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      Multidisciplinary management of women with pelvic organ prolapse, urinary incontinence and lower urinary tract symptoms.
      A clinical and psychological overview

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          Abstract

          Although female sexual dysfunctions are common among women with urogynecological conditions, they have not been thoroughly studied and there are still many questions without an answer. The recent evidence on sexual disorders in women with urogynecological diseases shows a quite wide spectrum of therapeutic approaches, which require the physicians to take into account not only the primary symptoms, but also all the associated factors negatively affected. It has been widely underlined that gynecological diseases are often associated with high stress and have a negative impact on quality of life and psychological well-being of women affected. For this reason, a multidisciplinary approach for the management of these diseases is highly recommended. Also in the case of urogynecological disorders, it is important to take into account psychological outcomes throughout the diagnostic and therapeutic process.

          In the light of these considerations, the aim of this short review is to evaluate the impact of the main urogynecological diseases and the currently available therapeutic options in order to improve quality of life and sexuality of these patients and to stress the need for a multidisciplinary approach in order to minimize the negative consequences of these diseases for the sexual well-being of women and their partners.

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          The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society.

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            The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study.

            To examine the effect overactive bladder (OAB) and other lower urinary tract symptoms (LUTS) on health-related quality of life (HRQoL) in a population sample, as OAB often occurs in conjunction with many other LUTS. A nested case-control analysis was performed on men and women with (cases) and without (controls) OAB, from the EPIC study. OAB was assessed using 2002 International Continence Society definitions. Based on their responses to questions about LUTS, cases were classified into five groups; continent OAB, OAB with incontinence, OAB + postmicturition, OAB + voiding, and OAB + postmicturition + voiding. Both cases and controls were asked questions about symptom bother (OAB-q), generic QoL (EQ-5D), work productivity (Work Productivity and Activity Impairment, WPAI), depressive symptoms (Center for Epidemiologic Studies Depression Scale), sexual satisfaction, and erectile dysfunction (men only) using the Massachusetts Male Aging Study. Cases answered additional condition-specific questions HRQoL (OAB-q short form), Patient Perception of Bladder Condition and work productivity related to a specific health problem (WPAI-SHP). General linear models were used to evaluate group differences. Of the EPIC participants, 1434 identified OAB cases were matched by age, gender and country, with 1434 participants designated as controls. Cases and controls were primarily Caucasian (96.2% and 96.7%, respectively), and most (65%) were female; the mean age was 53.8 and 53.7 years, respectively. Comorbid conditions differed significantly by case/control status, with cases reporting significantly greater rates of chronic constipation, asthma, diabetes, high blood pressure, bladder or prostate cancer, neurological conditions and depression. There were significant differences between the cases and controls in all reported LUTS. The OAB + postmicturition + voiding group reported significantly greater symptom bother, worse HRQoL, higher rates of depression and decreased enjoyment of sexual activity, than the other subgroups. OAB has a substantial, multidimensional impact on patients; OAB with additional LUTS has a greater impact. The diagnosis and treatment of OAB should be considered in conjunction with other LUTS, to maximize treatment options and optimize patient outcomes.
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              Anxiety and depression in patients with endometriosis: impact and management challenges

              Endometriosis is one of the most common gynecological diseases and affects ~10% of women in reproductive age. The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain (CPP), dysmenorrhea, dyspareunia and infertility. Symptoms of endometriosis often affect psychological and social functioning of patients. For this reason, endometriosis is considered as a disabling condition that may significantly compromise social relationships, sexuality and mental health. Considering this point, the aim of this narrative review is to elucidate the impact of anxiety and depression in the management of women with endometriosis. Psychological factors have an important role in determining the severity of symptoms, and women who suffer from endometriosis report high levels of anxiety, depression and other psychiatric disorders. In addition, endometriosis is one of the most important causes of CPP; women with endometriosis suffer from a wide range of pelvic pain such as dysmenorrhea, dyspareunia, nonmenstrual (chronic) pelvic pain, pain at ovulation, dyschezia and dysuria. Several studies have underlined the influence of CPP on quality of life and psychological well-being of women with endometriosis. Data suggest that the experience of pelvic pain is an important component of endometriosis and may significantly affect emotive functioning of affected women. It has been demonstrated that high levels of anxiety and depression can amplify the severity of pain. Further studies are needed to better understand the relationship between psychological factors and perception of pain. Treatment of endometriosis may be hormonal or surgical. Surgery is the primary treatment for more severe forms of endometriosis. There are few data in the literature about the influence of psychological factors and psychiatric comorbidities on the effectiveness of treatments. It is important to evaluate the presence of previous psychiatric diseases in order to select the most appropriate treatment for the patient.
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                Author and article information

                Journal
                Prz Menopauzalny
                Prz Menopauzalny
                MR
                Przegla̜d Menopauzalny = Menopause Review
                Termedia Publishing House
                1643-8876
                2299-0038
                05 November 2019
                December 2019
                : 18
                : 3
                : 184-190
                Affiliations
                [1 ]Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy
                [2 ]Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
                [3 ]Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
                [4 ]Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
                [5 ]Postgraduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
                [6 ]Bahiana School of Medicine and Public Health, Salvador, Brazil
                [7 ]Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
                [8 ]Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
                [9 ]Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
                [10 ]Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
                Author notes
                Corresponding author: Valentina Lucia La Rosa, Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy, e-mail: psicolarosa@ 123456gmail.com
                Article
                89496
                10.5114/pm.2019.89496
                6970416
                31975987
                27efea46-c252-4109-9280-6fddef70ff4b
                Copyright © 2019 Termedia

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License ( http://creativecommons.org/licenses/by-nc-sa/4.0/)

                History
                : 10 August 2019
                : 24 August 2019
                Categories
                Review Paper

                pelvic organ prolapse,urinary incontinence,luts,quality of life,sexuality

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