In the early 2000s, publications reporting the increasing incidence of severe obstetric lacerations began to emerge and in the United Kingdom, and the incidence of perineal lacerations of grade 3 or 4, with a reported incidence of 1.8% in 2000, was reported to rise to 5.9% in 2011, which exhibited a 3-fold increase(11). An increased risk for severe perineal lacerations were indicated associate with increased maternal age, instrumental delivery, Asian race, higher socio-economic status, birth weight of 4.000 g or above, and shoulder dystocia. Some publications reported that selective episiotomy decreased the likelihood of 3rd or 4th degree perineal lacerations;(12) whereas, in a large observational study that included approximately 3.000 births, risk of perineal lacerations was reported associated with a set of factors, mainly including median episiotomy(13). Today, there are two remarkable retrospective studies regarding mediolateral episiotomy. The first is a retrospective population-based study conducted in 2001, which comprised 284.000 vaginal births(14). In that study, risk factors for 3rd degree perineal tears were investigated and episiotomy rate was reported as 35.1%, the rate of 3rd degree perineal tears was presented much lower than those in previous reports (1.94% vs. 4-5%). The authors concluded that forceps delivery was the most remarkable risk factor for 3rd degree perineal laerations [odds rate (OR), 3.33; 95% confidence Interval (CI): (2.97-3.74)] and that mediolateral episiotomy should be performed as a primary measure in case of fetal macrosomia to prevent 3rd degree perineal lacerations. The latter was a retrospective study conducted by Baumann et al.(15) in 2006 that included 40.000 vaginal births. In contrast to the previous study, the rate of anal sphincter laceration in primiparous women was reported as high as 5.2% and 17 obstetric risk factors, which may result in sphincter injury. Moreover, it was emphasized that anal sphincter laceration was most strongly associated with episiotomy [OR, 3.23; 95% CI: (2.73-3.80)] and forceps delivery [OR, 2.68; 95% CI: (2.17-3.33)].
Although social and psychological factors play an important role in women's sexual problems, the role of physical factors such as vascular, neurological, and muscular factors in women's sexual function is undeniable.[7,14] Pelvic floor muscles play an important role in the stimulation and orgasm in women.[11,15] Therefore, weakness of these muscles causes decreased blood flow, decreased vaginal sensation, dyspareunia, and anorgasmia.[7,16] Pelvic floor muscle relaxation has been identified as an affecting factor on sexual satisfaction. Half of the women with pelvic organ prolapse suffer from sexual dysfunctions such as; decreased libido, orgasmic disorder, problems in sexual arousal,dyspareunia and sexual dissatisfaction.[17,18,19] On the other hand, reports show that the rate of cesarean delivery is increasing.[20] Today, some women prefer cesarean delivery to vaginal delivery to prevent damage to the pelvic floor and decrease in sexual function.[21,22]
Sex With Tight Vagina franco conpatibile f
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Inclusion criteria were: Being nulliparous, Iranians living in Mashhad, having the ability to read and write, living with husband, beginning the sexual activity after delivery, having passed 8 weeks of vaginal delivery, having a healthy baby, no postpartum complications, lack of special medical disease, lack of psychological disorder in couples, non-addictive couples, not using alcohol or drugs affecting sexual function, no uterine prolapse or cystocele or rectocele grade 3 and 4, and not having undergone stressful event during a month ago. Exclusion criteria included being pregnant during the study, doing regular exercises during the study, and not regularly performing Kegel exercise program based on the method proposed in the study.
Pelvic floor muscle strength was measured with Brink scale. This scale is a four-degree (1, 2, 3, 4) tool which is measured based on three criteria: Pressure, moving the fingers in the horizontal plane, and time. The minimum score is 3 and the maximum score is 12. If after the intervention, the scores obtained by this criterion are increased, it shows an increase in pelvic floor muscle strength. To determine the strength of the pelvic floor muscles by Brink scale, the sample was asked to lie down on the bed in supine position with knees bent and focus on the perineal area and completely relax the perineal area. Then two fingers were put inside the vagina, and she was asked to contract her pelvic floor muscles just like when she holds the urine and she had to try to pull the researcher's finger upward and inward.[27]
Morkved and Kar also reported that pelvic floor muscle strength increases after 8 weeks of performing the postpartum Kegel exercises.[33] In the study, the pelvic floor muscle strength also increased in the control group, which is inconsistent with result of the present study. It seems that the disagreement with the results of this study could be due to differences in measuring the strength of pelvic floor muscles and the study population (nulliparous and multiparous women, vaginal delivery and cesarean delivery). In the present study, control group also received postpartum care instructions that included Kegel exercises and 50% of them reported that they performed these exercises once or twice a week. Therefore, it could account for the increase in pelvic floor muscle strength in the control group.
The periodontal abscess is an acute destructive process in the periodontium resulting in localized collections of pus communicating with the oral cavity through the gingival sulcus or other periodontal sites and not arising from the tooth pulp. The prevalence of periodontal abscess is relatively high and it affects the prognosis of the tooth. Periodontal abscesses can develop on the base of persisting periodontitis but can also occur in the absence of periodontitis. The cause of the development of periodontal abscess originating from chronic periodontitis is the marginal closure of a periodontal pocket, or the pocket lumen might be too tight to drain the increased suppuration due to changes in the composition of subgingival microflora, alteration of bacterial virulence or host defenses. Diagnosis of a periodontal abscess is based on medical and dental history as well as oral examination (pocket depth, swelling, suppuration, mobility, sensibility of the tooth). The most prevalent group of bacteria: P. gingivalis, P. intermedia, B. forsythus, F. nucleatum and P. micros. Previous studies have suggested that the complete therapy of the periodontitis patients with acute periodontal abscess has to do in two stages: the first stage is the management of acute lesions, then the second stage is the appropriate comprehensive treatment of the original and/or residual lesions. The management of acute lesions includes establishing drainage via pocket lumen, subgingival scaling and root planing, curettage of the lining pocket epithelia and seriously inflamed connective tissue, compressing pocket wall to underlying tooth and periodontal support, and maintaining tissue contact. Some authors recommend the incision or to establish drainage and irrigation, or a flap surgery, or even extraction of hopeless teeth. We recommend the use of systemic antibiotics as a preventive measure of systemic disease or in case of systemic symptoms.
The best management for diverticulitis with abscess formation remains unknown. The purpose of this study was to determine the natural course and outcomes of patients with medically treated diverticular abscess. We conducted a retrospective review of all patients at our institution with diverticular abscess confirmed by CT from 2004 to 2014. This study was conducted in a tertiary referral hospital. A total of 1194 patients were treated for acute diverticulitis in 10 years; 210 patients with CT-documented diverticular abscess were analyzed (140 men (66.7%) and 70 women (33.3%); median age 45 years; range, 23-84 years). Overall recurrence and disease complication rates, as well as the need for subsequent operation after initial successful nonsurgical management, were measured, along with analysis of the whole cohort and the subgroup of patients with percutaneous drainage for diverticular abscess. During the initial presentation, 25 patients failed nonoperative management and required an urgent operation. A total of 185 patients were initially successfully managed without surgery and were discharged from the hospital. Of these, recurrent diverticulitis developed in 112 (60.5%) after an average time interval of 5.3 months (range, 0.8-20.0 months); 47 patients (42%) experienced more than 1 episode. The modified Hinchey stage at time of recurrence (compared with index stay) increased in 51 patients (45.6%). Seventy one (63%) of 112 recurrences showed local disease complications (recurrent abscess, fistula, stricture, or peritonitis). Fistula formation (colovesicular/colovaginal/colocutaneous) and recurrent abscess were the 2 most frequent complications. Twenty nine (26%) of 112 recurrences required an urgent operation; overall, 66 (59%) of 112 patients eventually underwent surgery at our institution. The original abscess size in patients who later developed recurrences was significantly larger than in patients who did not develop recurrence (5.3 vs 3.2 cm; p
Sacral colpopexy is an effective, durable repair for women with apical vaginal or uterovaginal prolapse. There are few reports of serious complications diagnosed in the remote postoperative period. A 74-year-old woman presented 8 years after undergoing posthysterectomy abdominal sacral colpopexy using polypropylene mesh. Posterior vaginal mesh erosion had been diagnosed several months before presentation. She suffered severe infectious complications including an infected thrombus in the inferior vena cava, sacral osteomyelitis, and a complex abscess with presacral and epidural components. Surgical exploration revealed an abscess cavity surrounding the mesh. Although minor complications commonly occur after sacral colpopexy using abdominal mesh, serious and rare postoperative infectious complications may occur years postoperatively. 2ff7e9595c
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