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Background It is known that sexual problems increase with age but little is known about the predictors of female sexual dysfunction (FSD) in Brazilian climacteric women. Aim To identify predictive factors for FSD in climacteric women. Methods This is a cross-sectional population-based study carried out through a household survey. Outcomes The measures investigated were sociodemographic characteristics, depressive symptoms, level of physical activity, presence of FSD, self-rated health and sleep satisfaction. Result A total of 381 climacteric, sexually active women were included, with a mean age of 55.04 (±7.21) years. The prevalence of FSD was 38.3%. All variables investigated were associated with FSD (P < .05). In the final model, the predictors for FSD were low satisfaction with sleep (OR 4.20; 95% CI 2.32–7.62), advanced age (OR 1.04; 95% CI 1.00–1.08), low education level (OR 0.90; 95% CI 0.85–0.97) and having a partner (OR 0.35; 95% CI 0.16–0.76). Clinical implication These aspects deserve attention from the health team to prevent and identify FSD early in life in climacteric women. Strengths & limitations This study support existing data about risk factors for FSD in climacteric women. However, it is not possible to attribute causality to any of the correlates identified, which is a limitation of cross-sectional studies. Conclusion Dissatisfaction with sleep, senility, insufficient income, low education, not having a partner, complaints of depression, and the worse perception of global health are predictive factors for FSD in climacteric women.

To date, no study has investigated the correlation between pelvic floor muscle function and urinary incontinence in female runners. The aim of the study was to investigate the relationship between pelvic floor muscle function and to correlate urinary leakage as measured by the modified pad test with kinematic variables of running. The sample consisted of 11 incontinent and 17 continent runners. On day 1, they performed a maximum velocity test on a treadmill using an incremental protocol. Their pelvic floor muscles were evaluated using vaginal palpation and manometry, and the adapted pad test was used to evaluate the severity of urinary incontinence. Then, running kinematics were evaluated on a treadmill using a circuit camera to capture vertical displacement, knee flexion during the load response phase, and the initial contact of the foot with the ground for subsequent analysis. The pad test was performed during the kinematic evaluation. The vaginal squeeze pressure of the continent group (mean = 43.40 mmHg, SD = 21.75) was higher in descriptive terms than that of the incontinent group (mean = 38.94 mmHg, SD = 31.08), but the difference was not statistically significant (p = 0.66). There was an association between the weekly training load and urinary leakage. No associations were found between pelvic floor muscle function or urinary leakage and the kinematic variables. Despite the correlation between the weekly training load and the severity of urinary leakage, no relationships were found between pelvic floor muscle functioning and the kinematics of running.

Objective The purpose of this study was to compare (1) the effects of the instrument-assisted perineal stretching technique with different application protocols in combination with perineal massage and (2) the effects of the isolated techniques on the extensibility and strength of the pelvic floor muscles (PFMs). Methods A randomized controlled clinical trial with parallel randomization, assessor blinding, and concealed allocation was conducted in the Campus Physical Education at the Federal University of Uberlândia in Brazil. Ninety-six pregnant women (18–40 years of age) were allocated into 4 groups: perineal massage (PnM) group (PnM protocol for 10 minutes); instrument-assisted perineal stretching with a long static protocol for 15 minutes [IStrLS group]); PnM + IStrLS group (both techniques applied in the 2 previous groups); and PnM + IStrSR group (the same techniques as used in the PnM + IStrLS group but with a short repeated protocol; 4 sets lasting 30 seconds each). Eight interventions were performed in all 4 groups twice weekly (beginning at the 34th gestational week). The primary outcome was PFM extensibility, assessed using vaginal dilator circumference, and the secondary outcome was PFM strength, assessed using vaginal manometry. Results For the PFM extensibility variable, a significant main effect of time (F2,88 = 87.951) and group (F3,88 = 7.193) was found. Tukey post hoc test results showed that the PnM + IStrSR group presented greater extensibility than the PnM and IStrLS groups. The PnM group showed increased PFM strength after 8 sessions compared with the other groups. Conclusions Women who were pregnant and received the combination of perineal massage and instrument-assisted perineal stretching with short repeated application had a greater increase in PFM extensibility than perineal massage and instrument-assisted perineal stretching alone. Impact The combination of perineal massage and instrument-assisted perineal stretching techniques with a short, repeated protocol led to better PFM extensibility results than the application of the techniques alone in women who were pregnant. Lay summary Pregnant women can benefit from intervention using the combination of perineal massage and instrument-assisted perineal stretching techniques with a short, repeated protocol.

Aims We aimed to compare pelvic floor muscle (PFM) strength and sexual function in primigravid and non-pregnant women and compare PFM strength between those who exhibited and did not exhibit sexual dysfunction. Methods A cross-sectional observational study was conducted. The sample consisted of 154 women, including 76 primigravid and 78 non-pregnant women. The inclusion criteria were as follows: non-pregnant nulliparous women or primigravid women who were pregnant with a single foetus at least 14 weeks of gestational age and reported having sexual intercourse at least once during the last 4 weeks. The exclusion criteria were as follows: inability to contract the PFMs and prior urogynaecologic surgery. PFM strength was assessed via vaginal palpation (using the Modified Oxford Scale) and vaginal squeeze pressure (using the Peritron™ manometer). Sexual function was assessedusing the Female Sexual Function Index (FSFI) questionnaire. Sexual dysfunction was identified based on low FSFI scores.The data were analyzed using the Mann-Whiney and Spearman correlation tests. Results To discussion, primigravid women had lower FSFI scores and lower PFM strength than non-pregnant women. Women with sexual dysfunction had lower PFM strength than women without sexual dysfunction, as indicated by vaginal palpation (scores of 2 out of 5 and 4 out of 5, respectively; P

Perineal preparation techniques for childbirth have been used with the aim of reducing perineal tears during the expulsive phase of labor. However, no studies were found to investigate the effects of instrument-assisted stretching versus perineal massage on pelvic floor muscle (PFM) variables. Therefore, the aim of this study was to evaluate the effect of instrument-assisted stretching versus perineal massage on the extensibility and strength of the PFMs. Primiparous women were randomized to the instrument-assisted stretching (IStr) group (n = 13) and perineal massage (PnM) group (n = 14). The groups participated in eight sessions, twice weekly, beginning at the 34th gestational week. The IStr group underwent the intervention for 15 min using EPI-NO®. The PnM group underwent a perineal massage protocol for 10 min. Each woman was evaluated by a blinded physiotherapist before, after four and after eight sessions for primary (PFM extensibility using the EPI-NO® circumference) and secondary (PFM strength using a manometer) outcomes. Covariate analysis (ANCOVA) was used to compare the groups using the baseline values as a covariate. Both groups showed an increase in PFM extensibility compared with the evaluations before and after four and eight sessions (PnM group from 17.6 ± 1.8 to 20.2 ± 1.9 cm; IStr group from 19.9 ± 1.6 to 22.9 ± 1.6 cm;p

Introdução: A alta prevalência de cirurgia cesariana é um grave problema de saúde pública mundial, ao qual tem-se associado um considerável risco de complicações materno-neonatais. Uma ampla gama de intervenções para reduzir esses altos índices de cesárea tem sido descrita na literatura. Métodos não farmacológicos para alívio da dor durante o trabalho de parto têm-se demonstrado uma alternativa promissora para esse fim. Apesar das evidências dos benefícios desses métodos, poucos estudos analisaram sua associação com a via de nascimento e complicações maternas e neonatais, a ela associados. Objetivo: Analisar o impacto do uso de métodos não farmacológicos para alívio da dor durante o trabalho de parto das mulheres atendidas no Hospital de Clínicas da Universidade Federal de Uberlândia (HCU-UFU) sobre a via de nascimento e complicações materno-neonatais. Material e métodos: Coorte retrospectiva com prontuários de mulheres admitidas em trabalho de parto espontâneo ou para indução de trabalho de parto no HCU-UFU, no período de 01 de janeiro de 2013 a 31 de dezembro de 2017. Os prontuários foram identificados por meio do uso dos seguintes códigos da 10ª Classificação Internacional de Doenças (CID-10): O80, O81, O82, O84.0, O84.1 e O84.2. Análises descritivas foram utilizadas para caracterização da população. Dados perdidos foram recuperados por meio de imputação múltipla aleatória. Realizamos regressão logística ajustada para características sociodemográficas e obstétricas maternas, a fim de analisar as chances das mulheres pertencerem ao grupo de cada desfecho materno-neonatal. Estimamos Risk Ratio (RR), por meio de modelos de regressão logística sem ajustes e ajustados para características sociodemográficas e obstétricas maternas, a fim de analisar os efeitos do uso de métodos não farmacológicos para alívio da dor e correlacioná-los aos desfechos materno-neonatais. Resultados: Foram analisados 5.293 prontuários de mulheres internadas em trabalho de parto espontâneo ou para indução do trabalho de parto. Desses, 2.006 (37,9%) apresentaram registro do uso de métodos não farmacológicos para alívio da dor durante o trabalho de parto: 1.582 (78,9%) registros de banho morno no chuveiro, 1.281 (63,9%) de bola suíça, 352 (17,5%) de variedade de posições, 175 (8,7%) de massagem relaxante e 97 (4,8%) da técnica da respiração orientada. Do total de prontuários analisados, 2.196 (41,5%) referiam-se a cirurgia cesariana e 448 (8,5%) apresentaram registro de alguma complicação materno-neonatal. O uso de métodos não farmacológicos para alívio da dor reduziu em aproximadamente 73% (RR 0,27; IC95% 0,24 - 0,31) o risco de cirurgia cesariana mas, não interferiu na ocorrência de complicações materno-neonatais (RR 0,89; IC95% 0,71 - 1,13). Conclusão: Apesar do uso infrequente dos métodos não farmacológicos durante o trabalho de parto, o uso desses métodos contribuiu significativamente para a redução do risco de cirurgia cesariana. Esse é um achado particularmente importante em cenários de alta prevalência de cirurgia cesariana, como no nosso hospital. Embora essa prática não interfira no risco de complicações materno-neonatais, estratégias de incentivo ao uso desses métodos, como a implementação de modelos de cuidados colaborativos, devem ser encorajadas para reduzir a ocorrência de cesáreas desnecessárias. Estudos posteriores sobre a eficácia de cada método, podem auxiliar profissionais de saúde na oferta de métodos mais apropriados a cada fase do trabalho de parto. Introduction: The high prevalence of caesarean sections is a difficult global public health problem with which several maternal and neonatal complications have been associated. A wide range of interventions to reduce the high rate of caesarean sections is described in the literature. Among them, non-pharmacological labour pain management methods seem to be an interesting strategy for this purpose. Despite evidence on the benefits of these methods, few studies analysed the association of these methods with maternal and neonatal complications. Objective: To analyse the impact of non-pharmacological labour pain management methods on delivery mode and maternal/neonatal complications among women admitted for labour at the Federal University of Uberlandia hospital (HCU-UFU). Methods: Retrospective cohort comprising medical records from all women who had spontaneous labour or were submitted to induction or augmentation of labour at the University Hospital of the Federal University of Uberlandia (HCU-UFU) between January 1, 2013 and December 31, 2017. Medical records were selected based on the following International Classification of Disease (ICD-10) codes: 080, 081, 084.0, O84.1 or O84.2. We used descriptive analysis to characterize the study population and adjusted logistic regression to compare maternal sociodemographic and obstetric characteristics according to delivery mode and presence of maternal and/or neonatal complications. Multiple imputation was used to handle missing data. To assess the effects of non-pharmacological labour pain management methods and to correlate them to the study outcomes, we estimated the RR using unadjusted ratios in logistic regression models and adjusted ratios for maternal sociodemographic and obstetric characteristics. Results: We analysed 5,293 medical records of women who had spontaneous delivery or were submitted to induction or augmentation of labour. Of these, 37.9% had the use of a non-pharmacological labour pain management method registered: 1,582 (78.9%) women took warm shower baths, 1,281 (63.9%) used the Swiss ball, 352 (17.5%) tried different positions, 175 (8.7%) received relaxing massages, and 97 (4.8%) received guidance on appropriate breathing techniques. From the total of medical records analysed, 2,196 (41.5%) referred to caesarean sections and 448 (8.5%) had some maternal and/or neonatal complication registered. The use of non-pharmacological methods reduced the risk of caesarean sections in approximately 73% (RR 0.27; 95% CI 0.24 - 0.31), but did not have a detectable impact on the occurrence of maternal and neonatal complications (RR 0.89; 95% CI 0.71 - 1.13). Conclusion: Despite its low prevalence, the use of nonpharmacological labour pain management methods proved to be a significant factor to decrease the risk caesarean section. This is an important finding, especially in scenarios with high rates of caesarean sections like ours. Although this practice did not have an impact on the occurrence of maternal and neonatal complications, strategies to encourage the use of these methods should be encouraged to reduce the occurrence of unnecessary caesarean sections. Further studies to identify the efficacy of each method may help health professionals to offer more appropriate methods at different stages of labour. Dissertação (Mestrado)