Tyrimo tikslas - nustatyti, kokia yra santykių su partneriu ir požiūrio į menopauzę reikšmė moters seksualiniam funkcionavimui menopauzės laikotarpiu. Tyrime dalyvavo 107 partnerį turinčios moterys nuo 45 iki 65 metų amžiaus. Tyrime naudojami R. Rosen ir kolegų (2000) moters seksualinės funkcijos rodiklis, D. P. H. Barelds ir kolegų (2003) olandiškas santykių klausimynas, B. L. Neugarten ir kolegų (1963) požiūrio į menopauzę skalė bei menopauzės simptomų įvertinimo skalė, sukurta Berlyno tyrimų institute „ZEG“ (2013). Tyrimo rezultatai atskleidė, jog moterų požiūris į menopauzę nėra susijęs su seksualinių funkcionavimu, santykiais su partneriu ir menopauzės simptomais, t. y. turinčios tiek teigiamą, tiek neigiamą požiūrį į menopauzę moterys nesiskiria pagal seksualinės funkcijos, santykių su partneriu kokybės ir menopauzės simptomų pasireiškimo lygį. Taip pat nustatyta, kad santykių su partneriu kokybė yra susijusi su moterų seksualiniu funkcionavimu, t. y. moterys, turinčios geresnės kokybės santykius su partneriu, pasižymi geresniu seksualiniu funkcionavimu nei moterys, kurių santykių su partneriu kokybė blogesnė. Be to, pastebėta, kad menopauzės simptomai netiesiogiai susiję su seksualine funkcija per santykius su partneriu, t. y. moterys, kurioms labiau pasireiškia menopauzės simptomai, būdingi žemesnės kokybės santykiai su partneriu nei moterims, kurios menopauzės simptomai pasireiškia silpniau. / The aim of the study is to identify the importance of relationships with the partner and attitude towards menopause to the woman‘s sexual behaviour during the period of menopause.. The subjects of the study were 107 women at the age from 45 to 65, who have partners. The index of woman‘s sexual behaviour, which was presented by R. Rosen and colleagues (2000), the Dutch questionnaire on relationships, which was presented by D. P. H. Barelds and colleagues (2003), the scale of an attitude towards menopause, which was presented by B.L. Neugarten and collegues (1963), and the scale for assessment of symptoms of menopause, which was created by Berlin Institute of Researches „ZEG“ (2013) were used in the study. The results of the study showed that women‘s attitude towards menopause is not related to sexual behaviour, relations with the partner and the symptoms of menopause, i.e. there is no difference between the levels of sexual behaviour, quality of relationships with the partners and the symptoms of menopause of the women with positive or negative attitude towards menopause. It is also found that the quality of relationship with the partner is related to women‘s sexual behaviour , i.e the higher quality of relations with the partners means the better sexual functioning comparing with those women, whose quality of relationships with the partner is worse. Moreover, it is noticed that the symptoms of menopause are indirectly connected with sexual behaviour through relationships... [to full text]

Introduction: Pelvic organ prolapse is a major health problem affecting 50% of parous women over the age of 50. The lifetime risk for pelvic floor surgery for prolapse is likely to be between 10 and 20% and a large number of patients require repeat surgery for recurrence. Cochrane review showed that mesh use at the time of anterior repair reduce the risk of recurrence. In our first study we prospectively evaluate the impact of mesh insertion during anterior repair on sexual function and quality of life. Mesh insertion may be associated with significant and in some cases serious adverse events. To justify its use, it seems necessary to identify women at high risk of prolapse recurrence. There is evidence indicating that levator ani avulsion injury is closely associated with prolapse recurrence. The aim of our second and main study was to demonstrate in a prospective randomized way that levator avulsion may be used to identify patients at high risk for failed native tissue prolapse surgery. Methods: The first study prospectively evaluated with validated questionnaires the impact of mesh insertion on quality of life and sexual function. The second study is a single-center, prospective, randomized interventional trial of two standard surgical procedures for post-hysterectomy vaginal vault prolapse in...

Base teórica A incontinência urinária (IU) é um sintoma comum, afetando mulheres em todas as idades, com prevalência estimada em 30%. A incontinência urinária aos esforços (IUE) pode representar cerca de metade dos casos. O treinamento da musculatura do assoalho pélvico (TMAP), associado a medidas comportamentais e reeducação vesical constitui a primeira linha de tratamento. Apesar dos bons resultados em curto e médio prazo, pode haver perda de motivação e adesão ao tratamento em longo prazo. Técnicas complementares como o biofeedback (BIO) podem auxiliar no treinamento inicial e contribuir para melhores resultados, mas permanece indefinido o perfil de casos que pode realmente se beneficiar desta abordagem. Novos estudos e a implementação de dispositivos facilitadores do tratamento são necessários, pois a adesão é etapa fundamental para manutenção dos resultados. Objetivo Determinar o efeito do TMAP associado ao BIO comparados ao treinamento vesical (TV), considerando resultados com questionários de sintomas, qualidade de vida (QV) e função sexual (FS). Investigação adicional a partir de dados do diário miccional (DM), avaliação da funcionalidade dos músculos do assoalho pélvico por meio de palpação manual e perineométrica do assoalho, gerando informações adicionais sobre o efeito de ambos os tratamentos. Métodos Ensaio clínico randomizado, paralelo, aberto, incluindo mulheres acima de 18 anos com IUE na ausência de prolapso genital. Recrutamento de casos de forma consecutiva em ambulatório de uroginecologia, com alocação aleatória para TV ou BIO, sendo comparadas a resposta aos sintomas, força muscular, escores de QV e FS ao final de 3 meses de tratamento supervisionado com fisioterapeuta. Para o cálculo amostral foi considerada a detecção de uma diferença de 42 pontos percentuais entre os grupos e estimadas 26 pacientes em cada grupo para um α=0,05 e β-80%. Resultados Ao final do estudo, das 53 pacientes inicialmente recrutadas, 28 pacientes foram analisadas, 14 em cada grupo. Ambos os grupos apresentaram melhores resultados em número de perdas diárias (P<0.001), micções noturnas (P<0.002) e no questionário de sintomas (p<0.001). Na FS, não houve diferença individual e entre os grupos. Alguns domínios do questionário de qualidade de vida foram significativamente melhores nas pacientes que fizeram o treinamento vesical (TV), mas a percepção geral de saúde não se modificou de forma significativa ao longo do tempo e entre os grupos TV (P=0.157) e BIO (P=0.795). Apesar de ter havido melhora subjetiva da contração perineal, esse achado não se correlacionou com aumento de força muscular (rs=0.428 P=0.144). Conclusão No presente estudo, os resultados em ambos os grupos foram equivalentes em termos de melhora clínica, nas ferramentas de medida utilizadas, não sendo possível demonstrar um efeito significativo do biofeedback. O desenvolvimento de tecnologias para melhorar a adesão e motivação dos pacientes para o tratamento conservador segue sendo um desafio atual. / Objective: To compare the effect of pelvic exercises combined with biofeedback, against bladder training, using questionnaires on symptoms, quality of life, and sexual function. Methods: Randomized clinical trial. Women over the age of 18 with stress urinary incontinence, but without genital prolapse, were recruited at a urogynecology clinic and assigned to bladder training or pelvic floor restoration at home with biofeedback. Results for muscle strength and symptoms, quality of life, and sexual function questionnaires were compared after 3 months of physiotherapist-supervised treatment. Results: Fourteen patients in each group were analyzed at the end of the study. Both groups exhibited improved results for number of daily leakages (P<0.001), nighttime micturitions (P<0.002) and symptoms (P<0.001). For sexual function, there were no individual or intragroup differences. Some quality of life domains were significantly better in the bladder training patients, but perceived general health did not change significantly and did not differ between the BT (P=0.157) and BIO (P=0.795) groups. Improvements in perineal contraction were not correlated with increased muscle strength (rs=0.428 P=0.144). Conclusion: The two methods had equivalent results, but larger patient samples could change certain findings. It remains a challenge to develop technologies to improve patients’ motivation and adherence to conservative treatment. Registration: Plataforma ReBec (Brazilian Clinical Trials Register - http://www.ensaiosclinicos.gov.br/). Reference code REQ:7854.

Resumo: Identificar as repercussões estruturais, funcionais e na qualidade de vida de mulheres submetidas à vulvectomia e linfadenectomia inguinal para tratamento cirúrgico do câncer de vulva. Estudo observacional, prospectivo, transversal. Foram avaliadas 28 mulheres submetidas ao tratamento cirúrgico para câncer de vulva e 28 mulheres saudáveis (grupo controle), pareadas por idade. Os dados demográficos e clínicos referentes ao câncer de vulva foram obtidos por meio de análise de registros médicos, entrevista, exame físico e dos questionários: European Organization for Reseach and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30), para qualidade de vida, International Consultation on Incontinence Questionnare - Short Form (ICIQ-SF), para avaliação da função urinária e o The Female Sexual Function Index (FSFI), para avaliar a função sexual. Os testes estatísticos utilizados foram qui-quadrado, t de Student, Spearman e Mann Whitney-U. A ocorrência de linfedema foi maior nas pacientes com câncer de vulva em comparação ao controles (p<0,05). O linfedema foi mais grave nas pacientes tratadas para câncer de vulva em comparação ao controle (p=0,003). Não houve diferença entre a gravidade do linfedema e as variáveis: estadiamento, tratamento adjuvante, lateralidade do linfedema e complicações. Houve associação entre gravidade do linfedema e as variáveis idade (p=0,04) e IMC (p=0,04). As escalas de qualidade de vida, definidas pelos domínios: físico, cognição, emocional, social, fadiga, dor, sono, e questões financeiras; se associaram com a gravidade do linfedema (p<0,05). Não houve influência das variáveis: estado civil, escolaridade, menopausa e câncer de vulva na qualidade de vida sexual. Houve associação entre qualidade de vida sexual com a idade (p=0,01) e parceiro estável (p=0,01). As variáveis: IMC, menopausa e câncer de vulva... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: To identify the impact structural, functional and quality of life of women before vulvectomy and inguinal lymphadenectomy for surgical treatment of cancer of the vulva. Observational, prospective, cross. We evaluated 28 women undergoing surgical treatment for cancer of the vulva and 28 healthy women (control group), matched for age. The demographic and clinical data relating to cancer of the vulva were obtained through analysis of medical records, interview, physical examination and questionnaires: European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30) for quality of life, International Consultation on Incontinence Questionnaire - Short Form (SF-ICIQ) for assessment of urinary function and The Female Sexual Function Index (FSFI) to assess sexual function. Statistical tests used were chi-square, t Student, Spearman and Mann-Whitney-U. The incidence of lymphedema was higher in patients with cancer of the vulva as compared to controls (p <0.05). The lymphedema was more severe in patients treated for cancer of the vulva as compared to control (p = 0003). There was no difference between the severity of lymphedema and the variables: stage, adjuvant treatment, laterality and complications of lymphedema. There was an association between severity of lymphedema and the variables age (p = 0.04) and BMI (p = 0.04). The scales of quality of life, defined by domains: physical, cognitive, emotional, social, fatigue, pain, sleep, and financial issues, became associated with the severity of lymphedema (p<0.05). There was no influence of variables: marital status, educational level, menopause and cancer of the vulva in the quality of sexual life. There was an association between sexual quality of life with age (p = 0.01) and stable partner (p = 0.01). The variables: BMI, menopause and cancer of the vulva did not influence... (Complete abstract click electronic access below) / Orientador: Agnaldo L. Silva Filho / Coorientador: Elyonora M. Figueiredo / Banca: Paulo Traiman / Banca: Sérgio Augusto Triginelli / Mestre

Base teórica A incontinência urinária (IU) é um sintoma comum, afetando mulheres em todas as idades, com prevalência estimada em 30%. A incontinência urinária aos esforços (IUE) pode representar cerca de metade dos casos. O treinamento da musculatura do assoalho pélvico (TMAP), associado a medidas comportamentais e reeducação vesical constitui a primeira linha de tratamento. Apesar dos bons resultados em curto e médio prazo, pode haver perda de motivação e adesão ao tratamento em longo prazo. Técnicas complementares como o biofeedback (BIO) podem auxiliar no treinamento inicial e contribuir para melhores resultados, mas permanece indefinido o perfil de casos que pode realmente se beneficiar desta abordagem. Novos estudos e a implementação de dispositivos facilitadores do tratamento são necessários, pois a adesão é etapa fundamental para manutenção dos resultados. Objetivo Determinar o efeito do TMAP associado ao BIO comparados ao treinamento vesical (TV), considerando resultados com questionários de sintomas, qualidade de vida (QV) e função sexual (FS). Investigação adicional a partir de dados do diário miccional (DM), avaliação da funcionalidade dos músculos do assoalho pélvico por meio de palpação manual e perineométrica do assoalho, gerando informações adicionais sobre o efeito de ambos os tratamentos. Métodos Ensaio clínico randomizado, paralelo, aberto, incluindo mulheres acima de 18 anos com IUE na ausência de prolapso genital. Recrutamento de casos de forma consecutiva em ambulatório de uroginecologia, com alocação aleatória para TV ou BIO, sendo comparadas a resposta aos sintomas, força muscular, escores de QV e FS ao final de 3 meses de tratamento supervisionado com fisioterapeuta. Para o cálculo amostral foi considerada a detecção de uma diferença de 42 pontos percentuais entre os grupos e estimadas 26 pacientes em cada grupo para um α=0,05 e β-80%. Resultados Ao final do estudo, das 53 pacientes inicialmente recrutadas, 28 pacientes foram analisadas, 14 em cada grupo. Ambos os grupos apresentaram melhores resultados em número de perdas diárias (P<0.001), micções noturnas (P<0.002) e no questionário de sintomas (p<0.001). Na FS, não houve diferença individual e entre os grupos. Alguns domínios do questionário de qualidade de vida foram significativamente melhores nas pacientes que fizeram o treinamento vesical (TV), mas a percepção geral de saúde não se modificou de forma significativa ao longo do tempo e entre os grupos TV (P=0.157) e BIO (P=0.795). Apesar de ter havido melhora subjetiva da contração perineal, esse achado não se correlacionou com aumento de força muscular (rs=0.428 P=0.144). Conclusão No presente estudo, os resultados em ambos os grupos foram equivalentes em termos de melhora clínica, nas ferramentas de medida utilizadas, não sendo possível demonstrar um efeito significativo do biofeedback. O desenvolvimento de tecnologias para melhorar a adesão e motivação dos pacientes para o tratamento conservador segue sendo um desafio atual. / Objective: To compare the effect of pelvic exercises combined with biofeedback, against bladder training, using questionnaires on symptoms, quality of life, and sexual function. Methods: Randomized clinical trial. Women over the age of 18 with stress urinary incontinence, but without genital prolapse, were recruited at a urogynecology clinic and assigned to bladder training or pelvic floor restoration at home with biofeedback. Results for muscle strength and symptoms, quality of life, and sexual function questionnaires were compared after 3 months of physiotherapist-supervised treatment. Results: Fourteen patients in each group were analyzed at the end of the study. Both groups exhibited improved results for number of daily leakages (P<0.001), nighttime micturitions (P<0.002) and symptoms (P<0.001). For sexual function, there were no individual or intragroup differences. Some quality of life domains were significantly better in the bladder training patients, but perceived general health did not change significantly and did not differ between the BT (P=0.157) and BIO (P=0.795) groups. Improvements in perineal contraction were not correlated with increased muscle strength (rs=0.428 P=0.144). Conclusion: The two methods had equivalent results, but larger patient samples could change certain findings. It remains a challenge to develop technologies to improve patients’ motivation and adherence to conservative treatment. Registration: Plataforma ReBec (Brazilian Clinical Trials Register - http://www.ensaiosclinicos.gov.br/). Reference code REQ:7854.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2018-12-13T10:42:05Z No. of bitstreams: 2 Tese - Rosa Azevedo da Luz - 2018.pdf: 1830561 bytes, checksum: 8a560c6377396b6810e18029f452005b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-12-13T11:41:37Z (GMT) No. of bitstreams: 2 Tese - Rosa Azevedo da Luz - 2018.pdf: 1830561 bytes, checksum: 8a560c6377396b6810e18029f452005b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-12-13T11:41:37Z (GMT). No. of bitstreams: 2 Tese - Rosa Azevedo da Luz - 2018.pdf: 1830561 bytes, checksum: 8a560c6377396b6810e18029f452005b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-07-26 / Objectives: To compare the quality of life (QoL) and sexual function of women with and without chronic pelvic pain and to investigate factors associated with QoL and sexual dysfunction in women with chronic pelvic pain. Methods: A cross-sectional study conducted between October 2014 and February 2016 at the gynecology outpatient clinic of the Federal University of Goiás Teaching Hospital, Goiânia, Goiás, Brazil evaluated 200 women, 100 with and 100 without chronic pelvic pain. Sociodemographic, clinical and behavioral characteristics were investigated. Pain intensity was measured using a visual analogue scale. QoL was evaluated using the World Health Organization’s short-form WHOQOL-BREF questionnaire, and the Female Sexual Function Index was used to evaluate sexual function. Anxiety and depression were investigated using the Hospital Anxiety and Depression Scale. Student’s ttest, the chi-square test and the Mann-Whitney test were used to compare sociodemographic, clinical and behavioral characteristics between the groups. A generalized linear model was used to compare QoL and sexual function scores between the groups and to identify factors associated with QoL in the women with chronic pelvic pain. Multiple logistic regression analysis was used to identify factors associated with sexual dysfunction in women with chronic pelvic pain. Results: The mean age of the participants with chronic pelvic pain was 37.8 ± 8.0 years compared to 37.2 ± 9.6 years for those without this condition (p=0.648). Analysis adjusted for potential confounding factors showed that women with chronic pelvic pain had significantly lower QoL scores for the physical health (p<0.001) and social relationships (p=0.025) domains. Anxiety, depression, pain intensity, diabetes mellitus, arterial hypertension, sexual dysfunction, lower monthly income and marital status (not having a partner) were factors found to be negatively associated with QoL. Employment status (being employed/in paid work), parity (≥ 1) and menopausal status (postmenopausal) were positively associated with QoL. The prevalence of sexual dysfunction was 81% in the women with chronic pelvic pain and 58% in those without it (p=0.003). Women with chronic pelvic pain had significantly lower scores in the desire (p=0.038), arousal (p=0.002), lubrication (p=0.011), orgasm (p<0.002) and pain (p<0.001) domains. There were no statistically significant differences with respect to the satisfaction domain or the overall score. Depression was the only factor found to be positively and independently associated with sexual dysfunction in women with chronic pelvic pain (p=0.012). Conclusions: QoL was poorer in the group of women with chronic pelvic pain, with various factors being negatively associated with QoL in this group. Sexual dysfunction was also more common in the group with chronic pelvic pain, with these women scoring lower in most of the sexual function domains. Depression was positively associated with sexual dysfunction in the chronic pelvic pain group. These findings highlight the need to take into consideration the influence of various different factors that affect the QoL of women with chronic pelvic pain. Furthermore, these results suggest that women with chronic pelvic pain should be routinely screened for sexual dysfunction, taking into account the effect of psychological factors. / Objetivos: Comparar a qualidade de vida e a função sexual entre mulheres com e sem dor pélvica crônica e investigar os fatores associados à qualidade de vida e à disfunção sexual de mulheres com dor pélvica crônica. Métodos: Conduziu-se um estudo de corte transversal entre outubro de 2014 e fevereiro de 2016, no Ambulatório de Ginecologia do Hospital das Clínicas da Universidade Federal de Goiás, Goiânia, Goiás, Brasil. Participaram do estudo 200 mulheres, sendo 100 com dor pélvica crônica e 100 sem dor pélvica crônica. Foram investigadas características sociodemográficas, clínicas e comportamentais. A intensidade da dor foi aferida aplicando-se a escala analógica visual. A qualidade de vida foi avaliada por meio do questionário da Organização Mundial de Saúde o WHOQOL-versão abreviada. Para avaliar a função sexual utilizou-se o Female Sexual Function Index. Ansiedade e depressão foram investigadas, utilizando-se a Escala Hospitalar de Ansiedade e Depressão. Para comparar as características sociodemográficas, clínicas e comportamentais entre os dois grupos foram utilizados os testes t de Student, Qui-quadrado e Mann-Whitney. Utilizou-se o modelo linear generalizado para comparar os escores de qualidade de vida e de função sexual entre os grupos e identificar os fatores associados à qualidade de vida de mulheres com dor pélvica crônica. Utilizou-se a análise de regressão logística múltipla para identificar os fatores associados à disfunção sexual de mulheres com dor pélvica crônica. Resultados: A média de idade das participantes com dor pélvica crônica foi de 37,8±8,0 anos e daquelas sem dor pélvica crônica de 37,2±9,6 anos (p=0,648). Após a análise ajustada por potenciais variáveis confundidoras, mulheres com dor pélvica crônica apresentaram escores significativamente menores de qualidade de vida nos domínios físico (p< 0,001) e relações sociais (p=0,025). Verificou-se que ansiedade, depressão, intensidade da dor, diabetes mellitus, hipertensão arterial, disfunção sexual, menor renda familiar mensal e estado marital (sem companheiro) associaram-se negativamente à qualidade de vida. A situação de trabalho (estar empregada/ter um trabalho remunerado), paridade (≥1) e estado menopausal (pósmenopausa) relacionaram-se positivamente à qualidade de vida. A prevalência de disfunção sexual foi de 81% em mulheres com dor pélvica crônica e de 58% em mulheres sem dor pélvica crônica (p=0,003). Mulheres com dor pélvica crônica apresentaram escores significativamente menores nos domínios desejo (p=0,038), excitação (p=0,002), lubrificação (p=0,011), orgasmo (p<0,002) e dor (p<0,001). Não houve diferença significativa no domínio satisfação e no escore total. Depressão foi o único fator associado positivamente e independentemente à disfunção sexual de mulheres com dor pélvica crônica (p=0,012). Conclusões: Mulheres com dor pélvica crônica apresentaram pior qualidade de vida do que aquelas sem dor pélvica crônica. Foram identificados vários fatores que se associaram negativamente à qualidade de vida de mulheres com dor pélvica crônica. A disfunção sexual foi mais comum em mulheres com dor pélvica crônica do que em mulheres sem dor pélvica crônica. Mulheres com dor pélvica crônica apresentaram menores escores na maioria dos domínios da função sexual. A depressão associou-se positivamente à disfunção sexual de mulheres com dor pélvica crônica. Estes achados demonstram a necessidade de considerar a influência de diversos fatores sobre a qualidade de vida de mulheres com dor pélvica crônica. Além disso, os achados indicam a necessidade de rastrear rotineiramente a disfunção sexual em mulheres com dor pélvica crônica, considerando a influência de fatores psicológicos.

Contexte : Le cancer de l'endomètre est le plus fréquent des cancers gynécologiques. Il a été suggéré que les traitements oncologiques entraînent des dysfonctions des muscles du plancher pelvien. Ces dysfonctions pourraient contribuer au développement de conditions débilitantes comme la douleur lors des relations sexuelles (dyspareunie) qui atteint plus de la moitié des survivantes. Or, à l'heure actuelle, aucune étude n'a investigué la fonction des muscles du plancher pelvien en lien avec la dyspareunie chez des survivantes d'un cancer de l'endomètre. Objectifs : L'objectif principal vise à explorer les différences quant à la fonction des muscles du plancher pelvien entre des survivantes d'un cancer de l'endomètre atteintes de dyspareunie et des femmes sans douleur ayant subi l'hystérectomie totale pour des raisons bénignes. L'objectif secondaire est d'explorer les différences entre les deux groupes quant aux variables urogynécologiques, sexuelles, psychologiques et sociales. Méthodologie : Dans cette étude comparative exploratoire bicentrique, des survivantes d'un cancer de l'endomètre atteintes de dyspareunie (n=7) et des femmes asymptomatiques (n=7) ont assisté à une séance d'évaluation menée par une physiothérapeute. Les deux groupes ont été équilibrés selon l'âge, l'indice de masse corporelle et le nombre d'accouchements par voie vaginale. La fonction des muscles du plancher pelvien, y compris le tonus, la force maximale, la vitesse de contraction, la coordination et l'endurance, a été évaluée à l'aide du spéculum dynamométrique. Des questionnaires validés ont permis d'évaluer les variables secondaires. Des tests de Mann-Whitney ont été employés pour comparer les deux groupes quant à la fonction des muscles du plancher pelvien et les variables urogynécologiques, sexuelles, psychologiques et sociales (!=0,050). Résultats : Concernant la fonction des muscles du plancher pelvien, les survivantes atteintes de dyspareunie ont démontré un tonus à une ouverture vaginale minimale supérieur (p=0,018) et une endurance inférieure (p=0,048) aux femmes asymptomatiques. Les survivantes ont également présenté plus d'incontinence fécale (p=0,005) et une fonction sexuelle inférieure (p=0,004) comparativement aux femmes asymptomatiques. Aucune différence n'a été détectée pour les variables psychologiques et sociales. Conclusion : Les résultats de cette étude exploratoire suggèrent des dysfonctions des muscles du plancher pelvien, notamment un tonus supérieur et une endurance inférieure, chez les survivantes d'un cancer de l'endomètre atteintes de dyspareunie. D'autres études sont nécessaires afin de confirmer ces résultats. Ces constats préliminaires pourraient servir d'assises pour mieux comprendre les dysfonctions des muscles du plancher pelvien impliquées dans la dyspareunie chez cette population. / Abstract : Context: Endometrial cancer is the most common cancer in gynecological cancers. Oncological treatments are suggested to cause pelvic floor muscle dysfunction that could contribute to the development of debilitating conditions such as pain during sexual intercourse (dyspareunia), which affects more than half of survivors. However, to date, no study investigated pelvic floor muscle function in relation to dyspareunia in endometrial cancer survivors. Objectives: The main objective is to explore differences in pelvic floor muscle function between endometrial cancer survivors with dyspareunia and women without pain who underwent a total hysterectomy for benign conditions. The secondary objective is to explore differences between the two groups on urogynecological, sexual, psychological and social variables. Methodology: In this exploratory, bicentric comparative study, endometrial cancer survivors with dyspareunia (n=7) and asymptomatic women (n=7) attended one evaluation session conducted by a physiotherapist. The two groups were balanced in terms of age, body mass index and number of vaginal deliveries. The pelvic floor muscle function, including tone, maximal strength, contraction speed, coordination and endurance, was assessed with the dynamometric speculum. Validated questionnaires were used to evaluate secondary variables. Mann-Whitney tests were used to compare the two groups on muscular, urogynecological, sexual, psychological and social variables (!=0.050). Results: Concerning pelvic floor muscle function, survivors with dyspareunia demonstrated higher tone at a minimal vaginal aperture (p=0.018) and lower endurance (p=0.048) compared to asymptomatic women. Survivors also presented more fecal incontinence (p=0.005) and lower sexual function (p=0.004) compared to asymptomatic women. No differences were detected for psychological and social variables. Conclusion: The results of this exploratory study suggest impaired pelvic floor muscle function, notably higher tone and lower endurance, in endometrial cancer survivors with dyspareunia. Further studies are needed to confirm these findings. This preliminary evidence can be used as empirical data to better understand pelvic floor muscle impairments implicated in dyspareunia in this population.

Obsessive-compulsive disorder (OCD), with a prevalence of 1-2 %, frequently leads a chronic course. Persons with OCD are often reluctant to seek help and, if they do, their OCD is often missed. This is unfortunate, since active treatment may substantially improve social function and quality of life. Serotonin reuptake inhibitors (SRIs) have welldocumented efficacy in OCD, but delayed response may be problematic. Methods to predict response have been lacking. Because SRIs are effective, pathophysiological research on OCD has focussed on serotonin. However, no clear aberrations of serotonin have been found, thus other mechanisms ought to be involved. Our aims were to facilitate clinical detection and assessment of OCD, to search for biochemical correlates of response and side-effects in SRI treatment of OCD and to identify any possible involvement of oxytocin in the pathophysiology of OCD. In study I, we tested in 402 psychiatric out-patients the psychometric properties of a concise rating scale, “Brief Obsessive Compulsive Scale” (BOCS). BOCS was shown to be easy to use and have excellent discriminant validity in relation to other common psychiatric diagnoses. Studies II-V were based on 36 OCD patients from a randomised controlled trial of paroxetine, clomipramine or placebo. In study II, contrary to expectation, we found that the change (decrease) of serotonin in whole blood was most pronounced in non-responders to SRI. This is likely to reflect inflammatory influence on platelet turnover rather than serotonergic processes within the central nervous system. In studies IV-V, we found relations between changes of oxytocin in plasma and the anti-obsessive response, and between oxytocin and the SRI related delay of orgasm, respectively. In both cases, the relation to central oxytocinergic mechanisms is unclear. In males, delayed orgasm predicted anti-obsessive response.

MUDr. Watcharaphol Alexandre Kamnerdsiri Determinants of Sexual Satisfaction in Czech Men Page 1 of 5 Determinants of Sexual Satisfaction in Czech Men Abstract Very legitimately, medicine as well as medical literature, especially in the field of sexology, focuses on the study and treatment of all disorders and dysfunctions that affect the human race and its sexuality. Through this thesis, we attempted to resist against this general trend and sought anything that would facilitate or promote a man's achievement of an accomplished and happy sexuality. These terms imply a sexuality that satisfies this man. There is indeed nothing more subjective than sexual satisfaction, despite the easy access to pornographic material that tends to introduce some elements of comparison in the mind of each man, however unrealistic. There are many tools to measure sexual satisfaction. However, it has been demonstrated that assessing sexual satisfaction with a single question is nearly as reliable as using more detailed questionnaires. As this thesis is integrated into a much larger research based on a 90-item questionnaire, it was decided to use only one question regarding sexual satisfaction. However, it has been divided into two variants, one on the overall sex life satisfaction, and the other on the recent sexual satisfaction...

Introduction: Burnout syndrome is a topical issue in the world and in the Czech Republic, not only in the healt sector. The diploma thesis is focused on finding the conection between burnout syndrome and sexuality of general nurses in emergency care. I chose the topic for my diploma thesis because it is close to me and I work in emergency care myself. In addition, the topic is not very well explored, and the research data will contribute to an international study examining the imapct od burnout syndrome on human health. This study in the Czech Republic is under the guidance of PhDr. Šárky Dynákové, Ph.D. and doc. PhDr. Jana Kožnara, CSc. Methodology: Data collection for research was conducted using two anonymous questionnaires. The first questionnaire focused on burnout syndrome using the Czech version of the Shirom-Melamed scale (Shirom, Melamed, 2006 In Ptáček, 2013). The second questionnaire examined the sexual function of a woman according to Mellan in Kratochvíl, S. (1999). The research sample consisted of general nurses working in emergency care at a teaching hospital. Results: The impact of burnout syndrome has been demonstrated by research in sexual desire (H1), self-assessment as a sexual partner (H2), and mood before sexual intercourse (H4). The results show that the area that achieved...