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Objective: Voiding Dysfunction (VD) is one of the most common disorders among women, which is characterized by a disorder in urination. Pelvic organ prolapse is one of the factors that can affect VD. In this study, the relationship between prolapse in the anterior, posterior, and apical areas and VD has been evaluated. Materials and methods: This is a cohort retrospective study. The participants in this study were women with VD, who referred to the pelvic floor disorders clinic of Imam Khomeini Hospital in Tehran in 2018-2020. Clinical information was obtained retrospectively from the hospital's electronic data system, also symptoms (intermittent stream, incomplete voiding, poor flow, post void dribble, straining to void, stage anterior, posterior and apical) and urodynamic parameters (including EMG, PVR100, Qmax12, and pdet20) were evaluated, which included detailed questionnaires (Urinary Distress Inventory 6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7)), pelvic examination, and complete urodynamic evaluation. Results: There was a direct relationship between the age of the patients and the stage of prolapse (p<0.001). So that, the stage increased with age. In addition, it was found that the severity of urinary symptoms is related to the stage of prolapse in the apical area (p=0.001). Also, the results showed that intermittent stream symptoms and the symptoms of staining to void had a significant relationship with the stage of prolapse (III and IV) in the apical and anterior areas. Also, it was shown that only PVR > 100 had a significant relationship with the stage of prolapse in the apical area (p=0.001). Conclusion: Intermittent stream and straining to void were related to the stages of prolapse in the apical and anterior regions. It was also concluded that the greater the prolapse, the higher the value of PVR > 100. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the quality of life, pelvic discomfort, and sexual function of patients who underwent posterior pericervical repair or level I to III surgical procedures for pelvic organ prolapse (POP) after 5 years of follow-up. This retrospective cohort study enrolled 107 women with POP who were referred to the Imam Khomeini Hospital Complex, an academic center affiliated with the Tehran University of Medical Sciences, Tehran, Iran, from 2014 to 2021. The patients underwent transvaginal surgery using native tissue, in which the rectovaginal fascia was attached to the pericervical ring. The Pelvic Floor Distress Inventory-20 (PFDI-20) and Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) questionnaires were completed by each patient before and 5 years after surgery. Of the 107 patients, only 78 completed the 5-year follow-up. The mean PFDI-20 scores before, 12 months, and 5 years after surgery were 141.87 ± 34.48, 100.87 ± 26.48, and 37.49 ± 56.39, respectively, indicating a significant improvement in the patients' symptoms after surgery (P < 0.001). The total mean score of ICIQ-FLUTSsex was 3.67 ± 3.63 (range, 0-10). In total, 22 (28.2%) women had an ICIQ-FLUTSsex score of 0, indicating no problems. The attachment of the rectovaginal fascia to the pericervical rings can be an effective surgical technique for correcting posterior vaginal wall prolapses, without significant morbidity. The PFDI-20 score improved significantly from before surgery to 12 months and 5 years after surgery. [ABSTRACT FROM AUTHOR]

Background & Objective: Defecatory dysfunction is a common problem among women who are referred for urogynecological care. Pelvic organs prolapse (POP) which is a downward displacement of pelvic organs is one of the common conditions among patients with defecatory problems. This study was planned to evaluate the correlation of obstructive defecatory symptoms with the site and severity of pelvic organ prolapse and the anorectal manometry results. Materials & Methods: This cross-sectional study was performed between Dec 2018 and Nov 2019. A total of 150 women with symptoms of defecatory problems were enrolled. Patients were classified in two groups according to each compartment prolapse staging and severity: stage =2 and stage >2. The correlation between defecatory symptoms and pelvic organ prolapse examination, anorectal examination and anal manometry were evaluated. Results: A total of 150 women were evaluated. There was a significant correlation between higher stage of anterior compartment prolapse (cystocele stage>2) and constipation (P=0.035). Although all the defecatory symptoms were more frequent in anterior prolapse stage>2, but the difference was not significant (P>0.05). There was no significant correlation between defecatory symptoms and severity of posterior compartment prolapse. There was a significant correlation between stage>2 of apical prolapse and all the defecatory symptoms (P=0.05). The abnormal anal resting and squeeze pressure and abnormal balloon expulsion test were more frequent in stage >2 of all compartments prolapse, but the difference was not significant (P>0.05). Conclusion: Obstructed defecation syndrome was more frequent in patients with higher stages of anterior and apical prolapse. Abnormal manometry results were more frequent in patients with defecatory dysfunction with advanced vaginal prolapse. [ABSTRACT FROM AUTHOR]

Constipation and obstructive bowel disorders are the most common symptoms of prolapse and posterior defects. Prolapse and obstructive defecation disorders are treated using various surgical techniques to repair posterior defects. This study aimed to evaluate the manometry results of patients before and after reconstructive surgery of the posterior compartment. This retrospective cohort study included 40 women with defecation disorders referred to the Imam Khomeini Hospital Complex, an academic center affiliated with Tehran University of Medical Sciences, Tehran, Iran, from 2020 to 2021. Data were collected through medical records and a checklist developed by the researcher before and after surgery. All analyses were performed using SPSS software (version 26), with significance at p<0.05. Forty women with a mean age of 49.47±9.66 years participated in this study. The manometry results showed significant differences in patients before and after surgery in parameters such as maximum resting pressure, push test, constipation, straining during defecation, finger support necessity, sensation of incomplete defecation, dyspareunia, and husband's sexual satisfaction (p<0.001). In addition, all patients had a grade 2 or higher posterior compartment prolapse, which improved in all cases after surgery (p<0.0001). Patients' symptoms significantly improved during the 12-month follow-up after DeLancey level 3 to 1 surgery. This type of surgery proved to be an effective surgical intervention without significant complications in the short-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Transverse vaginal septum is a rare mullerian anomaly. Patients with a complete transverse vaginal septum generally complain of primary amenorrhea. Here, we presented a rare case of high transverse vaginal septum with abdominal mass during infancy in addition to chronic pelvic pain and cyclic hematuria during adulthood. Case presentation: The patient was a 26-year-old female with complain of severe abdominal and pelvic pain with significant weight loss. She had a history of surgery for correction of hydrometrocolpos (fluid accumulation in the uterus and vagina) because of transverse vaginal septum at infancy period. She had no gynecologic follow-up until the age of 26 years. At the last surgical evaluation, diffuse pelvic endometriosis with advanced metastatic colon cancer was noted. Conclusion: After diagnosis of transverse vaginal septum during infancy period, detailed counseling should be performed about the other treatment and follow-up which is needed to prevent severe complications that could affect the quality of life. [ABSTRACT FROM AUTHOR]

There are several techniques for repairing prolapse in the posterior vaginal compartment, yet there is no general agreement on the best surgical procedure. This study was performed to investigate the outcomes of the common vaginal route technique for posterior vaginal wall prolapse repair in the first Iranian fellowship teaching center for female pelvic floor disorders. This prospective cohort study was performed on women with posterior vaginal wall prolapse with or without prolapse of other vaginal compartments who underwent surgery between 2014 and 2018 in a referral center for female pelvic floor disorders. A follow-up period of 12 months was considered. Patients subjected to the transvaginal technique by attachment of the rectovaginal fascia to the pericervical ring using vaginal native tissue were included. Among the 107 patients, the Pelvic Floor Distress Inventory-20 (PFDI-20) scores were 141.87 ± 34.48 and 100.87 ± 26.48 before and after surgery, respectively, showing the significant improvement of patient's symptoms after surgery in the 12-month follow-up. Comparing Pelvic Organ Prolapse Quantification (POP-Q) results before and after surgery, a significant improvement in patients' conditions was seen at the 12-month follow-up. Based on the results of the present study, the surgical procedure of the rectovaginal fascia attachment to the pericervical ring in posterior vaginal wall prolapse repair seems an effective surgical intervention without significant morbidity in the short-term follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Sexual dysfunction is a complex problem in postmenopausal women with a prevalence rate of 68%-86%. This study aimed to evaluate the effect of a fractional CO2 laser or vaginal cream on the improvement of sexual function in menopausal women. Methods: This is a two-group clinical trial study. Postmenopausal women with the inclusion criterion were enrolled and randomly divided into 2 groups of intervention (n = 25) and control group (n = 25). In the intervention group, CO2 laser therapy was performed every month for three months, and in the control group, Premarin vaginal cream was applied (0.625 mg, 3 nights a week for 3 months. Vaginal health index (VHI) scoring and Female Sexual Function Index (FSFI) questionnaires were completed before and three months after the treatment. Results: The effects of the laser treatment were greater than the Premarin group with respect to improvement in sexual desire, orgasms, sexual satisfaction, less pain during sexual relations, and overall sexual function (P < 0.05). Conclusion: It seems that the fractional CO2 laser may be more effective than hormonal therapy in improving sexual function in postmenopausal women. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse is a common complaint among older women. Vaginal pessary insertion is an appropriate treatment as a nonsurgical method with few complications. This paper is a prospective observational study of 68 patients with pelvic organ prolapse that was carried out at the Imam Khomeini Hospital's Pelvic Floor clinic. The degree of pelvic organ prolapse was graded according to the Pelvic Organ Prolapse Quantification (POP-Q) System. For all patients, the Pelvic Floor Distress Inventory-20 (PFDI-20) questionnaire was completed before vaginal pessary insertion, and after approximately 6 months of treatment. After 6-8 months, we found out that vaginal discharge was significantly increased and the feeling of fullness in the vagina was significantly decreased. However, sexual dissatisfaction, the feeling of incomplete evacuation, fecal and urinary incontinence, frequent urination, and pain or discomfort in the genital region were not significantly different after using a pessary. Approximately half a year later, 96.7% of the women with a successful pessary fitting trial were satisfied and reported a significant improvement in symptoms. Further studies with larger sample size, a different type of pessary, and a longer follow-up duration are recommended to evaluate all the symptoms associated with pelvic organ prolapse and its treatment. [ABSTRACT FROM AUTHOR]

Female genital cosmetic surgery (FGCS) is increasingly becoming popular among Iranian women. This study aimed to assess the relationship between sexual quality of life, female genital self-image, body image and sexual function, in women requesting genital cosmetic surgery. A sample of 50 women seeking genital cosmetic surgery without any medical indications and 100 women as comparison group participated in the study. Participants were selected by convenience sampling. Hierarchical regression analysis was performed by four steps to indicate factors that contribute to the female sexual quality of life. The results showed that education, age, duration of marriage, female genital self-image, body image, sexual function jointly accounted for 60% of the variance in sexual quality of life score between two groups. Of these, sexual function and body image showed the greatest coefficients (β = 0.493 and 0.282, respectively) and significant relationship with sexual quality of life score, p < 0.001. This study is the first investigation that examines FGCS in Iran. The findings suggest that there is association between seeking cosmetic vaginal surgery and female sexual functioning and body image, and that these are related to female sexual quality of life. Perhaps improving these factors might lead to the decreased unnecessary female genital cosmetic surgeries. [ABSTRACT FROM AUTHOR]

The current evidence regarding the association between vitamin D status and pelvic floor disorder (PFD) are inconclusive. This meta-analysis was aimed to summarize existing data demonstrating the association between Vitamin D status and PFD using published observational studies. All national and international databases including Web of Science, PubMed, Google Scholar, and Scopus were searched up until January 30, 2018, and related published studies retrieved for meta-analysis. The effect sizes of Vitamin D status were presented as standardized mean difference (SMD) with 95% confidence interval (CI), using random-effect models and inverse variance method. The Cochran Q statistic and I2 tests were used to evaluate the heterogeneity across included studies. Seven studies with 3219 women were included our meta-analysis. There was heterogeneity existing among included studies (I2 = 96.4%, P < 0.001), so a random-effect model was used. The findings of this meta-analysis revealed that the mean serum Vitamin D levels in women with PFD were significantly lower than healthy women (SMD −0.60; 95% CI, −1.06, −0.13; P = 0.01). This meta-analysis demonstrates lower levels of serum Vitamin D in women with PFD rather than healthy women. Additional prospective studies regarding the association between Vitamin D status and PFD are required to confirm our findings. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of sexual problems in Iranian women and association of sexual dysfunction with menopausal symptoms. Materials and methods: In this cross-sectional study, 151 married women with the age of 40-60 years old who were referred for treatment to Department of Gynecology in Vali-e-Asr Hospital (Tehran, Iran) from April to July 2012, were recruited. They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index (FSFI) questionnaire. Menopause rating scale (MRS) was developed for the diagnosis and quantification of climacteric symptoms. Results: Total frequency of sexual dysfunction was 53% with the domains of lubrication, arusal and desire being commonly affected 62%, 70% and 98.5% of cases respectively. There is a relationship between severity of somatic and urogenital symptoms with sexual dysfunction (p = 0.03, p = 0.00 respectively). Conclusion: A considerable percentage of women experienced sexual dysfunctions in this period. Somatic and urogenital symptoms during the menopausal period could be a factor to maintain or intensity of sexual dysfunctions. [ABSTRACT FROM AUTHOR]

Genitourinary tuberculosis is a common extrapulmonary manifestation of tuberculosis. Taking into consideration that genitourinary tuberculosis may be associated with a diversity of presentations, its diagnoses may be difficult. A young woman with an initial presumptive diagnosis of a uterine leiomyoma presented with abdominal pain and a pelvic mass that after further investigations, she was diagnosed with genital tuberculosis. [ABSTRACT FROM AUTHOR]

Overactive bladder (OAB) is a disabling disorder. Treatment of cases with OAB includes behavioral, pharmacological, surgical interventions and peripheral electrical stimulation. The goal of this study was to determine effects of posterior tibial nerve stimulation on sexual function and pelvic disorders in women with Overactive bladder (OAB). Fifty women were randomly assigned to PTNS (posterior tibial nerve stimulation) plus tolterodine or tolterodine alone treatment. Tolterodine group received 4 mg tolterodine daily for three months while the other group received this treatment plus percutaneous tibial nerve stimulation for 12 consequence weeks. Two in PTNS group and 8 in the control group withdrew from the study. Age, education level, and occupation status were not significantly different between two groups. Mean total FSFI and its subscales were not significantly different before and after treatment between two groups. Urine leakage associated with a feeling of urgency and loss of stool or gas from the rectum beyond patient's control became significantly different after treatment between two groups. Posterior tibial nerve stimulation could help urinary problems in women with a neurologic bladder. [ABSTRACT FROM AUTHOR]

Background: Polycystic Ovary Syndrome (PCOS) is presented with characteristic complications such as chronic an ovulation, obesity, and hyperandrogenism which can affect sexual function in women of reproductive age. Objective: Herein we evaluated the frequency and predisposing factors of sexual dysfunction in infertile PCOS patients. Materials and Methods: In this cross-sectional study, 130 married women with a definite diagnosis of PCOS who were referred due to infertility were recruited. They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index (FSFI) questionnaire. Results: The frequency of sexual dysfunction was verified 57.7% in PCOS patients with the domains of desire and arousal being commonly affected in 99.2% and 98.5%of cases respectively. BMI had a significant effect on sexual desire and arousal (p=0.02) while the effect of hirsutism was significant on all domains (p<0.001 for total FSFI score) except for dyspareunia. Conclusion: PCOS patients markedly suffer from sexual dysfunction as comorbidity. It seems appropriate to screen all PCOS patients for sexual function with a simple short questionnaire such as FSFI. Targeted interventions could be considered to help improve their quality of life along with other treatments. [ABSTRACT FROM AUTHOR]

Background: Female sexual dysfunction is a common problem among general population, especially in urogynecological patient, and can lead to a decrease in quality of life and affect martial relationship. Objective: This study was compared the effect of surgical methods versus physiotherapy on sexual function in pelvic floor disorder. Materials and Methods: This randomized controlled trial was performed in Urogynecology clinic since August 2007 to December 2009 on 90 patients aged from 25-55 years with previous delivery, positive history of sexual dysfunction with stage <3 of pelvic organ prolapsed and divided in two groups. Group A (n=45) received standard rectocele repair and prineorrhaphy, group B (n=45) received physiotherapy for eight weeks twice a week (electrical stimulation, Kegel exercises). The female sexual function index (FSFI) used to evaluate the sexual function in cases before and after intervention. Frequency of variable scores (libido, orgasm, dysparunia) included without disorder, frequently good, sometimes good, very much and extreme were compared between two groups. Results: Libido and arousal were improved in both groups (p=0.007, p=0.001 respectively). Orgasm and dyspareunia were improved in group B (p=0.001). Dysparunia was more painful in group A. There was significant difference between two groups (improvement of orgasm and dysparunia in group B) (p=0.001). Conclusion: It seems that physiotherapy is an appropriate method for treatment of sexual disorder in pelvic floor disorder. [ABSTRACT FROM AUTHOR]

Background: Human chorionic gonadotropin (HCG), one of the initial embryonic signals, is probably a major regulator of the embryo-endometrial relationship. This study aims to assess the advantage of HCG supplementation during the secretory phase of hormonally prepared cycles for the transfer of cryopreserved-thawed embryos. Materials and Methods: This study was a randomized clinical trial. Infertile women who were candidates for frozen-thawed embryo transfers entered the study and were divided into two groups, HCG and control. The endometrial preparation method was similar in both groups: all women received estradiol valerate (6 mg) po per day from the second day of the menstrual cycle and progesterone in oil (100 mg) intramuscular (I.M.) when the endometrial thickness reached 8 mm. Estradiol and progesterone were continued until the tenth week of gestation. In the HCG group, patients received an HCG 5000 IU injection on the first day of progesterone administration and the day of embryo transfer. Results: In this study, 130 couples participated: 65 in the HCG group and 65 in the control group. There was no statistically significant difference between groups regarding basic characteristics. Implantation rate, chemical pregnancy, clinical pregnancy, ongoing pregnancy, and abortion rates were similar in both groups. Conclusion: Although HCG has some advantages in assisted reproductive technology (ART) cycles, our study did not show any benefit of HCG supplementation during the secretory phase of frozen cycles (Registration Number: IRCT201107266420N4). [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to determine the frequency of urinary and fecal incontinence and their determinants in pre-menopausal and menopausal women in Iran. Materials and methods: This one-year cross-sectional study was performed on 304 women aged 40-55 who were admitted to women's clinic at Imam Khomeini Hospital. Symptoms of urinary, gas, and fecal incontinence and pelvic organs prolapse were diagnosed by a specialist through examination and a questionnaire. Patients were divided into two groups of with and without (urinary, gas, and fecal) incontinence symptoms. The probable risk factors of these disorders were studied and registered in the questionnaire and compared using t-test, chi-squared test, and regression of quantitative and qualitative variables. Results: Generally, 129 (42%) out of 304 women had pelvic floor dysfunction (urinary and fecal incontinence, and pelvic organs prolapse). Risk factors including menopause, hormone therapy, history of hysterectomy, inactivity, age, BMI, and first child's birth weight were compared between the two groups using chi-squared and t tests. There was a statistically significant difference between the two groups (P=0.000) as risk factors were more frequently observed in women with incontinence symptoms.. Conclusion: Some risk factors of pelvic floor dysfunction are menopause, hormone therapy, history of hysterectomy, inactivity, age, BMI, and first child's birth weight. Therefore, some strategies should be included in women's health education programs to prevent the above-mentioned risk factors. [ABSTRACT FROM AUTHOR]