Current Women's Health Reviews - Volume 9, Issue 1, 2013

Female genital tract malformations are known to be a frequent cause of reproductive problems. Besides, complex malformations also frequently generate serious gynaecological problems, often ones with inappropriate surgical solutions, as the gynecologist does not think of the malformation as either the cause of the symptoms or of its embryonic origin. Apart from analyzing the embryological bases in the development of the female genital and urinary tract, it is presented the update of the clinical and embryological classification for malformations. Knowing the embryological origin of the female genitourinary malformations, the schematic drawing of the malformations and their related symptoms, will allow the gynaecologist to choose the best therapeutical approach for the patient. Therefore, a discussion on ethiopathogenical deductions and therapeutical management of malformations is also done with clinical recommendations for the general gynaecologist.

The Central American (CA) isthmus consists of seven countries including Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama, some of the poorest countries in the world. Over the past twenty years, CA has made good progress in improving the health status of their populations. Analysis of the peer-reviewed literature, as well as national and international reports show that life expectancy at birth has increased and child mortality rates have fallen. Maternal mortality ratios (MMR) have declined by approximately 33%, however the MMRs for indigenous women remain at unacceptable levels. Despite the advances, made in many CA countries, the overall health status remains well below Latin American averages. In fact, in most CA countries, poor health outcomes are increasingly concentrated geographically among the poor and indigenous populations. Considering indigenous people make up the second largest population group in CA, any improvements in healthcare should significantly improve the health statistics for these countries. For these populations, the integration of local cultural practices and traditional healing methods with modern medicine and healthcare facilities is critical for acceptance. Investigations and analyses of local cultures, knowledge and traditional medicine practices should be used to determine the factors that contribute to poor health in these populations. Local health educational programs are needed, especially those that would involve men (spouses), families and entire communities. Furthermore, manywomen’s reproductive issues still need to be addressed, particularly those that focus specifically on maternal mortality and cancer. For reductions in maternal mortality, El Salvador and Costa Rica may be good examples to follow. Access to inexpensive (or free) healthcare that is culturally sensitive and community based, particularly for indigenous women, would greatly improve the overall health. The major stumbling blocks to progress are that the funding for programs to reduce maternal mortality is woefully inadequate and that there has not been a focus on improving healthcare for indigenous women.

A substantial proportion of the etiology involved in female infertility and adverse pregnancy outcomes remains idiopathic. Recent scientific research has suggested a role for environmental factors in these conditions. Secondhand tobacco smoke (STS) contains a number of known or suspected reproductive toxins, and human exposure to STS is prevalent worldwide. Robust evidence exists for the toxic effects of active smoking on fertility and pregnancy, but studies of passive exposure are much more limited in number. While the association between maternal STS exposure and declined birth weight has been fairly well-documented, only recently have epidemiologic studies begun to provide suggestive evidence for delayed conception, altered menstrual cycling, early pregnancy loss (e.g. spontaneous abortion), preterm delivery, and congenital malformations in relation to STS exposure. There is also new evidence that developmental exposures to tobacco smoke may be associated with reproductive effects in adulthood. To date, most studies have estimated maternal STS exposure through self-report even though exposure biomarkers are less prone to error and recall bias. In addition to utilizing biomarkers of STS exposure, future studies should aim to identify vital windows of STS exposure, important environmental co-exposures, individual susceptibility factors, and specific STS constituents associated with female infertility and adverse pregnancy outcomes. The role of paternal exposures/factors should also be investigated.

Caesarean delivery on maternal request is a subject of heated debate. Concerns about incontinence and prolapse in later life, and regarding vaginal trauma at birth are common reasons for patient choice caesarean delivery. Available evidence comparing planned vaginal delivery and planned caesarean delivery is scarce and not robust enough to evaluate fully the benefits and risks of these delivery modes. Clinicians should keep an open mind in relation to patient requests. It is mandatory that full, honest and unbiased information should be given based on the available information, though limited, and that women should participate fully in the decision making process. Consideration should be given to individual characteristics and conditions. The decision to perform caesarean delivery on maternal request should be individualized and consistent with the ethical principles of beneficience, justice and autonomy.

Background: A consensus among women is that the menopause is imminently associated with a reduction in the level of physical fitness, which is associated with an increase in body-weight and emotional disturbances. Such an understanding of the menopausal transition is strengthened by plethora of scientific reports on the biology of the menopause. However, there is a dearth of data on a means of modulation, other than pharmaceutical, of these detrimental phenomena. Discussion: The majority of scientific reports indicates that menopause and/or ageing is associated with an increase in Body Mass Index (BMI), Waist Circumference (WC), Total Cholesterol (TC), Tri-glyceride (TG), High-Density Cholesterol (HDL-C), Low-Density Cholesterol (LDL-C), Luteinizing hormone (LH), and Follicle Stimulation hormone (FSH) levels. Additionally, recent reports indicated that menopausal transition is also associated with changes in blood pressure (BP), serum uric acid levels (SUA), and serum creatinine (SCR). It has been shown that during the menopause, an interplay of these homeostasis regulating parameters adversely influences health-related quality of life (HQoL). Currently, physical exercises are considered as an alternative to pharmaceutical means of positive modulation of agedependent physiological changes. Summary: Through a combination of the results of scientific reports on an influence of physical exercises on the set of physiological parameters, I have established that physical exercises, encompassing endurance, aerobic, and strength exercises, may be used as a happy medium for preserving a high level of HQoL in ageing and menopausal women. However, I postulate that physical exercises applied in this regard should not be focused on an increase in a fitness level, expressed as an increase in a maximal oxygen capacity, but instead on a abate of the total body fat.