Journal of the Turkish German Gynecological Association最新文献

This systematic review and meta-analysis evaluated epithelial ovarian cancer (EOC) incidence rates associated with salpingectomy, with an exploratory assessment of temporal trends following guideline-driven increases in opportunistic salpingectomy. A literature search was conducted across PubMed, Web of Science, Cochrane, and Scopus, targeting cohort studies published between January 2015 and September 2023. Eligible studies were cohort studies reporting EOC incidence in women undergoing salpingectomy (opportunistic or risk-reducing) compared to controls without salpingectomy, with sufficient sample sizes (>100 salpingectomy cases) and homogeneous populations. The Newcastle-Ottawa Scale (NOS) was used to assess methodological quality. A meta-analysis calculated the risk ratio (RR) of EOC incidence, with subgroup analysis exploring temporal trends, using a random-effects model. Five cohort studies, involving 5,819,102 women with 31,586 EOC cases, were included, all with low risk-of-bias (NOS scores ≥6). Salpingectomy was associated with a 77.7% reduction in EOC incidence compared to control patients [RR =0.223, 95% confidence interval: (0.182, 0.274), p<0.001; I²=0]%. The 2022-2023 period should be interpreted as a recent evidence window rather than a formally powered comparative period owing to the small number of studies available. These findings confirm that salpingectomy, particularly opportunistic procedures, substantially reduces EOC incidence. Clinicians should consider offering salpingectomy to average-risk women during gynecologic surgeries, with informed consent. Further research with longer follow-up of contemporary cohorts is needed.

Objective: To compare hormonal and metabolic characteristics across Rotterdam polycystic ovary syndrome (PCOS) phenotypes (A-D) and identify key predictors of hyperandrogenism.

Material and methods: In this retrospective cohort study, women with PCOS were classified into four Rotterdam phenotypes. Hormonal and metabolic parameters were assessed in the early follicular phase, and composite indices including HOMA-IR, QUICKI, TG/HDL, and free androgen index (FAI) were calculated. Logistic regression and receiver operating characteristic analysis were used to evaluate predictors of hirsutism.

Results: The study included 226 women, with respective phenotype subgroups of: A n=85; B n=29; C n=43; and D n=69. Phenotype A showed the most pronounced hyperandrogenic and metabolic alterations, whereas phenotype D displayed the mildest profile with lower androgen levels and hirsutism scores. Significant differences in insulin resistance and lipid-related indices were observed across phenotypes. FAI was the strongest predictor of hirsutism (area under the curve =0.861), followed by total testosterone and dehydroepiandrosterone sulfate, while sex-hormone binding globulin was inversely associated.

Conclusion: PCOS phenotypes demonstrate distinct hormonal and metabolic patterns. Phenotype A represents the most metabolically and androgenically severe subgroup, whereas phenotype D is comparatively mild. FAI emerges as the most informative marker for hirsutism, supporting a phenotype-oriented approach to clinical assessment and follow-up in PCOS.

Objective: To investigate the relationship between belief in sexual myths and the presence of vaginismus, and to evaluate the influence of sociodemographic and cultural factors on sexual myth endorsement among Turkish women.

Material and methods: This case-control study included women diagnosed with vaginismus and an equal number of age-matched women without sexual dysfunction. Participants completed a sociodemographic questionnaire and the sexual myths (SMS). Comparative analyses were conducted to assess differences in total and subscale scores between groups, and multiple regression analysis was performed to evaluate the predictive role of sociodemographic variables on belief in sexual myths.

Results: Women with vaginismus (n=40) had significantly higher total scores on the SMS compared to the control group (n=40; p<0.001). Subscale analyses revealed that myths related to sexuality, gender roles, and sexual morality were more strongly endorsed by women with vaginismus. Multiple regression analysis showed that lower education level, conservative family background, and rural upbringing were significant predictors of stronger belief in sexual myths (p<0.05).

Conclusion: The findings suggest that belief in sexual myths is more prevalent among women with vaginismus and is influenced by key sociodemographic and cultural factors. Addressing these beliefs through culturally sensitive education and psychosexual interventions may enhance the effectiveness of vaginismus treatment.

We present a rare Müllerian anomaly known as "accessory cavitated uterine mass (ACUM)," which causes severe, refractory dysmenorrhea, and review the literature. A 17-year-old patient experienced severe, cyclic left-sided pelvic pain, correlating with menstruation. Magnetic resonance imaging (MRI) revealed a cystic lesion surrounded by myometrial tissue. Medical treatment with oral contraceptives was unsuccessful. Laparoscopic excision of the mass was performed, and histopathology confirmed the diagnosis of ACUM. At six months postoperatively, she remained asymptomatic, and follow-up MRI showed a normal-appearing uterus. ACUM is a rare Müllerian anomaly that is challenging to diagnose preoperatively, even with advanced imaging. Surgical excision remains the definitive treatment. This case highlights the importance of clinicians considering Müllerian anomalies in adolescents presenting with severe dysmenorrhea.

Objective: Contrary to international guidelines, intracytoplasmic injection (ICSI) has increasingly been applied to a widening range of indications. The aim of this study is to present our experience with conventional in vitro fertilization (C-IVF) in women in their forties and to contribute to the ongoing debate on whether advanced maternal age should be considered an indication for preferring ICSI.

Material and methods: We analyzed cases of non-male factor infertility in women aged ≥40 years. The primary outcome measures were fertilization rate, implantation rate, live birth rate, and miscarriage rate.

Results: The cohort included 204 patients with a mean age of 42.30±1.97 years, a mean antral follicle count of 4.65±2.60, body mass index of 25.80±4.54 kg/m² and a mean duration of infertility of 4.12±4.03 years. The mean duration of stimulation was 8.73±2.22 days, with a mean gonadotropin dose of 261.82±65.25 IU. The fertilisation rate was 74.69%. A mean of 1.77±0.60 embryos were transferred resulting in an implantation rate, clinical pregnancy rate and live birth rate of 10.44%, 18.62%, 12.25% respectively.

Conclusion: Fertilisation, implantation, live birth and miscarriage rates after C-IVF are satisfactory for women ≥40 years of age. Given its lower cost, ease of application and comparable clinical outcomes, C-IVF should be considered the preferred method of fertilisation in advanced-age patients.

Objective: To share our experience of ultrasonographic evaluation of fetal anatomy in the first trimester and pregnancy follow-up in a tertiary center.

Material and methods: This retrospective study was conducted in the Acıbadem University Atakent Hospital and Acıbadem University Bakırköy Hospital Prenatal Diagnosis Units between April 2015 and December 2019. The study group included pregnant women referred for first-trimester aneuploidy screening and anomaly survey.

Results: The mean maternal age was 31.28±4.43 years and ranged from 20-49 years. The median gestational week at which first-trimester evaluation was made was 12.4 weeks. Of 3254 cases, 55 (1.69%) had pathologic ultrasound findings in the first-trimester anomaly scan, including increased nuchal translucency (NT) value over 95th percentile in 34 fetuses (52.3%) with structural anomaly. Median (range) crown-rump length was 58.69 (45-83) mm, and the median NT value was 3,5 (1.5-12) mm for fetuses with abnormal sonographic findings. The total detection rate for sonographic anomalies in the first-trimester scan was 60.43%. Of note, 27.3% of fetuses with detected anomalies had multiple congenital anomalies. Twenty-four new cases were diagnosed in the second trimester, and 11 new cases were detected in the last trimester from the same cohort.

Conclusion: Screening between 11-14 weeks of pregnancy may be an opportunity to evaluate maternal health and detect severe fetal anomalies. The family should be counseled about structural anomalies that may be detected later, especially in the second and third trimesters, the limitations of the technique, and the ongoing progress of fetal development.

Autonomic nerves regulate the innervation and function of the bladder, uterus, and rectum via their terminal branches. This section emphasizes the superior hypogastric plexus, hypogastric nerve, pelvic splanchnic nerves, inferior hypogastric plexus, and its terminal branches, namely the vesical, rectal, and uterine nerves. Somatic nerves traverse the pelvis, providing motor and/or sensory innervation to the pelvic floor and lower limbs. It is important to recognize the obturator nerve, genitofemoral nerve, lateral femoral cutaneous nerve, lumbosacral trunk, and femoral nerve.

Objective: Human papillomavirus (HPV) positivity is associated with cervical, oropharyngeal, and anal cancers. There is insufficient published evidence regarding the effectiveness of obtaining oropharyngeal and anal swabs from patients with cervical HPV positivity to detect potential pathologies. Our aim was to analyze the feasibility of this potential screening protocol in a pilot group.

Material and methods: In this cross-sectional exploratory analysis, women diagnosed with cervical intraepithelial neoplasia (CIN) grades 1, 2, or 3 were recruited. In order to evaluate HPV infection beyond the cervix, oropharyngeal and anal swab samples from HPV-positive women presenting to the obstetrics and gynecology clinic with histopathologically confirmed CIN were collected.

Results: A total of 30 women who provided informed consent were included in this pilot study. HPV 16 was the predominant cervical HPV type across all CIN grades (46.7% of cases), but HPV genotype did not significantly correlate with the severity of CIN lesions (p=0.786). No statistically significant association was found between cervical and anal HPV infections (p=0.427). Oral HPV positivity was rare (6.7%) and similarly showed no significant correlation with cervical HPV infection (p=0.499).

Conclusion: These findings provide preliminary data on the effectiveness of multi-site HPV screening in this population. Future larger-scale studies are needed to determine whether detecting extra-cervical HPV in women with cervical HPV positivity will influence clinical management decisions.