Anna Padoa

Purpose: Overactive bladder (OAB) is common among women, increases in prevalence with age, and exerts a considerable physical, psychological and socioeconomic burden. This narrative review discusses issues specific to the management of OAB in women. Methods: The review is based on discussions at a symposium held at the International Urogynecological Association/European Urogynaecological Association meeting (Barcelona, Spain; June 2025) supplemented by a PubMed search of articles (published in English since 1 January 2020) describing current treatment practices, unmet clinical needs and future directions for the management of OAB in women. Results: The pathophysiology of OAB in women is multifactorial, involving detrusor overactivity, urothelial and sensory dysfunction, and central nervous system dysregulation, with additional contributions from hormonal and age-related changes. Management of OAB has evolved toward an individualised, stepwise approach. Behavioural and lifestyle interventions remain first-line therapy, followed by pharmacological options, such as antimuscarinics and β3-adrenergic agonists. For refractory cases, onabotulinumtoxin A and neuromodulation are established third-line treatments. Local oestrogen therapy or prasterone may provide benefit in selected postmenopausal women, whereas radiofrequency and urethral bulking strategies remain investigational. Emerging evidence supports newer β3-agonists, such as vibegron, which may provide comparable efficacy to established β3-agonists (e.g. mirabegron) with improved cardiovascular tolerability. Treatment selection for women with OAB should consider comorbidities, drug safety, cognitive and cardiovascular risk in older patients, and challenges with adherence. Conclusion: Further research into underlying mechanisms, long-term outcomes and strategies to optimise treatment adherence will be essential to improve symptom control and quality of life for women living with OAB.

Purpose To assess postpartum changes in dyspareunia, and to explore the prediction of postpartum dyspareunia by obstetrical outcomes and peripartum emotional reactions. Methods In this longitudinal observational study, postpartum women were recruited at the maternity ward of a single medical center (T1) two days postpartum, during April 2018-August 2020. Participants filled questionnaires addressing demographic and reproductive background, pre-partum dyspareunia, pain during labor, peripartum dissociation, sense of control and birth-induced acute stress disorder (ASD). Three months postpartum (T2), participants who reported resuming sexual activity filled questionnaires addressing dyspareunia, breastfeeding and depression. Obstetrical information was obtained from clinical records. Results At T1, we recruited 440 participants, among whom 240 (54%) reported resuming sexual activity at T2 and filled the dyspareunia questionnaire at both times. At T2, 52 (21.7%) women reported dyspareunia. Thirty-four (14.2%) women experienced new-onset dyspareunia, 18 (7.5%) had persistent dyspareunia, and 23 (9.6%) reported dyspareunia resolution. ASD symptoms at T1 predicted dyspareunia severity at T2 (B = 0.59, SE = 0.28, p = 0.004). Women with persistent dyspareunia reported greater dyspareunia severity, more dissociation, birth-induced ASD, lower sense of control during labor. At T2, nineteen (59.4%) women with new-onset dyspareunia reported breastfeeding vs. four (22.2%) women with persistent dyspareunia (p = 0.02). Conclusion We observed an association between negative peripartum experiences and postpartum dyspareunia. This finding highlights the importance of incorporating sexual history into prenatal care. Improving obstetric practices enhancing women’s control during childbirth and early detection of ASD symptoms, could lead to interventions reducing postpartum dyspareunia.

Pelvic organ prolapse (POP) affects millions of women around the world, with age-standardized prevalence rates of 2769 per 100,000 women in 2021. Although it greatly affects quality of life (QoL), only 18–50% of women experiencing this issue seek medical attention, largely due to a lack of knowledge, misunderstandings about the condition, and obstacles to accessing healthcare. This narrative review explores the progression of POP management towards a focus on patient-centered care, highlighting the importance of personalized treatment strategies that prioritize patient-reported outcomes (PROs) over solely anatomical factors. The approach to treatment has transitioned from being centered on anatomy to focusing on the patient, emphasizing the relief of symptoms and enhancement in QoL. Existing research indicates that monitoring without intervention is advisable for asymptomatic patients, as long-term studies have revealed that up to 40% of women experience stable or improved prolapse over a period up to 60 months. Pessary treatment has a fitting success rate above 90% and a treatment persistence rate of 60%, providing an effective non-surgical option for management. The approach to selecting surgical treatments has progressed to prioritize sufficient apical support as a key factor for achieving lasting results. For primary POP, native tissue repair (NTR) is now recommended as the first-line surgical option. Mesh-augmented repairs are used only in certain high-risk situations, whereas sacrocolpopexy offers the best anatomical stability for particular cases, such as those involving post-hysterectomy prolapse and recurrences. Contemporary POP management involves personalized, patient-focused decision-making that emphasizes addressing symptom severity and functional objectives rather than solely aiming for anatomical precision. The evidence suggests that NTR should be the primary surgical approach, while other procedures should be reserved for specially chosen patients. Success should primarily be evaluated based on PROs instead of anatomical factors, ensuring that treatments align with each patient’s preferences and expectations while reducing complications.

Objective: To evaluate the role of gynecologic findings in Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) by reviewing current international guidelines and identifying relevant gynecologic co‐morbidities. Methods: This consensus statement was developed through a systematic four‐phase process: (1) comprehensive literature review across PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases (inception‐January 2025) using predefined search terms related to IC/BPS and gynecologic conditions; (2) assembly of a 6‐member multidisciplinary expert panel including urologists, urogynecologists, gynecologists and pain specialists; (3) consensus development via modified Delphi technique comprising several electronic rating rounds and a face‐to‐face meeting, with consensus defined as ≥ 80% agreement; and (4) manuscript preparation with iterative review. Results: A number of associated gynecologic disorders may overlap with IC/BPS, our consensus committee identified five main co‐morbid disorders: Endometriosis/Adenomyosis, Genito‐Pelvic Pain Penetration Disorder/Sexual Dysfunction, Overactive Pelvic Floor Muscles, Hormone‐ Associated Genitourinary Changes, Vulvodynia/Vestibulodynia. Conclusion: While not exhaustive, this consensus highlights the most prevalent gynecologic co‐morbidities supported by current literature. Clinical evaluation should prioritize a detailed medical history and pelvic examination to identify these overlapping conditions. Future directions include developing a multidisciplinary diagnostic and treatment algorithm to guide clinicians—including urologists, gynecologists, urogynecologists, physical therapists—in comprehensive IC/BPS care.

Background: Childhood sexual abuse (CSA) has been associated with both posttraumatic stress disorder (PTSD) and lower urinary tract symptoms (LUTS), yet these associations remain underexplored in psychiatric inpatient populations. While emotion regulation strategies have not been directly linked to LUTS, they represent a theoretically relevant mechanism through which trauma-related psychopathology may affect somatic symptom severity.Objective: We studied the association between LUTS and PTSD related to childhood CSA among women admitted to an inpatient psychiatric ward while exploring the possible associations of mechanisms of emotional regulation strategies with LUTS and PTSD levels.Methods: Women diagnosed with PTSD with a history of CSA (n = 48), aged 18-50 (M = 30.51), that were admitted to a psychiatric ward at Merhavim Mental Health Centre completed self-report measures, assessing PTSD and LUTS, as well as emotional regulation strategies.Results: LUTS severity was found to be moderate (M = 15.25) and significantly positively associated with PTSD symptoms (r(47) = .58, p < .01). Expressive suppression but not cognitive reappraisal was strongly associated with PTSD symptoms, as well as LUTS (F(2, 44) = 14.76, p < .001; R² = 0.401).Conclusions: The participants exhibited a moderate level of LUTS, which were correlated with PTSD levels. Further, expressive suppression levels were found to be associated both with LUTS and PTSD severity. Given the highly specific clinical sample of hospitalized women with severe PTSD following CSA, these findings underscore the need for integrated care approaches that address both emotional regulation difficulties and somatic symptoms to improve treatment outcomes.

Introduction: Sexual dysfunction negatively affects approximately 40% to 50% of adult women across various stages of life. Common risk factors include sexual traumas, relationship problems, chronic conditions, medication side effects, and poor physical health, including iron deficiency. Objectives: This review summarizes a presentation from a symposium that discussed the types and causes of sexual dysfunction at key times in women’s lives, focusing on the relationship between iron deficiency and sexual dysfunction. Methods: The symposium was held at the XV Annual European Urogynaecological Association Congress, Antibes, France, in October 2022. Symposium content was identified through literature searches of PubMed. Original research, review articles, and Cochrane analyses discussing sexual dysfunction in association with iron deficiency/anemia were included. Results: Iron deficiency in women is commonly caused by abnormal uterine bleeding, but women may develop iron deficiency anemia (IDA) because of increased iron needs or reduced iron intake/absorption. Treatment with oral iron supplementation has been shown to improve sexual function in women with IDA. Ferrous sulphate is considered as a standard of care for oral iron treatment; prolonged-release iron formulations have improved tolerability, enabling lower doses and better tolerability. Conclusion: IDA and sexual dysfunction are related, so the identification of sexual dysfunction or iron deficiency in a woman should prompt an investigation of the other condition. Testing for iron deficiency is an inexpensive and simple step that can be routinely included in the workup of women with sexual dysfunction. Once identified, IDA and sexual dysfunction in women should be treated and followed to optimize quality of life.