Laparoscopic and Robotic Approaches to Apical and Vaginal Vault Suspension
Linda Cardozo, Staskin David in Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Pelvic organ prolapse (POP) is often described as a herniation of the pelvic organs toward the vaginal walls. It is further divided into different categories based on the anatomical location of the herniation to include anterior, apical, and posterior prolapse. Apical prolapse is further described as the descent of the uterus and cervix or vaginal vault in posthysterectomy cases toward the hymen. This chapter will focus on the treatment of apical prolapse using laparoscopic techniques with or without robotic assistance. The two techniques specifically discussed are high uterosacral ligament suspension (HUSLS) and sacrocolpopexy.
Child abuse and birth injuries
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
An injury that leaves a bruise over the abdomen would have needed more force than a child themselves would exert by falling. Need medical and possibly surgical management and full child protection investigations, which should be led by the paediatricians. Non-accidental injury is therefore likely and full investigations should be initiated to look for intracranial injury, fractures and retinal haemorrhages. The chest X-ray shows multiple old rib fractures. These are most likely to have been caused by abuse. The child needs investigation for other signs of abuse with Computed tomography head, skeletal survey and eye examination. A torn hymen can be caused by accidental injury if there is an appropriate history but it would not be gaping. This situation must be dealt with by an experienced paediatrician so that the chain of evidence is maintained. Self-harm is a common presentation of sexual abuse.
Uterine Swellings
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
The most common cause of uterine swelling is pregnancy, and this must always be considered during the reproductive years, particularly when associated with a history of amenorrhoea or menstrual upset. The size is dependent on the gestational age, but will usually become palpable abdominally from 12 weeks’ gestation. Uterine swellings have varying implications, depending on the age of presentation. The diagnosis is usually based on history and physical examination. Adolescent girls, unlike women in other age groups, may present with a uterine mass that is secondary to a Mullerian malformation, such as imperforate hymen, vaginal agenesis with a normal uterus and functioning endometrium, vaginal duplication with obstructing longitudinal septa, and obstructed uterine horns. Among the infective causes of uterine swelling, tuberculous endometritis deserves mention. It is secondary to a systemic infection by Mycobacterium tuberculosis , generally presenting in women of reproductive age.
How variability in hymenoplasty recommendations leads to contrasting rates of surgery in the Netherlands: an ethnographic qualitative analysis
Published in Culture, Health & Sexuality, 2017
Hymenoplasty is surgery to alter the shape of the hymen membrane in the vaginal canal, commonly performed to minimise the aperture. This medical operation is often requested by women who expect that their virginity will be under scrutiny, particularly during their first sexual encounter on their wedding night. Despite increasing demand for the surgery all over the globe, there is no one standard of practice in performing hymenoplasty. In the Netherlands, the manner in which medical consultations concerning the procedure take place depends heavily on the consulting physician. This paper looks at two different approaches to hymenoplasty consultation in the Netherlands: a pedagogical philosophy adopted in a public hospital and a practical approach employed by a private clinic. Each approach culminates in a contrasting result: patients in one medical establishment are twice as likely to undergo hymenoplasty than those visiting the other.
Appearance of external genital organs and types of hymen in Turkish female foetal cadavers
Published in Journal of Obstetrics and Gynaecology, 2017
Gülnur Özgüner, Kenan Öztürk, Cemil Bilkay, Ahmet Dursun, Osman Sulak, Esra Koyuncu
The present study’s purpose was to determine the size and morphometric development of the female external genital organs on foetal cadavers. Dimensions of labia majora, labia minora and clitoris, bilabial diameter, vertical and horizontal diameters of hymenal opening, distance between the external urethral orifice and hymenal opening, distance between the clitoris and external urethral orifice and anogenital distance were measured. The hymenal types were determined. Mean values of parameters according to gestational weeks, months and trimesters were calculated. Imperforate hymen were determined in the first trimester. Twenty-eight foetuses with annular hymen, 25 foetuses with imperforate hymen, and 1 foetus with septated hymen were determined in the second trimester. Twenty-four foetuses with annular hymen, 3 foetuses with imperforate hymen, 1 foetus with fimbriated hymen, and 1 foetus with hymenal tag were determined in the third trimester. All foetuses in the full term were determined with annular hymen.
Knowledge Regarding Hymens and the Sex Education of Parents
Published in Journal of Child Sexual Abuse, 2014
Verena W. Brown, Susan M. Lamb, Amy M. Perkins, Diana W. Naim, Suzanne P. Starling
The objective of this study was to ascertain beliefs and knowledge of pediatricians and parents regarding the hymen and to evaluate parental and pediatrician attitudes regarding sex education by pediatricians. Surveys were distributed anonymously to parents and pediatricians. Survey questions included knowledge of the female hymen and questions regarding attitudes toward sexual health education. There was a statistically significant difference in mean knowledge scores between pediatricians and parents regarding the hymen (3.7 versus 1.3; p < 0.0001). Almost two-thirds of pediatricians (63%) felt comfortable providing sexual health education directly to their patients, but only 41% felt comfortable educating parents. Pediatricians and parents demonstrate knowledge gaps about the hymen.