Search

Introduction and hypothesis Our aim was to determine the effects of pelvic floor physical therapy (PT) and levatordirected trigger-point injections (LTPI) on sexual function and levator-related pelvic pain. Study design A randomized trial among women with pelvic floor myalgia (PFM) was performed wherein participants received either PT or LTPI. Pain was assessed and 1 month posttreatment completion. Levator-based pain was assessed using a numeric rating scale (NRS) and the Patient Global Impression of Improvement (PGI-I) scale. Sexual function was assessed using the Female Sexual Function Index (FSFI). Results Twenty-nine women completed the study (17 had PT, 12 had LTPI). Both groups reported reduction in vaginal pain: mean NRS change from baseline of 4.47 [standard deviation (SD) 2.12) for PT and 4.67 (SD 1.72) for LTPI (p=0.8)]. A >50 % improvement in NRS was documented among 59 % of women receiving PTand 58 % receiving LTPI (p=1.0). ConsistentwithNRSscores,meanPGI-Iscorewas2.50(SD 1.17) for PTand 2.17 (SD 1.01) for LTPI (p=0.5). Mean change in FSFI favored PT [PT +8.87 (SD 5.60), LTPI +4.00 (SD 5.24), p=0.04], reflecting improvement in the sexual pain domain favoring PT (p=0.02). However, the time in weeks to effect improvement favored LTPI if controlling for the degree of change in NRS (p=0.01) and FSFI (p=0.01). Conclusions Vaginal myalgia and sex-related pain improved with pelvic floor PT and LTPI. Time-to-effect improvement and significance of therapy are dependent on treatment type.

This study aimed to determine the quality of available patient-centered information for pelvic organ prolapse (POP) on the Internet using a modified validated scale. Two independent investigators using three search engines (Google, Yahoo, Bing) searched and reviewed the top 30 unique sites for four terms: bladder prolapse; dropped bladder; uterine prolapse; dropped uterus. A total of 219 websites were reviewed by both reviewers excluding redundancies. A two-stage, 6-point rating scale with score range per question of 0–5 was developed from the DISCERN instrument. Also recorded was whether a site had Health On the Net (HON) Foundation certification. The 400 sites were (as stated) a separate search where in the the domain suffix for the top 100 sites per serach term was recorded. The summary of 400 sites reviewed across the four search terms identified 64 % .com, 19 % .org, 8 % .edu, 6 % other and 3 % .gov; .gov yielded the highest quality information. Only 23 (9.5 %) sites were HON certified, yet these sites possessed higher DISCERN scores (p

The optimal surgery for combined apical and posterior vaginal prolapse is not well defined. Our objective was to examine the anatomic and functional outcomes following sacrocolpopexy (SCP) with or without posterior colporrhaphy (PC).We retrospectively evaluated 258 women who underwent abdominal (n = 62) or laparoscopic (n = 196) SCP with or without PC. Preoperative anatomic support and standardized bowel symptoms were compared to 6-week and 1-year postoperative values, using Student's t test and Wilcoxon rank sum test, respectively.Six-week follow-up data were available for 235 of 258 (91.1 %) women, while 125 of 258 (48.4 %) women had 1-year anatomic and functional outcomes recorded. While the SCP + PC group had worse posterior descent and bowel function preoperatively, there were no significant differences in postoperative anatomic support or symptoms. Long-term pelvic floor function was similar, as measured by three validated instruments. Reduction in the proportion of women with splinting was greater in the SCP + PC group.SCP with or without PC is associated with improved posterior support and decreased obstructive and irritative bowel symptoms at 1 year in women with apical and posterior prolapse.

Recently, when asked why “cosmetogynecology” was wrong a colleague retorted, “Because there is no evidence.” The response poses an interesting question in whether evidence renders an ethic since ethics are dedicated to right conduct and correspondingly assign the labels right and wrong or good and bad. The outcry for restraint in the adoption of new pelvic floor repair kits or cosmetogynecology largely stems from the lack of evidence [1–3]. While evidence-based medical practice is certainly ethical, evidence is not an ethic, and if evidence is not an ethic, but a compliment to an ethic, how do we judge medical practice? Medicine is not ethically neutral. When we identify disease as “bad” and health as “good” we pronounce judgment on equally natural processes. While it is true that medicine can borrow ethical principles from a physician’s individual world-view, medicine has an intrinsic ethic. It can be convincingly argued that the Hippocratic Oath captures the salient features of this intrinsic ethic [4]. What is the fundamental goal of medicine? According to the Hippocratic oath a physician intervenes to “benefit the sick.” In essence physicians restore health, since this is what will benefit the sick. Who and in what ways an individual is sick can be reasonably debated, but physician duties are restorative. In one sense health is a unidirectional concept (e.g., healthy bowel function cannot be improved) and as such physicians do not apply therapies to create super-normal function. The ethics of medical enhancement to otherwise normal human function is ethically and culturally charged [5] and beyond this editorial. It will suffice to say that evidence can aid in defining normal, and with this medical practice, but the evidence only informs the overarching ethical principle to restore health; not included, as a first principle, is remuneration, ego, or personal advancement. It has been said that management of pelvic floor dysfunction is not about what could be done but what should be done. This is not a neutral statement. Questions of “should” bespeak judgments that are rooted in ethics. If physicians regularly practice interventions that evidence has consistently shown to be ineffective, this is fraud. Conversely, if a practice has abundant evidence documenting efficacy, is it de facto ethical? Obviously not, since harvesting organs from non-consenting trauma victims is wrong despite the evidence that organ transplantation can be highly effective (it is worth noting the presently simmering issue of presumed consent in organ donation). Ignorance can soften the first situation but the latter arises from a darkened world-view that is outside of any intrinsic medical ethic. When looking for a rule for practice and likewise rules to judge the ethics of any practice in medicine, we must recognize that individual world-views, in cooperation with the intrinsic medical ethic, can underlie the process. Such individual world-views can reorder care priorities to where the ends justify the means. If evidence demonstrated a therapy ineffective, yet it was practiced routinely, this would be bad. As stated above the situation is at least dishonest, but why is dishonesty bad? If self-interest is the prevailing human ethic then would not any medical practice that does not majority benefit the physician be bad? In 1991 Dr. L.D. Rue proposed at the American Academy for the Advancement of Science that modern culture needed a “noble lie” to foster moral behavior. The “lie” would be necessary as an authority to impart value to the universe and ourselves. While medicine Int Urogynecol J (2008) 19:745–746 DOI 10.1007/s00192-008-0617-8