Search Results (162)

Background/Objectives: Sexual health is shaped by lifestyle factors alongside biomedical determinants. This review synthesises evidence on physiotherapy, balneology/peloidotherapy, and diet therapy as preventive and therapeutic adjuncts for female sexual dysfunctions and related gynaecological conditions. Methods: A structured narrative review of PubMed and Google Scholar (June–July 2025) was conducted by three independent reviewers using predefined keywords in English and Polish. Case reports, preprints, and studies before 2015 were excluded. From 7322 records, 47 studies met the inclusion criteria for qualitative synthesis. Results: Physiotherapy—particularly pelvic floor muscle training, multimodal manual therapy, neuromuscular electrical stimulation (including PTNS), magnetostimulation, short-wave diathermy, and capacitive–resistive monopolar radiofrequency—was consistently associated with reductions in dyspareunia, chronic pelvic pain, and urinary symptoms, with parallel improvements in sexual function and quality of life. Balneological procedures (brine baths/irrigations, crenotherapy, selected radon/sulphide/iodine–bromine applications) and peloidotherapy demonstrated analgesic, anti-inflammatory, and perfusion-enhancing effects, with signals of benefit in vulvodynia, endometriosis, and infertility support. Dietary measures—higher fruit intake (notably citrus), adequate vitamin D, targeted omega-3 use in PCOS, a Mediterranean dietary pattern, and prudent red-meat limitation—were associated with favourable endocrine–metabolic profiles and, in selected contexts, reduced disease risk. Conclusions: Integrating lifestyle–medicine modalities with standard care may meaningfully prevent and manage female sexual dysfunctions by addressing pain, perfusion, neuromuscular control, and endocrine–metabolic drivers. Implementation frameworks and high-quality trials are warranted to refine indications, dosing, and long-term effectiveness. Full article

Background/Objectives: Among women with a history of cesarean section (CS), scar abnormalities are observed in 20–32% of cases. The presence of a scar in the lower abdomen may cause pain, dysmenorrhea, dyspareunia, and postural dysfunction. The aim of the study was to conduct a feasibility study and secondary exploratory analysis of the factors determining scar stiffness and elasticity in women after CS. Methods: The study involved 30 women aged 26 to 45 who had undergone at least one CS no earlier than six months before the start of the study. The following feasibility endpoints were analyzed: recruitment rate, completion rate, protocol deviations, and device usability. Myotonometry was performed to quantify the stiffness and decrement (a parameter that inversely reflects tissue elasticity) of the CS scar. The correlation between stiffness and decrement and age, BMI, time since the las CS, and the number of CSs was assessed. Results: All predefined feasibility criteria were met. Recruitment exceeded the target rate (3.3 participants/week), with a high completion rate (90%). One minor protocol deviation occurred without impact on safety or data integrity. The MyotonPro device showed good usability, with no reported discomfort and successful completion of all measurements. Secondary exploratory correlation analyses suggested a tendency toward a negative correlation between BMI and the stiffness and decrement (indicating increased elasticity) across most scar regions. No consistent correlations were observed between age and the examined scar parameters. Exploratory analyses further indicated a probable positive correlation between time elapsed since the last CS and stiffness and decrement (indicating reduced elasticity), which was observed only in the central region of the scar. The number of cesarean section procedures showed sporadic, region-specific correlations with scar parameters, limited to selected measurement points. Conclusions: These findings suggest that the study design is feasible and acceptable. Future research protocols should also include a comparison with healthy skin in the scar area. Preliminary exploratory analyses suggest a potential influence of BMI and time since last CS on scar stiffness and elasticity. However, due to the limitations of the pilot study, these observations should be considered preliminary and hypothesis-generating and may be used to design future confirmatory studies. Full article

Background and Objectives: Pelvic floor disorders are highly prevalent among women globally and can severely compromise daily functioning and well-being. Emerging energy-based modalities have reshaped conservative management strategies, by allowing individualized therapeutic approaches. The aim of this study was to evaluate the utility of customized energy-based applications, via an innovative multimodal EVA/DAFNE device that incorporates multimodal energy-based synergistic technologies for the treatment of pelvic floor dysfunction. Materials and Methods: Patients with PFDs (pelvic organ prolapse, all types of urinary incontinence, bladder voiding dysfunction, and dyspareunia) who selected conservative treatments were prospectively enrolled. Baseline and after-treatment quality of life was assessed using the following validated tools: Urinary Distress Inventory-6 (UDI-6), Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Female Sexual Function Index-6 (FSFI-6), Marinoff Scale, 0-100 VAS, and Vaginal Health Index. Overall improvement was measured through the Patient Global Impression of Improvement (PGI-I). Three to five sessions of treatment tailored according to the patient’s symptoms and clinical findings were delivered. Data were analyzed using standard statistical methods. Results: Twenty-six women with PFD who desired energy-based conservative treatment were recruited. Mean age was 48.6 ± 16.7 years. Indications for treatment were dyspareunia (n = 10; 38.5%), stress urinary incontinence (n = 9; 34.6%), mild pelvic organ prolapse (n = 6; 23.1%), genitourinary syndrome of menopause (n = 5; 19.2%), voiding dysfunction (n = 4; 15.4%), and overactive bladder syndrome (n = 2; 7.7%). Mean number of treatments was four. Baseline and after-treatment quality-of-life scores differed significantly. According to PGI-I scores 88.5% of patients considered themselves improved. Conclusions: Our study provides pilot estimates as to the safety and efficacy of a multimodal integrated treatment protocol for the treatment of PFD. Integrating multimodal energy-based conservative therapy into tailored treatment protocols can prove efficient and useful. Full article

Background and Objectives: This systematic review synthesized somatic and psychosocial determinants of postpartum sexual dysfunction (PSD) during the first 12 months after childbirth. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Web of Science, and Scopus from inception to 4 August 2025 without language limits for the indexed records. Eligible studies enrolled postpartum women (≤12 months) and reported validated sexual outcomes (FSFI/FSFI-6, PISQ-12), dyspareunia, or sexual activity, examining breastfeeding, partner support/body image, perineal trauma/instrumentation, or postpartum perineal/musculoskeletal pain. Two reviewers independently screened and extracted data; risk of bias was assessed with a modified Newcastle–Ottawa Scale. Results: Of 1127 records screened, 15 studies were included. Perineal morbidity and early pain consistently tracked with worse sexual outcomes; assisted vaginal birth increased 6-month dyspareunia odds (OR 2.5). Breastfeeding was often associated with lower early sexual function and higher dyspareunia (6-month dyspareunia OR 4.4), with attenuation by 12 months. Higher partner/family support and more positive body image correlated with better FSFI scores. Heterogeneity in timing, measures, and adjustment precluded meta-analysis; results were narratively synthesized. Conclusions: Perineal trauma and early pain are dominant risk signals; breastfeeding-related symptoms exert early and context-dependent effects; psychosocial resources are protective. Full article

Objectives: To evaluate the impact of hormonal therapy on the evolution of painful symptoms in premenopausal women with adenomyosis, with or without concomitant endometriosis, over an 18-month follow-up period. This study aimed to compare the symptomatic progression between treated and untreated patients, highlighting the potential role of medical therapy in symptom control and disease stabilization. Secondary, an objective was to explore sonographic changes within our study population, in parallel with clinical outcomes. Methods: This retrospective observational study, conducted at the Endometriosis Referral Center of the University Hospital of Siena, included 40 women with ultrasound evidence of adenomyosis with and without endometriosis. The population was divided into two groups: 20 patients receiving hormone treatment and 20 not receiving hormone treatment. All patients underwent clinical and ultrasound examinations throughout an 18-month follow-up period, during which types, locations, degrees of disease, and associated symptoms were evaluated. Results: Forty patients enrolled in the study presenting with symptoms such as dysmenorrhea, dyspareunia, and heavy menstrual bleeding were included. A total of 22 patients showed isolated adenomyosis, while 18 adenomyosis and endometriosis both. The mean age was 38.5 years (±4.2 SD), with 57.5% being nulliparous. The types of adenomyosis detected were focal in 25%, diffuse in 50%, and mixed (both focal and diffuse) in 25%. Disease severity was classified as mild in 15%, moderate in 45%, and severe in 40%. After 18 months of continuous hormonal therapy, a reduction in focal adenomyosis was observed in 10%, and an improvement of dysmenorrhea and Heavy Menstrual Bleeding (HMB) was noted, while a slight ameliorating of dyspareunia was detected. In contrast, untreated patients showed either unchanged or worsened symptoms. Conclusions: The findings underscore the value of medical therapy in the management of adenomyosis, supporting current recommendations. Given the heterogeneity of clinical presentations and frequent overlap with endometriosis, a personalized treatment approach remains essential. Further larger-scale, long-term studies are needed to confirm these preliminary results and explore the potential impact on fertility preservation. Full article

Background/Objective: Dyspareunia negatively affects women’s lives. Up to 35% suffer from postpartum dyspareunia. Many factors may influence the occurrence of postpartum dyspareunia, but little is known about them. This study aimed to look at the frequency of dyspareunia one year postpartum in a cohort of primiparae. Which perinatal factors influence the frequency of postpartum dyspareunia? Methods: A total of 3264 primiparae were included in this observational cohort study. Perinatal factors were documented, and a specially designed questionnaire was sent to them one year postpartum. The primary outcome was the frequency of dyspareunia one year postpartum. The secondary outcomes included potential influencing factors such as birthing method (spontaneous bed delivery, spontaneous delivery other than bed, water delivery, and vacuum-assisted delivery); perineal injuries (first- and second-degree perineal tears, obstetric anal sphincter injuries (OASIs), and episiotomies); and the use of oxytocin. Results: Postpartum dyspareunia was observed in 15% of the 3264 primiparae. In multivariate analysis, there were influences found in the perineal injury group, especially for first- and second-degree perineal tears and OASIs. In the oxytocin group, a trend toward a higher rate of postpartum dyspareunia was observed. No influence of the different birthing methods was found. Conclusions: Postpartum dyspareunia, affecting 15% of women one year after vaginal delivery, is associated with perineal injuries, particularly minor perineal tears and OASIs. This highlights the importance of good preparation of the perineum and pelvic floor before delivery, efficient perineal protection during labor, and the use of a precise repair technique for all perineal injuries. Full article

Background and Clinical Significance: Vesicovaginal leiomyomas are an exceedingly rare form of extrauterine fibroids. They represent less than 1% of all leiomyomas and have been reported in less than 300 cases worldwide since 1733. These benign smooth muscle tumors typically occur in perimenopausal women aged 35–50 years, presenting in young adults extraordinarily uncommonly. The rarity in younger patients creates significant diagnostic challenges, as clinical presentation often mimics malignant entities, particularly embryonal rhabdomyosarcoma. Case Presentation: This paper presents a 20-year-old nulliparous female who developed progressive dyspareunia and urinary dysfunction over 12 months due to a large vesicovaginal mass. Physical examination revealed a 6–7 cm smooth, firm mass obstructing the vaginal canal. Transvaginal ultrasound demonstrated a well-circumscribed, hypoechoic solid lesion measuring 6.9 cm in the vesicovaginal space. Magnetic resonance imaging showed a characteristic T2-hypointense signal with restricted diffusion consistent with leiomyoma, revealing an incidental septate uterus. Ultrasound-guided core needle biopsy confirmed benign leiomyoma with bland spindle cells, absent atypia, and minimal mitotic activity. The patient underwent successful transvaginal enucleation with complete symptom resolution. Conclusion: This case highlights diagnostic challenges posed by benign leiomyomas in young women presenting with solid pelvic masses. Systematic diagnostic approaches incorporating multimodal imaging and guided tissue sampling are essential to avoid misdiagnosis and unnecessary radical surgery. When malignancy is confidently excluded, management should prioritize fertility preservation in young patients. Full article

Objective: To retrospectively assess the safety and efficacy of endovaginal guidance for embolizing perivaginal varices associated with persistent localized symptoms, including dyspareunia and postcoital pain. Methods: From February 2024 to January 2025, 10 women (median age: 36 years, range: 23–45) underwent pelvic embolization using endovaginal guidance. Eight patients had already undergone endovascular embolization, with persistent perivaginal varices that were inaccessible by this approach, accompanied by dyspareunia or postcoital pain. Primary efficacy was assessed three months post-embolization, defined as a Visual Analog Scale (VAS) score of <2 and a ≥50% decrease. Outcomes were assessed through clinical and imaging follow-up. Results: Technical efficacy was achieved in all procedures (100%). Embolization was performed using Glubran/Lipiodol in eight cases (80%) and Onyx^® in two cases (20%). The primary efficacy of the procedures was 90.0% (9 out of 10 cases). A reduction in dyspareunia and postcoital pain was observed, with median VAS scores decreasing to one and zero, respectively, compared to initial scores of seven and seven (p = 0.002 and p = 0.016) and to scores after endovascular embolization to five and five (p = 0.004 and p = 0.016). No major complications were recorded. Imaging follow-up showed a significant reduction in perivaginal varicosities in all cases. Conclusions: Endovaginal guidance proves to be a fast and effective technique for the embolization of perivaginal varices, highlighting its integration into the principles of personalized medicine. Full article

Background/Objectives: Vestibulodynia is the prevalent form of vulvodynia, causing burning, irritation, rawness, and dyspareunia sensations. This sensory abnormality suggests sensitization to neuropathic pain. Methods: This was a randomized double-blind trial involving patients who applied a 5% cannabidiol gel with myrcene or a placebo to their vulvar vestibule for 60 days, assessing changes in dyspareunia, pain, and vestibular cotton swab test scores on a 0–10-point VAS scale. Results: This study enrolled 40 women, with 20 in the active treatment group and 20 in the placebo group. All symptoms improved in both groups, but the active treatment group showed a greater reduction in VAS scores for pain and swab tests. However, dyspareunia improved significantly more in the active treatment group. Conclusions: Cannabidiol’s positive effects on vestibulodynia patients can be attributed to its antinociceptive and anti-inflammatory properties. It desensitizes transient vanilloid receptor potential channels subtype 1, which are found in peripheral C-fiber nociceptors and mast cells. The results also suggest that myrcene, a terpene found in cannabis, can inhibit peripheral sensitization exerted by cannabidiol. Full article

Background: Female Sexual dysfunction (FSD) is a common but under-recognized outcome of rectal and anal cancer treatment. While survival has improved, sexual health remains insufficiently addressed in survivorship care, warranting a multidisciplinary perspective. Methods: A narrative review of studies published between 2000 and 2025 was conducted, including clinical trials, cohort studies, and guideline documents addressing female sexual dysfunction after anorectal cancer treatment. Articles that were not pertinent to the research topic, outdated, or methodologically inadequate were excluded from the analysis. Results: Over 60% of female survivors experience FSD, including decreased libido, vaginal dryness, dyspareunia, and arousal difficulties. Causes include hormonal deficiency, nerve injury, and radiation fibrosis, compounded by psychological distress, altered body image, stoma-related stigma, and communication issues. The FSFI is commonly applied but lacks specificity for this population. Geographic disparities persist, with greater stigma and limited care access in low- and middle-income countries. Emerging therapies, such as immunotherapy, may mitigate FSD risk, though evidence is scarce. Conclusions: FSD after anorectal cancer is highly prevalent and significantly impacts quality of life, yet remains under-assessed in follow-up care. Multidisciplinary, culturally sensitive strategies integrating screening, psychosexual support, and tailored rehabilitation are urgently needed. Future research should address sexual outcomes more systematically, particularly in novel treatment contexts. Full article

Objective: This study aimed to determine the prevalence of isthmocele in patients who had undergone cesarean delivery and to investigate its association with abnormal uterine bleeding (AUB). Additionally, a novel volume-based classification system (Er-Kay Classification) was developed to provide a more precise assessment of cesarean scar defects and their correlation with clinical symptoms. Material and Methods: This retrospective, hospital-based cohort study was conducted at Ankara Etlik Zübeyde Hanım Women’s Health Training and Research Hospital between October 2017 and March 2018. A total of 1098 patients who had undergone cesarean delivery and attended follow-up visits were included. Patients were categorized based on the presence of isthmocele (study group: n = 134) and its absence (control group: n = 964). Isthmocele volume was calculated using the formula (Height × Width × Depth)/3, and patients were classified as Grade 1 (≤50 mm³) or Grade 2 (>50 mm³) based on the novel Er-Kay Classification. Clinical symptoms, including AUB (pre-, inter-, postmenstrual bleeding), dysmenorrhea, dyspareunia, and postcoital bleeding, were compared between groups. Statistical analyses were performed using SPSS 27.0 (NY, USA),with a significance level of p < 0.05. Results: The prevalence of isthmocele was 12.2% (134/1098). Patients with isthmocele had significantly shorter menstrual cycles compared to those without (26.64 ± 5.35 vs. 28.08 ± 4.97 days, p = 0.038). Postmenstrual bleeding (47.0% vs. 4.7%, p < 0.001), dysmenorrhea (38.8% vs. 18.3%, p < 0.001), and dyspareunia (39.6% vs. 14.7%, p < 0.001) were significantly more frequent in the isthmocele group. According to the Er-Kay Classification, intermenstrual bleeding was significantly higher in Grade 2 (23.1%) than in Grade 1 (4.3%) (p = 0.001). Similarly, postmenstrual bleeding was more common in Grade 2 (56.9%) than in Grade 1 (37.7%) (p = 0.026). No significant differences were found for premenstrual bleeding, dysmenorrhea, or dyspareunia between the Er-Kay Classification groups (p > 0.05). Conclusions: The findings indicate that isthmocele is significantly associated with AUB, dysmenorrhea, and dyspareunia. The Er-Kay Classification, based on isthmocele volume, provides a more precise assessment of symptom severity, particularly in intermenstrual and postmenstrual bleeding cases. These results suggest that volume-based evaluations should be incorporated into clinical practice for better patient management and diagnosis of cesarean scar defects. Full article

Background and Objectives: A cesarean scar defect (CSD), also referred to as a niche or isthmocele, is often detected incidentally during transvaginal sonography (TVS) and is typically asymptomatic. However, the exact prevalence of symptomatic niches remains unclear. This study aimed to evaluate the incidence of cesarean scar niches and identify potential risk factors in a prospectively gathered cohort of Egyptian women. Materials and Methods: The primary endpoint was to determine the incidence of isthmoceles after six months following a cesarean section (CS) and to investigate any associated symptoms and risk factors. The study included 420 women, divided into three groups: Group A included 140 women who had undergone their first CS, Group B included 140 women with a history of two CSs, and Group C consisted of 140 women with more than two prior CSs. Results: Niches were identified in 23.8% of the participants via TVS. The highest incidence was observed in women with more than two previous CSs (31.2%, 39/125), followed by those with two prior CSs (24.4%, 30/123), and the lowest was among women with one previous CS (16.3%, 22/135). Of the 91 women diagnosed with a CS niche, only 23 (25.27%) reported symptoms—most commonly postmenstrual spotting (7.7%) and dyspareunia (8.8%). Conclusions: The findings indicate that multiple cesarean deliveries, the uterine positioning (as assessed via TVS), a postpartum fever, breastfeeding, low post-cesarean platelet counts, and maternal anemia are contributing factors to the development of cesarean scar niches. Full article

Aromatase inhibitors (AIs), with or without gonadotropin-releasing hormone analogs, are the cornerstone of adjuvant endocrine therapy for women with hormone receptor-positive early-stage breast cancer, offering significant reductions in recurrence risk and improving long-term survival. Their use is frequently accompanied by treatment-related toxicities that can adversely affect patients’ quality of life (QoL) and adherence to therapy. Commonly reported side effects include vasomotor symptoms, such as hot flashes; musculoskeletal disorders, such as arthralgia and myalgia; mood disorders; and genitourinary discomfort, such as vaginal dryness and dyspareunia. Additionally, AIs are associated with a heightened risk of bone loss, leading to osteoporosis and fractures, and may have implications for cardiovascular health. Effective management of these adverse events is pivotal in maintaining treatment adherence and preserving QoL. Evidence-based strategies to address these toxicities include pharmacological interventions, such as analgesics for joint pain, bisphosphonates or denosumab for bone health, and hormonal or non-hormonal approaches for vasomotor and genitourinary symptoms. Non-pharmacological measures, including physical activity, dietary adjustments, and complementary therapies, can also help mitigate symptoms. This review examines the broad spectrum of AI-associated toxicities, discusses their clinical implications, and provides an overview of evidence-based management strategies. These insights aim to support clinicians in optimizing patient care while minimizing the toxicities of therapy. Full article

Introduction: The decline of serum estrogen in postmenopausal women leads to several changes in the vulvovaginal and vesicourethral areas, resulting in the genitourinary syndrome of menopause (GSM), characterized by bothersome symptoms such as vaginal atrophy, lack of lubrication, dyspareunia, urgency, dysuria, and recurrent urinary tract infections. Nevertheless, this condition could also be experienced by younger women affected by hormone-dependent tumors. Although topical estrogens are considered “the gold standard”, hormonal treatments cannot be indicated in cancer survivors. As a result, energy-based devices using radiofrequency and laser technologies have emerged as alternative options. This prospective study aimed to evaluate the benefits of non-invasive monopolar radiofrequency (RF) in women affected by GSM who have contraindications to, did not respond to, or declined local estrogen therapy. Methods: The patients underwent five weekly sessions of second-generation monopolar RF. At baseline and at the fifth session, two validated questionnaires were administered to the patients: the Visual Analogue Scale (VAS) and the Female Sexual Function Index (FSFI-19). On the other hand, the vaginal mucosa status was evaluated by clinicians through the Vaginal Health Index (VHI). At the end of the cycle, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected. Results: Based on 44 patients who completed five sessions of radiofrequency, a significant improvement was observed in sexual function according to the FSFI scale (22.9 vs. 38.6; p < 0.001) and in VVA atrophy symptoms, as documented by the VAS score (223 vs. 125; p < 0.001). The mean VHI score increased by 3 points (p < 0.001). Moreover, according to PGI-I, 96% of patients reported a perceived improvement (PGI-I score ≤ 3). Conclusions: Radiofrequency could provide an innovative and safe therapeutic approach for patients suffering from GSM and VVA, especially when hormonal strategies are unsuitable. Full article

Sexual dysfunction affects an estimated 50–70% of cancer survivors but remains underrecognized and undertreated, impacting quality of life and emotional well-being. This narrative review involves a comprehensive search of PubMed/MEDLINE, CINAHL, Scopus, Web of Science, and ScienceDirect for English-language publications (January 2010–May 2025), using combined MeSH and free-text terms for ‘sexual health’, ‘cancer’, ‘nursing’, ‘roles of nurses’, ‘immunotherapy’, ‘targeted therapy’, ‘sexual health’, ‘sexual dysfunction’, ‘vaginal dryness’, ‘genitourinary syndrome of menopause’, ‘sexual desire’, ‘body image’, ‘erectile dysfunction’, ‘climacturia’, ‘ejaculatory disorders’, ‘dyspareunia’, and ‘oncology’. We used the IMRAD (Introduction, Methods, Results, and Discussion) approach to identify 1245 records and screen titles and abstracts. Fifty studies ultimately met the inclusion criteria (original research, reviews, and clinical guidelines on oncology nursing and sexual health). Results: All the treatments contributed to reduced libido, erectile dysfunction, dyspareunia, and body image concerns, with a prevalence of 57.5% across genders. Oncology nurses can provide sex education and counseling. Barriers (limited training, cultural stigma, and the absence of protocols) hinder effective intervention. Addressing these issues through sexual health curricula, formal referral systems, and policy reforms can enhance nursing care. Future research should assess the impact of targeted nurse education and the institutional integration of sexual health into cancer care. Full article