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Pelvic Examination (pelvic + examination)

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Medical Sciences	100%

Selected Abstracts

Emergency Department Pelvic Examination and Pap Testing: Addressing Patient Misperceptions

ACADEMIC EMERGENCY MEDICINE, Issue 4 2004
Michael S. Lyons MD
Objectives: Failure to obtain cervical cancer screening can be precipitated by limited knowledge. This study describes understanding of Papanicolaou (Pap) smear testing among women undergoing emergency department (ED) pelvic examination and tests the feasibility of educating patients in the ED. Methods: Patients undergoing pelvic examination in an urban, tertiary care ED were surveyed about Pap smear screening. Among the initial cohort, no education was provided prior to survey administration. Subsequently, a pilot study of scripted information provided by physicians alone or both physicians and counselors was conducted. Results: There were 81 patients in the non-intervention cohort and 32 patients in the intervention cohort. Of the 32 intervention patients, 16 received physician-administered intervention, and 16 received reinforced counseling (physician + counselor). Of 113 total patients, 90 (82%) were African American; mean age was 26 years (SD ± 7.7 years). Of the 81 non-intervention patients, six (7%; 95% CI = 3% to 15%) said they were told that a Pap test was not done, and 60 (74%; 95% CI = 64% to 82%) mistakenly believed they had a Pap test. Sixty-six (81.5%; 95% CI = 72% to 88%) patients stated they knew the purpose of a Pap test; only 17 (26%; 95% CI = 17% to 37%) of these correctly identified the Pap test as a test for cervical cancer. All 32 intervention patients were surveyed after physician counseling. Compared with the non-intervention group, fewer (56%; 95% CI = 39% to 72%) thought they had a Pap test, and more (31%; 95% CI = 18% to 49%) said they were told they did not receive a Pap test. All 16 reinforced intervention patients correctly denied receiving a Pap test after counselor education. Conclusions: Knowledge of Pap testing among women undergoing ED pelvic examination is poor; most mistakenly believe they receive a Pap test during ED evaluation. Educating patients may be feasible and effective in the ED setting. [source]

Tension-free vaginal tape-obturator procedure for treatment of severe urodynamic stress incontinence: Subjective and objective outcomes during 2 years of follow-up

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2009
Tsung-Hsien Su
Abstract Aim:, To report our experience of the tension-free vaginal tape-obturator (TVT-O) procedure for the treatment of severe female urodymanic stress incontinence (USI) during 2 years of follow-up. Methods:, Between January 2005 and June 2007, 67 women with severe USI who underwent the TVT-O procedure were enrolled in the study. Pelvic examination, pad test, urodynamic study, and quality of life (QoL) assessment were performed pre- and post-operatively. Regular follow-up was arranged for analysis. Results:, The median duration of follow-up was 24 months. The objective cure rate was 76.2%. The postoperative pad test revealed significant reduction of leakage. The subjective cure rate was 83.5%, and improvement occurred in 14.9%. The postoperative QoL showed significant improvement. One (1.5%) extrusion of tape occurred and three cases of de novo detrusor overactivity were detected. Three patients (4.4%) had immediate postoperative urine retention. No major complications occurred. Conclusion:, Our results show that the TVT-O procedure is an effective and safe surgical procedure for severe female USI with satisfactory outcomes, significant improvement in quality of life, and few complications during 2 years of follow-up. [source]

Malondialdehyde, nitric oxide and adrenomedullin levels in patients with primary dysmenorrhea

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2008
Ebru Dikensoy
Abstract Aim:, The aim of the study was to examine whether there was a relationship between primary dysmenorrhea and serum levels of malondialdehyde (MDA), nitric oxide (NO) and adrenomedullin (AM) in young women. Methods:, Sixty female subjects without serious medical problems, aged between 20 and 34, who had regular menses for at least six previous cycles, were involved. Blood samples were obtained from each patient on the first and the 21st days of her menstrual cycles. Pelvic examination and ultrasound were performed to determine any organic cause for dysmenorrhea in each patient. The subjects were divided into two groups. The study group consisted of 30 subjects with primary dysmenorrhea, and the control group consisted of 30 healthy subjects. Results:, No statistically significant difference was observed in comparison of the following variables between the groups: age, parity and body mass index. The serum levels of MDA, NO, and AM were significantly higher on the first day compared to those on the 21st day in the study group (P < 0.05). The serum levels of MDA, NO, and AM were significantly higher in the study group compared to the control group both on the first and the 21st days of the menstrual cycles (P < 0.05). Conclusion:, In conclusion, the results of this study showed that the serum levels of MDA, NO, and AM increase in subjects with primary dysmenorrhea, suggesting the possibility that lipid peroxidation and oxidative stress play a significant role in the etiopathogenesis of primary dysmenorrhea. [source]

Discrepancies between clinical staging and pathological findings of operable cervical carcinoma with stage IB,IIB: A retrospective analysis of 818 patients

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009
Yu QIN
Introduction and objectives:, Cervical cancer is the only gynaecological cancer that is staged clinically. The clinical stage of cervical cancer relies largely on the pelvic examination. The aim of this study is to analyse the discrepancy between clinical stage and pathological results, and to explore the accuracy of pelvic examination. Methods:, We collected retrospective data from 818 patients with cervical carcinoma staged IB,IIB, who were treated with primary surgery from January 1999 to June 2007. Clinical stages of those patients were determined by pelvic examination without anaesthesia. After surgery, all the patients were assigned to pT category according to the pathological findings. Comparisons were made between these two stages. Results:, The total concordance between clinical stage and pT category for stage IB,IIB was 53.1%, with an overestimation of 37.3% and an underestimation of 9.7%. The concordance in stage IB1, stage IB2, stage IIA and stage IIB were 85.4%, 77.4%, 35.3% and 20.5%, respectively. The most significant discrepancy was caused by the failure to detect the parametrial invasion accurately in stage IIB. The accuracy of pelvic examination to determine vaginal and parametrial disease was 70.2% and 74.0%, respectively. Conclusions:, There are significant discrepancies between clinical stage and pathological results. Pelvic examination has its limitations in staging determination. Thus for operable cervical cancer, clinical stage alone is not reliable for selecting postoperative therapies and surgical staging system may be considered. [source]

Human papillomavirus prevalence and cytopathology correlation in young Ugandan women using a low-cost liquid-based pap preparation

DIAGNOSTIC CYTOPATHOLOGY, Issue 8 2010
Janis M. Taube M.D.
Abstract Screening for HPV-driven cervical dysplasia and neoplasia is a significant public health concern in the developing world. The purpose of this study was to use a manual, low-cost liquid-based Pap preparation to determine HPV prevalence in HIV-positive and HIV-negative young women in Kampala, Uganda and to correlate cervical cytopathology with HPV-DNA genotype. About 196 post-partum women aged 18,30 years underwent rapid HIV testing and pelvic examination. Liquid-based cervical cytology samples were processed using a low-cost manual technique. A DNA collection device was used to collect specimens for HPV genotyping. HIV and HPV prevalence was 18 and 64%, respectively. Overall, 49% of women were infected with a high-risk HPV genotype. The most common high-risk HPV genotypes were 16 (8.2%), 33 (7.7%), 35 (6.6%), 45 (5.1%), and 58 (5.1%). The prevalence of HPV 18 was 3.6%. HIV-positive women had an HPV prevalence of 86% compared to 59% in HIV-negative women (P = 0.003). The prevalence of HPV 16/18 did not differ by HIV status. HIV-positive women were infected with a significantly greater number of HPV genotypes compared to HIV-negative women. By multivariate analysis, the main risk factor for HPV infection was coinfection with HIV. HIV-positive women were four times more likely to have abnormal cytology than HIV-negative women (43% vs. 11.6%, P < 0.001). These data highlight that HIV infection is a strong risk factor for HPV infection and resultant abnormal cervical cytology. Notably, the manual low-cost liquid-based Pap preparation is practical in this setting and offers an alternate method for local studies of HPV vaccine efficacy. Diagn. Cytopathol. 2010;38:555,563. 2009 Wiley-Liss, Inc. [source]

Emergency Department Pelvic Examination and Pap Testing: Addressing Patient Misperceptions

Long-term results of Burch colposuspension

INTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2000
Haluk Akpinar
Abstract Background: We aimed to determine the long-term results of Burch colposuspension. Methods: Patients who had undergone Burch colposuspension due to stress urinary incontinence (SUI) in our department between 1991 and 1995 were asked to participate in the study by telephone or mail. Fifty of 78 patients (64%) responded and these formed the study group. Patients were evaluated by a detailed questionnaire, pelvic examination, uroflowmetry and postvoid residual urine determination. Provocative stress test and urodynamic evaluations were performed in those who claimed leakage. Additionally, follow-up charts were retrospectively reviewed from the patients' files. Results: Mean follow-up time was 50.6 months. The subjective cure rate was 52% and the surgical success rate was 84%. The patient satisfaction rate in terms of incontinence was 86%. No correlation was found between pre-operative patient characteristics (i.e. age, number of vaginal deliveries and pregnancies, menopause, previous anti-incontinence surgery and presence of detrusor instability) and outcome of surgery. Although no patient was performing clean intermittent catheterization in the long term, two patients had significant residual urine and obstructive flows. Three patients had severe pelvic prolapse that required surgical correction. Conclusions: Our results indicate that Burch colposuspension operation is an effective and durable choice of treatment with low complication rates for the treatment of SUI. [source]

Repair of vaginal vault prolapse and pelvic floor relaxation using polypropylene mesh,

NEUROUROLOGY AND URODYNAMICS, Issue 7 2005
Matthew P. Rutman
Abstract Aims The sacrouterine ligament/cardinal (SULC) complex and prerectal fascia attach at the perineal body, forming a single support unit preventing levator descent. Many patients with vault prolapse have levator descent and widening of the hiatus. Existing transvaginal procedures do not address pelvic floor descent. We describe a technique utilizing polypropylene mesh to repair pelvic floor relaxation and prevent levator descent, along with restoration of the SULC complex in vaginal vault repair. Materials and Methods We prospectively evaluated 50 patients who had a transvaginal mesh vault/posterior wall reconstruction. A T-shaped soft prolene mesh is prepared fixing the two arms of the mesh and recreating the SULC complex in support of the cuff. The vertical segment of the mesh is transferred over the prerectal fascia and secured to the pelvic floor musculature. The rectocele is repaired incorporating the mesh distally preventing pelvic floor descent. Surgical outcome was determined by patient self-assessment including quality of life (QoL) measure as well as pelvic examination using POP-Q staging. Results Mean age was 67 years. Mean follow-up was 6 months (range 3,12). There were no intraoperative complications. There have been two apical (4%) recurrences. Mean QoL score postoperatively on a 0,6 scale was 0.74 (0,=,delighted, 1,=,pleased). Pelvic floor descent has been repaired on all patients. Postoperative POP-Q reveals restoration of normal anatomy. Conclusions We report a new technique that recreates the SULC complex in support of the vaginal vault with the aid of prolene mesh. It is the first transvaginal procedure described to reconstruct the pelvic floor in attempt to prevent pelvic floor descent. Neurourol. Urdynam. © 2005 Wiley-Liss, Inc. [source]

Treatment of Lifelong Vaginismus in Traditional Islamic Couples: A Prospective Study

THE JOURNAL OF SEXUAL MEDICINE, Issue 4 2009
Aziz Yasan MD
ABSTRACT Introduction., As sexual values and the meaning of sexuality are culturally dependent, the efficacy of sex therapy models may not necessarily be similar across cultures. Aim., The aim was to address two questions; the first was to identify whether a group of patients with lifelong vaginismus living in traditional Islamic culture benefited from the sex therapy. The second question addressed was how Muslim culture affects sex therapy in the treatment of vaginismus. Methods., Data were obtained from all patients with lifelong vaginismus who attended an outpatient clinic in the course of 1 year. Forty-four couples were investigated in the initial session. Thirty-six couples who completed the treatment were assessed after 3 months. Main Outcome Measures., In the final evaluation, pleasurable full vaginal penetration after active penile insertion was accepted as a successful outcome treatment for the present study. Results., In the study, 36 patients who had completed treatment were determined, 29 of whom had successful outcome of treatment, while eight dropped out. The model building process variable resulted in "married by matchmaker without consent (OR = 0.060, CI = 0.046,0.771, P = 0.031)" and "not allowing pelvic examination (OR = 0.124, CI = 0.016,0.941, P = 0.044)" as negative predictors for successful outcome of treatment. Conclusion., Sex therapy is a feasible method of treatment for vaginismus within the cultural environment investigated, although some modifications may be needed in some setting such as for those married by matchmaker without their consent. Yasan A, and Akdeniz N. Treatment of lifelong vaginismus in traditional Islamic couples: A prospective study. J Sex Med **;**:**,**. [source]

Comparison of Vaginal Cytokine Collection Methods

AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 5 2006
Constance J. Faro
Objective The objective of our study was to correlate the interleukin-6 (IL-6) concentrations detected in patient-collected specimens with provider-collected specimens and compare the reproducibility of the methods. Study design All enrolled participants underwent pelvic examination with collection of cytokine samples by the provider and also collected samples themselves using vaginal swabs. The order of sample collection was randomly assigned. All samples were frozen at ,80°C for batch analysis. A commercial enzyme-linked immunosorbent assay was used to determine the concentrations of IL-6 in all samples. Results IL-6 concentrations from wicks and swabs were correlated in a linear fashion (r = 0.67, P < 0.001). IL-6 concentrations in the two swabs (r = 0.94, P < 0.001) and the two wicks (r = 0.71, P < 0.001) were correlated in a linear fashion, although there was more variability in wick specimens. Conclusion IL-6 concentrations can be reproducibly measured using either method. The ease of patient swab collection and the correlation with provider-collected specimens may make frequent assessment of the vaginal cytokine environment more acceptable to patients. [source]

Self-administered Vaginal Swabs Are a Feasible Alternative to Physician-assisted Cervical Swabs for Sexually Transmitted Infection Screening in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 4 2009
Nicole Berwald MD
Abstract Background:, Screening for sexually transmitted infections (STIs) in the emergency department (ED) is limited by the need for pelvic examination. It has been suggested that using self-administered vaginal swabs (SAVS) for this purpose may save time and resources and may be more comfortable for patients. Objectives:, The objective was to test the feasibility of using SAVS for STI screening in the ED. Methods:, This was a prospective study of female ED patients 18 to 55 years old who consented to physician-assisted cervical swab (PACS) and SAVS in two urban teaching hospitals. The ED personnel offered the test to all patients, whether or not a pelvic examination was indicated, based on their chief complaint. All specimens were analyzed by polymerase chain reaction (PCR) assay. Data are presented as mean ± standard deviation (SD). Categorical data are presented as percentages with 95% confidence intervals (CIs). Patients with a positive test result for Chlamydia trachomatis and/or Neisseria gonorrhoeae were considered positive for STI. PACS were used as the criterion standard. Results:, One-hundred sixty-two subjects were enrolled from July 2006 to July 2007 (mean [±SD] age = 32 [±10] years). Eighty-one percent of patients had a genitourinary symptom (most common: vaginal bleeding/spotting). SAVS had a sensitivity of 91% (95% CI = 60% to 99%), specificity of 99% (95% CI = 95% to 99%), positive likelihood ratio of 91, and negative likelihood ratio of 0.09 in diagnosing STIs. None of the patients reported difficulty or discomfort using this technique. Conclusions:, Self-administered vaginal swabs can be utilized as a feasible alternative to PACS for STI screening in the ED. [source]

Population screening and early detection of ovarian cancer in asymptomatic women

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009
Anne E. NELSON
The National Breast and Ovarian Cancer Centre position statement: ,Population screening and early detection of ovarian cancer in asymptomatic women', was developed and agreed following a Forum in February 2009 attended by key Australian stakeholders. The final position statement and supporting background information have been endorsed by key Australian colleges and agencies. Position statement on population screening and early detection of ovarian cancer in asymptomatic women 1There is currently no evidence that any test, including pelvic examination, CA125 or other biomarkers, ultrasound (including transvaginal ultrasound), or combination of tests, results in reduced mortality from ovarian cancer. 2There is no evidence to support the use of any test, including pelvic examination, CA125 or other biomarkers, ultrasound (including transvaginal ultrasound), or combination of tests, for routine population-based screening for ovarian cancer. 3Further validation in large clinical trials is required before current or new biomarkers could be recommended for routine use in a population screening setting. [source]

Discrepancies between clinical staging and pathological findings of operable cervical carcinoma with stage IB,IIB: A retrospective analysis of 818 patients

Prediction of findings at defecography in patients with genital prolapse

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2005
Jan-Paul W.R. Roovers
Objective Defecography may be useful in pre-operative assessment of patients with genital prolapse. Defecography is an invasive and embarrassing procedure for patients and little effort has been made to optimalise selection criteria for defecography. This study investigated whether discrimination of high and low probability of abnormal defecography is possible based on the quantified findings from patient history, pelvic examination and a validated questionnaire. Design Prospective observational study. Setting Three teaching hospitals in The Netherlands. Population Eighty-two patients undergoing surgical correction of uterine prolapse Stages 2,4. Methods A history and pelvic examination were obtained from all patients. A validated questionnaire was used to assess the presence of defecation and micturition symptoms. Using multivariate logistic regression analyses with receiver operating characteristic curves, a diagnostic model to predict the presence of an abnormal defecography was systematically constructed and validated. Main outcome measure Presence of abnormal finding at defecography. Results The most important predictors for abnormal defecography were prolapse of the posterior vaginal wall, history of abdominal or pelvic surgery and the presence of constipation. With these variables, a prediction rule could be constructed which predicted the prevalence of an abnormal defecography (area under curve = 0.73; 95% CI 0.61,0.83). Conclusions This study shows that a diagnostic model based on findings obtained from a non-invasive workup can accurately predict the presence of an abnormal defecography. Such a model provides the possibility to tailor the request for defecography to the individual patient. [source]