Vanessa Santos Pereira-Baldon

Objective: This study evaluates the sexual function of Brazilian women of reproductive age and postmenopausal women during the COVID‐19 pandemic. Methods: A cross‐sectional observational study was conducted virtually between 2020 and 2021, involving 200 sexually active women, divided into two groups: 100 women of reproductive age (WRA) and 100 postmenopausal women (PMW, amenorrhea for at least 12 consecutive months). Sexual function was assessed using the Female Sexual Function Index (FSFI). Comparisons between groups were performed using the Mann–Whitney test, with a significance level of 5%. Results: No significant differences were observed between the groups in the total FSFI score (WRA: 17.29 ± 6.22; PMW: 17.38 ± 9.89). However, the WRA group had significantly higher scores in the desire domain ( P < 0.001), while the PMW group showed higher scores in the sexual arousal ( P = 0.015) and satisfaction ( P < 0.001) domains. No significant differences were found in the other domains. Conclusion: During the pandemic, both Brazilian women of reproductive age and postmenopausal women experienced impaired sexual function, as evidenced by reduced FSFI scores.

Background: Pelvic floor muscle training (PFMT) is a treatment that can be used during pregnancy. The main aim of this study was to evaluate adherence to PFMT and self-efficacy using a mobile application (app) named GoMAP. The secondary objective was to evaluate the correlation between self-efficacy and adherence of participants who used the GoMAP app. Methods: This is a feasibility study. The participants were pregnant women who underwent an 8-week PFMT protocol, provided through a previously validated GoMAP app. To assess self-efficacy, the Self-Efficacy Scale for practicing Pelvic Floor Exercises was applied four times—every two weeks after starting the PFMT program on the GoMAP app. Adherence was evaluated daily by a frequency questionnaire that was completed as the participant performed the exercise program. The data are expressed as mean ± standard deviation and percentage, and the Pearson correlation test was performed between quantitative variables. A 5% significance level was adopted. Results: Eighteen pregnant women completed the 8-week exercise protocol. The mean Self-Efficacy Scale after eight weeks of PFMT was 75.8±14.8 and the average adherence of pregnant women to the protocol was 30.4±14.0 days. The adherence and self-efficacy variables showed a strong correlation after eight weeks of PFMT (r=0.79, PConclusions: Women who used the GoMAP app demonstrated good adherence and self-confidence when performing the PFMT exercises. The app could be an important therapeutic resource when conducting a PFMT program for pregnant women.

Introduction: Urinary incontinence (UI) is defined as any involuntary loss of urine that causes negative impacts on women's lives. Pelvic floor muscle training (PFMT) is considered to be “level A” of scientific evidence in the treatment of UI. Despite its efficacy, it is known that the effect of PFMT may depend on continuous adherence. Therefore, healthcare professionals are looking for alternatives to improve adherence in their patients. Healthcare has been innovating through mobile device apps.Objective: Thus, the objective of this study was to verify the effects of PFMT with the use of a mobile device app in incontinent women.Trial Design: This was a controlled, randomized clinical trial that occurred remotely.Methods: A total of 104 women with stress UI and/or mixed incontinence, over 18 years old, literate, with preserved cognitive capacity, with internet access and a mobile device with the Android system, participated in this study. They were randomly divided into two groups: The App group and the Booklet group, which underwent a PFMT protocol guided by a mobile app and a booklet, respectively. Both groups received daily reminders to perform the exercises. Before and after 12 weeks of intervention, it was evaluated using the International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF) and the King's Health Questionnaire (KHQ).Results: Both groups showed improvements in the final ICIQ‐SF score. However, superior results were shown for the Booklet group (App: pre: 11.5 [±3.8], post: 9.8 [±4.5]; Booklet: pre: 12.6 [±4.5], post: 7.4 [±4.3]; p = 0.03).Conclusion: It was concluded that PFMT, with the use of a mobile app, is capable of reducing UI and the impact of UI, but it is not superior to training with the use of booklet instructions.

Introdução: Muitas gestantes buscam o parto vaginal, como uma via mais saudável e respeitosa, e as técnicas de massagem perineal e alongamento perineal assistido por instrumento tem como objetivo trazer melhores desfechos no pós-parto. Apesar disso, alguns partos podem não ocorrer como o esperado e finalizarem com intervenções ou parto cirúrgico. Objetivo: Analisar a influência das variáveis musculares no tipo de parto de mulheres submetidas a preparação perineal. Métodos: Trata-se de uma análise secundária de um ensaio clínico em que foram incluídas primíparas com idade gestacional de 33 semanas. Foram realizadas avaliações antes e após oito sessões de intervenção por meio de massagem perineal e alongamento assistido pelo instrumento Epi-No Delphine Plus®. Foram avaliadas as variáveis musculares distensibilidade perineal com uso do equipamento Epi-No Delphine Plus® e a força pico e média dos músculos do assoalho pélvico (MAP) por meio do manômetro vaginal Peritron. Após o parto foi questionado por contato telefônico o tipo de parto realizado. Para a análise estatística foi realizada a regressão logística univariada com nível de significância de 0,05. Resultados: Sessenta e uma primíparas foram incluídas no estudo (média de idade: 30 anos; DP: 4,8). Nenhuma das variáveis musculares examinadas foram preditores para o parto vaginal (p > 0,05). Conclusão: As variáveis musculares não influenciaram na via de parto final de mulheres submetidas a preparação perineal.

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.

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). 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. For the PFM extensibility variable, a significant main effect of time (F_2,88 = 87.951) and group (F_3,88 = 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. 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. 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. Pregnant women can benefit from intervention using the combination of perineal massage and instrument-assisted perineal stretching techniques with a short, repeated protocol.

Background: Labor, although natural and physiological, is a period that can be marked by stress, pain, anxiety, suffering, fear, and anguish for a woman. Thus, non-pharmacological methods that reduce pain during labor are important to allow a better experience without the use of medications. Therefore, the aim of this study is to evaluate the effects of non-pharmacological pain relief methods, added or not to the application of transcutaneous electrical stimulation (TENS), on pain, satisfaction with the childbirth, duration of labor, and newborn conditions. Methods: This is a randomized controlled clinical trial, with a non-probabilistic convenience sample, composed of women in the first active stage of labor, admitted to a public institution. The parturients will be divided into 3 groups: group 1 (n = 36) composed of parturients who will have continuous support and will be encouraged to walk, adopting different positions with the use of the Swiss ball and receiving back massage for 30 min; group 2 (n = 36) composed of parturients who will also have continuous support and will be encouraged to walk, adopt different positions using the Swiss ball, and will receive the application of TENS for 30 min; and group 3 (n = 36) composed of parturients who will have continuous support and will be encouraged to walk, adopting different positions with the use of the Swiss ball, and will receive placebo TENS application for 30 min. The outcomes evaluated in the study will be pain intensity assessed by the visual analog scale of pain applied before, immediately after, and 30 min and 1 h after the interventions; Experience and Satisfaction with Childbirth Questionnaire (QESP) applied 12 to 24 h after delivery; and data regarding delivery (type of delivery, total duration of labor, and possible obstetric complications) and neonate (weight, height, possible complications, Apgar score in the first and fifth minutes). Discussion: With this research, it is expected to understand the effects of the intervention through TENS electrostimulation added to other non-pharmacological methods for pain management during labor. Trial registration: Brazilian Registry of Clinical Trials (REBEC) RBR-68kh6j. Registered on March 17, 2020

RESUMO O objetivo deste artigo é analisar os efeitos da drenagem linfática manual sobre os sintomas de sensação de peso, dor, edema e formigamento nos membros inferiores de gestantes, assim como na redução da perimetria. A amostra foi composta por 23 voluntárias, e foram realizados 35 atendimentos. Foram incluídas gestantes com idade gestacional acima de 26 semanas, que apresentavam sensação de peso, dor, edema e formigamento nos membros inferiores, com autorização escrita do médico obstetra para que fossem submetidas a drenagem linfática manual utilizando o método Leduc. Foram excluídas gestantes que apresentaram pressão arterial superior a 140/100mmHg no momento da realização da drenagem linfática manual, lesão de continuidade da epiderme, doenças dermatológicas, linfáticas e cardíacas, infecções e varizes volumosas e/ou sintomáticas. As avaliações foram realizadas imediatamente após a aplicação da drenagem linfática manual e duas horas depois, por meio de questionário estruturado pelas pesquisadoras. Diferenças estatisticamente significativas foram encontradas antes, imediatamente após e após duas horas da intervenção no que se refere à melhora da dor (p=0,001*), do formigamento (p=0,01*), da sensação de peso (p=0,000*) e do inchaço (p=0,000*). Em relação à perimetria antes e após o tratamento, houve diminuição na maioria das mensurações realizadas. A técnica de drenagem linfática manual tem papel fundamental na melhora da qualidade de vida da gestante devido ao relaxamento e bem-estar proporcionado, componentes considerados essenciais para redução da ansiedade e com benefícios que podem perdurar até o parto.