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Introduction and objectives: Treatments for gynaecological cancer may contribute to symptoms of pelvic floor disorders including urinary incontinence, faecal incontinence and dyspareunia. These disorders are associated with lower physical activity (PA) levels and health-related quality-of-life (HRQoL) in the general population. There are currently no prospective studies assessing the prevalence and severity of pelvic floor disorders, PA and HRQoL prior to and following hysterectomy for gynaecological cancer. The aim of this study was to investigate the prevalence and severity of pelvic floor disorders, levels of PA and HRQoL in females before and after hysterectomy for gynaecological cancer. Methods: This longitudinal study included adult females undergoing hysterectomy for endometrial, ovarian, cervical or uterine cancer. Symptoms of pelvic floor disorders, PA levels and HRQoL were assessed pre-surgery, six-weeks and three-months after surgery using: the Incontinence Severity Index, the Pelvic Floor Distress Inventory-Short Form (PFDI-20), the PFDI-20 subdomains of the Urogenital Distress Inventory (UDI-6), the Colorectal-Anal Distress Inventory (CRADI-6) and the Pelvic Organ Prolapse Distress Inventory (POPDI-8), the Female Sexual Function Index, the International Physical Activity Questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire. Change over time in each outcome was analysed using generalised estimating equations or linear mixed models. Results: Of 277 eligible patients, 126 consented to participate. The majority of participants had stage 1 cancer (62%) and the most common cancer was endometrial cancer (69%). The prevalence of urinary incontinence was 66% before and 59% three-months after surgery, while the prevalence of faecal incontinence was 12% before and 14% three month after surgery, these differences were not statistically significant (Table 1). However, the prevalence of pelvic floor symptoms on the PFDI-20 and urogenital symptoms UDI-6 subdomain decreased significantly (Table 1). The incidence of urinary incontinence three-months after surgery was 10%, and 8% of participants developed new faecal incontinence. At three-months after surgery, 42% of participants reported sexual activity in the preceding four weeks compared to 27% before surgery (p=0.003). The prevalence of dyspareunia was high in those who had attempted penetrative intercourse both before (n =11/17) and three-months after surgery (n=11/20). Only 39% of the participants met PA guidelines before surgery, and this increased significantly to 53% at three-months post-surgery (p=0.020). Scores on the global health status/QoL domain of the EORTC-QLQ C30 did not significantly change from before surgery (mean 64.8/100, 95%CI 61.2, 68.4) to three-months (mean 69.4/100, 95%CI 65.6, 73.2) after surgery (mean difference 4.6, 95%CI -0.6, 9.8). Conclusions: Patients with gynaecological cancer experienced high rates of pelvic floor disorders before and after hysterectomy. New cases of urinary and faecal incontinence developed between pre-surgery and three-months post-surgery. Physical activity levels increased significantly, and HRQoL did not significantly change between pre-surgery and three-months post-surgery. These findings suggest that clinicians working with gynaecology-oncology patients undergoing hysterectomy may need to consider screening and providing treatment options for pelvic floor disorders. Further prospective studies are required to identify subgroups of patients most at risk of pelvic floor disorders, and clinical trials assessing feasibility and effectiveness of treatments are warranted. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Treatment for gynaecological cancer may impact pelvic floor function, with studies finding high rates of urinary incontinence (UI), faecal incontinence (FI) and pelvic floor muscle dysfunction after treatment. However, few studies of pelvic floor muscle training (PFMT) for UI or FI have been conducted and no studies to date have investigated PFMT delivered via telehealth without any in-person assessments to manage UI and/or FI in this population. Therefore, our study aimed to assess the feasibility of recruiting to and delivering such an intervention, and clinical outcomes before and after the intervention. Methods: In this pre-post single cohort clinical trial, women who had UI or FI after surgery for gynaecological cancer underwent a 12-week physiotherapist-supervised PFMT program delivered via telehealth and supplemented with an intra-vaginal pressure biofeedback device. The intervention involved seven videoconference sessions, with real-time feedback from the biofeedback device, and a daily home exercise program supported by an associated application which participants downloaded to their mobile device. Feasibility outcomes were the proportion of eligible patients recruited to the study, attendance at the videoconference sessions, and adherence to the home exercise program. Participant satisfaction and acceptability was rated on a 7-point numerical rating scale (from 1 = very dissatisfied/very unacceptable to 7 = very satisfied/very acceptable). Clinical outcomes were assessed at baseline, immediately post intervention and at three-months follow-up using the International Consultation on Incontinence UI module Short Form (ICIQ-UI SF), the International Consultation on Incontinence Bowel module (ICIQ-B) and the intravaginal biofeedback device. Means and 95% confidence intervals for all time points were analysed using bootstrapping methods. Results Feasibility outcomes A total of 63 women were eligible, of which 39 (62%) consented to the study. Baseline outcome measures were not completed by three participants who were not enrolled in the trial. Of the 36 participants who enrolled in the trial, 32 (89%) received the intervention. The majority (n=30, 94%) demonstrated high engagement, attending at least six of the seven videoconference sessions. Adherence was moderate, with 24 participants (75%) completing five-to-seven PFMT sessions per week during the 12-week intervention period. At the three-month follow-up, 25 (78%) participants reported doing regular PFMT, with 16 (50%) reporting a frequency of at least three PFMT sessions a week. Most participants (n=24, 77%) rated the videoconference sessions as very acceptable and 14 (44%) rated the intravaginal sensor as very acceptable. Clinical outcomes All clinical outcome measures improved immediately post-intervention (Table 1), however the magnitudes of these improvements were small. At three-months follow-up, improvements were sustained for prevalence, ICIQ-UI SF and ICIQ-B domains but not PFM outcomes. Conclusions: This study showed that PFMT delivered via telehealth may be feasible and acceptable to treat UI and/or FI after gynaecological cancer treatment. The study was not powered for the clinical outcome measures and did not have a control group, therefore large randomised controlled trials would be needed to investigate clinical effectiveness. [ABSTRACT FROM AUTHOR]

Introduction & Objectives: Compared with men, women participate in organised sport at a lower rate, and encounter unique barriers to participation.1 One in three women across all sports experience pelvic floor (PF) symptoms such as urinary incontinence during training/competition.2 Despite this, there is sparse qualitative research on the experience of women who play sport/exercise with PF symptoms. Through in-depth semi-structured interviews, we explored the experiences of symptomatic women within sports/exercise settings and the impact of PF symptoms on sports/exercise participation. Methods: A qualitative descriptive design was used. Random women from an existing database were invited to participate in a semi-structured interview via online platform (Zoom). Interviews were audio recorded and transcribed verbatim. Data were analysed using inductive qualitative content analysis, managed via NVivo software. Patterns of women's experiences within the data were identified, leading to development of a coding scheme that was then applied to all data. Codes were merged or linked to form themes representing the latent meaning of the content and agreed on in discussion by the research team. Quotations were selected to illustrate themes. Information power guided the decision to cease recruitment. Included participants (n=23) were 18-65-year-old women (average age 46.2 years), residing in Australia who had experienced a breadth of PF symptoms (96% urinary incontinence, 35% pelvic organ prolapse and 48% anal incontinence) whilst exercising (in the past or currently). Women needed a conversational level of English to participate. Results: Participants played a variety of sports and levels of participation (78% recreational). We identified four main themes: (i) I can't exercise the way I would like to, (ii) it affects my emotional and social well-being, (iii) where I exercise affects my experience and (iv) there is so much planning to be able to exercise. Women reported wide-ranging impact on their ability to participate in their preferred type, intensity and frequency of exercise. Women perceived judgement from others, anger, fear of symptoms becoming known and isolation from teams/group exercise settings as a consequence of symptoms. Meticulous and restrictive coping strategies were needed to limit symptom provocation during exercise, including limiting fluid intake and careful consideration of clothing/ containment options (Table 1). The culture of the sporting environment influenced whether women continued or ceased exercising - positive role models (other members or support staff), education and re-design of uniform to allow covert containment of leakage were strategies identified to promote a positive culture. Conclusions: Experiencing PF symptoms during sport/exercise caused considerable limitation to participation. Generation of negative emotions and painstaking coping strategies to avoid symptoms, limited the social and mental health benefits typically associated with sport/exercise in symptomatic women. In order to promote women's participation in sport, co-designed strategies for (i) screening and management of PF symptoms and (ii) promotion of a supportive and inclusive culture within sports/exercise settings are needed. [ABSTRACT FROM AUTHOR]

Introduction: The lifetime risk of undergoing surgery for pelvic organ prolapse (POP) or stress urinary incontinence in women is 20%1. The long-term outcomes following surgical correction of POP are sub-optimal, with anatomical recurrence rates up to 40% and subsequently high reoperation rates2,3. As pelvic surgery can result in recurrent or de novo pelvic floor dysfunction, a better understanding of the effects of surgery on the pelvic floor muscles (PFM) is essential to maximise long term outcomes for women. The primary aim of this review was to determine the effect of POP and/or continence surgery on PFM function and morphometry in women. The secondary aim was to investigate whether a relationship exists between the PFM measures and clinician reported objective outcomes, urodynamic results or pelvic organ prolapse quantification (POP-Q) post-operatively. Materials and methods: Six electronic databases (MEDLINE, CINAHL, PEDro, AMED, Embase, and the Cochrane Library) were searched from inception to March 2018. Randomised controlled trials or cohort studies were included if they examined the effect of POP and/or continence surgery on the PFM in women and provided both pre- and post-operative PFM data. Two reviewers independently screened abstracts, reviewed full texts and extracted data. For included studies, two reviewers independently rated the quality using the Downs and Black Checklist. Three meta-analyses were planned based on post-operative follow-up time according to different stages of tissue healing (0--6 weeks, 3 months and 6 or more months). Meta-analysis was completed if a minimum of two trials were clinically homogeneous. A sub-analysis comparing similar surgical procedures was also completed. The Grades of Research, Assessment, Development and Evaluation approach was used to assess the quality of evidence in this review. Results: Of the 3447 papers screened, five randomised controlled trials, 14 prospective cohort studies and two retrospective cohort studies were included. The review comprised 1063 women who received pelvic surgery with usual care. The age range of participants was 28 to 83 years, with mixed parity and mode of delivery. There was considerable variance in the methodological quality of included papers. Quality scores ranged from 12 to 26 (median = 21 out of 28 for controlled/cohort studies and 15 out of 24 for single-group studies). Studies were limited by inadequate consideration of confounders, poor reporting of the representativeness of the sample and insufficient power calculation. A wide range of surgical interventions was represented in the 21 included studies. Procedures for urinary incontinence were used in three studies; vaginal prolapse repair was undertaken in 12 studies; combined transvaginal procedures to address POP and urinary incontinence were used in three studies; and combined vaginal POP and rectal prolapse procedures were performed in one study. A total of 33 different measures of PFM function or morphometry were used across the included studies. Digital palpation scales were used in eight studies; objective tools such as manometry were used in 11 studies; and PFM morphometry was assessed in six studies. Meta-analysis showed no change in PFM function at 0 to 6 weeks following vaginal repair surgery (SMD = 0.04, 95% CI = --0.26 to 0.33). The evidence for this summary is low. At both three and six or more months postoperation, there was significant heterogeneity in reported PFM outcomes and surgical procedures therefore meta-analysis was not possible. At three months there was an overall trend favouring no change in PFM function and a pattern of positive change in PFM function when assessed via Modified Oxford Grading Scale. At six or more months the predominant trend was no change in PFM function or morphometry. There were a large number of different surgical procedures and PFM outcomes assessed at this time-point. None of the included studies investigated the relationship between PFM function and urodynamic results or POP-Q. Conclusions: The synthesis of studies within this review showed an absence of a clear effect of POP and/or continence surgery on PFM function or morphometry in women. This could be due to the quality and heterogeneity of studies, or because surgery does not measurably impact on PFM function in the short and medium term, and therefore is unlikely to in the longer term. To have greater certainty regarding this question, future research which is powered to detect a difference and applies robust outcomes is required to confirm the effect of POP and/or continence surgery on PFM function in women. Clinicians may continue to be guided by existing evidence-based recommendations for PFM training in women who present with symptoms of urinary incontinence or prolapse, with or without surgical treatment. Competing interest statement: none. [ABSTRACT FROM AUTHOR]

Introduction: Gynaecological cancer is one of the most common cancers in Australia. Following gynaecological cancer treatment, patients become less active and may experience bladder, bowel and sexual problems. A recent systematic review1 found that interventions with an exercise component may be effective to improve the level of physical activity and body mass index scores among patients with gynaecological cancer; however, current evidence is limited due to the small number and quality of the included trials. Although previous pilot RCTs suggest that pelvic floor muscle training (PFMT) may improve pelvic floor symptoms in gynecological cancer survivors2,3, little is known about the effects of a general exercise program on pelvic floor symptoms in this patient group. The aims of this pilot study were to: (1) investigate the feasibility of a general exercise program for patients following gynaecological cancer treatment; and (2) document prospective changes in pelvic floor symptoms post-operatively in an exercise group following an 8-week exercise program and at 6-months follow-up, and a quasi-control group over this time not exposed to the exercise intervention. Materials & methods: This was a subgroup analysis of data from a prospective observational study investigating the feasibility of an 8-week, twice weekly, supervised exercise program for patients following surgery for abdomino-pelvic cancer. For this exploratory analysis, data from patients following treatment for gynaecological cancer were analysed. Participants were enrolled either in the exercise group, or the quasi-control group who completed postal questionnaires only. Feasibility measures included recruitment, attendance, withdrawals, and adverse events. Pelvic floor symptom assessments using the Australian Pelvic Floor Questionnaire (APFQ), main outcome of interest, the International Consultation on Incontinence Questionnaire Bowel module (ICIQ-B) and Urinary Incontinence short form (ICIQ-UI SF), were measured before (T1) and immediately after the 8-week exercise program (T2) and at 6-months follow-up (T3). Participant self-perception of change in overall pelvic floor symptoms was assessed using a global rating of change scale at T2 and T3. Descriptive statistics were used to summarise data and non-parametric tests were used to compare changes over time. Results: A total of 30 participants (13 exercise group and 17 quasi-control) were enrolled. The consent rates to the exercise group and the quasi-control group were 12.3% (13/106) and 16% (17/106), respectively. The withdrawal rate was 15.4% at T2 and 0% at T3 for the exercise group, and 17.6% and 21.4% for the quasi-control group. The attendance rate to the program was 92%. Ten out of 13 participants (77%) completed all 16 sessions. No serious adverse events were reported during the study period. All pelvic floor symptom scores were similar at T1 between both groups. The APFQ domain scores (higher score = poorer outcome) decreased from T1 to T2 (median change scores: bladder = -0.4; bowel = -0.6; prolapse = 0; sexual = 0; total = -1.2) and increased from T2 to T3 in the exercise group. Similar patterns of changes were observed in ICIQ-B and ICIQ-UI SF scores. The APFQ domain scores remained stable over time in the quasi-control group (T1 to T2 median change scores: bladder = 0.1, bowel = 0, prolapse = 0, sexual = 0, total = 0; T2 to T3 median change scores: all domains = 0). Similar results were found in ICIQ-B and ICIQ-UI SF. The exercise group improvements at T2 were significant in the APFQ bowel domain (p = 0.006) and showed a positive trend in the bladder domain (p = 0.058). Of those participants in the exercise group, 77% reported a positive change in their overall pelvic floor symptoms at T2 and 38.5% at T3. In the quasicontrol group 29% and 23.6% reported positive change at T2 and T3, respectively. Conclusions: This pilot study suggests that an 8-week general exercise program is feasible for patients following treatment for gynaecological cancer. The preliminary clinical findings of this study suggest that participation in a general exercise program may improve pelvic floor symptoms during the supervised exercise phase. The findings from this pilot study contribute to the design of a fully powered RCT to test the short-term and long-term effects of a general exercise program, compared with a general exercise program combined with PFMT, on pelvic floor symptoms in patients following gynaecological cancer treatment. [ABSTRACT FROM AUTHOR]

Introduction: An association between high impact sport and urinary incontinence (UI) has been documented, with sports involving running and jumping associated with higher prevalence of UI. A majority of studies have included predominantly nulliparous athletes; there is limited prevalence data of UI in parous cohorts involved in high impact sports. Netball is a fast-paced high impact sport involving running, jumping and quick directional changes with repeated accelerations and decelerations. It is the most popular sport played by females in Australia with an estimated one-in-seven adult females playing on a regular basis. The prevalence of UI in netball players has not been explored. The aim of this study was to establish the prevalence of UI within nulliparous and parous netball players in a rural netball league. Materials & methods: An anonymised self-report survey in adult female netball players was undertaken. A survey specific to symptoms of UI while playing netball was designed and piloted. Urinary incontinence while playing netball was assessed with the question, 'Do you ever leak urine while training or playing netball?' The Questionnaire for Urinary Incontinence Diagnosis (QUID) was used to diagnose UI during activities of daily living. Demographic, obstetric, and self-management strategies data were also collected. Statistical analyses were performed using Microsoft Excel and SPSS version 24 for Windows package. Data were analysed by computing absolute numbers (n), frequencies (%) and 95% confidence intervals (CI). Results: A total 176 (77% response rate) participants responded. Of the sample 50% was parous, and 46% nulliparous. Age ranged from 18-50 years (mean 31, 95%CI 29.5-32) and BMI ranged from 17-48 kg/m2 (mean 25, 95%CI 24.2-25.6). Prevalence of UI during netball and self-management strategies are reported in the table 1. Responses to the QUD: 60.8% (95%CI 53.4-67.7) reporting UI in daily life, sub-type stress scores ranged from 0-11 (mean 1.8, 95%CI 1.4-2.2) and sub-type urge scores ranged from 0-12 (mean 2, 95%CI 1.6-2.4). Conclusions: Nearly a third of the cohort and a half of parous netballers experienced UI while playing netball. Disclosure of UI to a health professional was low, as was the proportion of women doing PFM exercises. These findings suggest that the majority of women experiencing UI while playing netball are self-managing their symptoms and not seeking treatment. This may reflect a lack of awareness of treatment for UI among netball players and lack of awareness of the problem in the sport. Screening for UI within netball clubs may assist symptomatic women to receive effective treatment. [ABSTRACT FROM AUTHOR]

Introduction: This novel research is the first time standardisation of exercise reporting details for pelvic floor muscle training (PFMT) interventions has been attempted and mapped against an internationally recommended exercise reporting guideline. Pelvic floor muscle training (PFMT) is effective for people with urinary incontinence (UI)1 but evidence from systematic reviews indicate that intervention reporting is incomplete and this hampers translation into clinical practice2. The internationally-endorsed Consensus on Exercise Re-porting Template (CERT) was developed by expert consensus in a modified Delphi process to address the problem of incomplete reporting of exercise interventions3,4. We propose that clinicians would be able to more accurately interpret, and apply, the evidence in their clinical practice if they had more complete descriptions of PFMT exercises. We hypothesise that clinicians can provide suggestions about information they need in PFMT descriptions. The aims were to (i) explore the beliefs and practices of clinicians who use PFMT for people with UI in order to understand what barriers, or enablers, may exist for clinicians to translate research evidence into practice; and (ii) make PFMT-informed modifications to the CERT checklist and Explanation and Elaboration Statement. Materials & methods: We recruited Continence Physiotherapists and Nurses from publicly available membership registers. We used qualitative methods for focus groups and interviews conducted by an experienced facilitator with predetermined questions. The sessions were audio-recorded and transcribed verbatim for independent analysis of emergent themes by at least two researchers. Data were analysed using thematic analysis within a Grounded Theory framework. Results: The pilot data have included 18 participants (17 physiotherapists with post-graduate qualifications and one continence nurse). Four themes were identified: (1) Detailed descriptions of the content of PFMT interventions are required; (2) PFMT needs to be tailored to the individual with UI; (3) There are specific cues and language that engage people in PFMT; and (4) Knowledge translation barriers include limited access to the published research and cumbersome clinical guidelines. Clinicians reported that they need to seek advice from experts when they were unable to access or interpret the literature. In the absence of published information, clinicians default to clinical reasoning and first principles of exercise. Clinicians considered that the language used to assist PFMT performance was unique and an 'information bank' would be helpful. Verbal cues and imagery were sourced from colleagues or post-graduate teaching. Clinical practice guidelines were inconsistently used because they were time-consuming to read, not user-friendly and did not contain specific exercise dosages and progressions. Conclusions: The 16 items contained in the CERT appear to be applicable to descriptions required of PFMT programs that have been reported as effective. The pilot data from this qualitative study indicate that a PFMTspecific amendment is required for the Explanation and Elaboration Statement to guide explicit reporting and requirements that are specific to PFMT. We encourage journal editors and authors to provide explicit details and this could be by application of the CERT in protocol and manuscript construction and online appendices. [ABSTRACT FROM AUTHOR]

Introduction: Although the literature shows significant negative impact of incontinence on physical activity following radical prostatectomy, there is limited evidence on the relationships between severity of urinary incontinence (UI) and level of physical activity in patients who have undergone a general exercise program, not including specific pelvic floor muscle training, following prostatectomy. The aims of this study were: (1) to explore the relationships between severity of UI and physical activity levels in patients who have undergone an exercise program following prostatectomy and (2) to determine whether preexercise program severity of UI was a predictive factor for a change in physical activity levels following an exercise program. Materials & methods: This was a subgroup analysis of data from 45 patients who participated in a prospective observational study investigating the feasibility of an 8-week, twice weekly supervised exercise program for patients following surgery for abdomino-pelvic cancer. For this analysis, data from patients who were experiencing post prostatectomy UI and who consented to participate in the exercise program were analysed. Physical activity levels were measured using the International Physical Activity Questionnaire short form (IPAQ-SF; higher score = better outcome) and severity of UI was measured using the International Consultation on Incontinence Questionnaire -- Urinary Incontinence Short Form (ICIQ-UI SF; higher score = poorer outcome) at pre-intervention (10 weeks post-prostatectomy) and post-intervention (18 weeks post-prostatectomy). The Spearman correlation coefficient was used to assess the relationships between severity of UI and physical activity levels at both time-points, and between the post-intervention and pre-intervention change scores of IPAQ-SF and ICIQ-UI SF. A multiple linear regression was used to identify whether baseline severity of UI (independent variable) was a predictor of change in physical activity levels (dependent variable) following the exercise program. Results: The mean (standard deviation) ICIQ-UI SF total score at pre- and post-intervention was 10.2 (4.5) and 6.0 (4.1), respectively, and the mean IPAQ-SF total physical activity levels were 1988.5 (2347.7) Metabolic Equivalent of Task (MET) -minutes/week at pre-intervention and 4768.1 (6072.1) MET-minutes/week at post-intervention. The pre-intervention ICIQ-UI SF total score demonstrated low to moderate positive and significant correlations with the post-intervention IPAQ-SF total physical activity level (rs(39) = 0.456, p = 0.004), and the change scores in vigorous (rs(38) = 0.344, p = 0.035) and total physical activity levels (rs(39) = 0.534, p < 0.001). Moderate positive and significant correlations were also found between post-intervention ICIQ-UI SF total score and postintervention IPAQ-SF walking (rs(36) = 0.330, p = 0.05) and total physical activity levels (rs(38) = 0.345, p = 0.034) and post-intervention ICIQ-UI SF total score and the change score of IPAQ-SF total physical activity level (rs(38) = 0.413, p = 0.010). After adjustment for age, body mass index and employment status, the preintervention severity of UI was a significant predictor of change in total physical activity levels (β = 0.403, p =0.020) following the exercise program. Conclusions: This is the first study to explore the relationships between severity of UI and physical activity levels in patients who had undergone an exercise program after prostatectomy. Severity of UI was positively correlated with physical activity levels following the exercise program. Higher severity of UI at pre-intervention (i.e. 10-weeks post-prostatectomy) was a significant predictor of improvement in physical activity levels following the exercise program. Randomised controlled trials are warranted to determine the effects of general exercise alone on UI in this population. [ABSTRACT FROM AUTHOR]

An abstract of the article "Pelvic floor muscle exercises for pregnant and postnatal women: improving implementation and uptake" by H. Frawley is presented.

Objective: To investigate the prevalence and severity of pelvic floor disorders (PFD), and the associations between treatment type and PFD, and cancer stage and PFD in patients before and after hysterectomy for gynaecological cancer; and the changes in outcomes over time., Design: Longitudinal cohort study., Setting: Gynaecological oncology outpatient clinics., Population: Patients undergoing hysterectomy for endometrial, uterine, ovarian or cervical cancer., Methods: Participants were assessed before, and 6 weeks and 3 months after hysterectomy. Changes over time were analysed using generalised estimating equations or linear mixed models. Associations were analysed using logistic regression models and analyses of variance., Main Outcome Measures: Incontinence Severity Index, Pelvic Floor Distress Inventory-short form (PFDI-20), Female Sexual Function Index., Results: Of 277 eligible patients, 126 participated. Prevalence rates of PFD were high before (urinary incontinence [UI] 66%, faecal incontinence [FI] 12%, sexual inactivity 73%) and after (UI 59%, FI 14%, sexual inactivity 58%) hysterectomy. Receiving adjuvant therapy led to moderate-to-very severe UI 3 months after surgery compared with surgery only (odds ratio 4.98, 95% CI 1.63-15.18). There was no association between treatment type and other PFD, or cancer stage and any PFD., Conclusion: Prevalence of PFD was high before and after hysterectomy for gynaecological cancer. Moderate-to-very-severe UI was associated with adjuvant therapy., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Introduction: There is considerable variation in the types of symptoms experienced by people living with endometriosis, and it is unclear which symptoms impact people the most. This study aimed to identify the specific symptoms that are "most impactful" to people living with the condition., Material and Methods: Two sequential online surveys were conducted. Women aged over 18 years with a diagnosis of endometriosis were eligible to participate. Participants first provided a free-text list of all the endometriosis symptoms they experienced (Survey 1, Australian only). Responses were condensed into a shorter list by grouping symptom types and selecting the top 20 most common and most impactful. Survey 2 (international) participants reviewed the list and selected all that they had experienced in the last 3 months, nominated one as their single "most impactful symptom", and rated its impact on one of five randomized scale types., Results: Survey 1 and Survey 2 had 195 and 983 responses, respectively. The mean age of respondents was 30.8 ± 7.9 years. There were 275 separate symptom descriptions from Survey 1, which were condensed into 104 groups, of which 25 met criteria for inclusion in Survey 2. The most commonly experienced symptoms were abdominal pain (93% of respondents), bloating (92%), and fatigue (90%), and the symptoms nominated as causing the most impact were pelvic pain (20%), abdominal pain (15%), and cramps (7%). Nearly everyone (99.7%) in Survey 2 reported experiencing at least one pain symptom. The symptoms that generated the highest impact scores were infertility (99.8/100), irregular menstrual cycles (95.3/100), and constipation (92/100). The average impact score was 87.5/100., Conclusions: There was substantial variation in the symptom selected as causing the most impact, and the level of impact was high. A focus on measuring the "most impactful symptom" in future research may enable us to better capture and measure the true symptom experience., (© 2024 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Objective: To evaluate the effectiveness of nonpharmacological conservative therapies for women with CPP., Data Sources: A systematic search of electronic databases (Amed, CINAHL, PsycINFO, SportDiscuss, Medline, PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed in January 2023, and updated in December 2023., Study Eligibility Criteria: Randomized controlled trials comparing a nonpharmacological conservative therapy to inert (eg, placebo, usual care) or nonconservative (eg, surgical, pharmacological) treatment were included. Conservative therapies of interest to this review were: multimodal physical therapy, predominantly psychological approaches, acupuncture, and other tissue-based monotherapies (eg, electrophysical agents, manual stretching)., Study Appraisal and Synthesis Methods: All study data were aggregated, and analyses of the included studies were performed. Effects on pain; sexual measures; psychological and physical function; health-related quality of life; symptom severity/bother; pelvic floor muscle function and morphometry; perceived improvement; and adverse events were analyzed. Meta-analyses (random effects model) were conducted using postintervention scores for data that included similar interventions and outcomes. Standardized mean differences were calculated. A narrative summary of findings that could not be included in the meta-analysis is provided. The quality of the evidence was assessed with the Physiotherapy Evidence Database scale and the certainty of evidence with Grading of Recommendations, Assessment, Development, and Evaluations criteria., Results: Of 5776 retrieved studies, 38 randomized controlled trials including 2168 women (mean age 35.1±8.6) were included. Meta-analyses revealed that multimodal physical therapy resulted in lower pain intensity compared to inert or nonconservative treatments in both the short (standardized mean difference -1.69, 95% confidence interval -2.54, -0.85; high certainty) and intermediate-terms (standardized mean difference -1.82, 95% confidence interval -3.13, -0.52; moderate certainty), while predominantly psychological approaches resulted in no difference in pain intensity (standardized mean difference -0.18, 95% confidence interval -0.56, 0.20; moderate certainty) and a slight difference in sexual function (standardized mean difference -0.28, 95% confidence interval -0.52, -0.04; moderate certainty). The level of evidence regarding the meta-analysis of the effects of acupuncture on pain intensity (standardized mean difference 1.08, 95% confidence interval -1.38, 3.54, nonstatistically significant results in favor of control treatment) precluded any statement of certainty. A limited number of trials investigated individual tissue-based monotherapies, providing a restricted body of evidence., Conclusion: This systematic review with meta-analysis revealed that multimodal physical therapy is effective in women with chronic pelvic pain with a high certainty of evidence., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: "Improvement in the most bothersome symptom" was recently selected as a core outcome for endometriosis intervention trials. This study aimed to explore the applicability of the construct of "symptom bother" in representing the lived experiences of people with endometriosis., Material and Methods: Semi-structured interviews were conducted to understand the meaning of "symptom bother" and related constructs. Eighteen interviews were conducted: 14 among people with a surgical diagnosis of endometriosis who were recruited from the community, and four with people who were recruited from a private gynecology clinic who had either a confirmed diagnosis or a high suspicion of the disease. All interviews were audio recorded, transcribed verbatim, and analyzed thematically., Results: Three primary themes were identified: (1) endometriosis symptoms and priorities vary with time and context, (2) endometriosis symptoms impair normal daily functioning, (3) endometriosis symptoms are more than just a "bother." The concept of "bother" to describe endometriosis symptoms did not resonate with most participants. Whilst "bother" was familiar language, it did not encompass the broader implications of living with endometriosis. Participants felt "bother" implied emotional distress, lacking a full understanding of the consequences of the disease. Instead, "symptom impact" was endorsed, allowing participants to quantify and objectively assess their symptoms, free from negative connotations., Conclusions: This was the first qualitative study to explore "symptom bother" among people living with endometriosis. Instead of "bother," "impact" was widely endorsed as a suitable construct. This term more appropriately captured the broad ways in which endometriosis symptoms impair daily functioning., (© 2024 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)