The swedish law against female genital mutilation (FGM) prohibits procedures that removes parts of the female genitalia and thereby makes permanent changes in the body. The problem with the wording of the law is that it may also apply to the western phenomenon cosmetic genital surgery. This paper therefore examines if cosmetic genital surgery should be covered by the swedish law against FGM, by making a critical comparing analysis. The paper begins with comparing FGM with cosmetic genital surgery to prove that there are more similarities than differences between the procedures. By using the theoretical perspectives universalism and postcolonialism, the paper then examines why, particularly in the West, there is a different approach to FGM than to cosmetic genital surgery, regardless of the similarities of the procedures. Further the paper also examines consent and why consent to FGM is seen as illegitimate while consent to cosmetic genital surgery is seen as legitimate. On basis of the critical comparing analysis the paper then argues: that the procedures cosmetic genital surgery and FGM are very much alike; that cosmetic genital surgery is accepted over FGM because it is more familiar in the West and; that consent should be as illegitimate when given to cosmetic genital surgery as when given to FGM. Thus the conclusion of the paper is that cosmetic genital surgery should be covered by the swedish law against FGM.

The genital ambiguity arises within the family and the health team as an emergency; the physical impairment of the child's genitalia impossible to identify whether it is a boy or a girl. From experience in a clinical genetics service, based on listening to parents of children with ambiguous genitalia, the interest of this work arises, which has to analyze how the parents of children with ambiguous genitalia deal with this genetic condition of their children. For the preparation of this work was used as a method to study cases, these built from calls made reports to parents of children with ambiguity. Thus were prepared two clinical case studies from psychoanalysis theoretical framework, covering the research objective. As a result the present study observed by clinical case studies that how every family, mother and father deal with the condition of genital ambiguity of their children occurs in a particular way; through the experiences that parents experience at the birth of these children, promotes particular forms incorporate this genetic condition. As the case studies pointed to each of the families read a particular way, by a doubt, others in the constitution of a family secret, and it is from this background that the subject child is. / A ambiguidade genital surge no contexto familiar e na equipe de saúde como uma emergência; o comprometimento físico da genitália da criança impossibilita identificar se a mesma é um menino ou uma menina. A partir da experiência em um serviço de genética clínica, com base na escuta a pais de crianças com ambiguidade genital, surge o interesse do presente trabalho. O mesmo tem como objetivo analisar de que forma os pais de crianças com ambiguidade genital lidam com esta condição genética de seus filhos. Para a elaboração do presente trabalho foi utilizado como método o estudo de casos, estes construídos a partir de relatos de atendimentos realizados a duas mães. Desta forma foram elaborados dois estudos de casos clínicos a partir do referencial teórico da psicanálise. Os resultados demonstram que cada família lida com a ambiguidade genital de seus filhos de forma particular; uma através da dúvida, outra pela constituição de um segredo familiar.

Resumo: A proposta do presente estudo foi estabelecer a prevalência de infecções do trato genital inferior em gestantes de baixo risco da Estratégia de Saúde da Família da Atenção Primária em Saúde em Botucatu, Estado de São Paulo-Brasil, e avaliar a relação de sinais e sintomas em infecções no trato genital inferior. Um total de 245 gestantes foi selecionado neste estudo, e durante o exame, o aspecto do corrimento e pH vaginal foram observados. Swabs foram utilizados para coletar secreções vaginais das paredes laterais da vagina para um esfregaço vaginal. O diagnóstico clínico foi baseado na combinação de sintomas e sinais, aferição de pH vaginal, realização do teste de aminas e exames laboratoriais. A taxa geral de infecção de diagnósticos clínicos foi de 45,7%. Vaginose bacteriana foi diagnosticada em 53 mulheres grávidas (21,6%), candidíase vaginal em 25 (10,2%), flora intermediária em 13 (5,2%), vaginite aeróbia em sete (2,9%), infecção mista em sete (2,9%) e outros achados em 2,9%. Entre as mulheres com sintomas e/ou sinais de infecções no trato genital inferior, 22,3% das mulheres foram diagnosticadas com vaginose bacteriana; 14,6% como candidíase vaginal; 5,7% como flora intermediária; 1,9% como vaginite aeróbia, 3,8% como infecção mista e 3,2% com outros achados, mas em 48,4% não foram identificadas infecções. A prevalência de infecções do trato genital inferior em mulheres grávidas de baixo risco na Estratégia de Saúde da Família da Atenção Primária em Saúde é alta e nossos resultados sugerem que somente sintomas não deveriam ser utilizados para tratamento direto. A melhor prática para as infecções do trato genital inferior em gestantes deveria combinar os sinais ou sintomas e exames laboratoriais. / Abstract: The purpose of the present study was to establish the prevalence of lower genital tract infection in low risk pregnant women of the Family Health Strategy of the Primary Care Services in Botucatu, São Paulo State, Brazil, and to evaluate the correlation of signs and symptoms to lower genital tract infections. Patients and Methods: A total of 245 pregnant women were enrolled in this study and during the exam, the appearance and pH of the vaginal discharge were noted. Swabs were used to obtain vaginal secretion from the upper lateral vaginal vault for a vaginal smear. The clinical diagnosis were based by combining the symptoms and signs with office-based testing and laboratory exams. Results: The overall infection rate by clinical diagnosis was 45.7%. Bacterial vaginosis was diagnosis in 53 pregnant women (21.6%), vaginal candidiasis in 25 (10.2%), intermediate vaginal flora in 13 (5.2%), aerobic vaginitis in 7 (2.9%), mixed infection in 7 (2.9%) and another findings in 2.9%. Among women with symptoms and/or signals of the lower genital tract infection, 22.3% of the women were diagnosed as having bacterial vaginosis; 14.6% as vaginal candidiasis; 5.7% as having intermediate vaginal flora; 1.9% as aerobic vaginitis, 3.8% as having mixed infection, 3.2% another infection but in 48.4% no infection was identified. The prevalence of lower genital tract infection in low-income pregnant women attended in the Family Health Strategy of the Primary Care Services is high and our results suggest that symptoms alone should not be used to direct treatment. The best practice guideline to lower genital tract infections in pregnant women should take the combining symptoms or signs and laboratory exams. / Orientador: Marilza Vieira da Cunha Rudge / Coorientador: Márcia Guimarães da Silva / Banca: Antonio Hélio Oliani / Banca: João Martinez de Oliveira / Mestre

El estudio determina las principales causas de dolor pélvico crónico en mujeres intervenidas laparoscopicamente en el Hospital EsSalud Angamos en el período comprendido entre enero 2001 - diciembre 2005. Para ello, se revisó 236 historias clínicas de los cuales 218 cumplieron con los criterios de inclusión. Entre los resultados se encontró que los diagnósticos laparoscópicos mas frecuentes encontrados fueron el síndrome adherencial y la endometriosis. Asimismo, la adhesiolisis fue el procedimiento quirúrgico mas frecuente. El dolor pélvico crónico puede ocurrir en pacientes en edad promedio de 33 años y la evolución del dolor en seis meses va en disminución en comparación a la evaluación del dolor al mes del procedimiento. / Tesis

Thirty five million people are currently living with HIV-1 today with women accounting for half of infected individuals globally. Sexual transmission is the main route of HIV transmission with approximately 40% of HIV infections occurring when the mucosal lining of the female genital tract (FGT) is exposed to HIV in semen from an infected male partner. Seminal plasma (SP), the fluid portion of semen, is a complex fluid which plays an immunomodulatory role in the FGT for successful conception, largely due to its high concentrations of TGF-β1. Several factors in SP from HIV-uninfected men have been shown to either inhibit or enhance HIV infection in target cells, however it is not clear how SP from HIV infected men would modulate genital epithelial cells (GECs), the first cells that encounter HIV in the FGT. The overall goals of this thesis were to compare inflammatory and regulatory cytokine concentrations in SP from HIV-uninfected and infected men, and subsequently compare GEC cytokine responses following exposure to SP from HIV-uninfected and HIV-infected men. I also investigated how SP and TGF-β regulated cytokine production and barrier function in GECs in the presence of HIV. The results summarized in this thesis demonstrated that HIV infection leads to different cytokine profiles in SP, based on stage of HIV-1 infection. HIV-infected men in acute stage contained higher levels of proinflammatory cytokines in their SP compared to HIV-uninfected and chronically infected men (CI men) which subsequently lead to higher levels of proinflammatory cytokines from GECs compared to CI men. In the follow up to this study we found that active TGF-β, which was found in higher concentrations in SP from CI men and led to decreased inflammatory response from GECs, was compartmentalized between blood plasma and seminal plasma. Higher levels of active TGF-β in SP correlated with decreased semen viral load and the immune activation marker sCD14 leading us to believe that ART-naive CI men in our cohort were naturally controlling their immune activation status, as active TGF-β levels were lower in ART-treated men. Short-term exposure of GECs to SP from CI men or TGF-β at comparable concentrations to SP protected the GEC barrier against HIV by decreasing inflammatory cytokines and preventing tight junction breakage. However, long-term exposure to TGF-β in the presence of HIV further increased inflammation in GECs suggesting a biphasic role for TGF-β in the FGT. This body of work summarized in this thesis demonstrates for the first time how semen from HIV-infected men modulates FGT epithelial cell cytokine responses and barrier function, an important consideration in the design of local therapeutic strategies to protect the FGT against HIV infection. / Thesis / Doctor of Philosophy (Medical Science)

Bovine Genital Campylobacteriosis is characterized by early pregnancy loss and temporary infertility in cattle. The purpose of this project was to compare diagnostic approaches to detect Campylobacter fetus subsp. venerealis and evaluate the efficacy of vaccination for Bovine Genital Campylobacteriosis. This thesis describes the results of two studies that compared different sample preparation methods for bovine vaginal mucus for real-time PCR and assessed a commercial vaccine in preventing infection and reproductive loss. The first study compared real-time PCR utilizing different bovine vaginal mucus sample preparation techniques to direct culture. The magnetic bead based protocol demonstrated higher sensitivity (48.4%, P=0.02) and lower specificity (78.9%, P=0.01) than the heat lysis protocol which involved an additional dilution step (Sens=29.4%, Spec=88.2%), but did not differ from the heat lysis protocol without sample dilution (Sens=35.0%, P=0.16; Spec=81.1%, P=0.62). The sample preparation method, designed for bovine preputial samples (Chaban et al. 2012. Can J of Vet Res; 76: 166), did not work well for vaginal mucus. All modifications of that method and magnetic bead based extraction technique had low sensitivity compared to culture probably due to the biophysical properties of vaginal mucus, which could cause loss of targeted DNA during processing, or repeated sample freezing and thawing. Release of DNA directly from vaginal mucus by a modified heat lysis protocol with consequent real-time PCR could be a promising rapid screening approach after validating on fresh samples. The second study compared the risk of infection and reproductive failure in heifers, vaccinated with a commercial multivalent vaccine containing C. fetus antigen, to heifers vaccinated with a comparable product without C. fetus, that were exposed to infected bulls. There was no significant difference between groups either in risk of Campylobacter fetus subsp. venerealis isolation (P>0.17) or in the proportion of heifers that cultured positive at least once (P=0.42), as well as in the median number times of cultured positive samples (P=0.24) and the time to first cultured positive (P=0.67). There was no difference by treatment in the weekly proportions of heifers diagnosed pregnant by either ultrasound (P>0.31) or serum concentration of pragnancy specific protein B (P>0.31) during the study, as well as in the time to first pregnancy for heifers ever diagnosed as pregnant (P=0.30) and those that remained pregnant at the end of the study (P=0.70). Similarly, the difference was not detected by treatment in the proportion of animals, ever detected pregnant during the study (P=0.57) and in pregnancy loss rates (P=0.28). However, heifers that aborted were 4 times more likely to be cultured positive than those that did not abort (P=0.01). Heifers that were not pregnant at the end of the study cultured positive 1.5 times more often than pregnant animals in treatment group (P=0.04), while in control group such difference was 4 times (P=0.01). Heifers that were not pregnant at the end of the study did not differ by treatment in the number of times cultured positive (P=0.14). In this study, the mean concentrations of ELISA antibodies to C. fetus after vaccination were more than 2 times higher in treatment group than in control group (P<0.02), but vaccination did not significantly reduce infection or improve pregnancy in heifers when exposed to Cfv-infected bulls. Sample preparation technique is important for successful real-time PCR; release of DNA directly from a CVM sample by a modified heat lysis protocol was easy to perform and could be promising as a rapid screening approach for Bovine Genital Campylobacteriosis after validating on fresh samples. Vaccinating of heifers with a polyvalent commercial vaccine, containing Campylobacter fetus antigen, according to the label, did not significantly reduce infection rate or improve reproductive performance when they were naturally challenged.

La infección por Chlamydia trachomatis es la infección de transmisión sexual bacteriana más frecuente en todo el mundo. La Organización Mundial de la Salud estima que 90 millones de casos ocurren a nivel mundial. El objetivo de este estudio fue evaluar el desempeño de la prueba rápida HEXAGON CHLAMYDIA para el diagnóstico de infección por Chlamydia trachomatis en muestras de secreción endocervical de mujeres usuarias que asisten al consultorio de planificación familiar del “Hospital Nacional Dos de Mayo” y trabajadoras sexuales del servicio PROCETTS del Centro de Salud “Alberto Barton”. Se estudiaron un total de 101 muestras de secreción endocervical, 50 muestra de mujeres que asistieron al consultorio de planificación familiar del “Hospital Nacional Dos de Mayo” y 51 muestras de trabajadoras sexuales del servicio PROCETTS del Centro de Salud “Alberto Barton”. A todas las mujeres se les tomó dos muestras de secreción endocervical, una de las muestras fue procesada por la prueba rápida inmunocromatografica HEXAGON CHLAMYDIA en evaluación y la otra por una prueba validada de amplificación de los ácidos nucleicos (nucleic acid amplification, NAATs, por sus siglas en inglés): APTIMA COMBO 2 basada en la metodología de amplificación mediada por transcripción (transcription mediated amplification, TMA, por sus siglas en inglés) Se detectaron 4 casos de infección por C. trachomatis, todos estos casos se encontraron en el grupo de usuarias del consultorio de planificación familiar mientras en el grupo de trabajadoras sexuales no se encontró ninguno. La sensibilidad y la especificidad de la prueba rápida HEXAGON CHLAMYDIA fue 75% y 84,5%.El valor predictivo positivo fue 16,7% y el valor predictivo negativo fue 98,7%. El valor Kappa fue 0,21. La prueba rápida HEXAGON CHLAMYDIA en este estudio tuvo un pobre desempeño al ser comparada con la prueba APTIMA COMBO 2

Female genital mutilation (FGM) has been illegal in Tanzania since 1998; nonetheless this procedure is still being performed in some regions of the country. Since the prohibition of this practice it has become harder to detect the practitioners. Nurses are one of the professions who can identify the women who have been exposed to FGM, which creates an opportunity to provide care for these women and educate them about the practice. The aim of this study is to describe Tanzanian nursing students’ views on FGM. Data was collected with focus group interviews with second and third year students at a nursing school in northwest Tanzania. Data was analysed inductively by content analysis. The results, the students’ views on FGM, were categorised into four themes; ‘FGM creates suffering’, ‘the right to sexual integrity’, ‘the role of nurses’ and ‘educating the patient and the community’. The findings clearly demonstrate that the students’ negative attitudes toward the practice are based on their knowledge of its harmful implications on health. For further research, it may be of interest to study nursing students’ views of the practice in more FGM-prevalent regions of Tanzania. / <p>Röda Korsets sjuksköterskeförening stipendium 2017</p>

El presente estudio tuvo como objetivo evaluar el efecto de los estadíos de desarrollo folicular: crecimiento, estático y regresión del folículo dominante al momento de la cópula, sobre la ovulación y sobrevivencia embrionaria en alpacas. Se utilizaron 116 alpacas con descanso post parto ³ 15 días, a las que se realizó evaluaciones con un ecógrafo Aloka SSD 500 y transductor lineal 7.5 MHz, para distribuirlas al azar a uno de los 4 grupos siguientes: G1 (folículo dominante en estadío de crecimiento, diámetro 6 mm), G2 (folículo dominante en estadío de crecimiento, diámetro ³ 7 £ 12 mm), G3 (folículo dominante en estadío estático, diámetro ³ 7 mm) y G4 (folículo dominante en estadío de regresión, diámetro ³7 mm). Posteriormente, fueron sometidas a empadre controlado dirigido, a excepción de 5 alpacas del grupo G1 que rechazaron al macho. El día del empadre fue considerado el día 0 y las evaluaciones ecográficas posteriores se realizaron en los días 2 (ocurrencia de ovulación), 9 (presencia y tamaño del cuerpo lúteo), 20, 25, 30 y 35 (presencia de vesícula embrionaria y/o embrión). En los días 0 y 15 post cópula se realizó la prueba de receptividad sexual. El 97,3% de los alpacas que fueron empadradas (n=111) presentaron ovulación al día 2 post cópula, sin diferencia significativa (p<0.05) entre los 4 grupos (G1=95.45%, G2=96.67%, G3=100% y G4=96.56%). La tasa de sobrevivencia embrionaria no presentó diferencia significativa entre grupos, pero hubo una tendencia a una mayor tasa de sobrevivencia para el grupo G2 (65,52%) en comparación con los grupos G1(52,38 %), G3(53,33 %) y G4(42,86 %) al día 35 post cópula. En el día 9 post cópula, no se encontraron diferencias significativas en el tamaño promedio del cuerpo lúteo entre los grupos (G1= 10.28 ± 1.74mm, G 2 =11.72 ± 1.73mm, G3= 11.07 ± 1.96mm, G4 = 11.11 ± 2.23mm). Estos resultados indicarían que el estadío del desarrollo folicular al momento de la monta no tendría efecto significativo sobre la tasa de ovulación y sobrevivencia embrionaria en alpacas. / The objective of this study was to evaluate the effects of growth, static and regression stages of the dominant follicle during mating, on the ovulation and the embryonic survival in alpacas. 116 female alpacas with a post-partum resting period ³ 15 days were used. The alpacas were evaluated with an ultrasound scanner Aloka SSD 500 with a 7.5 MHz transrectal transducer in order to distribute them randomly in one of the following 4 groups: G1 (dominant follicle in growth stage, diameter of 6 mm), G2 (dominant follicle in growth stage, diameter ³ 7 £ 12 mm), G3 (dominant follicle in static stage, diameter ³ 7 mm) and G4 (dominant follicle in regression stage, diameter ³ 7 mm). Subsequently, all the alpacas were mated with a male, except 5 alpacas of group G1 that rejected the male. The mating day was considered day 0, thus the subsequent ultrasound evaluations were carried out on days 2 (ocurrence of ovulation), 9 (presence and size of the corpus luteum); 20, 25, 30 and 35 (presence of the embryonic vesicle and/or the embryo). On days 0 and 15, the sexual receptiveness test was performed. 97.3% of alpacas that were mated (n=111) presented ovulation, but no significant differences (p<0.05) among the study groups (G1=95.45%, G2=96.67%, G3=100% and G4=96.56%) were observed. The embryonic survival rate was also not significantly different among the groups, but there was a tendency to a greater rate of survival for the group G2 (65.52%) in comparison with groups G1 (52.38%), G3 (53.33%) and G4 (42.86%) on day 35 after mating. On day 9, no significant difference in the average size of the corpus luteum was observed among the groups (G1 = 10.28 ± 1.74mm, G 2 =11.72 ± 1.73mm, G3 = 11.07 ± 1.96mm, G4 = 11.11 ± 2.23mm). These results suggest that the stage of the follicular development during mating does not have a significant effect on the rate of ovulation and embryonic survival in alpacas.

Objetivos: Comprender el significado de la disfunción sexual femenina no orgánica desde los discursos de las mujeres adultas tempranas atendidas en un establecimiento del Ministerio de Salud de Lima Metropolitana 2013. Materiales y Métodos: Diseño metodológico cualitativo fenomenológico. La muestra está constituida por diecisiete mujeres adultas tempranas con disfunción sexual femenina de origen no orgánico con tiempo de convivencia mayor a un año determinada por punto de saturación. Se utilizó una guía de entrevista a profundidad en base a los objetivos del estudio. Resultados Y discusiones: La presente investigación permitió la identificación de las siguientes categorías: vivencias experimentadas durante la niñez en mujeres con disfunción sexual, vida cotidiana en pareja, vivencias relacionadas al acto sexual en la mujer con disfunción sexual, sentimientos de las mujeres respecto a la disfunción sexual , importancia que la mujer le brinda a la disfunción sexual, cómo afronta la mujer la disfunción sexual, razones atribuidas por la mujer a la disfunción sexual, repercusiones de la disfunción sexual femenina, motivaciones en la vida de la mujer con disfunción sexual, temores en la vida de la mujer con disfunción sexual. El significado que las mujeres le dan a la disfunción sexual femenina está en relación a la importancia, sentimientos y la forma como afronta el problema. Consideraciones finales: El significado de vivir con disfunción sexual femenina para las mujeres adultas tempranas es que la disfunción sexual es una condición no normal, que requiere ayuda, mas no es considerada completamente como una enfermedad. Palabras clave: Disfunción sexual femenina no orgánica, adultas tempranas, investigación cualitativa.