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Al Salehi A, Zemmache MZ, Allegre L, Fatton B, de Tayrac R. Functional and sexual outcomes following surgical vaginal introital reduction. Prog Urol 2023:S1166-7087(23)00107-0. [PMID: 37263901 DOI: 10.1016/j.purol.2023.05.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/13/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Surgical introital reduction procedures are commonly performed for the treatment of vaginal laxity (VL), yet poorly studied. The aim of this study was to assess clinical outcomes following surgical vaginal introital reduction for VL. METHODS This was an ambidirectional cohort study conducted in a single urogynecology center. All sexually active women who had vaginal introital surgical reduction for VL between March 2015 and September 2020 were included in this study. VL was defined as a genital hiatus distance ≥4cm according to the POP-Q classification, associated with symptoms of laxity. The primary endpoint was sexual health assessed by the Pelvi-Perineal Surgery Sexuality Questionnaire (PPSSQ), while the secondary endpoints included postoperative pain, perioperative complications, rate of dyspareunia, patient satisfaction and success rate based on the Patient Global Improvement Index (PGI-I) and Vaginal Laxity Questionnaire (VLQ). RESULTS Of the 27 patients sent the questionnaires, 23 sexually active patients returned the completed ones and were included in the study. Participants had a mean age and BMI of 41 years (range 24-74) and 21.3 (range 17.6-31.9) respectively. The most prevalent preoperative symptom was feeling of VL in 82.6% followed by bulging sensation in 47.8%. Preoperative dyspareunia was reported in 8/23 (34.8%). Surgical interventions involved perineorrhaphy with (n=14) or without (n=9) levator ani plication. The PPSSQ mean sexual health score was 86.7/100 (SD 5.8; range 16.7-93.3) and the mean discomfort and pain score was 27.5/100 (SD 26.0; range 0-80). Postoperative sexuality was reported to better, identical or worse in 16 (69.6%), 2 (8.7%) and 5 (21.7%) patients respectively. On PGI-I, patients reported feeling much better, better, slightly better and no change in 10 (43.5%), 5 (21.7%), 5 (21.7%) and 3 (13.0%) respectively. None of the women reported feeling worse. The overall post-operative complication rate was 3/23 (13.0%), including a perineal hematoma, and two cases of reoperation for narrow introitus. De novo dyspareunia was reported by 11/18 (61.1%) patients, occurring often or more in 4/18 (22.2%) patients, due to narrow introitus (n=2), enlarge introitus (n=1) and vaginal dryness (n=1). CONCLUSION Vaginal introital reduction surgery is a viable treatment option for symptoms of vaginal laxity after failure of conservative measures. However, patients should be made aware of the risk of de novo dyspareunia. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Asma Al Salehi
- Obstetrics and Gynecology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Mohammed Zakarya Zemmache
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Lucie Allegre
- Obstetrics and Gynecology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Brigitte Fatton
- Obstetrics and Gynecology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Renaud de Tayrac
- Obstetrics and Gynecology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France.
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Mortier A, Cardaillac C, Perrouin-Verbe MA, Meurette G, Ploteau S, Lesveque A, Riant T, Dochez V, Thubert T. [Pelvic and perineal pain after genital prolapse: A literature review]. Prog Urol 2020; 30:571-587. [PMID: 32651103 DOI: 10.1016/j.purol.2020.06.001] [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: 05/25/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pelvic and perineal pain after genital prolapse surgery is a serious and frequent post-operative complication which diagnosis and therapeutic management can be complex. MATERIALS ET METHODS A literature review was carried out on the Pubmed database using the following words and MeSH : genital prolapse, pain, dyspareunia, genital prolapse and pain, genital prolapse and dyspareunia, genital prolapse and surgery, pain and surgery. RESULTS Among the 133 articles found, 74 were selected. Post-operative chronic pelvic pain persisting more than 3 months after surgery according to the International Association for the Study of Pain. It can be nociceptive, neuropathic or dysfunctional. Its diagnosis is mainly clinical. Its incidence is estimated between 1% and 50% and the risk factors are young age, the presence of comorbidities, history of prolapse surgery, severe prolapse, preoperative pain, invasive surgical approach, simultaneous placement of several meshes, less operator experience, increased operative time and early post-operative pain. The vaginal approach can cause a change in compliance and vaginal length as well as injury to the pudendal, sciatic and obturator nerves and in some cases lead to myofascial pelvic pain syndrome, whereas the laparoscopic approach can lead to parietal nerve damage. Therapeutic management is multidisciplinary and complex. CONCLUSION Pelvic pain after genital prolapse surgery is still obscure to this day.
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Affiliation(s)
- A Mortier
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - C Cardaillac
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - M-A Perrouin-Verbe
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; GREEN, groupe de recherche clinique en neuro-urologie, GRCUPMC01, 75020 Paris, France
| | - G Meurette
- Service de chirurgie viscérale, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Centre fédératif de pelvi-périnéologie, Nantes, France
| | - S Ploteau
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; Centre fédératif de pelvi-périnéologie, Nantes, France
| | - A Lesveque
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Centre fédératif de pelvi-périnéologie, Nantes, France
| | - T Riant
- Centre fédératif de pelvi-périnéologie, Nantes, France
| | - V Dochez
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, Centre d'investigation clinique, CHU de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes cedex 01, France
| | - T Thubert
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, Centre d'investigation clinique, CHU de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes cedex 01, France; GREEN, groupe de recherche clinique en neuro-urologie, GRCUPMC01, 75020 Paris, France; Centre fédératif de pelvi-périnéologie, Nantes, France.
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Fauconnier A, Borghese B, Huchon C, Thomassin-Naggara I, Philip CA, Gauthier T, Bourdel N, Denouel A, Torre A, Collinet P, Canis M, Fritel X. [Epidemiology and diagnosis strategy: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:223-230. [PMID: 29548620 DOI: 10.1016/j.gofs.2018.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/19/2018] [Indexed: 11/17/2022]
Abstract
Based on the best evidence available, we have provided guidelines for clinical practice to target the nature of endometriosis as a disease, the consequences of its natural history on management, and the clinical and imaging evaluation of the disease according to the level of care (primary care, specialized or referral). The frequency of endometriosis is unknown in the general population; endometriosis requires management when it causes symptoms (pain, infertility) or when it affect the function of an organ. In the absence of symptom, there is no need for follow-up or screening of the disease. Endometriosis may be responsible for various pain symptoms such as severe dysmenorrhea, deep dyspareunia, painful bowel movements or low urinary tract signs increasing with menstruation, or infertility. A careful evaluation of the symptoms and their impact on the quality of life should be made. The first-line examinations for the diagnosis of endometriosis are: digital examination and pelvic ultrasound. The second-line examinations are: the pelvic exam by an expert clinician, the pelvic MRI and/or the transvaginal ultrasound by an expert. MRI and ultrasound carrying different and complementary information. Other examinations may be considered as part of the pre-therapeutic assessment of the disease in case of specialized care. Diagnostic laparoscopy may be suggested in case of clinical suspicion of endometriosis whereas preoperative examinations have not proved the disease, it must be part of a management plan of endometriosis-related pain or infertility. During management, it is recommended to give comprehensive information on the different therapeutic alternatives, the benefits and risks expected from each treatment, the risk of recurrence, fertility, especially before surgery. The information must be personalized and take into account the expectations and preferences of the patient, and accompanied by an information notice given to the patient.
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Affiliation(s)
- A Fauconnier
- Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France; EA 7285 risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin-en-Yvelines, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France.
| | - B Borghese
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, Cancer, Inserm U1016, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
| | - C Huchon
- Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France; EA 7285 risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin-en-Yvelines, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France
| | - I Thomassin-Naggara
- Service d'imagerie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 06, institut universitaire de cancérologie, AP-HP, 21, rue de l'École-de-Médecine, 75006 Paris, Paris, France
| | - C-A Philip
- Clinique gynécologique et obstétricale, groupe hospitalier Nord-hôpital de la Croix-Rousse, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex, France
| | - T Gauthier
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87042 Limoges, France
| | - N Bourdel
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Encov-ISIT, UMR6284 CNRS, faculté de médecine, université d'Auvergne, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - A Denouel
- EndoFrance, BP 50053, 01124 Montluel cedex, France
| | - A Torre
- Centre Hospitalier Universitairede Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - P Collinet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France
| | - M Canis
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Encov-ISIT, UMR6284 CNRS, faculté de médecine, université d'Auvergne, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - X Fritel
- Inserm CIC 1402, service de gynécologie-obstétrique et médecine de la reproduction, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France
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Nohuz E, Albaut M, Bayeh S, Champel N, Khenifar E. [A Gartner's duct cyst mimicking a cystocele]. Prog Urol 2016; 26:1150-1152. [PMID: 27816463 DOI: 10.1016/j.purol.2016.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 09/28/2016] [Accepted: 10/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- E Nohuz
- Department of Obstetrics and Gynecology, General Hospital of Thiers, route du Fau, 63300 Thiers, France; Department of Obstetrics and Gynecology, University Hospital Estaing, place Lucie-Aubrac, 63000 Clermont-Ferrand, France.
| | - M Albaut
- Department of Obstetrics and Gynecology, General Hospital of Thiers, route du Fau, 63300 Thiers, France.
| | - S Bayeh
- Department of Obstetrics and Gynecology, General Hospital of Thiers, route du Fau, 63300 Thiers, France.
| | - N Champel
- Department of Obstetrics and Gynecology, General Hospital of Thiers, route du Fau, 63300 Thiers, France.
| | - E Khenifar
- Department of Surgery, General Hospital of Thiers, 63300 Thiers, France.
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Sarreau M, Bon D, Estrade V, Villemonteix P, Fritel X. [Sexual function after transobturator tape procedure for stress urinary incontinence and overall patients' satisfaction]. Prog Urol 2015; 26:24-33. [PMID: 26586638 DOI: 10.1016/j.purol.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/31/2015] [Revised: 09/08/2015] [Accepted: 10/06/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the quality of sexual activity after a transobturator tape procedure for urinary incontinence and to examine the global satisfaction reported by patients. MATERIALS AND METHODS This is a bicentric retrospective study, postoperative questionnaires were sent to 247 women operated for urinary incontinence by TOT/TVT-O surgery, after 1 year, prolaps were excluded. Patients' overall improvement was assessed using the French version of Patient Global Impression and Improvement (PGI-I), urinary symptoms were assessed with the use of ICIQ-Fluts and quality of sexual function using Lemack and Zimmern questionnaire and ICIQ-Fluts-Sex. A logistic regression analysis was run to analyse the factors associated with women overall improvement. RESULTS One hundred and sixty-five patients answered the questionnaire (66.8%). Average age was 55 (±11), and the average postoperative period was 39 months (±17.9). After surgery, according to the PGI-I 135 women (81.8%) found an overall improvement, 22 (13.4%) found their condition unchanged and 8 (4.8%) women found it worse. Among the 165 women, 118 were sexually active, 37 (31.4%) reported improvement in intercourse satisfaction whereas 11 (9.3%) complained about sexual function deterioration and 70 (59.3%) felt unchanged. The 37 women who reported sexual improvement described decreased coital incontinence in 54% of the cases. Eleven women who felt sexually worse, reported dyspareunia. Results of the logistic regression analysis suggested that overall improvement after surgery depended not only on the incontinence score (OR 0.83) but also on the quality of the postoperative sexual activity (OR 12.96). CONCLUSION One third of the women reported improvement of their sexuality after transobturator tape procedure. In fact, global satisfaction after surgery was as related to the improvement of urinary symptoms as it was to the quality of the sexual activity. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- M Sarreau
- Service de gynécologie-obstétrique, CHG Angoulême, rond-point de Girac, 16000 Angoulême, France; Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - D Bon
- Service d'urologie, CHG Angoulême, rond-point de Girac, 16000 Angoulême, France; Pôle de la femme, Inserm U947 IADI, maternité régionale universitaire de Nancy, université de Lorraine, 54000 Nancy, France
| | - V Estrade
- Service d'urologie, CHG Angoulême, rond-point de Girac, 16000 Angoulême, France; Pôle de la femme, Inserm U947 IADI, maternité régionale universitaire de Nancy, université de Lorraine, 54000 Nancy, France
| | - P Villemonteix
- Service de gynécologie-obstétrique, CHG Nord Deux-Sèvres, 79800 Bressuire, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Inserm U1018 CESP, équipe 7, genre, santé sexuelle et reproductive, Inserm CIC-P 1402, centre investigation, clinique plurithématique, CHU de Poitiers, 86000 Poitiers, France
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Abstract
INTRODUCTION The occurrence of pain during sex is one of the most common complaints in gynecological and sexological practice but nonetheless one of the most difficult problems to deal with and treat effectively. METHODS A literature review was conducted on Medline considering the articles listed until January 2012 dealing with sexual pain in women and men. RESULTS The different descriptions of painful intercourse (dyspareunia, vestibulo-vulvodynies, vaginismus) are not separate entities but the result of the interaction of many factors including genital pain, emotional and behavioral responses to penetration, caresses, desire and excitement, in a context of possible organic pathology (infection, endometriosis, inflammatory or dermatological disease, morphological or pelvic abnormality, hormonal deficiency) sometimes associated with chronic pain phenomena self-sustained by neurogenic inflammation. The clinical expression of sexual pain is as variable as its causes are many. The etiological investigation is essential but should not omit the sexological context and the need for appropriate management. The neurogenic inflammation and hypersensitivity impose an algological approach associated to etiological and sexological treatment. CONCLUSION Chronic sexual pains, whether they are superficial or deep, can be the sign of organic or psycho-sexual (primary or secondary) disorders. The development of a "therapeutic program" helps patients, allows them to restore self-confidence and leads to the disappearance of the symptom in more than half cases.
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Affiliation(s)
- M Monforte
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Arnaud-de-Villeneuve, 34000 Montpellier, France
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Abstract
OBJECTIVE To describe the main female sexual dysfunctions, their mechanisms, and the broad outlines of their therapeutic management. MATERIAL AND METHODS Review of consensus conferences and published guidelines on this subject and a reflexion from our own clinical experience, in urogynaecological practice. RESULTS Female sexual dysfunction is frequent and can present in different ways; pain, problems concerning desire and satisfaction. These symptoms can be associated with concomitant male sexual dysfunction. These symptoms can be managed by a gynaecologist if he/she is trained accordingly. Knowledge of this is essential for a gynaecologist in daily practice but also for an urologist treating both female urinary incontinence or pelvic prolapse and male sexual dysfunction. CONCLUSION Women's sexual disorders can considerably affect the quality of life of the partner and the couple. As the patients hesitate to speak of such matters the clinician should begin the dialogue with simple open questions.
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Nohuz E, Battista R, Tamburro S, Leonenko M, Bayeh S, Varga J, Mage G. [A more and more painful intrauterine device… where it is not enough to see the wires to exclude malposition!]. Gynecol Obstet Fertil 2012; 42:261-4. [PMID: 22521985 DOI: 10.1016/j.gyobfe.2011.08.019] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 11/17/2010] [Indexed: 10/28/2022]
Abstract
We report a case of a 30-year-old woman with an intrauterine device (IUD) improperly inserted deep within the myometrium, with a muscularis layer injury of the recto-sigmoid colon resulting of a uterine perforation and presented as abdomino-pelvic pain and dyspareunia. The ultrasonographic control of the IUD after the insertion (performed seven months before) was not checked. Cervical examination showed the strings of the IUD. The ultrasonographic exploration identified an intra-myometrial IUD with fundus perforation of the uterus. A laparoscopic exploration permitting the removal of the IUD revealed an insertion through the bowel wall. The lessons to draw of about this case report are discussed through a brief review of the literature.
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Affiliation(s)
- E Nohuz
- Service de gynécologie-obstétrique, centre hospitalier de Thiers, route du Fau, 63300 Thiers, France.
| | - R Battista
- Service de gynécologie-obstétrique, centre hospitalier de Thiers, route du Fau, 63300 Thiers, France
| | - S Tamburro
- Service de gynécologie-obstétrique, centre hospitalier de Thiers, route du Fau, 63300 Thiers, France
| | - M Leonenko
- Service de gynécologie-obstétrique, centre hospitalier de Thiers, route du Fau, 63300 Thiers, France
| | - S Bayeh
- Service de gynécologie-obstétrique, centre hospitalier de Thiers, route du Fau, 63300 Thiers, France
| | - J Varga
- Service de chirurgie générale et digestive, centre hospitalier de Thiers, route du Fau, 63300 Thiers, France
| | - G Mage
- Service de gynécologie-obstétrique, centre hospitalier de Thiers, route du Fau, 63300 Thiers, France; Service de gynécologie-obstétrique et biologie de la reproduction, CHU Estaing, 1, place Lucie Aubrac, 63003 Clermont-Ferrand cedex 1, France
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