Objective To understand the physical and emotional impact of postmenopausal vaginal discomfort on relationships between women and their male partners. Study design In a quantitative, Internet-based survey, 8200 individuals from the UK, Denmark, Sweden, Norway, Finland, France, Italy, US and Canada (postmenopausal, married/cohabiting women, aged 55–65 years, who had experienced vaginal discomfort, and male partners of such women) completed a structured questionnaire. Main outcome measures Results for respondents from the UK (500 men, 500 women), expressed as percentages of women/men describing particular answers, are reported. Results Avoiding physical intimacy because of vaginal discomfort was reported by 69% of women and 76% of male partners, mainly due to concern about sex being painful (women 63%; men 61%); 18% of women considered vaginal discomfort had created emotional distance between them and their partners. Local estrogen treatment was used by 21% of women, among whom 58% subsequently reported less painful sex. Following such treatment, 33% of women and 30% of male partners reported an improved sex life, while 33% of women and 34% of male partners described becoming emotionally closer. Although 73% of women did not consider enough information about vaginal discomfort to be available, 60% would consult a physician to obtain this. Conclusions Although vaginal discomfort has a substantial impact on postmenopausal women and their partners, improvements in sexual and emotional relationships can follow use of local estrogen therapy. Not all women may be aware of therapeutic options; healthcare providers can improve outcomes by more openly communicating and initiating discussion with patients.
Objectives To describe the attitudes and perceptions of postmenopausal women from the United Kingdom regarding menopause, vulvo-vaginal atrophy and its therapeutic management. Study design Post hoc analysis of the United Kingdom population from the REVIVE-EU Study. Main outcome measures The survey contained questions about women’s knowledge of menopause and vulvo-vaginal atrophy symptoms, impact on their life and sexual activities, communication with healthcare professionals and treatments. Results The most frequent symptom of menopause was hot flushes (75%). Vulvo-vaginal atrophy symptoms had a significant impact on participants’ ability to enjoy sexual intercourse (66%), spontaneity (62%) and ability to be intimate (61%); however, only 68% of women had been to their healthcare professional for advice. Half of the sample expected that doctors would initiate a discussion of menopausal symptoms and sexual health, but was in fact rare (5%). Only 27% were under current treatment without a clear therapy pattern, of which 43% used vaginal over-the-counter treatments, 28% prescription (Rx), and 13% both. Efficacy was the main limitation for over-the-counter treatments, while for Rx products were side effects and safety. Women highlighted the restoring of the natural condition of the vagina as the main goal for a treatment (35%). Many United Kingdom women did not feel the need to see any healthcare professional for their gynaecological symptoms. Overall satisfaction with treatment was only 44%. Conclusions Vulvo-vaginal atrophy remains underdiagnosed and undertreated in United Kingdom. There is a lack of coherent discussion about vulvo-vaginal atrophy symptoms with clinicians. Many United Kingdom healthcare professionals could improve proactive communication with patients about vulvo-vaginal atrophy.
Non-consummation of a relationship often presents late with embedded behaviours that may take time to resolve. Vaginismus may have always been present and contribute to unsuccessful sexual relationships or develop after a traumatic experience, recognised or unrecognised. Referral from primary care to the psychosexual clinic or gynaecology clinic depends on the general practitioner or practice nurse's perception of the causes of the non-consummation or vaginismus. One young woman presented to a gynaecology clinic with vaginismus associated with a history of frequent examinations by gynaecologists as a child, when she was found to have an 'interesting' combination of uterine and vaginal anomalies that required several operations. Skin and mucosal conditions are frequently associated with dyspareunia and therefore secondary vaginismus. There are many chronic pain conditions that will cause a secondary protective response which can result in vaginismus. A psychological response may logically be protection from sexual activity by loss of libido and/or sexual pain due to vaginismus.
Abstract Background Female sexual dysfunction (FSD), including vaginal laxity (VL), can lead to a decrease in quality of life and affect partner relationships. Aim We aimed to investigate the associated factors of VL and FSD and their relationship with other pelvic floor disorders in a female population. Methods This cross-sectional study was conducted at Chelsea and Westminster Hospital from July to December 2022. All women referred to clinical care at the urogynecology clinic were included. Participants were assessed according to sociodemographic and clinical aspects, the Pelvic Organ Prolapse Quantification system, sexual function, VL, sexual attitudes, sexual distress, sexual quality of life, vaginal symptoms, and pelvic floor disorders. Unadjusted and adjusted associated factors of VL and FSD were analyzed. Outcomes The primary outcome was the identification of the associated factors of VL and FSD in a female population, and secondary outcomes included the association between VL and pelvic organ prolapse (POP) with the questionnaire scores. Results Among participants (N = 300), vaginal delivery, multiparity, perineal laceration, menopause, and gel hormone were significantly more frequent in those reporting VL (all P < .05). When compared with nulliparity, primiparity and multiparity increased the odds of VL by approximately 4 and 12 times, respectively (unadjusted odds ratio [OR], 4.26 [95% CI, 2.05-8.85]; OR, 12.77 [95% CI, 6.53-24.96]). Menopause and perineal laceration increased the odds of VL by 4 and 6 times (unadjusted OR, 4.65 [95% CI, 2.73-7.93]; OR, 6.13 [95% CI, 3.58-10.49]). In multivariate analysis, menopause, primiparity, multiparity, and POP remained associated with VL. Clinical Implications Parity, as an obstetric factor, and menopause and staging of POP, as clinical factors, were associated with VL. Strengths and Limitations The investigation of associated factors for VL will contribute to the understanding of its pathophysiology. The study design makes it impossible to carry out causal inference. Conclusion Menopause, primiparity, multiparity, and POP were highly associated with VL complaints in multivariate analysis.
A summary is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content.
Heterotopic pregnancy is a well-established complication of assisted reproductive technology. We report a case of intrauterine pregnancy combined with abdominal pregnancy diagnosed at 12 weeks in a 37-year-old nulliparous woman. Following surgical resection of the ectopic, implantation of hemorrhagic ectopic trophoblastic tissue onto bowel serosa, mesentery and omentum persisted. Due to the high risk of additional bleeding, systemic methotrexate was administered to the patient. The intrauterine pregnancy progressed well and a live infant was born at 27(+3) weeks. In such difficult cases, systemic methotrexate appears to have therapeutically helpful effects at low dosing regimens without immediate fetal toxicity.
A summary is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content.
Patient-reported outcome measures to assess sexual function are perhaps those of most significant value as this sphere of activity is one of the most difficult in which to capture information that is meaningful. Traditionally, gynecologists and urologists have asked questions to their patients pertaining to sex, which are comfortable for both to ask and answer. The enquiry may be directed to areas perceived by clinicians as influenced by the disease or condition and that may reasonably be expected to improve with intervention. Designing instruments to measure sexuality requires a model to promote the understanding of female (and male) sexuality and its deviations. The International Consensus Group model of female sexuality indicates that a spontaneous sexual drive to be involved in sexual activity does not need to be present for satisfactory relationships to be maintained.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
