A capacidade de contração dos músculos do assoalho pélvico (MAP) está diretamente relacionada a viabilidade de realizar o seu treinamento. A literatura até hoje não traz informações a respeito da capacidade das mulheres estimarem sua própria contração dos músculos do assoalho pélvico. Os objetivos deste estudo foram avaliar a auto-percepção de mulheres da contração dos MAP e de sua intensidade, os relatos de sintomas de disfunções dos MAP, e avaliar a correlação entre os relatos de sintomas de disfunção dos MAP e a auto-percepção da contração muscular. Trata-se de um estudo observacional transversal conduzido no Centro de Saúde Escola Dr. Joel Domingos Machado de agosto de 2016 a abril de 2018. Foram recrutadas mulheres residentes em Ribeirão Preto com idades acima de 18 anos. A escala de Oxford modificada (EOM) foi utilizada como medida de desfecho para avaliar a percepção da contração dos MAP pelas mulheres. Uma avaliadora cega em relação a percepção da contração pelas participantes realizou o exame da função dos MAP utilizando o mesmo instrumento. Os sintomas de disfunção dos MAP foram avaliados por meio dos questionários validados International Consultation on Incontinence Questionnaire on Urinary- Short Form (ICIQ-SF), Pelvic Organ Prolaps/ Urinary Incontinence Sexual Questionnaire (PISQ-12), Pelvic Organ Prolaps Impact Questionnaire (PFIQ-7) e Pelvic Organ Prolaps Distress Inventory (PFDI- 20). Os seguintes testes foram utilizados na análise estatística: coeficiente de correlação de concordância de kappa ponderado, o coeficiente de correlação de Pearson e o teste exato de Fisher. As análises estatísticas foram realizadas utilizando o software estatístico SPSS 22. Os valores de p<=0,05 foram considerados estatisticamente significativos. Foram recrutadas 163 mulheres da cidade de Ribeirão Preto, destas 81 não comparecem para avaliação e 82 foram incluídas na pesquisa. A média de idade das mulheres foi de 46,83 (±17,94), 34 (41,5%) eram casadas, 59 (71,9%) brancas, 38 (46,4%) com 8 á 11 anos de escolaridade, multíparas com uma média de 2,17 gestações, 45 (54,9%) não apresentavam sintomas de IU e 77 (93,9%) nunca realizaram o treinamento dos MAP. As mulheres apresentaram uma baixa auto-percepção de contração dos MAP, somente 33% acertou corretamente a intensidade da sua contração. A avaliação da contração dos MAP por meio da palpação vaginal não apresentou uma concordância mínima com a auto percepção(p=0,087/?=0,139). A auto-percepção não apresentou correlação com os sintomas de disfunções através dos questionários PFDI-20, PFIQ-7, ICIQ-SF e PISQ-12. A avaliação da contração muscular apresentou uma correlação fraca negativa com o questionário PFDI-20 nos domínios IU (rs=-0,315/p=0,004), POP (rs=-0,330/p=0,002) e escore total (rs=0,387/p=0,000), uma correlação fraca negativa com o questionário PFIQ-7 nos domínios IU (rs=-0,320/p=0,003), POP (rs=-0,244/p=0,027) e escore total (rs=- 0,329/p=0,003). Uma correlação fraca positiva com o questionário de função sexual PISQ-12 (rs=0,360/p=0,008) e uma correlação negativa moderada com o questionário ICIQ-SF de sintomas de incontinência urinária (rs=-0,406/p=0,000). Concluiu-se que as mulheres dessa amostra apresentaram uma baixa auto-percepção da contração dos MAP, somente 33% estimou corretamente a sua contração muscular. / The ability to perform a pelvic floor muscles (PFM) contraction is directly related to the feasibility of performing their training. To date the literature does not provide information regarding to women\'s ability to estimate their own PFM contraction. This study aims to assess women\'s self-perception of PFM contraction and its intensity, the prevalence of PFM dysfunction symptoms, and to analyse the relation between these symptoms and self-perception of muscle contraction. This is a cross-sectional observational study conducted at Dr. Joel Domingos Machado School Health Center from August, 2016 to April, 2018. Women living in Ribeirão Preto aged above 18 years were recruited. The modified Oxford scale was used as an outcome measure to assess women\'s perception of PFM contraction. A blind evaluator regarding to women\'s self-perception of PFM contraction assessed PFM function using vaginal palpation to classify it with same instrument. PFM dysfunction symptoms were assessed using the following validated questionnaires International Consultation on Incontinence Questionnaire on Urinary- Short Form (ICIQ-SF), Pelvic Organ Prolaps/ Urinary Incontinence Sexual Questionnaire (PISQ-12), Pelvic Organ Prolaps Impact Questionnaire (PFIQ-7) e Pelvic Organ Prolaps Distress Inventory (PFDI-20). Weighted kappa concordance correlation coefficient, Pearson\'s correlation coefficient and Fisher\'s exact test were used in the statistical analysis. SPSS 22 statistical software was used and values of p<=0.05 were considered statistically significant. A total of 163 women were recruited, 81 did not attend for evaluation and 82 were included in the study. The mean age of the participants was 46.83 (± 17.94), 34 (41.5%) were married, 59 (71.9%) were white, 38 (46.4%) have from 8 to 11 years of formal education. Most of them were multiparous with an average of 2.17 pregnancies, 45 (54.9%) had no symptoms of urinary incontinence, and 77 (93.9%) had never performed PFM training. The participants had a low self-perception of PFM contraction, only 33% hit correctly the intensity of their contraction. PFM contraction assessed by vaginal palpation did not show a minimum agreement with self-perception (p = 0.087/ ?= 0,139). Self-perception did not correlate with dysfunctions symptoms evaluated by the questionnaires PFDI-20, PFIQ-7, ICIQ-SF and PISQ-12. The PFMfunction presented a weak negative correlation with the PFDI-20 questionnaire in the domains of UI symptoms (rs = -0.315 / p = 0.004), POP (rs = -0.330 / p = 0.002) and total score (rs = 0.387 / p = 0.0002), with PFIQ-7 questionnaire in the IU domains (rs = -0.320 / p = 0.003), POP (rs = -0.224 / p = 0.027) and total score 0.003). A weak positive correlation was found between self-perception and PISQ-12 questionnaire (rs = 0.360 / p = 0.008) and a moderate negative correlation with the ICIQ-SF (rs = -0.406 / p = 0.000). In conclusion women of this sample had a low self-perception of PFM contraction, only 33% correctly estimated their muscle contraction.

Chez les mâles, la testostérone joue un rôle important dans l'expression des signaux sexuels attractifs pour la femelle. Cependant, de nombreuses études mettent en évidence l'effet négatif de la testostérone sur les défenses immunitaires ou la résistance aux parasites. Selon l'hypothèse du handicap immunitaire (ICHH, Folstad et Karter, 1992), ce compromis permettrait d'assurer l'honnêteté du signal sexuel ; les mauvais mâles ne pouvant pas exprimer de signaux sexuels de bonne qualité tout en gérant l'immunosuppression due à la testostérone. Ma thèse a pour objectif de définir le rôle de la testostérone dans l'honnêteté des signaux sexuels dans un contexte de communication multimodale. Elle permet également de comprendre les mécanismes physiologiques par lesquels la testostérone module les signaux sexuels acoustiques et visuels chez les mâles Hyla arborea, un amphibien connu pour utiliser ces deux types de signaux pour attirer les femelles. Nos résultats montrent que les signaux sexuels acoustiques et visuels chez cette espèce sont testostéronedépendants. En revanche, puisque la testostérone n'a pas d'effet immunosuppresseur dans notre étude, elle ne serait pas le médiateur direct de l'honnêteté des signaux chez cette espèce. D'un point de vue physiologique, l'effet de la testostérone sur le chant s'explique par l'amélioration des propriétés contractiles des muscles du tronc responsables du chant lié à une augmentation de l'efficacité mitochondriale. D'autre part, les analyses biochimiques montrent que la couleur du sac vocal varie linéairement avec la quantité de pigments caroténoïdes présents dans le plasma, qui pourrait être testostérone-dépendant. Enfin, cette thèse montre également que la testostérone agit sur le comportement de chasse permettant l'acquisition de ressources énergétiques et de caroténoïdes pour le chant et la couleur des mâles / In males, testosterone plays an important role on attractive sexual signal expression. However, numerous studies highlighted that testosterone also has negative effects on immunity defenses and parasite resistance capacity. According to the immunocompetence handicap hypothesis (ICHH, Folstad and Karter, 1 992), this trade-off assures signal honesty because only good males could express powerful signals while managing the immunosuppression of testosterone. My thesis aims to define the role of testosterone on the signal honesty in a multimodal communication context. Moreover it allows us to understand some physiological mechanisms involved in the modulation of acoustic and visual signals in males Hyla arborea, an amphibian known to use both acoustic and visual signals to attract females. Our results show that acoustic and visual signals are testosterone-dependent. In contrast, since testosterone has no immunosuppression effect in our study, it would not be the direct mediator of the signal honesty in this species. From a physiological point of view, the testosterone effects on calls could be explained through the positive effect of testosterone on trunk muscle mitochondrial efficacy and their contractile properties. Besides, biochemical analyses show that vocal sac coloration varies with the amount of carotenoid pigments present in the plasma that could be testosterone-dependent. Finally, this thesis also assumes that testosterone acts on the hunting behavior permitting the acquisition of energy resources and carotenoids for singing and coloration of males