Current Women's Health Reviews - Volume 20, Issue 4, 2024

Objectives: Pregnancy and normal vaginal delivery, are the main risk factors for urinary incontinence in women. A variety of treatments such as bladder training and pelvic floor exercises are effective for urinary incontinence. This interventional study has been conducted to compare the influence of Kegel exercises and pelvic floor physiotherapy on the improvements of urge and stress incontinence in women with first or second singleton pregnancies who have experienced normal vaginal delivery. Methods: One hundred fifty women with urinary incontinence in the postpartum period, who were divided randomly into 3 groups of 50 patients, participated in this prospective interventional study. The women were primigravida or it was their second labor. None of them complained of urinary incontinence before pregnancy. All of them had a normal vaginal delivery. The first group included females who were asked to perform Kegel exercises. The second group had 8 weekly physiotherapy appointments. The control group, included mothers who received routine care. We compared the prevalence of urge and stress incontinence between groups. Results: We found that the relative risk of urge and stress incontinence among mothers in the control group was more than in the intervention groups, but this difference was only statistically significant in the subject of stress incontinence between the Kegel and control groups. The reduction of urge incontinence prevalence among mothers in the Kegel and physiotherapy groups, was more than control group, although this reduction was not significant. Conclusion: There is a significant decrease in the prevalence of stress urinary incontinence at the end of the 8th and 12th weeks postpartum compared to the control group. Although the prevalence of urge incontinence among women in intervention groups was lower than in the control group, it was not significant. It seems the effect of Kegel exercises and pelvic floor physiotherapy, in reducing stress incontinence at the end of the 8th week, is almost equal.

Ovarian cancer is one of the most common cancers in women in the world. It is also the 5th top cause of cancer-related death in the world. Despite chemotherapy being the primary treatment along with surgery, patients frequently suffer from a recurrence of ovarian cancer within a few years of the original treatment. The recurring nature of OC, therefore, necessitates the development of novel therapeutic interventions that can effectively tackle this disease. Immunotherapy has lately been found to offer significant clinical advantages. Some of the immunotherapy techniques being studied for ovarian cancer include adoptive T-cell treatment, immune checkpoint inhibition, and oncolytic virus. However, the most efficient way to increase longevity is through a combination of immunotherapy strategies with other disease therapeutic approaches such as radiotherapy, chemotherapy, and PARPi in additive or synergistic ways. To provide a more comprehensive insight into the current immunotherapies explored, this paper explores newly developed therapeutics for the disease with an emphasis on current outstanding immunotherapy. The current state of our understanding of how the disease interacts with host cells, current therapy options available, various advanced treatments present and the potential for combinatorial immuno-based therapies in the future have also been explored.

Background: Angiomyofibroblastoma was first described by Fletcher et al. in the year 1992. It is a distinctive benign tumor that most often occurs in the superficial area of the vulva and is rarely reported in men in the inguinoscrotal region. Case Presentation: A 23-year-old female presented with a painless pedunculated labial mass which was initially pea-sized and reached 7 cm in maximum dimension over four months. The case was diagnosed on morphology, IHC and the patient was treated surgically. The interesting feature of the case was the rarity of its incidence at labia minora and pedunculated form and its resemblance to other benign and more aggressive tumours. To the best of our knowledge, the extensive English literature search revealed only seven cases of pedunculated angiomyofibroblastoma at labia majora in middleaged female and one case of labia minora in a young female. Conclusion: The lesion must be differentiated from another benign mesenchymal tumor of vulva which requires extensive surgical management.

Aim: Present study was conducted to assess the knowledge and perception of men about menstruation and it's associated problems in their female partners. Background: Menstruation is considered a social stigma in many low- and middle-income countries. Objectives: To assess men’s attitudes, beliefs, understandings, and knowledge about menstruation. Methods: The study involved interviews of 80 male partners of females attending the Obstetrics and Gynaecology Department of the rural tertiary center of Southern India for various complaints over one year. Data obtained was analyzed using thematic analysis. Four themes with sub-themes reflecting responses to key questions were formed: men’s perception and knowledge about menstruation, cultural and societal issues, men’s observation and attitude towards their wives during menstruation, and the father’s role in generating awareness. Results: Of 80 participants, 92.5% were comfortable, 6.25% uncomfortable and 1.25% were not sure about the interview. Their feelings about menstruation varied from nothing, disgusting/bad, to normal. Men’s knowledge about menstruation was restricted and the majority were hesitant to discuss it. Almost everyone was aware of cultural taboos being followed at home, with most responses revealing menstruating women as untouchable/impure. Men observed changes in mood, sleep, and sexual desire of their partners before and during menstruation. The majority wanted their children to know about menstruation, but they don’t want to teach. Overall feedback about the interview was positive. Conclusion: Ignorance and secrecy related to menstruation, stop men from understanding the problems faced by women. Educating boys about menstruation and menstrual hygiene is the only way to uproot the long-standing stigma attached to menstruation.

Introduction: To evaluate the usefulness of homeopathy for the treatment of PCOS through a literature review and to develop a strategy for future research. Methods: A comprehensive search was done in electronic databases, including general medical databases MEDLINE, CENTRAL, Science Direct, specialised database for homeopathy CORE-Hom, CAM databases LILACS Chiro ACCESS, AYUSH Research Portal, Google Scholar, Research gate net, clinical trial registry, aimed to target the available literature of observational studies, randomized trials, controlled trials, case reports on PCOS in homeopathy and limited to the English language. The inclusion criteria are the studies with a full-text present in mentioned databases, studies with experimental or quasi-experimental designs published in peer-reviewed or partial peer-reviewed journals and studies with humans as their samples. Results: A literary search through databases helped to identify a few significant studies, such as one placebo-controlled trial, one comparative clinical study, one retrospective study, three clinical studies, and nine case reports. A retrospective study showed positive results for the role of homeopathic medicines in PCOS. The placebo-controlled trial showed a difference in outcome between the two groups. The verum group showed a positive effect in the regularization of menses. The comparative clinical study showed that both homeopathic medicines (Cal. carb, Lycopodium) appeared to be effective. Three clinical studies showed the effectiveness of homeopathic medicines in improving and curing PCOS. Nine case reports showed a positive effect of homeopathy in improving PCOS, out of which three cases showed positive outcomes also in infertility with PCOS. Conclusion: The results showed that Homoeopathy has positive effects on the management of PCOS in women. In the future, high-quality randomized controlled trials (RCT), comparative studies of homeopathy with conventional therapy, and in-vitro and animal model studies will be required to support the effectiveness of homeopathic therapeutics in PCOS.

Background: Pelvic organ prolapse (POP) may reduce women's quality of life and is one of the most important aspects in the occurrence of sexual dysfunction. Objective: This study aimed to assess sexual function in POP women with pelvic floor dysfunction pre and post-surgery. Methods: This study was a prospective cohort study. Using the total sampling technique at Arifin Achmad Hospital, Indonesia, the study recruited women who underwent POP surgery with active sexual function from July 2020 to December 2021. The pelvic floor disorder was evaluated through Pelvic Floor Distress Inventory (PFDI) questionnaires validated in the Indonesian language, pre, and postsurgery. The assessment of sexual function was carried out using the Indonesian linguistic validation of the Female Sexual Function Index (FSFI) questionnaires before and after surgery. Results: There was a decrease in the average value of pelvic floor disorder scores before and six months after surgery (P< 0.05). However, the sexual function increased with a cut-off score of FSFI > 20.25 at 3 and 6 months post-surgery, respectively as much as 61.1% (11/18 subjects) and 72.2% (13/18 subjects), compared to the pre-surgery sexual function scores by 7.8% (5/18 subjects). Out of the 6 domains of sexual function, an increase was found in the sexual arousal domain (P<0.05). Conclusion: There is a decrease in pelvic floor disorder and an increase in sexual function, particularly an increment in sexual arousal at six months post-surgery.

Placenta accreta spectrum (PAS) disorders, also known as morbidly adherent placenta (MAP) include anomalous adherence of the placenta to implantation location. PAS could be classified into 3 categories based on the penetration distance of trophoblasts via the myometrium and serosa of the uterus into placenta accreta, increta, and percreta. A recent study in 2020 showed that using the introduced model based on 3 parameters; uterovesical vascularity, unusual lacunae (grades 2 and 3), and bladder wall interruption, has 100% accuracy in the diagnosis of PAS. Accurate diagnosis of morbidly adherent placenta (MAP), helps in multidisciplinary team management at delivery, with better maternal and neonatal outcomes. PAS could be suspected early in pregnancy by recognizing women with doubted Cesarean scar pregnancy (CSP) because CSP in the first trimester and PAS in the second and third trimesters might denote various stages of a similar pathology. Gray scale US with or without adding color Doppler and made by transabdominal or trans vaginal route are commonly utilized for prenatal screening and diagnosis of PAS. In a recent study made by Alalfy et al. in 2021 they revealed the systematic combined approach with the use of Alalfy Simple Criteria for assessment of placenta previa and PAS using 3D TUI (Tomographic Ultrasound Imaging and 3D power Doppler has a high diagnostic value in the diagnosis of PAS from the non-adherent placenta, the estimation of the myometrial thickness and the depth of placental invasion with the determination of different PAS subgroup plus defining diffuse from focal invasion (Figs. 1 and 2).

Introduction/Background: One of the main problems of women of reproductive age is ectopic pregnancy. Lack of early diagnosis and treatment can lead to internal bleeding and death of the patient. Approximately 1.2 to 1.4% of the reported pregnancies is ectopic pregnancy and one of the rarest types of ectopic pregnancy is bilateral ectopic pregnancy, which is reported in only 0.0005% of pregnant women. Case Presentation: A 35-year-old woman with polycystic ovary syndrome, weight 65 kg and height 153 cm, referred for pregnancy. Using examination and history taking, ultrasound and β-hCG titer measurement, one of the masses at 5 to 6 weeks and in the area of the isthmus of the right tube and the other mass two weeks later at 7 to 8 weeks, in the area Infundibulum of the left tube was diagnosed. The most common complication that the patient complained about was abdominal pain and frequent bleeding. Both times, the patient underwent laparoscopy and because of the patient's condition, salpingectomy was performed on both left and right tubes of the patient. Conclusion: Due to the rarity of bilateral twin ectopic pregnancy, early diagnosis with the help of history taking and clinical examination, measurement of β-hCG titer and ultrasound is necessary. Early diagnosis can lead to the reduction of women's mortality.

Background: Despite the high percentage of pure forms of epithelial ovarian cancers (EOC), mixed epithelial cancer of the ovary is extremely rare and accounts for less than 1% percent of all epithelial ovarian cancers. Because of the low prevalence; there are only a few cases of mixed epithelial cancers published in the literature. This study presents the case of a mixed endometrioid (EC)/clear cell carcinoma (CCC), diagnosed in a woman with a complaint of low back pain and a history of infertility. Case Report: We report the case of a 35-year-old woman who came to our clinic complaining of progressive back pain and a history of infertility. Imaging showed a left ovarian mass that was compatible with malignant tumors. The patient underwent open surgery and a frozen section evaluation of the tumor was done during the operation. The pathology result demonstrated mixed CCC/EC histology in the left ovary. We decided to perform a total abdominal hysterectomy as well as right salpingooophorectomy, omentectomy, bilateral pelvic lymphadenectomy, and para-aortic lymphadenectomy. Adjuvant chemotherapy was administrated postoperatively. Conclusion: Although epithelial cancers account for more than 90% of all ovarian cancers (OC), developing mixed forms of epithelial cancers is extremely rare, and there are little data available in the literature about their presentation and histopathological features. The main purpose of this article was to report a mixed CCC/EC and to discuss different aspects of this rare histologic type of OC. More research is needed to determine metastatic potential as well as the likelihood of recurrence of these unique neoplasms.

Background: Premature delivery is a significant risk factor for mortality in both developed and developing nations, causing long-term adverse effects on families in terms of physical, psychological, and economic consequences. Objective: This research aimed to examine the elements influencing preterm delivery from the perspectives of obstetrics, gynecology specialists, and midwives in Mashhad, Iran's metropolis. Method: This study was a descriptive cross-sectional study. A questionnaire was used to collect data from 30 medical professionals working in clinics, hospitals, and health facilities in Mashhad in 2020. In this study, 30 medical professionals participated, including 10 obstetrics and gynecology specialists with a mean age of 50±8.0, and 20 midwives with a mean age of 34±4 years. The survey found that premature rupture of the amniotic sac (water sac) was the most frequent factor contributing to preterm delivery, with a frequency of 96.7%. This was followed by uterine abnormality, preeclampsia, and chorioamnionitis, each with a frequency of 93.3%. Other factors such as a history of preterm delivery and multiple pregnancies were also found to impact preterm delivery, with a frequency of 90%. Additionally, the study revealed that stress factors had the highest frequency in the high-impact spectrum, with a frequency of 86.7%. Results: This study is a survey of caregiver’s opinions about preterm birth from one location. The findings revealed that the main causes of preterm delivery were premature rupture of the amniotic sac, uterine abnormalities, preeclampsia, and chorioamnionitis. Conclusion: Furthermore, background factors, such as stress factors and domestic violence in mothers can affect this phenomenon. Overall, these findings highlight the critical role of clinical and lifestyle factors in preterm delivery.

Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder in females with excessive hormonal levels, but a reasonable cause is unknown. For PCOS, various pharmaceutical therapies have been offered, like oral contraceptive pills (which balance hormonal imbalances). PCOS is commonly used as an alternative to PCOD (Polycystic Ovary Disease). Although a part of the implicated mechanism in the occurrence of PCOS has been discovered, the specific etiology and pathophysiology are still unknown. Many types of complementary medicines are used to treat PCOD, and herbal medicines are one of them. Medical herbs have long been utilized to manage PCOS in women's gynecological and reproductive issues. This review article discusses the importance of herbal medicines and lifestyle modifications for PCOD patients. Many clinical studies proved that herbs like liquorice, cinnamon, Unkei-to, and fenugreek are helpful in PCOD management by improving hormone levels, ovulatory dysfunctions, obesity, and insulin resistance in the body. This review explores the natural plants that can be used to treat the disease naturally. The herbs can be used either alone or in combination.

Aims: To determine SUI prevalence and its association with urethral and bladder neck mobility among late third-trimester primigravid women. Introduction: Stress urinary incontinence (SUI) is a relatively common urogynecological disorder in pregnant women that significantly disrupts their quality of life. Although its prevalence is increasing along with gestational age, there have been reports of underreporting due to various reasons. Therefore, a diagnostic modality is needed to determine the presence of SUI in such a population. Methods: A total of 209 late third-trimester primigravid women included in the study between November 2016 and July 2019 were examined by translabial ultrasound. Bladder neck descent (BND), retrovesical angle (RVA), urethral rotation (RoU) and funneling were observed in each patient. SUI was diagnosed using a cough stress test and Questionnaire for Urinary Incontinence Diagnosis (QUID). Thirty-five subjects from each group were randomly selected for further analysis. Results: Among 209 late third-trimester primigravid women, SUI was observed in 57 patients (prevalence 27.3%). The RVA and funneling of the SUI group were significantly higher than the control group (P < 0.05). The BND and RoU were similar between groups. Identified risk factors of SUI were body mass index >23 kg/m2 and the presence of funneling in the translabial ultrasound. Conclusions: The prevalence of SUI among late third-trimester primigravid was 27.3%. Positive funneling and higher BMI were shown to be the independent risk factors for SUI.

Background: Breast cancer is one of the most common types of cancer in women globally, which poses a significant public health threat on a global scale. Continuous updates of the recent development in terms of drug development and diagnosis are the key to decoding the complexity of the location-specific different forms of breast cancer. The aim of this review is to sifter out the current advances and status of drugs, treatments, therapies and technologies related to breast cancer. Methodology: The authors searched for a number of article sources, and all possible data was collected from different databases like MEDLINE, EMBASE, Pub Med, Web of Science and Google Scholar. to identify recent development in drug development and diagnosis. Result: After a detailed literature survey, it was found that in drug discovery, a number of new drug candidates for breast cancer have completed clinical trials; in the diagnosis of breast cancer, a number of new technologies like artificial intelligence (AI), smart bra, smart vest, clinical breast exam have developed. It was found that breast self-awareness has immense importance in the early detection of breast cancer, which is par with the accuracy of modern diagnostic tools. Conclusion: An effort has been made to present all the updated data related to recent drug development, like surveillance status of drugs in clinical trials, diagnosis and social stigma of people with breast cancer recovery. Recent technological advances have led to the development of many devices for the early detection of breast cancer, providing efficacy in line with the diagnostic tools that pave the way for early treatment using effective drug candidates.

Background: Several methods have been designed to assess the risk of breast cancer. But according to studies conducted in Iran, the risk of Iranian women could not be correctly calculated. Objective: This study aimed to explore the experts' perspectives on the most important risk factors of breast cancer in Iranian women. Method: In round one, the risk factors identified from an integrative review of literature and specialist interviews (Delphi round one) were used to design a questionnaire survey. In round two, specialists were asked to rate the importance of each risk factor. In round three, respondents were asked to reprioritize moderate important risk factors. The items considered very important in round three were included in the core risk factors set. Results: In the first round, a total of 119 items were obtained from the results of an integrative review of the literature and interview with experts. In round two, 30 specialists (response rate 50%) prioritized 119 risk factors of BC, and 43 low, 51 moderate and 25 high-level risk factors were identified by the experts. From those, 43 low-level risk factors were removed, and 51 medium-level risk factors were carried forward to round three for consensus. No consensus was reached on any of the risk factors that went into round three (response rate 86.7%). Therefore, 25 high-level risk factors were recognized as the most important risk factors for BC in Iran. Conclusion: This study highlights the items that specialists feel would be most crucial to include in the clinical assessment of BC risk. This study has the potential to provide an appropriate and usable tool for detecting high-risk women in primary health care in Iran.

Background: During the last few years, Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has entered the national comprehensive cancer network guidelines as a new protocol for improving patients’ outcomes. However, there is no consensus on its long-term efficiency, and it still is under debate. Objectives: This study aims to evaluate the effectiveness of Cytoreductive Surgery Plus hyperthermic intraperitoneal chemotherapy in patients with advanced ovarian cancer in Iran. Method: Thirty patients with Stage IIIc and IV advanced ovarian cancer underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy at Jam Hospital with a fixed surgical team in Tehran, Iran, from 2019 to 2021. Fourteen patients were new cases, and sixteen of them were recurrent cases. At the end of cytoreductive surgery, by using a hyperthermic intraperitoneal chemotherapy device, Cisplatin was circulated in the peritoneal cavity for 90 minutes at a dose of 80-100 mg/ m2 at 43°C. Results: Among 30 patients with 54.97±10.74 years of mean age, the mean overall survival was 564.967 days, and 2-year survival rates were 66.7%. According to Fisher's exact test, there was a statistically significant relationship between disease-free after surgery and mortality rate (p=0.00). However, there was no statistically significant relationship between recurrence after surgery and mortality rate (p=0.093). Conclusion: Based on these findings, cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy had a survival rate of 66.7% within two years in advanced ovarian cancer patients. However, to achieve better results, careful selection of patients and complete cytoreductive surgery should be performed.