Journal of the Turkish German Gynecological Association最新文献

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: High-grade ovarian cancer (HGOC) remains a significant therapeutic challenge due to its aggressive nature and poor prognosis. The aim was to elucidate the molecular drivers of HGOC through an integrated bioinformatics analysis.

Material and methods: The microarray datasets (GSE6008 and GSE14764) served as the training set, while an independent microarray dataset (GSE23603) was used as the validation set. These datasets included low- and high-grade ovarian tumor samples and were downloaded from the ArrayExpress database. Selection criteria included clearly classified low-grade ovarian cancer and HGOC samples, as well as platform and sample processing methods compatibility. After normalization, differentially expressed genes (DEGs) were obtained using R software. Functional enrichment analysis [including gene ontology (GO) and pathway analysis] was performed using the DAVID database. A protein-protein interaction (PPI) network was constructed by STRING to identify hub genes associated with HGOC.

Results: A total of 106 common DEGs were identified across all three datasets, including 66 up-regulated and 40 down-regulated genes. Given the study's focus on potential oncogenic drivers, subsequent analyses prioritized the 66 up-regulated genes. The DEGs were classified into three groups by GO terms (21 biological process, 10 molecular function and 12 cellular component). Kyoto Encyclopedia of Genes and Genomes pathway analysis showed enrichment in metabolic pathways, oxidative phosphorylation, drug metabolism, and cell cycle regulation. The top nine up-regulated hub genes in the PPI network were GMPS, RFC4, YWHAZ, CHEK1, CYC1, MRPL13, MRPL15, SDHA, and CLPB.

Conclusion: The identification of these hub genes and pathways may represent an important step forward in our understanding of HGOC. While down-regulated genes may also hold biological significance, their analysis was beyond the scope of this study and warrants future investigation. Further experimental validation is needed to confirm the roles of the identified genes in disease pathogenesis and their potential as biomarkers and therapeutic targets.

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.

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.

Objective: The aim of this study was a sub-analysis of the FARBEN survey to compare the preferences and responses of participants from the Eastern and Western German federal states and to identify potential differences.

Material and methods: The preferences of the German participants from the respondents in the tri-national FARBEN study were analyzed. Participation was voluntary and anonymous. The questionnaire consisted of 62 questions covering topics such as the workplace in general, work-time models, and professional goals. In the present study, only the data of the participants working in Germany were analyzed.

Results: The sub-group consisted of 1,021 out of the total of 1,364 (74.85%) respondents for the FARBEN survey. Of these, 855 (83.7%) responses were from participants from the Western federal states, and 166 (16.3%) from the Eastern federal states. Gynecologists in the East generally became parents at a younger age (29.3 vs. 30.8 years) and the rate of childlessness was higher among gynecologists in the West (54.8% vs. 37.0%). In the West, full-time work was both more frequently preferred (13.0% vs. 5.4%) and practiced (52.1% vs. 41.5%).

Conclusion: Many family policy aspects of the former German Democratic Republic facilitated and continues to facilitate the compatibility of work and family life for mothers in the East. Historical perspectives can be helpful in implementing improvements for women in terms of work-family balance in a female-dominated medical field such as gynecology.

Objective: To determine the success rate and feto-maternal outcomes following trial of labor among women with one previous cesarean section (C/S) seen at the Federal Medical Centre, Bida, Nigeria.

Material and methods: This was a prospective cohort study among selected women with a previous C/S admitted for trial of labor after C/S over a 15 month period. Demographic and medical history data was collected by questionnaire. Women achieving vaginal birth after cesarean (VBAC) and those undergoing emergency repeat C/S (ERCS) were compared statistically for differences and associations based on a range of variables.

Results: A total of 150 women with one previous C/S were included. Out of 150 study participants, 105 (70.0%) achieved VBAC while 45 (30.0%) had ERCS. Women with previous vaginal delivery had higher odds of achieving VBAC. Poor progress of labor was the most common indication for ERCS (17/45; 37.8%). The most frequent maternal complication following abdominal delivery was post-partum hemorrhage (n=15; 33.3%) while perineal laceration (n=26;24.8%) was the commonest among women who achieved VBAC. The ERCS cohort suffered significantly more complications in comparison to those who had VBAC. Comparison of fetal outcomes by mode of delivery were comparable, except that neonates admitted into special care baby unit were more likely to have been born via ERCS (odds ratio 5.231; 95% confidence interval 1.247-21.950) compared to those born via VBAC. There was no perinatal or maternal mortality. However, one case of ruptured uterus was recorded.

Conclusion: These results demonstrated that good outcome following trial of labour is achievable among well selected women, even in low resource settings.