Full text
| |
| Author(s): |
Gláucia Miranda Varella Pereira
Total Authors: 1
|
| Document type: | Doctoral Thesis |
| Press: | Campinas, SP. |
| Institution: | Universidade Estadual de Campinas (UNICAMP). Faculdade de Ciências Médicas |
| Defense date: | 2023-08-25 |
| Examining board members: |
Luiz Gustavo Oliveira Brito;
Zilma Silveira Nogueira Reis;
Elizabeth Alves Gonçalves Ferreira;
Maria Laura Costa do Nascimento;
Rodolfo de Carvalho Pacagnella
|
| Advisor: | Cássia Raquel Teatin Juliato; Luiz Gustavo Oliveira Brito |
| Abstract | |
Introduction: Vaginal laxity (VL) is defined as a complaint of excessive vaginal laxity. Objective: To identify the clinical, diagnostic and therapeutic factors for VF. Methods: A systematic review of treatment for VL; a cross-cultural adaptation and validation for the Portuguese language of the Female Sexual Distress Scale–Revised (FSDS-R); a cross-sectional study evaluating vaginal thickness measurements by transvaginal (TVUS) and transabdominal (TAUS) ultrasound; a qualitative study on understanding the meanings that women attribute to the feeling of VL and its impact on self-perception, intimate affective relationships and sexuality; a cross-sectional study conducted in the United Kingdom evaluating predictors of VL and sexual dysfunction in a multi-ethnic population; an RCT and its protocol on the effect of RF and PFMT in the treatment of women with VL; and from the RCT, a secondary analysis of the sonographic findings of women with VL who underwent RF and PFMT. Results: In the systematic review of 38 studies, no differences were found between intervention and control groups in sexual function and VL sensation in energy-based treatments. Participants' satisfaction with surgical treatments was high. In the validation of the FSDS-R, both the FSDS-R and the questionnaires for sexual function and vaginal symptoms showed discriminant validity between women with and without VL and high internal consistency in women with and without VL. In the cross-sectional study and secondary analysis, a significant correlation was found between vaginal thickness and TAUS and TVUS in women with VF. In the qualitative study, the 16 participants interviewed faced difficulties identifying VL symptoms and pointed out strategies to deal with VL. In the UK cross-sectional study, of the 200 participants included, 67 had VL. Participants with VL had worse results regarding vaginal symptoms and sexual distress. Finally, in the RCT, both RF and PFMT showed improvements in genital prolapse symptoms and muscle strength. The study protocol presented the steps for performing the RCT. Conclusion: VL is a prevalent symptom among sexually active women. Multiparity, age, instrumental delivery, perineal laceration, menopausal status, and vaginal delivery and caesarean section were most frequently associated with VL complaints. VL negatively impacts the woman's relationship with her genitalia, her self-esteem, and her sexual well-being, in addition to hindering the affective bond with the partner. The FSDS-R proved to be a valuable instrument to assess sexual distress in women with VL, as these have worse scores in the assessment of sexual distress. Both TAUS and TVUS are capable of measuring vaginal wall thickness in women with VL. Energy-based treatments were not statistically different in restoring sexual function and VL sensation compared to sham or placebo in a meta-analysis, however, significant improvement was seen in an RCT in women treated with RF and PFMT after 30 days and six months of follow-up (AU) | |
| FAPESP's process: | 19/26723-5 - Effect of fractional microablative radiofrequency and pelvic floor muscle training in the treatment of women with of vaginal laxity: randomized clinical trial |
| Grantee: | Glaucia Miranda Varella Pereira |
| Support Opportunities: | Scholarships in Brazil - Doctorate |