. RESULTS Both groups achieved a statistically significant improvement in ICIQ-SF over time. However, the differences observed in the experimental group exceeded the minimal clinically important differences by 4 points (MD = -9.4, 95% CI = -12.6 to -6.3), which was not observed in the control group (MD = -3.9, 95% CI = -6.9 to -1.0). This was maintained at the 6-month follow-up with a significant time*group interaction (p < 0.001, ηp2 = 0.150). There was no time*group interaction in the other variables (p > 0.05). Additionally, a significant difference in favour of the experimental group was observed in the 1-h pad test and episodes of SUI per week (p < 0.05). CONCLUSIONS This study highlights the beneficial effects of adding transvaginal RF to PFMT on the severity and amount of leakage, as well as on the quality of life and urinary incontinence-related symptoms in women with moderate SUI. Future trials are needed to assess the effects of this intervention in women with severe SUI.
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Affiliation(s)
- Yasmin Er-Rabiai
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - María Torres-Lacomba
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Gueldini de Moraes AV, Costa-Paiva L, da Costa Machado H, Maciel TF, Mariano FV, Pedro AO. Comparison of the effect of noninvasive radiofrequency with vaginal estrogen and vaginal moisturizer in the treatment of vulvovaginal atrophy in postmenopausal women: a randomized clinical trial. Menopause 2024; 31:288-302. [PMID: 38412393 DOI: 10.1097/gme.0000000000002326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To compare the effect of noninvasive radiofrequency (RF) with vaginal estrogen (E), and vaginal moisturizer (M) on improving vulvovaginal atrophy (VVA) in women with genitourinary syndrome of menopause. METHODS A total of 32 postmenopausal women who met the inclusion criteria were randomized into three intervention arms to receive one of the following treatments: three sessions of noninvasive RF therapy (RF arm); intravaginal estriol cream 1 mg applied daily for 2 weeks, followed by 1 mg applied two times weekly or 1 mg of estradiol vaginal fast-dissolving film applied daily for 2 weeks, followed by 1 mg applied two times weekly (E arm); and intravaginal moisturizer two times a week (M arm). Assessments at baseline and after 4 months were conducted using Vaginal Health Index score, Vaginal Maturation, visual analog scale for VVA symptoms (dyspareunia, dryness, and burning), and Menopause Rating Scale (MRS) for urogenital symptoms. Vaginal wall biopsies were administered to participants who consented, pretreatment and posttreatment (at baseline and after 4 months of follow-up). RESULTS After 4 months, the Vaginal Health Index showed an increase of 6.6 points in mean total score in the RF arm, also in the E arm (+7.3 points), with no significant improvement in the M arm (+1.5 points) (interaction effect: RF, E ≠ M, P < 0.001). Regarding vaginal maturation, there was a significant increase in superficial cells in the E arm (+31.3), with no significant changes in the RF (+9.3) and M (-0.5) arms (interaction effect: E ≠ M, P < 0.001). Vaginal pH decreased significantly in the E arm (-1.25), with a similar response in the RF arm (-1.7), with no significant improvement in the M arm (-0.25) (interaction effect: RF, E ≠ M, P < 0.001).There was a significant improvement in the MRS score for VVA symptoms in the three intervention arms, with no predominance of any arm, whereas the improvement in the total MRS score for urogenital symptoms showed a predominance of the RF arm (ΔRF: -7.8; ΔE: -3.5; ΔM: -2.3; RF ≠ E, M). According to histopathologic analysis, there was no statistically significant increase in glycogenation ( P = 0.691) or epithelial cone height ( P = 0.935), despite an increase in the median delta (difference between pretreatment and posttreatment) in the three intervention arms (glycogenation: RF arm Δ = +118.4%; E arm Δ = +130.9%; M arm Δ = +24.9%; epithelial cone height: RF arm Δ = +33.5%; E arm Δ = +18.6%; M arm Δ = +22.3%). CONCLUSION The effect of noninvasive RF on the treatment of vulvovaginal symptoms of genitourinary syndrome of menopause was similar to vaginal estrogen, except for hormonal cytology, and superior to vaginal moisturizer, with improvement in some histomorphometric parameters. These findings are promising, especially for the population that cannot or prefers not to use vaginal estrogen therapy.
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Affiliation(s)
- Anna Valéria Gueldini de Moraes
- From the Department of Obstetrics and Gynecology of Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, São Paulo, Brazil
| | - Lucia Costa-Paiva
- From the Department of Obstetrics and Gynecology of Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, São Paulo, Brazil
| | | | - Tayná Figueiredo Maciel
- Department of Pathological Anatomy of Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, São Paulo, Brazil
| | - Fernanda Viviane Mariano
- Department of Pathological Anatomy of Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, São Paulo, Brazil
| | - Adriana Orcesi Pedro
- From the Department of Obstetrics and Gynecology of Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, São Paulo, Brazil
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Franić D, Franić Ivanišević M, Verdenik I. Radiofrequency as the New Opportunity in Treating Overactive Bladder and Urge Urinary Incontinence-A Single-Arm Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:197. [PMID: 38399486 PMCID: PMC10890003 DOI: 10.3390/medicina60020197] [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: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Until now, overactive bladder (OAB) with or without urge urinary incontinence (UUI) has been treated mainly in two ways: with behavioral methods and patient education, or using antimuscarinic drugs and/or beta-3 adrenergic receptor agonists. Unfortunately, these drugs may cause side effects in some women or are insufficiently effective, so patients abandon them. Therefore, in this pilot study, radiofrequency was evaluated as a new option in the treatment of OAB and UUI. Materials and Methods: Nineteen patients were enrolled in this pilot study using radiofrequency (RF), where the level of OAB and UUI was assessed using the validated ICIQ-OAB questionnaire. RF was applied four times for 20 min, once a week. Two weeks after treatment, the level of OAB and UUI was reassessed and processed statistically and the treatment effect evaluated. Results: Using the ICIQ-OAB, the severity of OAB and UUI was assessed: 0-3 mild symptoms; 4-7 moderate symptoms; 8-11 severe symptoms; 12-16 very severe symptoms. Before treatment, 10.5% of patients had mild symptoms, 21.1% moderate symptoms, 63.2% severe symptoms and 5.3% very severe symptoms. After treatment, 42.9% had mild symptoms, 50% moderate symptoms and 7% severe OAB and UUI symptoms. All four main symptoms-frequency, nocturia, urgency and incontinence-decreased statistically significantly, with the best results being found in urgency (p = 0.002). Conclusions: Based on this pilot study, RF seems a very promising method in the treatment of OAB and UUI. To extend our initial findings, it is necessary to perform a prospective, randomized and placebo-controlled study in order to obtain reliable results and to determine for how long one set of treatment maintains the results obtained immediately after the end of that treatment. In this way, we may determine how often the treatment needs to be repeated, if necessary, and when.
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Affiliation(s)
- Damir Franić
- Ginekologija Dr. Franić d.o.o., 3250 Rogaška Slatina, Slovenia
- Medical Faculty, University of Maribor, 2000 Maribor, Slovenia
| | - Maja Franić Ivanišević
- Obstetric and Gynecology Unit, Health Centre Slovenske Konjice, 3210 Slovenske Konjice, Slovenia;
| | - Ivan Verdenik
- Research Unit, University Gynecological Clinic Ljubljana, 1000 Ljubljana, Slovenia;
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de Oliveira CD, de Mello Bianchi AMH, Campos MLP, Nogueira MCC, Sartori MGF, de Góis Speck NM. Women with Genitourinary Syndrome of Menopause Treated with Vaginal Estriol, Microablative Fractional CO 2 Laser and Microablative Fractional Radiofrequency: A Randomized Pilot Study. Photobiomodul Photomed Laser Surg 2023; 41:718-724. [PMID: 38085184 DOI: 10.1089/photob.2023.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Objective: This pilot study intended to assess the feasibility of a large-scale randomized clinical trial designed to analyze the effectiveness of microablative fractional CO2 laser (CO2L) and microablative fractional radiofrequency (RF) compared with vaginal estriol (VE) as treatments for women with moderate-to-severe Genitourinary Syndrome of Menopause (GSM). Methods: Participants were randomized into VE, CO2L, or RF groups. In the VE group, women were required to use vaginal estriol cream for 14 days and then twice a week for 4 months. In the CO2L and RF groups, three energy therapies were administered at monthly intervals. Visual Analog Scale (VAS) for GSM symptoms, Female Sexual Function Index (FSF-I), Vaginal Health Index (VHI), and Nugent Score (NS) were analyzed before and 120 days after the beginning of the treatments. Pain scores were verified after each CO2L and RF session. Results: Thirty-four participants completed the study: 11 in the VE group, 11 in the CO2L group, and 12 in the RF group. No unexpected or serious adverse events were observed. We also verified that GSM symptoms, sexual function, and VHI significantly improved (p < 0.05) with no difference among the groups. NS did not show statistically significant difference before and after the treatments. Pain during RF application was associated with higher scores. Conclusions: The study is feasible and does not seem to have safety implications. Preliminary results suggest that CO2L and RF are good alternatives to VE for ameliorating clinical symptoms, FSF-I, and VHI in patients with GSM. Clinical Trial Registration number: NCT04045379.
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Affiliation(s)
- Carla Dias de Oliveira
- Department of Ginecology from Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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Tong Y, Li X, Yan W, Zeng X, Xie F, Li J, Zhou Y. Effect of radiofrequency combined with magnetic stimulation on mild and moderate pelvic organ prolapse. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:1696-1702. [PMID: 38432860 PMCID: PMC10929959 DOI: 10.11817/j.issn.1672-7347.2023.230070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVES The efficacy of using a single electrical or magnetic stimulation for treating pelvic floor dysfunction is limited. This study aims to investigate the efficacy of radiofrequency combined with magnetic stimulation treatment for mild to moderate pelvic organ prolapse. METHODS Patients who completed the treatment in the Third Xiangya Hospital, Central South University were screened, and were divided into 2 groups based on different treatment plans. There were 28 patients who completed magnetic stimulation therapy (the magnetic stimulation therapy group) and 21 patients who completed radiofrequency combined with magnetic stimulation therapy (the combined treatment group). The pelvic organ prolapse quantitation (POP-Q), pelvic floor muscle strength, and pelvic floor ultrasound results were analyzed to assess the efficacy before and after the treatment in both groups, and the POP-Q results of 3 months after the treatment were used to evaluate the maintenance effect of the treatment mode. RESULTS The POP-Q evaluation results of Aa, Ap, and C points after the treatment in both groups were better than those before the treatment, with statistical significance (all P<0.05). The Aa point POP-Q result of the combined treatment group was better than that of the magnetic stimulation therapy group, with statistical significance (P<0.05). Pelvic floor ultrasound evaluation showed that the bladder neck position during the valsalva maneuver in the combined treatment group was higher than that in the magnetic stimulation treatment group, with statistical significance (P<0.05). The persistence effect of the combined treatment group was long better than that of the magnetic stimulation treatment group, with significant statistical significance (P<0.01). CONCLUSIONS The combined treatment is more effective and has a longer lasting effect than single magnetic stimulation treatment.
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Affiliation(s)
- Yao Tong
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | - Xuhong Li
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Wenguang Yan
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xiaoling Zeng
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Fen Xie
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Jingjing Li
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Yanhua Zhou
- Department of Rehabilitation Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China.
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Sarmento ACA, Fernandes FS, Maia RR, de Araújo Santos Camargo JD, de Oliveira Crispim JC, Eleutério Júnior J, Gonçalves AK. Microablative fractional radiofrequency for sexual dysfunction and vaginal Trophism: A randomized clinical trial. Clinics (Sao Paulo) 2023; 78:100293. [PMID: 37839177 PMCID: PMC10589764 DOI: 10.1016/j.clinsp.2023.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES To evaluate Microablative Fractional Radiofrequency (MAFRF) as a possible option in treating vaginal atrophy. METHODS This was a randomized, controlled clinical trial with postmenopausal women diagnosed with vaginal atrophy. The treatment consisted of three sessions of MAFRF, compared to vaginal estrogen administration and an untreated control group. Assessments occurred at baseline and 90 days. The primary endpoints were sexual function, evaluated by the Female Sexual Function Index (FSFI), and vaginal health, assessed by the Vaginal Health Index (VHI). Secondary outcomes included vaginal microbiota composition (Nugent score) and epithelial cell maturation (Maturation Value ‒ MV). RESULTS One hundred and twenty women (40 in each group) were included. Concerning the FSFI, both groups, MAFRF (median 4.8 [3.6‒6.0]) and vaginal estrogen (mean 4.7 ± 1.1), experienced improved sexual desire when compared to the control group (median 3.6 [2.4‒4.8]). Regarding the total score of VHI, the authors observed an improvement in the mean of the MAFRF (23.7 ± 2.0) and vaginal estrogen groups (23.5 ± 1.9) when compared to the control (14.8 ± 2.9). The Nugent score was reduced in the MAFRF and estrogen groups (p < 0.01) compared to the control group. Lastly, the MV was modified after treatment with MAFRF (p < 0.01) and vaginal estrogen (p < 0.001). No differences existed between the MAFRF and vaginal estrogen groups in the studied variables. No adverse effects were reported following the MAFRF protocol. CONCLUSIONS Radiofrequency was comparable in efficacy to estrogen administration for treating vulvovaginal atrophy. It deserves consideration as a viable option in managing this condition.
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Affiliation(s)
- Ayane Cristine Alves Sarmento
- Health Sciences Postgraduate Program, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil; Department of Clinical Analysis and Toxicology, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | - Fabíola Sephora Fernandes
- Department of Clinical Analysis and Toxicology, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | - Rafaella Rêgo Maia
- Health Sciences Postgraduate Program, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | | | | | - José Eleutério Júnior
- Departamento Obstetrics and Gynaecology, Universidade Federal do Ceara, Ceara, CE, Brazil
| | - Ana Kataherine Gonçalves
- Health Sciences Postgraduate Program, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil; Department of Obstetrics and Gynaecology, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil.
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Arab M, Vasef M, Talayeh M, Hosseini MS, Farzaneh F, Ashrafganjoei T. The Effect of Radiofrequency Therapy on Sexual Function in Female Cancer Survivors (Gynecologic and Breast) and Non-cancer Menopausal Women: A Single-Arm Trial. J Lasers Med Sci 2023; 14:e32. [PMID: 37744017 PMCID: PMC10517569 DOI: 10.34172/jlms.2023.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/01/2023] [Indexed: 09/26/2023]
Abstract
Introduction: Up to 90% of postmenopausal women and female cancer survivors may be affected by the genitourinary syndrome of menopause (GSM), with a negative impact on sexual function and quality of life. A novel energy-based device among the treatment options for GSM is radiofrequency therapy (RFT). RFT is a treatment option that uses energy from radio waves to heat the tissue. The objective of this study was to assess the impact of RFT on sexual function in female cancer survivors (gynecologic and breast) and non-cancer menopausal women. Methods: In a single-arm prospective trial, the efficacy of RFT in both female cancer survivors (gynecologic and breast) and non-cancer menopausal women with sexual dysfunction at a tertiary and referral center (Imam Hossein Medical Center, Tehran, Iran) was evaluated between April 2022 and December 2022. The study protocol consisted of 3 monthly RFT sessions. Examination was performed at baseline (T0) and 3 months after the last RFT session (T1). The primary outcome was sexual function, which was assessed using the Female Sexual Function Index (FSFI). In addition, adverse events were evaluated during treatment and at T1. Results: A total of 37 female cancer survivors (mean [SD] age: 49.4 [8.9] years) and 37 non-cancer menopausal women (mean [SD] age: 53.8 [5.5] years) were enrolled. Patients exposed to RFT showed a significant improvement in FSFI scores when compared to baseline scores for both female cancer survivors (13.07, 95% CI: 12.27 - 13.86) and non-cancer menopausal women (13.18, 95% CI: 12.34 - 14.03). There was no difference in FSFI total score improvement between the two groups (t(72)=0.06, P=0.951). There were no serious adverse events associated with RFT. Conclusion: The efficacy of RFT as a treatment for sexual dysfunction has been demonstrated in both non-cancer menopausal women and female cancer survivors. In both groups, a significant improvement was confirmed.
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Affiliation(s)
- Maliheh Arab
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mahshid Vasef
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Maryam Talayeh
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Maryam Sadat Hosseini
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Farzaneh
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Ashrafganjoei
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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