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Ghaith S, Lewis GK, Craver EC, Li Z, Wasson MN, Burnett TL, Carrubba AR. The association of endosalpingiosis with chronic pelvic pain. Minerva Obstet Gynecol 2024; 76:151-158. [PMID: 36847525 DOI: 10.23736/s2724-606x.23.05241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Endosalpingiosis is a pathologic diagnosis of ectopic epithelium resembling the fallopian tubes. It has been described with clinical characteristics that are similar to endometriosis. The primary objective is to determine if endosalpingiosis (ES) has a similar association with chronic pelvic pain when compared to endometriosis (EM). METHODS This is a retrospective case-control analysis of patients with a histologic diagnosis of endosalpingiosis or endometriosis at three affiliated academic hospitals between 2000 and 2020. All ES patients were included, and 1:1 matching was attempted to obtain a comparable EM cohort. Demographic and clinical data were obtained, and statistical analysis was performed. RESULTS A total of 967 patients (515 ES and 452 EM) were included. ES patients were significantly older than EM patients (median age 52 vs. 48 years, P<0.001), but other demographic variables were similar. Fewer ES patients had baseline chronic pelvic pain than EM patients (25.3% vs. 47%, P<0.001), and patients with ES were less likely to undergo surgery for the primary indication of pelvic pain (16.1% vs. 35.4%, P<0.001). Pelvic pain as the surgical indication remained lower in the ES group in multivariable analysis (OR=0.49, P<0.001). There were similar rates of persistent postoperative pain between ES and EM groups (10.1% vs. 13.5%, P=0.109). CONCLUSIONS Although endosalpingiosis can be associated with chronic pelvic pain, the incidence of pain is significantly lower than in patients who have endometriosis. These findings suggest that ES is a unique condition that differs from EM. Further research including long-term follow-up and patient-reported outcomes is imperative.
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Affiliation(s)
- Summer Ghaith
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Gregory K Lewis
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Zhuo Li
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Megan N Wasson
- Department of Medical and Surgical Gynecology, Mayo Clinic, Scottsdale, AZ, USA
| | - Tatnai L Burnett
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA -
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Meiser RJ, Horton TS, Carrubba AR, El Nashar SA, Chen AH. Cervical atresia and an obliterated upper vagina presenting as primary amenorrhea. Am J Obstet Gynecol 2024:S0002-9378(24)00473-3. [PMID: 38555009 DOI: 10.1016/j.ajog.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/19/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Rebecca J Meiser
- Department of Obstetrics and Gynecology at UF Health Jacksonville, Jacksonville, FL.
| | - Toni S Horton
- Department of Gynecologic Surgery at the Mayo Clinic Florida, Jacksonville, FL
| | - Aakriti R Carrubba
- Department of Gynecologic Surgery at the Mayo Clinic Florida, Jacksonville, FL
| | - Sharif A El Nashar
- Department of Gynecologic Surgery at the Mayo Clinic Florida, Jacksonville, FL
| | - Anita H Chen
- Department of Gynecologic Surgery at the Mayo Clinic Florida, Jacksonville, FL
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Palin HS, Christopher B, Padula C, Carrubba AR. Right Adnexal Strangulation Due to Non-surgical Adhesive Disease. J Minim Invasive Gynecol 2023; 30:778-779. [PMID: 37379899 DOI: 10.1016/j.jmig.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Hannah S Palin
- Department of Medical and Surgical Gynecology (Dr. Palin, Ms. Christopher, and Dr. Carrubba).
| | - Brittany Christopher
- Department of Medical and Surgical Gynecology (Dr. Palin, Ms. Christopher, and Dr. Carrubba)
| | - Carlos Padula
- Department of Radiology (Dr. Padula), Mayo Clinic Florida, Jacksonville, FL
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology (Dr. Palin, Ms. Christopher, and Dr. Carrubba)
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Lewis GK, Chen AH, Craver EC, Crook JE, Carrubba AR. Trigger point injections followed by immediate myofascial release in the treatment of pelvic floor tension myalgia. Arch Gynecol Obstet 2023; 307:1027-1035. [PMID: 36513896 DOI: 10.1007/s00404-022-06880-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Pelvic floor physical therapy (PFPT) is first-line therapy for treatment of pelvic floor tension myalgia (PFTM). Pelvic floor trigger point injections (PFTPI) are added if symptoms are refractive to conservative therapy or if patients experience a flare. The primary objective was to determine if a session of physical therapy with myofascial release immediately following PFTPI provides improved pain relief compared to trigger point injection alone. METHODS This was a retrospective cohort analysis of 87 female patients with PFTM who underwent PFTPI alone or PFTPI immediately followed by PFPT. Visual analog scale (VAS) pain scores were recorded pre-treatment and 2 weeks post-treatment. The primary outcome was the change in VAS between patients who received PFTPI alone and those who received PFTPI followed by myofascial release. RESULTS Of the 87 patients in this study, 22 received PFTPI alone and 65 patients received PFTPI followed by PFPT. The median pre-treatment VAS score was 8 for both groups. The median post-treatment score was 6 for the PFTPI only group and 4 for the PFTPI followed by PFPT group, showing a median change in VAS score of 2 and 4, respectively (p = 0.042). Seventy-seven percent of patients in the PFTPI followed by PFPT group had a VAS score improvement of 3 or more, while 45% of patients in the PFTPI only group had a VAS score improvement greater than 3 (p = 0.008). CONCLUSION PFTPI immediately followed by PFPT offered more improvement in pain for patients with PFTM. This may be due to greater tolerance of myofascial release immediately following injections.
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Affiliation(s)
- Gregory K Lewis
- Department of Medical and Surgical Gynecology, Mayo Clinic, 4500 San Pablo South Road, Jacksonville, FL, 32224, USA.
| | - Anita H Chen
- Department of Medical and Surgical Gynecology, Mayo Clinic, 4500 San Pablo South Road, Jacksonville, FL, 32224, USA
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Julia E Crook
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, 4500 San Pablo South Road, Jacksonville, FL, 32224, USA
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Lewis GK, Carrubba AR, Stanton AP, Craver EC, Li Z, Chen AH. OnabotulinumtoxinA Injections for the Treatment of Myofascial Pelvic Pain: 12-year Experience at a Tertiary Care Academic Center. Gynecol Obstet Invest 2022; 88:37-46. [PMID: 36577396 DOI: 10.1159/000528177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 11/15/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to highlight the safety of OnabotulinumtoxinA (BTA) injections, with or without concurrent pudendal nerve block, in treating women with myofascial pelvic pain (MFPP). DESIGN This was a retrospective cohort study. SETTING Tertiary care academic center PARTICIPANTS/MATERIALS: We conducted a chart review of patients who were diagnosed with MFPP and treated with BTA with or without pudendal nerve block between January 2010 and February 2022. METHODS BTA was injected transvaginally into the pelvic floor muscle group. The primary outcomes were adverse events after BTA injections, and the secondary outcome was the effect of concomitant pudendal nerve block at the time of BTA injections. RESULTS The cohort included 182 patients; 103 (56.6%) received BTA injections with pudendal nerve block, and 79 (43.4%) received BTA alone. There were no significant demographic differences between the two groups. Post-treatment complications of BTA administration included worsening of pelvic pain (11.5%), constipation (6.6%), urinary tract infection (2.7%), urinary retention (3.8%) and fecal incontinence (2.7%). No statistical difference was noted in the number of phone calls, patient-initiated electronic messages, emergency room visits, or clinic visits for both groups within 30 days post-treatment. The mean number of total injections was 1.6 in the BTA-only group and 1.7 in the BTA with pudendal block group (p=0.421). Median time to re-intervention with a second BTA injection was 6.0 months; 5.6 months in the BTA with pudendal block group and 6.8 months in the BTA-only group; p=0.46. There were 63 re-intervention events after BTA injections. LIMITATIONS Limitations of our study include the retrospective design making it vulnerable to missing or incomplete data available for review CONCLUSION: OnabotulinumtoxinA is beneficial in treating women with MFPP; with a duration of therapeutic effect of approximately 6 months. The use of a concurrent pudendal nerve block did not impact clinical outcomes.
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Affiliation(s)
- Gregory K Lewis
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida, USA
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida, USA
| | - Amanda P Stanton
- Department of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Emily C Craver
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Zhuo Li
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Anita H Chen
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida, USA
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Neville CE, Carrubba AR, Li Z, Ma Y, Chen AH. Association of coccygodynia with pelvic floor symptoms in women with pelvic pain. PM R 2022; 14:1351-1359. [PMID: 34533893 DOI: 10.1002/pmrj.12706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/23/2021] [Accepted: 09/11/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Coccygodynia is a painful condition of the tailbone that occurs more commonly in females. The association of coccyx pain with pelvic floor symptoms and the prevalence of coccyx pain in women with pelvic pain has not previously been reported. OBJECTIVE To identify the prevalence of coccygodynia in women with pelvic pain and to describe the association of coccygodynia with pelvic floor examination findings and symptoms. DESIGN Retrospective cohort analysis. SETTING Tertiary medical institution. PARTICIPANTS One hundred twenty-seven women presenting for outpatient pelvic floor physical therapy treatment who underwent vaginal and rectal pelvic floor examination. MAIN OUTCOME MEASURES Prevalence of coccygodynia, pain scores, association of coccygodynia with other comorbidities and diagnoses, and association of coccygodynia with physical examination findings. RESULTS Sixty-three (49.6%) of 127 women with pelvic pain presented with coccygodynia and 64 (50.4%) did not. Women with coccygodynia had significantly higher rates of muscle spasm (50.8% vs. 31.2%, p = .025) higher visual analog scale pain scores (median 5 vs. 3, p = .014), higher rates of outlet dysfunction constipation (31.7% vs. 10.0%, p = .032), and higher rates of fibromyalgia (15.9% vs. 3.1%, p = .014). On pelvic examination, women with coccygodynia were significantly more likely to have sacrococcygeal joint hypomobility (65.1% vs. 14.1%, p < .001), coccygeus muscle spasm (77.8% vs. 17.2%, p < .001), anococcygeal ligament pain (63.5% vs. 9.4%, p < .001), external anal sphincter pain/spasm (33.3% vs. 13.1%, p < .001), and impaired pelvic floor muscle coordination (77.8% vs. 57.8%, p = .016). CONCLUSIONS Almost 50% of women seeking pelvic floor physical therapy for pelvic pain had coexisting coccygodynia. These women had higher pain scores, increased pelvic floor dysfunction, and significantly greater abnormal physical exam findings. This study demonstrates a strong link between coccygodynia, pelvic floor symptoms, and pelvic pain and highlights the importance of screening for and identifying coccyx pain when evaluating women with pelvic pain.
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Affiliation(s)
- Cynthia E Neville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida, USA
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida, USA
| | - Zhuo Li
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - Yaohua Ma
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - Anita H Chen
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida, USA
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7
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Lewis GK, Ghaith S, Craver EC, Li Z, Wasson MN, Burnett TL, Carrubba AR. The association of endosalpingiosis with gynecologic malignancy. Gynecol Oncol 2022; 167:81-88. [PMID: 35909004 DOI: 10.1016/j.ygyno.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Endosalpingiosis is a poorly understood condition of ectopic epithelium resembling the fallopian tubes. It has been described as an incidental pathology finding, a disease similar to endometriosis, and in association with malignancy. The objective of this study is to determine if endosalpingiosis (ES) has an increased association with gynecologic malignancy when compared to endometriosis (EM). METHODS This is a retrospective case-control analysis of patients with a histologic diagnosis of endosalpingiosis or endometriosis at three affiliated academic hospitals between 2000 and 2020. All ES patients were included, and 1:1 matching was attempted to obtain a comparable cohort of EM patients. Demographic and clinical data were obtained, and statistical analysis was performed. RESULTS A total of 967 patients (515 ES and 452 EM) were included. ES patients were significantly older than EM patients (median age 52 vs 48 years, p < 0.001). The ES group had significantly more cancer diagnoses at surgery than the EM group (40.1% vs 18.1%, p < 0.001); this difference persisted in a sub-analysis excluding patients with known or suspected malignancy (20.9% vs 5.6%, p < 0.001). ES patients had lower overall survival (10-year freedom from death: 77.0% vs 90.5%, p < 0.001). After adjusting for confounders, multivariable analysis showed that ES patients had increased cancer diagnosed at surgery (OR = 2.48, p < 0.001) and greater risk of death (OR = 1.69, p = 0.017). CONCLUSIONS Endosalpingiosis was found concurrently with malignancy in 40% of cases, and this effect was preserved in multi-variable and sub-group analyses. Further research consisting of longer follow-up and exploration of molecular relationships between ES and cancer are forthcoming.
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Affiliation(s)
- Gregory K Lewis
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, United States of America
| | - Summer Ghaith
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, United States of America
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States of America
| | - Zhuo Li
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States of America
| | - Megan N Wasson
- Department of Medical and Surgical Gynecology, Mayo Clinic, Scottsdale, AZ, United States of America
| | - Tatnai L Burnett
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, United States of America
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, United States of America.
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8
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Leon MG, Carrubba AR, DeStephano CC, Heckman MG, Craver EC, Dinh TA. Impact of robotic single and dual console systems in the training of minimally invasive gynecology surgery (MIGS) fellows. J Robot Surg 2022; 16:1273-1280. [PMID: 35025036 DOI: 10.1007/s11701-022-01369-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
The advantages of dual console use in robotic surgical education have not been described. The aims of this study are to compare fellow console time, surgical steps performed, and surgical takeovers between attending and fellow surgeons using dual versus single console robotic systems. Participants included minimally invasive gynecologic surgery (MIGS) fellows (N = 3) and subspecialty trained gynecologic surgeons (N = 5). Prospective data were obtained on 126 patients (N = 77 single console, N = 49 dual console) undergoing robotic hysterectomy. Variables included demographics, surgical characteristics (fellow, month of fellowship, attending surgeon, concomitant oophorectomy, additional surgical procedures, estimated blood loss, specimen weight), and outcomes (console time, docking time, console time/docking time ratio, total case time, number of surgical steps performed by the fellow, number of surgical takeovers, complications). After controlling for potential confounders, fellows spent a mean of 25.8 min longer (P < 0.001) at the console in dual console operations compared to single. Dual console surgeries had a greater number of steps performed by the fellow (OR[> 5 steps]: 3.37, P = 0.009), a higher console time/docking time ratio (P < 0.001), and more surgical takeovers between fellow and attending (OR [> 1 takeover]: 3.53, P < 0.001). There were no significant differences between the two groups regarding docking time (P = 0.15), case time (P = 0.79), or complications (P = 0.30). Our findings suggest dual console robotic training provide fellows the opportunity for more "hands-on" experience with longer console time, higher number of surgical steps performed, and added interaction with the attending surgeon when compared with single console training. These surgical metrics provide objectivity in competency-based robotic training without increasing the complications or surgical time.
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Affiliation(s)
- Mateo G Leon
- McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St # 1014, Houston, TX, 77030, USA.
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Tri A Dinh
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA
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9
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Vegunta S, Carrubba AR, Wasson MN. Changing US trends in contraceptive choices. Cleve Clin J Med 2021; 88:689-695. [PMID: 34857607 DOI: 10.3949/ccjm.88a.20110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Long-acting reversible contraceptives (ie, intrauterine devices and the etonogestrel subdermal implant) have become increasingly popular methods of contraception because of their convenience and safety profile. At the same time, the use of depot medroxyprogesterone acetate, one of the most prescribed contraceptives in the United States since its approval in 1992, is on the wane. The history and pros and cons of these contraceptive methods are reviewed.
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Affiliation(s)
- Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL
| | - Megan N Wasson
- Department of Medical and Surgical Gynecology, Mayo Clinic Hospital, Phoenix, AZ
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10
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Carrubba AR, Leon MG, Robertson MW. Mucinous Borderline Ovarian Cystadenoma Interpreted as Endometriosis in an Adolescent. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2021.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aakriti R. Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Mateo G. Leon
- Department of Medical and Surgical Gynecology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Matthew W. Robertson
- Department of Medical and Surgical Gynecology, Mayo Clinic Florida, Jacksonville, Florida, USA
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11
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Carrubba AR, Glasgow AE, Habermann EB, Stanton AP, Wasson MN, DeStephano CC. Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida. Gynecol Obstet Invest 2021; 86:460-468. [PMID: 34638126 DOI: 10.1159/000519517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/04/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to determine the oral morphine equivalents (OMEs) prescribed and refill rates following hysterectomy and hysteroscopy in the setting of opioid prescribing practice changes in 2 states. DESIGN This is a retrospective cohort analysis consisting of 2,916 patients undergoing hysterectomy or hysteroscopy between July 2016 and September 2019 at 2 affiliated academic hospitals in states that underwent legislative changes in opioid prescribing in 2018. METHODS Participants were identified using the Current Procedural Terminology procedure codes in Arizona and Florida. Hysterectomy was chosen as the most invasive gynecologic procedure, while hysteroscopy was chosen as the least invasive. Medical records were abstracted to find opioid prescriptions from 90 days before surgery to 30 days after discharge. Patients with opioid use between 90 and 7 days before surgery were excluded. Prescriptions were converted to OMEs and were calculated per quarter year. Statistical analysis included Wilcoxon rank sum t tests for OMEs and χ2 t tests for refill rates. Interrupted time-series analysis was used to determine significant change in OMEs before and after legislative change. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). RESULTS In Arizona, 1,067 hysterectomies were performed; 459 (43%) vaginal, 561 (52.6%) laparoscopic/robotic, and 47 (4.4%) abdominal. There were 530 hysteroscopies. Overall median OMEs decreased from 225 prior to July 2018 to 75 after July 2018 (p < 0.0001). The opioid refill rate remained unchanged at 7.4% (p = 0.966). In Florida, there were 769 hysterectomies; 241 (31.3%) vaginal, 476 (61.9%) laparoscopic/robotic, and 52 (6.8%) abdominal. There were 549 hysteroscopies. Overall median OMEs decreased from 150 prior to July 2018 to 0 after July 2018 (p < 0.0001). The opioid refill rate was similar (7.8% before July 2018 and 7.3% after July 2018; p = 0.739). LIMITATIONS Limitations include involvement of a single hospital institution with a total of 10 fellowship-trained surgeons and biases inherent to retrospective study design. CONCLUSIONS Legislative and provider-led changes coincided with decreases in opioid prescribing after 2018 in both states without increasing rates of refills and showed actual data reflected in the medical record. Gynecologists must actively participate in safe prescribing practices to decrease opioid dependence and misuse.
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Affiliation(s)
- Aakriti R Carrubba
- Division of Gynecologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Amy E Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda P Stanton
- Division of Gynecologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Megan N Wasson
- Division of Gynecologic Surgery, Mayo Clinic, Scottsdale, Arizona, USA
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12
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Leon MG, Carrubba AR, Dinh TA. Laparoscopic Transillumination for Extrapelvic Superficial Abdominal Wall Endometriosis. J Minim Invasive Gynecol 2021; 28:1810-1811. [PMID: 34237463 DOI: 10.1016/j.jmig.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Mateo G Leon
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida (all authors).
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida (all authors)
| | - Tri A Dinh
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida (all authors)
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13
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Affiliation(s)
- Aakriti R. Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida, USA
| | - Dana C. McKee
- Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, Arizona, USA
| | - Megan N. Wasson
- Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, Arizona, USA
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Carrubba AR, Ebbert JO, Spaulding AC, DeStephano D, DeStephano CC. Use of Cannabis for Self-Management of Chronic Pelvic Pain. J Womens Health (Larchmt) 2020; 30:1344-1351. [PMID: 33252316 DOI: 10.1089/jwh.2020.8737] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Chronic pelvic pain (CPP) affects up to 15% of women in the United States. The endocannabinoid system is a potential pharmacological target for pelvic pain as cannabinoid receptors are highly expressed in the uterus and other nonreproductive tissues. We hypothesize that cannabis use is common for self-management of CPP, and our primary objective was to determine the prevalence of cannabis use in this population. Materials and Methods: A cross-sectional survey of women with pelvic and perineal pain, dyspareunia, or endometriosis was performed between March and August 2019. Subjects were recruited in an outpatient gynecology office. An anonymous, confidential, electronic survey was performed using a tablet. Statistical analysis was performed using JMP (SAS, Cary, NC). Results: A total of 240 patients were approached, with 113 responses (47.1% response rate). There were 26 patients who used cannabis (23%). The majority used at least once per week (n = 18, 72%). Most users (n = 24, 96%) reported improvement in symptoms, including pain, cramping, muscle spasms, anxiety, depression, sleep disturbances, libido, and irritability. Over one-third (35%) stated that cannabis use decreased the number of phone calls or messages sent to their provider, and 39% reported decreased number of clinical visits. Side effects, including dry mouth, sleepiness, and feeling "high," were reported by 84% (n = 21). Conclusions: Almost one-quarter of patients with CPP report regular use of cannabis as an adjunct to their prescribed therapy. Although side effects are common, most users report improvement in symptoms. Our study highlights the potential of cannabis as a therapeutic option for patients with CPP.
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Affiliation(s)
- Aakriti R Carrubba
- Department of Gynecologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Jon O Ebbert
- Department of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron C Spaulding
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | - David DeStephano
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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15
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Carrubba AR, Jijon AJ, Heckman MG, Brushaber DE, Chen AH, Dinh TA, Destephano CC. Association of uterine dimensions and route of contained morcellation following laparoscopic hysterectomy. Minerva Ginecol 2020; 72:316-324. [PMID: 32677775 DOI: 10.23736/s0026-4784.20.04602-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to determine if uterine dimensions on preoperative imaging are associated with route of contained morcellation during laparoscopic hysterectomy. METHODS This is a prospective cohort study of patients undergoing laparoscopic hysterectomy and requiring morcellation for specimen extraction from March 2017 through August 2019. A contained extraction system was inserted and manual morcellation was performed vaginally, abdominally, or via a combination of both methods in cases of failed vaginal extraction. RESULTS A total of 47 patients were treated. Median age was 47 (range 38-70). Morcellation was performed vaginally for 29 patients (61.7%), abdominally for 13 patients (27.7%), and via combined approach for 5 patients (10.6%). The combined group had the highest frequency of patients who were black (vaginal: 24%, abdominal: 31%, combined: 100%; P=0.005), the longest median total operating time (vaginal: 167 minutes, abdominal: 183 minutes, combined: 268 minutes; P=0.006) and the longest median time of uterine morcellation (vaginal: 14 minutes, abdominal: 37 minutes, combined: 85 minutes; P<0.001). There was strong evidence of a positive correlation with time of uterine morcellation for both largest uterine diameter (Spearman's r: 0.62, P<0.001) and uterine volume (Spearman's r: 0.70, P<0.001). These associations remained consistent after multivariable linear regression models that were adjusted for route of morcellation, hysterectomy type, and BMI (both P<0.001). CONCLUSIONS Larger uterine dimensions are associated with increased total operating and morcellation times. Uterine size and volume on preoperative imaging were not associated with route of morcellation, but there was a trend towards failed vaginal extraction when uterine dimensions exceeded 16 centimeters.
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Affiliation(s)
- Aakriti R Carrubba
- Department of Gynecologic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA -
| | - Alfredo J Jijon
- Department of Gynecologic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Danielle E Brushaber
- Division of Biomedical Statistics and Informatics, Mayo Clinic Florida, Rochester, MN, USA
| | - Anita H Chen
- Department of Gynecologic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Tri A Dinh
- Department of Gynecologic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
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16
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Jijon AJ, Carrubba AR, Destephano CC, Heckman MG, Johnson PW, Dinh TA. Factors Associated with Burnout and Frustration among Minimally Invasive Gynecologic Surgery Fellows. J Minim Invasive Gynecol 2020; 28:75-81. [PMID: 32234351 DOI: 10.1016/j.jmig.2020.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE Determine the prevalence of burnout and frustration among participants currently completing a fellowship in minimally invasive gynecologic surgery (FMIGS). DESIGN Cross-sectional survey. SETTING An anonymous survey was distributed to fellows in November 2018. PARTICIPANTS Current FMIGS fellows. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS A total of 57 of 83 (67.7%) FMIGS participants in American Association of Gynecologic Laparoscopists-accredited programs completed a survey regarding fellowship characteristics and experiences. Overall, 40 participants (70.2%) indicated that they were satisfied with their fellowship program experience. There were 33 participants (57.9%) who reported burnout, and 38 participants (66.7%) had experienced anxiety, depression, or extreme fatigue during the last month. Of those who reported burnout, 26 (76.5%) reported that they did not receive support from their fellowship program. Participants who experienced burnout were more likely to be in their second year (p = .003), spent less time per week doing scholarly activities (p = .048), and were less satisfied with their fellowship experience (p <.001). Participants who experienced anxiety, depression, or extreme fatigue had more cofellows in their program (p = .031), worked on average more hours per week (p = .020), and were more often required to practice obstetrics in their fellowship (p = .022). CONCLUSION Burnout symptoms are common among physicians across multiple specialties. Our findings suggest that this issue is prevalent among FMIGS participants. In addition, there is a lack of access to emotional and psychologic support programs for fellows experiencing burnout. We hope that this study will prompt attention to this important topic by both individual programs and American Association of Gynecologic Laparoscopists as a society to increase awareness and access to resources and promote wellness for fellows.
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Affiliation(s)
- Alfredo J Jijon
- Department of Gynecologic Surgery (Drs. Jijon, Carrubba, Destephano, and Dinh), Mayo Clinic Florida, Jacksonville, Florida.
| | - Aakriti R Carrubba
- Department of Gynecologic Surgery (Drs. Jijon, Carrubba, Destephano, and Dinh), Mayo Clinic Florida, Jacksonville, Florida
| | - Christopher C Destephano
- Department of Gynecologic Surgery (Drs. Jijon, Carrubba, Destephano, and Dinh), Mayo Clinic Florida, Jacksonville, Florida
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics (Mr. Heckman and Mr. Johnson), Mayo Clinic Florida, Jacksonville, Florida
| | - Patrick W Johnson
- Division of Biomedical Statistics and Informatics (Mr. Heckman and Mr. Johnson), Mayo Clinic Florida, Jacksonville, Florida
| | - Tri A Dinh
- Department of Gynecologic Surgery (Drs. Jijon, Carrubba, Destephano, and Dinh), Mayo Clinic Florida, Jacksonville, Florida
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17
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Core JM, Carrubba AR, Paz-Fumagalli R. Rare case of a massive uterine arteriovenous fistula. Am J Obstet Gynecol 2020; 222:85-86. [PMID: 31301765 DOI: 10.1016/j.ajog.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/20/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
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Carrubba AR, Osagiede O, Spaulding AC, Cochuyt JJ, Hodge DO, Robertson MW, DeStephano CC. Variability between individual surgeons in route of hysterectomy for patients with endometrial cancer in Florida. Surg Oncol 2019; 31:55-60. [DOI: 10.1016/j.suronc.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/01/2019] [Accepted: 09/09/2019] [Indexed: 01/16/2023]
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Carrubba AR, Jijon AJ, Chen AH. X Marks the Knot: Simplified Laparoscopic Intra-Corporeal Knot Tying. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Carrubba AR, Jijon AJ, Heckman MG, Johnson PW, DeStephano CC, Dinh TA. Satisfaction among Participants Completing a Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) Program. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Acosta DA, Carrubba AR, Pettit PD, Chen AH. Urethral Diverticulum Excision and Placement of Autologous Fascia Lata Sling. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Carrubba AR, Whitmore GT, Radhakrishnan SJ, Sheeder J, Muffly TM. Postoperative infections in women undergoing hysterectomy for benign indications: a cohort study. ACTA ACUST UNITED AC 2019; 71:263-271. [PMID: 31146518 DOI: 10.23736/s0026-4784.19.04365-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is limited data on the incidence of postoperative infections following hysterectomy by route of surgery. We hypothesize that vaginal hysterectomy has lower rates of postoperative infection than laparoscopic and abdominal hysterectomies. METHODS A retrospective cohort study and independent hand review of charts of participants undergoing hysterectomy at five hospitals from September 2011 through May 2015 was performed. Cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes and were reviewed by the investigators. The primary outcome was the development of Clostridium difficile infection, urinary tract infection, surgical site infection, or yeast vaginitis within 60 days following surgery. RESULTS In total, 2742 women underwent hysterectomy: abdominal 17.5% (AH), laparoscopic 65.8% (LH), and vaginal 16.7% (VH). The composite postoperative infection rate for the four specified variables was 8.5% (232). In comparing surgical route, AH was most commonly associated with CDI (0.6%, p <0.001), SSI (6.0%, P=0.001), and yeast vaginitis (1.9%, p <0.001), while VH was most commonly associated with UTI (8.1%, P=0.002). After controlling for demographic and operative factors, multivariable analysis showed that hysterectomy route was not associated with infection. Independent predictors for postoperative infection were increasing age, American Society of Anesthesiologists physical status classification, operative time, and hospital type. CONCLUSIONS Infectious complications after hysterectomy are uncommon, accounting for 8.5% of cases. Multivariable analysis showed that demographic and operative variables were more likely to serve as independent predictors of development of infection than hysterectomy route.
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Affiliation(s)
- Aakriti R Carrubba
- Department of Obstetrics and Gynecology, Denver Hospital, Denver, CO, USA -
| | | | | | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, Denver Hospital, Denver, CO, USA
| | - Tyler M Muffly
- Department of Obstetrics and Gynecology, Denver Hospital, Denver, CO, USA
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23
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Moroney MR, Flink D, Sheeder J, Blake EA, Carrubba AR, Fisher CM, Guntupalli SR. Radiation therapy is not an independent risk factor for decreased sexual function in women with gynecologic cancers. Rep Pract Oncol Radiother 2018; 23:331-336. [PMID: 30127672 DOI: 10.1016/j.rpor.2018.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 04/07/2018] [Accepted: 07/22/2018] [Indexed: 01/02/2023] Open
Abstract
Aim To evaluate the associations of external beam radiation therapy (EBRT) and intracavitary brachytherapy (IB) with decreased sexual function. Background There's inconsistent evidence on whether radiation for gynecologic cancers has an impact on sexual health. IB, an underutilized treatment modality, is thought to have less adverse effects than EBRT. Materials and methods A cross-sectional study examining decreased sexual function following radiation for gynecologic cancers. A decrease in sexual function was measured as a change in the Female Sexual Function Index (FSFI) from before to after treatment, with a significant decrease determined by Reliable Change Index Statistic (RCIS). Chi-square and t-tests were employed. Results 171 women completed the survey; 35% (n = 60) received radiation, of whom 29 received EBRT and IB (48%), 15 EBRT alone (25%), 16 IB alone (27%). Women who received radiation had similar rates of decreased sexual function as women who did not (47% vs. 38%, P = 0.262). EBRT and IB had similar rates of decreased sexual function compared to women with no radiation (50% vs. 38% P = 0.166 and 47% vs. 38% P = 0.309). Women experiencing decreased sexual function were more likely to be under 50 years old (OR 5.4, 95%CI 1.6-18.1), have received chemotherapy (OR 5.7, 95%CI 1.4-22.9), and have cervical cancer (OR 7.8, 95%CI 2.1-28.8). Conclusions Treatment with EBRT or IB does not appear to impair sexual function in women with gynecologic cancer. Age less than 50, concurrent chemotherapy, and cervical cancer may place women with gynecologic cancer at higher risk for decreased sexual function following radiation.
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Affiliation(s)
- Marisa R Moroney
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Dina Flink
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Erin A Blake
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Aakriti R Carrubba
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Christine M Fisher
- Department of Radiation Oncology, University of Colorado Denver, Aurora, CO, USA
| | - Saketh R Guntupalli
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
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Carrubba AR, Flink DM, Sheeder J, Blake EA, Moroney M, Guntupalli SR. Surgical management is associated with sexual dysfunction in gynecologic cancer. Cogent Medicine 2016. [DOI: 10.1080/2331205x.2016.1265277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Aakriti R. Carrubba
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East, 17th Avenue, B198-6, Aurora, CO 80045, USA
| | - Dina M. Flink
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East, 17th Avenue, B198-6, Aurora, CO 80045, USA
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East, 17th Avenue, B198-6, Aurora, CO 80045, USA
| | - Erin A. Blake
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East, 17th Avenue, B198-6, Aurora, CO 80045, USA
| | - Marisa Moroney
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East, 17th Avenue, B198-6, Aurora, CO 80045, USA
| | - Saketh R. Guntupalli
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East, 17th Avenue, B198-6, Aurora, CO 80045, USA
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