Search Results (268)

Background/Objectives: This study explores the diagnostic and management pathways for dyspareunia in women seeking specialist care, focusing on gynecologists’ feedback and women’s perceptions of their experience. Methods: An online survey was conducted among 225 sexually active women to explore their perceptions of dyspareunia, its impact on relationships, and experiences with healthcare feedback, diagnosis, and treatment. The Numeric Rating Scale (NRS) for pain assessment and the Female Sexual Function Index (FSFI) were used. Gynecologists’ feedback was classified as positive, neutral, or negative based on its influence on the therapeutic pathway. Results: Of 78 women reporting dyspareunia, 12 with pain level ≥5 on NRS were selected for in-depth analysis. The mean pain score was 7.0 ± 1.53, with symptoms lasting from several months to over two years and occurring during most sexual encounters. The mean FSFI score was 24.86 ± 4.54, with half of the participants scoring within the sexual dysfunction range. Qualitative findings revealed frequent dismissive responses from healthcare professionals and limited access to appropriate management. Common self-management strategies included changing sexual positions and using lubricants, while half of the participants had not undergone a formal diagnostic process. Most frequent diagnoses were hormonal disorders and recurrent genital tract infections, and women were advised to undergo pharmacological treatment. Half of the participants were unaware of the possibility of physiotherapeutic management. Conclusions: Women with dyspareunia often face an inadequate diagnostic and therapeutic process. The care received is often insufficient and not aligned with a biopsychosocial model. Full article

Endometriosis is a complex disease that may affect a woman’s fertility and quality of life. Owing to substantial variations in symptom severity, lesion distribution, and reproductive impact, its management presents considerable clinical challenges. The most recent internationally recognized guidelines include those issued by the European Society of Human Reproduction and Embryology (ESHRE, 2022), the German Society of Gynecology and Obstetrics (DGGG/SGGG/OEGGG S2k, 2025), the World Endometriosis Society (WES), the National Institute for Health and Care Excellence (NICE, 2024), and the American College of Obstetricians and Gynecologists (ACOG, reaffirmed 2022). To provide a comprehensive overview of these recommendations, we critically compared these guidelines, with particular emphasis on the recently updated German S2k guideline. Searches were conducted through PubMed and institutional repositories using selected key terms, and the AGREE II tool (Appraisal of Guidelines for Research and Evaluation) was employed to assess methodological quality. Key clinical domains examined included indications for conservative and radical surgery, management of endometriomas and deep infiltrating endometriosis (DIE), the role of surgery before Assisted Reproductive Technology (ART), the impact of second-look procedures, and integration of psychosocial dimensions via Patient-Reported Outcome Measures (PROMs). The results show a general trend toward interdisciplinary treatment models, cautious use of radical resection techniques, and customized, symptom-based surgical interventions. Despite ongoing disagreements, there is general agreement on collaborative decision-making, preserving fertility, and adjusting surgery time and technique between the guidelines to meet the requirements of individual patients. Full article

Background and Objective: Changes in female sex hormone levels are closely linked to the development and progression of uterine fibroids (UFs). Clinical approaches to fibroid management vary according to guidelines and depend on patient symptoms, fibroid size, and clinician judgment. Despite available diagnostic tools, surgical decisions remain largely subjective. With the advancement of artificial intelligence (AI) and clinical decision support technologies, clinical experience can now be transferred into data-driven computational models trained with hormone-based parameters. To develop a clinical decision support algorithm that predicts surgical necessity for uterine fibroids by integrating fibroid characteristics and female sex hormone levels. Methods: This multicenter study included 618 women with UFs who presented to three hospitals; 238 underwent surgery. Statistical analyses and artificial intelligence-based modeling were performed to compare surgical and non-surgical groups. Training was conducted with each hormone—follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E2), prolactin (PRL), and anti-Müllerian hormone (AMH)—and with 126 input combinations including hormonal and morphological variables. Five supervised learning algorithms—support vector machine, decision tree, random forest, and k-nearest neighbors—were applied, resulting in 630 trained models. In addition to this retrospective development phase, a prospective validation was conducted in which 20 independent clinical cases were evaluated in real time by a gynecologist blinded to both the model predictions and the surgical outcomes. Agreement between the clinician’s assessments and the model outputs was measured. Results: FSH, LH, and PRL levels were significantly lower in the surgery group (p < 0.001, 0.009, and <0.001, respectively), while E2 and AMH were higher (p = 0.012 and 0.001). Fibroid volume was also greater among surgical cases (90.8 cc vs. 73.1 cc, p < 0.001). The random forest model using LH, FSH, E2, and AMH achieved the highest accuracy of 91 percent. In the external validation phase, the model’s predictions matched the blinded gynecologist’s decisions in 18 of 20 cases, corresponding to a 90% concordance rate. The two discordant cases were later identified as borderline scenarios with clinically ambiguous surgical indications. Conclusions: The decision support algorithm integrating hormonal and fibroid parameters offers an objective and data-driven approach to predicting surgical necessity in women with UFs. Beyond its strong internal performance metrics, the model demonstrated a high level of clinical concordance during external validation, achieving a 90% agreement rate with an independent, blinded gynecologist. This alignment underscores the model’s practical reliability and its potential to reduce subjective variability in surgical decision-making. By providing a reproducible and clinically consistent framework, the proposed AI-based system represents a meaningful advancement toward the validated integration of computational decision tools into routine gynecological practice. Full article

Background/Objectives: Genital discomfort, manifested by vulvar itching and burning, is a frequent complaint among women of all ages and has multifactorial origins—including dermatoses, infections, allergies, and hormonal disorders. The study aimed to determine whether selected medical history factors—age, obstetric history, and body mass index (BMI)—influence the frequency of genital discomfort as a reason for gynecological consultation. Methods: A pilot study included 288 female patients aged 11–91 years who presented to outpatient gynecological clinics between September 2018 and February 2025 with symptoms of vulvar itching and genital discomfort. Qualitative data were expressed as numbers and percentages, and age was described using mean, median, quartiles, and range. Associations between categorical variables were assessed using Pearson’s chi-square test, with statistical significance set at p < 0.05. Results: The mean age of patients was 47.4 ± 20.3 years. Most were diagnosed with ICD-10 code N90 (82.6%), while 17.4% had N76. Genital discomfort was most frequently reported by women aged 41–50 years (p < 0.0001). Comorbidities (p < 0.0001) and obstetric history (p < 0.0001) significantly influenced the occurrence of genital discomfort, which was more prevalent among women with chronic conditions and those who had been pregnant. No significant associations were found with BMI (p = 0.2353) or menopausal status (p = 0.3458). Conclusions: Genital discomfort is a common and multifactorial condition requiring an interdisciplinary diagnostic and therapeutic approach. Collaboration among gynecologists, dermatologists, endocrinologists, and dietitians is crucial for effective management and prevention. Full article

Background: Adequate folate intake before and during early pregnancy is essential for neural tube defect (NTD) prevention. In 2023, the Polish Society of Gynecologists and Obstetricians updated national recommendations, emphasizing the use of L-5-methyltetrahydrofolate (5-MTHF). Evidence on women’s awareness of these guidelines is limited. Methods: This cross-sectional online survey (2025) included 188 Polish women aged 18–45 years who were currently pregnant or had been pregnant within the previous 12 months. Knowledge, attitudes, and supplementation practices were compared between women with (n = 94) and without infertility (n = 94). Group differences were assessed using χ² tests, and predictors of 5-MTHF use were examined with multivariable logistic regression. Results: General awareness of folate recommendations was high (98.9%). However, detailed knowledge varied substantially. Women with infertility more frequently recognized different folate forms (87.2% vs. 72.3%; p = 0.018), knew the role of the MTHFR gene (77.7% vs. 39.4%; p < 0.001), and initiated supplementation ≥3 months before conception (88.3% vs. 47.9%; p < 0.001). Overall, 66% reported using 5-MTHF. Independent predictors of choosing 5-MTHF included awareness of folate forms, MTHFR knowledge, and awareness of emerging considerations related to folic acid metabolism. Infertility status was not an independent predictor. Conclusions: Although folate supplementation was nearly universal in this selective sample, more advanced knowledge—particularly regarding folate forms and genetic aspects of folate metabolism—remained limited. Higher awareness among women with infertility likely reflects greater exposure to medical supervision rather than inherent differences between groups. These findings may represent early signals of how the 2023 Polish recommendations are disseminating among women who are more engaged with health information, highlighting the need for continued public and professional education to support informed use of folate supplements. Full article

Background: The role of pulmonary metastasectomy has been increasingly questioned in the surgical community after the PulMiCC trial challenged its benefit in colorectal cancer. However, the view on pulmonary metastasectomy among people in non-surgical disciplines remains unclear. This study explored interdisciplinary attitudes toward pulmonary metastasectomy and identified the clinical expectations shaping its future role. Methods: An anonymous online survey of active board-certified physicians in oncology, urology, gynecology and dermatology was conducted (December 2024–June 2025). Twenty items covered attitudes to local ablative therapy, referral criteria, preferred modalities and future relevance. Group comparisons used Pearson’s χ²; ordinal ratings were compared by one-way ANOVA; associations were explored with Spearman’s ρ. Results: Of 2884 contacted physicians, 165 participated (≈5.7%), and 106 completed the questionnaire. All 106 (100%) endorsed local ablative therapy as meaningful; 92/106 (86.8%) favored routine integration into multimodal care. Surgical metastasectomy was selected by 49/106 (46.2%), SBRT was selected by 27/106 (25.5%) and image-guided ablation was selected by 7/106 (6.6%); preference for surgery differed by specialty (χ²(4) = 15.31, p = 0.004), while institutional availability (in-house thoracic surgery or radiation oncology) showed no association with selecting surgery or SBRT. Key referral determinants were number of lesions (105/106; 99.1%), anatomical location (86/106; 81.1%; p < 0.02 across specialties), and lesion size (81/106; 76.4%; p < 0.05); other factors showed no consistent inter-specialty differences. The perceived usefulness of metastasectomy was high (mode 8/10) and showed a weak, non-significant correlation with referral experience (ρ = 0.172, p = 0.077). Looking ahead, 46/106 (43.4%) anticipated a declining role of local ablative therapy with novel systemic therapies; interest in biomarker analysis from metastatic tissue compared to primary tumor tissue was very high 97/106 (91.5%). Conclusions: Local ablative therapy, particularly pulmonary metastasectomy, continues to be viewed as an integral and trusted element of metastatic disease management across specialties. Despite limited prospective evidence, clinicians maintain strong confidence in its clinical value and foresee its evolution toward biologically and patient-tailored indications. However, the interpretation of these findings is limited by a low response rate and potential selection bias toward European, academically affiliated respondents. To our knowledge, this is the first study to systematically capture perceptions of pulmonary metastasectomy among non-surgical oncology-related specialists. Full article

Background: Compassion fatigue (CF) is a state of emotional and physical exhaustion in the caregiving relationship, which can negatively impact patient safety and quality of care. Maternity care professionals are particularly vulnerable to CF due to their continuous empathetic engagement with patients in an unpredictable, high-stress work environment. Despite its significance, research on CF in maternity care is limited. The aim of this study is to explore experiences of CF among maternity care professionals. Methods: A thematic analysis of semi-structured in-depth interviews was conducted. The sample consisted of seven midwives and three gynecologists from different hospitals and outpatient care in Flanders (Belgium). Results: Experiences, risk factors and protective factors were identified as three organizing themes and further refined into 12 subthemes. Participants showed limited familiarity with the term CF but recognized its symptoms, including emotional exhaustion, reduced empathy, and a diminished ability to provide care, ‘as one normally would’. Key risk factors included high workload, emotional strain from ‘energy-consuming’ patients, fear of errors, and administrative burden. A supportive team environment, compassion satisfaction (CS), job autonomy and personal coping skills were identified as protective factors. Participants emphasized the need to recognize and address signals of CF. Conclusions: CF among maternity care professionals is underrecognized but appears to impact both caregiver well-being and patient care quality. Interventions should target awareness, team communication, psychological safety, and organizational context. A multilevel approach—combining individual, team, and systemic strategies—is needed to sustainably mitigate CF in maternity care. Full article

Background: Physiotherapy plays a crucial role in managing women’s health conditions, such as pelvic pain and postpartum recovery. However, its integration into standard care relies heavily on the awareness and referral practices of gynecologists and obstetricians, which may be suboptimal. Objective: To investigate the awareness, attitudes, and referral practices of gynecologists and obstetricians in Libya regarding the role of physiotherapy in women’s health. Methods: A cross-sectional study was conducted in public and private hospitals in Tripoli, Libya. A total of 100 practitioners were invited to participate. A self-administered questionnaire assessed demographics, awareness, attitudes, and practices. Results: The response rate was 67% (n = 67/100). The results revealed a key disparity: while the vast majority of respondents (94.1%) acknowledged the importance of physiotherapy in women’s health and 76.1% reported a willingness to refer patients, only 67.1% perceived physiotherapists as competent to manage these conditions. This indicates a significant gap in understanding specific physiotherapy techniques. Awareness percentage was significantly influenced by factors such as the type of hospital and prior exposure to physiotherapy education. Conclusions: A striking disparity was found between high general awareness (94.1%) and significantly lower perceived competence (67.1%) and knowledge of its role in specific conditions. This gap between general approval and specific understanding directly creates the critical barrier to referral. To improve interdisciplinary collaboration and patient access to care, enhanced educational initiatives for physicians, the development of clear clinical guidelines, and the establishment of dedicated women’s health physiotherapy clinics are strongly recommended. Full article

Background: Uterus transplantation (UTx) is a proven treatment for individuals affected by absolute uterine factor infertility (AUFI) who desire biological motherhood. Despite the fact that over 130 procedures have been performed worldwide in the past decade, UTx remains relatively unfamiliar, even among healthcare professionals. This study aimed to identify knowledge gaps regarding and evaluate attitudes toward UTx among Hungarian obstetricians/gynecologists and transplantation providers, in anticipation of the first procedure to be performed in the country. Methods: A Microsoft Forms^® questionnaire was distributed electronically among Hungarian medical professionals via e-mail, including members of the Hungarian Society of Obstetrics and Gynaecology and the Hungarian Transplantation Society. Additionally, participants of the “Update 2024” OB/GYN conference (held 28–29 November 2024, in Visegrád, Hungary) were invited to complete the survey through a QR code displayed during the event. Results: A total of 290 medical professionals completed the survey (response rate: 27.6%, 290/1050). Most of the respondents specialized in obstetrics and gynecology (81.7%, n = 237), with the remainder representing transplantation fields (18.3%, n = 53). Over half (56.6%, n = 161) reported they would recommend UTx to patients with AUFI, and 64.1% (n = 186) agreed that UTx should be available as a treatment option. The medical risks associated with the procedure were deemed acceptable for both living donors (58.0%, n = 168) and recipients (54.8%, n = 159). Conclusions: This is the first study to explore perceptions of UTx among Hungarian medical professionals. The findings suggest there is a generally favorable professional attitude toward its future clinical implementation. Full article

Background and Objectives: This study aims to analyze ESGO quality indicators for the surgical treatment of endometrial cancer patients at two gynecologic oncology departments in Slovenia and Croatia, providing insights for improving cancer care. Materials and Methods: We conducted a retrospective analysis of clinical data to evaluate ESGO quality indicators for surgical treatment of endometrial cancer patients from 2020 to 2022. ESGO quality indicators were calculated, and the results were discussed to formulate suggestions for enhancing cancer care. Institutional review board approval was obtained for the analysis. Results: The analysis reveals that the Slovenian Department for Gynecology and Breast Oncology in Maribor achieved compliance with 24 out of 26 quality indicators, while the Department of Obstetrics and Gynecology in Rijeka met 18 out of 26. The disparity may be partly attributed to Maribor’s status as an ESGO-accredited center in training since 2014, which facilitates more rapid updates in care practices. Conclusions: Based on our findings and epidemiological data, we recommend several actions to enhance cancer care in both countries: (a) advance initiatives for the centralization of care (2 to 3 centers in Slovenia and 5 to 6 in Croatia), (b) implement a national system for the prospective measurement of quality indicators, and (c) pursue center accreditation and gynecologist certification in subspecialty care by international societies such as ESGO, given the small size of both countries. Our results confirm that the analysis of ESGO quality indicators is a viable method for all stakeholders involved in enhancing cancer care. Full article

Background: Cervical cancer remains a significant public health concern in Kenya, with male partner involvement increasingly recognized as a key factor in effective prevention and control. However, limited research has explored the specific barriers and enablers to such involvement in the Kenyan context. This study aimed to examine the challenges and opportunities associated with male partner involvement in cervical cancer prevention in Central Kenya. Methods: A qualitative descriptive design was employed. Purposive sampling was used to select 73 participants, including 20 couples (40 individuals), 20 nurses, 2 clinical officers, 2 gynecologists, 6 community health workers, and 3 county health directors. Data were collected through interviews and focus group discussions and analyzed thematically to identify key patterns and insights. Results: The mean age of male partners was 36.9 years, and 30.5 years for female partners. Most couples (70%, n = 28) had attained secondary education. The average duration of professional experience for nurses and clinical officers was 13 years. Key challenges included knowledge gaps, financial and logistical barriers, limited moral support, time constraints, sociocultural beliefs, stigma, and inadequate facility infrastructure. Identified opportunities included community education, shifting norms, improved couple communication, practical support from men, and integration of services. Conclusions: This study identifies key challenges and practical opportunities for increasing male involvement in cervical cancer prevention. Clarifying and promoting specific male roles such as support for screening and vaccination can enhance the effectiveness of cervical cancer prevention strategies in Central Kenya. Full article

Background: The tumor microenvironment offers a new perspective in gynecologic oncology. In ovarian cancer, numerous preclinical studies, especially organoid models, have highlighted cellular, immune, and biochemical mechanisms. Beyond these sophisticated findings, more practical aspects require attention, such as the role of vaginal microbiota, which represents an interplay between external agents and internal genitalia, and its potential profiling role in early detection beyond the promise of microbiota-targeted therapies. Objectives: This review aims to assess whether such a correlation is speculative or scientifically grounded. Methods: A focused literature search was conducted on vaginal microbiota and its correlation with ovarian cancer to define the current state of knowledge. Results: Mixed outcomes have been reported, yet there is a rational and scientific basis supporting further investigation. Clinical approaches increasingly consider vaginal microbiota as relevant. However, we have to say that most available evidence is still preliminary and largely preclinical to set realistic expectations for readers. Although additional studies are needed, emerging insights highlight its importance and practical implications. We present a diagnostic–therapeutic management flowchart summarizing current evidence). Discussion: Most links between the vaginal microbiota and ovarian cancer are correlational rather than causal. The idea that microbes ascend from the vagina to the ovaries is proposed but still definitely not demonstrated. Confounding factors like age, hormones, and BRCA status complicate interpretation, and ovarian cancer itself could secondarily alter the microbiota. Mechanistic studies and longitudinal data are still needed to clarify whether dysbiosis contributes to carcinogenesis or is merely a consequence. As gynecologists, we summarize key aspects and emphasize to colleagues the importance of incorporating these findings into daily clinical practice. Vaginal dysbiosis should be considered not only a local imbalance but also a potential strategy for primary cancer prevention. Conclusions: Future research on the tumor microenvironment and vaginal microbiota will expand scientific knowledge and guide innovative preventive and therapeutic strategies. Full article

Background: The definitions and approaches used to diagnose gestational diabetes (GD) are varied. The two-step approach recommended by the American College of Obstetricians and Gynecologists (ACOG) combines the sensitivity of a glucose challenge test (GCT) with the specificity of a 3-hour oral glucose tolerance test (OGTT). We investigated if minor modification of the two-step procedure can provide improved detection of GD by identifying a risk group of pregnant women with high risk of GD. Methods: We conducted a prospective cohort study of pregnant women enrolled early during pregnancy and followed till delivery. All participants underwent the ACOG-recommended two-step procedure for GD diagnosis. Based on GCT and OGTT results, the participants were divided into four risk groups (RGs): GCT-negative (RG0), GCT-positive but OGTT normal (RG1), single abnormal value on OGTT or raised HbA1c (RG2) and diagnosed GD (RG3). Baseline evaluation included dietary history (24 hour recall) and physical activity. A series of multivariable logistic regression analyses were conducted to estimate the odds of maternal and fetal outcomes. Results: A total of 1041 pregnant women were included in the study, of whom 16 (1.6%) were diagnosed as GD. Our two-step approach identified 48 (4.6%) women as GD, while RG2, RG1 and RG0 comprised 75 (7.2%), 218 (20.9%) and 700 (67.2%), respectively. Compared to RG0, RG2 showed a higher likelihood of antepartum complications [odds ratio and 95% confidence interval 2.38 (1.16–4.15)], any adverse outcome without [2.04 (1.17–3.55)] or with cesarean section [2.09 (1.21–3.61)] and primary cesarean section [1.68 (1.01–2.81)] after adjustment for potential confounders. RG2 was also significantly associated with pregnancy-induced hypertension, meconium-stained amniotic fluid and premature rupture of membranes. Conclusions: In the study participants, we identified a subgroup (RG2) at high risk of GD with perinatal outcomes showing profile consistent with that of GD. Full article

Background/Objectives: Adnexal masses are commonly encountered in the routine practice of gynecologists, and transvaginal ultrasonography is the preferred imaging modality for assessing the masses in size and complexity. There has been a notable lack of focus on comparative studies concerning benign adnexal tumors. This study aimed to define and compare the specific morphological and vascular characteristics of ovarian mature cystic teratomas (MCTs) and endometriomas using transvaginal ultrasound and Doppler analysis. Methods: This retrospective analysis included 93 patients who underwent surgical intervention for benign adnexal masses at the Obstetrics and Gynecology Clinic Narodni Front from 1 January 2020 to 1 January 2022. Morphological parameters included the appearance of tumors, the largest diameter, volume, capsule thickness, and the presence of fluid in the pouch of Douglas. Hemodynamic parameters included the localization and quantity of blood vessels within the mass, Resistance Index (RI), peak systolic velocity (Vmax), and end-diastolic velocity (Vmin) within detectable tumor vessels. Flow was also assessed in the uterine arteries, calculating the AURI (uterine artery RI) on both the tumor and contralateral sides. Results: There were 46 patients with ovarian mature cystic teratomas, as well as 46 patients with endometriomas; 1 patient presented with both tumors. There were significant differences in ultrasonographic morphological appearance between the two groups. MCTs most frequently presented as multilocular solid cysts (51.0%) or unilocular solid cysts with hyperechoic content (20.4%). Conversely, the majority of endometriomas were classified as unilocular cysts with ground-glass echogenicity (45.5%). A significant difference was identified in the RI of intracystic vessels and the RI of the ipsilateral uterine artery (AURI). Endometriomas presented elevated RI values (0.57 vs. 0.54, p = 0.04) and reduced AURI (0.81 vs. 0.83, p = 0.02) compared to teratomas. Conclusions: These findings confirm that specific morphological and Doppler parameters, particularly the RI and AURI, can assist in distinguishing between endometriomas and mature cystic teratomas. This suggests a potential role for Doppler analysis in improving diagnostic precision for common benign adnexal tumors in clinical practice. Full article

Endometrial hyperplasia, presenting without atypia (EH) or as atypical hyperplasia (AH), is considered a precursor of endometrial cancer and affects women of reproductive or perimenopausal age, posing a major public health concern. The aim of this study was to review and compare the most recently published influential guidelines providing recommendations on the management of endometrial hyperplasia. Thus, a comparative review of guidelines from the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, and the American College of Obstetricians and Gynecologists was conducted. There is a consensus regarding the optimal management strategies for EH, with observation and medical treatment being the first-line options and surgical treatment with total hysterectomy offering a second line in specific cases. Moreover, there is agreement regarding patients with AH, with surgical treatment being the recommended approach, while medical therapy is preferred for women who seek fertility preservation. Notably, close surveillance with endometrial biopsies every 3 or 6 months is suggested unanimously, as well as long-term follow-up in high-risk patients. Controversy exists regarding the initial diagnostic approach, with RCOG and SOGC suggesting outpatient endometrial biopsy, while ACOG recommends diagnostic hysteroscopy, as well as the therapeutic regimens for the oral treatment of EH. Surgical techniques such as endometrial ablation, intraoperative frozen section analysis, intraoperative visual inspection of the uterus, and morcellation constitute areas of controversy among the reviewed guidelines, and the surveillance protocols for women with EH are addressed differently between RCOG and SOGC. Notably, RCOG is the only medical society offering recommendations regarding women under HRT and those on therapy for breast cancer. The development of consistent international practice protocols for timely management strategies and surveillance protocols is of paramount importance to safely guide clinical practice and subsequently improve women’s health. Full article