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Second Stage Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Perineal massage has been evaluated for a decrease in perineal lacerations. Perineal massage has not been associated with complications. For perineal massage during pregnancy and before labor, see Chap. 2. Perineal massage and stretching of the perineum with a water-soluble lubricant in the second stage of labor are associated with a 40% increased rate of intact perineum, a 51% decreased rate of severe perineal trauma, and a 44% decreased rate of episiotomy compared with controls [27]. A Cochrane review also favored perineal massage versus hands off for a 51% reduction in third- or fourth-degree tears [28]. In summary, perineal massage is recommended in the second stage of labor to decrease perineal trauma.
Non-erythematous lesions
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
This condition usually presents with genital itching and is seen as white atrophic plaques in the perineum (see p. 272). Rarely the trunk and limbs may also be involved. Small flat white atrophic macules and papules with a shiny wrinkled surface occur, most commonly on the upper trunk. Fortunately they are usually asymptomatic. Trunk lesions tend to be unresponsive to treatment.
Rhabdomyosarcoma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Gideon Sandler, Andrea Hayes-Jordan
Perineal and perianal RMS (Figure 61.3) can be mistaken for perianal abscess, is usually unresectable, and confers a poor prognosis. Following biopsy, neoadjuvant chemotherapy followed by DPE and RT is recommended. Fecal diversion should be considered if there is anorectal obstruction. Clinically suspicious lymph nodes should be biopsied. More aggressive surgery including sphincter sacrifice should be reserved for failure of primary therapy. The detailed technical aspects of perineal and perianal resections, diverting sigmoid colostomy, permanent sigmoid colostomy, resection of perianal tumors, and abdominoperineal resection are beyond the scope of this chapter.
Aromatherapy intervention on anxiety and pain during first stage labour in nulliparous women: a systematic review and meta-analysis
Published in Journal of Obstetrics and Gynaecology, 2021
Ching-Chu Liao, Shao-Huan Lan, Yea-Yin Yen, Yen-Ping Hsieh, Shou-Jen Lan
Complementary and alternative medicine (CAM) therapies for labour analgesia, including hypnosis, massage, hot compression, breathing exercise and aromatherapy, have been more popular in the past decade (Jones et al. 2012). Several studies showed the effectiveness of aromatherapy for relieving pain and anxiety of hospitalised patients (Lee and Hur 2011; Alavi et al. 2017). Furthermore, aromatherapy was revealed in one study to be associated with alleviating symptoms of pregnancy-related anxiety (Barcelona de Mendoza et al. 2016). Aromatherapy massages could significantly decrease stress and in turn enhance pregnant women’s immunity (Chen et al. 2017). Some studies investigated aromatherapy in the first stage of labour massage on maternal perineum condition and found that aromatherapy contributed to the reduced events of perineum rupture (Sriasih et al. 2018) and facilitated episiotomy healing (Vakilian et al. 2011). Other studies indicated aromatherapy’s effectiveness on reducing pain, fatigue and distress and in turn improving maternal moods of patients (Vaziri et al. 2017). Still other studies found aromatherapy’s effectiveness on reducing pain after a caesarean procedure (Joulaeerad et al. 2018) and preventing stress, anxiety and depression after childbirth (Kianpour et al. 2016).
The effect of suture techniques used in repair of episiotomy and perineal tear on perineal pain and dyspareunia
Published in Health Care for Women International, 2020
Meltem Aydın Besen, Gülay Rathfisch
Perineal pain is a common symptom, developing immediately after birth and continuing beyond the postpartum period, among women. This can affect the physical, psychological, and social well-being of the new mother (Fernando, 2007; Franscisco et al., 2014). In addition, delivery should be remembered as an impressive experience for women and their families. Perineal pain and dyspareunia experienced after delivery can cause fear and avoidance. Especially superficial dyspareunia may be associated with myofascial dysfunction of the perineal body. Episiotomy repair can be a cause of sclerotic healing and resultant superficial dyspareunia (Cassis, Mukhopadhyay, & Morris, 2017). As a result of all these, the tendency to cesarean section increases (Zaksek, 2015; Moore & Moorhead, 2013). In addition, the treatment of dyspareunia associated with postpartum perineal trauma is lacking robust evidence (Seehusen, Baırd, & Bode, 2014). All of these common postpartum effects were accompanied by efforts to reduce perineal pain and dyspareunia. One of them was the presentation of the effects of suture techniques on perineal pain and sexual health as evidence. The present study is a study evaluating the effect of continuous suture technique and interrupted suture technique on perineal pain and dyspareunia and showing that continuous suture technique is a reliable and superior technique.
Maintaining sexual function after pelvic floor surgery
Published in Climacteric, 2019
The female external genitalia consist of the labia (majora and minora), vestibule (interlabial space), and female erectile organs including the clitoris and vestibular bulbs. The clitoris comprises an outer glans, a middle corpus, and an inner crura, and the vestibular bulbs are erectile tissue located on either side of the female urethra. During sexual stimulation, the clitoris, labia minora, and vestibular bulbs become engorged. This results in increased lubrication, vaginal wall engorgement, and an increase in clitoral length and diameter. At the neurogenic level, nitric oxide, phosphodiesterase-V, and vasoactive intestinal peptide are believed to play a role in addition to the effect of the hormones estrogen and testosterone. The pelvic floor, on the other hand, forms the outlet of the bony pelvis and supports the abdominal and pelvic organs, maintains continence of urine and stool, and allows intercourse and parturition. It is formed by the levator ani muscle, urogenital diaphragm, and perineal membrane. The perineal membrane, consisting of the ischiocavernous, bulbocavernous, and superficial transverse perineal muscles, has a crucial role in sexual response.