Abstract Objectives The aim of the current study was to evaluate the prevalence and the impact of sexual dysfunction, sexual distress and interpersonal relationships in patients with endometriosis. ...Study design A questionnaire-based multicentre cohort study was conducted in eight tertiary referral centres in Austria and Germany. One hundred and twenty-five patients with histologically proven endometriosis and dyspareunia were included. The Female Sexual Function Index and the Female Sexual Distress Scale were used to screen women's sexuality. Additionally, we evaluated psychological parameters and pain intensity during/after sexual intercourse via a self-administered questionnaire. Results Female sexual distress and sexual dysfunction were observed in 97/125 and 40/125 patients. Statistically significant correlations were found between sexual dysfunction and pain intensity during/after sexual intercourse ( p < 0.01/ p < 0.01), a lower number of episodes of sexual intercourse per month ( p < 0.01), greater feelings of guilt towards the partner ( p < 0.01) and fewer feelings of feminity ( p < 0.01). Thirty-eight out of 125 women agreed that the primary motivation for sexual intercourse was to conceive and nearly half of women (46%) included stated that satisfying the partner acted as primary motivation for sexual contact. Conclusion Overall, our findings demonstrate that dyspareunia as a common complaint in patients with endometriosis causes a severe impairment of sexual function, relationship and psychological wellbeing.
Chronic pelvic pain in women represents a difficult diagnostic and therapeutic problem in the gynecological practice which is always a challenge when dealing with affected women.
Possible ...gynecological causes are endometriosis, adhesions and/or pelvic inflammatory disease (PID), pelvic varicosis and ovarian retention syndrome/ovarian remnant syndrome. Other somatic causes are irritable bowel syndrome, bladder pain syndrome, interstitial cystitis and fibromyalgia.
Psychosocial causes contributing to chronic pelvic pain are a high comorbidity with psychological factors, such as anxiety disorders and substance abuse or depression but the influence of social factors is less certain. The association with physical and sexual abuse also remains unclear.
Important diagnostic steps are recording the patient history, a gynecological examination and laparoscopy. Multidisciplinary therapeutic approaches are considered to be very promising. Basic psychosomatic care and psychotherapy should be integrated into the therapeutic concept at an early stage.
In this guideline, recommendations and standards for optimum diagnosis and treatment of endometriosis are presented. They are based on the analysis of the available scientific evidence as published ...in prospective randomized and retrospective studies as well as in systematic reviews. The guideline working group consisted of experts from Austria, Germany, Switzerland, and the Czech Republic.
Abstract
Introduction:
Pelvic pain is a common problem in gynaecological practice. It is often unclear whether definite causality exists between reported symptoms and objective clinical findings of ...the female genital tract, and medical or operative treatments do not always achieve long-term resolution of symptoms.
Methods:
This pilot study investigated 28 patients (age 20–65, median 36.5 years) from a gynaecology practice whose only clinical finding was painful pelvic floor muscle tightness. Following standardised gynaecological and physiotherapist examination, all patients received osteopathic treatment. Pain had been present for a median of 3 years (range 1 month to 20 years). 14 patients had previously confirmed endometriosis. Treatment success was evaluated on consultation with patients in person or in writing.
Results:
22 of the 28 participants completed the treatment according to plan. Overall, 17 reported symptom improvement, while 10 of the 14 patients with endometriosis did.
Conclusion:
Osteopathy is well received by women with painful pelvic floor muscle tightness and appears to be an effective treatment option.
Abstract
Introduction
Minimally invasive operative techniques are being used increasingly in gynaecological surgery. The expansion of the laparoscopic operation spectrum is in part the result of ...improved imaging. This study investigates the practical advantages of using 3D cameras in routine surgical practice.
Materials and Methods
Two different 3-dimensional camera systems were compared with a 2-dimensional HD system; the operating surgeonʼs experiences were documented immediately postoperatively using a questionnaire.
Results
Significant advantages were reported for suturing and cutting of anatomical structures when using the 3D compared to 2D camera systems. There was only a slight advantage for coagulating. The use of 3D cameras significantly improved the general operative visibility and in particular the representation of spacial depth compared to 2-dimensional images. There was not a significant advantage for image width. Depiction of adhesions and retroperitoneal neural structures was significantly improved by the stereoscopic cameras, though this did not apply to blood vessels, ureter, uterus or ovaries.
Conclusion
3-dimensional cameras were particularly advantageous for the depiction of fine anatomical structures due to improved spacial depth representation compared to 2D systems. 3D cameras provide the operating surgeon with a monitor image that more closely resembles actual anatomy, thus simplifying laparoscopic procedures.
Zusammenfassung
Einleitung
In der gynäkologischen Chirurgie sind minimalinvasive Operationsmethoden zunehmend auf dem Vormarsch. Die Erweiterung des laparoskopischen OP-Spektrums resultiert u. a. aus einer zunehmenden Verbesserung der Bildgebung. In dieser Arbeit wird untersucht, welche praktischen Vorteile der Einsatz von 3-D-Kameras in der operativen Routine mit sich bringt.
Material und Methoden
Es wurden 2 unterschiedliche 3-dimensionale Kamerasysteme mit einem 2-dimensionalen HD-System verglichen. Direkt postoperativ wurden hierzu die Erfahrungen der Operateure mittels Fragebogen erhoben.
Ergebnisse
Im Vergleich zum 2-D-Kamerasystem ergaben sich signifikante Vorteile durch die Verwendung von 3-D-Kamerasystemen beim Nähen und Schneiden von Strukturen. Dagegen waren die Vorteile beim Koagulieren nur gering. Die allgemeinen Sichtverhältnisse und insbesondere die Tiefendarstellung des Raumes war durch die Verwendung von 3-D-Kameras signifikant verbessert im Vergleich zum 2-dimensionalen Bild. Dagegen zeigte sich in der Bildbreitendarstellung kein signifikanter Vorteil der stereoskopischen Kameras. Die Darstellung von Adhäsionen und nervalen Strukturen des Retroperitoneums zeigte sich bei 3-D-Kameras signifikant verbessert. Diese Signifikanz war bei Gefäßen, Ureter, Uterus und Ovarien nicht gegeben.
Schlussfolgerung
Durch die räumliche Tiefendarstellung ergaben sich besonders signifikante Vorteile gegenüber 2-dimensionalen Kameras bei der Darstellung feiner anatomischer Strukturen. Mit dem Einsatz von 3-D-Kameras wird dem Operateur ein dem realen Situs näheres Monitorbild vermittelt. Daraus resultiert eine Erleichterung des laparoskopischen Operierens.
The idea of quality improvement in the management of endometriosis has been brought to attention throughout Europe. This - first and foremost - includes the implementation of centers specialized in ...treating endometriosis. This leads to qualification of both physicians and other medical staff, enforcement of research efforts, and informing the patients, the public, politicians, healthcare providers, and industry. Given limited budgets, focusing on the existing national commitment may be the first step.
Zusammenfassung
Die ärztliche Leitung einer Geburtsklinik steht vor einer Reihe typischer Probleme, die gelöst werden wollen, wenn bei der Versorgung auch von Gebärenden mit niedrigem Risiko keine ...Einbußen an der Qualität der Versorgung entstehen sollen. Die Personaldecke muss ausreichen (Strukturqualität), die Abläufe, wenn kein Facharzt im Kreißsaal anwesend ist, müssen klar geregelt sein (Prozessqualität), und die Zufriedenheit der bereits gewordenen muss den noch werdenden Eltern kommuniziert werden (Ergebnisqualität). Wir stellen unsere Lösungen dar, insbesondere die „Emmendinger Ampel“ zur Leitung der vaginalen Geburt.
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